STAFF SCRIPTS FOR THE FOUR FOOD GROUPS The words just roll off my tongue! Jenna R. Derango R.D.H.

STAFF SCRIPTS FOR THE FOUR FOOD GROUPS

The words just roll off my tongue!

Jenna R. Derango R.D.H.

When to approach the patient

Dr’s new exam patients New patients in hygiene Consult patients Patient checks Cleaning & Recall patients Restorative patients Esthetic patients

Dr’s New exam Patients

“Mrs. Jones, our exam today is going to be a lot like you would have at your medical doctors in that we will be discussing risk factors. Dental risk factors are three main reasons or risks that could cause you to lose or severely damage your teeth.”

“Mrs. Jones I know your main concern today is that you have a broken tooth. When doctor comes in he will be discussing with you dental risk factors. Three of the risk factors are reasons you could lose or break your teeth. So at the end of your appointment you will have a pretty good idea of the chances or odds you have of keeping the rest of your teeth.”

New Patient in Hygiene

“Mrs. Jones before we start your cleaning I would like to discuss with you what I will be evaluating during your appointment. The first thing I will be doing is an oral cancer screening. Even patients who do not smoke, drink, or chew tobacco can acquire oral cancer. The other thing we will be assessing is four dental risk factors. Three of these risk factors could cause you to lose or break your teeth.”

Consult Patients

“Today as we evaluate your concern we will also make note of your dental risk factors. In our office we evaluate four dental categories. Three of these categories could cause you to lose or break your teeth.”

Patient in office for a “check” “Mrs. Jones, while that x-ray is being

developed I would like to review your four dental risk factors. Three of these risks could cause you to lose or break your teeth.”

“Mrs. Jones, it appears that the large filling in the tooth we x-rayed has broken. Large fillings put your teeth at risk. If you remember at your last cleaning your hygienist discussed with you the dental risk factors. Biomechanics or the individual tooth structure is one of the three reasons you could lose or break your teeth.”

Cleaning and Recall Patients “Mrs. Jones, as I’m cleaning your teeth I

will be discussing with you the dental risk factors. Dental Risk factors, as you may remember, are four categories that affect treatment, three of the categories are reasons you could lose or damage your teeth.”

“Mrs. Jones, I notice you have several large fillings. Did you know that because of those fillings you are more at risk to fracture, break, or lose those teeth. In our office we evaluate dental risk factors. Risk factors are reasons you could lose your teeth.”

Restorative Patients “Mrs. Jones, today Dr. will be removing decay

from your tooth and replacing it with a filling. Caries is one of the categories of dental risk factors. There are three main risk factors that could cause you to lose or break your teeth.”

“Mrs. Jones, today we will be placing a permanent crown on the tooth on the bottom right where you had a large broken down filling. Although crowns are stronger than fillings, because it is not a completely natural tooth, it has the potential to break in the future. Restored teeth, or the structure of a tooth is one of your dental risk factors. Risk factors are three main reasons you could lose your teeth.”

Esthetics patients

“Mrs. Jones, today we will be placing six veneers on your front teeth. Although esthetics are important, your mouth is like building a house. You must have a great foundation in order for the house to be strong. In dentistry we evaluate risk factors. These risk factors allow us to evaluate the type of foundation in your mouth.”

Risk Factors

“In each category of risk you will be receiving a low, medium, or high risk. Each risk is indicated by a green, yellowyellow, or red dot. A low risk or green dot is the best and indicates no treatment necessary and a state of health. A yellow dot is usually a warning or a moderate risk. With treatment a moderate risk gives you a fairly good potential to keep your teeth. A high risk or red dot, indicates that even with treatment you could potentially break or lose teeth. Things can be done in most categories to decrease your risk factors. As I go through each category I will describe these options to you.”

For Example“Think of the degrees of dental risk factors as a stop light. Low risk is like going through a green light.

