Download CARIES PROTOCOL

Dr. Derango & Dr. Mueller’s
CARIES
PROTOCOL
The answers to your questions.
Jenna R. Derango R.D.H.
Past Methods of Treatment
1. Drill- remove all caries
2. Fill- place restorations
3. To cut is to cure- removing decay
and placing a restoration solved
the problem
Present Method for Treatment
1.
Bacterial control
2.
Reduce risk level
3.
Repair active decay
4.
Continued care
Bacterial Control
• Reduce number of caries causing
bacteria
• METHODS:
– Plaque Removal: brushing and flossing
– Anti-bacterial Mouth Rinse
– Xylitol Gum / Mints
Reduce Risk Level
• Decrease exposure to sugary / starchy
snacks
• Increase repair or remineralization process
• METHODS:
– Diet counseling
– Eliminate food sharing
– Fluoride application to strengthen weakened
areas
– Calcium Phosphate application to strengthen
teeth
Repair Active Decay
• Provide fluoride, calcium, and
phosphate to repair enamel
• Remove caries and replace with
restorations
• METHODS:
– Prescription strength Fluoride toothpaste
– Calcium and Phosphate paste
– Fillings for small caries
– Crowns for teeth with large caries
Continuous Care
• At home and in office
• METHODS:
– Review plaque removal and diet control
– 6 month cleaning appointments with
fluoride and x-rays
CARIES PROTOCOL
• Using x-rays and an oral exam, it has
been determined you have dental caries.
• You are a HIGH RISK patient who not
only needs treatment, but a method of
prevention for the future.
What are Dental Caries?
1. Caries is also known as: cavities or
tooth decay.
2. Caries, if stopped early enough, can
be reversible.
3. Caries is a bacterial infection
caused by specific bacteria.
4. Caries is transmissible, or can be
transferred from person to person,
and from tooth to tooth in a patient’s
mouth.
Caries as a Reversible Process
Different forms of Caries
• Inactive decay- When a tooth has a surface lesion but is
not rough upon examination.
- Inactive decay can be in a state of remineralization or repair. The
tooth, with help from fluoride, calcium, and phosphate is trying to
repair itself.
• Active decay- When a tooth is breaking down and leading
towards becoming a complete irreversible cavity. It appears
as a white chalky lesion that is rough upon examination.
- Active decay is also known as demineralization or decalcification the
loss of calcium and minerals from the teeth .
• There are periods of remineralization and demineralization
of the teeth depending on risk factors.
Factors in the Caries Process
Negative Factors
Bacteria
+ Sugar
Acid
(already living in your mouth)
(candy, soda, etc.)
Acid
+ Tooth
Caries
(Soda, fruit juice, etc)
Positive factors
Saliva
(Calcium & Phosphate)
+ Fluoride
Decrease of caries
Our Caries Management
Program
a.
b.
c.
d.
Caries Protocol is designed to:
Decrease bacteria levels that cause
caries
Increase the repair (remineralization)
process
Reduce the risk of future dental caries
Continually monitor patient status and
progress
Our Caries Protocol Components
•
•
•
•
•
•
•
•
•
Plaque Removal
Diet Review
Saliva Education
Restorations / Sealants
Antibacterial mouth rinse
Xylitol gum/mints
Fluoride toothpaste / varnish
Calcium Phosphate paste
3 month cleaning recall
Plaque Removal by Brushing
Brush time from beginning to end should be around
2 minuets. 30 seconds spent in each section of the
mouth (upper right and left, lower right and left).
1. Using a soft bristled brush place the toothbrush at
a 45-degree angle toward the gum line. Use gentle, short
strokes, moving the brush back and forth against the teeth
and gums along the outside and insides of your teeth.
2. To clean the chewing surfaces of your teeth hold the
brush flat across the surface and use a scrubbing motion
front to back.
3. To clean the inner front tooth surfaces, hold the brush
upright and use gentle up-and-down strokes with the tip
of the brush.
