MI Paste or Fluoride for Ortho Patients
Transcription
MI Paste or Fluoride for Ortho Patients
Decmeber 2010 – Volume 6, Issue 12 with Perio Reports by Trisha E. O’Hehir, RDH, BS Discussion from Hygienetown.com MI Paste or Fluoride for Ortho Patients hygienetown from trisha’s desk Sweeten Mom’s Kisses to Reduce Baby’s Risk of Caries by Trisha E. O’Hehir, RDH, MS, Hygienetown Editorial Director Babies are born germ free. Moms, dads, siblings, caregivers their saliva through normal kissing and sharing of food. At two and even the family dog share their oral flora with babies via years of age, Strep mutans levels were measured in the children saliva. Before teeth erupt, there is little chance Strep mutans will revealing 10 percent in the xylitol group positive for Strep colonize, without the benefit of nonsloughing enamel surfaces. mutans, 30 percent in the chlorhixidine varnish group and 50 When teeth erupt, kids are susceptible to bacterial colonization. percent in the fluoride varnish group. The difference between This provides a “window of infectivity,” according to Dr. Page the xylitol group and the fluoride group was fivefold! Caufield of New York University. When the children were five In a 1993 article in the Journal of years of age, results showed a long Trisha Live Dental Research, bacterial levels were lasting result with 70 percent less monitored in 46 mother-child pairs need for restorative care in children Here’s where you can catch Trisha live! To schedule from the child’s birth to five years of of the moms who chewed 100 Trisha to speak at your next national, state or local denage. By 26 months, 38 of the chilpercent xylitol-sweetened gum tal hygiene meeting, e-mail [email protected]. dren had acquired Strep mutans. compared to the other two groups. January 13-15, 2011 Only eight children escaped Strep These findings continued at this Rocky Mountain Dental Conference Denver, Colorado mutans colonization during the five level through evaluations at ages six January 22, 2011 years. When compared, moms and and 10. Make Yourself Indispensable Phoenix, Arizona kids had the same oral bacteria. The Xylitol reduced the levels of January 29, 2011 window of infectivity identified by Strep mutans in the mothers’ Drs. McCawley & DeTure Fort Lauderdale, Florida Dr. Caufield and his team was 19 to mouths, allowing for much less February 26, 2011 26 months of age. likely transmission to their babies. Make Yourself Indispensable Spokane, Washington If mom or the primary caregiver True caries prevention begins when has an oral flora replete with acidthe mother is pregnant. Efforts to producing Strep mutans, these bacteria are freely shared through establish a healthy oral flora include daily xylitol use, good oral saliva with the infant by kissing, tasting food first before feeding hygiene, healthy eating habits and now oral probiotics to change the child and sharing food. Besides being an opportunity for the oral flora to one conducive to health. With these changes in Strep mutans colonization, it is also the perfect place to prevent place, the stage is set for the baby to be protected when the first Strep mutans sharing, by helping moms share sweet kisses com- teeth erupt. Other researchers have shown that if Strep mutans posed of noncariogenic oral flora. Xylitol and oral probiotics will transmission can be prevented for the first two years of a baby’s make the difference. life, the baby has less risk for future caries activity. Beginning a Dr. Eva Söderling and her research team from the University baby’s life with sweet xylitol kisses should be the first step in preof Turku in Finland reported in the Journal of Dental Research in venting childhood caries. n 2000 about the transmission of Strep mutans between moms and babies. The 195 pregnant moms in the study all had high Strep In This Section mutans counts at the start of the study. There were three groups. One group of mothers chewed 100 percent xylitol-sweetened 3 Perio Reports chewing gum four times daily, beginning when their babies were 9 Townie Choice Awards 2010 three months old and continuing until they were 24 months. 21 Short Commentary: Moms in the second group had fluoride varnish applied to their Treating Returning Soldiers with a Traumatic Brain Injury teeth every six months for two years. Similarly, the third group 23 Message Board: MI Paste or Fluoride for Ortho Patients had chlorhexidine varnish applied every six months. Nothing was done to the children in this study. The moms simply shared n n n n 1 December 2010 » hygienetown.com You care enough to brush with toothpaste... WHAT IS XYLITOL? Go to whyxylitol.org VISIT US ONLINE: Shouldn’t you be using a nasal spray with xylitol? The only nasal spray with 100% Xylitol, Xlear® (pronounced “clear”) has been clinically shown to reduce airborne contaminates in the sinuses and upper respiratory tract, while soothing and moisturizing. Like brushing, a daily spray should be a part of your family’s health routine. www.xlear.com Available at: And other fine stores. hygienetown perio reports Perio Reports Vol. 22 No. 12 Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians. Perio Reports research summaries will be included in each issue to keep you on the cutting edge of dental hygiene science. Caries and Perio Found Together Vitamin B12 and Folate Prevent Aphthous Ulcers With studies showing caries and periodontitis found together and other studies showing either one disease or the other, research is contradictory. Both are bacterial in nature, impacted by the accumulation of bacterial biofilm. It is suspected that salivary pH might contribute to disease selection, with an acid pH leading to more caries and a basic pH contributing to calculus formation and periodontitis. Research hasn’t evaluated this theory. Researchers from the University of Oulu in Finland compared the incidence of both caries and periodontal disease in a group of 5,000 adults older than age 30 who were part of a national health survey. Clinical examinations were conducted by five field teams in community settings using a headlamp for light, a mouth mirror, a periodontal probe and explorer. Compressed air was available to dry teeth prior to examination. The deepest probing depth for each tooth was recorded in one of three categories: none, 4-5mm or 6mm. Dental caries were recorded if cavitation was present and the lesion was extending into the dentin. Of this group, 65 percent had 4mm probing depths; 21 percent had 6mm probing depths; and 29 percent had dental caries. The caries incidence was significantly lower than reported for the UK or the U.S. Perhaps the use of xylitol in Finland is responsible. In the group with 6mm probing depths, 44 percent also had caries. In the periodontally healthy group, 23 percent had caries. More severe periodontal disease and caries tend to be found in the same patients. Recurrent aphthous stomatitis (RAS) is a widespread, common oral mucousal lesion. Incidence levels vary with reports as high as 50 percent in women and 40 percent in men. The lesions are small, oval in shape with necrotic tissue in the center and a red inflamed border. The lesions are painful, especially with eating and regular oral hygiene. RAS is more common in younger people than older people. This difference might be explained by dietary intake of nutrients. Younger people are less likely to eat healthy, well balance meals than older people. Researchers at the University of Connecticut in Farmington analyzed the dietary intake of 100 subjects who experienced at least three episodes of RAS in the past year. These findings were compared to age- and gender-matched participants in the U.S. National Health and Nutrition Examination Survey (NHANES). Dietary intake was evaluated using DietCalc software that calculates specific nutrients based on the reported food intake. This allowed daily nutrient comparisons between the two groups. Nine nutrients were identified for comparison: vitamins A, B6, B12, C, E, thiamin, riboflavin, niacin and folate. Those in the RAS group had higher levels of seven of the nine nutrients than the controls. The two nutrients that were lower in this group were vitamin B12 and folate. This correlates to seven percent of the recommended daily intake level for vitamin B12 and 20 percent of the recommended level for folate. Just