Smiles Across America Webinar Series

9/8/2015

Innovative Dental Hygiene Solutions

/Oral Health America @Smile4Health

Connect with OHA!

/Oral Health America @Smile4Health

HOUSEKEEPING INFORMATION

• Please remember to MUTE your phone.

• Questions are welcome! We’ll allow 10-15 minutes after the presentation for questions.• Questions will be accepted in writing through the control

panel on the upper right hand of your screen.

• Submit questions at any time; we will address them at the end of the presentation.

• Webinar is being recorded; for rebroadcast on OHA’s website – OralHealthAmerica.org

• Your feedback is important to us. Please take our brief webinar evaluation after this session; link will be sent via email.

CE Credit Available

OUR MISSION

Oral Health America’s mission is to change lives by

connecting communities

with resources to drive access to care, increase

health literacy, and advocate for policies that

improve overall health through better oral health for

all Americans, especially those most vulnerable.

OHA PRIORITIES

ADVOCACYHEALTH

LITERACYACCESS

OHA’s Programs and Campaigns are designed to improve

access to care, oral health literacy and policies that

prioritize the impact of oral health on the overall health of all

Americans – particularly those most vulnerable.

Campaigns for Oral Health Equity

Educate the public, including policy makers, about the importance of oral health for overall health

Emphasize the need to prioritize oral disease alongside other serious health conditions

Advocate for policies that positively impact programs and stakeholders

Current campaigns include:

toothwisdom.org Demonstration

Projects

Professional

Symposia

Advocacy Health Education &

Communications

Technical Assistance

Product Donation

Grant Funding

Karen Stoklosa, MBA

Tabetha Magnuszewski, RDH

Innovative Dental Hygiene

Solutions

Disclosure

Innovative Dental Hygiene Solutions

DiagnosisCRT Bacteria

MaintenanceProxyt

PreventionHelioseal

Fluor Protector S

Cervitec Plus

Dental Caries

Worldwide Health Concern

20% of children age 5-11 have at least one

untreated decayed tooth.

Approximately 15% of adolescents aged 12-

19 have at least one untreated decayed

tooth.

91% of children have experienced dental

caries by adulthood.

Caries risk grows with increased age

Caries Development

Bacteria

High Sugar Diet

Acidic Metabolic Byproducts

Lower pH

Caries

Traditional Treatment Model

• No diagnosis

• Treat everyone

• #1 Goal – Removal of Plaque

• Brushing & Flossing

• Recall Exams

• New Restorations

Medical Model of Care

• Diagnosis is essential

• Restore diseased areas

• Eliminate the infection

• Decrease & eliminate bacteria

• Treatment ceases

• Recall to diagnose and retreat

Caries Risk Assessment

• Diagnose disease to identify causative organisms

• “Medical Model of Care”

• Identify patients susceptible to dental decay

• Focus on prevention and early intervention

• Treat patients individually before caries/lesions are

established

What is a Caries Risk Test?

A comprehensive test used to determine Streptococci mutans and

Lactobacilli count in saliva by means of a selective culture media.

Streptococci Mutans

• Caries initiators

• Capacity to adhere to tooth surface

• Sugar transport system

• Triggers the host response system

• Produces lactic acid

• Tolerant of acid environment

Lactobacillus

• Responsible for caries progression

• Indicative of frequent sugar intake and/or active caries

• Do not adhere to tooth surface

• Colonize via carious lesions

• Pit & Fissure

• Marginal Gap

• Brackets

CRT® Bacteria

Step by Step

• Have patient stimulate salivation by chewing on the paraffin pellet.

• Collect saliva in a suitable container.

• Remove agar carrier from the test vial.

• Place a NaHCO3 tablet at the bottom of the vial.

• Carefully remove the protective film from the two agar surfaces.

• Thoroughly wet both agar surfaces with saliva using pipette.

• Allow excess saliva to drip off.

• Slide the agar carrier into the vial and close tightly.

• Use a waterproof pen to note the name of the patient and date on the vial.

• Place the test tube upright in an 37°C incubator for 48 hours.

• Compare the density of mutans streptococci and lactobacilli colonies with model chart.

