Power Point Slide Catalogue From PreViser Corporation
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Transcript of Power Point Slide Catalogue From PreViser Corporation
Power Point Slide Power Point Slide CatalogueCatalogue
From PreViser From PreViser CorporationCorporation
www.previser.comwww.previser.com
Risk-Based Treatment for Risk-Based Treatment for CariesCaries
Tooth Decay DefinedTooth Decay Defined
An An infectioninfection caused by bacteria caused by bacteria commonly found in the mouth that commonly found in the mouth that destroys the toothdestroys the tooth
The bacteria are The bacteria are transmissibletransmissible from from parent or caregiver to child, child to parent or caregiver to child, child to child, and adult to adultchild, and adult to adult
The disease has The disease has many factorsmany factors and and many stages many stages
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Experimental DecayExperimental Decay
0 days 21 days 51 days Timeline
• No oral hygiene• Rinse 9x/day with 50% sucrose solution
• Regular oral hygiene• Fluoride use
Development of enamel decay
Decay arrested
Proof that:• bacteria causes decay• sugar increases risk• oral hygiene can prevent decay
von der Fehr et al 1970Courtesy PreViser Corporation, all rights reserved
Stages of DecayStages of Decay
The disease process begins with an The disease process begins with an infection, advances to demineralization, infection, advances to demineralization, and ends with a cavityand ends with a cavity
The process does not progress at a The process does not progress at a uniform rate but is cyclic and intermittentuniform rate but is cyclic and intermittent
Demineralization occurs when decay-Demineralization occurs when decay-causing bacteria produce acids from foodcausing bacteria produce acids from food
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Cyclic Process of DecayCyclic Process of Decay
Demineralization
Remineralization
Bacteria plus foodmakes the salivavery acidic within
5 minutes
Saliva is normal30 minutesafter eating
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Tipping the BalanceTipping the BalanceRemineralization Demineralization
• Infrequent or inadequate tooth cleaning• Frequent meals and snacks• Large amount of decay causing bacteria• Deficient fluoride in saliva
Cavity
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Decay ProgressionDecay Progression
0%10%
20%30%
40%50%
60%70%80%
90%100%
Decay No change Healed
Progression of 72 white spot lesions followed for 7 years
Backer-Dirks 1966
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Diagnosis of DecayDiagnosis of Decay
HealthHealth DecalcificatiDecalcificationon DecayDecay
VisualVisual Normal Normal tooth colortooth color White spotWhite spot Black or Black or
brownbrown
FeelFeel HardHard HardHard SoftSoft
X-RayX-Ray NormalNormal NormalNormal Black areaBlack area
None of these methods can detect all lesions early enough to implement treatment to reverse the disease
process
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Occurrence of SymptomsOccurrence of Symptoms
0 1 hour ? years 30 years
Time lineAnaphylacticShock
Toothache Heart Attack
• Each symptom occurs at the end of the colored bar• Each disease process is invisible to diagnostic methods for most or all of the time within the colored bar• Risk predicts chronic disease occurrence
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Risk-based treatment Risk-based treatment prevents disease prevents disease
progressionprogression
Risk-Based Treatment
Disease State
Cavity
Risk-based treatment Risk-based treatment prevents disease prevents disease
occurrenceoccurrenceHealth
Decalcification
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RepairRepair treats the treats the consequences of consequences of
disease, which may disease, which may increase the risk of new increase the risk of new
diseasedisease
Repair and Prevention
Disease State
Cavity
PreventionPrevention maintains a maintains a clinically healthy stateclinically healthy state
Health
Decalcification
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FillingsFillings
Fillings have no measurable effect on Fillings have no measurable effect on decay-causing bacteria present on tooth decay-causing bacteria present on tooth surfacessurfaces
Fillings have a finite life span and where Fillings have a finite life span and where each replacement filling leaves less tooth each replacement filling leaves less tooth structurestructure
Fillings increase the risk of an abscessFillings increase the risk of an abscess Fillings may increase the risk of tooth Fillings may increase the risk of tooth
fracture and gum diseasefracture and gum disease
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PreventionPrevention
Preventive treatment can be effective at Preventive treatment can be effective at any time and ageany time and age
A diagnosis of decay could be indicative A diagnosis of decay could be indicative that additional lesions not yet visible existthat additional lesions not yet visible exist
Apparently healthy teeth might be in the Apparently healthy teeth might be in the early undetectable stages of decayearly undetectable stages of decay
Risk assessment can identify when risk is Risk assessment can identify when risk is high and preventive treatment is high and preventive treatment is beneficialbeneficial
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Tooth Decay RiskTooth Decay Risk
