Innovative Dental Therapies for the Aging Population

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1 Innovative Dental Therapies for the Aging Population By Daniel H Ward DDS 1080 Polaris Pkwy Ste 130 Columbus OH

2 US Population is Aging million>60 14% of population million>60 17 % of population million >60 18% of population projected 92 million>60 25% of population Challenges of Patients over 60 Xerostomia Difficulty maintaining oral hygiene Root exposures Periodontal factors Significant previous dental treatment Some unable to tolerate long appointments Difficulty coming to office Fixed Income Role of Dentist treating Patients over 60 Maintain Oral Health Oral Physician Diet Counselor Age Considered Restorative Treatment Caries Manager Provide Adjunctive Therapies KISS Caries Management (3 R's) Recognize-Early Diagnosis Rejuvinate-Chemotherapeutic Repair-MID (Minimally Invasive Dentistry) Caries Risk-Negative Factors (BAD) Bacteria poor oral hygiene, biofilm loaded with acidogenic bacteria Acid Critical ph is less than 5.5 Diet Carbohydrate consumption Caries Risk-Positive Factors (SAFE) Saliva 1ml/minute stimulated salivary flow Awareness Educated and motivated patient Fluoride Daily exposure Environment Neutral ph with adequate calcium and phosphate ions Xerostomia Medications-most common side effect listed is dry mouth 25% of all adults exhibit dry mouth symptom Questions to ask? Do you have any difficulty swallowing?? Does your mouth feel dry when eating a meal?

3 ? Do you sip liquids to help in swallowing dry food?? Does the amount of saliva in your mouth seem to be little, too much, or do you notice? Clinical Appearance i. Tissues-dry pale, red atrophic ii. Tongue-devoid of papilla, atrophic, fissured iii. Carious Lesions-gingival margin, exposed root surfaces iv. Angular cheilitis-fungal infection v. Lips-cracked, angular, inflammed vi. Saliva-sticky or ropey Effects i. Rampant decay ii. Tooth loss iii. Periodontal disease iv. Difficulty speaking v. Candidiasis Xerostomia Products Liquids, gels, sprays-biotene, Oral Balance Chewing gum-biotene Toothpaste-Biotene Lozenges-Salese-contains oils, xylitol, sodium bicarbonate, ACP Fluoride Incorporates fluoride into hydroxyapatite resulting in fluorapatite Inhibits bacterial metabolism after diffusing into the bacteria as hydrogen fluoride when plaque is acidified Inhibits demineralization at the surface during acid challenges Enhances remineralization by forming a low-solubility acid-resistant veneer at the surface Result is critical ph is lowered to 4.5 Fluoride Products Topical Application-Enamel Pro Neutral NaF also has ACP Varnish-Enamel Pro Varnish Clear NaF also has ACP Prescription cream-prevident % Neutral NaF-use as a toothpaste, apply with finger, or use trays ACP-CPP Amorphous Calcium Phosphate-active ingredient Casein Phosphopeptide-carrier molecule Derived from milk products Localized at tooth surface by binding to plaque and bacteria In presence of acid Calcium and Phosphate ions are released Do not use if true milk allergy, lactose intolerant OK

4 Mode of Action Release of Calcium and Phosphate ions prevents mineralization and promotes re-mineralization Can re-mineralize subsurface lesions if no cavitation Seals dentinal tubules reducing sensitivity ACP-CPP Products MI Paste Provides bio-available calcium and phosphate to the oral cavity Aides remineralization Reduces localized hypersensitivity when used after scaling or tooth whitening Remains on tooth surface 3 hours MI Paste Plain Uses Dentinal sensitivity Temperature sensitivity After tooth whitening For pregnant mothers For children 6 & under During or after ortho Desensitization Poor Oral Hygiene Saliva substitute MI Paste Plus Addition of 0.2% NaF to MI Paste 900 ppm NaF (toothpaste =1100 ppm) If F - concentration too high-caf deposited on surface preventing absorption 150 micron penetration MI Paste Plus Uses White spot lesions Desensitization During or after ortho Medical compromised pts Xerostomia High Acid Environment High Caries Risk pts Extra Protection General Application of MI Paste Apply after toothbrushing No food or drink for 30 minutes May apply with trays for 3-5 minutes

5 Other Products Novamin (Calcium Sodium Phosphosilicate)-proprietary molecule Binds to tooth surface Elevates salivary ph to 8-9 Upon contact with saliva releases Ca & PO4 ions Hydroxycarbonite apatite formed Occludes Dentinal tubules Effective for root sensitivity Restore, Oravive, NuPro NU Solutions Amorphous Calcium Phosphate Upon contact with saliva releases Ca & PO4 ions Dentinal tubules occluded Effective for root sensitivity Enamel Pro, Relief ACP,ARM & HAMMER Enamel Care Xylitol Reduces caries, plaque and harmful bacteria Ingested by bacteria-cannot metabolize Bacteria wastes energy to rid Result-reduced strep mutans levels in saliva Reduces ability of plaque to produce acid Allow re-mineralization Trident Xtra Care with Recaldent 2 sticks chewed for 10 minutes qid for 3 months Chlorhexidine Rinse 0.12% Chlorhexidine Bacteriostatic & Bacteriocidal Helps prevent decay Antimicrobial Stains teeth Rinse bid Varnish-Cervitec Plus 1% Chlorhexidine 1% Thymol Dried effective dosage 10x Protect exposed roots Hypersensitivity Reduced bacterial activity

6 Glass Ionomer Restorative Materials Advantages of Glass Ionomer Materials Fluoride release/re-uptake Slight moisture is advantageous Bulk placement Anti-bacterial properties Reduced post-operative sensitivity Self-curing in minutes Elimination of polymerization shrinkage stress Expansion/contraction similar to tooth High fluoride release Bioactive Setting Reaction of Glass Ionomer Materials Acid/base Reaction Ionic bond to calcium of tooth structure Self-curing Glass Ionomer Restorative Material ( Equia (Fuji IX), FX-II, RIVA SC) Multiple carious lesions Class V restorations Repair around crown margins Crown buildups Open Sandwich technique Closed Sandwich technique High Fluoride Materials Sealants Long term interim restorations Affect of resin coating How long do they last? New Zinc Modified Materials Advantages of Resin-modified Glass Ionomer Materials Fluoride release/re-uptake Reduced post-operative sensitivity Less technique sensitivity Dual curing-quicker Anti-bacterial properties Setting Reaction of Resin-modified Glass Ionomer Materials Fluoro-alumino silicate glass (powder) Poly-acrylic acid (liquid) HEMA Acid/base reaction and Polymerization reaction Ionic bonding and micromechanical bonding

7 Resin-modified Glass Ionomer Restorative Material (Fuji II LC, RIVA LC) Definitive restoration Paste/paste dual curing Deciduous teeth Class V dentin and enamel margins Best color of all GI based materials Ease of Use Dual curing Emergency Temporaries prior to crown preparation appointment Restorations under crowns Sandwich technique under composite restorations Conservative modes of treatment Immediate bonded natural tooth pontic bridges Temporary crowns bonded to tooth In-office direct/indirect inlay/onlays In-office indirect inlay/onlays

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