Diagnosis – Streptococcus Mutans

Low Risk High Risk

Diagnosis - Lactobacillus

Low Risk High Risk

CRT® Bacteria

Advantages

• Identify caries risk at an early stage

• Test for both S. mutans and Lactobacillus

• Results in 48 hours

• Easy to conduct

• Great tool to educate and motivate patients

• Can be used to monitor specific therapies and treatment

Bacterial Testing

ClinPro™ L-Pop 3M ESPE

• Tongue sampling

• Tests lactic acid formation

Saliva Check Mutans GC

• S. mutans only

Oral Health Management

Caries Risk Test

Characteristics Advantages

Targeted and distinct treatment measures

Basis for periodical prophylaxis

Check of treatment success

Earnings

Prevent healthy teeth / caries prevention

Free of pain treatment

Quality assurance

Build-up a long-term patient loyalty

Better reputation: suggestions

Satisfied patients

Execution of the test by trained staff Expansion of job function

Economics

Innovative Dental Hygiene Solutions

DiagnosisCRT Bacteria

MaintenanceProxyt

PreventionHelioseal

Fluor Protector S

Cervitec Plus

Prevention

The higher the severity of risk factors at diagnosis, the greater the prevention strategy needs to be

*Several of these preventive agents are used off-label for caries prevention

• Fast & easy way of protecting

teeth from bacteria

• Acts as a barrier, protecting

enamel from plaque and acids

• Provides a smooth surface for

easy cleaning and maintenance

Types of Sealants

• Polymerization – self-cure vs. light-cure

• Color – clear, tinted or white

• Fillers – filled or unfilled

• Glass Ionomers

• Resin-based

High Caries Risk

Sealants have shown to reduce decay in permanent molars by 81% for

2 years after placement*

Proximal caries16%

Fissure caries84%

Caries Occurrence in Children and Adolescents in the US

*CDC 2013

ADA Report 1997

Helioseal®

Indications

• Premolar and Molar Pit & Fissures

• Lingual Foramen

Advantages

• Prevent bacteria from colonizing

• Cut off carbohydrate supplies

• Facilitate oral hygiene

Sealedfissure

Bacteria cannot survive

Carbohydrates &Bacteria

Helioseal®Helioseal®

White, Opaque

Medium Viscosity

Economical

Helioseal® F

White, Opaque

Medium Viscosity

Fluoride Release

Helioseal® Clear

Transparent

Excellent Esthetics

Easy Recall

Helioseal

Comparison of Fissure Sealants at 1 Year

Schlüter et al. 2011

1.Easy access 2. Tooth to be

sealed3. Cleaning 4. Isolation 5. Etching 6. Rinsing

7. Drying 8. Applying the

sealant

9. Light-curing/

polymerization

10. Checking

occlusion

11. Finishing 12. Check-up &

fluoridation

37

SEALANTS- STEP BY STEP

Prevention

The higher the severity of risk factors at diagnosis, the greater the

prevention strategy needs to be

*Several of these preventive agents are used off-label for caries prevention

Fluoride Delivery Forms

• Recommends the use of professionally-applied topical fluorides for caries prevention.

• Recommends using fluoride to prevent and control dental caries in the United States.

• Recommends fluoride use for prevention/control of caries. Is safe and highly effective in reducing prevalence in children.

Topical Fluoride Recommendations

Benefits of Fluoride Varnish

• Easy, fast & convenient application

• Saves time & money

• Achieve greater patient acceptance

• Safer then rinses & gels

• reduced risk of ingestion

• Increased fluoride release

Clinical Effectiveness of Fluoride Varnish

• Contact time/adherence

• Fluoride source/concentration

• Fluoride availability

• Flow & wetting behavior

A Healthy BalanceHealthy Saliva pH 6.6

Enamel DemineralizationpH 5.5

Fluoridation Process on the Enamel

Demineralized enamel

Weakened tooth structure

Increased risk of acid attacks/caries

Re-mineralized enamel

Protective coating from acid attacks

Fluoride depot

Long term protection

With VarnishWithout Varnish

Fluor Protector S

Innovative fluoride varnish

• Immediate fluoride release and safe

• Homogeneous formula with low

viscosity

• Thin, smooth and colorless on teeth

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Fluor Protector S Duraphat MI Varnish Profluorid Varnish untreated enamel