Tooth decay risk varies between Tooth decay risk varies between individuals and over time coincident individuals and over time coincident with a change in risk factorswith a change in risk factors
The highest decay-susceptible time is The highest decay-susceptible time is the first 2 years after tooth eruption, the first 2 years after tooth eruption, but can be high at any timebut can be high at any time
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Supplemental andSupplemental andNew Diagnostic MethodsNew Diagnostic Methods
Plaque Formation Rate (PFRI)Plaque Formation Rate (PFRI) Salivary level of mutans streptococci Salivary level of mutans streptococci
(SM)(SM) New Diagnostic MethodsNew Diagnostic Methods
Digital X-raysDigital X-rays Fiber-optic transillumination (FOTI)Fiber-optic transillumination (FOTI) Laser fluorescence (LF)Laser fluorescence (LF) Electrical conductance (EC)Electrical conductance (EC) UltrasoundUltrasound
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Plaque Formation RatePlaque Formation Rate
ScorScoree
DescriptionDescription
11 1%-10% of surfaces1%-10% of surfaces
2211%-20% of 11%-20% of surfacessurfaces
3321%-30% of 21%-30% of surfacessurfaces
4431%-40% of 31%-40% of surfacessurfaces
55 >40% of surfaces>40% of surfaces
Amount of new plaque accumulated in 24 hours following tooth cleaning where patient refrains from oral hygiene
Axelsson 1991Courtesy PreViser Corporation, all rights reserved
Caries Risk Based on SM and Caries Risk Based on SM and PFRIPFRI
PFRIPFRI
SM/mlSM/ml11 22 33 44 55
00 Very Low RiskVery Low Risk
<0.5 mill<0.5 mill
Low RiskLow Risk
Moderate RiskModerate Risk
0.5-0.9 0.5-0.9 millmill High RiskHigh Risk
>0.9 mill>0.9 mill
Axelsson 1991
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New Diagnostic MethodsNew Diagnostic Methods
Very little clinical data are available to Very little clinical data are available to validate these technologiesvalidate these technologies
Goal is better accuracy over traditional Goal is better accuracy over traditional methods to detect true cavities that should methods to detect true cavities that should be filledbe filled
Goal is detection of currently “invisible” Goal is detection of currently “invisible” lesions that are in a state of dynamic lesions that are in a state of dynamic decalcification and recalcificationdecalcification and recalcification Enhances risk assessment and application of Enhances risk assessment and application of
preventive treatment preventive treatment
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Preventing Tooth DecayPreventing Tooth Decay
Reduction of decay-causing bacteriaReduction of decay-causing bacteria Health promoting dietary practicesHealth promoting dietary practices Exposure to fluorideExposure to fluoride Sealing susceptible tooth defectsSealing susceptible tooth defects Proper frequency of dental visitsProper frequency of dental visits
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Reducing Decay-Causing Reducing Decay-Causing BacteriaBacteria
Personal teeth cleaningPersonal teeth cleaning Twice daily tooth brushing and flossing or Twice daily tooth brushing and flossing or
an equivalent aid for between the teethan equivalent aid for between the teeth Antibacterial rinses (chlorhexidene)Antibacterial rinses (chlorhexidene)
Rinse with 10 ml for 1 minute at bedtime Rinse with 10 ml for 1 minute at bedtime for 2 weeks repeating the cycle 2 months for 2 weeks repeating the cycle 2 months laterlater
Fluoride toothpasteFluoride toothpaste Treat all family membersTreat all family members
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““Teeth Cleaned” ClarifiedTeeth Cleaned” Clarified
All tooth surfaces including between teethAll tooth surfaces including between teeth About half of all decay affects the tooth About half of all decay affects the tooth
surfaces of adjacent teeth where a tooth surfaces of adjacent teeth where a tooth brush and oral rinse does not reachbrush and oral rinse does not reach
The equivalent of not cleaning between The equivalent of not cleaning between teeth is washing the palm and back of teeth is washing the palm and back of your hands but not between your fingersyour hands but not between your fingers Rinsing hands with water is not an effective Rinsing hands with water is not an effective
alternative to scrubbing with soapalternative to scrubbing with soap
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Dietary PracticesDietary Practices
Foods that are especially harmful contain Foods that are especially harmful contain sugars like sucrose, glucose, and sugars like sucrose, glucose, and fructose, cooked starch, and other fructose, cooked starch, and other carbohydratescarbohydrates
Eat and drink no more than 3 meals and Eat and drink no more than 3 meals and 3 snacks per day3 snacks per day
Sugar-free gum and mints, especially Sugar-free gum and mints, especially those that contain xylitol can be those that contain xylitol can be beneficialbeneficial
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FluorideFluoride
The incorporation of fluoride into The incorporation of fluoride into developing enamel inhibits tooth developing enamel inhibits tooth decay, however its primary decay, however its primary effectiveness occurs by its effectiveness occurs by its concentration in plaque and saliva to concentration in plaque and saliva to inhibit demineralization and enhance inhibit demineralization and enhance remineralizationremineralization
Fluoride inhibits plaque bacteriaFluoride inhibits plaque bacteria
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Fluoride, cont.Fluoride, cont.
