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![9/24/2014
30
These varnishes will remain on the teeth
for 3-4 hours. This is the critical time for
fluoride release and fluoride uptake by
enamel.
Sustained Time-release of
Fluoride
Cumulative Fluoride Release of Leading Fluoride Varnishes
(measured in micrograms mcg] per 55 mg of solid weight)
1000
900
800
700
se in mcg
3M Omni White Varnish
Preventech Vella
3M Vanish with TCP
MPL Varnish America
600
500
400
300
200
100
0
1 hr 2 hr
3 hr
4 hr
Cumulative fluoride releas
Time in hours
Premier Clear Enamel Pro Varnish
PULPDENT EMBRACE VARNISH
PULPDENT EMBRACE VARNISH
Premier Clear Enamel Pro
MPL Vanish America
3M Vanish with TCP
Preventech Vella
3M Omni White Varnish
1. Dry the teeth with a gauze pad. It is best if teeth are at least
minimally clean, but it is not necessary to do a prophylaxis.
For Geriatrics…if they can’t tolerate traditional hygiene visits…we
are trying to bring them in for a 30 minute prophy and Varnish
2. Remove the brush and peel off the foil seal, exposing the varnish.
3. Use the brush to apply a thin film of varnish on all surfaces of the
teeth. It is not necessary to use all the varnish. Discard any unused
material.
4. Patients should refrain from eating hard foods or drinking hot
liquids or alcohol for 3-4 hours after treatment. Eating soft foods for
the rest of the day is advantageous. Not brushing teeth until the
morning after treatment may also be beneficial.
5. The majority of varnishes can be removed by brushing and
Instructions for Use
flossing.](https://image.slidesharecdn.com/lo0316itkujhqfob2wug-signature-4f6769dc6c0ffc60f6c1b020dabeadc64c439247549ba7c7f8af2a53f912b765-poli-140925131037-phpapp01/75/Hygiene-drive-philosophy-handout-30-2048.jpg)
Hygiene drive philosophy handout
- 1. 9/24/2014 1 Eachand every team member must know what their doctor’s philosophical approach to their practice is and this is essential in how All therapies fit into each patients paradigm • Every appointment is customized for each patient • Success is based on “Caring” • Success is based on “Organized” • Success is based on the “Team”
- 2. 9/24/2014 2 Preventionat All Ages…how does your office customize? Caries Evaluation on Non restored teeth, caries evaluation on old restorations? Minimally Invasive Procedures…what are the protocols? How does occlusion fit into your philosophy? What role do the hygienists play? How do various periodontal phases fit into treatment planning? Comprehensive Periodontal Approaches Oral Cancer screening…what are the 1/2/3 steps each much follow Restorative concepts: composites versus crowns, implants versus bridges, orthodontics versus aggressive crown on bridge on natural dentitions How does esthetics fit into your approach? Sleep Apnea Botox, Anterior Orthodontics with 6 month smiles and Invisalign •Every Day has to be planned we review •Where patients are in various phases of hygiene care •Where patients are in their restorative treatment plans, work that still needs to be completed •Which patients on the doctors schedule are due for hygiene! •Who is do lab deliveries •Updates of the DAY and pass offs •Who requires a two-hour reminder for their appt or pre-medication via Smile Reminders •Room for emergencies •Who is do for charting, Velscope, periodontal and periodic exams, radiographs, and more Green is hygiene, Yellow is for doctors and assistants, Blue is front team If pure direct operative, no double books and my production is still geared per hour…so yes I bill per hour with direct restorative When I get up to do hygiene checks….all the hygienists have to be ready and this can only be done if they do their exams first (including review of medical and history changes)…a busy day … IT HAS TO FLOW! Growth Beyond a Value based practice…includes changing with the times, more non insured procedures, such as Invisalign, Six Month Smiles, Sleep Apnea and Botox. Equally, building a specialist role as part of your growth strategy was an option we adapted
