MEMORANDUM

 

TO:                 Professional Development Leave Committee

 

FROM:            Jane Batterson

 

RE:                 Spring Term Leave, 2004

 

DATE:            September 20, 2004

 

 

My professional development leave involved three areas of study:  exploration of new technologies in the field of dental hygiene, observation of specialists in the field of periodontics and a review of periodontal journals and research articles.

 

NEW TECHNOLOGIES

ENDOSCOPY

The Perioscopy™ System uses recent advances in fiberoptic technology and medical-grade cameras to allow actual visualization of root surfaces during periodontal instrumentation.  During my leave, I was able to study the use of this new technology in a variety of settings:

 

            Gail Myers, RDH:  Gail Myers is a registered dental hygienist with extensive experience in the use of dental endoscopy.  Years ago, she was hired by Dental View, the company that markets the Perioscopy™ System, to train office staff in the use of the system.  Although Gail is no longer employed by Dental View, she currently works in a periodontal practice in Santa Monica, California.  I had the privilege of observing her utilizing the Perioscopy™ System in her private practice.  She is so proficient with the use of the endoscope that she could hold the camera in her left hand and instrument the root surfaces with her right hand, while I watched it all on a computer monitor.  The monitor shows a circle 4 inches in diameter, which represents 3 millimeters, actual size.  It was fascinating to watch Gail instrument such a tiny area and remove miniscule calculus deposits so quickly and efficiently.  I was able to spend 8 hours with Gail and I learned so much from her, not only about the Perioscopy™ System, but also about different hand and mechanical instrumentation techniques.  The time I spent with Gail was truly one of the high points of my sabbatical.       

 

            University of Southern California Dental Hygiene Clinic:  I was invited to spend a day observing an advanced senior dental hygiene clinic at the USC School of Dentistry.  USC owns two of the Perioscopy™ Systems.  The systems allow a continuous stream of water to flow from the tip, allowing blood and debris to be flushed away for clearer viewing.  USC has experienced ongoing problems with the water flow for both systems.  When I contacted USC, both systems had been sent in for repairs, but I was able to plan my visit to coincide with the return of the newly repaired units.  However, when I arrived at the clinic, the instructors discovered, much to their consternation, that they were still unable to get water to flow from the dental unit through the Perioscopy™ Systems.   Thus, in order to utilize the endoscope, a student or instructor inserted the fiberoptic camera into the periodontal pocket, while another instructor sprayed water into the pocket with an air/water syringe and another student suctioned the area.  This procedure was quite cumbersome and I could sense frustration from both students and instructors.  I also discovered that neither the students nor the instructors were able to hold the camera in their nondominant hand, while simultaneously instrumenting the root surface with their dominant hand (as I had observed Gail Myers doing).  Rather, they utilized the endoscope to view, removed the endoscope to scale the root surfaces, and then placed the endoscope again to view the results of the instrumentation.  This procedure was quite time consuming.

 

            Pasadena City College: At this school, I was invited to observe a second-year dental hygiene evening clinic.  Pasadena City College owns one Perioscopy™ System.  I discovered that they, too, were having difficulty getting water to flow through the system.  Their utilization of the endoscope was identical to what I observed at USC.

 

            Dr. Kim Kutch:  Dr. Kutch is a general dentist who practices in Albany, Oregon.  His office owns two Perioscopy™ Systems and I was invited to observe the endoscope being utilized in his office by one of his hygienists.  Fortunately, the unit I observed was functioning properly and there was adequate water flow for the flushing of debris.  The hygienist admitted to me that she was in the beginning stages of learning endoscopy.  Like the students and instructors that I observed, she did not use the endoscope and scale simultaneously, but rather, utilized the system to check her scaling progress.  She admitted that it was quite a struggle to achieve the proper angulation and depth when inserting the fiberoptic camera. 

 

            Results of my exploration of endoscopy:  I was so fortunate to be able to observe the Perioscopy™ System in a variety of settings.  I saw what I believe to be the  optimum utilization as demonstrated by Gail Myers.  I truly believe that this is revolutionary technology.  It would be invaluable as an instructional tool to be able to virtually take students inside the pockets they are learning to instrument.  But I also see  problems that could potentially be encountered should we try to introduce this new technology into our LCC dental hygiene curriculum:

 

1.      There is a very steep learning curve.  How do we instructors gain proficiency so that we can use endoscopy as an instructional tool?  Those of us who work in private practice do not have access to this technology in our offices.  In fact, no dental practice in the Eugene/Springfield area currently owns the Perioscopy™ System.

