Meat and Potatoes of Dental Hygiene Practice Enamel

Transcription

1 Meat and Potatoes of Dental Hygiene Practice Enamel This presentation is supported by VOCO through an unrestricted educational grant. Presented by Shirley Gutkowski, RDH, BSDH Recognition and Credits PennWell is an ADA CERP recognized provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at PennWell designates this activity for 1 Continuing Education Credit. Dental Board of California: Provider 4527, course registration number This course meets the Dental Board of California s requirements for 1 unit of continuing education. The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2015) to (10/31/2019) Provider ID# Disclosure Declarations Presenter Disclosure: Shirley Gutkowski, discloses the following: She has received a stipend for this webinar. She has no commercial or financial interest in any products discussed in this webinar. Commercial Support:This course was developed with commercial support by VOCO The Dentalists Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity, No manufacturer or third party has had any input into the development of course content. CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with any commercial supporter, or with products or services discussed in this educational activity. Heather can be reached at hhodges@pennwell.com. Im age Authenticity: No images in this educational activity have been modified or altered. Scientific Basis: All content has been derived from references listed and the author s clinical experience. Research references are provided in the bibliography and/or supplemental materials. Educational Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise. 1

2 Shirley Gutkowski, RDH, BSDH Primal Air Orofacial Myofunctional Therapy and Breathing Re-training practice in Sun Prairie, WI. Speaker, writer, and practicing dental hygienist in a large group practice. Wife, mother, gramma, doctrinaire, radio talk show host, graduate of Marquette University, sought after interview for television, radio, and print SHIRLEY GUTKOWSKI Just like you! 2

3 I Ask Questions 3

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5 Ages How early To start Ages How early To start 5

6 We are the last health care providers to amputate infection as a treatment. Amputation doesn t stop The infection New Words 6

7 Images compliments of Xlear, Inc. Images compliments of Quantum Technologies 7

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9 Does this work? Three Main Components What s the goal of polishing? When s the last time your really thought about the polish you use or why you use it? 9

10 What s the goal of polishing? To remove biofilm and stain What s the goal of polishing? Dental biofilm (I know you know this) Starts with a specific bacterial strain Matrix sticks to the tooth Matrix encases inhabitants Stew Bacteria Yeast Virus 10

11 Activities of the biofilm Protect inhabitants Provide the proper ph Low ph dissolves the enamel Pits in the enamel harbor other biofilms Biofilm in the pocket Stimulates inflammatory cascade Brings cytokines to the site Disrupts tissue integrity Hides infectious microbes Who s hiding in there? E. coli H. pylori P. Gingivalis S. Pneumonia Too many others to count 11

12 Biofilm Management - Professional 12

13 Asthma Bronchitis Dental hygiene Diabetes Arthritis Stroke Hearth disease Living with myths Pumice Many times Speed pressure Damaged enamel Teeth Don t Heal 13

14 Teeth do heal Roots don t heal Selective polishing Traditional Air Traditional Air 14

15 Helicobacter pylori vacuolating cytotoxin, VacA, is responsible for gastric ulceration. Around 1988, Leunkand colleagues discovered that supernatants from broth cultures ofhelicobacter pylori induced massive vacuolar degeneration of various cultured epithelial cell lines. Infectious burden and atherosclerosis: A clinical issue Moreover, another indirect mechanism by which some infectious agents (such as H. pylori, C. pneumoniae, periodontal pathogens, etc.) may play a role in the pathogenesis of atherosclerosis is molecular mimicry. Given the complexity of the mechanisms by which each microorganism may contribute to atherosclerosis, defining the interplay of more infectious agents is far more difficult because the pro-atherogenic effect of each pathogen might be amplified. 15

16 Role of dental plaque, saliva and periodontal disease in H. pylori infection Nevertheless, recent studies have not only shown that the microorganism can be detected fairly consistently from the oral cavity but also demonstrated that the chances of recurrence of H. pylori infection is more likely among patients who harbor the organism in the oral cavity. Role of dental plaque, saliva, and periodontal disease in Helicobacterpyloriinfection Furthermore, initial results from clinical trials have shown that H. pylori-positivedyspeptic patients may benefit from periodontal therapy. Relationship between oral problems and Helicobacter pylori infection. The study suggested that to prevent or eradicate Hp infection, we need to focus on oral hygiene and prevention of oral problems, especially dental calculus and loose tooth. 16

17 Four teeth extracted for periodontal reasons were air polished. Bioactive hydroxyapatite was a cleaning powder with particle size of up to 10 μm. Bioactive natural hydroxyapatite is a very effective cleaning powder, which removes efficiently tartar from cementum surface and does not cause any damage. The qualitative analysis of cementum images after air-polishing with natural hydroxyapatite showed that the cementum surface was fully saturated with such elements as calcium and phosphorus, which was not observed on control cementum images. J Prosthet Dent The effect of airborneparticle abrasion on the shear bond strength of four restorative materials to enamel and dentin. The use of airborneparticle abrasion increased the shear bond strength of restorative materials tested to enamel and dentin. 17

