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As dental materials evolve it is crucial for dental professionals to learn the latest trends in patient treatment. However, determining which products available are best suited to obtain predictable results is often challenging. Join us as Ivoclar Vivadent, Inc., a major sponsor for our Product Donation Project, discuss dental care products as they apply to prevention and oral health maintenance. Throughout the lecture, caries prevention as well as an in-depth view of the current fluoride varnishes Ivoclar Vivadent, Inc. has available will be discussed. This is your opportunity to learn more about Ivoclar Vivadent, Inc.’s products and how they are striving to protect your teeth.
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HOUSEKEEPING INFORMATION
• Please remember to MUTE your phone.
• Questions are welcome! We’ll allow 10-15 minutes after the presentation for questions.• Questions will be accepted in writing through the control
panel on the upper right hand of your screen.
• Submit questions at any time; we will address them at the end of the presentation.
• Webinar is being recorded; for rebroadcast on OHA’s website – OralHealthAmerica.org
• Your feedback is important to us. Please take our brief webinar evaluation after this session; link will be sent via email.
OUR MISSION
Oral Health America’s mission is to change lives by
connecting communities
with resources to drive access to care, increase
health literacy, and advocate for policies that
improve overall health through better oral health for
all Americans, especially those most vulnerable.
OHA PRIORITIES
ADVOCACYHEALTH
LITERACYACCESS
OHA’s Programs and Campaigns are designed to improve
access to care, oral health literacy and policies that
prioritize the impact of oral health on the overall health of all
Americans – particularly those most vulnerable.
Campaigns for Oral Health Equity
Educate the public, including policy makers, about the importance of oral health for overall health
Emphasize the need to prioritize oral disease alongside other serious health conditions
Advocate for policies that positively impact programs and stakeholders
Current campaigns include:
toothwisdom.org Demonstration
Projects
Professional
Symposia
Advocacy Health Education &
Communications
Innovative Dental Hygiene Solutions
DiagnosisCRT Bacteria
MaintenanceProxyt
PreventionHelioseal
Fluor Protector S
Cervitec Plus
Dental Caries
Worldwide Health Concern
20% of children age 5-11 have at least one
untreated decayed tooth.
Approximately 15% of adolescents aged 12-
19 have at least one untreated decayed
tooth.
91% of children have experienced dental
caries by adulthood.
Caries risk grows with increased age
Traditional Treatment Model
• No diagnosis
• Treat everyone
• #1 Goal – Removal of Plaque
• Brushing & Flossing
• Recall Exams
• New Restorations
Medical Model of Care
• Diagnosis is essential
• Restore diseased areas
• Eliminate the infection
• Decrease & eliminate bacteria
• Treatment ceases
• Recall to diagnose and retreat
Caries Risk Assessment
• Diagnose disease to identify causative organisms
• “Medical Model of Care”
• Identify patients susceptible to dental decay
• Focus on prevention and early intervention
• Treat patients individually before caries/lesions are
established
What is a Caries Risk Test?
A comprehensive test used to determine Streptococci mutans and
Lactobacilli count in saliva by means of a selective culture media.
Streptococci Mutans
• Caries initiators
• Capacity to adhere to tooth surface
• Sugar transport system
• Triggers the host response system
• Produces lactic acid
• Tolerant of acid environment
Lactobacillus
• Responsible for caries progression
• Indicative of frequent sugar intake and/or active caries
• Do not adhere to tooth surface
• Colonize via carious lesions
• Pit & Fissure
• Marginal Gap
• Brackets
CRT® Bacteria
Step by Step
• Have patient stimulate salivation by chewing on the paraffin pellet.
• Collect saliva in a suitable container.
• Remove agar carrier from the test vial.
• Place a NaHCO3 tablet at the bottom of the vial.
• Carefully remove the protective film from the two agar surfaces.
• Thoroughly wet both agar surfaces with saliva using pipette.
• Allow excess saliva to drip off.
• Slide the agar carrier into the vial and close tightly.
