Oral Hygiene Mar/Apr 2023

LUNOS® PROPHY POWDER PERIO COMBI (TREHALOSE) –BENEFICIAL FOR WOUND HEALING

in terms of cell response and in contrast to Glycine-based prophylaxis powder.

Lunos® Prophy Powder Perio Combi, based on trehalose, can be used for supra- and subgingival air-polishing in prophylaxis as well as to support periodontal or periimplantitis therapy.

▪ effective

▪ highly soluble

▪ pleasant taste for patients

▪ low abrasive

LUNOS® PERIO COMBIFORBENEFICIAL(TREHALOSE) HEALINGWOUND

A recent in-vitro study (Weusmann et al. 2021) has shown that trehalose has no pro-inflammatory and no pro-apoptotic effects on human gingival fibroblasts. Wound healing of gingival tissue is, in contrast to glycine, not negatively influenced (Fig. 1).

1: Wound closure of human

(HGF) in the presence of glycine and trehalose over 48 h. *significant difference from all groups °significant difference to control Derived from (Weusmann et al. 2021).

Thus, the authors suggest that in terms of cell response, trehalose-based air-polishing powder might be more beneficial than glycine- based powder for air-polishing.

Fig.

gingival fibroblasts

Weusmann, Jens; Deschner, James; Imber, Jean-Claude; Damanaki, Anna; Leguizamón, Natalia D. P.; Nogueira, Andressa V. B. (2021): Cellular effects of glycine and trehalose air-polishing powders on human gingival fibroblasts in vitro. In: Clinical oral investigations. DOI: 10.1007/s00784-021-04130-0.

On the cover...

Award winning Piksters interdental brushes are now far easier to recommend and dispense thanks to the launch of a new Brush Gap Sizing Probe for professional use available in either plastic or stainless steel.

26

4 BRIEFS

6 NEWS & EVENTS

16 CPD CENTRE

20 ABSTRACTS

12

UNDERSTANDING THE ORAL MICROBIOME

The human microbiome is a complex and diverse ecosystem of microorganisms and in recent years, the oral microbiome has gained significant attention due to its immense role in overall health and disease reports Tabitha Acret

22

SEVEN WAYS TO ACHIEVE BRIGHTER TEETH

Prof. Laurie Walsh explores the common request from patients for improving the appearance of their teeth with 7 ways to a achieve a brighter smile

TOOTH SURFACE PROTECTION - FROM CONCEPT TO CLINIC

The concept of protecting enamel and root surface from dental caries is a very old idea that Prof. Laurie Walsh updates for the new millennium

32

INSTRUMENT REPROCESSING WITHOUT THE “BLACK BOX” OR “MAGIC WINDOW”

When students are undergoing clinical training at dental school and there is a lot to learn, their attention is focussed on patient care, rather than on all of the “back of house” support functions that keep the clinic running, like the sterilising room

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Publisher & Editor: Joseph Allbeury

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Oral Hygiene (formerly Auxiliary) ISSN 1323-4919 is printed in Australia and published six times per year by Main Street Publishing P/L ABN 74 065 490 655 • PO Box 586, Cammeray 2062

Telephone: (02) 9929-1900 Facsimile: (02) 9929-1999 Email: info@dentist.com.au

© 2023. All rights reserved. The contents of this magazine are copyright and must not be reproduced without the written permission of the publisher. Permission to reprint may be obtained upon application. Correspondence and manuscripts for publication are welcome. Although all care is taken, the editor and publisher will not accept responsibility for the opinions expressed by contributors to this magazine, or for loss or damage to material submitted for publication.

New VALO X broadband curing light

TUltradent Products, Inc. has launched the newest edition of its multi-awardwinning VALO™ curing light - the completely redesigned VALO™ X broadband LED curing light. As Ultradent’s most innovative curing light yet, the VALO X offers the ultimate in engineering and design when it comes to every aspect of the light—including durability, power, accessibility and versatility. Thanks to its larger 12.5 mm lens and new powerful custom LED chip, the VALO X curing light offers a more complete cure than ever before. Its superior features allow clinicians to cure with confidence and not have to question the capabilities of their light. This includes improved curing depth, beam collimation and thermal management. The VALO X comes equipped with two power modes (Standard Power and Xtra Power), two diagnostic light modes (black light and white light), as well as the ability to work corded or cordless. VALO X is milled from a single bar of aerospace-grade aluminum. Available from Dentavision on 1800-806-640 or Henry Schein on 1300-658-822. For more info, see www.ultradent.com

5 ways to use Instagram to grow your practice

Social media has become an important tool for practices to reach out to their target audience and connect with potential customers. Instagram is one of the most popular social media platforms and it can be a powerful marketing tool for dentists who want to increase their online presence and attract new patients.

Here are five ways dentists can best use Instagram...

Common mouthrinses reduce COVID-19 viral load in saliva

Share high-quality photos and videos. Instagram is a visual medium, so it’s crucial to share high-quality photos and videos that showcase your practice and services. Take pictures of your office, staff and patients to create a personal connection with your followers. You can also post before-and-after photos of dental procedures to demonstrate your expertise - as the saying goes, a picture paints a thousand words.

Use relevant hashtags. Hashtags are an excellent way to increase your reach and attract new followers. Use relevant hashtags such as #dentist, #dentalhealth, #smilemakeover and #teethwhitening to reach people who are interested in dental health and procedures.

Engage with your followers. Engagement is crucial on Instagram. Respond to comments and messages prom-ptly and make sure to like and comment on your followers’ posts. You can also ask your followers to tag your practice in their posts or share their photos on your account.

Show your personality. Instagram is a social platform, so it’s essential to show your personality and let your followers get to know you. Share behind-the-scenes photos and videos, post stories about your hobbies, social events and interests and showcase your staff’s personalities.

1 2 3 4 5

Promote specials and promotions. Use Instagram to promote specials and promotions to your followers. You can create custom graphics and posts that highlight your offers and encourage people to book appointments or visit your practice. Rather than offering discounts, consider bundling items such as free whitening with braces.

By Angus Pryor... more at dentalmarketingsolutions.com.au

Soon after the outbreak of the COVID-19 pandemic, preprocedural mouthwashes were recommended in Australia, Europe and the USA for temporarily reducing the intraoral viral load and infectivity of individuals potentially infected with SARS-CoV-2 in order to protect staff. Several mouthrinses have shown virucidal effects against SARS-CoV-2 in vitro. This randomised controlled clinical trial investigated the efficacy of commercially available mouthwashes containing cetylpyridinium chloride (CPC) and chlorhexidine digluconate (CHX) at 0.05% each, compared to a placebo mouthwash (0.9% NaCl) in 61 SARS-CoV-2-positive patients who had onset of symptoms within the last 72 hours. Oropharyngeal samples were taken at baseline and then patients gargled for 60 seconds with 20 mL of the test or placebo mouthwash. After 30 mins, further oropharyngeal samples were collected. Viral loads were analysed by quantitative reverse transcriptase polymerase chain reaction and infectivity of oropharyngeal specimens was analysed by cell culture and quantified as tissue culture infectious doses 50% (TCID50). Viral load significantly decreased upon gargling in the test groups (P = 0.0435) but not in the placebo group. Viral infectivity as measured by TCID50 also significantly decreased in the test groups (P = 0.0313). Furthermore, it was found that the samples from patients who had received a vaccine booster exhibited significantly lower infectivity at baseline as compared to those without a vaccine booster (P = 0.0231). Overall, this study indicates that preprocedural mouthwashes containing CPC and CHX can significantly reduce the viral load and infectivity in SARS-CoV-2–positive patients. Further studies are needed to investigate whether the observed reductions in viral load and infectivity translate into clinically useful effects in reducing COVID-19 transmission in the dental workplace.

Bonn EL, et al. Efficacy of a mouthwash containing CHX and CPC in SARS-CoV-2–positive patients: a randomized controlled clinical trial.J Dent Res. 2023;0(0). doi:10.1177/00220345231156415.

By Tabitha Acret

In my surgery...

“Refractory loupe options have certainly increased dramatically. This is an area I have been researching and I’m about to make the jump to 5x with a light. Even trying them on at the show, I could feel how it was impossible for my chronic slouching to happen!”

Fresh from my last column looking at what’s new in New York and hopefully coming to Australia soon, this time I went south. In April, I visited the ADX dental exhibition in Melbourne where I like to go to check out what’s new in Australia and to play with the latest toys all in one place!

them on at the show, I could feel how it was impossible for my chronic slouching to happen! I’m really excited to start a new journey with these ergonomic loupes and feel the difference that proper posture can bring at the end of the day!

Royal Australian Mint Tooth Fairy Kit

EMS was launching their brand new and improved PI tip for removal of calculus from dental implants and porcelain. The new and improved tip is longer than is predecessor and also much thinner, making it a lot easier to access deeper pockets than the old tip. The tip can not only be used on the implant abutment but it’s also safe on veneers and crowns and won’t leave a scratch like a regular ultrasonic would. The new tip screws onto your existing piezo handle and is a game changer for calculus removal.

Loupes

It was great to be able to go and look at all the loupes in one place, try them on and compare the various models to find one right for me. Refractory loupe options have certainly increased dramatically. This is an area I have been researching and I’m about to make the jump to 5x with a light. Even trying

Anew and different stand this year at ADX was from the Royal Australian Mint, with the cutest tooth fairy set! It comes in a special box with a toothbush, pen and tooth pouch and a $2 coin with a tooth fairy on it! This is real money so can be spent, but I cannot imagine many kids parting with the special $2 coin. It was very cute and a great way to celebrate the first tooth lost.

About the author

Tabitha Acret graduated from Newcastle University with a Bachelor of Oral Health and is currently studying her Masters in Public Health. She was previously the National VicePresident for the DHAA. Tabitha currently works as a clinical educator for implant maintenance and non-surgical periodontal therapy and lectures nationally and internationally on motivating patients, implant maintenance, disease prevention and periodontal therapy. Outside of her busy work life of lecturing and working clinically in private practice, Tabitha enjoys volunteering both locally and internationally to raise awareness and education of the benefits of good oral health. She was the winner of the 2018 leadership award in dental hygiene and 2019 award for clinical excellence.