Fluoride is released from dental plaque Fluoride is released from dental plaque during the acidic conditions of eatingduring the acidic conditions of eating
Released fluoride combines with calcium Released fluoride combines with calcium and phosphate to create a more decay-and phosphate to create a more decay-resistant enamel crystal structureresistant enamel crystal structure
Fluoride is available in water, toothpaste, Fluoride is available in water, toothpaste, over-the-counter rinses, prescription over-the-counter rinses, prescription toothpaste and rinses, professional gels, toothpaste and rinses, professional gels, foams, and varnishesfoams, and varnishes
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Fluoride, cont.Fluoride, cont.
Fluoridated toothpaste should be used twice Fluoridated toothpaste should be used twice dailydaily
Professional applications of fluoride is based Professional applications of fluoride is based on riskon risk High-risk patients should have this done 2 to 3 High-risk patients should have this done 2 to 3
times per yeartimes per year More fluoride is not necessarily better, More fluoride is not necessarily better,
especially for children younger than 6 years especially for children younger than 6 years as fluorosis can affect cosmetically visible as fluorosis can affect cosmetically visible developing teethdeveloping teeth
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Tooth SealantsTooth Sealants
Plastic coating bonded to the biting Plastic coating bonded to the biting surfaces of the back teethsurfaces of the back teeth
Susceptible tooth defects should be Susceptible tooth defects should be sealed regardless of agesealed regardless of age
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Frequency of Dental VisitsFrequency of Dental Visits
Twice annual professional tooth Twice annual professional tooth cleaning as the sole method to prevent cleaning as the sole method to prevent cavities is unlikely to be effective cavities is unlikely to be effective especially when risk is highespecially when risk is high
Frequency of dental visits can be Frequency of dental visits can be increased for closer monitoring of oral increased for closer monitoring of oral hygiene and dietary practices in hygiene and dietary practices in addition to applying fluoride and addition to applying fluoride and sealantssealants
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Dealing with ObjectionsDealing with Objections
Prevention doesn’t workPrevention doesn’t work Studies have shown that more than 90% of tooth Studies have shown that more than 90% of tooth
decay can be preventeddecay can be prevented Prevention is only for the youngPrevention is only for the young
Studies have shown that prevention works at any Studies have shown that prevention works at any ageage
The benefits of prevention take many yearsThe benefits of prevention take many years The benefits are immediate as prevention heals The benefits are immediate as prevention heals
the invisible lesionsthe invisible lesions
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Objections, cont.Objections, cont.
It costs too much; My insurance doesn’t cover It costs too much; My insurance doesn’t cover itit Filling cavities costs more than preventing themFilling cavities costs more than preventing them Cavities can result in a root canal, cap, or extractionCavities can result in a root canal, cap, or extraction Dentures could ultimately cost more than “saving” Dentures could ultimately cost more than “saving”
your teethyour teeth Insurance doesn’t care if you have denturesInsurance doesn’t care if you have dentures
Dentures are OKDentures are OK Dentures, especially lower ones, are not always Dentures, especially lower ones, are not always
successful, which then requires implantssuccessful, which then requires implants
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Objections, cont.Objections, cont.
Flossing is too hard; no time to flossFlossing is too hard; no time to floss Tying shoelaces for a child is difficult but Tying shoelaces for a child is difficult but
they learn the skillthey learn the skill Flossing takes only a minute or two after Flossing takes only a minute or two after
the skill is learnedthe skill is learned Fillings prevent decayFillings prevent decay
Fillings have no effect on decay-causing Fillings have no effect on decay-causing bacteria and hence do not reduce the bacteria and hence do not reduce the risk of having more cavitiesrisk of having more cavities
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