April 24, 2018

Bioactive Restoratives: 4 Tips for Dental Assistants

by Karen L Comisi, RDA, CDA, FAADA

Today’s dental assistants need to be flexible and adaptable. Although we have the opportunity to attend CE courses about new dental techniques and materials, we often end up learning about new procedures and products on the job.

One of the advances that I find most interesting in the dental industry is bioactive restorative materials. As more dentists begin to use bioactive restoratives like ACTIVA BioACTIVE (Pulpdent), it’s important for dental assistants to understand how these materials work. Here are 4 tips for dental assistants to keep in mind when using bioactive restoratives. 

Tip #1:  Understand What Bioactive Means
Bioactive materials stimulate the natural remineralization process. They are moisture friendly and elicit a response from living tissue. In the case of ACTIVA BioACTIVE-RESTORATIVE, the material responds to changes in oral pH by releasing and recharging calcium and  phosphate, which are the building blocks of tooth structure, along with fluoride, which makes teeth more acid resistant. To learn more about how bioactive dental restoratives work, download ACTIVA: A Closer Look at Bioactive Materials.

Tip #2:  Take The Bioactive Break
Many dental assistants are instructed to start light curing composites immediately after placement. When restoring a tooth with ACTIVA BioACTIVE, it is better to give the material a chance to penetrate and integrate with the tooth for 20 seconds prior to light curing the material. This 20-second pause is what I like to call the “Bioactive Break.” This extra time also mitigates the heat and polymerization stresses associated with curing composites.

Tip #3: Have Extra Automix Tips Ready
I like to have extra mix tips ready at my side when the dentist is restoring multiple teeth. ACTIVA BioACTIVE-RESTORATIVE is a dual cure material and will start to set up in the mix tip after 5-7 minutes at room temperature.  The ambient operatory light can accelerate the curing process, so covering the mix tip with an orange shield, opaque tape, or other light blocking material can help extend the setting time..

Tip #4: Practice Bioactive Infection Control  
Always follow manufacturers’ instructions regarding infection control. Items that come in contact with tooth structure or the mucous membranes are considered semi-critical according to the CDC and should be heat sterilized or immersed in a high-level chemical disinfectant. Since the popular syringe delivery systems we use cannot be reprocessed in this manner, placing a disposable barrier or sleeve to cover the entire syringe and tip is recommended.1 After the procedure is complete, the automix tip should be removed from the dual-barrel cartridge, discarded, and the syringe should be recapped.2

Advances in technology and research are allowing dental health care professionals to offer improved products and services to their patients.  Being a part of the dental team can be very rewarding, and your understanding of the methods and materials used by your doctor is essential to being an integral part of the team.

References

  1. www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DentalProducts/ucm404472.htm  
  2. www.pulpdent.com/wp-content/uploads/2015/12/IFU-R.BL_12.15web.pdf

About Karen L Comisi, RDA, CDA, FAADA
Over the past 33 years, Karen Comisi has held almost every staff position in the dental office, with the exception of dentist and dental hygienist. She has been an orthodontic dental assistant, oral surgeon dental assistant, general dentist assistant, front desk and insurance coordinator, office manager, CFO, Co-Founder of Dental Care with a Difference, PC and currently Co-Founder and CFO of Sleep Focused Solutions, Inc.  She is one of the first licensed, registered dental assistants in New York State and is a founding member and Treasurer of the Southern Tier Dental Assistants Society. Karen is a DANB Certified Dental Assistant, a member of the American Dental Assistants Association, the American Association of Dental Office Managers, the Office for Safety & Asepsis Procedures (OSAP), and The American Academy for Oral Systemic Health (AAOSH).

April 16, 2018

The Social Dentist Tip #5: Adapt and Stay Grateful

Dr. Ryan McCall grew his Indiana-based dental practice by engaging new and existing patients through Facebook, Instagram, Snapchat and Twitter. In this series, The Social Dentist, Dr. McCall offers tips on how to market your dental practice using social media.

Adapt
Ten years ago, Facebook was king of social media. It was inconceivable that it might decrease in popularity and I would have to promote my practice on other sites. Now I’m excited to have so many social media options to choose from. It means our practices can reach even more people who may want to become friends, patients, or business partners.

