Best Whitening Options

What’s In Your Whitening?

With patients requesting whitening procedures like they’re going out of style, now’s the time to brush up on your bleaching basics

‘Tis the season for whitening procedures, but sifting through the dozens of whitening systems on the market can be a headache for even the most seasoned dental professionals. There are many options available to dentists and consumers alike, including in-office whitening, office-distributed take-home kits, and a variety of over-the-counter products. Because of this, you might find your patients asking you, “what’s the best method?” The answer is partly subjective and includes consideration of the speed of whitening, in-office or at-home treatment, convenience, and cost.

Teeth whitening procedures are in demand for the Holidays

Teeth whitening procedures are in demand for the Holidays

Types of whitening agents

Tooth whitening is affected by (1) the concentration of the peroxide in the whitening agent and (2) the length of time it is in contact with the enamel. Higher concentrations are faster but lower concentrations can achieve the same result by extending the amount of time it is on the enamel. In-office products contain the highest concentration of active ingredients, making them more efficient in rapid whitening.

Types of active ingredients

There are two types of active ingredients that can be used for whitening procedures: carbamide peroxide and hydrogen peroxide. Both agents remove both intrinsic and extrinsic stains (unlike whitening toothpastes, which only remove extrinsic stains). Carbamide peroxide is a combination of urea and hydrogen peroxide. Once applied, it breaks down into these two components, thus releasing hydrogen peroxide. The addition of urea to hydrogen peroxide acts to stabilize the hydrogen peroxide and increases its shelf life. Thus, carbamide peroxide is most often found in OTC whitening products as well as some take-home kits. The hydrogen peroxide released is about 1/3 the concentration of the original carbamide peroxide, a process that takes about 4-6 hours. As a result, carbamide peroxide is best used in overnight trays.

In comparison, uncut hydrogen peroxide is less stable and more potent. High-concentration hydrogen peroxide whitening agents are more appropriate for in-office use.

Managing sensitivity

Tooth sensitivity is a common complaint during tooth whitening that can actually be well-managed. Sensitivity results in sharp, painful impulses in individual teeth. Continuing to remind patients that these “zingers” are not abnormal is a good way to mitigate their distress. There are many options available to reduce and treat sensitivity:

  • Advising your patient to use a desensitizing toothpaste containing potassium nitrate for 2 weeks prior to their whitening procedure
  • Administering a whitening agent that contains potassium nitrate
  • Using potassium nitrate alone or with fluoride
  • Applying a high-level (5,000 ppm) fluoride dentifrice
  • Using amorphous calcium phosphate (ACP) in the whitening agent or as a stand-alone gel

Potassium nitrate desensitizes the nerves, while fluoride and ACP work by plugging the open dentinal tubules.

Equip your practice

At PureLife, we carry both in-office and take-home whitening systems, many of them available in several concentrations of hydrogen peroxide and/or carbide peroxide. To help with sensitivity issues, some even contain fluoride.

No matter which type of whitening products you use, there’s no doubt your patients will be asking for bleaching procedures. Having a handle on each specific type can save you money…and help your practice to be more efficient. Happy whitening!

Superpowers of Chlorhexidine

The Grime Fighter’s Secret Weapon

Fight bacteria with the antimicrobial powers of chlorhexidine

You probably know chlorhexidine as the active ingredient in mouthwashes and oral rinses. It’s approved by the FDA and the ADA for control of plaque and gingivitis, and studies have reported plaque and gingivitis reductions averaging 60%. In addition to its use in oral rinses, did you know that chlorhexidine gluconate is a powerful disinfectant and preservative? Here’s an overview of this safe, effective, and versatile “superchemical.”

powHOW IT WORKS
Chlorhexidine is a broad-spectrum biocide effective against Gram-positive bacteria, Gram-negative bacteria and fungi. Depending on its concentration, the molecule can kill bacteria as well as inhibit bacterial growth, providing a residual effect. Chlorhexidine inactivates microorganisms with a broader spectrum than other antimicrobials (e.g., antibiotics) and has a quicker kill rate than other antimicrobials (e.g., povidone-iodine) — killing nearly 100% of Gram-positive and Gram-negative bacteria within 30 seconds after application. And, with its low toxicity level, chlorhexidine is a safe treatment option that produces little side effects.

BENEFITS AND USES
Chlorhexidine has been used in more than 60 different pharmaceuticals and medical devices. Its wide application is due to its broad-spectrum efficacy, safety profile and substantivity on the skin with low irritation. Chlorhexidine is widely used as a disinfectant in a range of healthcare products, including:

  • Oral rinses, toothpastes and varnishes
  • Hard surface disinfectants
  • Dental unit waterline disinfectants
  • Evacuation system cleaners
  • Endodontic irrigation solutions
  • Hand sanitizers and lotions
  • Hand washing solutions
  • Wound and burn care products
  • Central venous catheters and needleless IV connectors

Chlorhexidine has become the gold standard in dentistry due to its ability to adhere to soft and hard tissue and maintain a potent sustained release. In oral applications, chlorhexidine binds to the mouth tissue, oral mucosa and teeth. It is then released over time to kill bacteria and fungi. This helps to reduce the bacterial count and prevents dental plaque. In hard surface applications, products with chlorhexidine in combination with alcohol have been shown to be more effective than alcohol alone. Chlorhexidine has also been applied to medical devices such as dental implants, vascular catheters, needleless connectors and antimicrobial dressings.

