Dr. Derango & Dr. Mueller’s

CARIES PROTOCOL

The answers to your questions.

Jenna R. Derango R.D.H.

Past Methods of Treatment1. 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 ProcessDifferent 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 ProcessNegative 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 BrushingBrush time from beginning to end should be around2 minuets. 30 seconds spent in each section of themouth (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 teethand 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 motionfront to back. 3. To clean the inner front tooth surfaces, hold the brushupright 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. Simplylet the brush do all the work.

3. Don't forget to reach all areas, includingthe 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 andwrap 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 braces1. 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 toclean underneath your gum line and between teeth.

• Proxy brushes are also great ways to clean braces or between teeth withlarge 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.

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Grape fruit, Orange Juice, Soda

Battery Acid, Hydrofluoric Acid

Hydrochloric acid secreted by stomach lining

Lemon Juice, Gastric Acid, Vinegar

Tomato Juice, Acid rain

Soft drinking water, Black Coffee

Urine, Saliva

“Pure” water

Sea water

Baking soda

Great Salt Lake, Milk of Magnesia

Ammonia solution

Soapy water

Bleaches, Oven cleaner

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.

FluoridesSuggested 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 $