EMS PI tip

For long-term quality assurance of implant-supported restorations

For long-term quality assurance of implant-supported restorations

HDL Ergo and Dragonfly™ : How Orascoptic™ does deflection

ore than 64 percent of dental professionals suffer from general musculoskeletal pain. The new HDL Ergo loupes from Orascoptic fight work-related neck discomfort, improve your posture and prolong your career.

Ergo loupes, also referred to as deflection loupes, employ an innovative optical prism element that deflects light at a steep angle. This allows the clinician to look straight ahead, keeping their chin up and neck straight, while viewing the operating site below.

The use of prismatic loupes may significantly reduce the risk of developing

Mmusculoskeletal disorders (MSDs), including neck and shoulder pain and decrease perceived muscular exertion during the performance of dental work.

Designed for performance, the HDL Ergo optics deliver a crisp image with edge-to-edge clarity that enables precise movements. Each loupe is custom crafted to your desired working distance and features a field size of almost 90mm.

The telescopes can be mounted on six different frame models, including the new Dragonfly powered loupe that features a built-in headlight.

Dragonfly powered loupes

Dragonfly by Orascoptic is a loupe with fully integrated battery power and circuitry to operate a built-in headlight.

A true triumph of optical engineering, Dragonfly seamlessly combines Orascoptic’s industry-leading optics and

award-winning headlight into a single, lightweight product.

All electronics and batteries are completely contained within the custom-built frame, so there are no visible wires or cables. An innovative counter-balance design provides all-day comfort by minimising pressure on the wearer’s nose bridge. Dragonfly offers...

n Untethered freedom of movement.

n Magnification and illumination working in harmony.

n Balanced ergonomic comfort. Reduce the weight on your nose by as much as 30% compared to traditional loupes. With HDL Ergo and Dragonfly, you get the best of both worlds - enhanced ergonomics together with outstanding illumination, all with the exceptional quality you know and love from Orascoptic.

Schedule a free no-obligation demo by calling 1800-643-600.

Orascoptic HDL Ergo loupes mounted on Dragonfly powered loupe frames with built-in headlight.

Orascoptic telescopes on Dragonfly powered loupe frames.

Orascoptic RDH Elite™ telescopes on Dragonfly powered loupe frames.

Introducing Dragonfly: a new species of loupes that seamlessly integrates a built-in headlight.

The better your equipment, the better your work. But there’s something to be said about how your equipment makes you feel.  Sleek. Agile. On top of your game.

You have never owned a loupe like this because there has never been a loupe like this. Empower yourself with the vision and freedom to perform at your peak.

To schedule your free demo call 1800 643 600

The era of the powered loupe has arrived.

One probe covers

FREE PLASTIC PROBE

Click here

• Simple and easy size estimation using marks on the probe with corresponding sizes on the handle.

New Piksters interdental brush gap Sizing Probe available now

Ato the launch of a new Brush Gap Sizing Probe for professional use available in either plastic or stainless steel.

One probe covers all 9 interdental

One probe covers

NEW Get your FREE* Piksters®

• Laser marked to avoid paint scratch off.

• Simple and easy size estimation using marks on the probe with corresponding sizes on the handle.

NEW Get your FREE* Piksters®

• Generous 4mm band enables easy size visualisation.

ea

(After your initial free probe)

$19.50ea

FREE PLASTIC PROBE

ea

$19.50ea

Click here

(After your initial free probe)

Click here

FREE PLASTIC PROBE

Click here

One probe covers 9 sizes!

Click here

• Simple and easy size estimation using marks on the probe with corresponding sizes on the handle.

One probe covers 9 sizes!

3.

4.

• Simple and easy size estimation using marks on the probe with corresponding sizes on the handle.

• Generous 4mm band enables easy size visualisation.

• Laser marked to avoid paint scratch off.

• Generous 4mm band enables easy size visualisation.

How to use PIKSTERS® SIZING PROBE:

• Laser marked to avoid paint scratch off.

Step 1. Slide the probe into the interproximal space till it stops.

Step 2. Withdraw the probe 4mm and observe the black or white band that was previously hidden in the gap between the teeth.

Step 3. Read the corresponding Pikster number size on the handle.

Step 4. Using your piksters professional pack, select the estimated best brush size, go back to the mouth with this brush and confirm that the fit is not too tight or too loose. Use your clinical judgement to go one size up or down as needed. Some clinicians prefer a tighter, more aggressive scrubbing action and some prefer a looser fit for easier insertion.

How to use PIKSTERS® SIZING PROBE: Step 1. Slide the probe into the interproximal space till it stops. Step 2. Withdraw the probe 4mm and observe the black or white band that was previously hidden in the gap between the teeth. Step 3. Read the corresponding Pikster number size on the handle. Step 4. Using your piksters professional pack, select the estimated best brush size, go back to the mouth with this brush and confirm that the fit is not too tight or too loose. Use your clinical judgement to go one size up or down as needed. Some clinicians prefer a tighter, more aggressive scrubbing action and some prefer a looser fit for easier insertion.

This gap would use a size 6 Pikster.

Indicates point at which the probe binds in the tooth gap channel.

(For example, in the picture below - see pic 3, the second black band from the tip is shown in between the teeth for easy visualisation, but in real life, it is hidden between the teeth below the contact point. Pull the probe back out 4mm, and you can see which band was hidden in the contact area).

(For

Transform your practice with cloud technology

Using cloud technology has become the norm for many people, whether that is through Netflix™ and Amazon Prime™ to catch up on the latest shows, or by sharing content online with family and friends via Facebook™ or Instagram™. Industries worldwide have leveraged the power of the cloud to enhance and grow their busi nesses and Dentally from Henry Schein One is no different.

With the Health Care and Social Assis tance industry projected to grow by over 15% in the next five years, making it one of the four fastest-growing industries in Australia*, there has never been a better time to start thinking about what the future looks like for your dental practice.

Dentally’s complete cloud enabled practice management software uses the latest cutting-edge technology to help you adapt to the challenges you face in dentistry every day and help you grow and plan for the future.

With Dentally, all patient information is stored securely in the cloud, accessible from anywhere with a secure internet connection. Simply Chrome and go!

Getting technical

Dentally is one of a few, true cloudbased solutions, (SaaS - Software as a Service) using a network of multiple remote servers hosted online to store, manage and process data. In dentistry, the utilisation of cloud has enabled practices across the globe to overcome the challenges of the past few years – from keeping patients in the loop with Dentally Portal’s contactless journey, to overcoming staff shortages with flexible working capabilities.

Why choose cloud?

When searching for ways to improve and grow your dental practice, today’s market can be confusing and crowded with the number of solutions available and finding the right one is a task in itself. Dentally know how crucial it can be to not only find something that will work best for you now, but to find something that is future proof! You can be certain that with Dentally your software will scale with you as your practice grows.

User security

Dentally keeps everything in one place, eliminating the need for multiple software to run each aspect of the surgery. As a complete cloud solution, you no longer need any onsite data storage as your data will be stored safely and securely, so you don’t have to.

Dentally automatically backs up and syncs any changes straight to the cloud. Not only does this save you money on server maintenance and expensive IT, it gives you the assurance that you are working and reporting in real time.

Not just a software

Dentally’s services go beyond futureproofing your business through practice management software. Their dedicated support team are always available on a live chat to help you get the best out of the software.

You will also have access to the customer success pro gramme, Dentally Elevate Spend one to one time with a trained team where you can get advice and new perspectives on growing and thriving as a business with the use of Dentally’s easy to use tools, such as:

• Fast reporting - No more time wasted on loading screens; with Dentally’s live reporting tools, you get up-to-date results instantly.

• Intuitive automation features - Dentally’s automatic communications work in the background to remind and recall patients, freeing up time in surgery to continue to deliver exceptional patient care.

• Dentally Portal - Enhance your patient’s journey from beginning to end through online booking, payments and forms giving them convenient ways to keep on top of their own oral health.

• Live Dashboards - Dentally’s home screen has an overview of the practice data including white space, cancellations, revenue, etc. This snapshot of information is great for setting daily goals for your team.

The future is cloud

Dentally is committed to giving users an intuitive, easy-to-use practice management solution and with the use of built-in features, you can keep everything running smoothly whilst saving time and resources in the process. Dentally takes the stress out of running your practice.

Speak with the Dentally team today for a software demo and find out how it can help you thrive both now and in the future. Visit Dentally.com, call 1300-889-668 or email help@dentally.com.au.

* https://labourmarketinsights.gov.au/our-research/ employment-projections

future

Grow your practice with Elevate, our exclusive customer success programme

Understanding the oral microbiome

By Tabitha Acret,

BOH

The human microbiome is a complex and diverse ecosystem of microorganisms that inhabit various parts of our body, including the skin, gut, mouth and reproductive tract. In recent years, the oral microbiome has gained significant attention due to its immense role in overall health and disease. Various studies have emphasised the importance of maintaining oral health to prevent diseases and infections.

What is the oral microbiome?

The oral microbiome is the collective microbial community that inhabits the mouth or oral cavity. It comprises various microorganisms such as bacteria, viruses and fungi that form a complex and diverse ecosystem. The oral microbiome contributes significantly to the normal function of the oral cavity, oral hygiene and digestion. The oral microorganisms are involved in various metabolic and physiological processes that contribute to the well-being of the host.

Structure of the oral microbiome

The bacterial community is the most abundant and diverse, comprising over 800 different species. These can be divided into two groups based on their oxygen sensitivity: aerobes and anaerobes. The oral microbiome also consists of viruses and fungi that play crucial roles in shaping the oral microbial community.

The oral microbiome varies between individuals, depending on various factors such as age, diet, genetics and environmental factors.

