Smiles Across America Webinar Series
Innovative Dental Hygiene Solutions
9/8/2015
Connect with OHA! /Oral Health America
@Smile4Health
/Oral Health America
@Smile4Health
HOUSEKEEPING INFORMATION • •
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CE Credit Available
OUR MISSION Oral Health America’s mission is to change lives by connecting communities with resources to drive access to care, increase health literacy, and advocate for policies that improve overall health through better oral health for all Americans, especially those most vulnerable.
OHA PRIORITIES OHA’s Programs and Campaigns are designed to improve access to care, oral health literacy and policies that prioritize the impact of oral health on the overall health of all Americans – particularly those most vulnerable.
ACCESS
HEALTH LITERACY
ADVOCACY
Campaigns for Oral Health Equity Educate the public, including policy makers, about the importance of oral health for overall health Emphasize the need to prioritize oral disease alongside other serious health conditions Advocate for policies that positively impact programs and stakeholders Current campaigns include:
toothwisdom.org
Advocacy
Health Education & Communications
Professional Symposia
Demonstration Projects
Grant Funding
Product Donation
Technical Assistance
Innovative Dental Hygiene Solutions Karen Stoklosa, MBA Tabetha Magnuszewski, RDH
Disclosure
Innovative Dental Hygiene Solutions
Diagnosis CRT Bacteria
Maintenance Proxyt
Prevention Helioseal Fluor Protector S Cervitec Plus
Dental Caries Worldwide Health Concern 20% of children age 5-11 have at least one
untreated decayed tooth. Approximately 15% of adolescents aged 1219 have at least one untreated decayed tooth. 91% of children have experienced dental caries by adulthood. Caries risk grows with increased age
Caries Development Bacteria
High Sugar Diet
Acidic Metabolic Byproducts
Lower pH
Caries
Traditional Treatment Model • No diagnosis
• Treat everyone • #1 Goal – Removal of Plaque
• Brushing & Flossing • Recall Exams • New Restorations
Medical Model of Care • Diagnosis is essential
• Restore diseased areas • Eliminate the infection
• Decrease & eliminate bacteria • Treatment ceases • Recall to diagnose and retreat
Caries Risk Assessment • Diagnose disease to identify causative organisms
• “Medical Model of Care” • Identify patients susceptible to dental decay
• Focus on prevention and early intervention • Treat patients individually before caries/lesions are
established
What is a Caries Risk Test? A comprehensive test used to determine Streptococci mutans and
Lactobacilli count in saliva by means of a selective culture media.
Streptococci Mutans • Caries initiators
• Capacity to adhere to tooth surface • Sugar transport system
• Triggers the host response system • Produces lactic acid • Tolerant of acid environment
Lactobacillus • Responsible for caries progression
• Indicative of frequent sugar intake and/or active caries • Do not adhere to tooth surface
• Colonize via carious lesions • Pit & Fissure • Marginal Gap • Brackets
CRT® Bacteria Step by Step • Have patient stimulate salivation by chewing on the paraffin pellet. • Collect saliva in a suitable container. • Remove agar carrier from the test vial. • Place a NaHCO3 tablet at the bottom of the vial. • Carefully remove the protective film from the two agar surfaces. • Thoroughly wet both agar surfaces with saliva using pipette. • Allow excess saliva to drip off. • Slide the agar carrier into the vial and close tightly. • Use a waterproof pen to note the name of the patient and date on the vial. • Place the test tube upright in an 37°C incubator for 48 hours. • Compare the density of mutans streptococci and lactobacilli colonies with model chart.