Chances are you will pass the intersection safely, however, there is the slight chance someone could

come through the opposite light and cause an accident. It is the same with your dental risks. Although you may have a green dot or low risk it

does not mean you have no risk. LOW RISK DOESN”T MEAN NO RISK. A yellow light or dot indicates

some caution is necessary. Most of the time you may be safe running a yellow light, however, you are putting yourself at a higher risk every time you attempt to

run a yellow light. Finally, running a red light or proceeding with out treatment with a red dot immensely increases your risk to lose or break your teeth.”

Periodontal Risk “The first reason you could lose your teeth is from

periodontal disease. There are many different factors that play a role in periodontal disease. Patients with a personal or family history of the disease or another systemic disease along with patients who smoke are at an increased risk to developing the disease.”

What are pocket depths?

“At every hygiene appointment, today included, we will be checking your pocket depths. Pocket depths are natural occurring spaces next to every tooth in your mouth. This pocket can be measured using a periodontal probe. The probe is marked off in sections by millimeters, each indicating different levels of health or disease.”

Does it hurt?

“Since the pocket already exists and is a natural occurring space, most patients just feel a slight amount of pressure on their gums. Occasionally patients with gum irritation or gum disease may feel a slight pinch with the pressure.”

Healthy Gums

“This is a picture of a normal healthy mouth. Notice the tissue is pink and tightly bound to the tooth. The bone is very close to the neck of the tooth. If you were to brush and floss there would be very little to no bleeding.”

Neck of Tooth

Gingivitis

“In this picture you can see right away the red color to the tissue. This indicates a swelling of the gum tissue. The periodontal probe is now indicating 4 or 5mms. Notice, however, that the bone is still close to the neck of the tooth.”

Neck of Tooth

How it happens & what to do about it

“Plaque and bacteria can become trapped underneath the gums causing irritation. Your body responds by sending blood into your tissue to try and remove the plaque and bacteria for you. If you were to brush, floss, or get your teeth cleaned your tissue would bleed. The reason you are bleeding is not necessarily because you are hurting your gums by being too aggressive, but because they are not healthy. The good news is, it can be easily healed. Proper brushing and flossing for at least 10-14 days along with regular cleanings can completely eliminate the irritation and your gums will return to a state of health. When you look at your gums later, or when we measure your pockets at your next visit, we will not be able to tell where the diseased areas were.”

For example…

“Think of it as a sliver in your finger. Your bodies response is to swell up around the sliver and try and work it out of your system. Once the sliver is removed you are unable to tell where it was before and your finger is completely healthy again.”

Periodontal disease

“Our next picture indicates a stage of periodontal disease. The tissue, although not pink, will not necessarily be as red as it was in the last stage, gingivitis. Sometimes the tissue can almost appear normal and healthy.”

“The next thing we begin to see is the loss of some of the tissue and bone. The tissue loss is on the inside next to the tooth, not on the outside like you would see with recession. Some patients can have periodontal disease and not even know it because it does not usually cause any pain.”

Advanced Periodontal Disease

“In this last picture we see a very advanced case of periodontal disease. The tissue is receded away from the gums and the pockets that remain measure well over 5mm. The bone has been lost as well, leaving little to no support for the existing teeth. Teeth maybe extremely loose or even fall out.”

Radiograph importance

“The x-rays taken at your appointment are used to help us detect, diagnose, and monitor periodontal disease. It is essential, if gum problems exist that every year we take new x-rays to monitor your bone and periodontal health.”

Decreasing your Periodontal Risks

In order to decrease your risk of developing periodontal disease: Maintain good oral care by brushing a

minimal of twice daily, flossing nightly, and using an antiseptic mouth rinse (Listerine)

Return for regular cleaning visits See your medical doctor regularly Do not smoke

Biomechanical Risk

“The second risk factor is biomechanical. The biomechanical category has two sub categories: caries and structure.”

Caries

“Caries is another word for cavities or tooth decay. If you have decay in your mouth, your tooth is breaking down. If left alone the bacteria from the cavity can be spread to other teeth or even other people by sharing saliva. Eventually the tooth maybe lost if the decay is not treated in time.”

Pre-cavities

“There are also areas on your teeth called decalcifications. These white areas can be weak and turn into cavities or with the help of fluoride, calcium, and phosphate they can be made strong again.”

