traduccion minima invasiva

8/14/2019 Traduccion Minima Invasiva

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The Ultimate Prevention Plan ~

Conception to College

Sweetwater DentalHygienists Association

2004

The Ultimate Prevention Plan


Shirley Gutkowski, RDH, BSDH

Sponsored by Xlear, Inc and Dreir Pharmaceuticals

Operative Dentistry for Children

Not filling teeth but preserving the necessity forfilling teeth should be the dentists work. Let

him consider himself successful who canshow a clientele where his patients boast thatnever from babyhood to the grave have theyhad a stain or hole in any tooth. That is truedentistry, not this tiresome, painful pluggingof holes. It is an ideal possible for themajority of people. Why is our profession

permitting sixty percent to suffer needlessly?


M. Evangeline Jordan, DDS


Chapter IIIOral Prophylaxis

Copyright,


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J Perio August 2002


Conception to College Study on pregnant women with periodontal

disease

All measurements for a given woman wereperformed by the same examiner

Carious lesions were treated and all teeth

indicated for extractions were extractedfrom both groups

J Perio August 2002



6.38%12 PTB1.10%2 PTB

10.11%19 PLBW1.63%3 PLBW3.72%7 LBW0.55%1 LBW

188 Women

Control Group

163 Women

Treatment Group

The Ultimate Prevention Plan ~Conception to College

The Cavity Connection

DecayFour Ingredients

The tooth

GermsLacto

Strep mutansStrep

Germ Foodfermentable carbs

sugaracid

TimeExposure

pH


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3



The tooth

GermsLacto

Strep mutansStrep


sugaracid

TimeExposure

pH

Rebuilding

Fluoride Recaldent

Xylitol Saliva

1000 ppm Fluorideincorporated into thetooth as it forms

100 ppm Fluorideincorporated into thetooth as it forms

Both decay atthe same rate


Fluoride Works on the surface

Doesnt need super clean surface towork

Its in municipal water supply

Its in toothpaste

Office treatments 4 minute gel 1 minute rinse 1 minute gel 1 minute foam

Fluoride varnish

Home fluoride rinseHome fluoride rinse

Home fluoride gels RxHome fluoride gels Rx

Fluoride LozengesFluoride Lozenges


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The Tooth ~ Rebuilding with

Fluoride

Works in the pits

and fissures too!

The Tooth ~ Rebuilding with

Fluoride J Public Health Dent. 1992 Winter;52(2):111-6.

A comparison of the caries-preventive effects offluoride mouthrinsing, fluoride tablets, and bothprocedures combined: final results after eightyears.

Driscoll WS, Nowjack-Raymer R, Selwitz RH, Li SH,

Heifetz SB.

Disease Prevention Section, National Institute of Dental Research, National Institute ofHealth, Bethesda, MD 20816.

This paper presents final results of an eight-year clinical trial designed to compare the

caries-preventive benefits of two self-administered fluoride procedures when usedseparately and in combination with one another. Children in kindergarten and firstgrade residing in Springfield, Ohio, a nonfluoridated community, were assignedrandomly within school to one of three groups that either (a) rinsed once a week inschool with a 0.2 percent neutral NaF solution; (b) chewed, rinsed with, and thenswallowed daily in school a neutral 2.2 mg NaF tablet; or (c) carried out bothprocedures. At baseline (1981), 1,640 participants were examined clinically using theDMF surface index. Findings for 640 children remaining after eight years show thatsubjects in the combination group experienced a mean caries increment of 2.40DMFS, 15.2 percent lower than the mean score of 2.83 DMFS for children in the tabletgroup and 32.8 percent lower than the 3.57 DMFS for those in the rinse group. Onlythe difference in incremental caries scores between the combined fluoride procedureand the fluoride rinse was statistically significant (P less than .05).