Function of the oral microbiome

The oral microbiome plays a crucial role in maintaining oral health and function. The microorganisms in the oral cavity contribute to the digestion of food, maintenance of a healthy oral environment and protection against pathogens. The oral microbiome also has an essential role in the immune response and modulation of inflammation. The oral microbiome produces various metabolites such as short-chain fatty acids that promote a healthy ecosystem and contribute to overall health.

Potential health implications of the oral microbiome

The oral microbiome has been implicated in various health conditions and diseases, indicating its potential health implications. Poor oral hygiene and an imbalance in the oral microbiome can lead to various oral conditions such as tooth decay, periodontal disease and oral infections. The oral microbiome has also been associated with systemic health conditions such as diabetes, cardiovascular disease and cancer. An imbalance in the oral microbiome can lead to dysbiosis, which can contribute to the pathogenesis of various diseases.

Healthy oral microbiome

Ahealthy oral microbiome is characterised by a diverse bacterial community that is in balance. Beneficial bacteria, such as Streptococcus salivarius, produce antimicrobial compounds that inhibit the growth of harmful bacteria. Good oral hygiene practices, such as regular brushing and interdental cleaning, can help maintain a healthy oral microbiome by removing plaque and preventing the build-up of harmful bacteria.

Oral microbiome and disease

Dysbiosis, or an imbalance in the oral microbiome, can lead to various diseases such as tooth decay, periodontal

disease and oral cancer. For example, tooth decay is caused by bacterial acid production that can dissolve enamel and dentine. The bacteria responsible for tooth decay are primarily from the Streptococcus and Lactobacillus genera. Periodontitis is caused by the accumulation of plaque and tartar, leading to inflammation and ultimately destruction of the periodontal ligament. The bacteria responsible for periodontitis are primarily Porphyromonas Gingivalis (p.ginig) and Treponema denticola.

Future directions

The field of oral microbiome research remains relatively new and there is much left to learn about the interactions between the diverse microbial community and the host. Advancements in technology, such as next-generation sequencing and metagenomics, provide new opportunities to investigate the oral microbiome’s complexities further. Studying the interactions between the oral microbiome and the immune system could lead to the development of new treatments for oral diseases.

In conclusion, the oral microbiome is a crucial component of the human microbiome and plays a crucial role in maintaining oral health and overall health. The diversity and balance of microorganisms in the oral cavity are crucial for optimal function and immune response. The oral microbiome has immense potential in predicting and preventing various diseases and conditions by providing insights into

the balance and diversity of microorganisms in the oral cavity. Maintaining good oral hygiene and a healthy oral environment can promote a healthy ecosystem and contribute to overall health and well-being.

References

1. Human Microbiome Project Consortium. Structure, function and diversity of the healthy human microbiome. Nature 2012; 486: 207-14.

2. Baker JL, Bor B, Agnello M, et al. Oral microbiome composition reflects prospective risk for esophageal cancers. Cancer Res 2020; 80: 554-63.

3. Man WH, de Steenhuijsen Piters WA, Bogaert D. The microbiota of the respiratory tract: gatekeeper to respiratory health. Nat Rev Microbiol 2017; 15: 259-70.

4. Belkaid Y, Hand TW. Role of the microbiota in immunity and inflammation. Cell 2014; 157: 121-41.

About the author

Tabitha Acret graduated from Newcastle University with a Bachelor of Oral Health and is currently studying her Masters in Public Health. She was previously the National Vice-President for the DHAA. Tabitha currently works as a clinical educator for implant maintenance and non-surgical periodontal therapy and lectures nationally and internationally on motivating patients, implant maintenance, disease prevention and periodontal therapy. Outside of her busy work life of lecturing and working clinically in private practice, Tabitha enjoys volunteering both locally and internationally to raise awareness and education of the benefits of good oral health. She was the winner of the 2018 leadership award in dental hygiene and 2019 award for clinical excellence.

Figure 1. An imbalance in the oral microbiome can lead to periodontal disease.

Understanding the oral microbiome

TQuestion 1. The oral microbiome contains?

a. Bacteria

b. Viruses

c. Fungi

d. All of the above

Question 2. How many different species of bacteria does the oral microbiome contain:

a. 200+

b. 400+

c. 800+

d. 1000+

e. 2000+

Question 3. Dysbiosis is:

a. The process by which bacteria feed on sugar and form plaque.

b. An imbalance in the oral microbiome.

c. The inflammatory response that destroys the periodontal ligament.

d. A reduced immune response based on poor oral hygiene.

Question 4. The bacteria responsible for periodontitis are primarily:

a. Porphyromonas Gingivalis and Treponema denticola

b. Streptococcus salivarius

c. Lactobacillus salivarius

d. Granulicatella adiacens

Question 5. The health of the oral microbiome has been associated with systemic health conditions such as:

a. Diabetes

b. Cardiovascular disease

c. Cancers

d. All of the above

Seven ways to achieve brighter teeth

Question 6. A common contributor to external stains on teeth are:

a. Tannins and polyphenols from beverages such as tea, coffee and red wine.

b. Coloured molecules from beverages such as cola drinks.

c. Pigments from foods such as berries and soy sauce.

d. Mouth rinses like chlorhexidine and quaternary ammonium compounds.

e. All of the above.

Question 7. The most widely used abrasive particle in toothpastes has an RDA rating of:

a. Low

b. Medium

c. Highly

d. Harmful

Question 8. A short term improvement in the optical properties of teeth can be achieved with the toothpaste ingredient...

a. CPP-ACP

b. Sodium hexametaphosphate

c. Copper phthalocyanine

d. PAP+ and nano hydroxyapatite

Question 9. A highly abrasive ingredient in toothpaste is:

a. Sodium bicarbonate

b. Brushite

c. Perlite

d. Hydrated silica

e. Calcium pyrophosphate

Question 10. Shade reversion agents remove extrinsic stains and provide a permanent brightening effect:

a. True

b. False

Tooth surface protectionfrom concept to clinic

acid produced by dental plaque biofilms coming into contact with the enamel. Later work done in my lab by Jason Yap showed that modern fissure sealant materials and nano filled resins protect enamel from acid attack in the same way as the early materials of the 1960s. At the edge of the resin material, where a cariogenic dental plaque biofilm is present, a zone of demineralisation develops. Hence, with such materials, it is important to cover the area that you want to protect. This then leads onto the major problem with resin-based materials, which was the difficulty of reliably bonding a resin to partially erupted teeth where crevicular fluid, dental plaque and saliva were likely to be present. All of these local factors can impede the adhesion of resin to etched enamel. Adding to this, on erupting teeth, the most superficial layers of the enamel are aprismatic and as a result, do not etch particularly well. Areas of enamel may be present on newly erupted teeth that are not fully mineralised. To address these concerns, the concept of using glass ionomer cement as a less technique-sensitive and

Question 11. A zone of demineralisation develops at the edge of resin-based sealants:

a. Due to the difficulty of reliably bonding.

b. As the most superficial layers of enamel are aprismatic.

c. As a cariogenic dental plaque biofilm is present.

d. All of the above.

Question 12. Fluoride containing glass ionomer cements are “recharged” when exposed to:

a. Fluoride containing toothpaste.

b. Fluoride gel.

c. Fluoride mouth rinse.

d. All of the above.

Question 13. Fuji VII EP contains:

a. Hydroxyapatite.

b. Fluorapatite.

c. CPP-ACP

d. All of the above.

Question 14. A fundamental limitation of the concept of chemical synthesis of enamel is that it lacks the organic matrix structure which guides the formation of enamel by ameloblasts:

a. True

b. False

Question 15. Pellicle acts as a semipermeable ionic membrane protecting teeth from strong erosive challenges:

a. True

b. False

Question 16. Correct and proper instrument reprocessing is the responsibility of the:

a. The chairside nurse.

b. The sterilisation area nurse.

c. The treating clinician.

d. The practice manager.

Question 17. When using cassettes in an optimal workflow, instruments are removed from the cassette:

a. Chairside.

b. On entering the sterilistion area.

c. Prior to ultrasonic cleaning or automated washing.

d. Prior to sterilisation.

e. All of the above.

Question 18. Using cassettes:

a. Keeps instruments organised in sets.

b. Mitigates the risks of sharps injury due to reduced instrument handling.

c. Eliminates manual instrument cleaning and sorting.

d. All of the above.

Question 19. The “magic window” is a reference to:

a. Large internal windows into the sterilising room to give patients an opportunity to view reprocessing.

b. The dispensary at dental school where students collected their instruments.

c. The limited understanding of students about how instruments are reprocessed.

d. All of the above.

Question 20. Patients are more impressed by instruments in a cassette than a scary pile of instruments on a tray:

a. True

b. False

Infection Control BOOT CAMP

ON DEMAND ONLINE LEARNING PROGRAMME

29 VIDEOS - 8+ HOURS OF EDUCATION

Presented by Emeritus Professor Laurence Walsh AO

BDSc, PhD, DDSc, GCEd, FRACDS, FFOP (RCPA), FFDT (RCS Edin)

Learn from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control including from the Dental Board of Australia (July 2022), the ADA (4th edition guidelines August 2021 and the ADA Risk management principles for dentistry during the COVID-19 pandemic (October 2021)), the new guidelines from NHMRC (May 2019), Hand Hygiene Australia (Sept 2019) and the CDNA (Dec 2018) as well as recent changes in Australian Standards and TGA regulations that are relevant to infection control. The course provides a summary of how those changes interlink with one another and also covers practical implementation of the new requirements and what it means for everyday dental practice. Hear about the why and the how and keep up-to-date with the changes that are happening.

COURSE TOPICS

This one day course will cover changes in regulations and guidelines from 2018 to 2022 including:

n Risk-based precautions.

n Hand hygiene and hand care practices.

n Addressing common errors in personal protective equipment.

n Biofilm reduction strategies.

n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover.

n Correct operation of mechanical cleaners and steam sterilisers.

n Wrapping and batch control identification.

n Requirements for record keeping for instrument reprocessing.

n Correct use of chemical and biological indicators.

