June 7, 2018

Bioactive Composites for the Clinician and Patient

Dentist and educator Dr. Robert Lowe has published a new eBook called Bioactive Composites for the Clinician and Patient.

Download Free eBook by Dr. Robert Lowe

Dr. Lowe addresses the importance of patient education, saying that the dentists “have to get better at explaining the disease process of dental caries (decay) and the restorative options that best fit the needs of each patient.”

According to Dr. Lowe, “the majority of today’s dental restoratives are designed merely to occupy space” but bioactive filling materials like ACTIVA BioACTIVE “participate in an ionic exchange of calcium, phosphate, and fluoride that helps neutralize acid attack and supports the natural remineralization process.” Through this ionic exchange, the bioactive material becomes integrated into the tooth and helps create a protective seal.

Dr. Lowe shares best practices on how dentists can discuss treatment options and new technologies like bioactive fillings with their patients.

The eBook features a series of clinical cases, including:

Minimally invasive restorations
Bulk fillings
Root caries restorations
Pediatric dentistry
Geriatric dentistry

Dr. Lowe provides step-by-step instructions on how to use ACTIVA BioACTIVE-RESTORATIVE in these different clinical situations to ensure better patient outcomes. The cases involve patients of all ages, and Dr. Lowe notes that ACTIVA BioACTIVE addresses many of the challenges associated with both pediatric and geriatric patients.

About Robert A. Lowe, DDS
Robert A. Lowe, DDS, received his Doctor of Dental Surgery degree from Loyola University School of Dentistry. After completing his residency, Dr. Lowe went into private practice and began to pursue another passion: clinical teaching. While running his own practice, Dr. Lowe served as a Clinical Professor in Restorative Dentistry at Loyola University School of Dentistry until its closure in 1993. In 2000, he relocated to Charlotte, NC.

June 5, 2018

Heroic Dentistry: Asperger’s Syndrome and Special Care with ACTIVA

By Raymond Kimsey, D.M.D.

The Heroic Dentistry series celebrates oral health care providers who, like PULPDENT founder Dr. Harold Berk, have made it their mission to save teeth and help patients live in comfort and smile with confidence.

Rachel has been diagnosed with Asperger’s Syndrome and was referred to me for comprehensive dental care. She has acute anxiety around dental treatment, which can escalate into a panic attack. We faced the challenge of allaying her fears, keeping her calm, while operating smoothly and uneventfully.

Rachel was experiencing considerable discomfort. Her lower left second molar (#18) had extensive caries and appeared hopeless, but she was still young, and I wanted to try and salvage this tooth for her (Figure 1). Endodontic treatment on her first molar (#19) had been performed successfully at another office, but she had not returned to her dentist to have the tooth restored.

Figure 1. Shows extensive caries in lower left second molar (#18).

I would have to complete this case in one visit. Proper isolation would be imperative. My treatment plan was to excavate the second molar (Figure 2), isolate the area, quickly build up the entire distal-lingual wall, and proceed with root canal treatment. The wall would allow me to place a rubber dam with a good seal, contain the irrigating fluids within the confines of the tooth, and then use the wall as part of the final restoration.

Figure 2. Second molar after caries removal.

Controlling hemorrhaging from the gingiva is critical for these procedures. Placement of retraction cord treated (Figure 3) with ferric sulfate can stop bleeding, but the challenge is to prevent contamination and bleeding when building up the wall. For this reason, I selected ACTIVA Bioactive-Restorative. It is easy to control the flow and placement of ACTIVA through the bendable metal cannula, and this technique eliminates the use of hand instruments that could disturb the gingiva and cause bleeding.

Figure 3. Shows retraction cord in place.

I placed a thick layer of Teflon tape over the pulpal floor to facilitate access to the pulp chamber (Figure 4), and I built up the distal-lingual wall with ACTIVA (Figure 5). I could now place a well-sealed rubber dam and perform endodontic treatment on #18 (figure 6). After debriding the pulp (Figure 7) and obturating the canals (Figure 8), I completed the restoration with ACTIVA (Figure 9).

Figure 4. Teflon covers pulpal floor before building up distal-lingual wall.

Figure 5. Distal-lingual wall built up and margins sealed with ACTIVA.

Figure 6. Shows pulpal access, ACTIVA walls, and rubber dam in place.

Figure 7. After debriding pulp.

Figure 8. Canals are obturated.

Figure 9. Final ACTIVA restoration.

Using ACTIVA I could accomplish all this in one appointment with a material that provides an excellent foundation for a future crown and will be more resistant to recurrent caries at the margins.

About Dr. Raymond Kimsey
Dr. Kimsey is in private practice in Coral Gables, Florida. His specialties include implantology, anesthesia and IV sedation, and management of patients with mental and physical developmental defects.