Detection of Caries

“In our office we use three different methods to detect and diagnose dental caries. X-rays, an intra oral exam, and the Diagnodent. The Diagnodent looks like a pen with a red light as the ink. We hold the instrument over your teeth and it gives us a number reading 1-99. 99 being the most likely chance you have a cavity and 1 as not likely. Together using these three methods we can accurately detect and diagnose caries in very early stages.”

Decreasing your Caries Risk

In order to decrease your risk of developing dental caries: Maintain good oral care by brushing a minimal

of twice daily, flossing nightly, using an antiseptic mouth rinse (Listerine), and an anti-cavity mouth rinse (ACT).

Return for regular cleanings Limit the frequency you eat sugary foods or

using straws for sugary beverages. Do not share food, beverages, or saliva with

someone that has the caries bacteria.

Structure

“The second sub category of Biomechanical risk is structure. Structure deals with the condition of the existing teeth. Teeth are made up of different materials, one of which is enamel. Enamel is the hardest substance in the body. When enamel is weakened by caries, although a filling or dental restoration can restore the tooth, some of the tooth’s strength is lost.”

Structure risks

“Patients with large fillings or dental work on every tooth are at a higher risk to potentially lose, break, or form caries around their teeth. This is the risk of the tooth because of the filling. Although, your tooth may look fine today, it always has the potential to break at any time. That is the inherited nature of a restored tooth.”

Breakdown process

“As we chew a lot of force is generated upon our teeth. The tooth has some flexibility to move in and out to absorb the forces whereas the filling will not move as much. The constant pull in opposite directions may cause either the tooth or filling to break.”

For Example

“You may leave here today feeling fine, having no problems with your teeth, and we may not see anything that looks suspicious, however, you could being eating a piece of bread later this afternoon and break any of those teeth with large fillings in them. Once again, that is because those teeth are structurally compromised.”

Decreasing your Structure Risks

In order to decrease your risk of structurally compromised teeth: Place crowns on teeth with large

fillings. Replace broken or extremely

compromised teeth with implants.

Radiograph importance

“The x-rays taken at your appointment are used to help

us detect and diagnose caries, as well as, monitor your existing dental work. It is essential for patients with caries, or that have previously had several teeth restored, to have new x-rays taken every year to insure that there are no new caries beginning.”

Functional Risk

“The last category has a lot to do with your jaw and how your teeth come together. I will be looking for shifted or worn teeth. Some patients can grind their teeth and wear them away, yet, others that do not clench or grind can have wear as well. When a patient speaks or chews their teeth can rub together and wear away. I will also feel your joint as you open and close and check for popping or clicking in your jaw.”

Patient Questionnaire

Do you ever hear or feel your jaw popping, clicking, or locking?

Do you clench or grind your teeth during the day or at night?

Does your jaw become tired or fatigued while chewing?

Do you ever have pain in your joint, ear, or side of your face?

Have you noticed your teeth shifting, moving or becoming worn?

Decreasing your Functional Risk

In order to decrease your functional risk: Avoid chewing gum or chewy foods

such as bagels. Wear night guards when recommended

by your dentist. Receive orthodontics or braces as

recommended by your dentist.

Dentofacial

“The last category I wish to speak to you about is called dentofacial or esthetics. Esthetics is another word for the appearance of your teeth, or how you think they look. Has there ever been anything you have wanted to change about your teeth or anything you are unhappy with?”

Patient options

Invisalign Whitening Bonding Veneers

Important things to Remember

If at any point during the risk factor presentation a patient asks a question…Answer it.

If teeth are missing, Ask if the patient remembers how or why the teeth were lost.

Show the patients corresponding pictures to each category. Use the intra-oral camera.

Breakdown of the Profile Stickers

After rating a patient low, med, high, a brief note must be written to give further detail.

Charting Abbreviation Key

Perio PP1- Perio protocol 1 PP2- Perio protocol 2 PP3- Perio protocol 3 PP4a- Perio protocol 4a PP4b- Perio protocol 4b Stanke- Patient is alternating with the

periodontist. Note: Copy of x-rays and pocket depths must be sent at the C/R.