The Tooth ~ Rebuilding withFluoride

The pattern of these findings is similar to thatfound on the two interim examinations. Even

though the combined regimen showed anadditional caries-preventive benefit comparedwith the rinse, considerations of costeffectiveness and feasibility do not supportchanging an ongoing rinse program to onethat employs both procedures. For newprograms the best choice appears to be thetablet procedure alone.

www.drierpharmaceuticals.com

Bacterial Redistribution ~at homeThe key to the development of

a more acid-resistant toothis not the amount offluoride applied to thetooth, but the frequencyof its application.


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Saliva

1.12 +/- 0.100.60 +/- 0.05Stimulated salivary

flow (ml/min)

0.73 +/-0.090.43 +/- 0.03*Unstimulated

salivary flow (ml/min)

7.21 +/- 0.067.72 +/- 0.09*Stimulated salivary

ph

7.12 +/- 0.056.55 +/- 0.07*Unstimulatedsalivary pH

Without cariesWith Caries

Unstimulated and stimulated salivary pH and flow rate inpatients with and without caries

Saliva

Salivary pH changes during soft drinksconsumption in children

International Journal of Paediatric Dentistry2003: 13: 251-227

Coke pH 3.18

Sprite pH 2.23ADES N pH 3.20

Chocolate milk pH 7.1

One drink per week

No straw pH 9x first hour

Results averagedper child

Hydroxyapatite dissolves

Fluorohydroxyapatite dissolves

Recaldent

Supply Calcium and Phosphorus

Casein

From dairy products Available form

Not for people with milk allergies

OK for lactose intolerant


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From GC America SlideSeries

Minimally Invasive Dentistrythe saving of enamel


H+H+ H+

H+

HOW RECALDENT WORKS

Dr. E Reynolds


HOW RECALDENT WORKS

Dr. E ReynoldsFrom GC America SlideSeries

HOW RECALDENT WORKS

Dr. E Reynolds


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The tooth

GermsLacto

Strep mutansStrep


sugaracid

TimeExposure

pH

Killing Re-Distribution

ChlorhexidineRembrandt

Xylitol

At homeFlossBrush

At the OfficeHandpiece

polish



The toothGermsLacto

Strep mutans


sugaracid

TimeExposure

pH

Kill Them

ChlorhexidineRembrandt

XylitolArginine

metabolic Starving

Ecology

P. Dirckx 00


Illustration by Keith Kasnot, Scientific American, July 2001

http://www.altcorp.com/AffinityLaboratory/biofilms.htm


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Published in: Science, 21 May 1999, VOL 284 P. Dirckx 99 MSUCBE


Xylitol

Disrupts bacterial

metabolism Decreases lactic acid

output

Best in Gum


Xylitol

1. Interferes with MS metabolism

2. Effects oral ecology

3. Oral biology homeostasis

4. Stimulates saliva flow

5. Shifts equilibrium to enhanceremineralization


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Inoculation of Streptococcus Mutans

Window of Infectivity

median 26 months of age

Mohan 20% by 14 months

Milgrom 6 months and predentate


Conception to College XylitolStart with the mothers

Soderling March 2000

195 mothers

127 study group 2-3 times per day

At 2 years of age 9.7% colonized with MS 28.6% in CHX 48.5 in Fl group


Percent of Children Colonized at age 2

0

5

10

15

20

25

30

35

40

45

50

Xylitol Chlorhex Fl Varnish


Xylitol

Start with the mothers

Isokangas Nov 2000 143 mothers still available

Chewed Xylitol until children age 24months

Kids at age 5

71% less dmf than fluoride group

74% less dmf than CHX group


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Conception to College Xylitol Soderling May 2001

147 mother/child pairs

Kids are 6 years old

Children showed reduced MS counts 4 years aftermothers quit chewing xylitol

Concludes MS counts were still less in children atage 6

Caries prevention by xylitol compared to a control group

-90

-80

-70-60

-50

-40

-30

-20

-10

0

Turk

u1

Turk

u2

Sovie

tUnio

n

Fren

chPolyn

esia

Hung

ary

Mon

treal

Ylivi

eska

Beliz

e

Stan

nCreek

Dayto

n

Eston

ia

% Reduction in Caries for Xylitol vs. Control



Xylitol

Hujoel 1999

Only half the likelihood of decay 5 yearsafter chewing the experimental gum

Long-term caries risk is down 93% in teetherupting during the second year of habitualuse


Second Window of Infectivity

Occurs when first molars areerupting


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JADA May 2000Dennison


20% higher incidence of caries insecond molars [over first molars]

Featherstone reported in the 1980s 75% of children aged

5-11 years were caries-free and about 70% of the 12-17year olds had caries.