Diagnosis – Streptococcus Mutans
Low Risk
High Risk
Diagnosis - Lactobacillus
Low Risk
High Risk
CRT® Bacteria Advantages
• Identify caries risk at an early stage • Test for both S. mutans and Lactobacillus
• Results in 48 hours • Easy to conduct
• Great tool to educate and motivate patients • Can be used to monitor specific therapies and treatment
Bacterial Testing ClinPro™ L-Pop 3M ESPE
• Tongue sampling • Tests lactic acid formation
Saliva Check Mutans GC • S. mutans only
Oral Health Management Caries Risk Test
Characteristics
Advantages
Targeted and distinct treatment measures
Basis for periodical prophylaxis Check of treatment success Earnings
Prevent healthy teeth / caries prevention Free of pain treatment Quality assurance
Build-up a long-term patient loyalty Better reputation: suggestions Satisfied patients
Execution of the test by trained staff
Expansion of job function Economics
Innovative Dental Hygiene Solutions
Diagnosis CRT Bacteria
Maintenance Proxyt
Prevention Helioseal Fluor Protector S Cervitec Plus
Prevention The higher the severity of risk factors at diagnosis, the greater the prevention strategy needs to be
*Several of these preventive agents are used off-label for caries prevention
• Fast & easy way of protecting teeth from bacteria • Acts as a barrier, protecting enamel from plaque and acids • Provides a smooth surface for easy cleaning and maintenance
Types of Sealants • Polymerization – self-cure vs. light-cure
• Color – clear, tinted or white • Fillers – filled or unfilled
• Glass Ionomers • Resin-based
High Caries Risk Sealants have shown to reduce decay in permanent molars by 81% for 2 years after placement* Caries Occurrence in Children and Adolescents in the US Proximal caries 16%
Fissure caries 84% *CDC 2013
ADA Report 1997
Helioseal® Indications Carbohydrates &Bacteria
• Premolar and Molar Pit & Fissures • Lingual Foramen
Advantages
• Prevent bacteria from colonizing • Cut off carbohydrate supplies
• Facilitate oral hygiene
Sealed fissure
Bacteria cannot survive
Helioseal速 Helioseal速 White, Opaque Medium Viscosity Economical
Helioseal速 F White, Opaque Medium Viscosity Fluoride Release
Helioseal速 Clear Transparent Excellent Esthetics Easy Recall
Helioseal Comparison of Fissure Sealants at 1 Year
Schl端ter et al. 2011
37
SEALANTS- STEP BY STEP
1.Easy access
2. Tooth to be sealed
7. Drying
8. Applying the sealant
3. Cleaning
9. Light-curing/ polymerization
4. Isolation
5. Etching
6. Rinsing
10. Checking occlusion
11. Finishing
12. Check-up & fluoridation
Prevention The higher the severity of risk factors at diagnosis, the greater the prevention strategy needs to be
*Several of these preventive agents are used off-label for caries prevention
Fluoride Delivery Forms
Topical Fluoride Recommendations • Recommends the use of professionally-applied topical fluorides for caries prevention.
• Recommends using fluoride to prevent and control dental caries in the United States.
• Recommends fluoride use for prevention/control of caries. Is safe and highly effective in reducing prevalence in children.
Benefits of Fluoride Varnish • Easy, fast & convenient application
• Saves time & money • Achieve greater patient acceptance
• Safer then rinses & gels • reduced risk of ingestion
• Increased fluoride release
Clinical Effectiveness of Fluoride Varnish • Contact time/adherence
• Fluoride source/concentration • Fluoride availability
• Flow & wetting behavior
A Healthy Balance
Enamel Demineralization pH 5.5
Healthy Saliva pH 6.6
Fluoridation Process on the Enamel Without Varnish
With Varnish Re-mineralized enamel
Demineralized enamel Weakened tooth structure Increased risk of acid attacks/caries