Biomechanical: Caries Fl2 @ q C/R- Patient must receive a

fluoride treatment at every cleaning appointment regardless of recall intervals.

CP1- Caries protocol 1 CP2- Caries protocol 2 CP3- Caries protocol 3


Biomechanical: Structure MR- Patient with Mostly Restored teeth IBD- Insurance Based Dentistry

Patient would like to replace old or broken dental work slowly with insurance. Note: In September the hygienist and dentist should discuss teeth to be done by end of the year. Secretaries should have insurance information ready before recall appointment.


Functional RR- Risk to Restorative Patients that are a risk to the dentist to

do restorative work. Such as patients with:

Anterior open bite CCP or dysfunction patients Strong tongue and lips that would

interfere or slow the restorative process.


Esthetics A4- Any number and letter pairing

indicates the shade of a patients teeth. LLL- Patient with a low lip line. GUM- Patient with a gummy smile.

Classifying and Treatment of Patients

Guidelines to determine status of risk

Guidelines for treatment of each risk category

Classifying Low Risk Perio Patients

AAP Case Type 0 Clinical Definition Gingival tissue is coral pink, firm and

resilient without evidence of inflammation, bleeding or exudate. Gingival sulci 1-3 mm without muco- gingival defects.

Periodontal Pockets Junctional epithelium at or above CE junction

Alveolar Bone Loss None Furcation Involvement None Tooth Mobility None

Classifying Low Risk Perio Patients

AAP Case Type I Clinical Definition Inflammation of gingiva with hyperplasia,

edema, retractability and/or bleeding with gentle probing Color of gingiva is red to reddish blue No exudate

Periodontal Pockets Pockets or gingival pockets less than 4 mm Alveolar Bone Loss None Furcation Involvement None Tooth Mobility None

Classifying Low/ Moderate Risk Perio PatientsAAP Case Type II Clinical Definition Progression of gingival inflammation into

alveolar bone crest and early bone loss, resulting in moderate pocket formation. Enlargement and loss of stippling of gingiva. Moderate bleeding and slight exudate. Pocket depth 4-6mm Color of gingiva is reddish-blue

Periodontal Pockets Junctional epithelium apical to CE junction, but above bulbous crestal alveolar bone. Supra bony pockets 4-6 mm.

Alveolar Bone Loss Slight, usually up to 2 mm horizontal patterns.

Furcation Involvement Grade I or II Tooth Mobility Slight (Class I)

Classifying Moderate / High Risk Perio PatientsAAP Case Type III Clinical Definition A more advanced state of periodontitis

with increased destruction of structures, moderately deep pockets measuring 5-8 mm, moderate to severe bone loss Gingival inflammation changes Generalized exudate and generalized moderate bleeding

Periodontal Pockets Junctional epithelium apical to CE junction, and apical to crest of alveolar bone, supra bony and/or infra bony periodontal pockets Pocket depth 5-8mm

Alveolar Bone Loss Moderate, 2-4 mm horizontal pattern Furcation Involvement Grade II-IV Tooth Mobility Moderate (Class II)

AAP Case Type IV Clinical Definition Further progression of periodontitis with

severe destruction of periodontal structures, increased pocket depth greater than 7 mm, increased tooth mobility with possible immediate tooth loss, gingival inflammation, moderate bleeding and moderate exudate

Periodontal Pockets Junctional epithelium apical to CE junctions and apical to crestal alveolar bone, both supra and infra bony pockets

Alveolar Bone Loss Advanced/Severe, > 4mm horizontal pattern

Furcation Involvement Grades II-III

Tooth Mobility Moderate to severe (Class II or III)

Classifying High Risk Perio Patients

Treatment of Periodontal Low Risk

Regular Cleaning and Recall: 6,9, or 12 month

Reinforce good oral home care Continued periodontal probing at recall

appointments

Protocol 1 for Perio Treatment Date: Dr: Derango / Mueller A) Documentation

4 – 7 VBWS Pano FMX Full Perio charting including mcj,

Recession, pus, and bleeding points B) Diagnosis AAP Type II Risk Factor Moderate Prognosis Good C) Surgery / Referral Option

