DHG 165 Module 1

Three sensory nerve fibers that manifest tooth pain

A-delta fibers- composed of small myelinated fibers that evoke a sensation of well localized sharp pain (responsible for dentinal hypersensitivity) A beta fibers- more sensitive to electrical stimulation Unmyelianated C-fibers-results in dull localized aching type of pain usually associated with pulpal pain

sodium bicarbonate

Also known as baking soda Neutralizes acids produced by acidogenic bacteria Has antibacterial properties Delivered in toothpaste or solution for people with low saliva flow Used in air polisher

causes of gingival recession(5)

Anatomy of alveolar bone Poor oral hygiene Trauma from abrasion Frenal attachment Occlusal trauma

causes of enamel loss(TEA5)

Attrition Abrasion Erosion Abfraction Additional causes Aggressive scaling and root planning Teeth bleaching

Calcium sodium Phosphosilicate (NovaMin)

Bioactive silica as a carrier for calcium and phosphate Releases calcium and phosphate immediately with saliva Forms hydroxycarbonate apatite (HCA) Continued release for 7 days after application Goal: repair surface lesions, decrease sensitivity (Occludes tubules-soothe RX) enhance fluoride uptake www.novamin.com Fluoride varnish Toothpaste 5000 ppm demineralizing and desensitizing toothpaste used at least once per day (Sultan, Dentsply) Prophylaxis Apply, wait 1 minute and polish (therapeutic polish)

What are Prescription client applied fluoride mouth rinses indicated for? (6)

Caries, white spot lesions/demineralized areas, caries prevention Dentinal hypersensitivity Orthodontic clients Clients with Xerostimia Moderate caries risk Exposed roots

Cementum to enamel relationships

Cementum overlaps the enamel (14%) Cementum and enamel meet without overlap (76%) Cementum and enamel do not meet but with no exposed dentin (10%)

amorphous calcium phosphate

Contains same minerals as in the hydroxyapatite crystals of tooth enamel ACP will do the following Prevent caries progression Enhance enamel remineralization Occlude dentinal tubules Form a new hydroxyapatite coating with larger crystals

dentifrice

Dentifrice o Has therapeutic and cosmetic effects o active ingredient is fluoride o other active ingredients for reduction of various oral conditions o primary motivation for wide use is breath freshening and tooth whitening

casein phosphopeptides-amorphous calcium phosphate

Derived from cow's milk Contraindicated in people with milk allergies Self-applied products include trident white and trident extra care chewing gum Professionaly applied products include MI paste and MI paste Plus

Caries control for clients with xerostomia (management)(8)

Diet counseling Diligent home care Regular prophylaxis Chlorhexidine-thymol varnish Salivary substitutes Fluoride therapy Xylitol adjuncts Oral pH neutralizers

over the counter and prescription daily fluoride gels and pastes

Have higher concentrations of APF and neutral NaF designed for daily use by clients with high or extreme caries risk (rampant caries, xerostomia, head and neck radiation exposure, special needs or dentinal hypersensitivity. Used w/ custom tray or brushed on teeth for1 min and then expectorated APF - lower pH product (the lower pH of fluoride compounds the more enhanced the rate of reaction between the fluoride and hydroxyapatite

Prescription weekly fluoride mouth rinses in school based programs

High potency, low frequency NaF rinses (0.2%) 910-1000 ppm used weekly in school based programs for children who do not reside in communities with fluoridation

chlorhexidine products

In the United States, only 0.12% chlorhexidine gluconate is available by prescription as a mouth rinse Effective against S. Mutants and periodontal pathogens Therapeutic treatment for caries: rinse 1 minute daily for 1 week of each month for 6 months Apply at least 30 minutes after each use of toothpaste because fluoride and sodium lauryl sulfate will neutralize the chloehexidine

Emergency management for acute fluoride toxicity

Induce vomiting Administer fluoride-binding liquid (milk, milk of magnesia, calcium gluconate, etc. While client is receiving attention, second person contacts the emergency medical services (ems)

Prescription client applied fluoride mouth rinses

Low potency, high frequency 0.044% NaF in an acidulated APF Solution and 0.02% Neutral NAF rinses equal 1000 ppm used weekly, rinse 60 sec. 0.63% SnF2 (stannous fluoride rinse used 2x daily for 4 wks after nonsurgical periodontal therapy as an antimicrobial- has antimicrobial activity against periodontal pathogens and S. Mutants)

Signs and symptoms of acute fluoride toxicity

Mild-stomach upset, vomiting Severe-death

Xylitol

Non-cariogenic sweetener that looks and tastes like sucrose Inhibits attachment and transmission of S. mutants, reduces plaque biofilm formation, stimulates salivary secretion Delivered through chewing gum, mints, breath, sprays, toothpaste, or lozenges (check amount of xylitol in product to ensure therapeutic dose) Recommended ingestion of 6 to 10 g xylitol daily over the course of the day

Prevention of acute fluoride toxcicity

Use and storage of fluoride products must be monitored Clients, parents and caregivers must be educated as to the safe and use and storage of all fluoridated products Never leave a client alone when administering a professional fluoride treatment

probiotics

Use of probiotics to replace and displace cariogenic bacteria with non-cariogenic bacteria has shown preliminary results Creates a balance between beneficial and pathogenic bacteria in the oral cavity

Caries control for clients with xerostomia (Symptoms)(7)

Viscous, sticky saliva (thick and ropy) Difficulty speaking and swallowing Halitosis Altered sense of smell and taste Burning lips and mouth Cracking, fissuring and increased biofilm formation on the tongue Can be caused by menopause

Purpose of dentifrice

(toothpaste) is a substance used with a tooth brush or other oral hygiene device to clean the teeth, tongue and gingiva and to deliver cosmetic and therapeutic agents to the teeth and oral environment.

