CARIES PROTOCOL

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					  Dr. Derango & Dr. Mueller’s

  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 patient’s
   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
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
       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.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 Threaders
 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    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
7    “Pure” water
8    Sea water
9    Baking soda
10   Great Salt Lake, Milk of Magnesia
11   Ammonia solution
12   Soapy water
13   Bleaches, Oven cleaner
14   Liquid drain cleaner
Illinois State Dental Society
         “Got Rot”
                  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!
Risk Factors                                                                         Points
Number of smooth surface lesions                               _______ x 1.5
Number of occlusal lesions                                     _______ x 1.0
Number of recurrent decay                                      _______ x 1.0
Number of caries restored in the past year                     _______ x 1.0
Number of rough white spot lesions                             _______ x 0.5
Number of interproximal watches                                _______ x 0.5

Each of the following answers = 1 point
Caries restored in the past 3 years
Heavy plaque
Frequent sugary/starchy snacks
Saliva reducing facotors:
       - Medications
       - Head / Neck Radiation
       - Systemic Disease
       - Dry Mouth (other)
Occlusal or Diagnodent watches
Orthodontic appliances or partial dentures
Deep pits & fissures / developmental defects
Exposed root surfaces
                                                                          TOTAL
                                                              Protocol 1 (4-8 pts)
                                                      Oral Hygiene / Diet Review
                                                             Prevident Toothpaste
                                                               Spry Gum or Mints
Notes:                                                                       Fee     $
                                                            Protocol 2 (9-12 pts)
                                                      Oral Hygiene / Diet Review
                                                             Prevident Toothpaste
                                                               Spry Gum or Mints
                                                      Chlorhexidine Mouth Rinse
                                                            Fluoride Tx @ q C/R
                                                  MI Prophy Paste & home usage
Notes:                                                                        Fee    $
                                                             Protocol 3 (>12 pts)
                                                      Oral Hygiene / Diet Review
                                                             Prevident Toothpaste
                                                               Spry Gum or Mints
                                                      Chlorhexidine Mouth Rinse
                                                             Fluoride Tx @ q C/R
                                                  MI Prophy Paste & home usage
                                               Fluoride Varnish 3x within 10days
                                                                   GC Saliva Test
                                                  Bacterial Test @ 3 month recall
Notes:                                                                        Fee    $

				
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