May 22, 2018

Embracing Mission Experiences with Embrace Sealant Material

by Sherri M Lukes, RDH, MS, FAADH

The villages throughout the desert country of central Mexico are populated by poor villagers with little to no access to dental services. As a dental hygienist/university professor with a passion for mission work, I have had the privilege of serving annually on a team in this area for the past 15 years. Accompanied by eager dental hygiene students we descend on the area for a week, travelling to a different village each day, lugging portable equipment and supplies to provide preventive services from sun up to sun down.

Though an area entrenched with poverty, the children have no shortage of sugary foods and beverages. One child will present with marked dental fluorosis due to naturally occurring fluoride in the water supply while the next child will present with rampant decay, illustrating the multifactorial nature of dental caries. A substantial portion of the services provided each year include placing sealants on any of the children’s permanent teeth that haven’t already been affected by decay. Dental sealant placement, however, is a very technique sensitive procedure, necessitating a dry field for optimal retention. Indeed, moisture contamination is the most common cause of sealant failure.1 In this setting, not only are we working with anxious and “wiggly” children, the conditions are less than optimal for maintaining a dry field to place sealants. In addition, the dental hygiene students involved in the mission are still learning themselves, and not as adept as experienced clinicians.

The aforementioned issues have made Embrace sealant material a staple supply for every trip we’ve taken over the past several years. The first of its kind, this pit and fissure sealant material bonds to moist tooth surfaces, eliminating the need for an absolute dry field. Research on the product has shown remarkable sealing ability and adaptation to tooth structure.2,3

I specifically remember one of many days that were met with equipment malfunction during the mission trips. On this particular day the air/water syringe on one of the portable units was not sealed properly and the air flow contained a small amount of water when the stream of air was released from the syringe. Had we not been using a moisture tolerant material, we would have had no way to adequately place sealants on the endless lines of children waiting to be treated that day. What a great product solution for such conditions! I came back to the states and told the Pulpdent representative who served our institution that I would take nothing but Embrace sealant material on subsequent trips.

Any dental professional who has ever practiced in an alternative setting realizes the challenges associated with providing care without the amenities of a fully equipped dental operatory. Mission opportunities are such settings and can test the skills of even the best of practitioners. I am thankful for innovative products that enable me to follow my passion with the assurance that the service I am providing is going to be a lasting benefit to the patients’ oral health.

References
1. Feigal, Robert J. “Sealants and preventive restorations: review of effectiveness and clinical changes for improvement.” Pediatric Dentistry 1998;20: 85-92.
2. Kane B, Karren J, Garcia-Godoy C, Garcia-Godoy F. “Sealant adaptation and penetration into occlusal fissures”. American Journal of Dentistry 2009;22(2):89-91.
3. Strassler HE, O’Donnell JP. “A unique moisture-tolerant, resin-based pit and fissure sealant: clinical technique and research results”. Inside Dentistry 2008;4(9):108-110

About Sherri M Lukes, RDH, MS, FAADH
Speaker, author and public health advocate, Sherri Lukes has been a hygienist for 37 years. Most of her career has been in academia, retiring in 2014 as associate professor from Southern Illinois University where she taught oral pathology, public health and multicultural dental hygiene. Research efforts were concentrated in migrant farmworker oral health, oral pathology, and issues of other underserved populations. Mission work is a passion that was shared with her students for years and she continues to offer the opportunity for students and faculty to participate in bi-annual trips.

As professor emerita, Sherri is fortunate to be able to now integrate years of experience into CE courses to empower dental professionals in the process of care. She offers courses on oral pathology, cultural competence and older adult oral health. She can be reached at smlukes@siu.edu.

May 11, 2018

Pulpdent Corporation and UCLA School of Dentistry join forces to prevent early childhood caries

Pulpdent Corporation, a dental research and manufacturing company, has joined forces with the UCLA School of Dentistry to prevent early childhood caries (i.e., tooth decay in infants and young children). Pulpdent is donating 600 applications of Embrace Fluoride Varnish and 2,500 applications of Embrace Pit & Fissure Sealant to the UCLA Infant Oral Care Program (IOCP) in 2018.

A UCLA IOCP staff member conducts a pediatric dental exam while the patient’s mother watches.

According to research from UCLA and the Harvard School of Dental Medicine, “early childhood caries prevalence has increased significantly in children ages 2-5 years” and “disproportionally affects lower socioeconomic and minority groups.” Programs like the UCLA IOCP offer free education, prevention, diagnosis and treatment for underserved infants and children at UCLA’s local Federally Qualified Health Centers. The program also trains UCLA pediatric dental residents, dental students, pediatric medical residents, and advanced nurse practitioner students in culturally sensitive preventative oral health care.

Pulpdent will also provide Embrace Pit and Fissure Sealant to the UCLA IOCP program. Embrace is the first sealant that bonds to the moist tooth and contains no BPA, Bis-GMA or BPA derivatives. Research shows remarkable sealing ability and adaptation to tooth structure.

For over 70 years Pulpdent has been committed to product innovation, clinical education and patient-centered care.

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 20-30 seconds prior to light curing the material. This 20-30 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

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

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.