*Explain the concept of bioavailability

*Bioavailability occurs when medicinal agent is stable during storage and biologically active when used in the mouth to achieve the desired therapeutic effect. *Cocamidopropyl betaine increase the bioavailability of fluoride ions

non-fluoride caries preventive agents(3)

*are adjuncts only Chlorhexidine products Xylitol products Calcium and phosphate based products Other non-fluoride products and claims

Dentinal Hypersensitivity

- Characterized by short, sharp pain arising from exposed dentin that occurs in response to stimuli, typically thermal (both hot and cold), evaporative, tactile, osmotic, or chemical cannot be ascribed to any other form of dental defect or pathology

the role of nonmedicinal components in dentifrices

- is an additive that is necessary to make the formulation thick, hold together, clean efficiently or have particular color or flavor for consumer appeal.

Certainly lethal dosee

-The amount of fluoride that results in client death; 5-10 g of sodium fluoride is considered a CLD for a 70kg or 154lb adult

Local delivery methods (self applied modes of delivery)

-antimicrobial agent is applied directly to the oral cavity or to a specific location within it for topical application Self applied delivery methods dentifrices oral rinses oral irrigation and oral rinse products

Extreme risk (6+yrs) (high risk plus special needs or dry mouth)

1. 1.1 % NaF toothpaste 2x daily 2. OTC 0.05% NaF rinse when mouth feels dry and after snacking, breakfast, and lunch 3.initially 1-3 applications of NaF varnish 1 application at 3 mo recall 4.antibacterial-(chlorhexidine gluconate 0.12%, xylitol) 5.required calcium and phosphate paste 2x daily 6. exam- every 3 mo. 7.bitewings- every 6 mo.

High risk (6+yrs)

1. 1.1 % NaF toothpaste 2x daily 2. optional 0.2 NaF rinse daily 3. OTC 0.05% NaF rinse 2x daily 4. 1-3 aplications of NaF varnish at 3-4 mo recall 5.antibacterial-(chlorhexidine gluconate 0.12%, and xylitol) 6. bite wings- 6-18 mo. 7. exam-3-4 mo. 8. calcium phosphate supplements optional

Active ingredients (BPTQOAHH)

1. Bisbiguanides 2. phenolic compounds 3. triclosan 4. quaternary ammonium compounds 5. oxygenating and oxidizing agents 6. antibiotics 7. herbal extracts 8. halogens and fluoride others

Conditions associated with antibiotic therapy (8)

1. Gastrointestinal upset 2. sensitivity to sunlight 3. intrinsic staining in developing teeth 4. potential toxicity to pregnant mothers and fetus 5. increased in vaginal candidiasis 6. impaired absorption of some nutrients 7. depressed prothrombin activity 8. potential to render oral contraceptive less effective

More components of dentifrices (HWPBDFCT)

1. Humectants: used to retain moisture and ensure stability 2. water: 20% -30% of dentifrice 3. preservatives: inhibit mold and bacterial growth 4. binders- thickeners that prevent the separation of ingredients 5. detergents- foaming agents to loosen debris and stains 6. flavoring and sweetening agents: provide refreshing flavors and aftertastes 7. coloring agents; dyes 8. therapeutic agents(medicinal agents) Have preventive treatment, or beneficial purposes

Fluoride and children

1. Involve the clients parent or caregiver 2. emphasize key information: * importance of supervision of children when brushing their teeth *Delay fluoridated toothpaste for most children until the after age 2: higher oncentration products until after age 6 limit amount of toothpaste importance of expectorating and rinsing after brushing store products out of reah of children

moderate risk (6+yrs)

1. OTC fluoride containing toothpaste2x daily 2. 0.05% NaF rinse daily initially 3. 1 or 2 applications of NaF varnish, one application at 4-6mo recall 4. caries risk exam -4-6 mo. 5. bitewing radiographs=18-24 mo. 6. anti bacterial- per saliva test (xylitol gum) calcium phosphate supplements- not required

Self-Applied products for clients at risk for caries(4)

1. Over the counter daily client applied fluoride mouth rinses 2. Prescription client applied fluoride mouth rinses 3 Prescription weekly fluoride mouth rinses in school based programs 4 over the counter and prescription daily fluoride gels and pastes

Professionally applied delivery methods (8)

1. Pre-procedural rinse- therapeutic oral rinse before dental hygiene care and other dental procedures to decrease microorganisms in clinical environment during intraoral procedures and for reduction of transient bacteremia. 2.Professionally applied subgingival irrigation-not recommended as monotherapy, should be used in conjunction w/ periodontal debridement, can be deactivated by blood products 3.Varnish 4. Rinses 5. foams 6. gels 7. chips 8. microspheres