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- 4. 9/24/2014 4 BuildRelationship Establish Credibility Clinical Screenings Share Findings Dr. Exam Either 50 or 60 minutes routinely….building Value Oral Hygiene Instrumentation Create Value Hand-Off Op Break Down Build Relationship Establish Credibility Clinical Screenings Share Findings Dr. Exam Oral Hygiene Instrumentation Create Value 30 minutes max Hand-Off Op Break Down The key is allowing the hygienist enough time to be a total oral care provider
- 5. 9/24/2014 5 Xrays: individualized per patient: This is determined by periodontal and caries susceptibility along with age….Bite Wings Yearly, FMX every 4-5 years, Panorex, and coming… Cone Beams Periodontal exam: absolutely annually with full probing and more Clinical Attachment levels, fremitus, mobility, BOP, inflammation, infection Restorative/Occlusal Exam with both the doctor and hygienist working together, this can include Diagnodent and Spectra (when appropriate), Intra Oral imaging, and now the world of CariVu (may alternate with X-rays) transillumination, articulating paper, tooth sleuth, pulp vitality tester…..and more Build Relationship Establish Credibility Clinical Screenings Share Findings Dr. Exam Oral Hygiene Instrumentation Create Value Hand-Off Op Break Down Saliva Testing for Strep Mutans and Xerostomia and far more coming…. DNA testing for those patients whom we have to know what are bugs behind the disease Sleep Apnea with written questions and a visual examination (Mallamapati) Oral Cancer the essentials of a 1/2/3 screening program…one of the most important responsibilities
- 6. 9/24/2014 6 BuildRelationship Establish Credibility Clinical Screenings Share Findings Dr. Exam Oral Hygiene Instrumentation Create Value Hand-Off Op Break Down
- 7. 9/24/2014 7 SDI’sRadii Light Mandatory: Loupes and Lights Hygienist Responsibility
- 8. 9/24/2014 8 Helpsfind decay, cracks, examine restorations, tartar sub-gingival and more! For the doctors, it’s a great add on to simply remove their LED curing tip and pop this on to exam their preps for decay and cracks, root canal orifices, and their exams!
- 9. 9/24/2014 9 Routinely,poor hygiene Food traps, plaque issues, poor margins in many restorations Periodontal issues, restorative issues that can affect their daily lives Where do you start?
- 10. 9/24/2014 10 Whatdo you do…He hates his smile, teeth are in occlusal trauma… 3 periodontal visits which included an overall debridement then 2 appointments for full mouth therapy with lasers. We pre-medicated him based on his periodontal health, not per his medical history Peridex pre-treatment rinses, today we use OraCare Lots of hygiene discussions with care giver Extracting teeth that were not salvageable 3 and 14 New Crowns 24,25 and 29 Upper Radica Bridge for the rest of his life…. 1330 REVIEW OF ORAL HYGIENE 0180 COMPREHENSIVE PERIODONTAL EXAM Potential DNA, Genetic, Saliva Testing, Occlusal Evaluation, Restorative Evaluation, Sensitivity First Therapy 4355 Full Mouth Debridement with laser in decontamination setting Therapies 2 and 3 4341 Half mouth Debridement with lasers Systemic antibiotics were given Therapy 4 4341 Re-debride the areas treated that have deep pockets, these do not have to be in the same quadrant, use laser in either decontamination mode or debridement and apply Arestin at this point and or both Therapies 5 and 6 followed the same profile Re-evaluation 6 weeks later…NO probing
