hygiene the international C.E. magazine of dental hygiene

I 15hygiene 1_2013 C.E. article_ caries management I It is important to realize that the frequency of food consumption, time of consumption and types of foods consumed contribute to the demineralization process. Consumption of certain foods and drinks canalterthenormal6.7–7.0pHlevel.Challengesas- sociated with one of the most common dietary con- tributors to altered pH are confirmed by an example givenin2011byBillMarshofTheNewYorkTimes;he reported that the average American consumed 44.7 gallons of sodas per year (Marsh). Unfortunately, sodas are not the only contribut- ing factor: Fruit juices, energy drinks, coffees and alcoholicbeveragesarealsoon“TheList”ofacidchal- lenges.Therearemanysolidfoods,too,thatcontrib- ute to a lowered pH, such as certain cheeses, pickles, yogurts and fruits. These are only a small example of the many challenges. _Remineralization and therapies Demineralizing and remineralization occur as a natural cycle of the oral cavity; however, if the pH level stays in a lower acidic zone, potentially more demineralizing could occur (Marsh). Balancing the pHcanbedonethroughxylitolproductsandashort- term therapy of 0.2 percent sodium hypochlorite rinse. With xylitol products, cariogenic bacteria cannot be metabolized into acid, thus resulting in growth reduction and bacterial starvation. The sweet taste promotes salivary flow to aid in repair (Spolsky, 2003). The sodium hypochlorite rinse is bactericidal oncontacttoallbacteria.Ithasthecapabilitytoelim- inate and reduce cariogenic microbes, while replac- ing them with healthy organisms. The disadvantage is that the rinse alters taste and it is recommended for only patients who are age 6 and older (Kutsch & Bowers, 2012). Fluoride research started in the early 1900s by Dr. Frederick McKay, and today we still recognize the advantagesofcariesreductionthroughfluorideuse. It strengthens teeth, inhibits bacterial metabolism, inhibits the production of acids or demineralization, and enhances remineralization. An average of 35 percent reduction in carious lesions can be demon- strated with fluoride therapy (Spolsky, 2003; Feath- erstone, 2000). Fluorides formulations are available as gels, foams or rinses, and it is found in toothpaste andwater.AsreportedintheAugust2006Journalof the American Dentistry Association, gels and foams shouldbeadministeredasafour-minuteapplication inatray,andallfluoridesarerecommendedbasedon the patient’s age and level of risk. Fluoride varnish is FDA-approved for sensitivity relief. Varnish acts by slowly releasing fluoride ions atthesurfaceofthetooth.Thehighconcentrationof fluoride in varnish (22,600 ppm) produces sheet-like deposits of calcium fluoride that act as a reservoir, releasing fluoride over time. Wear time for release can be a little as two hours, while other varnish wear timeisaslongasfourhours—andsomerecommend longer.ApositionpaperpublishedbytheADACoun- cil of Scientific Affairs (JADA, 2006), recommends fluoride varnish for children under the age of 6 and for patients at high risk for dental caries. Chlorhexidine rinse has been characteristically used in the past for dental caries therapy; however, recent studies have revealed that caries preventive therapywithchlorhexidineresultedinpopulationin- creasesofhighlyacidogenicoracid-tolerantMutans streptococcus (Kutsch & Bowers, 2012). An April 2011 JADA article states that except for CHX-thymol varnish every three months for root surface lesions, all other CHX products in any form, foranylesionsite,foranyage,arenotrecommended. Another chemotherapeutic rinse is 10 percent Povi- done-Iodine, which reduces mutans streptococcus andlactobacillusinyoungchildren.Itisadministered only in the office — via swab or rinse (Featherstone, 2006). There is little evidence that PI is effective in adults,anduntilthosestudiesaredone,useofiodine in adults cannot be recommended as beneficial. (Featherstone, 2006; Kutsch & Bowers, 2012). Sealants have been clinically proven to prevent dental caries in occlusal pits and fissures in many clinical trials. Placing sealants soon after eruption to prevent decay and deter the need for future re- storative treatment is a part of preventative therapy. About 90 percent of carious lesions are found in Fig. 2_Consumption of certain foods and drinks can alter saliva’s normal 6.7 – 7.0 pH level. Soda, because so much is consumed in the U.S., is especially problematic for many dental patients. Fig. 2 More acidic Neutral More alkaline The pH scale 0 Battery acid 3 Soda, orange juice 2 Vinegar, lemon juice 1 Stomach-lining acid 4 Tomato juice, acid rain 7 Water 6 Saliva 5 Coffee 8 Ocean water 11 Ammonia solution 10 Great Salt Lake, milk of magnesia 9 Baking soda 12 Soapy water 13 Liquid bleach 14 Drain cleaner