Treating White Spot Lesions

 Preventive Dentistry  3 Responses »
May 222013
 

White Spot LesionsWhite spot lesions are very common both in kids and adults. One of the challenges with these lesions is how to treat them. There are several approaches from trying to bleach the surrounding tooth structure to make the color difference less noticeable to repairing the area with a composite restoration. The challenge with the bleaching approach is most often these areas are decalcified and need mineral support to the tooth structure. On the other hand taking away the lesion with a bur and restoring seems overly aggressive. In recent years I have been treating many of these lesions with MI paste and seeing great results.  I recommend taking before and after photos to document the improvement. Here are the recommendations for using Mi paste to treat white spot lesions.

• Apply etchant (phosphoric acid)to the white spot lesions for 10-30 seconds. Be careful not to over-etch the teeth. 1 minute is the maximum exposure time to the etchant. Only etch the white spot lesion, not the entire tooth.

•Pumice the tooth for 10 to 30 seconds, non-fluoridated, non-glycerin flour of pumice and then rinse.

• Dry the tooth. The tooth will appear frosty after the etch/pumice application. Sometimes it is necessary to etch/pumice a second time.

• Apply layer of MI Paste on the etched tooth surfaces with a prophy cup and leave on the tooth surface a minimum of 5 minutes. More time is better and improves remineralization.

We send our patients home with custom trays to continue to apply the MI paste for 5 minute sessions, twice daily for a week before we will see them to evaluate the results. Post-op instructions include nothing to eat or drink for 30 minutes after leaving the office, and to avoid foods that are likely to stain their teeth like wine, coke, coffee during the remineralization process. We schedule to evaluate the results in 1-2 weeks, and repeated treatments can be done to improve the results.

 

Are You Recommending Xylitol for Caries Control?

 Preventive Dentistry  2 Responses »
Apr 292013
 

gum and mintsThere are numerous artificial sweeteners on the market that report to be zero calorie and are added to “sugarless” gums, mints, candies and foods. Xylitol not only fulfills the diet requirement but helps prevent cavities. Xylitol has 9.6 calories per teaspoon compared to 15 for sugar, however it has 0 net carbs as it is a sugar alcohol and does not alter glycemic index. It has been understood for many years that xylitol is beneficial for patients at risk of getting cavities. This fact has made it very popular in the dental hygiene community. It is estimated that 80% of all hygienists discuss xylitol with patients and over 50% use xylitol products themselves on a daily basis. Continue reading »

Decreasing Caries Risk

 Preventive Dentistry, Restorative Dentistry  Comments Off
Oct 012012
 

Last Friday’s post looked at the concept of caries management by risk assessment ( CaMBRA) and it’s use to identify patients at risk for developing cavities. Identification of people with an elevated caries risk would be pointless unless we use that information to help them understand how to decrease their risk. One of the primary way sin which we assist patients is simply completing the assessment and creating awareness of the factors that combine to create their individual experience with getting cavities.  Beyond simple awareness comes the addition of antimicrobials, topical fluoride application and behavior modification to try and balance out the risk factors present. I think about it as a scale or balance between the risk factors and the protective factors. the more risk a patient has, the more preventive measures we want to add to try and cancel out the risk. With that said, we also need to be realistic about what patients will and will not do routinely. We have an assortment of options for our patients so that they can help us understand what works and what doesn’t based on their personality and lifestyle. Continue reading »

Caries Management

 Preventive Dentistry  2 Responses »
Sep 282012
 

I spent the morning in Minneapolis recording a video for 3M to help dental offices implement a CaMBRA system. CaMBRA stands for caries management by risk assessment and is a process for evaluating a patient’s caries risk and recommending preventive strategies that has been instrumental over the last decade. The California Dental Association and the American Dental Association have adopted the principles of CaMBRA and have assessment forms that can be downloaded to use in your office. There are variations int he risk assessment for small children(0-6yrs) and adults (7-up) but the basic premise is to place patients into a low, moderate or high risk category of risk for developing a cavity. I strongly support the use of a patient centered prevention protocol as part of the services we provide our patients. Continue reading »

Water Fluoridation: A Thing of The Past?