8 HOURS CPD

Laurie Walsh is a specialist in special needs dentistry who is based at the University of Queensland in Brisbane, where he is an emeritus professor. Laurie has been teaching and researching in the areas of infection control and clinical microbiology for over 25 years and was chief examiner in microbiology for the RACDS for 21 years. His recent research work includes multiple elements of infection control, such as mapping splatter and aerosols, COVID vaccines and novel antiviral and antibacterial agents. Laurie has been a member of the ADA Infection Control Committee since 1998 and has served as its chair for a total of 8 years, across 2 terms. He has contributed to various protocols, guidelines and checklists for infection control used in Australia and represented dentistry on 4 committees of Standards Australia and on panels of the Communicable Diseases Network of Australia and of the Australian Commission on Safety and Quality in Health Care.

Oral Hygiene Abstracts 2023

By Emer. Prof. Laurence Walsh AO

Filtration on wheels: When natural ventilation is inadequate

As the COVIID-19 pandemic has proceeded, ventilation has been recognised increasingly as an important tool in infection control in health workplaces with poor air management. Many hospitals in Ireland and the UK do not have mechanical ventilation systems such as airconditioning and instead depend on natural ventilation. Poorly ventilated spaces harbouring infectious persons, such as hospital wards, can pose a considerable threat to both patients and healthcare workers, with nosocomial COVID-19 outbreaks reported in the literature. The effectiveness of natural ventilation varies with atmospheric conditions and building design. In a challenge test of a legacy design ward, portable high-efficiency particulate air (HEPA) filtration units were used. Such units have previously been shown to remove SARS-CoV-2 RNA from air samples taken in COVID-19-surge hospital units. This study reports the effects of a portable air filtration unit (AFU) in clearing a common hospital air pollutant (nebulized Ventolin (salbutamol)) from a ward bay under renovation. Such fugitive drug aerosols of respirable size are common in hospitals and are useful proxies for persistence and circulation of infectious particles of respiratory origin. There was no heating, ventilation or air conditioning system for air handling in the ward. Laser light scattering was used to measure the concentration (μg/m3) of nebulised airborne particles in the size range of 0.3–2.5 μm. Mean peak particle count over background was lowest in the “windows open, AFU on” condition and particle clearance was fastest. The “windows alone” condition was unable to reduce concentrations back to baseline levels without aid of the AFU. Overall, the portable AFU successfully augmented natural ventilation in airborne particle clearance from a legacy design hospital ward by increasing the clearance rate of particles. The combination of AFU and natural ventilation may be synergistic, possibly because secondary air movement from the AFU increases currents through the windows.

Fennelly M, et al. Portable HEPA filtration successfully augments natural-ventilation-mediated airborne particle clearance in a legacy design hospital ward. J Hosp Infect. 2023;131:54-57

Gingival epithelial cell infection by SARS-CoV-2 is unlikely

SARS-CoV-2, the causative agent of COVID-19, is mainly transmitted by first infecting nasal and lung epithelial cells. Host cell entry by SARS-CoV-2 is mediated by the binding of the spike protein, a transmembrane class I fusion protein that is exposed on the viral surface, with the angiotensin converting enzyme 2 (ACE2) receptor on the host cell. In addition to ACE2, other host cell factors including transmembrane serine protease 2 (TMPRSS2) and Furin are required for viral entry, however alternative receptors including CD147 have been proposed. The mouth is also believed to be a viral portal site since certain types of oral epithelial cells were shown to express the ACE2 receptor. The oral cavity structures, keratinized and non-keratinized mucosa and salivary glands’ epithelia express SARS-CoV-2 entry and transmission factors, especially ACE2 and TMPRSS2. However, it is unclear whether oral epithelial cells are directly infected by SARS-CoV-2. In this study, we examined epithelial cells of oral gingiva. We found that KRT5+ and KRT18+ gingival epithelial cells do not express ACE2, but highly express TMPRSS2 and Furin as well as CD147, which was proposed to be an alternative receptor for SARS-CoV-2. However, using SARS-CoV-2 pseudoviruses containing the spike protein, it was observed that gingival epithelial cells were not susceptible to infection due to their lack of ACE2 expression and the inability of CD147 to mediate viral entry. These results strongly suggest that epithelial cells from the gingiva are not susceptible to SARSCoV-2 and CD147 is not a receptor for the SARS-CoV-2 virus. The susceptibility of oral cells from other oral structures under healthy and pathological conditions still needs to be confirmed to better understand the role of the oral cavity in COVID-19 infection and transmission. In this study, we found that previously detected ACE2 RNA expressed in gingival epithelial cells did not equate to expression of the ACE2 receptor on cell-surface. The use of cell-surface staining and in vitro/in vivo infection models with SARSCoV-2 pseudovirus or live virus is needed to confirm ACE2 expression and infection susceptibility of epithelial and non-epithelial cells in various oral tissues. An important question remains as to the source of virus found in the saliva of people infected with COVID-19 if the virus in saliva did not originate from oral epithelial cells. It can be argued that in such cases the infected lung and nasal epithelial cells are the source of virus in the saliva. More studies are still needed to confirm the susceptibility of different cell types found in various oral tissues and susceptibility to SARS-CoV-2 and the many variants under healthy and pathologic conditions to better understand the role of the oral cavity in COVID-19 infection and transmission. Bontempo A, et al. Assessment of SARS-CoV-2 entry in gingival epithelial cells expressing CD147. Eur J Oral Sci. 2023;131:e12906

Seven ways to achieve brighter teeth

By Emeritus Professor Laurence J. Walsh AO

Improving the appearance of teeth is a common request from patients. Intrinsic tooth colour varies between individuals and changes over the lifespan, with greater saturation in the yellow range in the later years of life.1-3 Yellow teeth are considered less popular because a yellow tooth colour adds to a perception of advanced age and reduced vitality.4

Common contributors to external stains are tannins and polyphenols from beverages (such as tea, coffee and red wine), coloured molecules from beverages (such as cola drinks) and pigments from foods (such as berries and soy sauce). Mouth rinses that contain active ingredients which are positively charged (chlorhexidine and quaternary ammonium compounds) will also bind to the negatively charged enamel surface and pellicle, causing discolouration.5,6

This article describes seven methods which can create variations in tooth colour to reduce the fundamental progression towards yellowing, other than traditional in office or at home bleaching methods, or the use of veneers.

1. Micropolishing toothpastes

The stain removal capabilities of conventional toothpastes depends on their abrasiveness, as measured by their relative dentine abrasivity (RDA) value.7 If one rates various abrasives used in

toothpastes according to their abrasivity, sodium bicarbonate and dicalcium phosphate dihydrate (also known as brushite) are considered soft; hydrated silica and calcium pyrophosphate are medium; and alumina and perlite are hard. The most widely used abrasive particle in toothpastes is particulate hydrated silica. Typically, the particles of hydrated silica are roughly polyhedral with sharp edges.8

There are international regulatory restrictions on the maximum abrasion levels permitted in a toothpaste and hence there are limits to how far the idea of using abrasive technologies alone to improve the appearance of teeth can be pushed.9-11

In micropolishing toothpastes, the abrasive particles are reduced in size by processes such as micronising or ball milling. These methods can be used with all common abrasive particles found in toothpastes including silica, calcium car-

bonate and naturally occurring minerals. Using smaller particles is more effective for removing extrinsic stains, provided that the bristles of the tooth brush can reach the area to properly apply the micronised particles in a slurry. In practical terms, this means that micropolishing toothpastes are very effective for removing stain on labial surfaces, but not interdentally. For patients who have a regular daily intake of tea and coffee, such toothpastes can be particularly good for reducing the buildup of tannins and polyphenols.12-14

For patients whose lifestyle does not contain foods or drinks that cause extrinsic staining, there is no value in using micropolishing toothpastes on a regular basis. On the other hand, for patients who are regular drinkers of tea or coffee, micronised particles can reduce the inevitable accumulation of external stains on their labial tooth surfaces.

Figure 1. Adhesive strips for at home use. A: Hydrogen peroxide strips. B: PAP+ nonperoxide strips.

2. Nano hydroxyapatite

One particular agent which is attracting current interest is nano hydroxyapatite. These nanoparticles are considered to have medium abrasivity.15 The enormous surface area of these nanoparticles means that there is sufficient saturation of apatite species into the water phase that they can contribute to remineralisation.16,17 While traditional abrasive particles used in commercial toothpastes are designed to help remove plaque and stains while causing only negligible levels of damage to tooth surfaces or gingival tissues, from a chemical perspective, most abrasive particle types other than nano hydroxyapatite are unable to contribute to remineralisation.18,19

Recent analyses indicate that regular use of oral care products containing nano hydroxyapatite exerts a whitening action on teeth.20 There are multiple reasons for this. Since hydroxyapatite nanoparticles are white and opaque, if they are deposited onto the surface of teeth they can mask the yellow appearance of teeth, as well as acting as an abrasive to remove extrinsic stains.21,22 There is some suggestion that a layer of white particles not only masks the underlying yellow colour of teeth, but may also block reflection of light from the dentine core of the tooth, not allowing this to pass through the tooth and back to any observers.23 Lastly, the nanoparticles may also fill in microcracks and defects in the enamel surface and enhance its reflectivity.24 As could be predicted, there is a dose-response relationship between the concentration of nano hydroxyapatite in toothpastes and its whitening effects on teeth.25,26

3. Decolourising surface stains

In this approach, the extrinsic stains which accumulate remain on the tooth surface, but are chemically altered by oxidation, so that they no longer absorb light and make the tooth surface appear dull. By its very nature, such an approach must be used periodically to “touch up” the appearance of the surface. Several methods that can be used to decolourise surface stains including an oxidising agent (such as hydrogen peroxide) in a regular toothpaste;27 adding an oxidising agent (such as a powder containing PAP+ and nano hydroxyapatite) to an existing

toothpaste; using a low concentration (0.5%) hydrogen peroxide mouthwash; applying whitening strips; applying paint-on gels; and using peroxide and non-peroxide whitening strips.