- 11. 9/24/2014 11 1330REVIEW OF ORAL HYGIENE 0180 COMPREHENSIVE PERIODONTAL EXAM Potential DNA, Genetic, Saliva Testing, Occlusal Evaluation, Restorative Evaluation, Sensitivity First Therapy 4355 Full Mouth Debridement with laser in decontamination setting Pre-medicated Therapies 2 and 3 4341 Half mouth Debridement with lasers Review of Oral Hygiene with patient and care provider The opportunity to remove the biofilm from the root surface in a systematic approach The deeper the presenting pockets the greater the opportunity for failure to remove such biofilms Unless your office is doing open flap procedures, multiple sequential appointments become the standard of care in debridement therapy
- 12. 9/24/2014 12 Youwill be debriding the most significant pockets (>6mm) after the initial debridement. This can include multiple quadrants in one appointment. The concept is to have subsequent opportunities to additionally fully debride these pockets in sequential visits. We use lasers at every appointment in one of two modes…Decontamination or De-epithelialization…depends if the laser is activated and where we are in therapy Every hygienist in my practice has their own laser and is laser certified…every patient gets the same quality of care In Full Mouth Cases, the approach is to an initial debridement with laser decontamination Then 2 visits of ½ full mouth scalings/planing's and then if necessary begin systemic antibiotics followed by further sequential therapy, re-entering deeper pockets to complete debridement in 1-3 additional visits if required Simple cases may only require 1-3 visits post the initial debridement due to only specific areas requiring treatment The more complex cases often need 3-6 visits because the disease process is more extensive and omnipresent WE treatment plan more and if less….great! This is variable based on their periodontal history, number of pockets, severity and more! Customized sensitivity treatments that may be prescribed include MI PASTE, ReMin Pro or other custom treatments for sensitivity prior to beginning treatment
- 13. 9/24/2014 13 Oral-BVitality Baseline n=50 n=50 Week 4 ADA Manual •4-Week study comparing an Oral-B Oscillating- Rotating brush to an ADA manual brush •Assessment of gingivitis, gingival bleeding, and plaque at baseline and 4 weeks Klukowska M et al. IADR 2010 Abstract 3695 80 70 60 50 40 30 20 Oral-B Vitality ADA Manual ent Reduction From Baseline Plaque Index (RMNPI) 10 0 Interproximal Whole Mouth Gingival Margin Perc Differences Statistically Significant*P<0.001 Klukowska M et al. IADR 2010 Abstract 3695
- 14. 9/24/2014 14 8,800Side to Side 40,000 gentle in-and- oscillations per out pulsations minute sweep per minute reach plaque away deep to loosen 48 800 ill ti plaque 48,800 oscillating-rotating- pulsating movements/minute Brush Head Design along with Oscillating- Rotation-Pulsation Technology Lead to Outstanding Clinically Relevant Performance Smart coaching informs patient to brush next quadrant Pressure sensor informs patient excess pressure is being applied
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- 16. 9/24/2014 16 Stannousfluoride is a broad-spectrum antimicrobial Bactericidal Gram positive and gram negative bacteria Bacteriostatic Metabolic inhibition – toxin reductions Reductions in plaque mass Strep Mutans Reacts with teeth to protect against caries Blocks dentin tubules to reduce tooth sensitivity Kills bacteria and inhibits plaque metabolism. Reduces gingivitis and caries. Reduces Malodor Bioavailability of Stannous Fluoride in original Crest formulation F F F F Bioavailability of Stannous Fluoride in Crest Pro-Health
- 17. 9/24/2014 17 Currentlyavailable on the market Self-applied topical fluoride treatments 0.4% Stannous Fluoride Gel Gel-Kam®, Oral-B Stop®, Omnii Gel™ Rinses (Rx) 0.63% Stannous Fluoride Oral Rinse PerioMed™, Gel-Kam® Oral Care Rinse Dentifrice (OTC) Crest Pro-Health Toothpaste EnamelON In addition to caries benefits, stannous fluoride is also effective against: Plaque Gingivitis Dentin hypersensitivity Malodor Stannous fluoride is the only fluoride that has been shown to provide a benefit against caries, plaque & gingivitis,malodor and dentin hypersensitivity Caries protection Plaque & gingivitis control Sensitivity protection Freshens breath Calculus protection Extrinsic stain removal Extrinsic stain protection