Flu

ori

de

con

ten

t (%

)

Varnish

Fluoride Uptake in Enamel after 1 Hour

3M ESPE Varnish Fluor Protector SNupro

Homogenous Formula

Wettability

FLUOR PROTECTOR S NUPRO WHITE VARNISH

PROFLUORID VARNISH3M ESPE VARNISH

Typical Applications

Orthodontic Dentistry Pediatric Dentistry

Prophylaxis Restorative Dentistry

Fluor Protector S

Step by Step

or

Clean Isolate

Apply Fluor Protector S Allow to dry for 60 seconds

Competitive Comparison- US

Ivoclar VivadentFluor Protector S

3M ESPEVanish Varnish

VOCOProfluorid

DentsplyNUPRO

Image

Varnish Formula 1.5% Ammonium Fluoride 5% Sodium Fluoride with Tri-Calcium Phosphate

5% Sodium Fluoride

5% Sodium Fluoride

FluorideConcentration

7700ppm (at application)30,000ppm (at setting)

26,600ppm 26,600ppm 26,600ppm

Food & Drink waiting time

1 Hour after treatment Immediately after application(soft diet only)

4 Hours 2 Hours

Mixing & Measuring recommended

No Yes Yes Yes

Viscosity Low High High High

Delivery form - Dispensing tube 7g (8.2ml) - Single Dose 0.26g (0.3ml)

- Single Dose 0.50mlin Aluminum-Blister

-Single Dose .4ml Single Dose .4g

Prevention

The higher the severity of risk factors at diagnosis, the greater the

prevention strategy needs to be

*Several of these preventive agents are used off-label for caries prevention

Antimicrobial Agents

Destroys or suppresses the growth of

microorganisms including bacteria

Chlorhexidine Gluconate Rinse

• Used off-label to reduce levels of MS bacteria

• Not effective against Lactobacilli

• Available as .12% rinse with/without alcohol

• Long term use leads to discoloration of teeth

and taste disturbances

Chlorhexidine

Indication

• Antimicrobial/bacterial reduction – destroys cell walls

• Prevent plaque formation

• Inhibition of inflammation

• Protection from gingivitis, periodontitis, peri-implantitis, stomatitis

• Caries prevention

• Low concentration levels bacteriostatic (rinses), high concentrations

bacterialcidal

Chlorhexidinefacts.com

Chlorhexidine

The American Dental Association recommends the application of 1:1

mixture of chlorhexidine/thymol varnish every three months to reduce

the incidence of root caries.

Photos: Dr. A. Peschke

Cervitec® Plus

Innovative chlorhexidine varnish

Contains 1% CHX & 1% Thymol

Increases to 10% when dry

Protection of exposed root surfaces

Alternative to chlorhexidine rinse

No unpleasant side effects

Longer CHX retention

More than 20 years of clinical

experience

Cervitec Plus helps ensure successful clinical outcome!

Cervitec Plus- Indications

Exposed root surfaces

Fissures

Erupting teeth

Proximal surfaces

Around brackets and orthodontic

bands

Along the margins of implant-retained

restorations, crowns or bridges

Restorative Dentistry

Prosthetic and restorative therapies generally require a healthy

periodontium as a prerequisite for successful outcome.

Apply Cervitec Plus immediately after

placing temporary or permanent

restorations!

Delivery Forms: Rinse vs. Varnish

Chlorhexidine Rinse Cervitec Plus

0.12% Chlorhexidine Gluconate (Peridex, Periogard)

10% Chlorhexidine on teeth (1% in solution)

70% loss, 30% Retention Targeted treatment, even dosage

Bacteriostatic Bacteriocidal

Patient Compliance (1-2 times daily) Professionally Applied (lasts up to 3 months)

Brown staining Clear and Esthetic Varnish (No staining)

Bad taste No bad taste

CERVITEC PLUS- STEP BY STEP

30

sec. Do not

rinse after

application

INNOVATIVE DENTAL HYGIENE SOLUTIONS

DiagnosisCRT Bacteria

MaintenanceProxyt

PreventionHelioseal

Fluor Protector S

Cervitec Plus

Dental Plaque

Yellowish biofilm

Sticks to tooth structure

Must be regularly mechanically removed

Begins with initial colonization of the pellicle

ends with complex formation of a mature biofilm

Plaque is the leading cause of tooth decay

Polishing Paste Characteristics

Hardness

Particle Size (Grit)