No referral necessary

D) Controlling Local Factor

1. Mechanical

6 unit full mouth prophy Reinforced oral hygiene instructions, Mechanical brush(sonicare) Oral irrigators

2. Antimicrobial

Commercial Mouthwash Chlorhexidine

F) Recall Frequency

4 Month recall 6 units G) Evaluation

Full Perio Re-Evaluation every 16 months (after 4th visit) At 4th visit renew all documentation, review with patient at an 8 unit hygiene appointment

Patient name: Hygienist: Vicki / Jenna / Christina Visit 1 2 3 4 Date

Ins code

Fee

Date

Risk Factor

Prognosis

Date

Referral

Stimudents Proxy brush Rubber tip

Date

Antimicrob

Ins code 4381 4381 4381 4381

Fee

Date Re-eval Ins code 4910 4910 0120 4910 Re-eval Fee $54 $54 $18 $54 Re-eval Re-evaluation apt. Date Ins code 4910 0120 9999 Fee $54 $18 $25



Recession, pus, and bleeding points B) Diagnosis AAP Type II Early type III Risk Factor Moderate Prognosis Good C) Surgery / Referral Option

A. No referral necessary


1. Mechanical

6 unit full mouth prophy Reinforced oral hygiene instructions, Mechanical brushing Oral irrigators

2. Antimicrobial Commercial Mouthwash Chlorhexidine Atridox Periochip

F) Recall Frequency

3 Month recall 6 units G) Evaluation

Full Perio Re-Evaluation every 15 months (after 5th visit) At 5th visit renew all documentation, review with patient at an 8-unit hygiene appointment. After hygiene a separate Dr. Exam of 2 units.

Patient name: Hygienist: Vicki / Jenna / Christina Visit 1 2 3 4 5 Date

Ins code

Fee

Date

Risk

Prognosis

Date

Referral


Date

Antimicrob

Ins code 4381 4381 4381 4381 4381

Fee

Date eval

Ins code 4910 0120 4910 4910 0120 4910 eval

Fee 54 18 54 54 18 54 eval

Re-evaluation apt Date

Ins code 4910 9999 0150

Fee $54 $20 $35



Recession, pus, and bleeding points B) Diagnosis AAP Type II III Risk Factor Moderate High Prognosis Good Fair C) Surgery / Referral Option

Recommended unless good prognosis


1. Mechanical

7 unit with deep cleaning 1 quad / visit Reinforced oral hygiene instructions, Mechanical brush Oral irrigators

2. Antimicrobial

Commercial Mouthwash Chlorhexidine Atridox Periochip

F) Recall Frequency

3 Month recall 7 units S&R plane 1 quad/visit

G) Evaluation

Full Perio Re-Evaluation every 15 months (after 5th visit) At 5th visit renew all documentation, review with patient at an 8-unit hygiene appointment. After hygiene a separate Dr. Exam of 2 units.

Patient name: Hygienist: Vicki / Astrid /___________________

Visit 1 2 3 4 5 Date

Ins code

Fee

Date

Risk

Prognosis

Date

Referral

Stimudents Proxy brush Rubber tips

Date

Antimicrob

Ins code 4381 4381 4381 4381 4381

Fee

Date

Quads Re

Ins code

4355 4341

0120 4355

4341 4355 4341

0120 4355

4341 Re

Fee 54 49

18 54

49 54 49

18 54

49 Re

Re-evaluation apt Date Ins code 4910 9999 0150 Fee $54 $20 $35



Recession, pus, and bleeding points B) Diagnosis AAP Type II III IV Risk Factor Moderate High Prognosis Good Fair Poor

C) Surgery / Referral Option

Recommended. Must sign release unless AAP II with good prognosis


1. Mechanical 7 unit scaling and root planning by quads

4 visits within a 6-8 week period Reinforced oral hygiene instructions, Mechanical brush Oral irrigators

2. Antimicrobial

Commercial Mouthwash Chlorhexidine Atridox Periochip Perio Stat during 4 quads(active disease)

F) Sequence and Recall Frequency

3 Month recall from 1st appointment in series

G) Evaluation

Re-evaluate at 1st 3 month recall for referral or new protocol. Protocol 4 can only be used once

