Meat and Potatoes of Dental Hygiene Practice - Enamel · Woodall 1992. 5/9/16 21 Instrumentation...
Transcript of Meat and Potatoes of Dental Hygiene Practice - Enamel · Woodall 1992. 5/9/16 21 Instrumentation...
5/9/16
1
MeatandPotatoesofDentalHygienePractice
Enamel
Presented by
ShirleyGutkowski,RDH,BSDH
This presentation is supported by VOCO through an unrestricted educational grant.
RecognitionandCredits
PennWell is an ADA CERP recognized provider . ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/goto/cerp.PennWell designates this activity for 1 Continuing Education Credit.Dental Board of California: Provider 4527, course registration number 01-4527-15079.“This course meets the Dental Board of California’s requirements for 1 unit of continuing education.”
The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2015) to (10/31/2019) Provider ID# 320452
DisclosureDeclarationsPresenter Disclosure: Shirley Gutkowski, discloses the following: She has received a stipend for this webinar. She has no commercial or financial interest in any products discussed in this webinar.Commercial Support: This course was developed with commercial support by VOCO – The Dentalists
Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity, No manufacturer or third party has had any input into the development of course content.
CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with any commercial supporter, or with products or services discussed in this educational activity. Heather can be reached at [email protected].
Image Authenticity: No images in this educational activity have been modified or altered.
Scientific Basis: All content has been derived from references listed and the author’s clinical experience. Research references are provided in the bibliography and/or supplemental materials.Educational Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.
5/9/16
2
ShirleyGutkowski,RDH,BSDH
PrimalAirOrofacialMyofunctionalTherapyandBreathingRe-trainingpracticeinSunPrairie,WI.
Speaker,writer,andpracticingdentalhygienistinalargegrouppractice.
SHIRLEYGUTKOWSKI
Wife,mother,gramma,doctrinaire,radiotalkshowhost,graduateofMarquetteUniversity,soughtafterinterviewfortelevision,radio,andprint
Just like you!
5/9/16
3
I
Ask
Questions
5/9/16
4
5/9/16
5
Ages
Howearly Tostart
Ages
Howearly Tostart
5/9/16
6
We are the last health care providers to amputate infection
as a treatment.
Amputation doesn’t stopThe infection
NewWords
5/9/16
7
Images comp l imen ts o fX lear, In c.
Images comp l imen ts o fQuan tumTechno lo gies
5/9/16
8
5/9/16
9
Doesthiswork?
ThreeMainComponents
What’sthegoalofpolishing?
When’s thelasttime yourreallythoughtabout thepolish youuseor whyyouuseit?
5/9/16
10
What’sthegoalofpolishing?
Toremovebiofilm andstain
What’sthegoalofpolishing?
Dentalbiofilm(Iknowyouknowthis)
Starts withaspecificbacterialstrain
Matrixstickstothetooth
Matrixencases
inhabitants
Stew• Bacteria• Yeast• Virus
5/9/16
11
Protectinhabitants
Provide theproperpH
LowpHdissolves theenamel
Pits in theenamel
harborotherbiofilms
Activitiesofthebiofilm
Biofilminthepocket
Stimulatesinflammatorycascade
Bringscytokinestothesite
Disruptstissueintegrity
Hidesinfectiousmicrobes
Who’shidinginthere?E.coli
H.pylori
P.GingivalisS.Pneumonia
Toomanyotherstocount
5/9/16
12
BiofilmManagement- Professional
5/9/16
13
Dentalhygiene
Asthma
Bronchitis
Diabetes
Arthritis
Stroke
Hearthdisease
Livingwithmyths
Damagedenamel
Pumice
Manytimes
Speed
pressure
TeethDon’tHeal
5/9/16
14
Teethdoheal
Rootsdon’theal
Selectivepolishing
Traditional Air
Traditional Air
5/9/16
15
Helicobacterpylori vacuolating cytotoxin,VacA,isresponsibleforgastriculceration.
Around1988,LeunkandcolleaguesdiscoveredthatsupernatantsfrombrothculturesofHelicobacterpylori inducedmassivevacuolardegenerationofvariousculturedepithelialcelllines.
