12/8/2016. The Hygienist s Role: Implementing Invisalign Therapy A Two-Part Series. About the Speaker: Lauren Gueits, RDH BS. The Hygienist s Role:

Transcription

1 The Hygienist s Role: Implementing Invisalign Therapy A Two-Part Series Lauren Gueits, RDH, BS About the Speaker: Lauren Gueits, RDH BS Lauren Gueits, a dental hygienist of 20+ years and a recipient of the 2010 RDH Sunstar Award of Distinction, lectures nationally to health professionals on Comprehensive Care and Oral/Systemic links. Lauren received her degree from the State University of New York at Farmingdale in 1991 and post graduate training in Myofunctional Therapy through the AOMT in Lauren is a published author and has been seen on WNBC, WABC and the Colgate Oral Health Network raising awareness about diabetes and oral health. She is passionate about the perio-ortho connection and the health benefits of aligned teeth, thus enjoying her role as Hygiene Education Manager for Align Technology. *Mom of 3 all in Invisalign treatment The Hygienist s Role: Implementing Invisalign Therapy A Two-Part Series Lauren Gueits, RDH, BS 1

2 Our Time Together: Part One and Part Two Part I Ortho 101: Perio-Ortho-Systemic Connections Long Term Oral Health Solutions with Invisalign Therapy Abfractions vs. Abrasions Implementing Ortho in the Dental Practice Part II Orthodontic Conversations from the Hygiene Chair Hygiene Ortho Exam Effective Strategies for Increased Case Acceptance Case Reviews PART I The Hygienist s Role in Identifying Malocclusion and the Benefits of Proper Tooth Alignment Comprehensive Care Don t Forget the ORTHO! 2

3 RDH: Really Delivering Health Care EVALUATE EDUCATE ENGAGE Make a difference by being an important part of your patients overall health care team! Comprehensive Care/Treatment? Assessing Risk Factors: Periodontal/Systemic Disease/Sleep Apnea Educating Patients on the Inflammatory and Systemic Ramifications of Periodontal Disease Non-Surgical Periodontal Therapy Strategies Recognizing Malocclusion and Orthodontic Solutions Myofunctional Therapy? Educating and Screening Diabetes Patients CAMBRA Caries Management for Risk Assessment Oral Cancer Screening Communication with Medical Team Smoking Cessation/Nutritional Counseling Ortho 101 SAGITTAL (ANTERIOR-POSTERIOR) TRANSVERSE (HORIZONTAL) VERTICAL 3

4 Sagittal Relationship: Anterior Posterior (AP) Daskalogiannakis J., Glossary of Orthodontic Terms, Chicago, Il, 2000, Quintessence Publishing Co. Phinney, DJ, and Halstead, JH, Delmar s Dental Assisting; A Comprehensive Approach. Ed 1, Albany, NY, 2000, Delmar Thomson Learning Sagittal Dimension Molar and Cuspid Relationship Class 1 Class 2 Class 3 Transverse Dimension (Horizontal) Daskalogiannakis J., Glossary of Orthodontic Terms, Chicago, Il, 2000, Quintessence Publishing Co. Phinney, DJ, and Halstead, JH, Delmar s Dental Assisting; A Comprehensive Approach. Ed 1, Albany, NY, 2000, Delmar Thomson Learning 4

5 Transverse Dimension: Arch Shape U Shape V Shape Square Omega Transverse Dimension: Arch Width Normal Spacing Crowding 3 Causes of Crowding Improper Arch Form Improper Arch Width Buccolingual Inclination 5

6 Vertical Force vs. Horizontal Force vs Vertical Dimension Daskalogiannakis J., Glossary of Orthodontic Terms, Chicago, Il, 2000, Quintessence Publishing Co. 6

7 Vertical Dimension: Anterior Bite Normal Edge to Edge Deep Bite Open Bite Overbite (OB): Vertical overlapping of the upper teeth over the lower. Ideal OB is 10 30% overlap

