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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
INNOVATIONS IN HYGIENEBETTER AND EASIER CLINICAL PRACTICE
  • DIAGNOSIS
  • TREATMENT: CARIES
  • TREATMENT: PERIO
  • ERGONOMICS
  • FUTURE

FAY GOLDSTEP DDS, FACD

MARCH 10, 2006

slide2

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%
diagnodent readings
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
current fissure caries anatomy model coke bottle shape
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

scanning fissures
SCANNING FISSURES

Rotate the DIAGNOdent tip to “read” the fissure walls

microlux transilluminator
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
slide7

Prevention

Diagnosis

EARLY CARIES EVOLUTION

Pulpal lesion

Dentin lesion

Enamel lesion

Cavity

Caries process

White spot

No Cavity

De-&Re- mineralization

Colonization

Adhesion

Time

caries management
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

indications for each type of fluoride
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:
choosing the best fluoride
Active Ion

Anti-

Bacterial

Anti-

Inflammatory

CHOOSING THE BEST FLUORIDE:

Sodium Fluoride (NaF)

Acidulated Phosphate

(APF)

Stannous Fluoride

(SnF2)

choosing the best fluoride11
Reduction

of tooth

sensitivity

Caries

Prevention

Remineral-

ization

CHOOSING THE BEST FLUORIDE:

Acidulated Phosphate

(APF)

Stannous Fluoride

(SnF2)

Sodium Fluoride (NaF)

gc saliva check 10mins
GC Saliva Check – 10mins
  • Hydration
  • Consistency
  • Resting saliva pH
  • Stimulated saliva flow 5mins
  • Stimulated saliva pH
  • Buffering capacity
slide14

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,

treating hypersensitivity depolarization
TREATING HYPERSENSITIVITY:DEPOLARIZATION
  • DEPOLARIZATION OF SYNAPSES→
  • DECREASED CONDUCTION OF PAIN
  • 5% KNO3
  • SHORT ACTING
    • UltraEZ (ULTRADENT)
    • CREST SENSITIVITY PROTECTION
    • RELIEF (DISCUS)
calcium sodium phosphosilicate reaction

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)

summary
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
caries development niche environment theory
CARIES DEVELOPMENT:NICHE ENVIRONMENT THEORY
  • COMMONLY ACCEPTED MODEL FOR CARIES DEVELOPMENT:
  • REQUIREMENTS FOR CARIES:
    • FERMENTABLE DIETARYCARBOHYDRATES
    • SALIVA
    • SUSCEPTIBLE SITE
    • COMMENSAL BACTERIA
    • TIME

=CARIOGENESIS

slide20

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

slide21
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
healozone treatment benefits
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
periodontal disease therapeutic strategies
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

atridox doxycycline hyclate 8 8 indications and usage
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
slide25

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

atridox billing codes
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
risk factors that increase periodontal disease severity
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.

sources of destructive collagenase
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

periostat
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)

stainbuster
StainBuster
  • Gently removes cement, stains from the enamel surface
  • Does NOT abrade tooth enamel, ceramic, implants
  • Does NOT affect the soft tissues
piezon scaling
PIEZON SCALING
  • Ultrasonic
  • No circular or elliptical movement
  • Integrated microcontroller
  • Optimum power with optimum control
  • Decreased vibration
  • Decreased noise
slide32

Piezon Scaling 

  • Instrument PS:
  • Excellent interproximal & deep

pockets. (CRA: Best

interproximal and

subgingival access)

  • Ideal for maintenance therapy

and pocket irrigation

  • Maximum patient comfort
the sidekick sharpener
The Sidekick Sharpener
  • Portable Power Sharpening Device
  • Maintenance Sharpening
    • Scalers and Curettes
the sidekick sharpener34
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