Mineral Rites - Dentaltown
MineralRitesTo prevent caries, tooth enamel needsto stand strong against acidic attacks.Here’s why some patients are likelyto need help—and how to proceedby Deborah Levin-GoldsteinDeborah Levin-Goldstein is agraduate of the University ofPennsylvania and ColumbiaUniversity. She has been adental hygiene educator atNorthampton CommunityCollege in Bethlehem,Pennsylvania, for 34 years. Levin-Goldstein haspresented continuing education courses on avariety of topics to dental and dental hygienesocieties, and is a recurring contributor toDentaltown. She has been published in the Journalof Dental Hygiene and is a contributing author forsix chapters in the textbook Head, Neck and DentalAnatomy, 4th Edition.80DECEMBER 2016 // dentaltown.comDental caries continues to be amajor public health problemdespite the increased availabilityof commercial preventive products—includingpowered toothbrushes and flossers—and animproved understanding of the caries diseaseprocess. As a result, the dental hygienist andthe dentist are the solution to individualized,comprehensive caries management.Oral bacteria, known as plaque or biofilm,constantly forms on the teeth. Eating ordrinking foods containing sugars causesthe bacteria in biofilm to produce acids thatattack tooth structures. The stickiness ofthe plaque and biofilm keeps these acids incontact with the tooth and, over time, theenamel can break down, forming a cavity.This is the process of demineralization,during which calcium and phosphate areremoved from the enamel.Saliva and fluoride aid in the re-establishment of calcium and phosphateback into the enamel, which is known asremineralization. Acid challenges aboundin the oral cavity throughout the day as theequilibrium between demineralization andremineralization continually shifts.Continued on p. 82
Continued from p. 80Keeping the balanceAssessing caries riskThe caries imbalance model (Fig. 1) wascreated to represent the multifactorial natureof dental caries disease and to emphasize thebalance between pathological and protectivefactors in the caries process.Oral health is sustained when there’s abalance between protective and pathologicalfactors. Tooth enamel rods/prisms arecomposed of hydroxyapatite crystals calcifiedto 96 percent. Although highly inorganic,enamel is still vulnerable to demineralization. Its main biological defense is saliva,which has buffering ability and containscomponents of calcium and phosphate.Salivary phosphoproteins help stabilizecalcium and phosphate ions to ensure theyremain bioavailable and can diffuse intomineral-deficient enamel lesions, mainlyon the surface layer.Without calcium and phosphate in saliva,fluoride cannot repair tooth structure. Iffluoride is present in the biofilm when bacteriaproduce acids, it will penetrate along withthe acids at the tooth’s subsurface, adsorbto the hydroxyapatite crystal surface andprotect the crystals from dissolution.Remineralization occurs only whenthere are sufficient calcium and phosphateions from saliva, along with f luoride,to enter the demineralized enamel andform a new layer of fluorapatite. Theseremineralized crystals are less acid-solublethan the original ones.Placing a restoration does very little tomanage the caries disease process. A shift awayfrom the “drill and fill” mentality occurred in2007, when the California Dental AssociationFoundation, in partnership with the Universityof California at San Francisco School ofDentistry, published evidence in the Journalof the California Dental Association that cariescould be prevented and contained throughrisk assessment following the medical model.Caries management by risk assessment(CAMBRA) is a method of assessing cariesrisk. The questionnaire enables the clinicianto make dental treatment and restorativerecommendations based on a patient’s cariesrisk. CAMBRA forms for ages 0–6 and ages 6and older are available to dental professionalsfrom the American Dental Association,the California Dental Association, PhillipsSonicare and CariFree.By using the CAMBRA approach toassess caries risk, dental professionals canperform tests for oral bacteria levels, takeradiographs, and examine disease indicatorsand risk factors. This includes current decaycondition and bacterial challenges, dietaryhabits, prescription medications, saliva flow,systemic medical conditions and oral hygienehabits. Then hygienists or dentists can makerecommendations based on those risk factors.Patients at high risk of caries require dental intervention, including dietary counseling,more frequent radiographs, fluoride varnishCaries Imbalance ModelProtective Factors:S-A-F-EDisease Indicators:W-R-E-CWhite SpotsRestorations 3 yearsEnamel LesionsCavities/DentinRisk Factors: B-A-DBad BacteriaAbsence of SalivaDietary Habits (poor)Saliva and SealantsAntibacterialsFluorideEffective DietHealthy pHLow pHCaries ProgressionNo CariesFig. 1: J.B. Featherstone, S. Domejean, L. Jenson, M. Wolff, and D. Young, “Caries Risk Assessment inPractice for Age 6 Through Adult,” CDA Journal 35, No. 10 (October 2007).82DECEMBER 2016 // dentaltown.com