Ideal properties of oral rinse (9)

1. Safe to use over long periods of time 2.Palatable 3. Inexpensive 4. Highly soluble and stable in storage 5. Effective 6. Broad spectrum of effectiveness 7. Adequate bioavailability 8. Minimal side effects 9. Adequate retention

*Dentifrice: Adverse Health effects

1. Some ingredients in toothpaste can affect te overall health of those who suffer from allergies or intolerances 2.fluoride: fluorosis when ingested during tooth development 3. soft tissue reactions: Tartar control and herbal-erythema, scaling and fissuring of the perioral area, cheilitis, gingivitis, cricumoral dermatitis sodium lauryl sulfate-mucosal desquamation or ulceration Essential oils: cheilitis or circumoral dermatitis antimicrobial- staining or soft-tissue irritation Flavoring- allergic reactions

*Explain the process of demineralization and remineralization that occurs in the oral environment

1. Streptococcus mutants ad streptococcus sobrinus and lactobacilli live in plaque biofilm that attach to teeth 2. They metabolize fermentable carbohydrates when ingested 3. pH drops and produces acidic environment 4. Minerals (calcium, phosphate) are dissolved from tooth (demineralization) 5. When ingestion of carbohydrates stops pH returns to neutral (30-60 min) 6. Saliva provides minerals (calcium and phosphate) for deposition into demineralized tooth structure (remineralization) 7. Remineralization-builds on crystal remnants(new mineral is less soluable, fluoride speeds up remineralization)

indications for chemotherapeutic interventions in the prevention and treatment of inflammatory periodontal disease (4)

1. incorporation of an active ingredient within the delivery system for preventing or controlling oral disease 2. reduce the number of pathogenic organisms 3. alter microorganisms to reduce their pathogenic potential 4. used as an adjunct to traditional mechanical means

desensitizing agents and their mode of action

1. nerve indicator- potassium nitrate 2. tubule obtundents- fluorides, oxalates, calcium compounds n(CPP, ACP), sodiumnitrate, strontium chloride 3.Protein precipitants- strontium chloride, silver nitrate, formaldehyde, glutaraldehyde

Self applied topical fluorides (prescription and nonprescription)(4)

1.Dentifrices- brushing twice daily most effective way to control decay. High-fluoride concentration fluoride products (5000ppm require prescription)) are more effective in high risk caries risk individuals and more effective for root caries prevention 2. Mouth rinse-0.05% NaF or 0.4% stannous fluoride used as an adjunct to brushing (not recommended for children under 6) 3. Fluoride gels-Stannous fluoride and NaF also an adjunct to manage dental caries 4. Self-applied prescription strength neutral and APF(acidulated phosphate fluoride) 5000ppm are used for individuals with high risk and extreme caries risk such as that resulting from administration of radiation for head and neck cancers and those with systemic medial conditions and those who routinely use meds that reduce salivary flow

different types of dentifrice and their purpose (NIFFAAAS)

1.Non-foaming to low-foaming -for use with power toothbrushes or children 2.ingestible- for persons with special needs 3. free of preservatives- sodium lauryl sulfate, dyes, and so on for persons who are allergic 4. fluoride -to prevent caries and to remineralize teeth 5. amorphous calcium phosphate- to remineralize teeth and add luster 6. antibacterial -for controlling plaque and gingivitis 7. antisensitivity- to control dentinal hypersensitivity 8. salivary enzymes and lubricants- for dry mouth

Criteria for high Caries risk: Age 6-adult

1.One or more disease indicator and or multiple risk factors 2.compiled with little or no protective factors

What are the steps in integrating CAMBRA

1.Risk assessment is the first step: this is the estimation of the likelihood that an event will occur in the future 2.CAMBRA is aimed at prevention Risk Factors Caires disease indicators protective factors 3. Clinican determines level of caries risk (low, moderate, high, extreme) 4. then An evident -based care plan is created

dentifrice pH

1.The pH of a dentifrice can be beneficial or detrimental to dental structures by interfering with or supporting the remineralization process 2. The majority of dentifrice have a neutral pH 3.Adavantages of low pH include the formation of fluorapatite crystals 4. disadvantages of pH of less than 6.5 include the erosion of dentin and cement on exposed root surfaces: these dentifrices can also tarnish titanium implants and affect sealants nd composite restorations

*Discuss dental caries risk assessment for children 0-5 years of age

1.The primary cause of demineralization in infants and toddlers primarily involves cariogenic bacteria and a diet high in fermentable carbohydrates. 2. Mothers, caregivers, siblings and other children transmit mutant streptococci to infants and young children 4. In addition frequent or prolonged feeding with bottled milk, fruit juices, sugared drinks are highly cariogenic(ECC) 5. Recommended that all children have their first preventative dental visit by 12 months of age

Therapeutic agents (ADAAA)

1.anticaries agents: fluoride, nonfluoride components;antimicrobial components that target caries pathogens 2.desensitizing agents 3.antigingivitis agents: triclosan, chlorhexidine gluconate 4. anticalculus agents 5.antistain agents: hydrogen peroxide: sodium bicarbonate 6.antihalitosis agents