EXPERIENCE THE POWER
Try the amazing bactericidal, virucidal, and fungicidal properties of chlorhexidine for yourself! PureLife carries a wide range of safe and effective products containing chlorhexidine, including BioSURF Surface DisinfectantBioVAC Evacuation System Cleaneroral rinses and endodontic solutions.

All About Anesthesia

From Laughing Gas to Lidocaine

An inside look at the dynamics of anesthetics

DISCLAIMER: The material included in this article is intended for informational purposes only and does not constitute full prescribing information.

Evolution of Anesthesia

The concept of lowering the pain threshold has existed for centuries, but the first anesthetic agents — ether and nitrous oxide — weren’t introduced in dentistry until the 1840s. Anesthetics were used only during extractions until the first nerve block was introduced in the 1880s. Cocaine was the first local anesthetic used, and although effective for achieving profound anesthesia, was highly addictive. The first synthesized cocaine, procaine, was introduced at the turn of the 20th century. When mixed with a very small concentration of epinephrine, procaine was found to be highly effective, non-addictive and safe as a local anesthetic agent for most patients. Novocain procaine was widely used until it was replaced by lidocaine in the 1950s, which remains the gold standard to this day. The newest local anesthetic, articaine, has similar time of onset and profoundness of anesthesia as lidocaine, but is claimed to last two to three times longer.

A Closer Look at Local Anesthetics

Local anesthetics are the most widely used anesthetic agents in dentistry. The table at the bottom of this page shows the most common types of injectable local anesthetics in use today.

Determining Total Dose:

The total dose (mg) of a local anesthetic is a function of its concentration (%). For any given percent solution, the easiest way to calculate dose is to move the decimal one place to the right (reflecting mg/ ml) and then doubling it for the dose per cartridge (one cartridge = ~2 ml of solution). For example, one cartridge of 3% mepivacaine is equivalent to ~2 ml at 30 mg/ml, or ~60 mg total. Similarly, 2 1/2 cartridges of 2% lidocaine is equivalent to ~5 ml at 20 mg/ml, or 100 mg total.

Addition of Vasoconstrictors:

Solutions containing a vasoconstrictor like epinephrine increase the duration of the anesthetic by slowing down its rate of absorption. They vary in concentration, representing grams of solute dissolved in milliliters of solvent. The most common is epinephrine 1:100,000 (10 micrograms/ml). Higher concentrations may provide better hemostasis at the surgical site compared to lower concentrations. Remember, 1:200,000 (5 micrograms/ml) is half the concentration of 1:100,000. Similarly, 1:50,000 (20 micrograms/ml) is double the concentration of 1:100,000.

Adverse “Allergic” Reactions:

It is not unusual for patients to claim they are allergic to local anesthetics, when most likely they are sensitive to epinephrine. Since epinephrine is a hormone produced in the body, it is impossible to be allergic to it. However, some patients occasionally experience symptoms resembling an allergic reaction, which can be attributed to preservatives (methylparaben) or antioxidants (bisulfites) contained in the solution. Solutions without a vasoconstrictor should be used in these types of cases, or when a patient has severe heart disease or recent myocardial infarction

anesthetics chart

SOURCES

1 Perno Goldie, M. (2009). The evolution of analgesia and anesthesia in oral health care. RDH (29) 9

2 Becker, D. & Reed, K. (2006). Essentials of local anesthetic pharmacology. Anesthesia Progress, 53 (3), 98-109

Oral-Systemic Connection

Dentists: The New Disease Detectives

The eyes are the windows to the soul, but the mouth is the window to overall health

Ironically, oral healthcare is considered separate from the rest of the healthcare system. But, new research has revealed an important connection: oral health can impact overall systemic health. Dentists are now taking on a new role in healthcare, becoming the lead investigators in preventive cardiology, diabetic care, and inflammatory disease.

bacteria

BACTERIA GOES BEYOND THE MOUTH
The mouth is the port of entry for most of the pathogenic bacteria that affect our health, making it a hotspot for potential infections and diseases. Without proper oral hygiene, the body’s natural defenses cannot combat the high levels of bacteria that cause oral infections, such as dental caries and gingivitis. Bacteria also cause oral inflammation associated with periodontitis—the most common inflammatory disease in humans and affecting 85% of the US adult population. Inflammatory diseases that can be triggered by oral inflammation include cardiovascular disease, diabetes, kidney disease, Alzheimer’s disease, pneumonia, preterm and low-weight births, and various cancers.