applications, prescription fluoride gels or rinses, antimicrobial rinses,prescription or over-the-counter (OTC) salivary stimulants, and useof prescription or OTC remineralizing agents. These patients mayneed existing tooth decay restored and protected with sealants, andalso may need to postpone elective cosmetic dental procedures ororthodontics until their risk levels can be decreased. Recurrent decaycan cause expensive dental work to fail. A remineralizing productused twice a day may be suggested for these individuals.Patients at moderate risk should receive a recommendation touse a prescription or OTC fluoride mouth rinse and a remineralizingagent once a day, as they have or had a risk factor that can move themto high risk at any time, such as previous decay or localized recession.Patients at low risk may receive recommendations for home-carepreventive products, such as toothpaste with fluoride, to keep risklevels low. They will be better candidates for fewer radiographs andelective cosmetic procedures. These patients do not need to use aremineralizing product.Patients who will most benefit from remineralizing productsinclude: Adults and children with a high caries risk (visible cariouslesions). Those with tooth sensitivity. Patients undergoing orthodontic treatment. Those with sensitivity before or after bleaching or whitening. Patients suffering from xerostomia or salivary dysfunction. Those with exposed root surfaces or erosion. Oncology patients. Those suffering from gastric reflux.Products with a punchRemineralizing products in the form of gels or creams have beencreated to replace calcium and phosphate loss from enamel for usein both children and adults.These products include varying amounts of fluoride and mayor may not require a prescription by a dentist. They may be appliedwith a toothbrush, a finger or a custom tray. Their ability to remainactive in the mouth for extended periods of time differs and theyare safe for daily multiple applications.Currently, five different types are available: Amorphous calcium phosphate (ACP). Found inEnamelon Preventive Treatment Gel by Premier. This OTCproduct contains 970 parts per million (ppm) stannousfluoride. It eliminates the need for prescription-strengthtoothpastes and home rinses. Calcium sodium phosphosilicate. Also known asNovaMin. Originally developed for the treatment of dentinalhypersensitivity, products with NovaMin aren’t widelyavailabile in the United States, but include Nupro Extra Careprophy paste with fluoride and NovaMin. The paste can beapplied before or after scaling to decrease sensitivity. Casein phosphopeptide- amorphous calcium phosphate(CPP-ACP), also known as Recaldent. It has a three-hourFREE FACTS, circle 22 on carddentaltown.com \\ DECEMBER 201683
Hydroxyapatite:fills superficial enamel lesionsXylitol:bacteriostaticeffect of xylitolFluoride:open dentin tubules are sealedFig. 2: courtesy of Voco 84DECEMBER 2016 // dentaltown.comsubstantivity. Derived from caseinin cow’s milk, CPP-ACP is safe forlactose-intolerant clients, but shouldnot be recommended for clients withmilk allergies. It is safe for use in theprimary dentition. An example is MI(minimum intervention) Paste withRecaldent by GC America. This is aprescription product that is digestibleif swallowed. The company also offersMI Paste Plus with Recaldent with900 ppm sodium fluoride. It is notrecommended for children underthe age of 6 and pregnant women,because of its fluoride content.Tricalcium phosphate (TCP).Found in two products by 3M ESPE:Clinpro 5000 1.1% sodium fluorideanticavity toothpaste contains 5,000ppm sodium fluoride, thus requiringa prescription. It is used in place ofregular toothpaste at night. ClinproTooth Crème is a dentifrice containing 950 ppm sodium fluoride. Noprescription is necessary and it is usedonce a day in place of a conventionaltoothpaste. It may be purchased onAmazon.Remin Pro by Voco is a waterbased cream that containsnano-hydroxyapatite, an enamelprototype and ingredient unique tothis product. It also has the provencariostatic agent xylitol, which influences remineralization by transportingcalcium ions deeper into the cariouslesion, as well as 1,450 ppm sodiumfluoride. These three ingredientsare key factors in the “triple threat”against caries (Fig. 2). Remin Proadheres to the tooth substance andprotects the tooth against demineralization. It fills enamel porositiesand seals exposed tubules in dentin,thereby decreasing patient hypersensitivity. Xylitol in Remin Pro stimulatessalivation, promoting natural remineralization and neutralizing the acidicenvironment. The sodium fluoridestrengthens the enamel, making itmore resistant to acid attacks.Remin ProProtocol for the use of Remin Pro is tofirst brush with your regular toothpaste. Thenapply a pea-sized amount with a toothbrush,a finger or a custom tray. It is kept in themouth for three minutes without interruption.Any excess should be expectorated andno cream should be swallowed, due to
