This week on A Tale of Two Hygienists TIPisode we are joined by Andrea Wiseman, RDH to talk to us about fluoride, remineralization and antimicrobial products, highlighting when they should be used for each indication.
- Dose response
- Over the counters, and who should use them
“Always remember to look at the ingredients, and look at the actives”
“Tartar control products are designed to stop mineralization of plaque into calculus; This is the same remineralization process that repairs de-mineralization areas, if you stop one process, you stop the other”
“Read those labels well”
“This is a catch 22 because if the patient brushed well in the first place they wouldn’t need stannous”
“Is the patient at risk for caries only? Or Caries, Gingivitis, and Perio?”
“Chlorhexidine stays present in the mouth for 8-12 hours killing bacteria”
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This TIPisode has been transcribed for your viewing pleasure:
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode, this week brought to you by Elevate Oral Care.
Andrea Wiseman: Hello, everyone. Andrea Wiseman, RDH, here with Elevate Oral Care to cover the latest TIPisodes on preventive dentistry.
One of the most difficult things in providing at-home care to patients is knowing what products to provide to them for which indications. Even small things like recommending an over the counter toothpaste can be detrimental to a patient’s needs if the patient has a sensitivity to paste ingredients.
Today, I’m going to cover many of the different fluorides, remineralization products, and antimicrobial products, and when they should be used for each indication. There are plenty of brands available, and some can be confusing with similar names. Always remember to look at the ingredients and define what ones are the actives. This is how you know you can provide the best products to produce the best results.
Let’s start with the most common product you recommend: toothpaste. Hopefully, all of your patients at least brush, preferably with a fluoride-containing toothpaste. For low-risk patients — those with good oral hygiene, dietary practices, adequate fluoride exposure, and limited risk factors — let them keep using what they have used. It’s working, so don’t change it.
For those patients at moderate to high risk for caries, you want to ensure that they are using a prescription strength 5,000 parts per million fluoride dentifrice. Or, if they do not accept your prevention treatment plan and stay with the over the counter, they should not use tartar control products if incipient or white spot lesions exist. Tartar control products are designed to stop mineralization of plaque into calculus. This is the same mineralization process that repairs demineralization areas on our teeth. If you stop one, you stop the other. Incipient white spots in these patient’s mouth will never heal.
On the other hand, if you have a low-risk patient with healthy teeth, instructing them to use tartar control toothpaste will prevent plaque from calcifying, helping reduce the risk of white spot lesions and caries.
Fluoride also has what is called a dose response. That means the higher the dose and more frequently it’s used, the better it works. Using over the counter toothpaste with 1,000 parts per million of fluoride is less effective than using a 5,000 parts per million fluoride medicated dentifrice, brushing twice a day is better than one time, and so on.
There are many other mineralization products like calcium- and phosphate-based products. There is no doubt that calcium and phosphate are necessary building blocks to mineralize our teeth. In fact, most of the tooth is made of these minerals. While calcium and phosphate are necessary, it is normally supplied in an ample quantity from our saliva naturally. Only when patients have significant dry mouth or reduced minerals from some medications or ailment will they truly benefit from a calcium phosphate additive in a product.
Keep in mind that calcium and fluoride must be protected from each other if in the same container. If a tube contains fluoride, calcium, and water, it will form calcium fluoride and become ineffective before it gets used. Read those labels well.
Let’s move on to stannous fluoride. If you ask any hygienist what stannous does, they’ll tell you it stains, and that is partially true. Stannous fluoride is actually too large of a molecule to stain the tooth itself. It will only stain plaque and calculus buildup on the tooth’s surface. That means good brushing will prevent it from staining at all. That’s somewhat a catch-22. If a patient brushes well in the first place, they wouldn’t need stannous fluoride. You can actually use this as a positive and teach patients where they need to brush better to eliminate and prevent discoloration.
But when would you use stannous fluoride over sodium fluoride products? Just ask one question: is the patient at risk for caries only or caries, gingivitis, and perio involvement? If it’s caries only, use a sodium fluoride product. If there’s any gingival involvement, use a stannous fluoride product.
Stannous fluoride has an antimicrobial properties [sic] and astringent properties that sodium fluoride does not. Stannous kills many bacterias associated with gingivitis, oral malodor, and even periodontal disease. It causes the blood vessels at the surface of the gingival to actually contract as well, helping to reduce swelling. It’s also not water-soluble, meaning that you can eat and drink right away and not have to wait the 30 minutes and still benefit from up to 8 hours of the antimicrobial therapy.
You can almost think of stannous fluoride products as something you can start gingivitis patients on and gradually move them back to a 1.1 sodium fluoride toothpaste, and hopefully, if they lower their risk levels enough, finally back down to over the counter toothpaste. Use them stepwise depending on where the patient’s health is and is headed.
The strongest widely available antimicrobial product we have in dentistry is chlorhexidine gluconate. Chlorhexidine is not only great at wiping out large varieties and quantities of bacteria but it’s also doing over a long period of time. Chlorhexidine stays present in the mouth for 8 to 12 hours, killing bacteria. Products like hydrogen peroxide are effective at killing bacteria, but only for a few minutes before things begin to grow back. Essential oil type products are a little longer lasting than hydrogen peroxide but not as long lasting as chlorhexidine.
The downside to chlorhexidine is similar to stannous: staining. In this case, the stain is more intrinsic and harder to remove. For this reason, chlorhexidine products have been pushed into being used only in the most advanced perio cases rather than in everyday gingivitis cases. While the stain is hard to remove, it is a very effective product. It only leaves a few bacterias behind.
There are many other products and chemistries we didn’t touch on today like povidone iodine. So, if you’d like to learn more, please reach out to Elevate Oral Care and schedule a webinar or an in-person staff meeting to learn more. We’re happy to provide education on anything prevention related even if it’s not one of our products. That is why our team of prevention care consultants are truly the prevention experts.
Michelle Strange: Thanks for listening to another TIPisode, and thank you to Elevate Oral Care for sponsoring this week’s episode. You can find out more about their great products at elevateoralcare.com. And don’t forget to hit the “subscribe” button in your podcast app, follow us on Facebook or Instagram, and head over to our website, ataleoftwohygienists.com, to sign up for our newsletter. We always appreciate ratings and reviews. Thanks for listening to your unofficial dental hygiene podcast.