Infectiousburdenandatherosclerosis:Aclinicalissue
Moreover, anotherindirectmechanismbywhichsomeinfectiousagents(suchasH. pylori,C.pneumoniae, periodontal pathogens,etc.)mayplayaroleinthepathogenesisofatherosclerosisismolecularmimicry.
Giventhecomplexityofthemechanismsbywhicheachmicroorganismmaycontributetoatherosclerosis,definingtheinterplayofmoreinfectiousagentsisfarmoredifficultbecausethepro-atherogenic effectofeachpathogenmightbeamplified.
5/9/16
16
Roleofdentalplaque,salivaandperiodontaldiseaseinH.pyloriinfection
Nevertheless,recentstudieshavenotonlyshownthatthemicroorganismcanbedetectedfairlyconsistentlyfromtheoralcavitybutalsodemonstratedthatthechancesofrecurrenceofH. pylori infectionismorelikelyamongpatientswhoharbortheorganismintheoralcavity.
Roleofdentalplaque,saliva,and periodontaldiseaseinHelicobacterpylori infection
Furthermore,initialresultsfromclinicaltrialshaveshownthatH. pylori-positivedyspepticpatientsmaybenefitfrom periodontal therapy.
RelationshipbetweenoralproblemsandHelicobacter pylori infection.
Thestudysuggestedthattoprevent oreradicate Hp infection, weneedtofocusonoralhygieneandprevention oforalproblems, especially dentalcalculus and
loose tooth.
5/9/16
17
Fourteethextractedforperiodontalreasonswereairpolished.Bioactivehydroxyapatitewasacleaningpowderwithparticle sizeofupto10μm.
Bioactivenaturalhydroxyapatiteisaveryeffectivecleaningpowder,whichremovesefficientlytartarfromcementumsurfaceanddoesnotcauseanydamage.
Thequalitative analysisofcementumimagesafterair-polishing with naturalhydroxyapatite showed thatthecementum surface wasfullysaturated with suchelements ascalcium andphosphorus,
which wasnot observed oncontrolcementum images.
• Theeffectofairborne-particleabrasion ontheshearbond strengthof fourrestorative materials toenamelanddentin.
JProsthetDent. 2004
• increased theshearbondstrengthofrestorativematerials tested toenamelanddentin.
Theuseofairborne-particle
abrasion…
5/9/16
18
Prosthesis isnot enamel• Gold• Amalgam• Resins• Nanoparticles• Porcelain• Anymanmadematerial
Cananddoesgetdamagedbypolishing
Effectsoffluorideornanohydroxiapatite onroughnessandglossofbleachedteeth.
Microsc ResTech. 2011Dec
Effectsoffluorideornanohydroxiapatite onroughnessandglossofbleachedteeth.• Microsc ResTech. 2011Dec
Glossshowedsignificantincreaseafter polishing withnHA.
5/9/16
19
Minimallyinvasivecaries removal usingbio-activeglassair-abrasion.
JDent. 2011Jan
Minimallyinvasivecaries removal usingbio-activeglassair-abrasion.• JDent. 2011Jan
Aluminaair-abrasionhasbeenusedtocleanteethandshowntoover-prepareaccesscavitypreparationtocaries.
Thisstudyinvestigatedtheworkinghypothesisthatbio-activeglassair-abrasionismoreself-limitingthanaluminaforminimallyinvasivecaries removal.
Minimallyinvasive caries removal usingbio-activeglassair-abrasion.
• JDent. 2011 Jan
Bio-activeglassabrasionremoved extrinsic stain andsubstantialquantitiesofenamelfromallcariousfissuresbutnotfrom sound,whereonlyminimalmicroscopic surfacemodificationswereobserved.
