The gingivitis jungle

It’s up to us not to let the undergrowth take over

By Shannon M. Nanne, RDH

The true genius of dental hygienists never ceases to amaze me. Regardless of whether your professional training was two years or ten years in length, the bottom line still remains: We want to help people. My brother, Matthew, would say that it all started with a bunch of puppets. But for me I remember it a bit differently. It really started for me with the helicopter. Not just any helicopter, but a medical helicopter I see flying directly over my home in Sagamore Hills, Ohio, several times a day. At this point, you are probably wondering, what do puppets and helicopters have to do with hygiene? I will most definitely get back to that, but first let me tell you a story that started for me on a Thursday evening last year on April 14.

I had just gotten dressed to meet a friend for dinner when I got the call from my mom. “Have you spoken to Matthew today?” I thought for a bit and replied no. I called my husband and found out he had not either. Once you become a mom, you worry for life, and she knew something wasn’t right. Matthew hadn’t shown up for dinner, a Thursday night tradition at my parents’ home for him. I told her not to worry, but they decided to drive to Matthew’s office to find him. As I was on my way to meet my friend, I decided to just peek in Matthew’s garage to see if his truck was there. Oh, my. It was.

I called. I rang the doorbell a million times, but no answer. Did I have my key? Of course not! I started to panic and called my parents. “Get here fast,” I said. Luckily they were just a few minutes away. As I ran around the outside of the house trying desperately to get a glimpse inside, I noticed blood on the siding from where my knuckles were bleeding from banging so hard. The neighbors’ dogs were barking loudly, and alas … I heard a moaning sound, maybe a slight groan from inside the house. Just as I was holding a rock in my hand and getting ready to break the window, the “angels” arrived and opened the door. We found Matthew unresponsive on his bed with wet towels around his head and on the floor. We would realize later he had been lying there for 22 hours fighting for his life. I dialed 911 and ran outside. Those four minutes waiting for an ambulance felt like an eternity.

Just now while writing this, it all comes back so clearly, as if each minute from here on out could be an article in itself. The flashing lights, the sirens, the oxygen, the team working on Matthew, the sticky pads all over his body, the blood pressure cuff … the still unresponsive Matthew. Being over six feet tall, the team had a difficult time getting his unconscious body from his bedroom to the ambulance. Helpless is the best word to explain what we felt as my mom got into the ambulance with Matthew. My dad and I got into my car to follow them to the emergency room, which was three miles away. The policewoman did not want me to drive, but I knew I could do it.

I can’t even begin to describe the pacing in the ER waiting room, the nausea, and the fear. When my parents, my husband, and I were finally called back to discuss the doctor’s findings, Matthew looked stable. He had several tubes coming out of him, but he was still unresponsive. The surgeon looked at us and gently pulled off his surgical cap. He said, “Matthew had an aneurysm rupture in his brain.” My husband, a chiropractor, fell to the floor. He knew all too well how serious and life threatening this diagnosis was. My mother replied quickly, “Fix him.” The doctor replied, “We have done all we can do here. The ‘bird’ is on its way.” I asked the surgeon what we could do now. His reply to all of us standing there will haunt me forever: “PRAY.” My father held Matthew’s hand and whispered to him, “If you are in there, please squeeze my hand,” and he did.

I remember when the life flight team came in. They were wearing shiny black flight jackets with medical patches all over them. They were moving so fast. I begged to ride along in the helicopter with him, as Matthew is so afraid to fly. There was no room for me though; we would have to meet him at the main campus of the Cleveland Clinic. As we dropped off all of the vehicles at my house a few miles away, I looked up as I had so many times before and saw the helicopter flying literally over my head, carrying my brother.

The “bird,” as the ER team referred to it, was the only prayer Matthew had for survival. It would be the fastest way to get him to the Cleveland Clinic to receive the medical attention he needed. After beating the small percentage of odds and surviving the emergency surgeries he had to go through to save his life, there was another issue at hand. Yes, my hygiene homies, you guessed it … his oral care in Neuro ICU. This, of course, was one of the last things on anyone’s mind, but one of the first on my mind once my brother opened his eyes and recognized me. I hope and pray that none of you will ever have to endure the anguish of having a family member in this state, but if you do, you can be prepared.