18 Prosthesis is not enamel Gold Amalgam Resins Nano particles Porcelain Any man made material Can and does get damaged by polishing Effects of fluoride or nanohydroxiapatite on roughness and gloss of bleached teeth. Microsc Res Tech Dec Effects of fluoride or nanohydroxiapatite on roughness and gloss of bleached teeth. Microsc Res Tech Dec Gloss showed significant increase after polishing with nha. 18

19 Minimally invasive caries removalusing bio-active glass air-abrasion. J Dent Jan Minimally invasive caries removal using bio-active glass air-abrasion. J Dent.2011 Jan Alumina air-abrasion has been used to clean teeth and shown to over-prepare access cavity preparation to caries. This study investigated the working hypothesis that bio-active glass air-abrasion is more self-limiting than alumina for minimally invasive caries removal. Minimally invasive caries removal using bio-active glass air-abrasion. J Dent Jan Bio-active glass abrasion removed extrinsic stain and substantial quantities of enamel from all carious fissures but not from sound, where only minimal microscopic surface modifications were observed. 19

20 Bioactive Glass Professional Intervention against biofilm Scaling Polishing Purpose of Subgingival Instrumentation...to create a biologically acceptable root surface by the removal of plaque, calculus and endotoxin Woodall

21 Instrumentation Comparisions Root substance removal: 360 sites Curette Diamond burr Sonic scaler Ultrasonics microns microns 93.5 microns 11.6 microns Ritz, Hefti, Rateitschak, J Clin Perio 1991 Scaled with curette Smear layer C. Dri s k o, Perio 2000, 1996 Professional intervention on enamel breakdown Salivary support Fluoride 21

22 Remin Pro is biomimetic nanotechnology Now we know about the enamel biofilm interface Common Decay Sites Common decay sites of tooth enamel surfaces 1. Deep fissures 1 22

23 Common Decay Sites Common decay sites of tooth enamel surfaces 1. Deep fissures 1 2. Root surface 2 Common Decay Sites Common decay sites of tooth enamel surfaces 1. Deep fissures Accessible sides 2 3. Interproximal sites BMC Pediatr.2013 Oct 25; 13: 174. doi : / Vitamin Dst at us of chi ldren wi th severe earl y chi ld hoo dcari es: a case-co nt rol st u dy. Schroth RJ, Levi JA, Sel lers EA, Friel J,Kli ewere, Moffat ME. 23

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25 Does their diet support health Fluoride support Fluoride support 25

26 ADA study states fluoride varnish is: Effective in preventing caries in both primary and permanent dentition of children & adolescents (ADA Council on Scientific Affairs, JADA, Vol. 137, August 2006)As of Jan 2007, fluoride varnish has its own code (D1206) ADA - Statement Fluoride Varnishes Take less time Creates less patient discomfort Achieve greater patient acceptance Than does fluoride gel, especially in preschool-aged children Active Ingredient Listing Profluorid Varnish 50 mg (NaF) Sodium Fluoride in 1 gram contains 11.3mg F Resin is based on Colophony (Yellowish gum rosin/sap from Pine trees) Eugenol-free! 26

27 Application Process Profluorid adheres to moist surfaces It tolerates residue of moisture or saliva Thoroughly clean surface to be treated Apply evenly so that the entire surface is covered by a thin coat Post Treatment Care Do not brush or floss for at least 4-6 hours If possible, wait 24hrs to resume normal oral hygiene Eat a soft food diet during the treatment period Avoid hot drinks and products containing alcohol (i.e.: beverages, oral rinses, etc.) Patients will be able to feel the varnish on their teeth. At the completion of the treatment period, you may brush and floss to remove any remaining varnish 27

28 User Feedback on Material [%] User Feedback on Material [%] User Feedback on Material [%] 28

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30 Clinical practice guidelines for oral management of Sjögren disease: Dental caries prevention. (2016) Final recommendations for patients with Sjögrendisease with dry mouth were as follows: topical fluoride should be used in all patients (strong); 30

31 We have the tools For early diagnosis of caries and periodontal infection For the treatment of caries and perio 31

32 Operative Dentistry for Children Not filling teeth but preserving the necessity for filling teeth should be the dentist s work. Let him consider himself successful who can show a clientele where his patients boast that never from babyhood to the grave have they had a stain or hole in any tooth. That is true dentistry, not this tiresome, painful plugging of holes. It is an ideal possible for the majority of people. Why is our profession permitting sixty percent to suffer needlessly? 32

33 Operative Dentistry for Children M. Evangeline Jordan, DDS Operative Dentistry for Children Chapter III Oral Prophylaxis Copyright, 1925 Cross Link Radio On Host Shirley Gutkowski 33

34 Thank You! Presented by Shirley Gutkowski, RDH, BSDH This presentation is supported by VOCO through an unrestricted educational grant. To claim CE credit for your participation in this activity you must complete the program post-exam. Instructions for completing the post-exam and receiving your Letter of Credit are provided on the following slide. 34