its fluoride content. Rinsing, eating anddrinking should be avoided for 30 minutesafter use. It has two-hour substantivity, somultiple applications throughout the dayare appropriate.It is safe for patients with milk allergies,unlike other remineralizing pastes, since itdoes not contain milk proteins. Remin Prodoes not require a prescription and can beobtained only by the patient at a dental office.The dentist purchases the product from eitherPatterson Dental or Henry Schein Dentaland resells it to the patient.AlternativesFluoride varnish products are relativelynew to the United States, but have been widelyused as dental caries prevention therapiesfor more than 30 years in Western Europeand Canada. The U.S. Food and DrugAdministration has approved them to beused as cavity liners and for the treatmentof hypersensitive teeth, but they also can beused off-label as caries prevention agents.Fluoride varnishes contain 22,600 ppmsodium fluoride and are easily painted ontothe teeth as a type of topical fluoride therapyto aid in the remineralization process. Inaddition to sodium fluoride, some productscontain xylitol, such as Profluorid Varnishfrom Voco and Embrace Varnish 5% sodiumfluoride with xylitol, calcium and phosphate.Xylitol cannot be converted into harmfullactic acid by cariogenic bacteria.Enamel Pro Varnish 5% sodium fluoridecontains ACP; Vanish 5% Sodium FluorideWhite Varnish has TCP; and MI Paste Varnish contains Recaldent. Dental pros shouldcontact the manufacturers for informationabout patients with pine-nut allergies.ConclusionAssigning risk assessment levels can makea difference in the effective control of dentalcaries. Dental professionals can significantlycontribute to decreasing decay and reversinginitial breakdown of tooth structure simplyby finding the right product for each patient.The advantage of these agents is theincreased availability of calcium and phosphate to prevent demineralization. Someproducts simultaneously deliver multipleingredients, such as fluoride and xylitol,in addition to calcium and phosphate, torestore enamel. Varnish is easy to apply andenhances the remineralization process. Itdecreases sensitivity as well. Remineralizingproducts and varnishes provide novel andexciting therapeutic options for dentists andhygienists. By using theCAMBRA approachto assess cariesrisk, dentalprofessionals canperform tests fororal bacteria levels,take radiographs,and examinedisease indicatorsand risk factors.FREE FACTS, circle 40 on carddentaltown.com \\ DECEMBER 201685
Fluoride varnishes contain 22,600 ppm sodium fluoride and are easily painted onto the teeth as a type of topical fluoride therapy to aid in the remineralization process. In addition to sodium fluoride, some products contain xylitol, such as Profluorid Varnish from Voco and Embrace Varnish 5% sodium fluoride with xylitol, calcium and phosphate.
marriage and funeral rites. is language recalls Arnold van Gennep's foundational early twenti-eth-century work !e Rites of Passage,14 in which he observes a similar three-part structure among life-cycle rites around the globe. Although van Gennep did not identify healing rites in his par-adigm, the Lutheran World Federation does so in
other congratulatory rites (garye 嘉禮), reception of foreign envoys (binrye賓禮), military rites (gunrye 軍禮), and royal funeral and other related rites (hyungrye 凶禮). There are other state events that are outside of these Five Rites, and were conducted with equal formality, and uigwe books produced afterwards. Some examples are .
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CE-Porcelain Veneers_Layout 1 2/20/13 1:04 PM Page 89. MARCH 2013» dentaltown.com 90 continuing education feature . Malliari M, Tortopidis D, Koidis P. Survival of ceramic veneers made of differ-ent materials after a minimum follow-up period of five years: a systematic review and meta-analysis. Eur J Esthet Dent. 2012 Summer;7(2):138-52. 8 .
Contemporary Implant Dentistry & Removable Prosthodontics Jerome Smith, DDS 76 dentaltown.com September 2006 ContinuingEducation Educational objectives: Upon completion of this course, participants should be able to: Fully understand the various available treatment options for edentulous patients today and how they differ.
Year 8 Knowledge Organisers Term 3: Rites of Passage different beliefs in a religio Topics Covered Rites of Passage are Ceremonies that mark important transitional periods in a person's life, such as birth, puberty, marriage, having children, and death. We will be looking at these in Islam, Hinduism, Christianity and Sikhism: Useful Links:
the existence of soul, when someone dies proper rites and ritual and offering were made for the soul. Poumai Nagas classify deaths into two types; natural death and unnatural death. Every death is not treated equal for burial rites and rituals. Some deaths were highly regarded whereas others are not.
BIODIESEL FROM ALGAE: A POTENT ALTERNATE RENEWABLE SOURCE ⃰Dr Praveen Purohit1, 3Dr O.P.Jakhar2, and C.P.Sharma 1, 2, 3 Government Engineering College Bikaner Abstract With the ever increasing demand for energy and progressive depletion of fossil fuel, it has become necessary to find alternatives to conventional fossil fuels. Biodiesel is one such alternative to it and can be defined as a .