- 18. 9/24/2014 18 CetylpyridiniumChloride (CPC): Potent, broad spectrum antibacterial - - - CPC interacts with bacteria walls - Inserts, solublize, & weakens cell membrane. - - - - - - - - - - + + + + + + - - Cellular pressure disrupts cell membrane – killing bacteria Effective against a broad range of bacteria commonly associated with plaque and gingivitis, including: • Actinomyces viscosus • Fusobacterium nucleatum • Porphyromonas gingivalis • Prevotella intermedia • Campylobacter rectus • Eikenella corrodens • Streptococcus sanguinis
- 19. 9/24/2014 19 DaytimePlaque Effects of Power Brush, Therapeutic Paste and Rinse” Presented by Gerlach et al at the American Association for Dental Research Washington, DC March 6, 2010
- 20. 9/24/2014 20 TreatmentGroups Dentifrice 0.454% SnF2 Regular Brush Power (R/O) Manual Rinse 0.07% CPC None (no floss) Two-week, randomized, examiner-blind, N=43 with 2 minute brushing and Digital Plaque Imaging endpoints-24 hr plaque Timing of Digital Plaque Imaging Measurement Morning Brushing Evening Brushing Acclimation Morning Brushing Evening Brushing Morning Brushing Evening Brushing Plaque Measurement Plaque Measurement Plaque Measurement Baseline Day 7 Day 14 Digital Plaque Imaging Measurement Performed Morning Prebrushing - Baseline Day 1 Standard manual brushing
- 21. 9/24/2014 21 MorningPostbrushing - Day 1 Standard manual brushing Night Prebrushing - Day 1 (Daytime Plaque Accumulation) Standard manual brushing Morning Prebrushing – Day 2 (Overnight Plaque Accumulation) Standard manual brushing
- 22. 9/24/2014 22 24-HourAnti-Microbial Effects of PRO-HEALTH Paste and Rinse Sodium Fluoride Stannous Fluoride + Cetylpridinium Chloride
- 23. 9/24/2014 23 Longterm provisionalization system... Comparable to indirect composites with high strength, wear properties Outstanding long term esthetics Glass ionomer provisional luting cement Very retentive Will stick too tooth, so avoid on lower molars! Releases fluoride (1600 μg/cm2 over 30 days) Easy clean up Low film thickness May help in reducing tooth sensitivity
- 24. 9/24/2014 24 Eugenolfree High bond strengths to tooth structure, very retentive for long term provisionals Easy clean up BUT…you have to mix power and liquid The Regimen of Crest Pro Health: Elimination of the majority of plaque and gingivitis
- 25. 9/24/2014 25 1.Helps Prevent Caries 2. Helps Prevent Gingivitis 3. Treats Sensitivity Stabilized SnF2 (970 ppm) Preventive Treatment Gel 1. Independent Testing Data: Therametric Technologies, Inc. 2014 2. Negative Control (Water) recorded an uptake of 8 ppm
- 26. 9/24/2014 26 *In-VitroTesting on Surface Human Dentin 1. Stabilized stannous fluoride (970 ppm F) 2. ACP technology 3. Substantivity Enhancers 1. Ultramulsion® patented technology* 2. Gantrez® 4. Spilanthes *Ultramulsion is a trademark of Whitehill Technologies, Inc. Promotes sustained release of ingredients calcium, phosphate, tin, fluoride, flavor Provides substantivity Slow dissolving silicone copolymers Polydimethylsiloxane Poloxamers 407 and 338 Long lasting in the oral environment Reduces surface tension Reduces dental plaque adhesion Inhibits biofilm attachment, staining Mucoadhesive - Moisturizes oral mucosa Beneficial for dry mouth patients coats the soft tissue creating a smooth, slippery, feel
- 27. 9/24/2014 27 Providessubstantivity specifically made for denture adhesives Not the same Gantrez as in Total Functionalized with calcium Promotes sustained release of ingredients calcium, phosphate, tin, fluoride, flavor Mucoadhesive sticks to the hard and soft tissue in the mouth Flowering Herb Naturally enhances salivation Enhances flavor Provides a tingling, cooling sensation Safe for all age groups Safe alternative to 5000 ppm fluoride pastes Option for young children without increased risk of fluorosis Nonabrasive (RDA 8) Saliva-stimulating No SLS No dyes, gluten, or dairy-based ingredients Clinical Studies shows very effective for root caries