Guiding principles for caries management for high risk individuals (4)

1.placing restorations does not reduce the bacterial challenge 2. fluoride use and concentration should be increase for remineralization 3. bacterial challenge can be reduced through antibacterial therapy 4. pathologic factors should be balanced w/ protective factors

Factors that affect bioavailability (3)

1.type of fluoride 2. a pH of less than 6 3. The presence of sodium lauryl sulfate (SLS)

0.4% stable stannous fluoride (SnF2)

1000 ppm once daily brush on after brushing with conventional dentifrice OTC Exp. Gel Kam

0.1% sodium fluoride(NaF) or 0.1% sodium monofluorophosphate (MFP) dentifrice

1000-1500 ppm (some countries manufacture childrens toothpaste at 50-550 ppm) Twice daily brush on OTC: Crest Colgate and arm and hammer

Recommending dentifrices to clients

1Comparing dentifrices is important so that available products can be recommended with confidence 2. a client who uses peroxide containing toothpaste daily increases his or her risk of tooth surface erosion over time.

0.05% NaF rinse

230 ppm once daily rinse OTC- Fluorigard

1.1% NaF and acidulated phosphate fluoride

5000 ppm once daily custom tray or brush on after using conventional dentifrice Prescription Exp. Prevident, Clinpro 5000

1.1% neutral NaF gel

5000 ppm once daily custom tray or brush on after using conventional dentifrice Prescription EXP. Prevident Neutra Care

Abrasiveness scale of dentifrices

72% of dentifrices fall below 2% on the abrasiveness scale, which means that they do not risk damaging dentin or exposing cementum The relative dentin abrasivity (RDA) Scale measures the abrasiveness of most dentifrices

0.02% Neutral NaF rinse

910 ppm Once weekly rinse typically in a school based program prescription examples: Fluororise, prevident

*Explain the dental caries balance

Balance between protective factors and pathologic factors to remineralize early carious lesions and or prevent future caries

Caries management

Caries management is aimed at restoring and maintaining the caries balance between pathologic factors and protective factors. • Pathologic factors - factors that contribute to the possibility that a client will develop caries • Protective factors- factors that can improve the chances that a client will not develop caries

Describe the different forms of dentifrices (PLGFGp)

Dentifrices come in powders, liquid gels, gels, pastes, foam and gel paste combinations • Fluoride gel containing potassium nitrate, w/ saliva and temperature of mouth becomes a foam. Then infiltrates interdental surfaces. • Fluoridated liquid gel dentifrice- in caries prevention because it reaches interproximal surfaces and deep grooves of teeth.

Hypersensitive dentin has the following characteristics:

Dentinal tubules open to oral cavity Large and numerous dentinal tubules Thin and poorly calcified or breached smear layer

High Risk (0-5 yrs)

Fluoride varnish at initial visit and caries recall examinations OTC fluoride toothpaste and combination calcium phosphate combination 2x daily sodium fluoride treatments gels and rinses Xylitol gum, foods, drinks for child xylitol gum or lozenges 2 sticks of gum or 2 mints 4x daily for the caregiver radiographs- 6-12 mo. exam- every 3 mo. antibacterial- chlorhexidine 0.12%

Extreme risk (0-5yrs)

Fluoride varnish at initial visit, at each caries recall and after prophylaxis OTC fluoride toothpaste and phosphate paste combination 2 x daily sodium fluoride treatments gels and rinses Xylitol foods, drinks for child Xylitol gum lozeges2 sticks of gum or 2 mints 4x daily for the caregiver radiographs- every 6 mo. exam- every 3 mo.

Name the professionally applied fluorides for caries management(5)

Gels Varnishes Thixotropic gels foams rinses

Professionally applied fluoride (2 Types)

Gels-For coronal caries prevention in children and adolescents and for root caries in the elderly. APF (1.23 % 12300 ppm) ( NaF 2% 9090ppm) Neutral NaF recommended when client has tooth colored restorations Varnishes-used on teeth to prolong fluoride exposure, used to reduce the risk of inadvertent ingestion in children younger than 6 years. Also effective in preventing caries in high risk populations. painted on with a resin or synthetic base

Dentinal hypersensitivity- contributing fators

Gingival recession Loss of enamel Toothbrush abrasion Erosion Abfraction Acidic foods Periodontal history Occlusal hyperfunction Cusp grinding Instrumentation (root planning, scaling, extrinsic stain removal) Cosmetic tooth whitening

Caries Bacteria test

If any one of the four disease indicators is present, a bacterial culture should be taken Results can be use to motivate client compliance with recommended antibacterial regimens

*Define dental caries

Infectious transmissible disease process (preventable and in some cases reversible) in which a complex cariogenic biofilm, in the presence of an oral environmental status that is more pathologic than protective leads to demineralization and eventual cavitation of dental hard tissues

Insoluble and soluble materials of dentifrices

Insoluable materials affect the abrasiveness of dentifrices Higher levels of abrasiveness (>2%) remove more biofilm and acquired pellicle faster Disadvantage- can increase abrasion and cause hypersensitivity

Caries Management involves what?(5)