how vitamin deficiencies affect RAS is unknown. Clinical Implications: Observe your patients to see how often they present with both caries and periodontal disease. Clinical Implications: Increasing dietary B12 and folate or adding nutritional supplements seems an easy way to prevent recurrent aphthous ulcers. Mattila, P., Niskanen, M., Vehkalahti, M., Nordblad, A., Knuuttila, M.: Prevalence and Simultaneous Occurrences of Periodontitis and Dental Caries. J Clin Perio 37: 962-967, 2010. n 3 December 2010 » hygienetown.com Kozlak, S., Walsh, S., Lalla, R.: Reduced Dietary Intake of Vitamin B12 and Folate in Patients with Recurrent Aphthous Stomatitis. J Oral Pathol Med 39: 420-423, 2010. n perio reports hygienetown Systemic Markers After SRP and SX Periodontal infection is associated with several systemic inflammatory markers. Low-grade systemic inflammation is evident by increased concentrations of biomarkers including C-reactive protein (CRP), leucocyte counts, serum amyloid-A and other blood markers. Researchers at the University of Pisa in Italy monitored these serum inflammatory markers at baseline, and days seven, 30, 90 and 180 following SRP. They were also monitored after flap surgery out to day 270. The 14 study subjects all had chronic moderate periodontitis. Baseline probing depths revealed an average of 64 pockets measuring 4mm or more per patient. Patients all received baseline data collection, oral hygiene instructions and full-mouth SRP completed within 24 hours. Pockets were reduced at three months to 16 and by six months to 15. Surgery was done in two sessions after the six-month visit and resulted in further pocket depth reductions to eight pockets per patient on average. CRP levels increased after the SRP visit and to a lesser level after each surgery. Other serum markers also showed more significant increases after SRP, with much smaller impacts after the two surgeries. This is most likely attributed to the fact that full-mouth SRP was done when the area of periodontal infection was considerably larger than the areas undergoing localized surgery. The extent of periodontal infection influences the changes in inflammatory markers following treatment more than the particular treatment provided. Scanning electron microscope image of circulating human blood Clinical Implications: Treating a full-mouth with moderate periodontitis will lead to higher serum levels of systemic inflammatory markers than levels immediately following localized periodontal surgery. Graziani, F., Cei, S., Tonetti, M., Paolantonio, M., Serio, R., Sammartino, G., Gabriele, M., D’Aiuto, F.: Systemic Inflammation Following Non-Surgical and Surgical Periodontal Therapy. J Clin Perio 37: 848-854, 2010. n C-reactive Protein Produced Systemically Periodontitis, as well as other systemic diseases are associated with elevated levels of C-reactive protein (CRP) measured in both serum and gingival crevicular fluid (GCF). Treatment of periodontitis reduces CRP levels. CRP is produced by the liver in response to inflammation or tissue necrosis. Even mild serum levels of CRP are evidence of a tissue damaging process going on somewhere in the body. Recent research shows evidence that CRP can be produced in small amounts by cells other than hepatic cells. Based on these findings, researchers at the University of Adelaide in South Australia wondered if CRP might originate in gingival and periodontal tissues as well as systemically from the liver. If CRP is synthesized in gingival tissues, signs of mRNA would be present in tissue samples. Tissue samples were collected from patients undergoing periodontal surgery and from periodontally healthy patients undergoing crown lengthening or who allowed a tissue biopsy prior to tooth extraction. GCF samples were also collected and analyzed. Tissue samples were collected from 46 subjects with periodontal disease and 13 periodontally healthy subjects. GCF flow in those with periodontal disease was double that of the healthy subjects. Polymerase chain reaction was used to determine if CRP was manufactured within gingival tissue. No evidence of mRNA was found in the tissue samples. The authors conclude that CRP measured in GCF is indicative of systemic inflammation, either periodontal disease or infection somewhere else in the body. Clinical Implications: Chairside kits are being developed that have the potential to provide an alternative to blood tests for measuring systemic CRP that might reflect systemic inflammation. Megson, E., Fitzsimmons, T., Dharmapatni, K., Bartold, M.: CReactive Protein in Gingival Crevicular Fluid May be Indicative of Systemic Inflammation. J Clin Perio 37: 797-804, 2010. n continued on page 5 hygienetown.com « December 2010 4 hygienetown perio reports continued from page 4 Oral Cancer Screening Devices Compared In 2008, oral cancer cases numbered 35,000, with 7,500 deaths. ViziLite Plus with TBlue and the VELscope were developed to enhance oral cancer screening exams in the hope of identifying lesions not readily seen by clinicians. Researchers at Moti Lal Nehru Medical College in India compared two diagnostic light systems, ViziLite Plus and VELscope. The study took place at a rural district hospital in central India. A total of 258 patients were examined using an overhead dental light and found to have Prescribing antibiotics to prevent infection resulting from third clinically innocuous lesions that the examiners molar extractions is a topic of considerable debate. In 2007 the decided required no further attention other than American Heart Association issued new antibiotic prophylaxis guidelines routine follow-up. Subjects were randomly based on current evidence of the risks associated with antibiotic overuse. assigned to examination with either the ViziLite Adverse reactions to the drugs and development of drug-resistant bactePlus system or the VELscope. All subjects then ria are greater risks than infection. underwent surgical biopsies. Researchers at the University of Otago, in Dunedin, New Zealand The ViziLite system was used on 102 subcompared impacted third molar extractions in the same patient with and jects. Biopsies revealed one mild dysplasia, two without antibiotic prophylaxis. Ninety-five patients were divided into moderate dysplasias and one cancer. None were two groups and each served as their own control, receiving the assigned correctly identified by the ViziLite or the cliniantibiotic dose for one surgery and a placebo for the other surgery. cians. ViziLite correctly identified 74 out of 98 Group one received 1g of amoxicillin one hour before surgery. In addibenign lesions as negative. Incorrectly identified tion, group two also received 500mg of amoxicillin every eight hours for as positive were 24 benign lesions. two days after surgery. The VELscope was used on 156 subjects. No significant differences were observed between test and placebo Tissue biopsies revealed 11 dysplasias, and one groups for pain, swelling, temperature or trismus. Post-operative cancer. The VELscope correctly identified five infections occurred in just six cases or two percent of the 380 extracdysplasias and the cancer, thus half were correctly tions. Three dry sockets were reported in the placebo group and one identified by the VELscope. The VELscope in the group receiving one dose of amoxicillin. In the group receiving correctly identified 56 of 144 negative findings multiple doses of amoxicillin, one patient experienced a dry socket and six of the 12 positive findings. Eighty-eight after both the antibiotic and the placebo. Differences between the VELscope positives were actually benign. groups were not significant as the overall rate of post-operative infection was so low. Clinical Implications: Identifying precancer- Antibiotics for Third Molar Extraction ous and cancerous lesions is difficult for clinicians, and the VELscope appears to provide benefit in identifying cancer, but also identifies as positive lesions that are not cancer. Doing an oral cancer screening examination on every patient is essential. Mehrotra, R., Singh, M., Thomas, S., et al: A Cross-Sectional Study Evaluating Chemiluminescence and Autofluorescence in the Detection of Clinically Innocuous Precancerous and Cancerous Oral Lesions. JADA 141: 151156, 2010. n 5 December 2010 » hygienetown.com Clinical Implications: Each