- 28. 9/24/2014 28 Saveswaste Saves money Controlled dose delivery After whitening in tray What are the advantages of using a FL varnish over other topical fluorides? 9 Fluoride varnish works by increasing the concentration of fluoride in the outer surface of teeth, thereby enhancing fluoride uptake during early stages of demineralization. 9 The varnish hardens on the tooth as soon as it contacts saliva, allowing the high concentration of fluoride to be in contact with tooth enamel for an extended period of time (about 1 to 7 days). This is a much longer exposure compared to PPM Type 900 MI Paste Plus other high-dose topical fluorides such as gels or foams, which is typically 10 to 15 minutes. 9 The amount of fluoride deposited in the tooth surface is considerably greater in demineralized versus sound tooth surfaces.* 9 The benefits of fluoride varnish are greatest for individuals at moderate-risk or high-risk for demineralization or tooth decay.** Can we say Geriatrics! 900 -1,500 OTC Toothpaste 5,000 Prescription Toothpaste 12,300 Fluoride Gel 22,600 Fluoride Varnish Source: Fluoride Varnish: an Evidence-Based Approach Research Brief Association of State and Territorial Dental Directors Fluorides Committee September 2007 * (Skold-Larsson, Modeer, Twetman, 2000; ten Cate, Featherstone, 1991) - ** (Marinho et al, 2004; Marinho et al, 2004a; ADA 2006) MI Varnish GCAmerica Embrace Varnish CxP PulpDent
- 29. 9/24/2014 29 MIVarnish is a natural Casein and the phosphopeptides (CPP) binds to the oral surfaces, Amorphous Calcium Phosphate (ACP), which is found in the RECALDENT™, is also a source of calcium and phosphate. • Embrace Varnish is a resin-based varnish containing 17.6% Xylitol, sodium fluorideֽ calcium, phosphate, and less than 20% ethanol. • It too releases fluoride, calcium and phosphate ions over a four hour period EMBRACE™ Varnish CXP The nano-coated calcium and phosphate salts are encapsulated with Xylitol and do not react prior to exposure to saliva. As a result, the calcium, phosphate and fluoride are bioavailable and provide all the benefits of fluoride varnish. Nano-Coated with Xylitol: Bioavailable, Sustained Time-release
- 30. 9/24/2014 30 Thesevarnishes will remain on the teeth for 3-4 hours. This is the critical time for fluoride release and fluoride uptake by enamel. Sustained Time-release of Fluoride Cumulative Fluoride Release of Leading Fluoride Varnishes (measured in micrograms mcg] per 55 mg of solid weight) 1000 900 800 700 se in mcg 3M Omni White Varnish Preventech Vella 3M Vanish with TCP MPL Varnish America 600 500 400 300 200 100 0 1 hr 2 hr 3 hr 4 hr Cumulative fluoride releas Time in hours Premier Clear Enamel Pro Varnish PULPDENT EMBRACE VARNISH PULPDENT EMBRACE VARNISH Premier Clear Enamel Pro MPL Vanish America 3M Vanish with TCP Preventech Vella 3M Omni White Varnish 1. Dry the teeth with a gauze pad. It is best if teeth are at least minimally clean, but it is not necessary to do a prophylaxis. For Geriatrics…if they can’t tolerate traditional hygiene visits…we are trying to bring them in for a 30 minute prophy and Varnish 2. Remove the brush and peel off the foil seal, exposing the varnish. 3. Use the brush to apply a thin film of varnish on all surfaces of the teeth. It is not necessary to use all the varnish. Discard any unused material. 4. Patients should refrain from eating hard foods or drinking hot liquids or alcohol for 3-4 hours after treatment. Eating soft foods for the rest of the day is advantageous. Not brushing teeth until the morning after treatment may also be beneficial. 5. The majority of varnishes can be removed by brushing and Instructions for Use flossing.