Protective coating from acid attacks Fluoride depot Long term protection
Fluor Protector S Innovative fluoride varnish
• Immediate fluoride release and safe • Homogeneous formula with low
viscosity • Thin, smooth and colorless on teeth
Fluoride Uptake in Enamel after 1 Hour 4.5 4
Fluoride content (%)
3.5 3 2.5 2 1.5 1 0.5 0
Fluor Protector S
Duraphat
MI Varnish Varnish
Profluorid Varnish untreated enamel
Homogenous Formula
3M ESPE Varnish
Nupro
Fluor Protector S
Wettability
FLUOR PROTECTOR S
3M ESPE VARNISH
NUPRO WHITE VARNISH
PROFLUORID VARNISH
Typical Applications
Orthodontic Dentistry
Prophylaxis
Pediatric Dentistry
Restorative Dentistry
Fluor Protector S Step by Step
or
Clean
Apply Fluor Protector S
Isolate
Allow to dry for 60 seconds
Competitive Comparison- US Ivoclar Vivadent Fluor Protector S
3M ESPE Vanish Varnish
VOCO Profluorid
Dentsply NUPRO
Varnish Formula
1.5% Ammonium Fluoride
5% Sodium Fluoride with TriCalcium Phosphate
5% Sodium Fluoride
5% Sodium Fluoride
Fluoride Concentration
7700ppm (at application) 30,000ppm (at setting)
26,600ppm
26,600ppm
26,600ppm
Food & Drink waiting time
1 Hour after treatment
Immediately after application (soft diet only)
4 Hours
2 Hours
Mixing & Measuring recommended
No
Yes
Yes
Yes
Viscosity
Low
High
High
High
Delivery form
- Dispensing tube 7g (8.2ml) - Single Dose 0.26g (0.3ml)
- Single Dose 0.50ml in AluminumBlister
-Single Dose .4ml
Single Dose .4g
Image
Prevention The higher the severity of risk factors at diagnosis, the greater the prevention strategy needs to be
*Several of these preventive agents are used off-label for caries prevention
Antimicrobial Agents Destroys or suppresses the growth of microorganisms including bacteria Chlorhexidine Gluconate Rinse
• Used off-label to reduce levels of MS bacteria • Not effective against Lactobacilli • Available as .12% rinse with/without alcohol • Long term use leads to discoloration of teeth and taste disturbances
Chlorhexidine Indication • Antimicrobial/bacterial reduction – destroys cell walls • Prevent plaque formation • Inhibition of inflammation
• Protection from gingivitis, periodontitis, peri-implantitis, stomatitis • Caries prevention • Low concentration levels bacteriostatic (rinses), high concentrations bacterialcidal
Chlorhexidinefacts.com
Chlorhexidine The American Dental Association recommends the application of 1:1 mixture of chlorhexidine/thymol varnish every three months to reduce the incidence of root caries.
Photos: Dr. A. Peschke
Cervitec® Plus Innovative chlorhexidine varnish Contains 1% CHX & 1% Thymol Increases to 10% when dry
Protection of exposed root surfaces Alternative to chlorhexidine rinse No unpleasant side effects
Longer CHX retention More than 20 years of clinical experience Cervitec Plus helps ensure successful clinical outcome!
Cervitec Plus- Indications Exposed root surfaces Fissures Erupting teeth Proximal surfaces Around brackets and orthodontic bands Along the margins of implant-retained restorations, crowns or bridges
Restorative Dentistry Prosthetic and restorative therapies generally require a healthy periodontium as a prerequisite for successful outcome.
Apply Cervitec Plus immediately after placing temporary or permanent restorations!
Delivery Forms: Rinse vs. Varnish Chlorhexidine Rinse 0.12% Chlorhexidine Gluconate (Peridex, Periogard)
Cervitec Plus 10% Chlorhexidine on teeth (1% in solution)
70% loss, 30% Retention
Targeted treatment, even dosage
Bacteriostatic
Bacteriocidal
Patient Compliance (1-2 times daily)
Professionally Applied (lasts up to 3 months)
Brown staining
Clear and Esthetic Varnish (No staining)
Bad taste
No bad taste
CERVITEC PLUS- STEP BY STEP
30 sec.