Involves the following: • Suppressing bacteria that cause the infection • Remineralizing early noncavitated carious lesions by: o enhancing salivary flow, o using fluorides o calcium and phosphate paste products (especially if client is extreme caries risk (low salivary flow) • Protecting tooth surfaces by using sealants and fluorides • Decreasing the frequency of sugar intake • Surgically removing carious lesions,restoring the teeth with minimally invasive techniques and materials

Over the counter daily client applied fluoride mouth rinses

Low potency, high frequency 0.02%-0.05% NAF (sodium fluoride) w/230ppm (exp. Listerine total care, ACT, Crest Pro Health) used as adjunct to manage dental caries, 1-2 tsp. swish for 60 sec. Not recommended for children, older children use alcohol free

Fluoride

Naturally occurring nutrient that decreases dental caries risk and has a reparative effect in the right concentrations

Compare methods to evaluate dentifrices abrasiveness

Not easily compared because of the various methods used to evaluate abrasiveness. Dentifrices may be compared only from the same manufacturer or resort to an independent laboratory that conducts testing using the same protocols.

Low risk (6 + yrs)

OTC Fluoride containing paste 2x daily Optional NAF varnish if excessive root exposure or sensitivity caries risk exam -6-12 mo. bite wing radiographs- 24-36 mo. antibacterial-per saliva test calcium phosphate supplements- not required

moderate risk (0-5 yrs)

OTC fluoride toothpaste 2xdaily Pea size amount sodium fluoride treatments gels and rinses Xylitol gum , foods, drinks for child xylitol gum or lozenges 2 sticks of gum or 2 mints 4x daily for the caregiver radiographs-12-18 mo. exam- every 6 mo.

US and Canadian Organizations (4)

Organizations that contribute to ensuring safety and efficacy for oral chemotherapeutic products (in United states and Canada) US food and drug administration (FDA) American Dental Association Council on Scientific Affairs Health Canada Canadian dental association (CDA)

Pathologic Factors of dental caries(3)

Pathologic factors: (Caries) 1.Acidogenic (acid producing) bacteria (streptococci, lactobacilli) 2.Frequent eating and or drinking of fermentable carbohydrates 3.Subnormal salivary flow or function

photodynamic thrapy (2 stage method)

Photo sensitizing solution placed by operator w/in the pocket then nonthermal laser light illuminates area for 60 sec

dentinal hypersensitivity-prevalence and distribution

Prevalence is age related Increase in reparative dentin formation reduction in pulpal chamber size, vascularity and pulpal nerve fibers presence in dentinal sclerosis Most prevalent in, buccal cervical regions of teeth

Protective Factors of dental caries balance

Protective factors: (NO Caries) Saliva flow and Components(Calcium, phosphate, proteins) Fluoride: remineralization (fluoride in saliva,) Antibacterial agents : Chlorhexidine, xylitol ect.

Dentinal hypersensitivity- radiographic criteria

Radiolucency may be present at the cervical third of the tooth where pain is reported No pulpal inflammation or apical pathology Absence of distinct fracture line No radiolucent areas under restorations

Discuss systemic delivery methods (FIPSN)

Systemic delivery methods- ingested and then delivered via the blood stream. Fluoride supplements Ingestion of fluoridated water-self delivered Prescription antibiotics-for treatment of periodontitis (doxycycline, penicillin, metronidazole, and clindamycin Subantimicrobial systemic dose-administration of a reduced quantity of a drug for purposes other than the elimination of a pathogenic microorganism Nonsteroidal Anti-Inflammatory drugs (NASIDS)-block enzymes promoting the inflammatory response , thereby reducing inflammation for alveolar bone preservation

Salivary flow rate test

This test should be conducted if inadequate salivary flow is noticed or if the client reports having dry mouth. Reason for an low salivary flow rate needs to be determined to plan for caries management.

Characteristics of dental caries (6)

Transmissible bacterial infection Preventable Sometimes reversible Not self-timing Not amenable to a course of antibiotics Most common dental disease in US and Canada

professionally applied desensitizing agents(8)

Varnishes Precipitants Primers containing hydroxyethyl methacrylate (HEMA) Polymerizng agents Iontophoresis Lasers Restorations Periodontal plastic surgery

triclosan

a bisphenol considered to be safe broad spectrum antibacterial not associated with any side effects, found in dentifrices

substantivity

agents ability to durable bind w/ oral tissues and then released over a period of time, adding efficacy

Self applied desensitizing agents

amorphous calcium phosphate 5% potassium nitrate 8% arginine and calcium carbonate 1.1% sodium fluoride 0.4% stannous fluoride

Metronidazole Gel(elyzol)-

antibiotic available as a controlled release gel that has apositive impact on pocket depths and CAL improvements

antibiotics

antimicrobial drug group that inhibits or destroys pathogenic microorganisms and that may possess a broad or narrow spectrum of target organisms. For reduction of periodontal disease (metronidazole and amoxicillin)

Chlorhexidine Chip (PerioChip)

biodegradable 4-5mm hydrolyzed gelatin chip, incorporates 2.5mg of chlorhexidine d-gluconate for insertion into pockets to inhibit subgingival bacteria

