Good In Theory, But Not In Practice

We are glad to have the opportunity to publish this blog written and proudly shared to us by Rebecca Comstedt, RDH. It is a very interesting story that will make you stop, think and contemplate at the relationship between learning and experience.

Every quarter, a local periodontal group hosts a live CE for dental hygienists. In the past, I have prioritized these events because I love CE! (Read: they serve a good dinner, two drink coupons, it’s free, and the doctors are easy on the eyes…)

The CE nightmare

A while back, the topic was “Implant maintenance.” The world of implants is changing so quickly (to probe or not to probe, titanium instruments or not, ultrasonic scaling, etc.), and I was excited to learn the newest information. The lecturer was an educator for the implant company sponsoring the event, but she was no longer practicing as an RDH.

This instructor taught us the “lasso technique” to disrupt the biofilm around the neck of an implant.  She also recommended products such as TePe brushes and mentioned subgingival air polishing. All great info, or so I thought.

A few weeks later, I had a patient with an implant on #13. I was finally able to use the lasso technique! I talked her through what I was doing so she could also do it at home, and I was happy to be providing my patient with current information. I tried to be gentle as I circled the floss around the tooth and then gently pulled back and forth on the ends to disrupt the subgingival biofilm.

A week later, she was on the doctor’s schedule with a “large swelling on the inside of the implant and so much pain” that started right after I flossed her implant! The doctor could not determine anything clinically, and the x-ray looked normal. He prescribed antibiotics and recommended she see the oral surgeon who placed the implant.

About a month later, I read the correspondence from the oral surgeon. He had prescribed another round of antibiotics and expected the problem to resolve, “Especially if it is just associated with flossing, as the patient suggests.” My doctor reassured me that flossing doesn’t cause anything like this.  Or does it?

Don’t believe everything you hear

It wasn’t until I heard information from Shavonne Healy that I learned flossing COULD, in fact, cause problems. Ms. Healy (co-founder of RDH Innovations) does NOT recommend flossing with the lasso technique, for the very reason that it may leave floss remnants in the pocket of the implant! Ms. Healy is a researcher, educator, and a practicing clinician.  She gets to practice what she preaches, and this gives her a great deal of wisdom in addition to her base of knowledge.

This experience has taught me to be more discerning in who I will take advice from. It’s easy to find knowledgeable people these days, but finding professionals who have knowledge and wisdom is more difficult. Let’s look at this another way.

When we notice a lump, bump, rash, pain, or anything that seems new and abnormal, what is our first response? “Siri, what is this _______?” Siri is probably the most knowledgeable source out there, and despite having endless knowledge at our fingertips, we lack the wisdom and experience to correctly disseminate all the information.

The professionals who lecture to us are no different. They peruse the studies and research that is coming out (at a rapid pace), but do they have the wisdom to put the research into its proper context and articulate accurate implications for patient care? I am becoming more leery of new product and technique recommendations from educators who are no longer clinicians personally using the tricks and tools they teach. Reading the books, I would think, yes, flossing around an implant is a good idea; however, real life experience tells me otherwise.

Going back to that original CE course, there was also good information presented.  For example, subgingival air polishing (aqueous powder streaming) is becoming the standard for biofilm disruption, and TePe brushes are great according to the Hygienists who research and use the products all the time! Unfortunately, I quickly utilized the bad information from the CE course, and probably did more harm than good, because I did not yet have the wisdom of experience with this technique, and neither did the speaker.

Recognizing quality CE sources

So where do we access these professionals who have not just read the research but also have the wisdom that comes from practicing? I was honored that Ms. Jeong asked me to guest write a blog because her site “DentalToaster” is such a place! The contributors she has partnered with are practicing clinicians and educators. It is these individuals (Ms. Healy and Ms. Strange) who know that the lasso flossing technique around an implant may sound good in theory, but it’s not a good idea in practice.

We all want free CE, with food, drinks, and speakers who are easy on the eyes. But what we need is quality CE.  We need to be able to trust the source to convey not just what the research says but what experience says. Start to be picky in your choice of CE; rather than choosing based on what is free, get to know the qualifications of those who are presenting the information.  

Do not hesitate to do your own research.

    • PubMed is a great site to visit to see the current research.  
    • Network with local hygienists who work in specialty offices to pick their brains (joining ADHA is a great way to network with leading Dental Hygienists).
    • Find reputable sources for CE (like DentalToaster!).
    • When you attend conferences, talk to the exhibitors, learn all about the variety of products available, and why one product is better than another (obviously there will be bias, but it can be a good source of information).
    • Read books! Dental Diet, Dying from Dirty Teeth, etc.; there are some great dental books out there that will challenge your thinking (which is good!).
  • Listen to podcasts; this is an easy way to hear new information.

When you have a large base of knowledge to draw from, you will begin to see the patterns in what products, tools, and techniques are recommended as opposed to what may be good in theory but not in practice.

Dental hygiene is an exciting field, but if you are just doing the same old thing day in and day out, you’ll eventually burn out. Take initiative to keep learning, and don’t feel it is your employer’s responsibility to pay for your CE. You are worth the investment in your career! When it comes to choosing your next CE, I encourage you to prioritize the speaker’s credentials, experience, and clinical practice above the cost of the CE.

– Rebecca Comstedt

About the Author

Rebecca Comstedt, RDH, BS Dental Toaster articleRebecca Comstedt, RDH, BS, is a practicing clinical Dental Hygienist in Westminster, Colorado. She is passionate about a holistic approach to oral health and the role Dental Hygienists’ play in improving total health. As founder of RDH Companion, LLC., (www.RDHCompanion.com) she supports other clinical Hygienists by providing one place for leading Hygiene educators to share current research, controversies, FAQ’s and patient education. She is also a mom to three beautiful daughters!


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