Hydrogen peroxide-containing polyethylene strips have been used for many years, with the concept being that the adhesive provides a sustained exposure of the tooth surface to the hydrogen peroxide bleaching agent.28-30 Bleaching strips are also available that use alternative oxidants such as PAP. This has the advantage of avoiding gingival soft tissue irritation, which will otherwise cause sensitivity (Figure 1).

If a paint-on material is being used, removing saliva from the surfaces of the teeth to be treated will improve the results that are obtained, because saliva contains lactoperoxidase and catalase that will inactivate hydrogen peroxide by converting it into water and oxygen.

4. Repelling surface stains

Sodium hexametaphosphate is an ingredient found in some toothpastes (such as in the Oral-B Pro-Health series). This has the ability to bind strongly to pellicle and enamel because of the strong charge of the polyphosphate component.

Figure 2. In-office treatments. A and B: Particle beam devices for removal of extrinsic stains. C and D: dental prophylaxis for polishing the enamel surface as well as for extrinsic stain removal. E and F: Polishing the enamel surface using graded disks such as those in the 3M Sof-Lex™ system.

As a result, when the polyphosphate has bound to pellicle on a freshly brushed tooth, the coating prevents the accumulation of stains from the diet. A second effect is that the existing stains do not bind as strongly to pellicle as the hexametaphosphate and so they will be dislodged and displaced.31

Numerous randomised controlled trials of stain removal and the rate of deposition of stains by sodium hexametaphosphate have been undertaken, testing the effects on external stains in patients with diverse backgrounds and lifestyles. Reductions in external stain of up to 90% have been seen with regular use of such toothpastes twice-daily over six weeks.32,33

5. Professional prophylaxis

Prophylaxis using a rubber cup or an abrasive particle beam device is a highly efficient way of removing external stains from all aspects of teeth. Methods that rely upon the patient will inevitably fail to reach interdental areas,34 whereas professional prophylaxis deals with all erupted surfaces of teeth. As well as removing extrinsic stains, calculus and dental plaque, depending on the type of abrasive that is used in the prophylaxis paste, a micro polishing effect of the tooth surface can also be achieved. Likewise, graded abrasive disks can rapidly polish a tooth surface (Figure 2). Normal enamel is not microscopically smooth. Small irregularities on the enamel surface at the micron scale readily scatter light, particularly light of the shorter wavelengths in the visible spectrum. When such small irregularities are removed by polishing, more specular mirrorlike reflections occur from labial surfaces, making these appear brighter.

6. Tooth surface lightening

In this approach, a remineralising treatment is undertaken using optimal conditions to ensure that a surface layer of regularly formed perfectly crystalline fluorapatite is formed on the tooth surface.35,36 To achieve this, enamel micro abrasion is performed (using phosphoric acid and pumice) and the patient then uses a topical crème containing CPP-ACP (GC Tooth Mousse™) or CPP-ACP and 900 ppm fluoride (GC Tooth Mousse Plus™) over the following four weeks, each night before retiring (Figure 3).

The timing of night time use is designed to ensure that there is optimal availability of the rate-limiting ingredient of calcium ions during the overnight period when the resting salivary flow and intraoral pH will drop. Such products are able to drive remineralisation reactions under acidic pH conditions (down to pH 4 in the case of Tooth Mousse Plus). This is possible because of the release of stabilised calcium and phosphate and fluoride at the ideal atomic stoichiometric ratios to form fluorapatite. The perfectly formed mineral crystals on the surface are better able to reflect short wavelengths of visible light, particularly those in the blue and violet range, making the tooth appear less yellow. The yellow to blue tooth colour shift that is achieved produces an overall improvement in the perception of tooth shade and the effect is permanent.

7. Shade reversion agents

T his concept relies on the application of a single dye, such as blue covarine, or a mixture of dyes, onto the tooth surface (Figure 4). The dyes can be applied as part of a toothpaste, or

Figure 3. Tooth lightening. A: 10% CPP-ACP topical crème with 900 ppm fluoride. B: Baseline appearance. The incisal edges were smoothed with a disk and then enamel microabrasion undertaken. C: Appearance after 4 weeks of daily use of GC Tooth Mousse Plus™. Note the reduction in yellow.

Figure 4. Relevant chemical structures. A: Typical tannins from tea that cause extrinsic staining. B: CI 74160/ copper phthalocyanine/ blue covarine dye used in Oral-B toothpastes. C: CI17200/ D&C Red No. 33 (upper) and CI42090/FD&C Blue No.1 (lower) used in HiSmile V34 colour corrector foam and serum.

applied directly in a mixture that contains a binding agent, so that they are retained on the tooth surface for several hours. These light blue and purple dyes reflect violet and blue light, making the tooth appear less yellow for as long as there is a sufficient amount of retained dye on the surface of the tooth.

Blue covarine dye (also known as copper phthalocyanine or CI 74160) is used in several Oral-B toothpastes for the specific purpose of changing the optical properties of the teeth to gain a short-term improvement in their appearance.37-40 There are other violet dye mixtures

available on the market for gaining an improvement in the shade of the teeth for several hours, e.g. HiSmile™ V34 colour corrector foam or serum, which uses CI 17200/D&C Red No. 33, and CI 42090/ FD&C Blue No.1. These types of products are brushed on to the teeth and left in place.

About the author

Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 390 journal papers, with a citation count of over 18,300 citations in the literature. Laurie holds patents in 8 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.

References

1. Joiner A. Tooth colour: a review of the literature. J Dent. 2004;32 (Suppl 1):3-12.

2. Joiner A, et al. A review of tooth color and whiteness. J Dent. 2008;36(Suppl 1):2-7.

3. Gómez Polo C, et al. Correlation of natural tooth colour with aging in the Spanish population. Int Dent J. 2015;65:227-234.

4. Newton JT, et al. The impact of tooth colour on the perceptions of age and social judgements. J Dent. 2021;112:103771.

5. Walsh LJ. Cosmetic dentistry – the discoloured tooth. Brisbane: Knowledge Books and Software, 2002. ISBN: 1875219994.

6. Walsh LJ. Tooth stain removal: a critical appraisal. ADAQ News 2017;637:13-14.

7. González-Cabezas C, et al. Abrasivity testing of dentifrices - Challenges and current state of the art. Monogr Oral Sci. 2013;23:100-107.

8. Joiner A. Whitening toothpastes: A review of the literature. J Dent. 2010;38:e17-e24.

9. International Standards Organisation ISO 11609, Dentistry-Toothpastes. Requirements, Test Methods and Marking, 1995.

10. Goldberg M, et al. Undesirable and adverse effects of tooth-whitening products: A review. Clin Oral Investig. 2010;14:1-10.

11. Wiegand A, Schlueter N. The role of oral hygiene: Does toothbrushing harm? Monogr Oral Sci. 2014;25:215-219.

12. Raoufi S, Birkhed D. Effect of whitening toothpastes on tooth staining using two different colour-measuring devices - a 12-week clinical trial. Int Dent J. 2010; 60:419-423.

13. Schemehorn BR, et al. Abrasion, polishing, and stain removal characteristics of various commercial dentifrices in vitro. J Clin Dent. 2011;22:11-18.

14. Casado BGS, et al. Efficacy of dental bleaching with whitening dentifrices: A systematic review. Int J Dent. 2018;2018:7868531.

15. Epple M, et al. A critical review of modern concepts for teeth whitening. Dent J. 2019;7:79.

16. Chen L, et al. Hydroxyapatite in oral care products - a review. Materials 2021;14:4865.

17. O’Hagan-Wong K, et al. The use of hydroxyapatite toothpaste to prevent dental caries. Odontology 2022;110:223-230.

18. Sarembe S, et al. In vitro whitening effect of a hydroxyapatite-based oral care gel. Eur J Dent. 2020;14:335-341.

19. Limeback H, et al. Biomimetic hydroxyapatite and caries prevention: A systematic review and metaanalysis. Can J Dent Hyg. 2021;55:148-159.

20. Limeback H, et al. Tooth whitening with hydroxyapatite: a systematic review. Dent J. 2023;11:50.

21. Niwa M, et al. Polishing and whitening properties of toothpaste containing hydroxyapatite. J. Mater. Sci. Mater. Med. 2001;12:277-281.

22. Dabanoglu A, et al. Whitening effect and morphological evaluation of hydroxyapatite materials. Am J Dent. 2009;22:23-29.

23. Steinert S, et al. Daily application of a toothpaste with biomimetic hydroxyapatite and its subjective impact on dentin hypersensitivity, tooth smoothness, tooth whitening, gum bleeding, and feeling of freshness. Biomimetics 2020;5:17.

24. Fabritius-Vilpoux K, et al. Quantitative affinity parameters of synthetic hydroxyapatite and enamel surfaces in vitro. Bioinspired Biomim Nanobiomater. 2019;8:141-153.

25. Kim BI, et al. Tooth whitening effect of toothpastes containing nanohydroxyapatite. Key Eng Mater. 2006;309:541-544.

26. Shang R, et al. Tooth whitening with an experimental toothpaste containing hydroxyapatite nanoparticles. BMC Oral Health 2022;22:331.

27. Kleber CJ, et al. In vitro tooth whitening by a sodium bicarbonate/peroxide dentifrice. J Clin Dent. 1998;9:16-21.

28. Gerlach RW, et al. A randomized clinical trial comparing a novel 5.3% hydrogen peroxide bleaching strip to 10%, 15% and 20% carbamide peroxide tray-

An important point is that shade reversion agents do not remove extrinsic stains, but provide a temporary brightening effect that reduces the yellow appearance of the teeth. It is good practice to always combine shade reversion agents with a method that removes extrinsic stains.