- 31. 9/24/2014 31 Verticalbitewings every year and full mouth X-rays every 3 years Hygiene visits every 3 months (weather is an issue) with pre rinse of OraCare (ACTIVE CHLORINE DIOXIDE) Varnish application Every Visit, MI Varnish from GCA , Embrace Varnish from Pulp Dent Customized Home Care treatments…routinely Oral B Brush and appropriate pastes and rinses Perio Protect, customized treatment for both perio and caries, so many indications in this population for prevention Looking into xerostomia product lines for long term benefits Why is this so Important? An activated oral cleanser and health rinse… not just a mouthwash
- 32. 9/24/2014 32 ƒOracareis comprised of a two-part Halex OC system containing Natural EnhanceMint and Activated ClO2 ƒClO2 is safe and has been used for over 125 years ƒUsed by over 1000 US municipalities to purify drinking water ƒSterilized wounds and surgical instruments in the military ƒSanitize water in canteens for hikers Chlorhexidine Anti-Bacteria Exceptional Exceptional Anti-Virus Good Poor Anti-Fungal Exceptional Fair Neutralizes VSCs Exceptional Poor Disrupts unhealthy Exceptional Poor bio-film layer Oxidizes Pro-inflammatory Exceptional None Cytokines As a daily preventive care rinse for all patients Pre and Post operative rinsing Periodontitis, Gingivitis, Pericoronitis rinse Pre-root plane sulcular irrigation Post root plane & laser curettage care Post oral surgery care rinsing for one week Apthus Ulcer, Chemotherapy oral mucositis and Lichen Planus care Treatment of Dry Socket AND POTENTIALLY PREVENT
- 33. 9/24/2014 33 Killsall 10 of the most virulent oral bacteria and the C. albicans fungus faster and in greater numbers than rinses already on the market, creating a sanitary oral environment for routine and complex procedures Eradicates 99% - 100% of all volatile sulfur compounds (VSCs) Breaks down unhealthy bio-film
- 34. 9/24/2014 34 98% of bad breath is caused by bacteria and bacteria toxins, (VSCs) What Causes Bad Breath? Reduction of Volatile Sulfur Compounds (VSCs) that cause bad breath. Bacteria from bad breath to periodontal disease to tooth decay, are the primary causes of most oral health diseases and problems Viruses: thought to have a role in periodontal disease, can cause Oral Cancer (HPV), oral herpes, and oral warts. Fungi: cause of Candida Infections; very common in denture patients and can be a factor in Periodontal disease. Activated Chlorine Dioxide is unique because it has been used to kill a wide range of Bacteria, Fungi, Bacteria Toxins (VSCs), viruses and breaks down unhealthy bio-film.
- 35. 9/24/2014 35 Whenleft on the tongue or in the periodontal pocket, the anaerobic bacteria can yield the "rotten egg" smell of volatile sulfur compounds (VSCs) such as hydrogen sulfide, methyl mercaptan, allyl methyl sulfide, and dimethyl sulfide. VSC toxins may also contribute to periodontal disease. Implant placement care and bone graft and membrane care Implant maintenance and failure care Candida infections Halitosis care and sore throats Immediate denture care and healing Canker sores, and oral viral infections Cleaning your toothbrush Soaking and Scrubbing dentures
- 36. 9/24/2014 36 69year old: Smoker and the nicest guy! Long history of periodontal issues and few restorations Last visit to the dentist 3 years ago Occlusion with fremitus: 4/5, 7/8 Literally no occlusion on the left side Decay:3D,8D,14D He wants to save his teeth! Where do you start????? Does he have what it takes????