Patient name: Hygienist: Vicki / Jenna / Christina Visit 1 2 3 4 5 Date Ins code Fee Date Risk Prognosis Date Referral


Date

Antimicrob

Ins code 4381 4381 4381 4381 4381

Fee

Date Re-ev

Quads Re-ev

Ins code 4341 4341 4341 4341 Re-ev

Fee $125 $125 $125 $125 Re-ev

Re-evaluation apt Date Ins code 4910

Fee $54

Protocol 4B for Perio Treatment Date: Dr: Derango / Mueller A) Documentation


Recession, pus, and bleeding points B) Diagnosis AAP Type II III IV Risk Factor Moderate High Prognosis Good Fair Poor

C) Surgery / Referral Option

Recommended. Must sign release unless AAP II with good prognosis


1. Mechanical 8/9 unit scaling and root planning by

arches 2 visits within a 2-3 week period Reinforced oral hygiene instructions, Mechanical brush Oral irrigators

2. Antimicrobial

Commercial Mouthwash Chlorhexidine Atridox Periochip Perio Stat during 4 quads(active disease)

F) Sequence and Recall Frequency

3 Month recall from 1st appointment in series

G) Evaluation

Re-evaluate at 1st 3 month recall for referral or new protocol. Protocol 4 can only be used once

Patient name: Hygienist: Vicki / Jenna / Christina Visit 1 2 3 4 5 Date Ins code Fee Date Risk Prognosis Date Referral


Date

Antimicrob

Ins code 4381 4381 4381 4381 4381

Fee

Date Re-ev

quads Re-ev

Ins code 4341 4341 4341 4341 Re-ev

Fee $65 $65 $65 $65 Re-ev

Re-evaluation apt Date Ins code 4910

Fee $54



Recession, pus, and bleeding points B) Diagnosis AAP Type III IV Risk Factor Moderate High Prognosis Fair Poor C) Surgery / Referral Option

Storngly Recommended.

Must sign release D) Controlling Local Factor

1. Mechanical

Protocol 2 or 3 Reinforced oral hygiene instructions, Mechanical brush Oral irrigator

2. Antimicrobial

Commercial Mouthwash Chlorhexidine Atridox Periochip

F) Recall Frequency

Recall every 3 months Protocol 2 or 3

G) Evaluation

Full Perio Re-Evaluation every 18 months (after 6th visit) At 6th visit renew all documentation, review with patient at an 8 unit hygiene appointment. After hygiene a separate Dr. Exam of 2 units.

Patient name: Hygienist: Vicki / Jenna / Christina Visit 1 2 3 4 5 6 Date Ins code Fee Date Risk Prognosis Date Referral

Stimudents Proxy brush Rubber tips

Date

Antimicrob

Ins code 4381 4381 4381 4381 4381 4381

Fee

Date

Quads Eval

Ins code Eval

Fee Eval

Re-evaluation apt Date

Ins code 4910 9999 0150

Fee $54 $20 $35

Risk Factors Points Number of smooth surface lesions _______ x 1.5 Number of occlusal lesions _______ x 1.0 Number of recurrent decay _______ x 1.0 Number of caries restored in the past year _______ x 1.0 Number of rough white spot lesions _______ x 0.5 Number of interproximal watches _______ x 0.5 Each of the following answers = 1 point Caries restored in the past 3 years Heavy plaque Frequent sugary/starchy snacks Saliva reducing facotors: - Medications - Head / Neck Radiation - Systemic Disease - Dry Mouth (other) Occlusal or Diagnodent watches Orthodontic appliances or partial dentures Deep pits & fissures / developmental defects Exposed root surfaces

TOTAL Protocol 1 (4-8 pts)