Our message can be adapted to fit any platform.  If Facebook isn’t around in ten years, we will adapt and move on #NBD (no big deal).    

Be Grateful
When I started out as a struggling young dentist, I had to focus on profits first in order to meet my financial obligations. Over time I have developed a deep appreciation for the patients who have put their trust in me. This attitude of gratitude has gone a long way in building trust and confidence, the cornerstones of any successful business. 

I sensed the same sense of gratitude when I visited Pulpdent and attended a factory tour and educational seminar with Larry Clark.

Afterwards I emailed Larry and told him how refreshing it was to see an expert in his field who was so concerned with making a difference and leaving a lasting impression. He responded with pure gratefulness. Naturally, I look forward to collaborating more in the future.

More Articles by The Social Dentist

Dr. Ryan McCall

About Dr. Ryan McCall
Dr. Ryan D. McCall was raised in Illinois. He received his BS in Biology and Chemistry from Indiana University and dental degree from the University of Illinois School of Dentistry. He maintains private practices in Indianapolis and Lebanon, Indiana.

April 6, 2018

Dr. Jack Griffin Discusses Bioactive Materials in Free CE Webinar

Dentist and popular lecturer Dr. Jack Griffin will present “Regenerative Restorations – Durable, Comfortable and Aesthetic Results,” a Continuing Education (CE) webinar on May 8, 2018 at 4:00 PM PT / 7:00 PM ET. 

Sign Up for Dr. Griffin’s Free CE Webinar

Dr. Griffin’s webinar will provide an overview of bioactive materials that are durable, aesthetic and easy to for dentists to use. Participants will learn about dental materials which “not only offer clinical performance but also reduce microleakage while releasing the bio-stimulating ions calcium, phosphate, and fluoride.”

For the past several years, Dr. Griffin has used ACTIVA BioACTIVE, which releases and recharges calcium, phosphate and fluoride ions. He chose ACTIVA because it “lasts longer, looks better and is much kinder to gum tissues” than traditional dental materials like glass ionomers. His three Missouri-based dental practices use ACTIVA BioACTIVE materials for a variety of procedures on patients of all ages. “Our dentists are confident that by using ACTIVA they can provide patients with faster, better healthcare,” said Dr. Griffin in a recent interview.

Dr. Griffin’s free CE webinar “Regenerative Restorations – Durable, Comfortable and Aesthetic Results,” will be available for On-Demand viewing after May 8, 2018 on www.pulpdentlearning.com.

 

About Dr. Jack D Griffin
Dr. Jack D Griffin is one of the most honored and awarded dentists in the country. Jack is one of a hand-full of dentists awarded by his peers Diplomat status with the American Board of Aesthetic Dentistry (ABAD), accreditation with the American Academy of Cosmetic Dentistry (AACD), and Mastership in the Academy of General Dentistry (AGD). Jack graduated dental school from Southern Illinois University, where he received student dentistry awards and then went on to complete a general dentistry residency at the University of Louisville in Kentucky, with an emphasis in advanced dental care in restorative dentistry, emergency care, implants, oral surgery, and special patient care. Dr. Griffin began his dental practice in Eureka in 1988.

March 23, 2018

Shedding Some Light on LEDS

by John C Comisi, DDS, MAGD

LED lights are a great asset to today’s dental practice. LEDs do not require fans for cooling, so they are smaller, quieter, and more convenient than halogen lights. However, clinicians should be aware of potential challenges posed by these high intensity curing lights.

A study published in the Journal of Dentistry in 2017 surveyed 1313 dentists in Norway regarding safety awareness and their knowledge of the practical use and technical features of their curing lights. Over 55.8% of those surveyed respond to the survey. The results showed that the average length of light cure of a typical layer of composite was 27 seconds. Almost one-third of respondents used inadequate eye protection against blue light, and 78.3% of the respondents were unaware of the irradiance value of their curing lights. Interestingly, regular maintenance was not performed by many dentists in this group.

The implications of this article are troubling for two reasons:

1. The wavelength of light emitted from LEDs can cause irreversible eye damage. 
2. Unlike halogen lights which “blow out,” it is harder to tell when an LED light no longer provides sufficient energy to polymerize the resins in restorative materials.

