Therapy for Caries ( that does not involve cutting any teeth )
By Dr . Steve Parrett
INTRODUCTION
I hope this article will give you some pause for thought … about our true mission as dentists , and what most patients have expected for almost 200 years .
I will be describing a case of a 37-year-old woman who came new to my practice and how our treatment has progressed over the last two-plus years . My focus in this presentation will be about an innovative way to treat dental caries , non-surgically . I will discuss how my thinking about this treatment evolved over the two years of her experience and conclude with where the protocol stands today . The idea of using Silver Diamine Fluoride to arrest and reverse decay may require some changes in your philosophy of treating dental disease to adopt a similar protocol .
I hope to inspire you to focus on treating the causes of dental disease ( caries AND periodontitis ), and not just the destruction caused by diseases .
The current dental literature is packed full of well-written , scientifically sound articles related to this topic of bacterial treatment and control . I have stacks of them . It will be worth your efforts to Google these topics and present a new “ Gold Standard ” treatment to your patient , one that involves silver ! Allow me to offer a few topics to start you on your journey of discovery :
n International Caries Consensus Collaboration 2015 in Belgium
n G . V . Black 1905 trip to Colorado and how long-ago Silver Nitrate was used for treating decay
n Who actually discovered the “ Colorado black stain ” on teeth was due to fluoride ( I will give you a hint on this one ; it was a chemist at the Alcoa plant in Pittsburgh in 1950 . GO PA !)
n CAMBRA , motivational interviewing , KOBRA ( it may not pop up until this article comes out ; it is my patient-friendly interviewing / assessing tool included in this article )
n Laser fluorescence and decay detection / monitoring using Diagnodent
n Silver Diamine Fluoride , SDF , remineralization
n December 1937 The Dental Cosmos / JADA article by Dr . James Prime , “ Controlling Dental Caries ”
n Go to www . ElevateOralCare . com and ask for the “ Scientific Literature Review ” packet or file
n Proactive Intervention Dentistry
n Microbiologically Monitored and Modulated Periodontal Therapy , just to expand on the bacterial focus of dental disease treatment
The above will keep you busy for a while and open your mind wide !
Once you have digested the basics of this approach and accept the premise and proof , you will probably find you spend a lot more time talking to your patient and addressing a pressing need for many of them . I highly recommend bringing your whole office staff on board with the approach you develop . Every one of them can take part in the educational process your patients will need . Both patients and staff will benefit .
I am not suggesting that we ignore some of the other innovative products and treatments that have come into existence , such as halitosis and sleep apnea treatments , cosmetic dentistry , implants , tooth whitening , and others ... the list is longer . But treat dental disease first and best .
As we get into the details of this case , I have attached supporting photos , X-rays and forms that are part of what we consider our protocol when using SDF on our remineralization patients . I think your learning will accelerate if you get coached . Feel free to forward questions to me . I will leave contact information at the end of this article .
Back to my opening statement , what people have expected for 200 years . Who does not come back from a dentist visit and get asked the question “ did you have any cavities ?” First thing ! And there is the classic new fluoride toothpaste commercial from the 50s or 60s where the youngster exclaims , “ LOOK MOM NO CAVITIES !”
24 JANUARY / FEBRUARY 2021 | PENNSYLVANIA DENTAL JOURNAL