Particle Shape

Agent Contact time

Applied Pressure

Speed

Concentration & Quantity

Abrasiveness

Prophy Paste

Proxyt – Targeted, Gentle, Reliable

The advantages of Proxyt

• 3 abrasive values for individual needs

• Creamy consistency does not splatter

• Contains Xylitol and Fluoride

• Scratch-free polishing of ceramics and composite

restorations. (Proxyt Fine)

• Fluoride free option for restorative effectiveness

• Hygienic and economical delivery

The next generation of prophy pastes for

professional tooth cleaning and polishing

Proxyt- RDA Scale

0 25070 100 150

Low Abrasive

Medium Abrasive

Highly Abrasive

Regarded as harmful limit

fine medium

(Stookey & Schemehorn 1979)

Proxyt – Next Generation

Gentle care of precious surfaces

Composite Surface Gloss-Nupro

Baseline

Nupro CourseNupro Fine

Composite Surface Gloss-Proxyt

Proxyt CourseProxyt Fine

Baseline

Comparsion of Prophy Pastes

Appearance of abrasive particles

Proxyt fine Cleanic Nupro fine

(Ivoclar Vivadent, R&D 2010)

71

Proxyt – Study Results

0.00

0.05

0.10

0.15

0.20

0.25

Control Proxyt fine Proxyt coarse Nupro fine Nupro coarse

Su

rfa

ce

rou

gh

ne

ss

Effect of Prophylaxis Pastes on IPS Empress CAD

(Yazici et al. 2012)

72

Direct RestorativesPREPARE BOND FILL CURE FINISH MAINTAIN

Isolation

Advantages:

- Considerably enlargedaccess to the treatmentfield

- Enhanced patientcomfort due to three-dimensional flexibility

- Wide range ofindications

OptraGate®

The gentle solutionfor a better view

SculptableComposites

FlowableComposites

Advantages:

- Bulk placement up to 4 mm due to Ivocerin®, the new light initiator

- Low shrinkage and low shrinkage stress for superior margins

- Sculptable consistency, extended working time under operatory light

Tetric EvoCeram® Bulk Fill

The fast posterior composite

Manual Instruments

Advantages:

- Non-stick shaping andcontouring thanks to foam pad attachments

- Highly elastic foam pads ensure the creation of smooth and even surfaces

- Reference scales on the instrument handle facilitate professional esthetic results

OptraSculpt® Pad

Efficient contouring due to non-stick surface

Polishers

Advantages:

- Smooth surface finish and perfect lustre due todiamond particles

- Quick high-gloss polishing in only oneworking step

- Multiple use for greatercost-efficiency

OptraPol®

Simply brilliant-in just on step

Care Products

Proxyt®

Keeping restorations in good condition

Curing Lights

Advantages:

- Every hand – comfortable to hold for men and women

- Every material – universal use due to Polywave® LED with broadband spectrum

- Every time – optional cordedoperation due to Click & Cure

Bluephase® Style

The smallest LED forevery use

All-Etch-Adhesives

Advantages:

- Efficient delivery- Universal application- Predictable results

Adhese® Universal

The universal adhesive

Fluor Protector S

Maintaining theinvestment

INNOVATIVE DENTAL HYGIENE SOLUTIONS

DiagnosisCRT Bacteria

MaintenanceProxyt

PreventionHelioseal

Fluor Protector S

Cervitec Plus

*All 3 steps are

imperative for a

successful caries

prevention program

Karen Stoklosa, MBA

Karen.Stoklosa@ivoclarvivadent.com

Tabetha Magnuszewski, RDH

Tabetha.Magnuszewski@ivoclarvivadent.com

www.ivoclarvivadent.com

THANK YOU!!

Video References

• https://youtu.be/1zSuXQJJszY

• R&D testing facility, Amherst, NY, USA 2015

• R&D testing facility, Schaan, Liechtenstein, 2015

Question and Answer Session

• Questions are welcome! This session may last for 10-15 minutes.

• Write your questions in your control panel on the upper right hand of your screen.

• Submit questions at any time.

CE Credit Available

Contact Information