A New Paradigm For The Treatment Of Dental Caries

A New Paradigm For The Treatment Of Dental Caries

Clinical Trends In The Diagnosis And The Treatment Of Dental Caries LOW RISK PATIENT No cavitated lesions May have inactive white spots (smooth shiny). Bacteria MS levels are low Diet is normal sugar levels low Normal Saliva levels Low DMF (Hx) MODERATE RISK PATIENT No cavitated lesions Some active white spot lesions (rough/chalky) Bacterial MS levels elevated Moderate sugar use Saliva normal or reduced (xerostomia) Moderate DMF (Hx) HIGH RISK PATIENT One or more cavitated lesions May have white spot lesions (active or inactive) Bacterial MS levels are very high

Sugar intake very high Saliva levels low (xerostomia) High DMF (Hx) 1. Bacterial Control A. Surgical Antimicrobial Tx Treat cavitated lesions first. Fill with glass ionomer, compomer, composite or IRM. Very large lesions may require temporary crowns (subgingival margins),RCT, or EXT. Place sealants as needed: 1) Occlusal surfaces with chalky white spots 2) Deep grooves and Old fillings with poor margins 3) Molars > Premolars Surgical choices based on Site(pit & fissures vs. smooth surface), Activity and Risk. Treatment Plan Medical Model 1. Bacterial Control A. Surgical Antimicrobial Tx (Restorations)

Wound debridement / I&D = Fill/Temporize cavitated lesions/Place sealants B. Chemotherapeutic Antimicrobial Tx(meds) Fluoride Varnish, CHX, and Xylitol Gum 2. Reduce Risk Level of At-Risk Patients 3. Reverse Active Sites = Remineralization 4. Long Term Follow Up and Maintenance A. B. C. Home maintenance Office Recall/Continuing Care Heal Vs.Cure (Process/Relationship) 1. Bacterial Control A. Surgical Antimicrobial Tx Treat cavitated lesions first. Fill with glass ionomer, compomer, composite or IRM. Very large lesions may require temporary crowns (subgingival margins),RCT, or EXT. Place sealants as needed: 1) Occlusal surfaces with chalky white spots

2) Deep grooves and Old fillings with poor margins 3) Molars > Premolars Surgical choices based on Site(pit & fissures vs. smooth surface), Activity and Risk. 1. Bacterial Control B.Chemotherapeutic Antimicrobial Tx 1) 2) 3) Fluoride Varnish 1-3 initial applications upon completion of Surgical Tx. Use 3 applications in 10 day period for patients who need remineralization or for patients with CHX issues or compliance problems (possible use of Iodine rinse). CHX = Chlorhexidine Rinse 0.12% take oz. before bed for 2 weeks. Repeat in 2-3 months Xylitol Gum. Use 2 pieces for 5 minutes minimum 5 times a day. Mutans Test for Very High Risk patients

2. Reduce Risk Levels of At Risk Patients Reduce Sugar !!!!!!!!!!!!!!!!! (Xylitol/Sucrose substitutes) Reduce Bacteria (antimicrobials, Xylitol gum, and OHI) and MS test PRN. Increase Saliva (Xylitol gum and mints, Rinses, change medications if possible). Increase Home Fluoride use. 3. Reverse Active Sites Remineralization Tx In Office Fluoride varnish 3 applications in 10 day period (if not done as a part of Step 1B) At Home Fluoride 1) Moderate or High Risk Patient: Toothpaste (1000 ppm) qd + 5000 ppm dentifrice or gel qd +OTC (over the counter) rinse 250 ppm several times a day especially hs. 2) Very High risk Patient: Toothpaste 5000 ppm dentifrice or gel qd + 5000 ppm dentifrice or gel in a tray qd +OTC (over the

counter) rinse 250 ppm several times a day especially hs. Xylitol gum: 2 pieces 5 times a day. Calcium Source: Cheese or new gums with amorphous Calcium Phosphate. 4. Long Term Follow Up A. Home Maintenance 1) At Home Fluoride a) b) 2) 3) 4) Moderate or High Risk Patient: Toothpaste (1000 ppm) qd + 5000 ppm dentifrice or gel qd +OTC (over the counter) rinse 250 ppm several times a day especially hs. Very High risk Patient: Toothpaste 5000 ppm dentifrice or gel qd + 5000 ppm dentifrice or gel in a tray qd +OTC (over the counter) rinse 250 ppm several times a day especially hs. Xylitol gum 2 pieces 5 times a day. Decreased use of sucrose between meals Calcium Source.

