Prior to commencing the use of remin 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 very useful product for removal of the biofilm is 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 loose sight of the tooth’s ability to repair. There are an increasing number of remineralisation products on the market which involves the hydroxyapatite layer being repaired or strengthened. Tooth Mousse and Tooth Mousse +, from GC, are a real gold standard in this field. It has been very well documented that with the presence of CCP-ACP in these products they help the remin process and decrease the amount of Strep. Mutans on the pellicle layer.
Flairesse prophy range from DMG is also of great benefit useful for those high risk patients with multiple lesions and should be used as a matter of urgency at the first visit. Their range is all encompassing with a variety of different modes of delivery that could be adapted for most cases. All of these products can be applied very quickly with the minimum of work being required and the GC products could be for home use as well. 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 a great and low cost way of reducing caries in high risk patients. As we know they are very useful 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 very effective product with extensive use in Third World countries for treating caries. At present we have a product in the UK from SDI in Riva Star. This has three essential components in silver , fluoride and iodide. This product is marketed as being able to reduce “hypersensitivity instantaneously”. I feel that you should research its wide spread 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 but also in the permanent dentition. So, we have a product that can be literally painted on teeth that halts the progress of dental decay and reduces pain from it. This was mentioned in the OCDO document and it should be used far more widely. I would forward that it is so much more than a desensitising agent and should be used far more widely in the permanent dentition. 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.