case must be evaluated individually, however the risks associated with taking antibiotics seem to outweigh the risks due to infection after extractions. Siddiqi, A., Morkel, A., Zafar, S.: Antibiotic Prophylaxis in Third Molar Surgery: A Randomized Double-Blind Placebo-Controlled Clinical Trial Using Split-Mouth Technique. Int J Oral Maxillofac Surg 39: 107-114, 2010. n Probiotics. They aren’t just for digestion anymore. © 2010 Oragenics, Inc. All Rights Reserved. Introducing EvoraPro™ probiotic mints from Oragenics – the first professional-strength probiotics for oral health. Oragenics probiotic products were developed from basic research begun 25 years ago at the Harvard-affiliated Forsyth Institute in Boston. This body of research has shown that a few key naturally occurring oral bacteria can act as antagonists to harmful oral bacteria. EvoraPro and EvoraPlus are 100% natural, and will not harm tooth enamel, dental work, bridges, or dentures. Used just once a day for 10 days after a professional cleaning, EvoraPro supports dental and gingival health and extends the “fresh from the dentist” clean. Each mint contains an extra-strength blend of ProBiora3® probiotics. These beneficial bacteria bind to teeth and go deep under the gingival margin, crowding out harmful bacteria. Let us help you maintain your patients’ oral health while making them more active in their own care. For more information, call us at 877-803-2624 ext. 248 or visit www.ForEvoraPro.com. A 2009 Journal of Applied Microbiology study determined that use of ProBiora3 promotes periodontal and dental health by helping to maintain a healthy balance of bacteria in the mouth1. Since a professional cleaning removes both good and bad bacteria, the days immediately after a cleaning are an ideal time to replenish the good bacteria that are essential for oral health. 1. Journal of Applied Microbiology, 2009; 107: 682-690. EvoraPro PROBIOTIC MINTS AT A GLANCE • Professional-strength probiotics for oral care • Contains ProBiora3 blend of beneficial bacteria After using the 10-day supply of EvoraPro, patients should use regular-strength EvoraPlus® for ongoing maintenance. Used daily over a period of weeks, EvoraPlus substantially reduces levels of certain oral bacteria associated with bad breath. Beneficial bacteria in EvoraPlus also produce a continuous low dose of hydrogen peroxide as a natural metabolic by-product. In a four-week laboratory study, this process provided continuous whitening on stained dental surfaces. 877-803-2624 ext. 248 • Promotes healthy bacterial balance in mouth • Extends effects of professional cleaning • Does not harm tooth enamel, dental work, or dentures • 100% natural I www.ForEvoraPro.com See us at the Yankee Dental Congress in Boston, January 27 – 29, Booth 2034. townie choice awards 2010 That Time of Year is Here! The 2010 Townie Choice Awards Anesthesiology Cosmetic Dental Hygiene Infection Control Periodontics Practice Management Radiology 10 11 11 16 17 19 20 We all look forward to this magical time of year, when we dim the lights, stoke the fire, pour ourselves a mug of hot cider, curl up on the couch and, like caffeinated Tasmanian Devils, tear through the pages of the December issue of Hygienetown Magazine to find out which dental companies, products and services were awarded the highly sought-after Townie Choice Awards! It’s a time of mirth and whimsy, when we all get together online afterward to debate with friends and colleagues the final results of the most important annual poll in dentistry. Happy holidays, indeed! Yes, friends, welcome to the official 2010 Townie Choice Awards showcase! You can pick up the phone and talk to a few of your dental hygiene friends to find out what they use. You can scan the message boards of Hygienetown.com to see what dental hygienists are debating. But do you have the time to sift through the facts or the arguments when you need to help place the order right now? For seven years, the Townie Choice Awards have cut to the chase and answered the basic root of your practice’s purchasing concerns, “What are other dental hygienists using right now?” After months of tabulating thousands of votes cast by honestto-goodness, real-world, practicing dentists, we are pleased to present the winners in each of our TCA categories – from Anesthesiology to TMD. As in years past, in some instances, the race to the finish was close; in others, winners were determined by a large margin. You can find the list of runners-up as well as the winners from the past seven years on Hygienetown.com. Thank you for your participation and continued support of Hygienetown! For the first time this year, TCA voters who cast their ballot by August 7, 2010, were eligible for our $500 early-bird drawing. Congratulations to Dr. George Valentine of Middletown, Connecticut, for winning the $500 Early Voter prize! Dr. Valentine began practicing over 37 years ago and has been a member of Dentaltown since 2002. “I feel that by participating in the Dentaltown surveys and Townie Choice Awards, I can at least, in a small way, return something to an organization (Dentaltown) that I feel offers the premier forum in dentistry for active exchange of professional experiences, ideas, concepts and solutions to the many issues and problems facing dental providers and practices today.” 9 December 2010 » hygienetown.com anesthesiology tca 2010 Congratulations To Our $1,000 Winner Joshua Haremza, DDS Voters of the Townie Choice Awards were automatically entered in a drawing to win $1,000. This year’s winner is Dr. Joshua Haremza of Mendon, New York. Born and raised in New York, Dr. Joshua Haremza graduated Magna Cum Laude in 2005 from State University of New York at Buffalo School of Dental Medicine and completed his one-year general practice residency at Strong Memorial Hospital in Rochester, New York. Dr. Haremza currently practices with 11 staff members and two other doctors in Palmyra, New York, a suburb of Rochester, where he started as an associate in 2006, and purchased 50 percent ownership in January 2008. He now lives in Mendon, New York with his wife, Joanne, and two Beagles, Banana and Oscar, which many Townies might recognize from his posts on Dentaltown.com. “I like using Dentaltown because it keeps me up to date on new technologies and advances in dentistry. I refuse to become one of those dentists that is still using technology from 20 years ago and Dentaltown is the best way to make sure of that.” Anesthetics: Local (Injected) Septodont: Septocaine Septocaine is consistently the number-one branded product in the U.S. Septocaine is indicated for local, infiltrative or conductive anesthesia in both simple and complex dental procedures. It’s available in two formulations so you can decide which epinephrine concentration is right for the patient and the procedure. For more information call 800872-8305. (Votes: 678 of 1,031) Anesthetics: Topicals Sultan Healthcare, Inc.: Topex Anesthetics: Technique System Milestone Scientific: STA System The STA System utilizes computer-controlled local anesthetic delivery to enhance the injection process for dentists and patients. Intraligimentary injections can be administered more precisely as STA provides audio and visual confirmation of proper needle placement and controls the flow of anesthetic. Visit www.stais4u.com. (Votes: 72 of 1,031) Syringes Hu-Friedy: Aspirating Anesthetic Syringe Hu-Friedy’s Aspirating Anesthetic Syringe is Topex is a fast-acting 20 percent ergonomically designed with proportional Benzocaine topical anesthetic. It can finger and thumb grips which increase conbe used to comfort patients with trol and adds comfort during aspiration ulcers, wounds and other minor while reducing hand fatigue. Hu-Friedy’s mouth irritations and eliminates the syringes are available in two styles, a gag reflex when performing radiographs, periodontal and prosType A and Type CW. Visit www.huthetic impressions. Available in seven patient-pleasing flavors. friedy.com for more information. (Votes: 288 of 1,031) Visit www.sultanhc.com. (Votes: 208 of 1,031) continued on page 11 hygienetown.com « December 2010 10 tca 2010 cosmetics dental hygiene tca 2010 continued from page 10 Cosmetic Bleaching: In-Office System Discus Dental, Inc.: Zoom1/Zoom2/Zoom! Advanced Power/ Zoom! Advanced Power Plus Zoom is faster and