Prevention requires routine: Here's help

April 16, 2013

The most effective prevention routines have both an in-operatory and at-home component. You and your patient are a team!

The most effective prevention routines have both an in-operatory and at-home component. You and your patient are a team!

As dental hygienists, we have an undeniable opportunity to positively influence each of our patients’ overall oral health. Our treatment prevention protocols in-office and our recommendations for home care not only affect an individual’s oral health, but more importantly, his or her entire well-being.

In the world of dental hygiene, caries is recognized as a transmissible and infectious bacterial disease, and one that can be managed from a preventive medical perspective rather than a surgical or restorative process.¹ Most dental professionals do recognize that caries is a biological disease, but whether it progresses in patients is understood as a function of behavior. Oral hygiene habits, daily practices and patients’ routines play a large factor in whether caries is allowed to progress.

When using traditional methods of caries detection, it becomes very difficult to spot early caries with a radiograph. By the time caries are seen through this method, usually 20-30% of the enamel has eroded.¹ Learning how to locate and treat signs and symptoms of decay is an essential part of practicing a medical model of dentistry.

Essentially skipping the whole concept of treating a bacterial infection¹ and only restoring the damage created by the caries disease will not aid in improving patients’ overall oral health.

Hopefully, most clinicians are familiar with caries management by risk assessment (CAMBRA), which focuses on treating and preventing caries at an early stage, rather than waiting until it causes damage to tooth structure.² Caries risk management involves looking at the individual’s current condition and risk factors for dental caries. This includes examining the individual patient’s bacterial load, reducing the patient’s future susceptibility by using fluorides and other remineralizing agents, and exploring and improving the patient’s initiative for mechanical oral hygiene, specifically brushing and flossing.¹

The difficulty is that this risk assessment protocol-although increasing-is not widely used as part of the traditional discipline of prevention. The key to caries treatment and disease prevention is to focus on modifying and correcting the biofilm disease component and modifying oral factors to favor health.² In other words, the solution to managing caries and patient care is to perform early diagnosis, patient risk assessment, in-office treatments and then enhancement of remineralization processes1 with the aide of specific preventative products.

Simplifying the regimen

Having a plethora of products on the market with subtle variations and applications can add a definite layer of difficulty to managing the prevention process with the ideas of CAMBRA. It’s important to choose appropriate products that will simplify and add value to your prevention procedures, so as not to discourage protocol use in a practice.

Tip
Creating a prevention protocol in your practice that the whole team follows ensures a consistent message to your patients.

I have found that when you have a simplified regimen, you don’t need many products to achieve successful reduction of patients’ susceptibility to caries-whether in-office or for at-home use. New solutions have been particularly helpful in my regimen as a hygienist, both for in-office sensitivity treatments, and at-home treatment for remineralization of decayed and potential problem areas.

Prevent future damage

In office, I always take the patient through a fluoride application, using a 5% sodium fluoride white varnish. If the patient complains of sensitivity or is hesitant for me to touch a specific area in the mouth, I use 3M ESPE’s Vanish™ XT Extended Contact Varnish. This product provides a site-specific, light-cured durable coating that not only creates an immediate layer of protection to relieve dentinal hypersensitivity, but acts as a barrier against demineralization from acids. Vanish XT varnish works well because it reduces dentin permeability by up to 88%, and immediately penetrates and then seals open tubules for at least six months or longer.

The American Dental Association has stated that exposed root surfaces put individuals at a greater risk for decay, but by protecting a patient with a long-term varnish, I’ve found it fully guards these at-risk surfaces. As always, using reliable products has truly given me confidence that I’m offering the patient the best treatment that can be found to halt further demineralization.

I appreciate when a varnish is simple to apply and is versatile for areas with root exposure. As a hygienist, I’ve learned varnish is particularly helpful in guarding newly cleaned surfaces following scaling and root planing. Fluoride varnish also can be used to protect the teeth of children with their 6- to 12-year molars erupting, until we’re able to use a conventional sealant. The Centers for Disease Control and Prevention has proven dental caries is the most common chronic disease of children aged 5 to 17 years.¹ This is why using reliable products for your preventive and caries management regimen is so vital. I’ve even used it on orthodontic patients to protect against further demineralization.

Remineralization homework

The author uses Vanish XT, but there are many fluoride varnishes to choose from. Above, VOCO America Inc.’s Profluorid Fluoride Varnish. For more fluoride varnishes click here.

Along with in-office treatments, offering take-home treatments to patients is absolutely vital in caries management and the overall prevention protocol we’re enforcing as hygienists.

I choose to offer Clinpro™ 5000 Anti-Cavity Toothpaste for every at-risk patient’s homecare.

What is intriguing about this formula is it contains an innovative tri-calcium phosphate ingredient. This product continues to deliver fluoride with daily use, and most significantly, it actually helps strengthen enamel and reverse white spot lesions.

I send patients home with anti-cavity toothpaste for use once or twice a day, as a simple replacement of their conventional toothpaste. I’ve seen more patient compliance with toothpaste versus any other homecare recommendation because it does not add complexity to patients’ home oral healthcare regimen, nor does it add an extra step, such as a rinse. It’s merely a simple switch of product, and it’s important to choose a product patients enjoy using and will last the entire time between dental appointments. This will ensure patients don’t change back to their original product before they visit the dental office again.

Since we began this program in January, our office has seen an immense reduction in decay after three month check-ups with patients using this in-office and at-home regimen.

Routine matters

Recognizing that caries is an infectious disease that is preventable is one of the most important steps toward improving the dental health of our patients. A large challenge that will continue to face dentistry is the fact that dental professionals don’t always take caries risk assessment seriously.¹

Dental professionals may be hesitant about implementing new preventive ideas if they will cause significant changes in the routine.³ Believing in the process is the first step toward success followed by implementing a proven and useful routine, and using high quality products that are easy to use and effective. As a dental professional, I appreciate and assume full responsibility for the opportunity to improve the oral health of children and adults in the United States, one patient at a time. 

Teddie A. Dominy, RDH, BBA, is the President-Elect of the Georgia Dental Hygienists’ Association, as well as a 3M ESPE Dental Practice Specialist in Atlanta, Ga. She consults and works part-time for Dr. Stanley Rye, also of Atlanta, Ga.

References are available upon request. E-mail mh@advanstar.com.