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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 hhodges@pennwell.com.

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.

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ShirleyGutkowski,RDH,BSDH

PrimalAirOrofacialMyofunctionalTherapyandBreathingRe-trainingpracticeinSunPrairie,WI.

Speaker,writer,andpracticingdentalhygienistinalargegrouppractice.

SHIRLEYGUTKOWSKI

Wife,mother,gramma,doctrinaire,radiotalkshowhost,graduateofMarquetteUniversity,soughtafterinterviewfortelevision,radio,andprint

Just like you!

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I

Ask

Questions

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Ages

Howearly Tostart

Ages

Howearly Tostart

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We are the last health care providers to amputate infection

as a treatment.

Amputation doesn’t stopThe infection

NewWords

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Images comp l imen ts o fX lear, In c.

Images comp l imen ts o fQuan tumTechno lo gies

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Doesthiswork?

ThreeMainComponents

What’sthegoalofpolishing?

When’s thelasttime yourreallythoughtabout thepolish youuseor whyyouuseit?

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What’sthegoalofpolishing?

Toremovebiofilm andstain

What’sthegoalofpolishing?

Dentalbiofilm(Iknowyouknowthis)

Starts withaspecificbacterialstrain

Matrixstickstothetooth

Matrixencases

inhabitants

Stew• Bacteria• Yeast• Virus

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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

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BiofilmManagement- Professional

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Dentalhygiene

Asthma

Bronchitis

Diabetes

Arthritis

Stroke

Hearthdisease

Livingwithmyths

Damagedenamel

Pumice

Manytimes

Speed

pressure

TeethDon’tHeal

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Teethdoheal

Rootsdon’theal

Selectivepolishing

Traditional Air

Traditional Air

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Helicobacterpylori vacuolating cytotoxin,VacA,isresponsibleforgastriculceration.

Around1988,LeunkandcolleaguesdiscoveredthatsupernatantsfrombrothculturesofHelicobacterpylori inducedmassivevacuolardegenerationofvariousculturedepithelialcelllines.

Infectiousburdenandatherosclerosis:Aclinicalissue

Moreover, anotherindirectmechanismbywhichsomeinfectiousagents(suchasH. pylori,C.pneumoniae, periodontal pathogens,etc.)mayplayaroleinthepathogenesisofatherosclerosisismolecularmimicry.

Giventhecomplexityofthemechanismsbywhicheachmicroorganismmaycontributetoatherosclerosis,definingtheinterplayofmoreinfectiousagentsisfarmoredifficultbecausethepro-atherogenic effectofeachpathogenmightbeamplified.

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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.

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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…

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Prosthesis isnot enamel• Gold• Amalgam• Resins• Nanoparticles• Porcelain• Anymanmadematerial

Cananddoesgetdamagedbypolishing

Effectsoffluorideornanohydroxiapatite onroughnessandglossofbleachedteeth.

Microsc ResTech. 2011Dec

Effectsoffluorideornanohydroxiapatite onroughnessandglossofbleachedteeth.• Microsc ResTech. 2011Dec

Glossshowedsignificantincreaseafter polishing withnHA.

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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.

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BioactiveGlass

ProfessionalInterventionagainstbiofilm

Scaling

Polishing

PurposeofSubgingivalInstrumentation

...tocreateabiologicallyacceptable root surface bytheremovalofplaque, calculus and

endotoxinWoodall1992

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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

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Remin Proisbiomimetic

nanotechnology

Nowweknowabouttheenamelbiofilm interface

CommonDecaySites

Commondecaysitesoftoothenamelsurfaces

1. Deepfissures 1

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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 .

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Doestheirdietsupporthealth

Fluoridesupport

Fluoridesupport

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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

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ApplicationProcess

Profluorid adherestomoistsurfaces

Ittoleratesresidueofmoistureorsaliva

Thoroughlycleansurfacetobetreated

Applyevenlysothattheentiresurfaceiscoveredbyathincoat

PostTreatmentCare

• Donotbrushorflossforatleast4- 6hours• Ifpossible,wait24hrstoresumenormaloralhygiene• Eatasoftfooddietduringthetreatmentperiod• Avoidhotdrinksandproductscontainingalcohol(i.e.:beverages,oralrinses,etc.)

• Patientswillbeabletofeelthevarnishontheirteeth.Atthecompletionofthetreatmentperiod,youmaybrushandflosstoremoveanyremainingvarnish

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UserFeedbackonMaterial

[%]

UserFeedbackonMaterial

[%]

UserFeedbackonMaterial

[%]

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UserFeedbackonMaterial

[%]

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Clinical practice guidelines fororalmanagement ofSjögren disease:Dental cariesprevention. (2016)

FinalrecommendationsforpatientswithSjögrendiseasewithdrymouthwereasfollows:topical fluoride shouldbeusedinallpatients(strong);

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Wehavethetools

Forearlydiagnosis ofcariesand

periodontal infection

Forthetreatmentofcariesandperio

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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?

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OperativeDentistryforChildren

M.EvangelineJordan,DDSOperativeDentistryforChildrenChapterIIIOralProphylaxis

Copyright,1925

Cross Link RadioOn www.crosslinkradio.comHost Shirley Gutkowski

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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.