• Use a waterproof pen to note the name of the patient and date on the vial.
• Place the test tube upright in an 37°C incubator for 48 hours.
• Compare the density of mutans streptococci and lactobacilli colonies with model chart.
CRT® Bacteria
Advantages
• Identify caries risk at an early stage
• Test for both S. mutans and Lactobacillus
• Results in 48 hours
• Easy to conduct
• Great tool to educate and motivate patients
• Can be used to monitor specific therapies and treatment
Bacterial Testing
ClinPro™ L-Pop 3M ESPE
• Tongue sampling
• Tests lactic acid formation
Saliva Check Mutans GC
• S. mutans only
Oral Health Management
Caries Risk Test
Characteristics Advantages
Targeted and distinct treatment measures
Basis for periodical prophylaxis
Check of treatment success
Earnings
Prevent healthy teeth / caries prevention
Free of pain treatment
Quality assurance
Build-up a long-term patient loyalty
Better reputation: suggestions
Satisfied patients
Execution of the test by trained staff Expansion of job function
Economics
Innovative Dental Hygiene Solutions
DiagnosisCRT Bacteria
MaintenanceProxyt
PreventionHelioseal
Fluor Protector S
Cervitec Plus
Prevention
The higher the severity of risk factors at diagnosis, the greater the prevention strategy needs to be
*Several of these preventive agents are used off-label for caries prevention
• Fast & easy way of protecting
teeth from bacteria
• Acts as a barrier, protecting
enamel from plaque and acids
• Provides a smooth surface for
easy cleaning and maintenance
Types of Sealants
• Polymerization – self-cure vs. light-cure
• Color – clear, tinted or white
• Fillers – filled or unfilled
• Glass Ionomers
• Resin-based
High Caries Risk
Sealants have shown to reduce decay in permanent molars by 81% for
2 years after placement*
Proximal caries16%
Fissure caries84%
Caries Occurrence in Children and Adolescents in the US
*CDC 2013
ADA Report 1997
Helioseal®
Indications
• Premolar and Molar Pit & Fissures
• Lingual Foramen
Advantages
• Prevent bacteria from colonizing
• Cut off carbohydrate supplies
• Facilitate oral hygiene
Sealedfissure
Bacteria cannot survive
Carbohydrates &Bacteria
Helioseal®Helioseal®
White, Opaque
Medium Viscosity
Economical
Helioseal® F
White, Opaque
Medium Viscosity
Fluoride Release
Helioseal® Clear
Transparent
Excellent Esthetics
Easy Recall
1.Easy access 2. Tooth to be
sealed3. Cleaning 4. Isolation 5. Etching 6. Rinsing
7. Drying 8. Applying the
sealant
9. Light-curing/
polymerization
10. Checking
occlusion
11. Finishing 12. Check-up &
fluoridation
37
SEALANTS- STEP BY STEP
Prevention
The higher the severity of risk factors at diagnosis, the greater the
prevention strategy needs to be
*Several of these preventive agents are used off-label for caries prevention
• Recommends the use of professionally-applied topical fluorides for caries prevention.
• Recommends using fluoride to prevent and control dental caries in the United States.
• Recommends fluoride use for prevention/control of caries. Is safe and highly effective in reducing prevalence in children.
