Presentation on theme: "Dr. Derango & Dr. Muellers CARIES PROTOCOL The answers to your questions. Jenna R. Derango R.D.H."— Presentation transcript:
Dr. Derango & Dr. Muellers 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 patients 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 (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
Our Caries Management Program Caries Protocol is designed to: a.Decrease bacteria levels that cause caries b.Increase the repair (remineralization) process c.Reduce the risk of future dental caries d.Continually monitor patient status and progress
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.htmhttp://www.andrewsbraces.com/pages/brushing.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 Threadershttp://www.andrewsbraces.com/pages/brushing.htm
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 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Grape fruit, Orange Juice, Soda Battery Acid, Hydrofluoric Acid Hydrochloric acid secreted by stomach lining Lemon Juice, Gastric Acid, Vinegar Tomato Juice, Acid rain Soft drinking water, Black Coffee Urine, Saliva Pure water Sea water Baking soda Great Salt Lake, Milk of Magnesia Ammonia solution Soapy water Bleaches, Oven cleaner Liquid drain cleaner
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!