Conception to College Xylitol

Hujoel 1999

data suggest that xylitolgum-chewing should start at

least 1 year prior to[permanent] tooth eruption.


Alanine

ArginineAsparagine

Aspartic AcidCysteineGlutamic AcidGlutamineGlycineHistidine

IsoleucineLeucineLysineMethionine

PhenylalanineProlineSerineThreonine

Tryptophan

TyrosineValine

Minimally Invasive Dentistrythe saving of enamel


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Conception to College Other methods to kill germs

OTC mouthwashes Lister ine

Alcohol

Artificial colors

Rembrandt Dazzling Fresh Mouth and Age Defying

No Alcohol

No Colors Tea Tree Oil

Prescription mouthwashes Chlorhexidine

Assessing risk

Recent decay

Family history

Past decay history

Diet

Caries Activity Test

Home care

X-rays

Fluoride sources

Water

Toothpaste

Soft drinks

Tea

DIAGNOdent

QLF Saliva quality

Assessing risk

Disclosing solution not just for kids

IO camera

Assessing risk

X-rays


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Assessing risk x-rays

Quality of film

Readability

Reproducibility

Good Contrast

Low radiation dose

Assessing risk x-rays

High contrast and high max densitysupport diagnosis

Extra soft, smooth corners/edges,disinfectable

Short exposure times

Firm/flexible

Archival quality ensured for 30 years Agfa Film

Assessing risk

White spot lesions can remin. Completelyprovided no mechanical damage occurred.

Occlusal caries is over total cariesexperience

Occlusal surfaces accounts for only 13%of tooth surfaces

Assessing risk

Probing tests show probing pressureincreases during the day

Save to infer increased explorerpressure as well


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Slide from KaVoDIAGNOdent series

These areas mayThese areas may

not benot be

decalcified, and adecalcified, and a

explorer wontexplorer wont

stickstick

Bacterial Redistribution ~ theoffice


Misdiagnosis

20-80% of true

enamel caries called

sound

5-20% of soundfissures are called

carious

Cariesprocess

Assessing risk QLF

Time

Cavity

No CavityWhite spot

Enamel lesion

Dentin lesion

Pulpal lesion

De- & Re- mineralization

Colonization

Adhesion

30+

25-30

20-25

5-10

0-5

PreventiveTherapy

NoAction

15-20

10-15

DIAGNOdentreading

Possible Course of Action

PreparationSealantRecord

andMonitor

Assessing risk QLFPlaque Assessment

Plaque: Can we detect plaque with QLF and is it possible to assess

the threat this plaque poses?

Non-stained plaque in a caries

prone person.

Non-stained plaque in a caries

inactive person after 5 days

abstaining from brushing.

Stained plaque in the same

patient.All pictures courtesy of Dr. R. Heinrich-Weltzien and Dr. J. Knisch,

Friedrich-Schiller University of Jena, Erfurt, Germany


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Evolution in Dentistry

Advancements in Patient Care

Advancements in Technology

Philosophy shift from extraction toprevention



The tooth

GermsLacto

Strep mutansStrep


sugaracid

TimeExposure

pH

Redistribution

Mechanicalat Home

Manual ToothbrushCross Action

CrestTess

Power brushSonicareCrest SpinOral Giene

InterdentalStimU DentsProxa brush

End tuft brush



The tooth

GermsLacto

Strep mutans


sugaracid

Time

ExposurepH

Redistribution

MechanicalAt the Office

PolishingPaste

Clinpro PolishAir Polish

HandpieceErgonomic

Midwest RDHNSK America


The American Academy ofPediatric Dentistry

Position on Sealants


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American Academy ofPediatric Dentists