Proper eye protection is absolutely essential for both the dental team and the patient. Safety is always our first concern.

The routine use of a digital radiometer with a numerical readout is absolutely necessary to ensure sufficient irradiance energy to fully cure resin-based materials. Otherwise, practitioners run the risk of under-curing resin-based materials. Unpolymerized resins can result in what I like to call a “Tootsie Pop” restoration, i.e., crunchy on the outside and soft on the inside, which can lead to patient sensitivity, pulpal necrosis, and restoration failure.

Reference
1. Kopperud, et al. Light curing procedures-performance, knowledge level and safety awareness among dentists. Journal of Dentistry 2017;58:67-73.


About Dr. John Comisi
Dr. John Comisi is the president and CEO of Sleep Focused Solutions and an assistant professor of the Medical University of South Carolina College of Medicine. He is a graduate of Northwestern University Dental School, a master of the Academy of General Dentistry, and a Scientific Advisory Board member of the Dental Biomaterials Science and Research Group. He holds Fellowships in the Academy of Dentistry International, the American College of Dentists, the Pierre Fauchard Academy, and the International College of Dentists.

March 15, 2018

The Social Dentist Tip #4: Stay Engaged and Step It Up

Dr. Ryan McCall grew his Indiana-based dental practice by engaging new and existing patients through Facebook, Instagram, Snapchat and Twitter. In this series, The Social Dentist, Dr. McCall offers tips on how to market your dental practice using social media.

Stay Engaged
As an independent practice owner, I strive to differentiate my services from large corporate practices by actively engaging patients on social media. I often run ads targeting fans of our pages and their friends.

Sharing posts on social media has become the new word of mouth. Many of our referrals come through social media, and patients who read good reviews about us online are always eager to start treatment.   

Step It Up
Social media posts (i.e., content you publish), likes (from patients, prospective patients and others), and tags are a good start, but you’ll eventually have to step up your media efforts to maintain a steady flow of patients and referrals.  Consider adding email marketing and targeted ad campaigns to your media mix. Facebook ads allow you to target specific demographics, and they have a pixel tracking function that shows which ads drive traffic to your website. We use the Facebook pixel tracking tool every day to track new leads, and then I follow through with great content.  

More Articles by The Social Dentist

 

Dr. Ryan McCall

About Dr. Ryan McCall
Dr. Ryan D. McCall was raised in Illinois. He received his BS in Biology and Chemistry from Indiana University and dental degree from the University of Illinois School of Dentistry. He maintains private practices in Indianapolis and Lebanon, Indiana.

March 5, 2018

Embracing a Preventative Plan for Pediatric Patients

By Jarod W. Johnson, DDS, ABPD

Dental caries is the most common chronic disease in children. It is more common than obesity, asthma, and diabetes.1 It is estimated that one in five children will experience tooth decay in a primary tooth between ages two and five, and three in five will experience tooth decay between age twelve and nineteen.2 If left untreated, tooth decay can lead to pain, swelling, infection, and in rare occasions, hospitalization or death. Because infants and toddlers are often uncooperative, treating young children can be challenging for dental practitioners.  

Prevention Starts with a Dental Home
The AAPD, AAP, and ADA all recommend establishing a dental home by age one or when the first tooth erupts.3  This provides parents and caregivers with guidance and information regarding the health and wellbeing of the child’s teeth. In addition to a clinical assessment and necessary diagnostic tests, preventive guidance should include counseling on oral hygiene, diet, injury prevention, non-nutritive habits (pacifier or digit habits), and speech and language development.4 A complete assessment allows practitioners to establish a patient’s caries risk and make a referral to a pediatric dentist, if necessary.
Completing a caries risk assessment is important because dental caries is a multifactorial disease. Parents must be educated and motivated to change habits, and it is unrealistic to assume this can be done after one visit. The assessment allows practitioners to establish a preventive plan for high caries risk patients with the use of fluoride treatments, such as Embrace Varnish, to release calcium, phosphate and fluoride, and potentially delay expensive or high risk procedures, such as sedation.

Embrace Varnish as a Component of Active Surveillance and a Preventative Plan
The application of fluoride varnish has been shown to reduce primary tooth decay by over one third when applied professionally,5 and therefore, the prevention plan for high risk pediatric patients should include quarterly applications of fluoride varnish.

