Sharper Tools Mean Greater Efficiency
Instruments are essential to any dental procedure, and the sharper they are, the better. Proper sharpening techniques not only make for longer-lasting instruments, they enable quicker patient turnover due to more efficient hygiene procedures. Do your practices measure up?
For your 6-month prophylaxis appointments, it’s recommended you sharpen your instruments at least once a week. For your scaling and root planing procedures, sharpen your instruments before each procedure. Manual stones are easier because they are portable and can be used anywhere in the office. Automatic sharpeners require a power source, which limits when and where you can use them.
The average office should order new instruments at least once a year. A good rule of thumb is to have enough procedure setups for a half-day’s patients. This number can be determined by averaging the number of procedures per day over several weeks. If your practice doesn’t have a good supply of instruments, invest in more setups to improve your efficiency.
The most unbiased and universal way to check if an instrument is sharp would be to use a test stick. Each hygienist uses different pressures when scaling teeth; thus, basing instrument sharpness on pressure applied isn’t an objective test.
DID YOU KNOW?
PureLife carries every instrument needed for your hygiene procedures. The Montana Jack scaler and Wingrove Titanium Implant Instruments are unique additions to any dental office. The ultra-light Montana Jack is a hybrid universal scaler that can be used for the entire mouth. The Wingrove Titanium Implant Instruments boast solid medical-grade titanium that won’t scratch implants.
More Than Cleaning
Incorporate elective services into routine visits
Standardizing and organizing examination protocols creates a framework for recare and restorative visits. Here is an “old school” way to integrate whitening acceptance into your daily routine. The two key pieces of equipment for this tip are: a hand mirror and a shade guide.
One way to increase whitening business is for assistants and hygienists to make a habit of doing a “color analysis” for each patient. With the patient looking into a mirror, simply say to them, “We know that teeth can change color over time. What I’d like to do now is to determine the current color of your teeth. I’ll need your help with this part.” This immediately gets the patient involved in their care and gives you an opportunity to talk whitening options.
Each operatory (hygiene too) should be equipped with shade guides. Set it up from lightest to darkest; make sure the shade guide also includes newer ‘bleaching’ colors. Hold the shade guide so that your patient can see the colors.
Next, have the patient guide the selection of the shade–this gives them an idea of what their teeth could look like. If your patient has an interest in whitening, he/she will normally take up the issue with you and you will have permission to ask other questions. These might include: “Other than the color shifts, is there anything else that you notice about your smile?”
Thanks to mainstream media, talk shows and magazines, patients are more knowledgeable about tooth discoloration, malodor and the importance of a healthy mouth to overall health. Incorporating something as basic as a shade guide review (at least yearly) is a powerful way to make regular inquiries into all of your aesthetic services.
Tips and Pointers in Selecting Shades
- For most accurate results, the colors in the room should be neutral as well as the patient’s clothes. Drape the patient with a neutral gray bib or towel when taking a shade. It neutralizes the eyes’ color perception.
- Female patients: If applicable, remove lipstick.
- Make sure teeth are not dehydrated.
- The mouth of the patient should be at eye level.
- Determine the amber or gray color type of the patient.
- Determine the base shade of the patient and remove matching shade group (Chromascope).
- Determine the shade intensity within the shade group.
- Compare the selected shade once again with the natural tooth.
- Color Map: Note range of shade, striations, and color banding or mottling. Close examination will reveal a blending of various colors.
- Collaborative Whitening: All team members can perform color assessments.
In sum, incorporating simple, “old school” basics into your protocols will help your patients understand the full menu of services offered by your practice and can help drive elective procedures such as whitening
Beyond the Label
The “off-label” benefits of using fluoride varnish for caries prevention
Dentists and hygienists have been applying high-concentration fluoride compounds directly to patients’ teeth for over 50 years. Interestingly, there has been an uptick in the number of fluoride varnishes being introduced in the last several years. According to the FDA, varnish is indicated for use as a desensitizer and cavity liner, but many are recognizing its “off-label” use as a topical fluoride treatment. With all the fluoride products and delivery systems on the market, does fluoride varnish measure up?
FLUORIDE GEL AND FOAM
The most widely used fluoride application in dental practices is 1.23% acidulated phosphate fluoride (APF) gel (Sheehan 2001). In 1993, 1.23% APF foam hit the market. It is claimed to deliver the same protection as APF gel with 75 percent less fluoride, which lessens the risk of a toxic amount being accidentally swallowed. However, some research has shown that both foam and gel deliver the same amount of fluoride.
First introduced in the 1960s under the trade name Duraphat, sodium fluoride varnish is relatively inexpensive, easily applied to exposed root surfaces, and prolongs contact time between fluoride and enamel, thereby achieving deeper fluoride uptake (Sheehan 2001). The benefits of fluoride varnishes also include long-term fluoride release and a higher delivery of fluoride into cementum. Varnish has been used as an effective anticaries agent in Europe and Canada for over three decades (Sheehan 2001). It has not yet been approved for use in this capacity in the United States; rather, it has been cleared by the FDA for use as a desensitizing agent and cavity liner. Caries prevention is regarded as a drug claim, and companies would be required to submit appropriate clinical trial evidence for review before this product could be marketed as an anticaries agent.
That being said, fluoride varnish is still an effective caries prevention solution. According to CDC Recommendations, a prescribing practitioner can use fluoride varnish for caries prevention as an “off-label” use. The American Academy of Pediatric Dentistry emphasized in a 1996 recommendation, “Unapproved does not imply an illegal use. The word unapproved is used merely to indicate lack of approval, not to imply disapproval or contraindication based on positive evidence of a lack of safety or efficacy.”
“Although varnishes are not FDA-approved as a topical fluoride treatment […] many studies show they are clinically as effective, if not more so, than APF treatments.”
– Dr. Timothy Wright, Professor of Pediatric Dentistry, University of North Carolina
Several reviews of the use of fluoride therapies in preventing dental caries have been published since the year 2000, including 2 evidence-based reports. The Cochrane reviews of this topic concluded, “Fluoride varnishes applied professionally two to four times a year would substantially reduce tooth decay in children.” In addition, an expert panel of the American Dental Association recently concluded, “Fluoride varnish applications take less time, create less patient discomfort and achieve greater patient acceptability than fluoride gels, especially in preschool-aged children.”
Studies examining the effectiveness of varnish in controlling early childhood caries are currently being conducted in the United States. More research on fluoride varnish is likely to continue in both Europe and North America to determine optimal fluoride concentration, the most effective application protocols, and its efficacy relative to other fluoride modalities (CDC 2001).
AVAILABLE VARNISH PRODUCTS
PureLife offers the top brands of fluoride varnish, including Vanish by 3M ESPE, NUPRO White Varnish by Dentsply Professional, DuraShield CV by Sultan Healthcare, Duraflor Halo by Medicom, and the BPA-free Embrace Varnish by Pulpdent. To learn more about these great products, call our product experts at 877-777-3303.
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.
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.
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!
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.”
HOW 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 Disinfectant, BioVAC Evacuation System Cleaner, oral rinses and endodontic solutions.
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
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
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 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
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.