Oral Hygiene / Diet Review Prevident Toothpaste

Spry Gum or Mints Notes: Fee $

Protocol 2 (9-12 pts) Oral Hygiene / Diet Review

Prevident Toothpaste Spry Gum or Mints

Chlorhexidine Mouth Rinse Fluoride Tx @ q C/R

MI Prophy Paste & home usage Notes: Fee $

Protocol 3 (>12 pts) Oral Hygiene / Diet Review

Prevident Toothpaste Spry Gum or Mints

Chlorhexidine Mouth Rinse Fluoride Tx @ q C/R

MI Prophy Paste & home usage Fluoride Varnish 3x within 10days

GC Saliva Test Bacterial Test @ 3 month recall

Notes: Fee $

Classifying and Treating Caries Risk

Treatment of Caries Low Risk

Regular Cleaning and Recall: 6,9,12 months

Review of Oral Hygiene Radiographs as necessary

Caries Protocol Components

Oral Hygiene instruction / Plaque removal Diet counseling and Saliva education Restorations / Sealants Anti-bacterial mouth rinse/Chlorhexidine Xylitol Gum / Mints Fluoride: Prevident / Fluoridex toothpaste

Duraphat / Cavity shield MI Paste

DIET

Reducing the number of sugary and starchy foods, snacks, drinks, or candies can help reduce the development of tooth decay. That does not mean you can never eat these types of foods, but you should limit their consumption particularly when eaten between main meals. A good rule is three meals per day and no more than three snacks per day. It is also important to note that eating small amounts of sugary foods throughout the day is more likely to cause decay than a large amount of sugary snacks all at once.

SALIVA

Saliva is critical for controlling tooth decay. It neutralizes acids and provides minerals and proteins that protect the teeth. If you cannot brush after a meal or snack, you can chew some sugar-free gum. This will stimulate the flow of saliva to help neutralize acids and bring lost minerals back to the teeth. Sugar-free candy or mints could also be used, but some of these contain acids themselves. These acids will not cause tooth decay, but they can slowly dissolve the enamel surface over time (a process called erosion). Some sugar-free gums are designed to help fight tooth decay and are particularly useful if you have a dry mouth (many medications can cause a dry mouth). Some gums contain baking soda, which neutralizes the acids produced by the bacteria in plaque. Gum that contains xylitol as its first listed ingredient is the gum of choice. If you have a dry mouth, you could also fill a drinking bottle with water and add a couple teaspoons of baking soda for each 8 ounces of water and swish with it frequently throughout the day. Toothpastes containing baking soda are also available from several companies.

RESTORATIONS / SEALANTS

Restorative work includes any type of dental work that reconstructs tooth structure after all the decay has been eliminated. Fillings or crowns can come in composite, porcelain, or metal material depended on what is needed to completely return the function of your tooth. Sealants are plastic coatings bonded to the biting surfaces of back teeth to protect the deep grooves from decay. In some people, the grooves on the surfaces of the teeth are too narrow and deep to clean with a toothbrush, so they may decay in spite of your best efforts. Sealants are an excellent preventive measure for children and young adults at risk for this type of decay.

Suggested Protocol: All decay must be removed before any other treatment or preventative measures are taken. Since decay is a bacterial process that is transmissible complete elimination of the decay is necessary so new decay is unable to form.

ANTI BACTERIAL MOUTH RINSE

Rinses that your dentist can prescribe are able to reduce the number of bacteria that cause tooth decay and can be useful in patients at high risk for tooth decay. The reviewed literature showed that chlorhexidine is effective in reducing the incidence of dental caries in the populations tested.

Suggested Protocol: After normal brushing and flossing in the morning, pour some Chlorhexidine in a cup. Dip your clean toothbrush into the mouth rinse and briefly brush it around you mouth. Then take the remaining mouth rinse left in the cup and rinse for 30 seconds. Repeat daily until the bottle is gone or as directed by your dentist.

XYLITOL PRODUCTS

Xylitol is a sugar substitute with sweetness equal to that of table sugar. Xylitol has a number of effects on S. mutans (bacteria responsible for the decay process) that may account for some of its clinical effects in caries reduction. Short-term consumption of xylitol is associated with decreased S. mutans levels in both saliva and plaque.5 Long-term habitual consumption of xylitol appears to have a selective effect on S. mutans, resulting in selection for populations less adherent to tooth surfaces. These colonies, therefore, are shed more easily from plaque into saliva.6 this effect may not only be important to the individual’s decay experience, but may also influence the transmission of S. mutans from mothers who consume xylitol to their children.