Bisbiguanides

cationic, broad spectrum antimicrobials effective for both gram positive and gram negative bacteria. o Chlorhexidine gluconated" "gold standard "predominantly used in prescription oral rinses, irrigation solutions and controlled release products. Remains active for 8-12 hrs

active ingredient

chemical or drug component w/in a particular delivery system

chlorhexidine as an antibacterial for dental caries

chlorhexidine gluconate 0.12% 1. regimen, rinse 1 minute daily for 1 wk each month 2. must be used in conjunction with fluoride remineralization therapy 3. adverse reactions: affects taste, compliance is poor, staining teeth

Ingested fluoride (3)

community water fluoride in food and water beverages prescription fluoride supplements

Prevention and control of periodontal disease and dental caries depend on what factors? (3)

controlling oral biofilm minimizing risk factors for oral diseases affecting the hosts response If mechanical disruption of the plaque biofilm through oral self care is not sufficient, then incorporation of oral chemotherapeutic agents is implemented

Doxycycline Gel (Atrodox)-

decreases pockets and improves CALs, Contraindicated for sensitivity to tetracycline

Iontophoresis

delivery of sodium fluoride through electrical current through cervical dentin

quaternary ammonium compounds

destroy microorganisms by interacting with the bacterial cell membrane o Cetylpyridinium chloride- (crest prohealth) has been shown to reduce halitosis o Sanguinarine- alcohol extract from root of the plant sanguinaria Canadensis (Viadent)

foams

developed to address the ingestion risk associated with using high potency fluoride products rinses

Dentinal hypersensitivity- diagnosis and clinical criteria

diagnosis of exclusion Sensitivity or pain when stimulus is applied Exposed dentin at the site of sensitivity No clinical signs of dental caries No evidence of fracture lines in tooth structure Restoration margins flush with tooth structure

Explain why each member of a family should have his or her own tube of toothpaste

each family member must have his or her own tube of toothpaste because *The orifice of the tube can be a source of cross contamination *permits the transmission of infectious diseases such as hepatitis B, gastroenteritis, the common cold and the flu *to meet his or her own unique oral care needs

Low risk (0-5 yrs)

fluoride and antibacterial-not required,, exam- 6-12 mo. bitewings- after age 2 18-24 mo.,

thixotropic gels

gels that flow under pressure, remain viscous when under pressure

Minocycline microsphere and ointment

helps pocket depths and CALs when its used as an adjunct to scaling and root planning

oxygenating and oxidizing agents

hydrogen peroxide) mediums that have oxygen added to them, they antimicrobials as a result of release of oxygen. o Oxidizing agents-(chlorine dioxide) - products that have had an increase in oxidation number forming derivatives of Oxygen. For cosmetic use, relief of halitosis

primary mechanisms of fluoride action (3)

inhibition of demineralization enhancement of remineralization inhibition of plaque bacteria

monotherapy

intervention used on its own

bactericidal

kills microbes directly

bacteriostatic

metabolism or reproduction of microbes is affected

fluoride therapies

naturally occurring element in many minerals, water supplies and foods

calcium and phosphate as antibacterial therapeutics

needed to replace minerals missing in saliva used on clients with inadequate salivary flow, extreme risk or special needs

Oral rinses

o Cosmetic and therapeutic use-prescription or over the counter o OTC (listerine) and Prescription chlorehexidine (Peridex) have ADA Seal o Rinse twice daily for 30 sec w/ 1oz rinse o Believed to reach most inaccessible areas missed by mechanical means o Concerns of containing Alcohol (contraindicated for recovering alcoholics), implicated w/ xerostimia o Contains sodium that can be absorbed in oral mucosa

Effects dentifrice can produce ( 3 types)

o Cosmetic effect: prevents or removes stains, inhibits supragingival calculus formation, whitens teeth, freshens breath and controls malodor o Hygiene effect: removes food particles and oral biofilm o Therapeutic effect: prevents or reverses dental caries: reduces gingivitis, oral biofilm, or dentinal hypersensitivity

phenolic compounds

o Essential oils- components of plants that contain phenolic compounds that destroy microorganisms by compromising the cell membrane and inhibiting enzyme activity Exp. LISTERINE

oral irrigations

o Powered and manual mechanisms for delivering an active ingredient w/in a solution via an irrigation tip into gingival sulcus Decreases proinflammatory mediators and increases anti-inflammatory agents with in the gingival crevicular fluid (GCF) 2 TYPES o Home irrigation-standard jet tips to deliver pulsating stream of fluid o Cannulas(needle like tips) reserved for professional use

halogens and fluoride

o Stannous fluoride- is believed to enter the bacterial cell and impair its metabolism, counteracting is growth and adherence properties. (Lack of stability in storage and staining properties.)

