Before commencing the use of remineralisation products, we must address the presence of a cariogenic biofilm, as all our efforts are drastically undermined until we try to remove as much as possible as soon as possible, especially when treating particularly at-risk carious patients. This will have two main effects. It will reduce the acid attack on the teeth and, of equal importance, allow the effects of the remineralising products to penetrate into the tooth surface. The removal of the biofilm was mentioned in the OCDO guidelines.
A beneficial product for the removal of biofilm is the HYBENX Dental Debriding Solution. Again accompanied by appropriate OHI and compliance. Once embarking upon a treatment plan, we should consider remineralisation of damaged tooth structure and not lose sight of the tooth’s ability to repair. An increasing number of remineralisation products on the market involve the hydroxyapatite layer being repaired or strengthened. Tooth Mousse and Tooth Mousse +, from GC, are a real gold standard in this field. It is well documented that the presence of CCP-ACP in these products help the remineralisation process and decreases the amount of Strep. Mutans on the pellicle layer.
Flairesse prophy range from DMG is also helpful for high-risk patients with multiple lesions and should be used immediately at the first visit. Their range is all-encompassing with various modes of delivery that could be adapted for most cases. All of these products can be applied very quickly with the minimum of required work, and the GC products could also be for home use. There has been a massive increase in the use of fluoride varnish and in particular, those with 5% ACP with Xylitol as the sweetener. The varnishes from DMG, 3M/ESPE, Premier and Voco all show good qualities. The new Spry Xylitol range offers an excellent and low-cost way of reducing caries in high-risk patients. As we know, they are beneficial in patients where the saliva has a reduced natural buffering capability. Xylitol has health benefits as a natural sweetener in addition, it does not cause a spike in blood sugar or insulin. It starves plaque of nutrients and feeds friendly microbes in the digestive system.
Silver Diamene Fluoride 38% is another low cost but a very effective product with extensive use in Third World countries for treating caries. Currently, we have a product in the UK from SDI in Riva Star. This has three essential components: silver, fluoride and iodide. This product is marketed as being able to reduce “hypersensitivity instantaneously”. I feel that you should research its widespread use and realise what a fantastic game-changing material this is. We are talking about the evidence showing it arrests dental decay with massive success in deciduous teeth and permanent dentition. So, we have a product that can be literally painted on teeth that halts the progress of dental decay and reduces pain. As mentioned in the OCDO document and it should be used far more widely. It is so much more than a desensitising agent and should be used far more widely in permanent dentition, especially the most vulnerable children, and thise in care homes. The success rate of 65%+ is improved with the removal of the biofilm, and it increases even more if applied twice a year. Again a simple cost effective anti-cariogenic treatment. I cannot stress highly enough to encourage reviewing these products and consider their use, especially in the high-risk caries patients of the younger and less cooperative groups. Alone they will not work but with a willingness on all sides can reap massive benefits and satisfaction.
Click on the image for an excellent video on how to apply silver diamine fluoride. It's by a mum to a daughter. I posted a video a while back with my view we could get parents to apply fluoride varnish every six months. As a teeth4life Facebook message.