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INNOVATIONS IN HYGIENE BETTER AND EASIER CLINICAL PRACTICE

INNOVATIONS IN HYGIENE BETTER AND EASIER CLINICAL PRACTICE. DIAGNOSIS TREATMENT: CARIES TREATMENT: PERIO ERGONOMICS FUTURE. FAY GOLDSTEP DDS, FACD. MARCH 10, 2006. DIAGNO dent. Scientific measuring instrument - practical, precise, sensitive

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INNOVATIONS IN HYGIENE BETTER AND EASIER CLINICAL PRACTICE

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  1. INNOVATIONS IN HYGIENEBETTER AND EASIER CLINICAL PRACTICE • DIAGNOSIS • TREATMENT: CARIES • TREATMENT: PERIO • ERGONOMICS • FUTURE FAY GOLDSTEP DDS, FACD MARCH 10, 2006

  2. DIAGNOdent • Scientific measuring instrument -practical, precise, sensitive • Accurate, reproducable detection of early caries, in > 90% of cases • Comparative diagnostic rates • Swiss Journal for Dentistry. Prof. Dr. Adrian Lussi, University of Berne: • Fissure discolouration 40% • Magnified visual examination 56% • Visual examination 57% • Examination + probing 58% • Frosted enamel appearance 65% • Radiography 67% • DIAGNOdent 90%

  3. DIAGNOdent readings • Can correlate values with disease progression (Lussi et al, 1998; Longbottom et al, 1998; Reich et al, 1998) • Health or disease progression: • 0 -10 means sound enamel • 10 -20 indicates surface enamel caries • 20 -30indicates deeper enamel caries • > 30 indicates dentinal caries

  4. CURRENT FISSURE CARIES ANATOMY MODEL(“coke bottle” shape) Organic plug Decalcified or hypocalcific enamel (caries in this zone is undetectable by probe) (This area may not be decalcified thus probe will not stick) Enamel defects in fissure wall De-mineralizing dentin

  5. SCANNING FISSURES Rotate the DIAGNOdent tip to “read” the fissure walls

  6. Microlux Transilluminator • High Intensity Light Emitting Diode (LED) • For Detection and Evaluation of: • Caries • Fractures • Subgingival calculus • Extremely long 50,000-hour life • Very portable • Autoclavable

  7. Prevention Diagnosis EARLY CARIES EVOLUTION Pulpal lesion Dentin lesion Enamel lesion Cavity Caries process White spot No Cavity De-&Re- mineralization Colonization Adhesion Time

  8. PATHOLOGY Transmissible bacterial infection (s. mutans, lactobacilli) Diet (fermentable carbs) Salivary disfunction PROTECTION Antimicrobials (F, CHX, I) Healthy diet Saliva (flow, components) Tongue cleaning & OH Remineralization (Ca, PO4, F) Xylitol CARIES MANAGEMENT A MEDICAL MODEL

  9. NaF Sensitivity (when greater than 5000ppm) Caries Control SnF2 Inflammation Sensitivity Caries Control Antimicrobial NaF Varnish Sensitivity Caries Control APF Caries Control INDICATIONS FOR EACH TYPE OF FLUORIDE:

  10. Active Ion Anti- Bacterial Anti- Inflammatory CHOOSING THE BEST FLUORIDE: Sodium Fluoride (NaF) Acidulated Phosphate (APF) Stannous Fluoride (SnF2)

  11. Reduction of tooth sensitivity Caries Prevention Remineral- ization CHOOSING THE BEST FLUORIDE: Acidulated Phosphate (APF) Stannous Fluoride (SnF2) Sodium Fluoride (NaF)

  12. OTHER ANTI-MICROBIALS

  13. GC Saliva Check – 10mins • Hydration • Consistency • Resting saliva pH • Stimulated saliva flow 5mins • Stimulated saliva pH • Buffering capacity

  14. When to Use MI Paste Prevention: high risk patients, erosion, gastric reflux, ortho Repair Enamel: white spots, fluorosis, pre/post whitening Densensitization: whitening, dentin exposure Xerostomia: medication, chemo, radiation,

  15. TREATING HYPERSENSITIVITY:DEPOLARIZATION • DEPOLARIZATION OF SYNAPSES→ • DECREASED CONDUCTION OF PAIN • 5% KNO3 • SHORT ACTING • UltraEZ (ULTRADENT) • CREST SENSITIVITY PROTECTION • RELIEF (DISCUS)

  16. TREATING HYPERSENSITIVITY:OCCLUDING TUBULES

  17. Na+ Ca2+ PO43- Calcium Sodium Phosphosilicate Reaction Unlike all other sensitivity treatments which depend on salivary calcium SootheRx produces its own ionic calcium and phosphate. Higher levels of salivary calcium and phosphorus have been definitively linked to better oral health status. 3. Sodium ions increase oral pH and enhance Ca+PO4 precipitation Oravive Particle Silica Rich Remnant particle 1. Oravive particles becomes exposed to saliva, releasing sodium, calcium and phosphate from the soluble silica network. 2. Tooth surface acts as nucleation site for calcium and phosphate ions to complex into Hydroxycarbonate apatite crystals, restoring tooth surface. Available fluoride will incorporate into the mineral forming fluorapatite. Open Dentinal Tubules (The cause of sensitivity) Closed Tubules (Reduced tooth sensitivity) Open Dentinal Tubules (The cause of sensitivity)

  18. Summary • Xylitol Aids in: • Raising the pH of the Oral Environment • Increasing Available Calcium and Phosphate • Weakening S. Mutans • Increasing Saliva Flow and Volume • Reducing Fermentable Carbohydrates in the Mouth • Keeping the Insulin Response Low