The larger medical community is now addressing this issue. Dr. Marc Penn, MD, PhD, former director of the Cardiac Intensive Care Unit at Cleveland Clinic, considers periodontal disease as “an important source of inflammation in reference to cardiovascular disease.” Dr. Bradley Bale, MD, mirrors this view, stating, “One of the reasons heart attacks are not being prevented is because healthcare providers are not recognizing the link between cardiovascular disease and oral-systemic health.”

ORAL-SYSTEMIC HEALTH LINK
Here are a few statistics that suggest a strong correlation between oral and systemic health:

  • Even as few as two professional cleanings per year can reduce the risk of heart attack by 25% (American Heart Association)
  • Obstructive sleep apnea affects 20 million people and increases the risk for cardiovascular disease, but effective treatment of sleep apnea can add ten years to a person’s lifespan
  • Appropriate periodontal treatment has been shown to be as effective in lowering the A1C levels in diabetic patients as most medications, but without the adverse side effects
  • Reduction in oral inflammation in diabetic patients can reduce their yearly overall healthcare costs by up to 25%

PERSONALIZED MEDICINE AND DENTISTRY

Tray Setup

With evidence supporting the link between oral and systemic health, dentists are able to customize care with different combinations of treatments. By treating patients according to their overall health risk factors, a visit to the dentist becomes more than just an oral checkup, but a total wellness exam. This new approach may include a traditional dental exam plus expanded diagnostic testing, such as a microbial assessment, genetic testing, salivary diagnostics and health risk assessment. Many of these tests are available to dental professionals as an added level of prevention.

The future of dentistry involves total alignment with the broader healthcare system. The medical and dental communities are now starting to view oral health as a key player in overall health, but the next step will involve collaboration between dentists and physicians to create personalized medical plans. Dentistry has always been one of the few medical sects specializing in prevention. The best way to avoid disease is to prevent it from happening in the first place, and it all starts with the mouth.

What’s Lurking In Your Waterlines?

A Comprehensive Look at Dental Unit Waterlines

Eliminating the risk of contamination requires going beyond the status quo

In 2011, the dental industry received international attention when an 82 year old Italian woman died from a case of Legionnaire’s disease she contracted during dental treatment—its source traced to contaminated water from dental unit waterline tubing.

operatoryA Perfect Storm for Biofilm
Bacterial biofilm is virtually universal in untreated dental unit waterlines and can begin forming in a new dental unit within days. Although there has only been a handful of reported cases of dental waterline contamination since 1963, many microorganisms of concern have been isolated from dental unit water, namely Pseudomonas species, non-tuberculosis mycobacteria, and Legionella, the causative agent of Legionnaires’ disease. Legionella poses a particular threat because it can be transmitted by inhaling aerosols or aspirating water contaminated with the bacteria. Because of their narrow tubing (1/8” to 1/16”), dental waterlines provide particularly well-suited conditions for biofilm–a community of bacteria and other microbes that adhere to surfaces and form a protective slime layer. Low water pressure, low flow rates, and frequent periods of stagnation also encourage any bacteria introduced from municipal water to accumulate within the tubing.

Anomalies of Waterline Testing
According to the American Dental Association (ADA) Council on Scientific Affairs’ 1999 report to the profession on dental unit waterlines, evaluating water quality before a treatment protocol is implemented is controversial. Because the scientific literature suggests that all units are highly contaminated, pre-testing to confirm contamination is of questionable value. However, testing water quality after initiation of a treatment regimen ascertains whether a waterline product or protocol achieves the desired outcome. Monitoring water quality according to an established schedule can help identify problems in performance or compliance and provide documentation of water quality.

Waterline Monitoring Recommendations
Both in-office monitoring devices and commercial testing services are available. Dentists should consult with the manufacturer of their dental unit or water delivery system to determine the best method for maintaining acceptable water quality (i.e.,

Waterline Treatment Options
FLUSHING: Mechanical flushing alone does little to control contamination in waterlines. Although it can temporarily reduce the number of microbes in the water delivered to patients by clearing away many of the free-floating organisms in the waterline, biofilm bacteria continually break free and recontaminate dental unit water during the course of clinical treatment. Flushing for several minutes between patients, however, may be valuable in removing contaminants that can enter the water system during patient treatment.

SELF-CONTAINED WATER SYSTEMS: Also referred to as independent water systems or reservoirs, these isolate the dental unit from the municipal water supplies, instead providing water or treatment solution from reservoirs filled and maintained by office staff. They allow the practice to control the quality of water that is used in the unit.

CHEMICAL DISINFECTANTS: A number of chemicals are reported to inactivate or prevent biofilm, whether through periodic (intermittent or “shock” treatment) or continuous presence in the waterline. Periodic disinfection involves purging the waterlines, adding a chemical to the water reservoir, filling the lines for the recommended time period, and flushing. Continuous chemical treatment refers to waterline treatment via an irrigant/coolant solution or the use of automated metering devices. Metering devices release low levels of chemical germicide into the treatment water to control biofilm to lower bacterial counts in the water. Some products may require both intermittent and continuous line treatments to maintain water quality.

No matter the treatment option you implement in your practice, strict compliance with the recommended treatment regimen is the key to consistent water quality.