The application of Embrace Fluoride Varnish, which contains 5% sodium fluoride, Xylitol, and bioavailable calcium and phosphate, can help treat superficial, non-carious enamel lesions (white spots) and provide minerals known to be beneficial for tooth structure. Calcium and phosphate are the building blocks of teeth, and the addition of these minerals provides benefits to patients who may be deficient in these minerals, such as patients with xerostomia or poor dietary habits.

Embrace Fluoride Varnish can play a key role in the active surveillance of a child’s cavities. Applications every three months in high risk children with sub-acute needs may help delay the necessity for sedation for dental treatment and provide practitioners with the opportunity to improve oral hygiene and correct dietary habits over time. More frequent visits can also help desensitize children to the office experience and detect problems in the early stages.

At each visit the child should have a clinical exam and necessary diagnostic testing; a child’s risk for developing cavities should be assessed. While we can’t always control what patients do at home, we can utilize the abilities of a prevention program. Embrace Varnish applied at the appropriate frequency, to help improve oral conditions, can create an environment that helps reduce the incidence of dental decay.

Why Choose Embrace Varnish?
As clinicians we must choose products that maximize efficacy for our patients. In vitro studies have shown that Embrace Varnish has ten times more cumulative fluoride release than the leading brand during the 4-hour treatment period.6 High fluoride release in varnishes helps provide conditions that are favorable for strong, healthy, more acid-resistant teeth. Embrace has a proprietary resin carrier with Xylitol-coated calcium and phosphate. In the mouth, saliva dissolves the xylitol and releases significant amounts of calcium and phosphate ions, which are key components of enamel.7

Teeth are made of calcium and phosphate in the form of hydroxyapatite. The presence of fluoride precipitates fluorapatite onto the enamel surface. Fluorapatite is more resistant to the acidic environment than hydroxyapatite.8 The ability of a product to deliver calcium, phosphate and fluoride is important to consider when selecting an in-office fluoride treatment. The high concentration of calcium, phosphate and fluoride release makes Embrace Varnish appealing for use in high caries risk patients and those with compromised tooth structure.

References
1. American Academy of Pediatric Dentistry. Early Childhood Caries (ECC). Chicago: American Academy of Pediatric Dentistry.
2. Dye B, Thorton-Evans G, Li X, J. Lafolla T. Dental Caries and Sealant Prevalence in Children and Adolescents in the United States, 2011–2012. Centers for Disease Control. November 6, 2015. Available at: https://www.cdc.gov/nchs/data/databriefs/db191.htm. Accessed February 7, 2018.
3. American Academy of Pediatric Dentistry. Policy on the Dental Home. Pediatric Dentistry. 2017;39(6):29-30.
4. American Academy of Pediatric Dentistry. Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance, and Oral Treatment for Infants, Children, and Adolescents. Pediatric Dentistry. 2017;39(6):188-195.
5. Marinho V, Worthington H, Waslh T, Clarkson J. Fluordie varnishes for preventing dental caries in children and adolescents. Chochrane Database of Systematirc Reviews. 2013(7):1-95.
6. Milburn J, Henrichs L, Banfield R, Stansell M, Vandewalle K. Substantive Fluoride Release from a New Fluoride Varnish Containing CXP. Dentistry. December 2015;5(12).
7. Neelakantan P, Hemagaran G. Remineralization of the Tooth Structure – The Future of. International Journal of PharmTech Research. April-June 2014;6(2):487-493.
8. Casamassimo P, Fields H, McTigue D, Nowak A. Pediatric Dentistry: Infancy through Adolescence. 5 ed. St Lous: Elsevier; 2013.

 

About Jarod Johnson, DDS, ABPD
Dr. Jarod Johnson of Arctic Dental is a provider of pediatric dentistry in Muscatine, IA. He earned a bachelor’s degree in biomedical engineering from the University of Iowa in 2009, and his DDS from the same school in 2013. He earned a certificate in pediatric dentistry from the University of Nevada, Las Vegas, School of Dental Medicine. Johnson is a diplomate of the American Board of Pediatric Dentistry.