  19. CARIES DEVELOPMENT:NICHE ENVIRONMENT THEORY • COMMONLY ACCEPTED MODEL FOR CARIES DEVELOPMENT: • REQUIREMENTS FOR CARIES: • FERMENTABLE DIETARYCARBOHYDRATES • SALIVA • SUSCEPTIBLE SITE • COMMENSAL BACTERIA • TIME =CARIOGENESIS

  20. COMMENSAL BACTERIA EXCRETE ACIDS AFTER MEAL ACIDS LOWER LOCAL AND SALIVA pH→ DEMINERALIZATION “NICHE ENVIRONMENT” RECOLONIZED WITH ACIDURIC BACTERIA CARIES DEVELOP ALONG LINES OF LEAST RESISTANCE ACIDURIC BACTERIA ARE MORE ACIDOGENIC MORE ACID LOWERS LOCAL pH→MORE DEMINERALIZATION

  21. HEALOzone Indications • Pit and fissure enamel caries • Early occlusal caries just into dentine • All root caries • Treatment of deep caries before every restoration • Prophylactic use, eg. erupting molars

  22. HEALOZONE: TREATMENT BENEFITS • RESTORATIVE PREDICTABILITY • DECREASED INVASIVENESS • STRONGER, CARIES RESISTANT DENTITION • LESS TRAUMA, PAIN, FEAR • LESS ANESTHESIA REQUIRED • NATURAL HEALING PROCESS IS APPEALING TO PATIENTS

  23. diabetic control smoking cessation improved oral hygiene corrective dentistry improved nutrition stress reduction mechanical removal of infectious agent surgical reduction of periodontal pockets topical antimicrobials systemic antimicrobials PERIODONTAL DISEASE: THERAPEUTIC STRATEGIES Reduction of Risk factors- Risk Management Reduction of Bacterial Burden BEST CHANCE FOR CLINICAL IMPROVEMENTS Modulation of Host Response “Enzyme Suppression” systemic administration of host modulating PERIOSTAT

  24. ATRIDOX(doxycycline hyclate 8.8%) Indications And Usage • Initial therapy in conjunction with scaling • Maintenance therapy patient • Indicated for pocket depths (5-7 mm) • Pockets that are difficult to instrument (furcations, unusual root shapes) • Phobic patients who fear or refuse surgery

  25. ATRIDOX IS APPLIED USING THE ATRIGEL SYSTEM APPLIED AS A LIQUID FLOWABLE POLYMER GEL FLOWED TO THE BASE OF THE POCKET AS A LIQUID FILLS & CONFORMS TO POCKET MORPHOLOGY RELEASES ANTIBIOTIC, DOXYCYCLINE HYCLATE 10%, AS POLYMER BIODEGRADES CONTACT WITH MOISTURE MAKES ATRIDOX MALLEABLE SOLIDIFIES TO WAX-LIKE SUBSTANCE

  26. ATRIDOX BILLING CODES Chemotherapeutic/antimicrobial agents, topical application • 43511 one unit of time • 43519 each additional unit of time • 43421 one unit SRP • 99555 additional expense materials • For example, in Ontario 2006 • 43511 $52.17 • 43519 $52.17 • 43421 $47.42 • 99555 $75.00

  27. RISK FACTORS THATINCREASE PERIODONTAL DISEASE SEVERITY Risk factors that can affect the onset of periodontitis, rate of progression, severity of periodontitis, and the response to therapy include: Smoking Heredity: Genetic IL-1 polymorphisms Diabetes Medication – i.e., calcium channel blockers Hormonal Variations – i.e., pregnancy, menopause Previous history of periodontal disease Stress & Nutrition Others: Immunocompromised patients, Iatrogenic dentistry, Systemic Diseases Ryan ME. CDA Journal 2002;30(4):285-295.

  28. SOURCES OF DESTRUCTIVE COLLAGENASE Most of the destructive collagenase responsible for breakdown of collagen in the periodontal tissues and bone comes from infiltrating (PMN) and host cells, not from bacteria Infiltrating Cells – PMNs Local Host Cells – Other Fibroblasts Macrophages Keratinocytes Osteoblasts Epithelial Cells Endothelial Cells Osteoclasts Bacterial Collagenase

  29. Periostat R - Prescription X Disp: 180 Tablets SIG: 1 Tab BID Refills 2 “Periostat® has been shown to help stop the progression of periodontitis when used as directed as an adjunct to scaling and root planing, in a conscientiously applied program of oral hygiene and regular professional care.” Council on Scientific Affairs-American Dental Association (ADA)

  30. StainBuster • Gently removes cement, stains from the enamel surface • Does NOT abrade tooth enamel, ceramic, implants • Does NOT affect the soft tissues

  31. PIEZON SCALING • Ultrasonic • No circular or elliptical movement • Integrated microcontroller • Optimum power with optimum control • Decreased vibration • Decreased noise

  32. Piezon Scaling  • Instrument PS: • Excellent interproximal & deep pockets. (CRA: Best interproximal and subgingival access) • Ideal for maintenance therapy and pocket irrigation • Maximum patient comfort

  33. The Sidekick Sharpener • Portable Power Sharpening Device • Maintenance Sharpening • Scalers and Curettes

  34. The Sidekick Sharpener • FEATURE • BENEFIT • Compact Size • Easy to Use Anywhere • Instrument Guide Channel • Reproducible Angles • Cordless Power • /Reciprocating Stone • Efficient Sharpening • CeramicStone • Neat - no oil/can be sterilized

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