SPECIAL CARE ADVOCATES IN DENTISTRY 2019 ANNUAL SEMINAR

1. SPECIAL CARE ADVOCATES IN DENTISTRY 2019 ANNUAL SEMINAR LITERATURE REVIEW Drs. Mannie Levy and Doug Veazey

3. Silver Diamine Fluoride: A Successful Anticarious Solution with limits (Article #115) J.O. Burgess and P.M. Vaghela University of Alabama Advances in Dental Research 2018

4. SDF solutions contain ammonia, silver, & fluoride • Amount of Fl varies from 4,753 to 53,728 ppm • Fl produces fluorohydroxyapatite • Silver is active antimicrobial agent • Ammonia stabilizes the components in solution • SDF reduces caries in multiple ways • It is a direct antimicrobial by disrupting metabolic and reproductive pathways of the bacteria producing cell death. Inhibits the growth of cariogenicbiofilms on teeth. • Reacts with hydroxyapatite forming fluorohydroxyapatite reducing and preventing future caries. • Inhibits collagenases and protects dentin collagen from destruction.

5. SDF and Adhesive Bond Strength SDF penetrates into the dentin tubules. This occlusion is why it can be used as desensitizing agent. BUT may block penetration of adhesive bonding agents into the tubules and lower the bond strength of resin. REC: Glassionomer • A small study showed increased pulp cell death if remaining dentin is too thin over pulp. • 2017-nanosilver particles maybe as effective as SDF without producing dark stain • High levels of Fl may produce fluorosis in kids especially if multiple applications.

6. SILVER DIAMINE FLUORIDE Dr. C.Y. LOO - TUFTS For EDIC MAY 14, 2019 • 2014- FDA approved for dentinal hypersensitivity • 2016- FDA approved to arrest decay in kids & adults • SDF- pH- 10, bactericidal- affect DNA & destroys cell wall • Anti-enzymatic. Occludes dentinal tubules. • Harder on surface of lesion. When you go deeper it is carious lesion. • Can harden to depth of 2.5 mm. • Caution for deep lesions • Unsure of effect on pulp- slides showed some silver in pulp • USES: • Caries prevention • Caries arrest and control • Desensitizing agent

7. Dr. C.Y.LOO-- continued • Cost-$162.50 for 8 ml bttl.= 250 drops= $0.65/drop • Can clean out food and debris and plaque from carious lesion. But don’t have to excavate any decay. • Not replacement for restoration. INTERIM treatment. • JADA 2018- they used annual application of 38% SDF. • Used for caries control. • Treated area showed less plaque accumulation. • Primary teeth- SDF every 6 mos. • Permanent teeth- SDF every 12 mos. • CONTRAINDICATIONS: • Silver allergy • If patient has ulcers present in area. • If teeth are symptomatic • CAUTION- if patient breast feeding or pregnant.

8. Dr. C.Y.LOO-- continued • TREATMENT: 1-2 drops. Treats up to 5 teeth. Isolate if possible. • Apply SDF- ALLOW TO ABSORB FOR 1 MINUTE. • Remove excess with cotton to keep off tissue. • Can put Vaseline on tissue to protect. Can air dry gently. • Solution NOT STABLE. Use immediately. Recap bottle ASAP. • Tastes BAD. • Usually follow in 1-2 weeks. To see if dark black stain. Use explorer to check hardness. If not effective –CAN REAPPLY AT THIS POINT. • IF APPLICATION WAS EFFECTIVE CAN REAPPLY IN 6 MOS. • Does not stain sound enamel or dentin. No stain for sensitivity. • Will stain gingiva and tissue or skin. Fades in a few days in 2-14 days will exfoliate.

9. Dr. C.Y. LOO-- continued • 2 Drops of SDF= 0.25 Fluoride varnish • SDF= 44,800 PPM of FL. • *** Hard to mask staining if restored later • If esthetics to be problem, can USE RIVA STAR- SDF with Potassium Iodide. Apply the SDF 1st then apply Potassium Iodide- will stay same color as decay. • BEST RESTORATION AFTER SDF= GLASSIONOMER • There will be some effect on bonding strength with RESIN. • If treating more than 5 teeth, safety requires to reappt. in 1 week for another treatment. • NC & NJ- only states where DH can NOT apply SDF.

11. Oral Health of Patients with Special Health Care Needs After General Anesthesia: a 25 year retrospective study (Article #26) T.J. Oh, DMD, O.H.Nam, DDS, et al Seoul, Korea Pediatric Dentistry May/June 2018

12. Purpose was to compare oral health and dental tx. outcomes of patient with Special Health Care Needs (SHCN) after General Anesth. According to their compliance with dental check ups. • 157 patients treated during period 1991- 2016. • American Academy of Pediatric Dentist (AAPD) defines SHCN as “any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs.”