- 37. 9/24/2014 37 FullExam including Periodontal Exam Pictures Diagnostic Casts Discussion of current oral hygiene DNA Culturing Expectations and Desires Microbial Challenge • Connective Tissue and Bone Host Immuno- Inflammatory Response • Clinical Signs of Disease Increased Antigens Increased LPS cytokines MMP’’s Metabolism p PMN’s Antibodies MMP prostanoids Genetic Component and Environmental and Acquired Risk Factors Kornman 97
- 38. 9/24/2014 38 1330REVIEW OF ORAL HYGIENE 0180 COMPREHENSIVE PERIODONTAL EXAM Potential DNA, Genetic, Saliva Testing, Occlusal Evaluation, Restorative Evaluation, Sensitivity First Therapy 4355 Full Mouth Debridement with laser in decontamination setting 2nd and 3rd Therapies 4341 Half mouth Debridement, with lasers if you can, Systemic antibiotics were given 4th Therapy 4341 Re-debride the areas treated that have deep pockets if required, these do not have to be in the same quadrant, use laser in either decontamination mode or debridement and apply Arestin at this point and or both. 5th-6th Therapies follow the same profile This all depends on how many pockets and severity First Appointment, DNA Test and an overall debridement to remove all the tartar supra-gingivally and just into the pockets, Oral Hygiene instructions and Oral B power brush Occlusal Equilibration and impressions for initial mouth guard 2nd and 3rd appointments were for full mouth debridement therapies (laser each visit) and more visits to follow. Placement of Antibiotics after 3rd appointment 4th,5th and appointments were for further debridement along with lasers and Arestin as a further option
- 39. 9/24/2014 39 115 DNA(bacterial) Testing (MyPerioPath®) establishes bacterial risk and can help guide therapy based on causation DNA (genetic) Testing (MyPerioID® PST®) establishes genetic risk and can help guide therapy based on genetics DNA (viral) Testing (OraRisksm HPV) identifies HPV status Bacteria Load Genetic Susceptibility Clinical Signs and Symptoms 116 Label: Put Name and DOB on Barcode Label, and place Barcode Label lengthwise on Collection Tube. Swish: Ask Patient to Swish for 30 seconds. Expectorate: Ask Patient to spit into Collection Tube. Seal tube. Note: Specimen should be collected prior to cleaning (e.g. debridement or rinsing with antimicrobials); probing and other evaluations ok. 117
- 40. 9/24/2014 40 Crackopen the seal, swish and spit into the Spitoon!
- 41. 9/24/2014 41 Compliance:Is the patient taking the medication as prescribed? Drug Resistance Drug Interaction Side Effects…This is a huge issue today We only use systemic antibiotics in periodontal treatment when we have moderate to severe periodontal issues that are often omnipresent in our new patients or occasionally in our refractory patients who require “active therapy”
- 42. 9/24/2014 42 Arethe medications reaching MIC levels for the appropriate pathogens? That’s why we wait until after the debridement phase 5 visits with lasers were set up after initial exam Synchronizing treatment essential Occlusal Adjustment and night-guards Home Care that changed drastically He liked Sensodyne…Brushed 4 times daily with an Oral B electric brush (the head size distinguishes it here) Flossed twice daily We added a Hydrofloss and loved it! Used every night Sent an e-mail to me detailing his daily protocol Continued to smoke Pictures then taken with follow up…his hygiene was awesome! Occlusal adjustment on 4/5/7/8 and opposing teeth to remove fremitus He instantly felt the difference 2nd appointment and beyond…continued adjustments Delivery for bruxism appliance Soft night guard while we made him a traditional full upper mouth guard
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- 44. 9/24/2014 44 Phase2 Lower right osseous surgery and extraction of 30 (finances were very important) Phase 3 Final restorative with 2 implants for the upper left and upper right bicuspid areas and lower cast partial Ongoing SPT every 3 months and Perio Protect Trays after Upper Implants Delivered because with all that he does…he still bleeds, still smokes and has some 5’s The Upper Biscuspid/Molar Dilemma You would have loved more space, but the reality… you only had room for one implant
- 45. 9/24/2014 45 Notethe emergence profiles…easy to cleanse The cement upon removal off the silicone abutments is more towards the deeper internal aspects and not near the margins Once inserted, I immediately spray light water at the margins Thick Floss (Easy Floss from Butler) is then brought around the crowns Water spray again Final explorer removal of any cement
- 46. 9/24/2014 46 PERIOPROTECT
- 47. 9/24/2014 47 3months 3months 3months 3 th 3months 3 th Can we find better ways to compliment patients homecare beyond brushing, flossing and rinsing? Can we find approaches to shorten treatment time and enhance both long term outcomes? Perio Protect…. Patients after our sequential, laser therapy that still have BOP and inflammation and often good oral hygiene Patients after surgery that still have pocketing and BOP Patients with on-going implant issues and now…to prevent such issues! Patients who want to bleach and have been to sensitive High caries risk patients, especially xerostomic patients, and the geriatric group Oral Cancer patients with radiation ports Patients who don’t want to have required periodontal surgery