Topical Fluoride Recommendations
Benefits of Fluoride Varnish
• Easy, fast & convenient application
• Saves time & money
• Achieve greater patient acceptance
• Safer then rinses & gels
• reduced risk of ingestion
• Increased fluoride release
Clinical Effectiveness of Fluoride Varnish
• Contact time/adherence
• Fluoride source/concentration
• Fluoride availability
• Flow & wetting behavior
Fluoridation Process on the Enamel
Demineralized enamel
Weakened tooth structure
Increased risk of acid attacks/caries
Re-mineralized enamel
Protective coating from acid attacks
Fluoride depot
Long term protection
With VarnishWithout Varnish
Fluor Protector S
Innovative fluoride varnish
• Immediate fluoride release and safe
• Homogeneous formula with low
viscosity
• Thin, smooth and colorless on teeth
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Fluor Protector S Duraphat MI Varnish Profluorid Varnish untreated enamel
Flu
ori
de
con
ten
t (%
)
Varnish
Fluoride Uptake in Enamel after 1 Hour
Competitive Comparison- US
Ivoclar VivadentFluor Protector S
3M ESPEVanish Varnish
VOCOProfluorid
DentsplyNUPRO
Image
Varnish Formula 1.5% Ammonium Fluoride 5% Sodium Fluoride with Tri-Calcium Phosphate
5% Sodium Fluoride
5% Sodium Fluoride
FluorideConcentration
7700ppm (at application)30,000ppm (at setting)
26,600ppm 26,600ppm 26,600ppm
Food & Drink waiting time
1 Hour after treatment Immediately after application(soft diet only)
4 Hours 2 Hours
Mixing & Measuring recommended
No Yes Yes Yes
Viscosity Low High High High
Delivery form - Dispensing tube 7g (8.2ml) - Single Dose 0.26g (0.3ml)
- Single Dose 0.50mlin Aluminum-Blister
-Single Dose .4ml Single Dose .4g
Prevention
The higher the severity of risk factors at diagnosis, the greater the
prevention strategy needs to be
*Several of these preventive agents are used off-label for caries prevention
Antimicrobial Agents
Destroys or suppresses the growth of
microorganisms including bacteria
Chlorhexidine Gluconate Rinse
• Used off-label to reduce levels of MS bacteria
• Not effective against Lactobacilli
• Available as .12% rinse with/without alcohol
• Long term use leads to discoloration of teeth
and taste disturbances
Chlorhexidine
Indication
• Antimicrobial/bacterial reduction – destroys cell walls
• Prevent plaque formation
• Inhibition of inflammation
• Protection from gingivitis, periodontitis, peri-implantitis, stomatitis
• Caries prevention
• Low concentration levels bacteriostatic (rinses), high concentrations
bacterialcidal
Chlorhexidinefacts.com
Chlorhexidine
The American Dental Association recommends the application of 1:1
mixture of chlorhexidine/thymol varnish every three months to reduce
the incidence of root caries.
Photos: Dr. A. Peschke
Cervitec® Plus
Innovative chlorhexidine varnish
Contains 1% CHX & 1% Thymol
Increases to 10% when dry
Protection of exposed root surfaces
Alternative to chlorhexidine rinse
No unpleasant side effects
Longer CHX retention
More than 20 years of clinical
experience
Cervitec Plus helps ensure successful clinical outcome!
Cervitec Plus- Indications
Exposed root surfaces
Fissures
Erupting teeth
Proximal surfaces
Around brackets and orthodontic
bands
Along the margins of implant-retained
restorations, crowns or bridges
Restorative Dentistry
Prosthetic and restorative therapies generally require a healthy
periodontium as a prerequisite for successful outcome.
Apply Cervitec Plus immediately after
placing temporary or permanent
restorations!