easier than ever before. With a redesigned patient kit with everything needed for a procedure, along with the award-winning Zoom whitening lamp, comprehensive training materials and a full suite of professionally designed marketing materials, Zoom is a true practice builder. (Votes: 238 of 1,043) Cosmetic Bleaching: Take-Home System Ultradent Products, Inc.: Opalescence/Opalescence Treswhite Supreme Cosmetic Bleaching: Over-the-Counter Products Proctor & Gamble: Crest Whitestrips The Crest Whitestrip Supreme Professional Strength Whitening System offers the highest concentration of take-home whitening available through the dental office among leading brands. The kits include: 14-percent-longer upper-strips and 18-percentlonger lower-strips. Whitens up to 18 teeth. For more information, visit www.crest.com. (Votes: 520 of 1,043) Laboratory: Veneer & High Aesthetic Glidewell Laboratories Our smile-makeover specialists extend a warm thanks for this Opalescence is available in a carbamide peroxide and hydrogen per- award. These technicians take great pride in working with you to oxide formula for superior whitening. The sticky and viscous con- handcraft the beautiful smiles your patients desire. We appreciate sistency prevents the gel from leaching when placed. It’s your support and look forward to helping you meet your patients’ combined with potassium nitrate and fluoride for expectations in the future. sensitivity and is available in a variety of concenCall 800-854-7256 or visit trations, flavors and kit configurations to meet www.glidewelldental.com. all whitening needs. (Votes: 520 of 1,043) (Votes: 96 of 821) Dental Floss: Coated Proctor & Gamble: Crest Glide Dental Floss: Floss Threaders Oral-B: Super Floss Glide Floss is designed to resist shredding. It removes plaque and helps prevent gingivitis for healthy teeth and gums. With Glide Floss, you’ll be able to easily slide floss between teeth due to the light coating of natural wax. For more information, visit www.crest.com. (Votes: 470 of 1,236) Oral-B Super Floss is ideal for cleaning braces, bridges and wide gaps between teeth. Its three unique components – a stiffened end, spongy floss, and regular floss – all work together for maximum benefits. Available in regular or mint flavor, each box contains 50 premeasured strands. For more information, visit www.oralbprofessional.com. (Votes: 424 of 1,236) Dental Floss: Pre-strung Flossers Johnson & Johnson Healthcare Products: REACH ACCESS Flosser Dental Floss: Unwaxed Johnson & Johnson Healthcare Products: REACH The REACH Access Flosser makes flossing as easy as brushing. Convenient, disposable snap-on heads are filled with shred-resistant floss, and the toothbrush style handle with comfortable, easy-to-hold grips and an angled neck reaches back teeth where most problems begin. Fits into toothbrush holders to serve as a daily reminder. (Votes: 317 of 1,236) From Johnson & Johnson, REACH is available in an unwaxed, unflavored floss. It is accepted by the American Dental Association (ADA). Daily flossing has been clinically proven to remove plaque between teeth to help prevent gum disease. For more information, visit www.jnj.com. (Votes: 366 of 1,236) continued on page 13 11 December 2010 » hygienetown.com IS HARD AT WORK BEFORE ACT STARTS WORKING ® * 7x more fluoride uptake 68% more tooth remineralization ACT Total o Care stronger Makes teeth 50% str onger than with fluoride toothpaste e alone e**† POWERED BY Rapid Fusion Technology™ Visit V isit JJDentalProfessional.com JJDentalProfessional.com LISTERINE SMART RINSE ® ® 2.4x Recommend rinsing with LISTERINE® Brand F Fluoride luoride Rinses twi twice daily daily.. Use all pr products roducts o onl onlyy as dir directed. re ected. *Data on file, McNEIL-PPC, Inc. Fluoride ride Rinse, ACT T® Fluoride Rinse for Kids, ACT T® Restoring™ Mouthwash, **Compared Comparred e to ACT T® Fluor Total o otal Care™ Carre™ e in n a laboratory study study. y. and ACT T® T † Compared Compar red e to Cr Crest rest e t® fluoride toothpaste and rinsing with water in a laboratory boratory study study. y. The thir third-party rd-party d trademark trademarks ks used her herein rein e ar are re trademarks of their rrespective e espect owners. espective ©McNEIL-PPC, Inc. 2010 tca 2010 dental hygiene continued from page 11 In-Office Sensitivity Products (non-fluoride varnish) GC America, Inc.: MI Paste/MI Paste Plus In-Office Topical Fluoride: Foam Oral-B: Minute-Foam, Neutra-Foam GC America’s MI Paste and MI Paste Plus (with 900ppm fluoride), with Recaldent (CPP-ACP), created the calcium phosphate treatment category – a breakthrough in the science of remineralization. GC America is on the forefront in the development of preventive products for the dental hygiene professional. Visit www.gcamerica.com. (Votes: 279 of 1,236) Oral-B Minute-Foam is a leading fluoride topical available to dental offices. Its light, airy foam consistency provides unsurpassed coverage and clears easily and quickly from the mouth. Oral-B Minute-Foam’s low pH (3.5) ensures a fast, effective fluoride uptake in 60 seconds. Available in seven flavors. Visit www.oralbprofessional.com. (Votes: 299 of 1,236) In-Office Topical Fluoride: Gel Oral-B: Minute-Gel In-Office Topical Fluoride: Rinse Oral-B Oral-B Minute-Gel offers your patients a treatment to fit their individual requirements and personal tastes. Fast, effective fluoride uptake (12,000ppm in one minute) shortens treatment time and reduces potential for gagging or gel ingestion. Available in four flavors to encourage patient compliance. Visit www.oralbprofessional.com for more information. (Votes: 155 of 1,236) Oral-B Fluorinse is an alcohol-free rinse containing 0.2 percent sodium fluoride. Used once a week, Fluorinse makes patient compliance easy. Available in two flavors, mint and cinnamon. For more information, visit www.oralbprofessional.com. (Votes: 154 of 1,236) In-Office Topical Fluoride: Varnish 3M ESPE: Vanish 5% NaF White Varnish Interdental Devices: Brushes Sunstar Americas, Inc.: GUM Proxabrush Proxabrush products are for people with orthoVanish White Varnish virtually disappears dontic appliances, implants or galvanic sensitivity. The antibacterial bristles inhibit bacterial growth so after application, so there is no trace of the your brush stays cleaner between uses. It is available in a ugly yellow color you see with traditional varnishes. Vanish White Varnish safely delivers 22,600ppm fluoride and contains travel-size brush or handle and refill system and can come tapered xylitol. It takes just seconds to paint on and sets rapidly in the or cylindered with five handle sizes. Visit www.gumbrand.com presence of saliva. Visit www.3mespe.com/preventivecare. for more information. (Votes: 348 of 1,236) (Votes: 299 of 1,236) Interdental Devices: Sticks/Piks Johnson & Johnson Healthcare Products: Stim-U-Dent Mouthrinses: Alcohol-Free GlaxoSmithKline: Biotene Dry Mouth Mouthwash Stim-U-Dent is clinically proven to fight gum disease by removing plaque from between teeth. Just firm enough to clean and polish without abrasion. Just soft enough to invigorate tissue gently and safely with its unique shape which conforms to spaces between teeth. Convenient for use when away from home, anytime, anywhere. Visit www.jnj.com. (Votes: 284 of 1,236) Unlike some harsh mouthwashes that can leave you wincing, Biotene Dry Mouth Mouthwash gently cleans and moisturizes minor irritation in the mouth and freshens breath. Biotene Mouthwash is alcoholfree and uses the LP3 salivary enzyme-protein system. Plus, its moisturizing polymers offer oral comfort and help strengthen saliva’s natural properties. (Votes: 266 of 1,236) 13 December 2010 » hygienetown.com dental hygiene tca 2010 Mouthrinses Johnson & Johnson Healthcare Products: Listerine Antiseptic Listerine kills the germs that cause bad breath, plaque and the gum disease gingivitis. Listerine offers 24-hour protection against plaque and gingivitis germs and has the American Dental Association (ADA) Seal of Acceptance for helping to prevent and reduce gingivitis and plaque. For more information, visit www.listerine.com. (Votes: 589 of 1,236) Oral Cancer Screening Zila Pharmaceuticals, Inc.: ViziLite Plus with TBlue ViziLite Plus, the only adjunct oral cancer screening system with TBlue, is a simple, three-step examination system to help