Conclusions

Each of the seven strategies discussed above can be used in various combinations to achieve worthwhile outcomes. Key considerations are the extent of effort that the patient is prepared to make in using products as part of their self-performed oral care, versus relying on professional interventions undertaken in the dental clinic. It is important to understand the patients’ demands and to have a realistic approach to meeting these, that takes into account practicability as well as cost.

based bleaching systems. Compend Contin Educ Dent. 2000;21:S22-S28.

29. Gerlach RW, et al. Objective and subjective whitening response of two self-directed bleaching systems. Am J Dent. 2002;15:7A-12A.

30. Walsh LJ. New Oral-B 3D White Whitestrips provide a useful adjunct to in-office or at home bleaching treatments. Australas Dent Pract. 2014; 25(1):12-14.

31. Park YD, et al. Research about changes of abrasiveness and whiteness of each dentifrice including nano-hydroxyapatite, sodium metaphosphate. Key Eng Mater. 2006;309:545-548.

32. Gerlach RW, et al. Removal of extrinsic stain using a 7.0% sodium hexametaphosphate dentifrice: a randomized clinical trial. J Clin Dent. 2002;13(1):6-9. 33. Gerlach RW, et al. Extrinsic stain removal with a sodium hexametaphosphate-containing dentifrice: comparisons to marketed controls. J Clin Dent. 2002;13(1):10-14.

34. Walsh LJ. Interdental cleaning – the final frontier for mechanical plaque control. Auxiliary 2016;26(3):18-19.

35. Walsh LJ Tooth lightening: a new concept of maximizing surface aesthetics. Australas Dent Pract. 2008;19(2):48-50.

36. Walsh LJ. Molecular and pharmaceutical aspects of novel methods and materials for the prevention of tooth structure loss. Curr Pharm Biotechnol. 2017;18(1):45-51.

37. Joiner A et al. A novel optical approach to achieving tooth whitening, J Dent. 2008;36:s8-s14.

38. Collins LZ, et al. Instant tooth whitening from a silica toothpaste containing blue covarine. J Dent. 2008;36:s21-s25.

39. Joiner A. A silica toothpaste containing blue covarine: a new technological breakthrough in whitening. Int Dent J. 2009;59(5): 284-288.

40. Tao D, et al. Tooth whitening evaluation of blue covarine containing toothpastes. J Dent. 2017;67: S20-S24.

Tooth surface protectionfrom concept to clinic

By Emeritus Professor Laurence J. Walsh AO

The concept of protecting enamel and root surface from dental caries is a very old idea. Going back into the writings of GV Black, he proposed placing margins for class II cavities into a zone that he had identified histologically as not being affected by the caries process.

Unfortunately, using the histology methods available at his time, which precluded sectioning of teeth with associated soft tissues, he did not realise that this zone, which was spared from demineralisation, was unfortunately in fact the zone where the junctional epithelial cells attached. Despite this false start, much work has been done to develop the concept of tooth surface protection into its most modern forms.

Resin-based materials

In the 1960s, the work of Richard Simonsen on resin-based fissure sealants was instrumental in establishing the concept of protecting pits and fissures by covering the enamel with an unfilled resin.1,2

Later studies of fissure sealants applied to erupted permanent molar teeth showed high effectiveness for the areas where the sealant materials remained over time.3-5 The principle that arises from this is that resins are an inert material which covered the surface to prevent acid produced by dental plaque biofilms coming into contact with the enamel. Later work done in my lab by Jason Yap6 showed that modern fissure sealant materials and nano filled resins protect enamel from acid attack in the same way as the early materials of the 1960s. At the edge of the resin material, where a cariogenic dental plaque biofilm is present, a zone of demineralisation develops. Hence, with such materials, it is important to cover the area that you want to protect.

This then leads onto the major problem with resin-based materials, which was the difficulty of reliably bonding a resin to partially erupted teeth where crevicular fluid, dental plaque and saliva were likely to be present. All of these local factors can impede the adhesion of resin to etched enamel. Adding to this, on erupting teeth, the most superficial layers of the enamel are aprismatic and as a result, do not etch particularly well.

Areas of enamel may be present on newly erupted teeth that are not fully mineralised.7 To address these concerns, the concept of using glass ionomer cement as a less technique-sensitive and

“The whole concept of pellicle being inert turned out to be incorrect, since pellicle is now known to be inherently helpful as a means of protecting the enamel from the outside world...”

more reliable fissure sealant approach for erupting teeth emerged.8,9 The GIC forms a transition zone with the enamel, creating a region of greatly increased resistance to acid dissolution. This acidresistant zone remains even when gross fracture of the overlying cement occurs because of high occlusal stresses.

Glass ionomer cements

The next logical development from studying the impact of glass ionomer cements used in the early 1990s in field trials of atraumatic restorative dentistry was the concept of deliberately placing high fluoride releasing glass ionomer cements onto partially erupted teeth, as a form of tooth surface protection.10 The underlying principle here is that materials such as GC Fuji VII not only display extremely high fluoride release, but also impressive recharging abilities when the material is subsequently exposed to a fluoride containing toothpaste, a fluoride gel or another fluoride product.11 When present in thin layers, fluoride ions will move through the material from the oral environment to become incorporated into the enamel. In this way, the overlying Fuji VII helps to not only protect the enamel of the tooth, but also to encourage its greater mineralisation. Laboratory studies of Fuji VII reveal that the material provides a wide zone of protection beyond its borders, defending the enamel even from strong carious attacks from organic acids.6,12 Repeated attacks by strong mineral acids will of course eventually cause the Fuji VII to dissolve away, sacrificing itself to protect the underlying tooth.12 This can be likened to a sacrificial anode effect, drawing a parallel to the electrochemistry behind a modern domestic electrical hot water system.

Having found this approach using GIC highly successful on erupting permanent teeth, the concept was then extended to root surfaces. Certain sites in the mouth are known to be highly prone to root surface caries, most notably the buccal furcation area of mandibular molar teeth and the buccal surfaces of the mandibular

premolar teeth. These surfaces show the highest attack rates for root surface caries. In a patient with a high caries risk, for example due to salivary gland hypofunction from polypharmacy, Fuji VII can be painted in a thin layer onto the root surface.10 The fluoride released alters the metabolic behaviour of the overlying dental plaque biofilm, reducing its acid production. The later development of Fuji VII EP, which contains CPP-ACP, added further to the concept because the release of CPP from this material causes prebiotic effects,13,14 encouraging the growth of health associated bacteria which naturally inhibit the growth of acid tolerant and acid producing cariogenic bacteria.15,16

Let there be light

The idea of altering the chemical structure of teeth using intense light goes back to the 1980s. It was driven very much by dental scientists who had an interest in the physical chemistry of enamel mineral.17 By using wavelengths of light that were absorbed strongly into enamel, superficial heating could be achieved.18 As a result, the chemical composition of the enamel could be altered, as well as its porosity.19-21 Sufficient amounts of applied heat could even create a liquefied form of tooth mineral, which could flow over the tooth surface to reshape existing pits and fissures, removing their deep recesses.18 A similar approach could also be used to sinter synthetic hydroxyapatite particles onto the surfaces of teeth.22

Figure 1. Images from recent clinical trials at UCSF using the carbon dioxide laser for caries prevention. The upper middle image shows Dr John Featherstone. The clinician in the lower image is Dr Peter Rechmann, the lead author of the recent UCSF laboratory and clinical studies (See references 39-41).

A key consideration for pulpal safety was that the carbon dioxide laser radiation had to be delivered in a pulsed manner, to prevent inadvertent thermal stress.23

Much of the early work used the carbon dioxide laser and the Er:YAG laser, since the far and middle infrared wavelengths of light produced by these lasers (e.g. 2.94 and 9.3 to 10.6 µm) were all strongly absorbed in enamel and were also able to vaporise any unbound water in the enamel. The idea of deliberately lasing surfaces transition from the laboratory, to in situ studies using enamel slabs in removable appliances, through to clinical assessments. Numerous narrative and systematic reviews of the positive effects of infrared laser energy on enamel have been published in recent years.24-27,38

More recently, there have been clinical trials undertaken of 9.3 µm carbon dioxide laser treatments for caries prevention at the University of Southern California in San Francisco, where Drs John Featherstone and Peter Rechmann have been pioneers of the concept of using far infrared laser energy to enhance enamel resistance to carious attack (Figure 1).39-41

Light plus fluoride

The next conceptual development was to explore the interaction of topical fluoride gels with applied laser energy.28-35 This was tested by applying fluoride gel followed by the laser, or in the reverse sequence, assessing parameters such as fluoride uptake, chemical conversions within the enamel, surface microhardness, surface loss and resistance to standardised challenges that replicate dental caries or dental erosion, such as lactic acid solutions or hydrochloric acid solutions, respectively. Studies of fluoride uptake showed that a threefold improvement could be obtained over simply applying the fluoride gel onto the tooth surface alone.

This work extended through to in situ studies and then into the clinical setting. In special needs clinical practice, this method was quite useful for patients with severe salivary gland hypofunction (e.g. Sjogren’s syndrome or post head and neck radiotherapy), as it made treated surfaces less likely to decay and break down over time.36

From a photobiological perspective, when using a light-based therapy, it is important to determine its action spectrum, which is the region or regions of

Table 1. Tooth surface protection approaches for caries prevention

light that are responsible for the effect and which are most effective for therapeutic use. As an example of the action spectrum effect, one can use various standardised photobiological light sources to simulate solar radiation and then determine which parts of the ultraviolet, visible and infrared spectrum are responsible for effects such as photo-ageing, cataract formation and erythema (sunburn). During my training as a photo biologist, I determined the action spectrum for sunburn using sensitive measures of invisible inflammatory changes that pre-seed the visible appearance of redness in the skin.37

Applying the same thinking to the light and fluoride interaction, a series of studies at UQ were undertaken to map out the action spectrum of the effect, testing wavelengths through the visible spectrum and well into the infrared.28,29 While we and others were able to demonstrate that all the wavelengths tested were effective to some degree, we noticed a particularly high efficacy for wavelengths in the visible blue-green regions. It is perhaps no coincidence that the same wavelengths have the greatest penetration through water.