Delivery Forms: Rinse vs. Varnish
Chlorhexidine Rinse Cervitec Plus
0.12% Chlorhexidine Gluconate (Peridex, Periogard)
10% Chlorhexidine on teeth (1% in solution)
70% loss, 30% Retention Targeted treatment, even dosage
Bacteriostatic Bacteriocidal
Patient Compliance (1-2 times daily) Professionally Applied (lasts up to 3 months)
Brown staining Clear and Esthetic Varnish (No staining)
Bad taste No bad taste
INNOVATIVE DENTAL HYGIENE SOLUTIONS
DiagnosisCRT Bacteria
MaintenanceProxyt
PreventionHelioseal
Fluor Protector S
Cervitec Plus
Dental Plaque
Yellowish biofilm
Sticks to tooth structure
Must be regularly mechanically removed
Begins with initial colonization of the pellicle
ends with complex formation of a mature biofilm
Plaque is the leading cause of tooth decay
Polishing Paste Characteristics
Hardness
Particle Size (Grit)
Particle Shape
Agent Contact time
Applied Pressure
Speed
Concentration & Quantity
Abrasiveness
Prophy Paste
Proxyt – Targeted, Gentle, Reliable
The advantages of Proxyt
• 3 abrasive values for individual needs
• Creamy consistency does not splatter
• Contains Xylitol and Fluoride
• Scratch-free polishing of ceramics and composite
restorations. (Proxyt Fine)
• Fluoride free option for restorative effectiveness
• Hygienic and economical delivery
The next generation of prophy pastes for
professional tooth cleaning and polishing
Proxyt- RDA Scale
0 25070 100 150
Low Abrasive
Medium Abrasive
Highly Abrasive
Regarded as harmful limit
fine medium
(Stookey & Schemehorn 1979)
Comparsion of Prophy Pastes
Appearance of abrasive particles
Proxyt fine Cleanic Nupro fine
(Ivoclar Vivadent, R&D 2010)
71
Proxyt – Study Results
0.00
0.05
0.10
0.15
0.20
0.25
Control Proxyt fine Proxyt coarse Nupro fine Nupro coarse
Su
rfa
ce
rou
gh
ne
ss
Effect of Prophylaxis Pastes on IPS Empress CAD
(Yazici et al. 2012)
72
Direct RestorativesPREPARE BOND FILL CURE FINISH MAINTAIN
Isolation
Advantages:
- Considerably enlargedaccess to the treatmentfield
- Enhanced patientcomfort due to three-dimensional flexibility
- Wide range ofindications
OptraGate®
The gentle solutionfor a better view
SculptableComposites
FlowableComposites
Advantages:
- Bulk placement up to 4 mm due to Ivocerin®, the new light initiator
- Low shrinkage and low shrinkage stress for superior margins
- Sculptable consistency, extended working time under operatory light
Tetric EvoCeram® Bulk Fill
The fast posterior composite
Manual Instruments
Advantages:
- Non-stick shaping andcontouring thanks to foam pad attachments
- Highly elastic foam pads ensure the creation of smooth and even surfaces
- Reference scales on the instrument handle facilitate professional esthetic results
OptraSculpt® Pad
Efficient contouring due to non-stick surface
Polishers
Advantages:
- Smooth surface finish and perfect lustre due todiamond particles
- Quick high-gloss polishing in only oneworking step
- Multiple use for greatercost-efficiency
OptraPol®
Simply brilliant-in just on step
Care Products
Proxyt®
Keeping restorations in good condition
Curing Lights
Advantages:
- Every hand – comfortable to hold for men and women
- Every material – universal use due to Polywave® LED with broadband spectrum
- Every time – optional cordedoperation due to Click & Cure
Bluephase® Style
The smallest LED forevery use
All-Etch-Adhesives
Advantages:
- Efficient delivery- Universal application- Predictable results
Adhese® Universal
The universal adhesive
Fluor Protector S
Maintaining theinvestment
INNOVATIVE DENTAL HYGIENE SOLUTIONS
DiagnosisCRT Bacteria
MaintenanceProxyt
PreventionHelioseal
Fluor Protector S
Cervitec Plus
*All 3 steps are
imperative for a
successful caries
prevention program
Karen Stoklosa, MBA
Karen.Stoklosa@ivoclarvivadent.com
Tabetha Magnuszewski, RDH
Tabetha.Magnuszewski@ivoclarvivadent.com
www.ivoclarvivadent.com
THANK YOU!!
Video References
• https://youtu.be/1zSuXQJJszY
• R&D testing facility, Amherst, NY, USA 2015
• R&D testing facility, Schaan, Liechtenstein, 2015
Question and Answer Session
• Questions are welcome! This session may last for 10-15 minutes.
• Write your questions in your control panel on the upper right hand of your screen.
• Submit questions at any time.
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