8 Study: Effects of Crowding in the Lower Anterior Segment Study found that anterior crowding of 3mm or more serves as an individual host factor for periodontal disease Staufer K, Landmesser H. J Orofac Orthop Jan; 65(1): Department of Orthodontics, University of Witten/Herdecke. Progression of Periodontal Disease *Comparison of microbial composition in the subgingival plaque of adult crowded versus non-crowded dental regions Chung et al, International Journal of Adult Orthodontics and Orthognathic Surgery 8

9 The Role of Oral, GI and Pulmonary Pathogensin Atherosclerosis Vojdani, Aristo. Laboratory Medicine. March Number 3. Volume 34 Without Good Periodontal Health, You Can t Have Good General Health RESPIRATORY INFECTIONS STROKE SEVERE OSTEOPENIA HEART DISEASE PRETERM OR LOW BIRTHWEIGHT BABIES UNCONTROLLED DIABETES Malocclusion and Patient Health Connection Malocclusion may create improper bite forces Malocclusion may increase the risk for periodontal disease Links between periodontal disease and systemic health risks 9

10 The Etiology and Prevalence of Gingival Recession Causes of Recession: Trauma, Sex, Malpositioned Teeth, Inflammation and Tobacco Consumption 1+ Sites with Recession: 88% of people % of people 18 to 64 years of age Clinical Implications: Dentists should be knowledgeable about the etiology, prevalence and associating factors of gingival recession, as well as treatment options, so that appropriate treatment modalities can be offered to patients. Treatments for gingival recession include gingival grafting, guided tissue regeneration and orthodontic therapy. Such treatments typically result in esthetic improvement, elimination of sensitivity and a decreased risk of developing root caries. Kassab MM1, Cohen RE.J Am Dent Assoc Feb;134(2):220-5 Gingival Cleft: Mosby s Definition n. A Cleft of the marginal gingiva; may be caused by many factors, such as incorrect tooth-brushing, a breakthrough to the surface of pocket formation, or faulty tooth positions, may resemble a V-shaped notch Mosby s Dental Dictionary 3 rd Edition N.Dicke. Access Magazine, Nov

11 Non-carious Class V Lesions: What s Really Going On? Nichole Dicke, LDH, BS N.Dicke. Access Magazine, Nov.2012 Abfractions Are Non-carious Class V Lesions The term abfraction refers to a non-carious Class V Lesion with an etiology that includes tooth flexion and occlusal stress * * Lee WC, Eakle WS. Possible role of tensile stress in the etiology of cervical erosive lesions of teeth. J Prosthet Dent. 1984;52: Malocclusion and Premature Wear Premature Wear Abnormal Lateral Force Contact Point Poorly aligned teeth can create abnormal lateral force and stress on surrounding periodontal structures can lead to Worn down shortened teeth Poor root support, tooth mobility and eventually tooth loss Chipping, recession, abfraction Chipping, Abfraction 11

12 Clefting present? Cusps flattened? 1 4C s 4 2 Abfraction vs. Abrasion Canines involved? (GM of canines in tact?) 3 Collisions? (teeth sliding or colliding?) Clefting Clefting 1 Cusps 4 2 Canines 3 Collisions Tooth Brush Abrasion...Really? Clefting 1 Cusps 4 2 Canines 3 Collisions 12

13 Look Familiar? Recession and Abfraction Improvements BEFORE AFTER Courtesy or Ben Miraglia, DDS Short Term vs. Long Term Solutions: Providing Patients with Options CONDITIONS SHORT TERM TREATMENTS LONG TERM ORTHODONTIC SOLUTIONS Abfractions Anterior Incisal Fracturing Worn Down/Fractured Posterior Teeth Class V composite/gingival graft Occlusal adjustments Veneers/Crowns/Occlusal adjustments Crowns Occlusal adjustments Night Guards Uprighting teeth to correct the vertical alignment and take teeth out of trauma Correcting the malocclusion. Usually end to end, anterior crossbite, deep bite Correcting the malocclusion by taking teeth out of trauma. Providing canine guidance or group function. Grinding Night Guards Occlusal adjustments Proper occlusion by moving teeth not grinding down teeth. Provide canine guidance/group function. Gingival Recession Grafting: Usually refer to Periodontist Uprighting teeth to correct the vertical alignment and take teeth out of trauma 13

