Partners in Prevention

Partners in Prevention

Patient Education

Fluoride

Nutrition

Plaque Control

Dental Sealants

Dental Sealants

defined as a clinical procedure where a thin coating of a dental material is applied to the pits and fissures of the occlusal surface of posterior teeth to form a physical barrier to prevent dental caries

*You will learn more about dental sealants as a material in DAS 120. For this course, we are focusing on the criteria for application (see page 915), the procedure methods, and troubleshooting (see pages 917 - 918). Chapter 59 MDA

indications

contraindications

procedure

troubleshooting

Procedure Steps & Supplies:

basic/exam set

etch

hve

dental floss

sealant material

coronal polish items

microbrush

articulating paper holder w/paper

dry-angles

cotton rolls

1. Clean the occlusal surface of the tooth/teeth that the sealant will be placed on. (selective polish)

2. Place moisture control/isolation items.

3. Etch the area of the tooth that will be sealed with the material. (see page 918)

4. Place sealant material, making sure to keep the tip down in the material as to not create bubbles.

5. Use a microbrush to blend the edges and remove any excess material. (being careful not to remove all of the material)

6. Cure the material with a curing light

7. Check the cured material with an explorer for voids and seal

8. Check bite/occlusion and adjust as needed (EFDA)

Plaque Control

do i really have to brush and floss?

So many choices...(see pages 156 - 161)

You want to develop a program of oral hygiene strategies to be followed routinely at home. Instructing the patient on how to remove plaque is the initial instruction for most patients. The goal is to thoroughly remove plaque at least once daily. After plaque has been thoroughly removed, it takes about 24 hours for it to form again. Techniques selected must be based on the needs and abilities of the individual patient. A wide variety of oral hygiene products are currently available. It is important for dental assistants to stay up to date on the newest products on the market so that they can advise patients, make recommendations, and answer questions.

Toothbrushes and Toothbrushing

• manual or electric toothbrush
• What is the patient's dexterity like?
• There is a proper way to brush your teeth to be effective and safe
• you can be too aggressive while brushing, which can lead to gingival recession and enamel abrasion

Dental Floss or Tape

• when to floss
• how to floss (you can be too aggressive with this too)
• what is the patient's dexterity like?

Interdental Aids

• who needs to use these?

Toothpaste (dentifrice)

• one toothpaste "type" does not work for every patient

Mouth Rinses

• cosmetic or therapeutic?

Dentures

• you mean I have to clean my mouth still?

Oral Irrigation Devices

Fluoride

the good, the bad, and the truth...

A naturally occurring mineral that is released from rocks into the soil, water, and air. Almost all water contains some fluoride, but usually not enough to prevent tooth decay. Fluoride helps control the caries process by slowing demineralization and enhancing remineralization. According to the patient's needs, various ways are available to receive fluoride therapy.

• Systemic: ingested in food, water, beverages, or supplements
• Absorbed by the intestines into the bloodstream and transported to the tissues (where needed)
• The body excretes (gets rid of) excess systemic fluoride through the skin, kidneys, and feces.
• Topical: applied in direct contact with the teeth
• Toothpaste
• Mouth rinse
• Application of rinses, gels, foams, and varnishes

Fluoride Needs Assessment

Fluoride Pros & Cons

Moisture control &Isolation

For optimum results in a dental procedure, a tooth, a quadrant, or even the entire arch must be kept dry and isolated from its environment. Characteristics of isolation: • Easy to apply • Protective of soft and hard tissues • Comfortable for the patient • Retraction that provides better visualization for the operator • Prevention of moisture contamination • Isolation of the area of concern The three most common isolation methods are (1) cotton roll isolation, (2) dry angles, and (3) the dental dam. The clinical situation will dictate which isolation technique is best suited for that procedure.

The dry-angle isolation technique involves the use of a triangular absorbent pad called the dry angle. This pad helps isolate posterior areas in the maxillary and mandibular arches. The pad is placed on the buccal mucosa over the Stensen’s duct, which extends from the parotid gland and is located opposite the maxillary second molar (Fig. 36.13). These pads block the flow of saliva and protect the tissues in this area.

Cotton roll isolation is the use of a preshaped, tightly formed absorbent cotton positioned close to the salivary gland ducts to absorb the flow of saliva and close to the working field to absorb excess water. It is the most common type of isolation used for short procedures.

Advantages:• Easy application. • No additional equipment is required. • Cotton rolls are available in a variety of sizes and are flexible for easy adaptability to areas of the mouth. Disadvantages: • Does not provide complete isolation. • Does not protect the patient from aspiration • If removed improperly, a dry cotton roll may stick to the oral mucosa and cause irritation. • Cotton rolls are replaced frequently throughout a procedure because of saturation. • Limited retraction.

Patient Education For the dental assistant to properly educate a patient, they must first be educated. Giving the patient false or inaccurate information can be harmful to the patient and to the dental assistant's career. If you do not know the correct response to a patient's question or concern, it is ok to say, "I am not sure of the correct answer. Let me ask or research this, and I will get back to you." Patients appreciate your honesty and that you want to give them accurate and unbiased information.Steps: (see page 150) 1. Listen carefully to learn how patients perceive their dental healthcare needs. 2. Assess the patient’s motivations and needs. 3. Select home care aids. 4. Keep the instructions simple. 5. Reinforce home care during the patient’s return visits for dental treatment.

Not all patients need fluoride...

A needs assessment helps determine the patient's need for fluoride treatment. (see page 152)Things to consider:

• Does the patient live in a rural or urban area (does the area have treated water)
• What kind of water is the patient currently drinking (tap or bottled)
• Medications and medical treatment (can cause xerostomia (dry mouth))
• Restorations
• Orthodontics
• Regular or irregular dental care
• Home care
• Strong family history of decay
• ETC.

Proper Nutrition: What is true for our body's physical health is true for our oral health. What we eat and drink matters! Dental caries cannot occur without dietary sugars. Cariogenic means caries-causing. When you read Chapter 14 (Nutrition) in Dental Science and Health (DAS 115), you will learn that fermentable carbohydrates are a determining factor for the caries process. Educating the patient and having them do a dietary analysis is a helpful way to determine whether or not their diet is playing a role in their overall oral health. While changing a patient's dietary habits might prove impossible, we can educate and help patients modify their diets in positive ways.

proceed with dental sealants on patients with...

• Patient with poor oral hygiene.
• High caries risk.
• Lack of exposure to fluoride because fluoride helps reduce the risk for decay.
• Diet high in sugar increases the susceptibility for decay.
• Teeth with dentinal defects, such as amelogenesis imperfecta, dens in dente are more prone.
• Patients with underlying systemic diseases that affect the oral environment, causing a higher caries risk.
• Medications that affect the oral environment cause a higher caries risk.
• Tooth is fully erupted. If a sealant is to be placed, the entire occlusal surface must be exposed.

sealants are not advised for patients with...

• High level of enamel mineralization with lack of deep pits and fissures (Fig. 59.4). • Obvious dental decay on the occlusal surface. • Proximal surface decay that would include the occlusal surface to be restored. • Insufficiently erupted teeth. • Primary teeth expected to be lost soon. • Poor patient cooperation in the dental chair.