#17 – Thorough knowledge of preventive dentistry: Fluoride, perio aid, brush, floss, keys, sealants, kids pc

This information, as it should be presented to the client, is contained in the two client handouts: “Kids” and “Preventive Dentistry.”

Here is some other information

1. Tartar Control Toothpaste
a. Advantages
1. Reduce supragingiva calculus buildup by as much as 35%
2. Less tenacious calculus
3. Easier recall appointment (extend number of months between recalls?)
4. Improved health of gums
5. Better esthetics

2. Fluoride supplements
a. Background
1. Ingested, fluoride replaces hydroxylions and forms fluorapetite crystals. These are smaller and less soluble than hydroxyapetite crystals
b. Sold in 2 forms
1. Drops
2. Chewable tablets – best if chewed
c. Adjusted for water supply
d. Over consumption can lead to fluorosis
e. Home filtration units may receive fluoride, so sink water should be tested

3. Water Testing – Fluoricheck – cost $12
a. If a child’s home has it’s own well water supply, the fluoride content must be determined before a supplement can be given.
b. Discuss with parent.
c. Kit contains a sample bottle in a postage paid preaddressed box
d. Results reported to parents and us by mail so we can prescribe supplement.

4. Topical fluoride (30-40% reduction in decay)
a. Gel – best if patient will use it at home regularly-see section #22
1. Fluoride concentration APF – 12,300 ppm, Naf – 9000 ppm
2. Tray application 4 minutes
3. Foam – reduces risk of ingestion
4. Not used in children younger than 6
5. Carries reduction of 21%

b. Tray – 4 minute in office at PC appointments if bottle won’t work
1. Seat patient upright to minimize material swallowed.
2. Try in F trays to assure coverage slightly past distal of last molar.
3. Dispense just enough foam into tray to cover teeth when patient closes into tray.
4. Have patient rinse with water to clear food debris (prophylaxis is not necessary).
5. Clear saliva.
6. Air dry teeth well & insert trays (lower tray first).
7. Start 4 minute timer & place where both clinician & patient can see it.
8. Use saliva ejector to clear excess F & saliva throughout contact time.
9. Remove trays & ask patient to expectorate for 1 minute, but do not rinse.
10. Instruct patient not to eat or drink for 30 minutes.

c. Topical fluoride benefit is additive – the more times used, the better, but child must be old enough to spit (not swallow)-Fluoriguard has 5 times more fluoride than Crest.

5. Fluoride varnish (available as 5% sodium fluoride = 22,600 ppm fluoride)
a. Used since 1970 in Europe
b. Duraphat – cover crowns after prophy for those prone to decay
c. Advantages versus gels/forms (2009 Christianson)
1. On teeth longer
2. Higher fluoride level 22,600 ppm versus 12,000 ppm
3. Less ingested
4. No gagging
5. Caries reduction primary dentition 33%, adult teeth 46%
6. Ideally applied 4 times a year

d. Indications
1. Reduce decay potential
2. Reduce sensitivity
3. Children 3 and younger (don’t use gel)

e. Clinical tips
1. Isolate, air dry a quadrant
2. Apply generously (quadrant takes 1-4 minutes)
3. Apply quickly for smoothness
4. Moisten cheek after application so cheeks will not pull off varnish
5. Don’t cover facial of anteriors (looks better)
6. Best use with 5000 ppm toothpaste, not in place of
7. Client – soft diet rest of day and do not brush or floss

6. Dentrifices
a. Over the counter
i. 1000-1100 ppm
ii. Best is twice daily
iii. Can start at age 2
iv. Decay reduced 24%
b. Prescription
i. 5000 ppm
ii. Use in place of regular dentrifices
iii. Fifty-seven percent (57%) caries decrease

7. Xylitol gum contains no sugar and has an anti-caries effect

8. Chlorhexidrine rinse
a. very anti-cariogenic
b. reduce plaque
c. toothpaste inactivates
d. kills streptocaucus

9. Power toothbrushes
a. fluid dynamics create turbulence that disrupts biofilm
b. avoid timer-it’s not how long (2 minutes), it’s how well

10. PC booklet has this page: “toothpaste abraisiveness”

How to use Caesy cd rom to educate patients:
1. Use mouse/light pen to click on Media Play in taskbar – this will bring up the Caesy program
2. Click on Caesy Main Menu (bottom right button)
3. Use the remote –press computer channel ____ – this will make the TV show the same images on your computer
4. Use your mouse to select the module you want
5. Adjust the volume on your white TV so your patient can hear (usually increase volume)
6. When the module is finished – adjust the volume on your white TV back down (usually decrease volume)
7. Use the remote –press 86 (for Smile channel)
8. Press escape on your keyboard – this will close Caesy & return you to Dentrix.

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