Pictures courtesy of Oral B (Proctor & Gamble http://www.oralb.com/learningcenter/dailycare/brushing.asp
Plaque Removal by Electric
Toothbrush
1. Direct the brush head along the gum line guiding the
brush head slowly from tooth to tooth, following the curve
of the gum and the shape of each tooth.
2. Hold the brush head in place for a few
seconds before moving on to the next tooth.
It isn't necessary to press hard or scrub. Simply
let the brush do all the work.
3. Don't forget to reach all areas, including
the inner and chewing surfaces, and behind
your back teeth.
4. It is also important to brush your tongue using
a forward sweeping motion.
Courtesy of Oral B (Proctor & Gamble http://www.oralb.com/learningcenter/dailycare/brushing.asp
Plaque Removal by Flossing
1. Remove an arms length of floss from the holder and
wrap around your middle fingers. You will use your index
finger and thumb to guide the floss between your teeth.
Make sure to have only a small area, about one inch of
floss between your finger tips at a time to allow for better
control.
2. Ease floss between teeth, being careful not to snap it
roughly against your gums. Pull the floss tight to hug
one side of your tooth gently moving up and down
underneath your gums as far as the floss will go. Lift
up slightly, just enough to move over the tip of the gums
but staying in between the same two teeth, move the floss
towards the other side of the tooth and repeat.
3. As you move to the next area unwind your floss and use a
clean piece. Repeat the above process.
4. Floss between all teeth and behind the last teeth as well.
Pictures courtesy of HIVdent http://www.hivdent.org/_peag/faq-essc.htm
Plaque Removal with braces
When brushing braces it is important to use a
prescription fluoride toothpaste.
1.
In order to clean around brackets first place your brush with
the bristles angled down away from your gums towards your brackets.
Vibrate brush back and forth gently until all areas are clean.
2. Next take your brush facing towards your gums but placed near
the ends of your teeth. Gently vibrate and continue till all areas are
cleaned.
3. Hold your toothbrush straight on with your brackets and gently
scrub to remove any plaque or food from your brackets. Use this same
method to clean the backside and chewing surfaces of your teeth.
4. Finally, tilt your brush vertically to clean behind your front teeth.
Photos courtesy of http://www.andrewsbraces.com/pages/brushing.htm &
http://www.6daydental.com/pages/ortho/care.htm
Plaque Removal with braces
1. To floss between brackets use a floss threader or
specially designed floss with a stiff end.
2. Place floss through large loop in threader.
Use the straight end of the flosser to enter behind
your wire between two teeth.
3. Once the flosser is completely pulled through
teeth separate floss so that an end is on each side
of the wire.
4. Use floss as you normally would gently taking floss
below the gum line following the contour of the teeth.
5.
Remove and repeat until all areas are complete. Any
areas with out brackets or wires should be flossed as normal
as well as behind the very back teeth.
Photos courtesy of http://www.andrewsbraces.com/pages/brushing.htm & GUM® Eez-Thru® Floss Threaders
Other methods of plaque removal
• Some patients especially those
with braces can greatly benefit from
water picks. Water picks are used to
clean underneath your gum line and
between teeth.
• Proxy brushes are also great ways
to clean braces or between teeth with
large spaces.
DIET
• Eating sugary or starchy snacks
increase the risk of caries.
• The sugar mixes with your bacteria to
create acid. The acid then eats away
at the tooth to create caries.
• Reduce the number of sugary / starchy
snacks, food, or drink between meals.
• Reduce the frequency of sugary /
starchy snacks.
0
Battery Acid, Hydrofluoric Acid
1
Hydrochloric acid secreted by stomach lining
2
Lemon Juice, Gastric Acid, Vinegar
3
Grape fruit, Orange Juice, Soda
4
Tomato Juice, Acid rain
5
Soft drinking water, Black Coffee
6
Urine, Saliva
7
“Pure” water
8
Sea water
9
Baking soda
10
Great Salt Lake, Milk of Magnesia
11
Ammonia solution
12
Soapy water
13
Bleaches, Oven cleaner
14
Liquid drain cleaner
Illinois State Dental Society
“Got Rot”
Saliva
• Neutralizes acid to
protect teeth.