Part of the journey of exploration was to test such effects using light emitting diodes. This leverages the recent transition of dental curing lights away from halogen lamps and plasma arc lamps to LEDs. When one converts the exposure parameters for blue and green lasers (488, 515 and 532 nm) to the 460-470 nm wavelength range of a traditional dental

curing light, the required 15 J/cm2 equates to one 20 second curing cycle for an LED light with a 6-8mm diameter tip and optical power of 1000-1500 mW (Figure 2). This is a fortunate convenience since it makes the clinical application of the concept quite straightforward.

In recent years, work has shown that a range of hard tissue laser wavelengths in the middle infrared range are also effective for enhancing fluoride uptake and improving resistance to acid attack. There have been published systematic reviews of the laboratory studies, as well as of the multiple clinical trials which have been conducted of light enhanced fluoride therapy.24,25,27 Of note, the definition used in the current edition of the ADA Schedule and Glossary for item 121 mentions the activation of the remineralising agent, which is a contracted version of the initial longer description dating back to 2008 which explicitly mentioned lasers and fluoride used together.

When considering what situations might suit the application of a light-enhanced fluoride approach, one must consider carefully the underlying chemistry of what is happening. There are over six different physical and chemical processes involved, with a major one being the conversion of surface hydroxyapatite into fluorapatite.30 This is responsible for an increase in surface microhardness and greater resistance to attack by both organic and mineral acids. This effect requires the availability of fluoride ions in an

phase on the tooth surface.

Knowing this, there is no known value or benefit in using a curing light when one is applying a fluoride varnish, including a fluoride varnish containing CPP-ACP, or Tooth Mousse Plus. In the case of the varnishes, there is rapid precipitation of calcium fluoride granules, which form a layer several microns thick over the enamel surface. This layer can take up to a week to dissolve. The light does not interact with the calcium fluoride. In the case of Tooth Mousse Plus, the fluoride is initially bound to the peptide and then when released forms part of the neutral ion species which interacts with and penetrates deeply into the tooth surface. The stoichiometry of the product is such that there is not a gross excess of free fluoride ions.

One situation where there could be significant amounts of free fluoride ions is immediately following the application of stannous fluoride or silver fluoride. The issue here is the susceptibility to oxidation and light sensitivity of the stannous and silver ions respectively. When products such as SDI Riva Star or Riva Aqua are used in combination with potassium iodide, one has to remember that silver iodide will be formed and this will be very light-sensitive. All halide compounds of silver are exceptionally light sensitive and even metallic silver itself is unusually sensitive to certain wavelengths of violet light (around 420 nm), which cause a phenomenon known as plasmon resonance. One must also remember that a darkened tooth surface becomes a broad-spectrum absorber of light and so any intense light applied to the tooth can cause thermal stress to the dental pulp as heat is conducted through the dentine.

Key recommendations for the use of various tooth surface protection measures are given in Table 1.

Chemical synthesis of enamel

In the laboratory, there are well-known methods for chemical synthesis of hydroxyapatite and fluorapatite. These can produce the materials in microscopic aggregates or as nanoparticles, depending on the method of synthesis. The challenge has always been, can such methods be applied on the surface of teeth to recreate enamel that has been lost? Over 40 years of work on the concept of chemical synthesis of enamel has been done and the most that has been achieved by any

research group has been to generate layers that are up to 0.5 µm in thickness. To give a sense of scale, this is approximately the thickness of a single bacterial cell and more than 25 times less than the amount of enamel that would be lost as a result of drinking a single can of black cola soft drink. A fundamental limitation of the concept of chemical synthesis of enamel is that it lacks the organic matrix structure which guides the formation of enamel by ameloblasts. Further, through the enamel there are various complex arrangements of enamel prisms to create structural support systems (such as the Rainey ridge in molar teeth), which are difficult if not impossible to recreate.

Sintering studies using synthetic apatites have been conducted and these can generate sizeable portions of tooth like structure using additive manufacturing laser sintering methods. As a point of history, the first successful work of this type was done in the early 1990s.22 The major limitations encountered with this approach include the fact that it is a benchtop rather than intraoral method, as well as the predictable challenges working with very small apatite particles because of electrostatic effects that cause clumping and aggregation. The sintering process itself alters the chemistry of the apatite, leading to conversion to beta

tricalcium phosphate. This makes the resultant material inferior from a structural point of view (lower compressive strength), unsuitable for bonding and highly opaque in appearance and thus aesthetically unacceptable.

Nature thought of it first

In the mid-1980s, I recall attending a symposium held as part of the International Association of Dental Research general meeting in North America. One of the major topics of discussion was what would be the design characteristics for a material that could be coated onto enamel to protect it. A range of people working in the field contributed their opinions and shared their experiences on what they had tried and found to be lacking in one way or another. The discussion shifted to then explore what the inherent usefulness was of pellicle, the saliva glycoproteins that adsorb onto the surface of exposed enamel. Up to this point, there had been a generally held view that pellicle was fundamentally either useless or harmful.

The latter concept grew from the recognition that several primary colonisers of teeth had adhesin molecules that bound to pellicle, allowing them to form a stable anchorage.

Figure 2. Exposure parameters when neutral sodium fluoride gel (e.g. 9,000 or 12,300 ppm fluoride) is applied to teeth and fluoride uptake into the enamel is enhanced using a 460-490 nm LED curing light.

clinical

This whole concept of pellicle being inert turned out to be incorrect, since pellicle is now known to be inherently helpful as a means of protecting the enamel from the outside world.

About the author

Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 390 journal papers, with a citation count of over 18,300 citations in the literature. Laurie holds patents in 8 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.

References

16. Walsh LJ. Contemporary uses of CPP-ACP technologies in 2021. Part 2. Prebiotic actions. Australas Dent Pract. 2021;32(3):64-68.

enhanced dental erosion. This explains the characteristic pattern of damage in patients with uncontrolled gastric reflux, where there is frequent regurgitation of gastric contents. The hydrochloric acid protein releases the pellicle, making the enamel completely bare and exposed, which then leads to its rapid dissolution. When pellicle is present, since it acts as a semipermeable ionic membrane, teeth are more protected from strong erosive challenges. Fortunately, manufacturers of toothpastes now understand the value of pellicle and make toothpastes with low levels of abrasivity, which means that they do not remove all traces of pellicle from the tooth surface during ordinary brushing, even for periods of up to 2 minutes. This invisible layer continues to protect us, even though we may not be aware of it.

29. Vlacic J, et al. Laser-activated fluoride treatment of enamel as prevention against erosion. Aust Dent J. 2007;52(3):175-180.

2. Walsh LJ. Pit and fissure sealants: current evidence and concepts. Australas Dent Pract. 2006;17(6):122-124.

3. Charbeneau GT, et al. A filled pit and fissure sealant: 18-month results. J Am Dent Assoc. 1977;95(2):299-306.

4. Mejare I, et al. Caries-preventive effect of fissure sealants: a systematic review. Acta Odontol Scand. 2003;61(6):321-330.

5. Ahovuo-Saloranta A, et al. Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev. 2004;(3):CD001830.

6. Yap J, et al. Evaluation of a novel approach in the prevention of white spot lesions around orthodontic brackets. Aust Dent J. 2014;59:1-11.

7. Dennison JB, et al. Evaluating tooth eruption on sealant efficacy. J Am Dent Assoc. 1990;121(5):610-614.

8. Yip HK, Smales RJ. Glass ionomer cements used as fissure sealants with the atraumatic restorative treatment (ART) approach: review of literature. Int Dent J. 2002;52(2):67-70.

9. Frencken JE, et al. ART restorations and glass ionomer sealants in Zimbabwe: survival after 3 years. Community Dent Oral Epidemiol. 1998;26(6):372-381.

10. Walsh LJ. Tooth surface protection – well beyond just fissure sealing. Auxiliary 2014;24(4):22-24.

11. Arbabzadeh-Zavareh F, et al. Recharge pattern of contemporary glass ionomer restoratives. Dent Res J. 2012;9(2):139-145.

12. Perera D, et al. Acid resistance of glass ionomer cement restorative materials. Bioengineering 2020;7(4):150.

13. Mazzaoui SA, et al. Incorporation of casein phosphopeptide-amorphous calcium phosphate into a glass-ionomer cement. J Dent Res. 2003;82(11):914-8.

14. Mao B, et al. Casein phosphopeptide-amorphous calcium phosphate modified glass ionomer cement attenuates demineralization and modulates biofilm composition in dental caries. Dent Mater J. 2021;40(1):84-93.

15. Philip N et al. Randomized controlled study to evaluate microbial ecological effects of CPP-ACP and cranberry on dental plaque. JDR Clin Trans Res. 2020;5(2):118-126.

17. Walsh LJ. Applications of infrared lasers in preventive dentistry. Dent Today 1990;6:1-4.

18. Walsh LJ, Perham SJ. Enamel fusion using a carbon dioxide laser: a technique for sealing pits and fissures. Clin Prev Dent. 1991;13(3):16-20.

19. Aminzadeh A, et al. Raman spectroscopic studies of CO2 laser-irradiated human dental enamel. Spectrochimica Acta. 1999;55:1303-1308.

20. Rodríguez-Vilchis LE, et al. Morphological and structural changes on human dental enamel after Er:YAG laser irradiation: AFM, SEM, and EDS evaluation. Photomed Laser Surg. 2011;29: 493–500.

21. Shahabi S, et al. FT-Raman spectroscopic characterization of enamel surfaces irradiated with Nd:YAG and Er:YAG lasers. J Dent Res Dent Clin Dent Prospects. 2016;10:207-212.

22. Walsh LJ. Burgeoning technology: future directions in oral health. In: Dental Perspectives. An overview of clinical issues facing community dentistry. 1998;2:6-8.

23. Sandford MA, Walsh LJ. Differential thermal effects of pulsed vs. continuous CO2 laser radiation on human molar teeth. J Clin Laser Med Surg. 1994;12:139-142.