dental practices identify potentially cancerous lesions in the oral cavity. For more information or to place an order, please call 800228-5595 or visit www.zila.com. (Votes: 170 of 1,236) Oral Irrigators Water Pik, Inc. Pit & Fissure Sealants Ultradent Products, Inc.: UltraSeal XT Plus The Waterpik dental water jet is the only brand clinically proven to be an effective alternative to traditional dental floss for removing plaque and reducing gingival bleeding and inflammation. The Waterpik dental water jet removes plaque biofilm both subgingivally and interproximally, and massages and stimulates gingival tissue. (Votes: 498 of 1,236) UltraSeal XT plus is a light-cured, radiopaque, pit and fissure sealant, making it stronger and more wear-resistant. Because it is a 58 percent filled resin, UltraSeal XT plus has less polymerization shrinkage than competitive products. When used in conjunction with Ultradent’s PrimaDry (the priming and drying agent) microleakage is virtually eliminated. (Votes: 348 of 1,236) Prescription Fluoride: Daily Use Colgate-Palmolive Co.: PreviDent 5000 Booster/Dry Mouth/Sensitive (Rx) PreviDent 5000 Booster/DryMouth/Sensitive all contain 1.1 percent NaF (5000ppm) for caries protection. PreviDent 5000 Booster provides general caries protection, while PreviDent 5000 Sensitive contains 5 percent KNO3 for sensitivity relief and PreviDent 5000 Dry Mouth is an SLS-free formula for dry mouth. (Votes: 792 of 1,236) Prophylaxis: Handpieces DENTSPLY Professional: MIDWEST Midwest RDH hygiene handpiece was designed with one specific goal in mind: a hygienist’s comfort. The lightweight, ergonomic design provides a balance of weight, equilibrium and size for reduced hand and wrist fatigue. A smooth finger-tip swivel provides free-flowing access, greater maneuverability and control and less paste splatter. (Votes: 457 of 1,236) Prophylaxis: Prophy Angles Young Dental Prophylaxis: Prophy Paste DENTSPLY Professional: NUPRO Young Disposable Prophy Angles are manufactured with a screwtype cup, giving hygienists reliability and a smooth polishing experience. Young’s leading line of angles is available in the Classic or Contra body and features a variety of prophy cup options, ranging from traditional web to Elite cup; latex-free choices are available. (Votes: 211 of 1,236) The leading prophy paste, NUPRO brand provides everything you need for excellent stain removal and polishing. With a truly splatter-free formula, it rinses cleanly and easily. Choose from four grits and 10 great tasting flavors with 1.23 percent fluoride ion. Select flavors are also available without fluoride. Visit www.denstply.com. (Votes: 404 of 1,236) continued on page 15 hygienetown.com « December 2010 14 tca 2010 dental hygiene continued from page 14 Tongue Cleaners Discus Dental, Inc.: BreathRx Toothbrushes: Manual Oral-B The simple, easy action of tongue scraping has shown to significantly reduce oral malodor as a regular part of patient’s daily hygiene. BreathRx tongue scrapers have a gagreducing slim profile to lift and remove odorcausing bacteria and food debris off the tongue’s surface for fresh breath all day. (Votes: 239 of 1,236) Oral-B Pulsar redefines the manual toothbrush category. It is clinically proven to remove more plaque than the leading manual and battery brushes and uses technologies protected by more than 15 patents. The brush has soft, flexible MicroPulse bristles and a new innovative split brush head. Visit www.oralbprofessional.com for more information. (Votes: 478 of 1,236) Toothbrushes: Power Philips Oral Healthcare: Sonicare/Sonicare FlexCare Toothpaste: Desensitizing GlaxoSmithKline: Sensodyne The Philips Sonicare elite e9000 Custom Care System comes with two brush head sizes, allowing patients to reach posterior teeth and interproximal spaces. The new compact brush head is clinically proven to remove more plaque than the standard brush head in posterior areas. Exclusive offer for dental professionals, visit www.sonicare.com. (Votes: 626 of 1,236) One in every three adults has suffered from dentin hypersensitivity, yet few patients bring the issue to the attention of their dentist. Sensodyne provides the unsurpassed relief from dentinal hypersensitivity that comes with KNO3, helping relieve hypersensitivity in as few as two weeks. (Votes: 762 of 1,236) Toothpaste Colgate-Palmolive Co.: Colgate Total Toothpaste: Whitening Proctor & Gamble: Crest Colgate Total Advanced Clean toothpaste has a unique Triclosan plus Copolymer formula that delivers 12-hour antibacterial protection, even after eating and drinking. It contains micro-particles for enhanced cleaning, and has been proven effective over a range of patient benefits in more than 60 wellcontrolled clinical studies with more than 15,000 patients. (Votes: 516 of 1,236) Crest Whitening Toothpaste includes the bad breath fighting power of Scope, all in one product. Crest tooth whitening provides cleaning action to help prevent calculus buildup and remove surface stains. The added Scope provides icy, fresh breath while fighting tooth decay and calculus. Visit www.crest.com for more information. (Votes: 211 of 1,236) Xerostomia Products GlaxoSmithKline: Biotène Products (Oral Balance) The Biotène family of products offers more options to better meet specific patient needs. There are products that relieve and moisturize, products for ongoing hygiene and products for saliva stimulation. Biotène helps manage dry mouth while supplementing some of saliva’s natural enzymes. (Votes: 871 of 1,236) 15 December 2010 » hygienetown.com Share Hygienetown Share with your hygienists the Web site that was created just for them. A site where they can obtain online CE, participate in peer learning and get more out of their careers – www.hygienetown.com infection control tca 2010 Gloves: Latex Glove Club Gloves: Non-Latex Glove Club The Glove Club offers a comprehensive line of high-quality gloves with unique features to meet the needs of the entire office. All Glove Club brand gloves have been designed specifically to address the concerns of health care workers, such as latex sensitivity, powder levels, and inconsistent sizing and fit. Visit www.glove club.com. (Votes: 114 of 1,000) The Glove Club offers a comprehensive line of high-quality gloves with unique features to meet the needs of the entire office. All Glove Club brand gloves have been designed specifically to address the concerns of health care workers, such as latex sensitivity, powder levels, and inconsistent sizing and fit. Visit www.glove club.com. (Votes: 111 of 1,000) Gloves: Powder-free Glove Club Masks Crosstex International The Glove Club offers a comprehensive line of high-quality Crosstex masks exceed ASTM barrier specifications for low, gloves with unique features to meet the needs of the entire office. moderate and high exposure. They provide submicron filtration and fluid resistance, are latexAll Glove Club brand gloves have been designed specifically free, odorless and comfortable – to address the concerns of health care workeverything you want in a mask and ers, such as latex sensitivity, powmore! Visit www.crosstex.com for der levels, and inconsistent sizing vital mask selection guidelines and and fit. Visit www.gloveclub.com. information. (Votes: 302 of 1,000) (Votes: 112 of 1,000) Pre-Sterilization: Ultrasonic Units Coltène/Whaledent, Inc.: BioSonic Protective Eyewear Gargoyles The BioSonic UC125 Ultrasonic Cleaner is equipped with a programmable LCD display, a degas mode, a digital solution usage timer, easier/faster draining and customizable operation. An exclusive feature automatically adjusts the power in the tank based upon load requirements. Visit www.coltenewhaledent.com or call 800-221-3046. (Votes: 393 of 1,000) Gargoyles Safety Glasses Classic/85s, are optically correct protective safety glasses. ANSI Z87.1 and NATO approved. Unique wrapback design provides 210 degrees of peripheral protection, exceeding OSHA requirements for splash and splatter. Side shields are also available with every model. 