 

2.      Cost is a factor.  The Perioscopy™ System costs $20,000.  Each usage requires a sterile sheath, which costs $54. per sheath.  We only charge $50. for periodontal scaling in our dental hygiene clinic. (In private practice, use of endoscopy is generally billed at $435.00 to $485.00 per hour.)

3.      Dental View spent 20 million dollars marketing the Perioscopy™ System in the United States.  Recently they stopped marketing in the US and are concentrating on their home territory of northern Europe.  I am concerned that technical support and prompt service will be lacking.  The water flow problems I observed are of particular concern.

 

4.      How would we incorporate this new technology into the existing dental hygiene curriculum?  I can see that the utilization of the endoscope is time consuming.  I also question the advisability of spending time on a technology my students are unlikely to encounter in the practices where they are hired upon graduation.

 

This is certainly an area for discussion among the entire dental hygiene faculty. I have discussed with Gail Myers the possibility of her offering an endoscopy in-service to the LCC dental hygiene faculty.  Dr. Kutch would allow us to use his office and his Perioscopy™ Systems.

 

 

COMFORT CONTROL™ SYRINGE

 

The Comfort Control™ Syringe is a computer-regulated anesthetic delivery system.  Dr. Rene Watts, who practices general dentistry in the Eugene/Springfield area, allowed me to observe her administering injections with this new technology.  I was impressed with the ease of operation of this particular device.  Much of the discomfort experienced during the administration of local anesthetics in dentistry is due to fluid moving through the tissues.  The Comfort Control™ Syringe deposits the anesthetic solution much more slowly and consistently than is possible manually.  The syringe costs $1000.  I would like to explore the possibility of purchasing one for use in the LCC dental hygiene clinic.  We must continue to teach the basic manual injection technique as students must demonstrate their proficiency in the manual technique during their Western Regional (WREB) Anesthesia Board Exam.  However, I believe students could be able to utilize this new technology during spring term of their second year.  Dr. Watts owns three units and has agreed to provide a demonstration and hands-on experience for my second-year students Spring Term, 2005.

 

 

PERIODONTAL OFFICE VISITATIONS

 

As part of their coursework fall term of second year, my students visit a periodontal office and submit an office visitation report.  I am responsible for grading those reports and I found that students were describing procedures that I had not had the privilege of observing myself.  Thus, I spent a number of days in the periodontal practices of Dr. John Stringer and Dr. Stan Kull, observing a variety of periodontal surgeries:

 

            Gingivoplasty

            Flap surgery with subsequent root planing and curettage

            Bone regeneration

            Xenografts, utilizing Emdogain™ and Bio-Oss™

            Crown lengthening on both anterior and posterior teeth

            Connective tissue grafts

            Osseous surgery to repair deep bony defects

            Sinus perforation repair

            Free gingival grafts

            Frenectomies

            Implant procedures, both maxillary and mandibular

 

Dr. Kull and Dr. Stringer both lecture to the second-year dental hygiene students as part of our periodontics curricula.  It was a privilege for me to spend time in their offices, not only observing surgeries, but also having the opportunity to engage them in discussions on a wide variety of concepts and issues relating to the practice of dental hygiene.

 

 

JOURNAL AND RESEARCH ARTICLES 

A portion of my professional development leave time was spent reviewing professional journals and research articles that I have been accumulating.  A bonus of my time spent with Dr. Kull was the discovery of a new series of periodontal journals to which he subscribes.  They are the Periodontics 2000 series, published in Denmark.  Dr. Kull allowed me to borrow many issues with information I can use to update my own periodontal lectures.

 

 

CONCLUSION        

I am very grateful for the opportunity I was given to take a sabbatical last spring term.  Not only did I learn a great deal in a variety of subject areas of interest to me, but I also felt that I had time for reflection.  This allowed me to ‘step back’ and take stock of myself as an instructor and the institution in which I teach.  I am returning with renewed energy.  After having spent time visiting other dental hygiene schools during their busy clinic times, I have a renewed appreciation for my own educational setting: a beautiful, spacious dental hygiene clinic; colleagues who are supportive of me and my efforts; and a learning environment that is much more positive than I observed elsewhere.

 

None of my activities produced any income.   I also did not seek short-term professional funding for my trip to southern California, but paid all expenses myself.