Suggested Protocol: Xylitol comes in mint and gum form. Chew or use saliva to dissolve two pieces of the product three to five times daily.

FLUORIDES

Fluorides help make teeth more resistant to being dissolved by bacterial acids. Fluorides are available from a variety of sources such as drinking water, toothpaste, over-the-counter rinses, and products prescribed by your dentist such as brush-on gels used at home or gels and foams applied in the dental office. Daily use is very important to help protect against the acid attacks.

Suggested Protocol: Prevident or Fluoridex toothpaste is to be used nightly immediately before bed. Apply paste to a dry toothbrush, brush as normal and spit. DO NOT rinse your mouth with water. In order for the prescription fluoride to work at full strength it is essential not to eat, drink, or rinse, your mouth for 30 minuets after use.

Suggested Protocol: Cavity Shield or Duraflor fluoride varnish can be applied at home or n office. Both types must be applied to all teeth three times within a 10 day period. Patients should not eat or drink for an hour to an hour and a half after application.

MI PASTE

Casein Phosphopeptide (CPP) are natural occurring molecules which are able to bind calcium and phosphate ions and stabilize Amorphous Calcium Phosphate (ACP) Replaces lost minerals, improves the protective qualities of saliva, improves fluoride uptake, and soothes sensitive surfaces.

Strengthens tooth enamel, Reduce sensitivity, Buffer plaque acid Prophy cup application , Custom tray application, at-home follow-up applied daily MI Paste is indicated for post-bleaching sensitivity, root planing and scaling, as well as during prophylaxis.

Suggested Protocol: Apply a pea sized amount to the tip of your finger. Use finger to rub on to the surfaces of your teeth. Once the paste is gone from you finger, use your tongue to rub paste across every tooth surface until it is dissolved completely. Since the product is made completely of animal products it is safe to swallow, however, if you prefer you may spit the excess paste into the sink. Do Not eat, drink, or rinse for 3 minuets after using the paste. Apply 2-3 times daily.

Classifying Function

1. Acceptable Function2. Dysfunction3. Constricted Chewing Pattern4. Parafunction5. Neurological disorders

Recognizing Acceptable function

Minimal to no signs or symptoms of pain or joint problems

Physiological wear i.e.: diet or age Pathological wear from chemical

erosion

Risk Category: LOW

Recognizing Dysfunction Posterior interference or avoidance Wear patterns on posterior teeth Can not find their “Home” in chewing or

bite pattern

Risk Category:

MODERATE

HIGH

Recognizing Constricted Chewing Patterns Also called restricted envelope Maxillary arch locks lower teeth Anterior wear patterns Wear on maxillary lingual and mandibular

facial Usually minimal posterior wear

Risk Category:

MODERATE

HIGH

Recognizing Parafunction

Horizontal wear patterns-irregular and advanced

Wear patterns on night guard match teeth wear patterns

Sleep disturbances Possible TMD

Risk Category: HIGH

Recognizing Neurologic Function

Recognition by medical history Due to disease

Ex: Epileptics Drug induced

Ex: Ecstasy

Risk Category: HIGH

Treating Acceptable Function

No treatment necessary

Treating Dysfunction

Joint position that allows teeth, muscles and joint to work in harmony

Equilibration- bite adjustment Helping patients find a “home” with equal

intensity and simultaneous bilateral contacts Anterior Guidance- teeth the guide to

home that is not too steep nor too shallow

Treating Constricted Chewing Patterns

Orthodontics- maxillary teeth out and or mandibular teeth in

Open bite orthodontically or restoratively

Treating Parafunction

Force management principle- shallow guidance- no deep overbite

Treating Neurologic Disorders

No solution for patients with genetic or systemic diseases

Replace or remove patient from the drug inducing the functional problem if possible

STAFF SCRIPTS FOR THE FOUR FOOD GROUPS The words just roll off my tongue! Jenna R. Derango R.D.H.

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Transcript of STAFF SCRIPTS FOR THE FOUR FOOD GROUPS The words just roll off my tongue! Jenna R. Derango R.D.H.