100 percent UV protection lifetime warranty. (Votes: 84 of 1,000) Sterilization Pouches DUX Dental: PeelVue+ Sterilizers MIDMARK PeelVue+ Sterilization Pouches offer the highest quality dental pouch. When you use PeelVue you are meeting CDC recommendations. The pouch features builtin internal and external indicators and user friendly color identification that makes ordering and grabbing the right size pouch easy. (Votes: 181 of 1,000) The Midmark family of sterilizers is an all-inclusive solution for your sterilization needs. Combine the capacity of the Midmark M11 and M9 UltraClave Automatic Sterilizers with the simplicity and speed of the M3 UltraFast to create the most efficient workflow for your office. (Votes: 349 of 1,000) continued on page 17 hygienetown.com « December 2010 16 periodontics tca 2010 tca 2010 infection control continued from page 16 Surface Disinfectants Kerr TotalCare: CaviCide Spray/Wipes Unit Waterline Treatments A-dec, Inc.: ICX CaviCide and CaviWipes are tuberculocidal, bactericidal, virucidal and fungicidal surface disinfectants. CaviCide is ideal for dental operatories, instrument-processing rooms and dental labs. Also effective against HIV, HBV and HCV and a reliable means of preventing cross contamination. Visit www.kerrtotalcare.com. (Votes: 388 of 1,000) A-dec’s ICX waterline treatment tablets offer a unique and effective way to maintain clean dental unit waterlines. As the tablet dissolves, it releases ingredients that help prevent deposits and contaminant buildup. ICX continues working after each treatment to help protect waterlines against contamination. For more information, call 800-547-1883 or visit www.a-dec.com. (Votes: 139 of 1,000) Hand Instruments: Curettes & Scalers Hu-Friedy: NEVI 4 Instrument Sharpening Devices Hu-Friedy: Sidekick Sharpener Hu-Friedy’s Nevi 4 posterior sickle scaler features tapered, dual cutting blades that provide effective removal of burnished, heavy and tenacious deposits and precise access for effective deposit removal – made with revolutionary EverEdge technology, which allows the edge to stay sharper longer. Increased shank rigidity provides powerfully effective stokes with less effort and fatigue for the clinician. (Votes: 291 of 1,049) Hu-Friedy’s Sidekick Sharpener helps you maintain sharper instruments with less effort. Our easy-to-use Guide Channels and Vertical Backstop guide you and your scaler to sharp, consistent results time after time. This routine maintenance will actually extend the life of your instruments and protect your investment. The Sidekick is compact, cordless and requires minimal counter space. (Votes: 165 of 1,049) The New Standard for Dental Isolation Now with Two Solutions! Both the original Isolite™ with 5 levels of brilliant Lightless but brilliant! intra-oral lighting and the new lightless IsodryTi™ systems provide continuous adjustable suction, tongue and cheek retraction, throat protection, and a comfort bite block. Professionals using this awardwinning isolation technology are experiencing: U 30% Faster Procedures UÊ I mproved UÊ Reduced Patient Comfort Ergonomic Strain To Learn More about Isolite, Call 800-560-6066 OR VISIT I S O L I T E S Y S T E M S . C O M DTN2010 17 December 2010 » hygienetown.com Superior intra-oral lighting periodontics tca 2010 Periodontal Charting Henry Schein Practice Solutions: DENTRIX The DENTRIX Perio Chart is widely recognized as one of the most comprehensive periodontal charting software programs available enabling you to record standard perio measurements. Data can be compared from multiple visits and viewed and printed numerically or graphically using the graphic chart. Visit www.dentrix.com. (Votes: 245 of 1,049) Periodontal Chemotherapeutics: Local Drug Delivery OraPharma, Inc.: ARESTIN (Minocycline Hydrochloride) Microspheres, 1mg. ARESTIN (minocycline hydrochloride) Microspheres, 1mg. is indicated as an adjunct to scaling and root planing procedures for reduction of pocket depth in patients with adult periodontitis. ARESTIN may be used as part of a periodontal maintenance program which includes good oral hygiene, scaling and root planing. (Votes: 519 of 1,049) Periodontal Probes Hu-Friedy: Colorvue Piezo Tips Parkell, Inc. Hu-Friedy’s Colorvue Probe provides faster and more consistent results. The vivid yellow tip and black markings provide increased intraoral visibility and instant readability. The flexible, rounded tip is safe for use around implants and ensures greater patient comfort and acceptability. The convenient twist-on design allows you to use the clinician-friendly ergonomic handle to easily replace worn tips. (Votes: 246 of 1,049) Parkell’s Piezo Tips are precision-crafted and built to last. They’re available in four models, including the Perio, Universal Straight, Universal Arched and popular Burnett Power-Tip, to cover everything from low-power procedures up through serious calculus blasting. Parkell’s Piezo Tips are easy to work with and compatible with most EMS-brand scalers. (Votes: 105 of 1,049) Power Scalers: Ultrasonic Magnetostrictive DENTSPLY Professional: Cavitron Power Scalers: Sonic DentalEZ Group: StarDental Titan The newly launched StarDental Titan BlisSonic Ergonomic Sonic Scalers are portable, air-powered sonic scalers available in 4-line swivel and fixed backend configurations. The scalers come equipped with five exclusive StarDental-patented scaling tips. For more information, call 866-383-4636 or visit www.dentalez.com. (Votes: 80 of 1,049) Cavitron Sustained Power System (SPS) technology provides scaling efficiency and patient comfort by maintaining power when the insert tip encounters tenacious deposits. The Cavitron JET Plus scaler/air polishing unit and Cavitron Plus scaler offer a 360-degree wireless foot control with hands-free boost. Visit www.dentsply.com. (Votes: 516 of 1,049) Power Scalers: Ultrasonic Piezo Electro Medical Systems SA: miniMaster/Piezon Master 600 Ultrasonic Inserts DENTSPLY Professional Parkell’s TurboPIEZO scaler includes many features of its popular Turbo-SENSOR magnetostrictive scaler, but incorporates European-style piezo technology. The ultrasonic vibration is provided by oscillating crystalline plates within the handpiece, so the TurboPIEZO scaler generates less heat. Call 800-243-7446 or visit www.parkell.com. (Votes: 71 of 1,049) Increase productivity with Cavitron Inserts for better access and adaptation during subgingival and supragingival scaling. Cavitron Bellissima Inserts have a soft grip for clinician comfort and reduced hand fatigue. Water delivery with Cavitron Focused Spray Inserts enhances clinician visibility and patient comfort. Visit www.dentsply.com. (Votes: 367 of 1,049) continued on page 19 hygienetown.com « December 2010 18 tca 2010 practice management continued from page 18 Dental Marketing Demandforce, Inc.: Demandforce D3 Equipment Finance Wells Fargo Practice Finance (formerly Matsco) Demandforce D3 is a software-as-a-service application used by thousands of customers to grow revenue, keep patients coming back and manage operations using e-mail, text messaging, online appointment scheduling, reputation management tools and third-party Internet services. Demandforce D3 integrates seamlessly with existing practice management systems to deliver unparalleled results. www.demandforce.com. (Votes: 113 of 1,060) Wells Fargo Practice Finance provides customized financing solutions supported by business planning tools and resources to help dentists acquire, start and expand their practices. We’re here to help you achieve your goals and are the only practice lender endorsed by ADA Business Resources. Call 888-937-2321 or visit wellsfargo.com/practicefinance. (Votes: 66 of 1,060) Internet Marketing & Web Services Demandforce, Inc.: Demandforce D3 Patient Finance CareCredit Demandforce D3 is a software-as-a-service application used by thousands of customers to grow revenue, keep patients coming back and manage operations using e-mail, text messaging, online appointment scheduling, reputation management tools and third-party Internet services. Demandforce D3 integrates seamlessly with existing practice management systems to deliver unparalleled results. www.demandforce.com. (Votes: 113 of 1,060) Eight-time Townie Choice Award Winner! For more than 23 years, CareCredit has provided patient financing to the Townie community, helping more patients accept needed care. Call for a special offer to get started with the program offered by over 85,000 of your colleagues. Call 800-300-3046, x4519 or visit carecredit.com/dental. If already enrolled, call 800-859-9975. (Votes: 736 of 1,060) Practice Finance Wells Fargo Practice Finance (formerly Matsco) Practice Management Consultants Scheduling Institute: Jay Geier Wells Fargo Practice Finance provides customized financing solutions supported by business planning tools and resources to help dentists acquire, start and expand their practices. We’re here to help you achieve your goals and are the only practice lender endorsed by ADA Business Resources. Call 888-937-2321 or visit wellsfargo.com/practicefinance. (Votes: 73 of 1,060) The Scheduling Institute is a results-focused program that will help you grow your practice by leveraging your existing resources. We begin with training your staff to more effectively handle new patient phone calls; significantly increasing the number of new patients your practice sees. For a special Townie offer call 866-4707203 or go to www.schedulinginstitute.com. (Votes: 117 of 1,060) Software: Patient Communication Systems Demandforce, Inc.: Demandforce D3 Software: Patient Education Patterson Dental: CAESY Education Systems Demandforce D3 is a software-as-a-service application used by thousands of customers to grow revenue, keep patients coming back and manage operations using e-mail, text messaging, online appointment scheduling, reputation management tools and third-party Internet services. Demandforce D3 integrates seamlessly with existing practice management systems to deliver unparalleled results. www.demandforce.com. (Votes: 147 of 1,345) CAESY Education Systems content is distributed via video and computer networks or DVD players throughout the clinical and reception areas of dental practices. The CAESY product family includes CAESY DVD, Smile Channel DVD, CAESY Pediatrics and CAESY Enterprise, which includes Smile Channel and ShowCase. Visit www.caesy.com. (Votes: 357 of 1,344) 19 December 2010 » hygienetown.com tca 2010 practice management radiology tca 2010 Software: Practice Management Henry Schein Practice Solutions: DENTRIX Software: Practice Management Enhancements National Electronic Attachment, Inc.: NEA FastAttach Dentrix is the leader in dental practice management systems with more than 30,000 customers. With the release of Dentrix Mobile, dentists can now use their smart phones and mobile devices to access current information about patients, appointments, medical alerts and prescriptions. Dentrix also provides powerful new tools to increase profitability with Practice Advisor and Profitability Coaching. (Votes: 400 of 1,344) NEA’s FastAttach offers dental providers a cost effective and reliable method of transmitting supporting documents for electronic claims. The unparalleled flexibility of FastAttach is ideal for single, multiple or large clinic practices. Whatever your size, FastAttach will improve your revenue cycle. (Votes: 156 of 1,344) X-Ray Equipment: 3D Imaging Software Nobel Biocare: NobelGuide X-Ray Equipment: Conebeam CT Scanner Imaging Sciences International, Inc.: i-CAT NobelGuide is a complete treatment concept that can be used The i-CAT leads with enhanced features for effective treatment for all indications. NobelGuide offers dental professionals full planning and predictability. These features flexibility in surgical access, loading timing and include the fastest scan and reconstruction prosthetic solutions. Clinical procedures to use rates, an Amorphous Silicon Sensor that capNobelGuide with mini- and full-flap surgical tures multiple-sized scans, full skull to single access are also available. Coming in 2011, the arch, included and shareable i-CATVision, new face of NobelGuide will be launched plus compatibility with major 3D planning as NobelClinician. (Votes: 26 of 1,027) programs. (Votes: 53 of 1,027) X-Ray Equipment: Digital Image Management Software DEXIS, LLC: DEXIS Digital Imaging Software The user-friendly DEXIS software provides easy integration with major practice management programs, digital panoramic systems, cameras and scanners to create a true dental “Imaging Hub” where the practitioner can capture, store and access all intra- and extra-oral clinical images for maximum productivity. (Votes: 221 of 1,281) X-Ray Equipment: Intraoral Machines Gendex Dental Systems: GX-770, expert DC, 765DC The expert DC provides reliable consistency in imaging while offering unique features for flexibility in workflow, such as Quickset controls on the tubehead. Compatible with digital sensors, PSP and film, the unit has a 0.4mm focal spot (the smallest in the market) for maximum image resolution. (Votes: 222 of 1,027) X-Ray Equipment: Digital X-Ray Sensors DEXIS, LLC: DEXIS Intra-oral Sensors The gold standard in digital imaging goes platinum with the new DEXIS Platinum intra-oral sensor. This new version of the PerfectSize sensor achieves direct USB connectivity without docking stations or controllers for maximum portability, TrueComfort design for precise placement and optimum patient comfort, and PureImage technology for remarkably clear images. (Votes: 240 of 1,281) X-Ray Equipment: Panoramic/Cephalometric Machines (Digital) Planmeca: ProMax/ProOne The ProMax Digital Panoramic/Cephalometric X-ray has all the great features of the ProMax Digital Pan, plus the added benefits and imaging programs of a ceph. These are available as a single transportable sensor system or dual-fixed sensor system, and utilize the latest in CCD technology. Visit www.planmecausa.com or call 630-529-2300. (Votes: 100 of 1,027) hygienetown.com « December 2010 20 hygienetown short commentary by Cindy Kleiman, RDH, BS Since 2001 the wars in the Middle East have killed more than 5,300 U.S. soldiers, and 35,000 American soldiers have been injured.1 According to one study at Walter Reed Army Medical Bob Woodruff Center, 62 percent of troops returning from Iraq have suffered head trauma, often due to IEDs (improvised explosive devices).2 The phrase traumatic brain injury (TBI) has increased in use during these years and has led to a growth in medical knowledge in this area. Lives that could not be saved before are now saved; some threatened with lifelong disability are returning to the life they knew before. ABC’s Bob Woodruff was a reporter who became one of these statistics. Oral complications are intertwined with these injuries and are significant. They must be addressed by our profession. Many patients will be permanently in the Veterans Administration system, yet there will be those who want to return to their home-based private dental practice. The following is just a short sample of some of the issues we might be presented with. TBI patients who are in critical care are often placed on a ventilator to assist with breathing. There is no area in medicine where oral hygiene plays a more important role. Poor oral hygiene has an evidencebased connection to ventilator-associated pneumonia.3 This disease has a high morbidity and mortality rate. If the patient survives this first round of challenges, they will be moved to rehabilitation care. Oral care is an important activity of daily living that is sometimes necessary to relearn. If the patient has a knowledgeable and experienced occupational therapist, 21 December 2010 » hygienetown.com this challenge will often be met. If not, he or she might return home needing to start at the very beginning. When providing care on a TBI patient, much homework should be done prior to their appointment. Establish their level of independence and cognitive function. Does he need to be treated in the wheel chair, or is he able-bodied and treatable in the dental chair? How long has it been since the injury? Take time prior to the appointment to completely review the medical history. Is there a shunt or metal plate in the head? Does he need premedication or a medical consultation? Prior to the appointment review all of the medications listed. Most will be on anticonvulsive medications due to the fact that TBI patients are usually left with a seizure disorder. What type of seizures does he have and how often does he experience them? Is he on a medication that produces gingival hyperplasia? Oral hygiene treatment should be provided with the family member or attendant present if that is the comfort level of the patient. Remember, there is a huge range of levels of injury and return of function. You might be seeing someone that is the same person you knew before, or an entirely new personality could be waiting for you. If there is a family member