14 Gingival Grafting Treatment for Non-carious Class V Lesions (Abfractions) Standard GP Treatment 1.Wait-and-Watch 2.Class V Buccal Composites Controversial GP Treatment 1.Occlusal Adjustments 2.Occlusal Splints Micheal.Et al Australian Dental Journal Volume 54, Issue 1, pages 2 8, March 2009 Class V Buccal Composites Low retention rate: After 2 years, 1/3 of the composites were lost * Patients blame doctor for poor workmanship Most dentists do not like performing these types of restorations *Onal and Pamir, Two-Year Performance of Esthetic Restorative Material in Non Carious Cervical Lesions, JADA Vol. 136,No11, ,

15 Before Invisalign Tx After Invisalign Tx ADA Definition of Evidence Based Dentistry Summary 3 Realm Approach 1. Science 2. Clinician s Judgement 3. Patients Needs/Preference External clinical evidence can inform, but can never replace, individual, clinical expertise * Dr. David Sackett 1.ADA Policy Statement on EBD, August 29,2013 : http.// statements/policy-on-evidence-based-dentistry 2. Frantsve-Hawley, et al. Using the Best Evidence to Enhance Dental Hygiene Decision making: JDH vol89 Sup1 Feb 2015 Improved Periodontal Charting Courtesy of Ben Miraglia, DDS Aligned Teeth = Health Permission to use? Compendium, July Vo.25,No.7(Suppl 1) 15

16 Recognizing Malocclusion/Malpositioned Teeth Is Paramount to Patient Health Malocclusion and abnormal tooth position are now recognized as potential contributors to the disease process when they cause occlusal traumatism. 1 Excessive functional stress may initiate inflammatory changes in the periodontium and thus enhance destructive bacterial processes. 2 1.Geiger AM. Malocclusion as an etiologic factor in periodontal disease: A retrospective assay. Am J Orthod Dentofacial Orthop. 2001;120: Goldman H, Schluger S, Fox L, Cohen DW. Periodontal Therapy. 7. Philadelphia: W.B. Saunders; p. 52. Implementing Ortho into Every Day Dentistry Clinical Protocol: TX Planning PERIO ORTHO RESTORATIVE* *Restorative takes precedence if active decay/pathology/pain 16

17 Why Discuss Orthodontics? Professional responsibility. AAP / ADHA guidelines Advise on the latest advances in dentistry Treat an orthodontic problem with an orthodontic solution ING Conversation Starters: This Concerns Me Because ING Conversation Starters: This Concerns Me Because Show and Tell Your gums are receding Your teeth are chipping The enamel is thinning Your teeth are shifting Your teeth are wearing How is Dr. going to fix this in 10, 20 years? Your teeth are colliding rather than sliding RecedING Chipp Thinn Wear Shift Slid 17

18 PCS: Problem, Consequence, Solution IDENTIFY PROBLEM SHOW AND TELL CONSEQUENCE PROVIDE SOLUTION Malpositioned teeth causing malocclusion ING Words Chipping, receding, shifting Hard and soft tissue damage Tooth loss and costly dentistry: surgery, implants Take your teeth out of trauma Proper Tooth Alignment Can Lead To Solid foundation Proper occlusion Decreased risk of occlusal trauma and abnormal wear Healthier teeth and periodontium Motivated patients Easier periodontal maintenance And Beautiful smiles Action Item: Be an Ortho Detective Is This Condition Related to Malpositioning? Try an ING or Two! 18

19 Wednesday, October 28 th : 4pm pacific 7pm eastern PART II: The Hygienist s Role in Implementing Ortho in the Dental Practice How to implement ortho into clinical practicality Specific verbiage to engage patients to value your prevention plans Specific Role plays 6 Words to avoid from the hygiene chair can you guess what they are? Thank You Transforming people s lives by improving the journey to a healthy, beautiful smile Contact: lgueits@aligntech.com 19