24. Ramalho KM, et al. Erbium lasers for the prevention of enamel and dentin demineralization: a literature review. Photomed Laser Surg. 2015; 33:301-319.

25. Lombardo G, et al. Sub-ablative laser irradiation to prevent acid demineralisation of dental enamel. A systematic review of literature reporting in vitro studies. Eur J Paediatr Dent. 2019;20:295-301.

26. Al-Maliky MA, et al. Laser-assisted prevention of enamel caries: a 10-year review of the literature. Lasers Med Sci. 2020;35:13-30.

27. Pagano S, et al. Lasers to prevent dental caries: a systematic review. BMJ Open. 2020;10:e038638.

28. Vlacic J, et al. Laser-activated fluoride treatment of enamel against an artificial caries challenge: comparison of five wavelengths. Aust Dent J. 2007;52(2):101-105.

30. Vlacic J, et al. Photonic conversion of hydroxyapatite to fluorapatite: a possible mechanism for laser-activated fluoride therapy. J Oral Laser Appl. 2008;8(2):95-102.

31. Bevilácqua FM, et al. Fluoride uptake and acid resistance of enamel irradiated with Er:YAG laser. Lasers Med Sci. 2008;23:141-147.

32. Rios D, et al. In vitro evaluation of enamel erosion after Nd:YAG laser irradiation and fluoride application. Photomed Laser Surg. 2009;27:743-747.

33. Hossain M, et al. Effect of pulsed Nd:YAG laser irradiation on acid demineralization of enamel and dentin. J Clin Laser Med Surg. 2001;19:105–108.

34. Mei ML, et al. Prevention of dentine caries using silver diamine fluoride application followed by Er:YAG laser irradiation: an in vitro study. Lasers Med Sci. 2014;29:1785–1791.

35. Fekrazad R, Ebrahimpour L. Evaluation of acquired acid resistance of enamel surrounding orthodontic brackets irradiated by laser and fluoride application. Lasers Med Sci. 2014;29:1793–1798.

36. Walsh LJ. Clinical evaluation of dental hard tissue applications of carbon dioxide lasers. J Clin Laser Med Surg. 1994;12:11-15.

37. Walsh LJ. Ultraviolet B irradiation induces mast cell degranulation and release of tumour necrosis factor-alpha. Immunol Cell Biol. 73,226-233. 1995.

38. Xue VW, et al. Combined effects of topical fluorides and semiconductor lasers on prevention of enamel caries: a systematic review and meta-analysis. Photobiomodul Photomed Laser Surg. 2022;40(6):378-386.

39. Rechmann P, et al. Caries inhibition with a CO2 9.3 μm laser: An in vitro study. Lasers Surg Med. 2016;48(5):546-554.

40. Rechmann P, et al. In vitro CO2 9.3-μm shortpulsed laser caries prevention-effects of a newly developed laser irradiation pattern. Lasers Med Sci. 2020;35(4):979-989.

41. Badreddine AH, et al. Demineralization inhibition by high-speed scanning of 9.3 µm CO2 single laser pulses over enamel. Lasers Surg Med. 2021;53(5):703-712.

Hygiene is in our DNA. The new Hygoclave 50.

5“ high-resolution colour touch display for intuitive navigation

With Hygoclave 50, Dürr Dental and A-dec offers dental practices a professional Class B solution that combines impressive performance with a well thought-out operating concept – for maximum efficiency and exceptional user friendliness designed to cope effortlessly with tough day-to-day working environments. Available with a volume of 17 or 22 litres. More information under www.duerrdental.com

3-fold flexible fresh water supply with integrated quality control

All in view and documented thanks to connection to the practice network

High-performance sterilization- and drying system

Integrated dust protection filter

Instrument reprocessing without the “black box” or “magic window”

When students are undergoing clinical training at dental school and there is a lot to learn, their attention is focussed on patient care, rather than on all of the “back of house” support functions that keep the clinic running, like the sterilising room. Instrument reprocessing is not handled by students, who will drop off used dirty instruments to the sterilising room and collect sterilised instruments from a dispensary, often without thinking very much about the “Black Box” of instrument reprocessing, or all the hard work that has gone on behind the “Magic Window” of the dispensary to make the instruments fit and safe for re-use.

Students need to understand what happens behind the “Magic Window”, since the responsibility for proper instrument reprocessing sits on the clinicians who are using the instruments in patient care. Dental clinicians need to understand the scope and importance of proper reprocessing and how it impacts the entire practice. It is more than just prevention cross contamination, since the processes must also be right from both a safety and compliance standpoint. There are several regulators that oversee infection prevention and control in dentistry - including the Dental Board of Australia and the public health units in states and territories.

INFINITY SERIES™

The most sophisticated solution for instrument management

The most sophisticated solution for instrument management

That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:

That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:

Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy

Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.

• An open hole pattern that promotes water flow throughout the cassette

• An open hole pattern that promotes water flow throughout the cassette

when it comes to the perfect fit, Hu-Friedy is just right.

• An open hole pattern that promotes water flow throughout

Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.

WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:

©2016

•

• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing

WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:

• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing

WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:

• Ideal height and mesio-distal width

• Easy-to-use, ergonomic latch that allows for one-handed opening

• Ideal height and mesio-distal

• Easy-to-use, ergonomic latch that allows for one-handed opening

•

• Ideal height and mesio-distal width

• Pre-trimmed and pre-crimped for simple placement

• Accurate occlusal anatomy that matches the natural tooth

Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment.

Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment.

• Pre-trimmed and pre-crimped for simple placement

• Accurate occlusal anatomy that matches the natural tooth

©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.

Younger clinicians often don’t realise that while they might assign the instrument reprocessing tasks to their staff, they are ultimately responsible for ensuring their practice is meeting all required standards. These clinicians need to have a good understanding of the steps in reprocessing. This aspect is also important when bringing on a new staff member.

So, to both inform and refresh, here are three key insights about instrument reprocessing:

1. Instrument Management Systems improve efficiency and safety

2. Instrument reprocessing requires specific PPE

Proper PPE must always be worn when reprocessing contaminated patient equipment. This includes using gloves when handling instruments and cassettes following patient treatment and utility gloves in the sterilising room when loading cassettes into ultrasonic cleaners or into instrument washers. Utility gloves should not be bulky and should enable tactical sensitivity. Contaminated utility gloves should only be worn on the dirty side of the sterilisation area and should be disinfected according to the manufacturer’s instructions.

3. Instrument reprocessing is a patient showcase opportunity

More than ever, patients are looking for reassurance that dental practices are emphasising infection prevention and control and instrument reprocessing can be a good aspect of the practice to showcase.

Instrument reprocessing takes time and handling contaminated instruments is a safety risk for staff. Instrument Management Systems like the IMS™ Cassette from Hu-Friedy address those challenges because they are designed to keep instruments organized and intact throughout the entire process, from cleaning to chairside. Many dental schools already use cassettes for this reason, so some students will already be familiar with the concept.

IMS cassettes eliminate time-consuming tasks like manual instrument cleaning and sorting, while making it easy to standardise procedural set-ups and to train new staff. Those small time-savings throughout the day add-up and lead to more time spent with patients in the chair.

Cassettes provide safety benefits because the handling of contaminated sharp items is minimised. The instruments stay secured throughout the entire reprocessing cycle, reducing the risk of injury or exposure to bloodborne pathogens.

Instrument Management Systems provide better efficiency and improved safety, which is ultimately a win-win for all involved in instrument reprocessing.

As an example, some practices feature a glass wall or large internal windows into the sterilising room to give patients an opportunity to view reprocessing and see the steps being performed. Additionally, the practice website can give patients a virtual tour of the sterilising room so they can see for themselves how much effort the practice puts into cleanliness, organisation and safety.

If your practice uses IMS Cassettes, you can open the cassette in front of the patient as a demonstration. A well-organised and nicely presented cassette can make a world of difference when compared to a tray of loosely arranged instruments.

“Some practices feature a large window into the sterilising room to give patients an opportunity to view instrument reprocessing...”

INFINITY SERIES™ CASSETTES

INFINITY SERIES™ CASSETTES

INFINITY SERIES™ CASSETTES

The most sophisticated solution for instrument management

The most sophisticated solution for instrument management

Learn How to Scale

The

The most sophisticated solution for instrument management

Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.

Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.

That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:

That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:

The

That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:

That’s right, you deserve it. You deserve the peace of mind and confidence that you are employing the most contemporary method of processing instruments. innovator of the cassette-based instrument management system, Hu-Friedy

• An open hole pattern that promotes water flow throughout the cassette

• An open hole pattern that promotes water flow throughout the cassette

Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.

• An open hole pattern that promotes water flow throughout the cassette

WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:

• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing

Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.

WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:

• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing

• Ideal height and mesio-distal width

• Easy-to-use, ergonomic latch that allows for one-handed opening

WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:

• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing

WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:

• Ideal height and mesio-distal width

•

• Ideal height and mesio-distal width

• Easy-to-use, ergonomic latch that allows for one-handed opening

• Pre-trimmed and pre-crimped for simple placement

• Ideal height and mesio-distal width

• Accurate occlusal anatomy that matches the natural tooth

• Pre-trimmed and pre-crimped for simple placement

Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment.

• Pre-trimmed and pre-crimped for simple placement

• Accurate occlusal anatomy that matches the natural tooth

• Accurate occlusal anatomy that matches the natural tooth

• Pre-trimmed and pre-crimped for simple placement

Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment.

• Easy-to-use, ergonomic latch that allows for one-handed opening Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment.

VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit

©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.

©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.

©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.

• Accurate occlusal anatomy that matches the natural tooth

Removes+ 99.9% of odour-causing bacteria*3-5

Lifts stains, removes discolouration6,7

Helps keep appliances looking clear1,2

Compatible with common dental appliance material1,2

Retainers

Aligners

Night Guards

Mouthguards

For more information or to request free clinic samples, visit www.haleonhealthpartner.com or scan the QR code