What are the five common dentifrice abrasives(POCAS)

phosphates other substances carbonates Aluminum compounds silicas

what is the most common desensitizing agent

potassium nitrate

the role of medicinal components in dentifrices

produces therapeutic or beneficial effect on either the hard or soft tissues. may be beneficial but not therapeutic (To be therapeutic it must improve oral health in a safe and effective way)

xylitol as an antimicrobial for dental caries

recommended for caries management individuals with moderate to high and extreme risk (2 tabs of gum or 2 lozenges 4-5 times daily

loss of tooth structure can result from what? (TFTPDMSI)

results from diverse causes such as Type of dentifrice frequency of brushing toothbrush filament harness pressure during brushing direction of brush strokes manual or powered toothbrush surface substrate brushed insufficient mount of salivary flow or constituents

topical fluoride (3 types)

self applied in the form of nonprescription (OTC products) (dentifrices, mouthrinses, gels) Self applied in form of prescription products (dentifrices, mouthrinses, gels) professionally applied in the form of prescription products (gels with use of a tray teqhnique, varnishes)

antiseptics

substances that inhibit growth and development of microorganisms

safety tolerated dose

the amount of fluoride that can be ingested without causing serious acute toxicity, approximately one quarter of the CLD

Controlled release drug therapy delivery (MCDMP)

use of intracrevicular devices that are professionally placed and that provide drug delivery for sustained periods of time Minocycline microsphere and ointment- Chlorhexidine Chip(PerioChip) Doxycycline Gel (Atrodox) Metronidazole Gel(elyzol) Photodynamic disinfection therapy

Delivery: Tray technique- gel and foam

• 4-minute treatments are recommended; 1-minute treatments are not endorsed by the ADA • Choosing the correct size optimizes anti-caries efficacy and prevents ingestion

acute fluoride toxicity

• Acute reaction from rapid ingestion of excessive fluoride within a very short period of time • Safety tolerated dose (STD)- • Certainly lethal dose(CLD)

The American Dental Association Council of Scientific Affairs

• Assists oral health care providers and the public health with the selection and use of chemotherapeutics agents by evaluating new, nonprescription products for safety and efficacy • Products approved by the FDA may apply to receive the ADA Seal Of acceptance -granted to those products that demonstrate therapeutic efficacy in accordance with published criteria

The future of caries prevention

• Caries prevention research has increased during the last decade Natural compounds- research is hopeful but inconclusive Tea extracts, grape seed extracts, coconut oil, Chinese herbs, and bioactive flavonoids(plant pigments) Biomolecules- smart molecules that eradicate specific bacteria Caries vaccine Demineralization repair-resin infiltrant, ICON Discovery of new infectious agent, Scardova wiggsiae

Client selection for Profesionally applied fluoride treatments-Risk factors (13)

• Caries risk factors that may indicate a need for a professionally applied topical fluoride include the following: new carious lesions on previously sound surfaces, denta caries experience in previous 2-3 years • Secondary lesions associated with restorations margins'' • High levels of cariogenic bacteria • Poor family oral health status • Irregular professional dental care • Enamel defects, white spots, exposed roots • Cariogenic diet • Wearing of orthodontic appliances • Compromised salivary flow • Radiation therapy • Age related conditions • Medical conditions, physical or cognitive disabilities • For children and infants, poor denal caries status of the caregiver and siblings and low socioeconomic status

Chronic fluoride toxicity

• Caused by chronic ingestion of fluoride that exceeds optimal level • Signs and symptoms; hypo mineralized, discolored, pitted or brittle enamel • Management; children using fluoride products must be monitored to decrease the risk of acute and chronic toxicity.

Parent/Caregiver recommendations for caries prevention

• Daily oral hygiene o Small amount of fluoride-containing toothpaste by cloth or brush twice daile o Selective daily flossing • Diet o Elimination of bottles withsugared fluids or juices o Limited between meal snacks, limited sodas; substitution of non caries causing snacks • Sugar free gum o For parent or caregiver of high risk infant, use of xylitol-containing gum four to five times daily • Antibacterial rinse o For parent or caregiver, use of chlorehexidine gluconate (0.12%)once daily for 1 week every month and use of fluoride rinse (0.05% NaF) daily in intervening weeks

Caries management approaches (7)

• Decreasing frequency of sugar and fermentable carbohydrate intake • Educating expectant mothers and conducting early risk assessment • Suppressing infectious agents • Remineralizing early noncavitated carious lesions (exp. Improving homecare) • Avoiding use of explorer tips on demineralized tooth surface • Protecting tooth surfaces by using dental sealants, fluoride therapy and other non-fluoride agents • Surgically removing carious lesions: restoring teeth with minimally invasive techniques

factors to reduce dentinal hypersensitivity(3)

• Dietary choices (avoiding carbonated beverages, acidic foods, and extrems in hot and cold foods) • Use of daily fluoride mouth rinse • Low abrasive dentifrice for sensitive teeth

Fluoride can be delivered in a variety of methods (5)

• Drinking water -most common fluoride delivery system, too much fluoride in community water has the potential of causing chronic fluoride toxicityin children • Foods • Beverages-raw tea leaves and tea tree oils are high in fluoride content. Children are at risk of dental fluorosis in some areas where it is customary to drink tea at a young age ( India, Australia, and parts of Asia) • Supplements (drops, tablets, lozenges)-The goal of supplementation is to offer children in non-fluoridated communities a caries reduction advantage similar to children living in fluoridated communities. Avoid milk product after fluoride supplemts bc cailcium interferes with the bioavailability of fluoride. • Professionally applied or self-applied topical techniques