Bacterial Redistribution ~ the office

1. Bonded resin seals,effectiveness increasedwith good technique

2. Benefit increasedsealing high risk teeth

3. Best risk eval done byexperienced clinician(tooth morphology,clinical diag., past historyof caries/fluoride/oralhyg.

4. Caries risk may exist inany tooth with a pit orfissure at any age

5. Placement methods shouldinclude careful cleaning ofthe pits and fissures withoutremoval of any appreciableenamel.

6. Low viscosity, hydrophilicmaterial bonding layer hasbeen shown to enhance thelong term retention

7. Glass ionomer are ineffectiveas sealants, but could beused as transitional seals

8. Profession must be alert tonew preventive methods


S. Mutans prefers to live in pits andfissures

Saliva and neighboring teeth arebelieved to be the main source of

infection 50% of decay is on 13% of tooth

surfaces


Sealant facts

Fluoridated community molars scored

initially sound becae carious at a rate of13% if not sealed

Fluoridated community molars scoredinitially sound became carious at a rate of8% if sealed

Ped Dent 24:5; 2002

Use of Fissure sealants

Feigal reporting on Heller 1995

J Pub Health Dent


Sealant facts

Fluoridated community molars scored as

incipient or questionable became cariousat a rate of 52% if not sealed

Fluoridated community molars scored asincipient or questionable became cariousat a rate of 11% if sealed.


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Ped Dentistry 24:5 2002Feigal



Sealant Facts The last remnants of caries in a fissure should

be inconsequential to the success of thesealant.

Surface cleaning is all that is appropriate,unless one judges a fissure to contain cariesthat has progressed to the dentin. Thus,

caries-detecting dyes hold no therapeuticvalue.

Defects in theDefects in the

fissure walls canfissure walls can

lead to dentinlead to dentin

caries withcaries with

NONO enamelenameldecalcificationdecalcification

CantCant

diagnosediagnose

this with athis with a

explorer orexplorer or

CariesCariesDetectionDetection

Dye (CDD)Dye (CDD)




Fluoride Releasing

Fluoride Recharging

Transitional Sealant

Transitional Restoration

No etching

Moisture friendly

Acts as a physical barrier

Surface protectant

Announcing Triage White


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The Ultimate Prevention Plan ~Boomers and Beyond


The tooth

GermsLacto

Strep mutansStrep


sugaracid

TimeExposure

pH


Boomers and Beyond


Journal of Public Health Dentistry 2003 Spring

Atraumatic restorative treatment (ART): a three-year

clinical study in Malawicomparison ofconventional amalgam and ART restorations

Results: The survival rates of ART restorations after threeyears were lower than those of amalgam restorations. 81%vs 90% p= 0.067

Conclusions: ART class I restorations is competitive withthat of conventional amalgam restorations


Caries Research 2003 Jul-Aug

Six-year success rates of occlusal amalgam andglass-ionomer restorations placed using three

minimal intervention approaches.

Secondary caries observed for 2% of glass-ionomer and10% of amalgam restorations. p=0.001

ART approach using glass-ionomer performed equally wellas conventional restorative approaches using electricallydriven equipment and amalgam for tx dentinal lesions inocclusal surfaces after 5 years


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#18

B 22

#18

B 35

#28MP55

#28MP66

#3

B 352 moF

Varnish#3

B 50Mike

#12DP15

4 moF

Varnish#12

DP 30Derek

Secondreading

Timelapse

Inter-vention

FirstReading

Patient


Drink it fast

Drink it with a straw

Rinse with tap waterafter (source of fl)