13. “Methods of physical restraint cause great stress and reluctance to patients and their guardians.” • In the irregular checkup group, about 40% of the patients underwent repeated GA. In the regular check up group, about 10% of the patients underwent repeated GA. • The timer interval between GA procedures was approximately 6 years on average and did not differ between groups. • Patient with SHCNs showed reduced risk of invasive dental treatment and repeated GA with routine dental checkups within at least 6 months after tx. under GA.

15. Randomized clinical trial: Efficacy of strategies to provide oral hygiene activities to nursing home residents with dementia who resist mouth care (Article #6) R. Jablonski, A. Kolanowski, et al ***School of Nursing, University of Alabama Gerodontology June 2018

16. Purpose to study the efficacy of MOUTh (Managing Oral Hygiene Using Threat Reduction) a non-pharmacologic, relationship base intervention with nursing home (NH) residents with dementia who resisted mouth care. • Research assistants included 3rd & 4th year nursing students, undergraduate public health students, undergraduate kinesiology students and certified nursing assistants. • Patients received mouth care twice daily for 3 weeks.

17. Mouth care is oral infection control.** • Increased plaque retention is associated with increased rates of nosocomial pneumonia, and the pathogens identified are overwhelmingly genetically identical to those flora in the oral cavity. • In Nursing home residents with dementia, overall prevalence of Care-resistant behavior (CRB) is 63.4% and increases with dementia severity. • 95% of NH Nurses who encounter CRBs during oral hygiene simply OMIT mouth care. • Mouth care providers were trained to approach patients no more than 3 times to obtain assent. If non-cooperative, interaction classified as “not done, unable to obtain assent.”

18. Managing Oral Hygiene Using Threat Reduction • 1. Establish rapport with patient with pleasant and calm demeanor. • 2. Provide mouth care in front of sink & mirror • 3. Avoiding elderspeak or “baby talk” • 4. Chaining- involved starting mouth care and having patient finish the task. • 5. Cueing using gestures. • 6. Distraction • 7. Bridging- patient is asked to hold a toothbrush during mouth care. • 8. Rescue-2nd provider replaces 1st if CRBs escalate • 9. Hand over Hand- patient places hand over providers hand during mouth care.

19. “Finding reflect the reality that mouth care may be a low priority in NH and that use of alternative mouth care techniques, including Toothettes or other mechanism for mouth care may be nonideal.” • Chronic use of oral care products containing chlorhexidine may contribute to multidrug-resistant dental plaque bacteria. • An important clinical implication of this study is that the quality of mouth care may be more important than the frequency.

21. Plaque Removal with Triple Headed Vs. Single headed manual toothbrush- A Systematic Review (Article # 131) International Journal of Dental Hygiene Amsterdam, The Neterlands February 2018

22. Conclusion: • When patient performed brushing, majority showed no difference between triple-headed brush and the single-headed brush, with a few favoring the triple. In comparison when the caregiver performed the mouth care, they preferred the triple-headed brush which performed significantly better to reduce plaque.

23. Evaluation of Periodontal Ligament cell Viability in Different Storage Medium Based on Human PDL Cell Culture Experiments- A Systematic Review Bosnia & Herzegovina December 2018 (Article # 46) Most Recommended Medium for Storage and Transport of Avulsed Teeth Pakistan (Article # 119) April 2018

24. Conclusions from both articles: • Best treatment is immediate re-implantation. • MILK remains the most convenient, cheapest, and readily available solution while also being able to keep PDL cells alive.

25. Botulism Toxin for Treatment of Myofascial Pain in the Masticatory Muscles (Article # 67) Oral Maxillofacial Surgery Clinics- North America Richmond, Virginia August 2018

26. Conclusion: • Although Botulism Toxin has been recommended for management of myofascial pain and dysfunction, the precise mechanism of action remains undetermined. • Botulism toxin does not seem to be a logical treatment of myofascial pain and dysfunction.

27. Potential Erosive Effects of Mouth Rinses on Enamel and Dentin General Dentistry May- June 2018 (#89) In Vitro Effects of Alcohol- Containing Mouth Washes on Human Enamel and Restorative Materials Brazil Oral Research Journal March 2018 (#97)

28. pHs of Mouth Rinses (#97) • Crest Pro Health- 7.05 • ACT Total Care- 6.31 • Scope Classic- 5.18 • Listerine Original- 3.98 • Listerine Total Care- 3.43 • Listerine Ultraclean- 3.87 • Critical pH at which saliva and plaque fluids cease to be saturated with Calcium & Phosphate. Highest pH at which there is net loss of enamel is 5.5.

29. Conclusion from #97: • Long term exposure to low pH, alcohol-containing, and peroxide-containing mouth wash formulations caused no ultra-structural or chemical elemental change in human enamel or dental restorative materials in vitro.

30. Dry Brushing: Does it Improve Plaque Removal? A Secondary Analysis (#65) International Journal for Dental Hygiene Amsterdam, The Netherlands November 2018

31. Conclusion: • Following a 2 minute brushing exercise, plaque scores were reduced by 57% or more. • Dry brushing did not contribute significantly to toothbrush efficacy. • Participants did not find that pre-wetting a toothbrush influenced the cleaning capability and filament stiffness.