The U.S Food and Drug Admnistration

• Ensures the safety and efficacy of prescription drugs and the over the counter products that make therapeutic claims • For OTC drugs reviews active ingredients and labeling within the respective therapeutic class

Factors involve in Acute fluoride toxicity(4)

• Factors involved: Route of administration Client age Client weight Rate of absorption

Caries control for clients with xerostomia

• Growing numbers of clients with xerostimia at a higher risk for developing caries because of less saliva and its benefits

protective factors for clients age 6-adult(11)

• Lives/Works/school fluoridated community • Fluoride toothpaste at least once daily • Fluoride toothpaste at least twice daily • Fluoride mouth rinse (0.05% NaF) daily • 5000 ppm F fluoride toothpaste daily • Fluoride varnish in past 6 months • Office Fluoride topical in past 6 months • Chlorihexidine prescribed /used 1 week each of past 6 months • Xylitol gum/lozenges 4 times daily past 6 months • Ca and Po4 supplement paste during past 6 months • Adequate saliva flow( > 1 mL/min stimulated)

*Risk factors for clients age 6 -adult (9)

• MS and LB both medium or high counts (by Culture) • Visible heavy plaque on teeth • Frequent snacking (more than 3 times daily between meals • Deep pits and fissures • Recreational drug use • Inadequate saliva flow by observation or measurement (if measure, note flow rate) • Saliva-reducing factors (medications/radiation/systemic) • Exposed roots • Orthodontic appliances

Factors for High caries risk Ages 0-5 (11)

• Mother or primary caregiver has had active dental decay in the past 12 months • Child has had recent dental restorations • Parent and/or has low Socioeconomic status and/ or low health literacy • Child has developed problems • No dental home/ episodic dental care • Child has frequent(greater than 3 times) between snacks of sugars/cooked starch/sugared beverages • Child has saliva-reducing factors present, including medications(exp. Asthma hyperactivity) medical(exp. Cancer treatment or genetic factors) • Child continually uses bottle • Child sleeps with bottle or nurses on demand • Bleeding gums or heavy plaque • Appliances present

Protective Factors for ages 0-5 (6)

• Mother/caregiver decay free past 3 years • Child has a dental home and regular dental care • Protective factors (biological) • Child lives in a fluoridated community or takes fluoride supplements by slowly dissolving or as chewable tablets • Childs teeth are cleaned with fluoridated toothpaste (pea size daily) • Mother/caregiver chews/sucks xylitol chewing gum/lozenges 4-5 times daily

Caries management planning

• Ongoing dynamic data collection and reassessment process • Requires careful attention and planning by the dental hygienist and adherence by the client All clients should have a dental home by the age of 12 months Careful risk assessment for dental caries must be made at each appointment thereafter

hydrodynamic Theory

• Proposes that stimuli (exp. Thermal, tactile, chemical) are transmitted to the pulp surface via movement of fluid or semifluid materials found within dentinal tubules • Exposed dentin necessary for such hypersensitivity most commonly result of gingival recession and enamel loss

*List Saliva's beneficial actions (8)

• Provide calcium ad phosphate for remineralization • Caries topical fluoride around the mouth for remineralization • Neutralizes organic acids produced in plaque biofilm • Discourages the growth of bacteria, inhibiting infection • Recycles ingested fluoride into the mouth • Protects hard and soft tissues from drying • Facilitates chewing and swallowing • Speeds oral clearance of food

*legal and ethical responsibilities of the dental hygienist with regard to dentifrices (5)

• Recognize that persons may be using dentifrices that place them at risk • Assess client's health, dental, and pharmacologic histories to make sure there are no conditions, allergies or medications that would contraindicate a particular dentifrice recommendation • Make recommendations based on a clients assessed needs and expectations and product evidence * recommend products have been accepted by the ADA or CDA and contain ingredients that have been approved by the U.S food and drug administration • Document recommendations in clients record including the product, frequency, dosage and reasons for use. Confirm with clients signature clients

Caries disease indicators for clients age 6-adult (4)

• Teeth with Cavities /lesion shown in radiograph penetration to dentin • Approximal enamel lesion (shown in radiograph) • Restorations past 3 years • Visual White spots

*Explain the team approach in integrating CAMBRA into an oral healthcare practice.

• The team approach is essential for the successful caries management program. Every team member is essential. Role of the dental hygienist is critical in the overall management of the program

delivery: Paint on technique

• Varnish--lacquer containing the highest available concentration of 5 % sodium fluoride often 22600ppm in a ROSIN base. Holds fluoride in close proximity to teeth surfaces for longer periods of time than other concentrated fluoride products. Clients should be instructed to avoid hot, hard or crunchy foods, brushing and flossing for 4-6 hrs.

Rationale for chemical Therapeutics

•Although bacterial plaque biofilm is believed to be the primary etiologic agent in inflammatory periodontal diseases, it is recognized that the host immune response modulates the progression disease Despite the wide spread use of mechanical plaque removal and technological advances in tooth brushes and interdental tools, difficulties for clients and clinicians remain in the traditional approaches to care, particularly in areas of the mouth that pose access issues. • In recent years, research has concluded that some oral chemotherapeutic agents have an adjunctive benefit for reducing plaque biofilm and improving gingival outcomes beyond that accomplished with mechanical means alone