or assistant accompanying the patient, always speak directly to the patient. Have patience! The appointment could be tiring and frustrating for both of you, yet with a multitude of rewards. Your clinical goals might need to be compromised or achieved in increments. It might be appropriate to complete clinical care in two or three appointments. There are so many wonderful oral hygiene products available to our patients. We no longer need to make short commentary hygienetown flossing our number-one mantra, as companies have created many interproximal cleaning options, such as water irrigators and disposable flossers. Powered toothbrushes like the Sonicare Flexcare can lead to increased ease of use for both the patient as well as for the attendant if needed. Utilizing the twominute timer is a must to keep on track. Well considered choices of toothpaste, fluoride and remineralizing products can all lead to improved prevention for these patients. How wonderful that we can partner with them to minimize oral complications and to increase their overall health. They have been through enough already. With the treatment of TBI patients, hygienists have the opportunity to augment their reputation for caring and compassion. It is important to take the time to study this medical condition prior to treatment. We hope that all patients who have suffered a TBI have the comeback potential and success experienced by ABC’s reporter Bob Woodruff. Returning to lead a full and productive life is a reachable goal for many. ■ References 1. Unknown News, http://www.unknownnews.net/casualties.html [Accessed April 2010] 2. Patoine, Brenda, The Dana Foundation, Head Injury Increase in Military Highlights Limited Treatment Options: New Research Seeks Answers, http://www.dana.org/media/detail.aspx?id=14054 [Accessed April 2010] 3. Fields, Lorraine, 2008, Oral Care Intervention to Reduce Incidence of Ventilator-Associated Pneumonia in the Neurologic Intensive Care Unit, The Journal of Neuroscience Nursing, 40 (5) 291-298. Author’s Bio Cindy Kleiman graduated from the University of Pennsylvania and has worked with medically compromised patients for more than 25 years. She provides CE programs internationally and can be reached at [email protected]. See what you’ve been missing! Check out Hygienetown.com today! Message Boards Ask questions, Get answers Get advice on everything from the latest products and treatment options to how to deal with your co-workers Online CE Courses on the hottest topics in Hygiene Perio Reports Easy to read Perio news you can use …and so much more! Connecting you with YOUR dental hygiene community 24/7 hygienetown.com « December 2010 22 hygienetown message board MI Paste or Fluoride for Ortho Patients Patients going through orthodontic treatment are at risk for caries around the brackets and along the gingival margin. A variety of preventive protocols are suggested for these cases. This message board has 31 replies and 945 views. mudehy Posted: 5/19/2010 ■ Post: 1 of 32 Total Posts: 168 23 Which do you recommend? Currently the dentist has all ortho patients on OMNI Gel. I usually put them on MI Paste with fluoride as well. What does everyone else do? ■ lindadouglas Posted: 5/19/2010 Post: 2 of 32 Total Posts: 3,536 MI Paste and fluoride work well together, in the correct ratio. I think that if you are using fluoride, MI Paste Plus is not necessary. MI Paste without fluoride would be better. Tim Ives is really up to date on this; perhaps he will have some more info for you. ■ rdh1982 Posted: 5/19/2010 Post: 3 of 32 Total Posts: 1,243 Very timely topic! I just treated a 16-year-old male ortho patient with extensive decalcification, demineralization and acid erosion throughout his entire mouth! When I questioned him about his dietary acid influences I found out he was drinking 30oz of Gatorade daily plus other fruit-flavored boutique waters like Propel and energy drinks like Monster. Then to top it off, he ate sour candy! Without any hesitation he was prescribed 3M Clinpro 5000 with tri-calcium phosphate for daily home use. I love this product! The calcium and phosphates help rebuild the damaged enamel/root surfaces while the supercharged fluoride helps reharden the enamel. All dietary acids remove calcium and phosphates from the hard tooth structure while Clinpro 5000 helps replenish these essential ingredients. ■ timothyives Posted: 5/20/2010 Posts: 4 & 7 of 32 Total Posts: 258 Thanks for the “big up” Linda. There are a couple of really important points here regarding remineralization and GC probably won’t like me for it! Providing there is no xerostomia and no malfunction of the salivary glands in terms of their mineral output, then CPP-ACP is a waste of time. Saliva is supersaturated with calcium and phosphate and will provide the minerals for remineralization. The only way to find this out is to do a buffering test and a stimulated flow and resting flow rate. If the patient has a low resting flow rate, they need to drink more, which is much cheaper than CPP-ACP! If they have a low stimulated flow rate or buffering problems, they need a lot of CPP-ACP. The key to this whole equation is the pH of the mouth. No matter how much CPP-ACP someone uses, minerals (calcium and phosphate) will not be taken into the teeth unless the pH is at least 5.5 and ideally 7 to 8 where a maximum uptake occurs. Fluoride will be taken into the teeth down to a pH of 4. Below this all the minerals are lost. So to summarize, before deciding which products are appropriate, you need to look at the saliva and (critically) ensure the pH is correct before using them. December 2010 » hygienetown.com message board hygienetown I recommend all my caries-prone patients with the above issues to use CloSYS (stabilized chlorine dioxide) as a prebrush rinse. This ensures the optimum pH and therefore the right environment for remineralization prior to brushing with a high fluoride toothpaste or further rinsing with a fluoride rinse. [Posted: 5/20/2010] Incidentally, another avenue that you could go down is CariFree. All of their products are aimed at neutralization and remineralization at the correct pH. Check out the Web site. I love the CariFree products aimed at babies and toddlers. ■ Fascinating. Saliva flow rate “buffering” testing. This is the first I’ve heard of this test. How do you do it, how much does it cost, and who sells the kit to do it in office? ■ skr RDH Posted: 5/20/2010 Post: 8 of 32 Total Posts: 1,282 In addition to GC America Saliva Check, there is another buffer test made by Orion Diagnostica. These test saliva’s ability to buffer an acid challenge. I also mention these briefly in my Hygienetown online CE course on xerostomia (a shameless plug here). ■ Lindadouglas Posted: 1/23/2010 Post: 11 of 25 Total Posts: 3,429 I have a few more questions. I am familiar with CloSYS II, but I’m ashamed to admit that I did not realize its full purpose or benefit, so thanks for that info. I am curious as to whether you incorporate xylitol into this situation. Wouldn’t that be beneficial for creating an environment for remineralization? I am familiar with the saliva check tests, but I doubt my doctor will ever go for that in our office. ■ JJW, RDH Posted: 5/21/2010 Post: 14 of 32 Total Posts: 2 JJW, Xylitol, yes, yes, yes. It makes me want to believe in God! The cure for caries is sugar, how ironic is that? In my opinion, everyone should recommend it to all their patients from the age of zero. Come visit www.dentalvillage.co.uk (with your DDS) as we have a lot of links to various MI sites and downloads with recent articles we have written on the subject, and protocols to use in the clinic. ■ timothyives Posted: 5/21/2010 Post: 15 of 32 Total Posts: 258 MI Paste is as close to a neutral pH as you can get – most products have a very low pH because of preservatives. Take litmus paper and test PreviDent and Clinpro – you will be amazed! Also, test your patients’ saliva with litmus paper (or GC saliva check buffer). If you see a patient with acidic saliva, give them a pea size bit of MI paste and test their pH right after. You will see it will change from acidic to neutral. (We did this at a Dr. Ngo seminar – really amazing!) ■ DSanzeri Posted: 8/6/2010 Post: 21 of 32 Total Posts: 10 Fluoride for Ortho Find it online at www.hygienetown.com hygienetown.com « December 2010 24