5/9/16
20
BioactiveGlass
ProfessionalInterventionagainstbiofilm
Scaling
Polishing
PurposeofSubgingivalInstrumentation
...tocreateabiologicallyacceptable root surface bytheremovalofplaque, calculus and
endotoxinWoodall1992
5/9/16
21
InstrumentationComparisions
R itz, Hefti , Ra tei tsch a k, JC l in P erio 1 99 1
Root substance removal:• 360sites
Curette108.9microns
Diamond burr118.7microns
Sonic scaler93.5microns
Ultrasonics 11.6microns
Scaled with curette
Smear layerC. Dris k o, Perio 2000, 1996
Professionalinterventiononenamelbreakdown
Salivarysupport
Fluoride
5/9/16
22
Remin Proisbiomimetic
nanotechnology
Nowweknowabouttheenamelbiofilm interface
CommonDecaySites
Commondecaysitesoftoothenamelsurfaces
1. Deepfissures 1
5/9/16
23
CommonDecaySites
Commondecaysitesoftoothenamelsurfaces
1. Deepfissures
2. Rootsurface
1
2
CommonDecaySites
Commondecaysitesoftoothenamelsurfaces
1. Deepfissures
2. Accessiblesides
3. Interproximalsites
1
2
3
B MC P edi at r.2013 Oct 25;13:174. doi : 10.1186/1471-2431-13-174.V i tamin Dstatus of chi ldren wi th severe early chi ld hoo dcaries: a case-co ntrol stu dy.S chroth RJ, Levi JA, Sel lers EA, Friel J,K li ewerE, Mof fatt ME .
5/9/16
24
5/9/16
25
Doestheirdietsupporthealth
Fluoridesupport
Fluoridesupport
5/9/16
26
ADAstudystatesfluoride varnishis:
“Effectiveinpreventingcariesinbothprimaryandpermanentdentitionofchildren&adolescents”
(ADACouncilonScientificAffairs,JADA,Vol.137,August2006)AsofJan2007,fluoride
varnishhasitsowncode(D1206)
ADA- Statement
• Takelesstime• Createslesspatientdiscomfort• Achievegreaterpatientacceptance• Thandoesfluoridegel,especiallyinpreschool-agedchildren
FluorideVarnishes
ActiveIngredientListing
• 50mg(NaF)SodiumFluoridein1gramcontains11.3mgF
• Resinisbasedon“Colophony”(Yellowishgumrosin/sapfromPinetrees)
• Eugenol-free!
ProfluoridVarnish
5/9/16
27
ApplicationProcess
Profluorid adherestomoistsurfaces
Ittoleratesresidueofmoistureorsaliva
Thoroughlycleansurfacetobetreated
Applyevenlysothattheentiresurfaceiscoveredbyathincoat
PostTreatmentCare
• Donotbrushorflossforatleast4- 6hours• Ifpossible,wait24hrstoresumenormaloralhygiene• Eatasoftfooddietduringthetreatmentperiod• Avoidhotdrinksandproductscontainingalcohol(i.e.:beverages,oralrinses,etc.)
• Patientswillbeabletofeelthevarnishontheirteeth.Atthecompletionofthetreatmentperiod,youmaybrushandflosstoremoveanyremainingvarnish
5/9/16
28
UserFeedbackonMaterial
[%]
UserFeedbackonMaterial
[%]
UserFeedbackonMaterial
[%]
5/9/16
29
UserFeedbackonMaterial
[%]
5/9/16
30
Clinical practice guidelines fororalmanagement ofSjögren disease:Dental cariesprevention. (2016)
FinalrecommendationsforpatientswithSjögrendiseasewithdrymouthwereasfollows:topical fluoride shouldbeusedinallpatients(strong);
5/9/16
31
Wehavethetools
Forearlydiagnosis ofcariesand
periodontal infection
Forthetreatmentofcariesandperio
5/9/16
32
OperativeDentistryforChildren
Notfilling teethbutpreservingthenecessityfor fillingteethshould bethedentist’swork.Lethim consider himself
successful who can showaclientelewherehispatients boastthatneverfrom babyhood tothegravehavetheyhadastainorholeinanytooth. Thatistruedentistry,notthistiresome,
painful plugging ofholes. Itisanidealpossible for themajorityof people. Whyisourprofession permitting sixty
percenttosuffer needlessly?
5/9/16
33
OperativeDentistryforChildren
M.EvangelineJordan,DDSOperativeDentistryforChildrenChapterIIIOralProphylaxis
Copyright,1925
Cross Link RadioOn www.crosslinkradio.comHost Shirley Gutkowski
5/9/16
34
Thank You!
To claim CE credit for your participation in this activity you must complete the program post-exam.
Instructions for completing the post-exam and receiving your Letter of Credit are provided on the following slide.
Presented by
ShirleyGutkowski,RDH,BSDHcrosslinkpresent@ao l.com
This presentation is supported by VOCO through an unrestricted educational grant.