4. Long Term Follow Up B. In Office Continuing Care 1) 2) 3) 4) 3 Month Visit a) Polish (If this is also a 3 mo perio maint patient do perio probing/scaling first) b) Exam / evaluate white spots for remineralization / return to steps 1-3 PRN (D0140) c) Fluoride varnish (D1204) 6 Month Visit (3 months later) a) PSR or Perio Probing / Scaling / Polish b) Exam / evaluate white spots for remineralization / return to steps 1-3 PRN (D0120) c) Fluoride varnish (D1204) 9 Month Visit (3 months later) a) Polish (If this is also a 3 mo perio maint patient do perio probing/scaling first)

b) Exam / evaluate white spots for remineralization / return to steps 1-3 PRN (D0140) c) Fluoride varnish (D1204) 1 Year Visit (3 months later) a) Bite wing + other x-rays PRN b) PSR or Perio Probing / Scaling / Polish c) Fluoride varnish (D1204) d) Exam / Evaluate Activity Levels I.e. white spot and interprox x-rays (D0120) e) Exam / Evaluate Risk Level for next years CC schedule (Low Risk 6mo CC / Moderate or High risk 3mo CC if active: 6mo CC if inactive/ Very High Risk 3mo CC) Treatment Groups by Risk/Activity Status. Low Risk (LR)

Moderate Risk Inactive (MRI) Moderate Risk Active (MRA) High Risk Cavitated (HRC) High Risk Cavitated Active (HRCA) High Risk Inactive (HRI) Very High Risk (VHR) TREATMENT GROUP Filling Temp Cr Seal # 1 FLV st Per Yr CHX Xylitol

Moderate Risk Active MRA CC FLV + 6 5000 ppm Paste + Rinse 2 + 3 + High Risk Cavitated HRA +

+ + 1 2 + 6 + High Risk Cavitated Active HRCA + + + 3 2

+ 3 + + 6 + + 3 + Very High Risk VHR + + ++ 3

12 Home Fluoride 1000 ppm Paste 3 High Risk Inactive HRI Remin Ca 6 Low Risk LR Moderate Risk Inactive MRI CC Interval Months

+ 5000 ppm Paste + Rinse 5000 ppm Paste + Rinse + 5000 ppm Paste + Rinse 5000 ppm Paste + Rinse + 5000 ppm Paste In a Tray + Rinse

Recently Viewed Presentations

  • Neurons, Synapses, and Signaling - Fillingham

    Neurons, Synapses, and Signaling - Fillingham

    Neurons, Synapses, and Signaling. Chapter 48. YOU MUST KNOW. The anatomy of a neuron. The role of active transport in establishing the membrane potential of a neuron. How long-distance and short-distance signaling is done in neurons. The mechanisms of impulse...
  • House of Hope Freedom Quest Rejuvenate Series Session

    House of Hope Freedom Quest Rejuvenate Series Session

    Behavioral reactions and brain blood flow responses typical for an adult to 'pain' are seen at 26 wks. Fetus is possibly sedated and anesthetized in the womb. Representational memory (identify pain source and learn reactions) develop 2-4 mo after birth....
  • Coodinate-Free Geometric Programming

    Coodinate-Free Geometric Programming

    Forward kinematics is straightforward Forward kinematics map can be considered as a coordinate transformation The next lecture: How to solve the inverse problem Programming Assignment #1 Create a tree-structured hierarchical model of human figures You have to compute the forward...
  • INTRODUCTION TO SYSTEMATIC ANATOMY & INTRODUCTION TO REGIONAL

    INTRODUCTION TO SYSTEMATIC ANATOMY & INTRODUCTION TO REGIONAL

    REGIONAL ANATOMY. INTRODUCTION TO SYSTEMATIC ANATOMY. Trillions of the cells in the human . body. INTRODUCTION TO SYSTEMATIC ANATOMY. Tissues. INTRODUCTION TO SYSTEMATIC ANATOMY. 78 . organs in the . body. INTRODUCTION TO SYSTEMATIC ANATOMY. 12 . systems.
  • OSR On some interesting Curves... Aditya Kiran Grad

    OSR On some interesting Curves... Aditya Kiran Grad

    The word catenary is derived from the Latin word ' ... Y(t)=aCosh(t/a) Curvature: k(t)= Special properties.. A catenary is also the locus of the focus of a parabola rolling on a straight line. The catenary is the evolute of the...
  • The War in Heaven: What does it take

    The War in Heaven: What does it take

    "O Lord, where, today in this hour of crisis and need and desperation, where are the men of God and the saints in the house of the Lord who devoted unto our great Saviour their lives unto death? Who seal...
  • Understanding the MBTI - Julie Anne Law

    Understanding the MBTI - Julie Anne Law

    Judging: Preferences in Work Settings. Want to plan their work and follow the plan . Happiest after decisions have been made. Have a "work ethic" work first, play later . Set goals and work toward achieving them on time ....
  • Tips for Reading the World History Comprehensive Volume

    Tips for Reading the World History Comprehensive Volume

    WHAT was the Arab Empire and WHO were its Successors. How was . the Empire Created? Why did the Arabs undergo such a rapid expansion in the seventh and eight centuries, and why were they so successful in creating and...