Do not rinse after application
INNOVATIVE DENTAL HYGIENE SOLUTIONS Diagnosis CRT Bacteria
Maintenance Proxyt
Prevention Helioseal Fluor Protector S Cervitec Plus
Dental Plaque Yellowish biofilm Sticks to tooth structure
Must be regularly mechanically removed Begins with initial colonization of the pellicle ends with complex formation of a mature biofilm
Plaque is the leading cause of tooth decay
Polishing Paste Characteristics Hardness Particle Size (Grit) Particle Shape Agent Contact time Applied Pressure Speed Concentration & Quantity Abrasiveness
Prophy Paste The next generation of prophy pastes for professional tooth cleaning and polishing
Proxyt – Targeted, Gentle, Reliable The advantages of Proxyt • • • •
3 abrasive values for individual needs Creamy consistency does not splatter Contains Xylitol and Fluoride Scratch-free polishing of ceramics and composite restorations. (Proxyt Fine) • Fluoride free option for restorative effectiveness • Hygienic and economical delivery
Proxyt- RDA Scale
fine
medium
0
70
Low Abrasive
100
Medium Abrasive
(Stookey & Schemehorn 1979)
250
150
Highly Abrasive
Regarded as harmful limit
Proxyt – Next Generation Gentle care of precious surfaces
Composite Surface Gloss-Nupro
Baseline
Nupro Fine
Nupro Course
Composite Surface Gloss-Proxyt
Baseline
Proxyt Fine
Proxyt Course
71
Comparsion of Prophy Pastes Appearance of abrasive particles
Proxyt fine
Cleanic
Nupro fine
(Ivoclar Vivadent, R&D 2010)
72
Proxyt – Study Results Effect of Prophylaxis Pastes on IPS Empress CAD 0.25
Surface roughness
0.20 0.15 0.10 0.05
0.00 Control
(Yazici et al. 2012)
Proxyt fine
Proxyt coarse
Nupro fine
Nupro coarse
Direct Restoratives PREPARE Isolation
FILL
BOND All-Etch-Adhesives
Flowable Composites
Sculptable Composites
CURE Manual Instruments
Curing Lights
FINISH Polishers
MAINTAIN Care Products
OptraGate®
Adhese® Universal
Tetric EvoCeram® Bulk Fill
OptraSculpt® Pad
Bluephase® Style
OptraPol®
Proxyt®
The gentle solution for a better view
The universal adhesive
The fast posterior composite
Efficient contouring due to non-stick surface
The smallest LED for every use
Simply brilliantin just on step
Keeping restorations in good condition
Advantages:
Advantages:
Advantages:
Fluor Protector S
Advantages: - Considerably enlarged access to the treatment field - Enhanced patient comfort due to threedimensional flexibility - Wide range of indications
Advantages: - Efficient delivery - Universal application - Predictable results
Advantages:
- Non-stick shaping and - Bulk placement up to 4 mm due to contouring thanks to Ivocerin®, the new light initiator - Low shrinkage and low shrinkage stress for foam pad attachments - Highly elastic foam pads superior margins ensure the creation of - Sculptable consistency, extended working smooth and even surfaces time under operatory light - Reference scales on the instrument handle facilitate professional esthetic results
- Every hand – comfortable to - Smooth surface finish hold for men and women and perfect lustre due to - Every material – universal use diamond particles due to Polywave® LED with - Quick high-gloss broadband spectrum polishing in only one - Every time – optional corded working step operation due to Click & Cure - Multiple use for greater cost-efficiency
Maintaining the investment
INNOVATIVE DENTAL HYGIENE SOLUTIONS *All 3 steps are imperative for a successful caries prevention program
Diagnosis CRT Bacteria
Maintenance Proxyt
Prevention Helioseal Fluor Protector S Cervitec Plus
THANK YOU!! Karen Stoklosa, MBA Karen.Stoklosa@ivoclarvivadent.com Tabetha Magnuszewski, RDH Tabetha.Magnuszewski@ivoclarvivadent.com www.ivoclarvivadent.com
Video References • https://youtu.be/1zSuXQJJszY • R&D testing facility, Amherst, NY, USA 2015 • R&D testing facility, Schaan, Liechtenstein, 2015
Question and Answer Session • Questions are welcome! This session may last for 10-15 minutes. • Write your questions in your control panel on the upper right hand of your screen. • Submit questions at any time.
CE Credit Available
Contact Information