• Brushing or chewing
sugar free gum can
increase saliva to
help buffer more
acid.
• Patients with little
saliva should drink
several glasses of
water throughout
the day.
Restorations
• First step in the caries elimination
process after diagnoses.
• Placed after removal of caries.
• Replaces diseased tooth structure with
whatever dental material is necessary.
Antibacterial Mouth Rinse
• Reduce number of bacteria
that cause tooth decay.
• Proven to reduce bacteria for
months after use.
• Must be used in addition to thorough plaque
removal and regular cleanings.
Chlorhexidine
Suggested Protocol:
Rinse with 10 ml of the mouth rinse
in the morning after normal brushing
and flossing for 1 minuet. Use for
two weeks or as prescribed by your
dentist.
Xylitol Gum / Mints
• Sugar substitute with anti-bacterial
affect
• Studies show not only decrease in
caries risk of patient but decrease risk
in transfer of caries from mother to
child.
Xylitol Gum & Mints
• Suggested Protocol:
• Chew or dissolve two pieces
three to five times daily. Use
until the product is gone.
Fluorides
• Help strengthen teeth from being dissolved by bacterial acids.
• Many sources of fluoride: prescription toothpaste and varnish
most effective in preventing and caries and repairing
(remineralizing) teeth.
Fluorides
Suggested Protocol for Pastes:
Brush nightly without water. Do not
eat or drink for 30 minuets.
Suggested Protocol for Varnishes:
Three full mouth applications within a 10 day
period.
MI Paste
• Calcium and Phosphate combination used
to strengthen teeth and assist in the
absorption of fluoride.
MI Paste
Suggested Protocol: Apply pea sized amount
to your finger rub on the surface of your teeth
then use your tongue to rub around to all
surfaces. Use a minimum of twice daily after
brushing and flossing
3 Month Recall
• 3 month cleanings are recommended to
eliminate plaque, provide fluoride, and
re-examine your teeth.
• We will evaluate your home care and
answer any questions that you may
have.
Protocol Results
• Again, we want to stress that you have been
diagnosed as a HIGH RISK caries patient.
We know that by reducing decay causing
bacteria, we can significantly decrease your
risk for future dental caries.
• Our goal for all of our patients is not only to
fix teeth, but to lower your dental risk factors.
By working together with this recommended
program, we can and will achieve this goal!
Points
Risk Factors
Number of smooth surface lesions
Number of occlusal lesions
Number of recurrent decay
Number of caries restored in the past year
Number of rough white spot lesions
Number of interproximal watches
_______ x 1.5
_______ x 1.0
_______ x 1.0
_______ x 1.0
_______ x 0.5
_______ x 0.5
Each of the following answers = 1 point
Caries restored in the past 3 years
Heavy plaque
Frequent sugary/starchy snacks
Saliva reducing facotors:
- Medications
- Head / Neck Radiation
- Systemic Disease
- Dry Mouth (other)
Occlusal or Diagnodent watches
Orthodontic appliances or partial dentures
Deep pits & fissures / developmental defects
Exposed root surfaces
Notes:
Notes:
Notes:
TOTAL
Protocol 1 (4-8 pts)
Oral Hygiene / Diet Review
Prevident Toothpaste
Spry Gum or Mints
Fee
Protocol 2 (9-12 pts)
Oral Hygiene / Diet Review
Prevident Toothpaste
Spry Gum or Mints
Chlorhexidine Mouth Rinse
Fluoride Tx @ q C/R
MI Prophy Paste & home usage
Fee
Protocol 3 (>12 pts)
Oral Hygiene / Diet Review
Prevident Toothpaste
Spry Gum or Mints
Chlorhexidine Mouth Rinse
Fluoride Tx @ q C/R
MI Prophy Paste & home usage
Fluoride Varnish 3x within 10days
GC Saliva Test
Bacterial Test @ 3 month recall
Fee
$
$
$