 Practice of Dentistry, Preventive Dentistry  2 Responses »
Jul 182012
 

In the next few weeks the legislature of the City of Phoenix will decide whether or not to continue fluoridation of the public water supply. The topic is being discussed everywhere, people have very strong opinions, and it is a conversation being repeated in state after state. My e-mail has been inundated with information on supporting continued fluoridation, asking me to speak to patients and take a stand. There are pieces of this conversation I am clear about.

  • Water Fluoridation decreases dental disease
  • The caries rate will increase without water fluoridation, and increased caries early in life leads to a lifetime of dental treatment.
  • Fluoride is not evil and does not have the horrible medical implications those opposed claim. Continue reading »

Oral Uses for Topical Anti-Oxidants

 Preventive Dentistry  2 Responses »
Jun 132012
 

In previous posts I tried to define a process called oxidative stress, which occurs when our cells are exposed to more oxidizing agents than they can detoxify. Fortifying our cells against this process, and even increasing healing is the premise behind the use of topical anti-oxidants. We have numerous studies that have shown that wound healing is diminished in the presence of oxidzing agents. In addition these studies have shown that the addition of a combination of anti-oxidants topically reverses the cell damage process and even encourages wound healing. From these original studies clinical research was completed. there are a variety of conditions on which the use of topical anti-oxidants has been shown to have a positive effect: Continue reading »

Oxidative Stress and Periodontal Disease

 Preventive Dentistry  3 Responses »
Jun 122012
 

The link between periodontal disease and systemic disease has been clarified, and we are still uncovering new relationships that confirm he importance of maintaining periodontal health. For example inadequately controlled moderate to severe periodontal disease increases the systemic inflammatory load on our bodies. This increased inflammatory load may increase our risk of cardiovascular disease. It has been shown that patient’s who are diagnosed with periodontal disease in their early adult years have a four-fold risk of developing Alzheimer’s disease. There has also been a positive link confirmed between periodontal disease and obesity, as well as the known link with Diabetes.  Active period therapy decreases the amount of systemic inflammatory cytokines, which are directly related to insulin resistance and stabilizing blood sugar in diabetic patients. This is important information that we can share with our patients, to help them understand the whole body value of a healthy periodontium. Continue reading »

Antioxidants & Perio Therapy: What is Oxidative Stress

 Preventive Dentistry  Comments Off
Jun 072012
 

I recently had the opportunity to watch a one hour video from the Seattle Study Club Annual Symposium of Dr. pat Allen. His presentation looked at the relationship between anti-oxidants, periodontal disease and oral healing. The data presented left me compelled to try the use of topical anti-oxidants in my practice as an adjunct to our periodontal therapy regimen. I will keep you posted on the results I see, but wanted to share the incredible information. Before we can look at the role of anti-oxidants therapeutically we need to understand the process called oxidative stress. Continue reading »

Porcelain Stain, Does it Last?

 Dental Materials, Esthetic Dentistry, Preventive Dentistry  1 Response »
Dec 142011
 
Central Crowns and Lateral Veneers

Stained Ceramic Crowns and Veneers

Years ago the majority of our porcelain restorations were completed with layered powder liquid ceramics to create the esthetics.  Today because of our new monolithic materials with improved esthetic and strength, a large portion of restorations are simply stained and glazed. This stain is used to create the incisal and interproximal appearance of translucency and cervical chroma gradient.

A question to ask is how this external layer of stain and glaze will endure in the mouth. Restorations are subjected to abrasion from food and toothpastes. Many of our patients eat a highly acidic diet. We add to this by using prophy paste, prophy jet’s and ultrasonic scalers at their hygiene visits. So what do we need to know and tell our patients about the longevity of the esthetics of their restorations? Continue reading »

No More Brushing After Meals

 Preventive Dentistry  Comments Off
Dec 092011
 
Tooth Erosion on the side of the Non-Dominant Hand

Right Side, Right Handed

Don’t you wish you could get more of your patients to brush after every meal? Well, based on our current understanding that may not be the best thing to wish for if they are eating or drinking acidic foods. Acid demineralizes tooth structure. We use this process everyday as the foundation of adhesive dentistry. This demineralized tooth structure is more susceptible to erosion and abrasion, both from parafunction and tooth brushing. A common example of this today is patients who suffer from gastric reflux, anorexia or bulimia. Continue reading »

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