1. Dr. Derango & Dr. Mueller’s CARIES PROTOCOL
The answers to your questions.
Jenna R. Derango R.D.H.

2. Past Methods of Treatment
Drill- remove all caries
Fill- place restorations
3. To cut is to cure- removing decay and placing a restoration solved the problem

3. Present Method for Treatment
Bacterial control
Reduce risk level
Repair active decay
Continued care

4. Bacterial Control Reduce number of caries causing bacteria METHODS:
Plaque Removal: brushing and flossing
Anti-bacterial Mouth Rinse
Xylitol Gum / Mints

5. 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

6. 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

7. Continuous Care At home and in office METHODS:
Review plaque removal and diet control
6 month cleaning appointments with fluoride and x-rays

8. 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.

9. What are Dental Caries?
Caries is also known as: cavities or tooth decay.
Caries, if stopped early enough, can be reversible.
Caries is a bacterial infection caused by specific bacteria.
Caries is transmissible, or can be transferred from person to person, and from tooth to tooth in a patient’s mouth.

10. 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.

11. Factors in the Caries Process
Negative Factors
Bacteria (already living in your mouth)
+ Sugar (candy, soda, etc.)
Acid
Acid (Soda, fruit juice, etc)
+ Tooth
Caries
Positive factors
Saliva (Calcium & Phosphate)
+ Fluoride
Decrease of caries

12. Our Caries Management Program
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

13. 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

14. 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

15. Plaque Removal by Electric Toothbrush
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.
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.
Don't forget to reach all areas, including
the inner and chewing surfaces, and behind
your back teeth.
It is also important to brush your tongue using
a forward sweeping motion.
Courtesy of Oral B (Proctor & Gamble

16. 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

17. Plaque Removal with braces
When brushing braces it is important to use a
prescription fluoride toothpaste.
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 &

18. 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.
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 & GUM® Eez-Thru® Floss Threaders

19. 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.

20. 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.

21. Battery Acid, Hydrofluoric Acid
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
“Pure” water 7
Sea water 8
Baking soda 9
Great Salt Lake, Milk of Magnesia 10
Ammonia solution 11
Soapy water 12
Bleaches, Oven cleaner 13
Liquid drain cleaner 14

22. Illinois State Dental Society
“Got Rot”

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. Xylitol Gum & Mints Suggested Protocol: Chew or dissolve two pieces
three to five times daily. Use
until the product is gone.

29. 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.

30. 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.

31. MI Paste
Calcium and Phosphate combination used to strengthen teeth and assist in the absorption of fluoride.

32. 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

33. 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.

34. 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!