Chew gum withRecaldent in it

Brush your teeth twicea day until all the stuffthat looks like paste isoff

Rinse with ACT beforebed

Have a dental checkup 4x/yr

Get a power brush

Use Lozi-flur asdirected

Dont rinse out thetoothpaste


Summary of Remineralization plan

Assess

Offer options Take more clinical responsibility


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The tooth

GermsLacto

Strep mutansStrep


sugaracid

TimeExposure

pH

Meal f requency Chew ing Gum

Acid RefluxSugar free

Aspertamesorbitol

xylitol


Advancements in dentistry today

Technological advancements

For Patients Xylitol

Home fluoride

Power brushes

Recaldent

Municipal water fluoride Fluoride toothpaste

Educated clinicians



Preventive Philosophy

Medical view

Physicians of the mouth

Bacterial nature of decay and perio




Preventive Philosophy

Prevent decay

Prevent perio Prevent tooth loss

Prevent systemic diseases


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Medical view

Generalists

Treating disease without surgery

Treating diseases

Referring advanced cases



Physicians of the mouth

Not acting as a carpenter

Acting as a physician

Looking for potential diseases

Treating diseases early

Asking questions

Treating the Whole family



Bacterial nature of decay and perio

means medicines as well as debridement

understanding bacteria understanding biofilms

no longer surgical basis to treatments




For Clinicians Clinpro paste

Weightless handpieces NSK cordless

Fluoride varnishes

Fluoride lozenges

DIAGNOdent

Intraoral cameras

Lasers

X-ray film and digital x-rays


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Boomers and Beyond

Preventing Injury acrobatics,

baseball,

basketball,

bicycling,

boxing,

equestrian events,

field events,


Boomers and Beyond

Preventing Injury field hockey,

football,

gymnastics,

handball,

ice hockey,

in-lineskating,

lacrosse,

martial arts,

racquetball,

rugby,

shot put,

skateboarding,

skiing,

skydiving,

soccer,

softball,

squash,

surfing,

volleyball,

water polo,

weight lifting,

and wrestling

O-pro

Impressions

Lab molded

Under $50

www.Opro.com


Prevent dental phobes using music orother distractions


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JDHA Fall 2000 Behav ManagInstruct of Anxious Clients...


Visual distractions work better thanauditory

Deep breathing

Modeling

Siblings

Parents

Peers/video

JDHA Fall 2000 Behav ManagInstruct of Anxious Clients...


Retaining control

General Anesthesia v Local w/N2O

Less anxiety with Local w/N2O

Muscle moves bone

The lip exerts 100

grams of pressure Teeth need 1.7 grams

of pressure to move

The tongue exerts 500grams of pressure

Relapse

Fixed appliancesdont affect muscle

Myofunctionalappliances that createbiofeedback


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Myoresearch.com

MRC Positioner acts as a protectantagainst the brackets and bands

Opens the occlusion decreasing fixedappliance time by up to 15%

Can be for children and adults

6 months for the first soft appliance

Finish when the lips are competent.

Moulded into the anterior section (similar toorthodontic archwire).

1. Tooth Channels.

2. Labial Bows impart a light force on misalignedanterior teeth as they are developing..

3. Tongue Tag actively trains the positioning ofthe tongue tip as in myofunctional and speechtherapies.

4. Tongue Guard stops tongue thrusting when inplace and forces child to breathe through thenose.

5. Lip Bumpers to discourage over-activementalis muscle activity.

6. Edge to Edge Class I Jaw Po sition isproduced when in place (same as most functionalappliances). Combined with prevention of tonguethrusting and forcing the child to nose breathe,Class II correction in particular, is achieved.

http://www.agd.org/


Tobacco users who dip or chew 8 to 10 times a daymay be receiving the nicotine equivalent of 30 to 40

cigarettes a day.

The risk of developing oral cancer for long-term spittobacco users is approximately six times greater than

for non-users.

Children who use spit tobacco products are 4 to 6times more likely to develop oral cancer than non-

users.www.tobaccofreekids.org


id you know that:More than 5 million children alive today will dieprematurely from smoking-related illnesses?

Nearly every adult who smokes (almost 90 percent)took his or her first puff at or before the age of 18?

Or, that increasing tobacco taxes is an effectiveway to prevent and reduce smoking, especiallyamong kids?


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Oral Cancer facts:

Increase in people under forty

Largest increase in people with no riskfactors

Oral cancer survival is 50% due to late

diagnosisMost Oral cancer is detected in the

Physicians office


www.oralcancer.org


Chemotherapy

Radiation therapy

Caries reduction

traduccion minima invasiva

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