For family members of dental hygienists, oral care can become as important as it is for us. Matthew has beautiful coral pink, stippled gingiva. Let me tell you what a few days in ICU without oral care can do to healthy tissues — kiss it all goodbye and welcome to the gingivitis jungle! The “stick with a sponge” provided in the hospital care kit was not going to cut it for the 21-day visit in ICU. Extreme measures had to be taken, and fast! Although my brother has no memory of our daily mornings filled with brushings and flossing, it put a smile on his face and he continued to remind me to get the distal of his second molars, something he never lets me forget in the operatory on his six-month recall visits. The nurses would watch me as I opened up my hygiene kit every morning and got to work. I recall them smiling as I put my gloves on. Sharing this with you reminds me of my good friend, Cindy, and how she gave her father oral care. Little did I know when I listened to her special story that I would be in a similar boat one day with my 34-year-old brother.

What astonished me most is how healthy gingiva can deteriorate so quickly. We have all gone into the office and reviewed charts in preparation for the patients on our schedules. Granted, surprises and emergencies arise, but when you practice in the same office for several years, you have a pretty accurate feeling about what to expect. Just a few days prior to my brother’s having an aneurysm — while I went about my daily routine — I never imagined what tomorrow would bring.

Why don’t hospitals have dental hygienists on staff? ICU patients are in desperate need of better oral care. I have the utmost respect for the ICU nurses who keep these patients alive; I understand this is their main priority. But if simple brushing and flossing can keep patients out of the gingivitis jungle, then we need to make this known. I remember working in ICU with Medline and educating nurses on ventilator-associated pneumonia (VAP). I taught the nurses how oral care can help prevent patients from getting VAP. With that said, Matthew was lucky enough not to have a ventilator — something for which I was prepared and knew how to avoid the dangers.

I have to admit — knowing the correct dental products to use in special situations is a true gift we can give our patients. You have been there, walking the exhibit floor filled with the oldies but goodies, and the newest products on the market just awaiting our recommendation. Recommending the right product for the right patient before he or she walks out the door for another three to six months is magical. What about the nurses on the ICU floor? They have only what is supplied to them — a pink sponge on a white stick. It is imperative that the hospital kit include at least a toothbrush and some dental floss.

I believe continuing education requirements are a gift from our state dental boards. I hear complaints all the time from hygienists who are not happy about the mandated hours we need to keep our licenses current. Take these requirements and make them work for you! Start thinking outside the box and look for courses that are different and that may spark your internal hygiene passion. If you learn one thing from a course and use it in your office, then the course made a difference. Our patients are inundated with commercials telling them what they need, when, in fact, what they really need is our expertise to advise them on what will actually make a difference in their life. Our continued learning is crucial. I know it seems repetitious at times; however, when you change the life of one patient, that person will remember it for a lifetime.

I am happy to report after eight months, more miracle coil, and two stents added to Matthew’s brain in January 2012, he is flourishing. His oral hygiene has never been better, and his teeth are sparkling diamond clean, especially since he hasn’t had one cigarette since the aneurysm. I never imagined how the sensitive mode on a sexy new Sonicare could help make miracles happen.

Getting back to those puppets, I can’t tell you too much because Matthew is planning to write a book about the puppets. One of his first outings with me was to the Museum of Natural History. They had a contest to win some dinosaur puppets. Matthew got a call a few days later notifying him that he was the winner. As we picked up the puppets, Matthew looked at me and said, “It all started with a bunch of dinosaur puppets.” He explained to me later that this was when he found his strength. Never having won anything before, he felt he made it over this hurdle. This was “the sign” for him to shift from the phase of facing death head-on and moving forward with life.

All of the paths I have taken have taught me so many things. I feel completely blessed to have experienced the opportunities that being a dental hygienist has to offer. The possibilities are endless within our profession and right within our grasp. Maybe one of you reading this will jump into the gingivitis jungle and start an oral care hospital program. It takes only one voice to be heard. Will it be yours?

I have to admit that speaking is truly my passion and continues to be the highlight of my professional career. I have thoroughly enjoyed each path, and I know you will too. As dental hygienists, we continue to improve the quality of life for our patients every day — whether chairside or bedside, family or friend.

Don’t be afraid to spread your wings and soar to the top of your professional career. Life really is like a box of chocolates — you may not know what you are going to get, but you can continue to bite them all until you find the piece that makes you truly happy!

Shannon M. Nanne is a registered dental hygienist who has been practicing since 1994 when she graduated from the University of Pittsburgh School of Dental Medicine. She is currently the immediate past president of the Cleveland Dental Hygienists’ Association, and she spearheaded the first annual Oral Cancer Walk in the Cleveland area on Sept. 12, 2010. Shannon received the 2011 Award for Excellence in Public Service from the Oral Cancer Foundation. Shannon is a national and international lecturer to dentists, hygienists, pharmacists, and oncologists. She has published “A Patient’s Guide to Periodontal Disease” to help her colleagues educate patients periodontal disease. She can be contacted at [email protected].