Renee Knight is a freelance writer and editor who's been covering the dental industry for 15 years. 

Renee Knight

	In the past, Dr. Joyce Bassett felt like she had to compromise between strength and esthetics when placing composite in the anterior. Kerr Harmonize, a universal composite with Adaptive Response Technology, enables her to place restorations anywhere in the mouth with confidence.

	What Dr. Joyce Bassett says about Kerr Harmonize universal composite:

, I would use a stronger composite on the lingual surface of the tooth, then I would use an esthetic, high polishable microfill composite that was weaker for the final facial layer. I don’t have to do that anymore. Harmonize is not only strong, but it blends in with the surrounding enamel really well. The composite just disappears. You can’t see where the restoration ends and the tooth begins. It’s strong and it’s beautiful, so you can use it in both the anterior and the posterior. I feel confident using this material in load-bearing areas and in areas that demand visual imperceptibility.

Related reading: 5 ways composite advances can change your workflow

 changed the nanoparticle filler network, so it now has silica and zirconia. The nanoparticles form together, which is what makes the material so much stronger. Harmonize is the strongest universal composite Kerr has ever offered. So if you want a strong composite in the back of the mouth, you can use Harmonize for traditional incremental layering. I prefer bulk fill in the posterior, but if you choose to cap the last 1 to 2 mm over a bulk fill, this composite is my choice because it is both esthetic and strong and it polishes amazingly well. Basically, you can use Harmonize everywhere.

	Before, I felt like I had to compromise between strength and esthetics, but Harmonize was designed to meet this demand. The universal composite has clinical performance in strength, handling and optical properties. Harmonize isn’t sticky; it’s easy to handle and has great scluptability. When I’m building a Class IV or Class V in the anterior, it does not slump and it stays wherever I put it.

	Using Harmonize saves me time and makes my job easier, but the most important point is the fact that it’s imperceptible, which patients love. They don’t want to see the restoration. Many patients analyze their smiles with magnifying mirrors and they are disappointed if they can see the line where the restoration ends and the tooth begins.

	I always say when you’re ready to buy a composite, do not buy the same composite if there is a newer generation. Always purchase the next generation. The manufacturers and scientists are always upping their game and idealizing and improving on their previous generation when creating their newest generation of composite, so it’s worth giving the newest generations a try.

	I suggest you purchase a few of the most common shades you use, like B1E, A1E, XLE and XL2D, and get started. Your patients will love the results.

Articles

One doctor’s take on the benefits of this universal composite with Adaptive Response Technology.

I Use That: Kerr Harmonize

	Many patients don’t realize just how important it is to use the right toothbrush. They typically rely on the sample they get after their 6-month dental visit or pick up a cheap option at their local grocery store. To them, all toothbrushes are basically the same, and they don’t see a reason to invest in an electric version.

	While using a manual brush is, of course, better than nothing, many oral health care professionals want their patients to make the switch to electric. These brushes help ensure patients get their mouths as clean as possible-reducing their cavity risk and the likelihood they’ll develop gingivitis.

Check out Listerine's Office Essentials program for free patient samples, helpful resources and more!

	“I can typically tell when somebody uses an electric toothbrush versus a manual toothbrush just by looking at their oral health,” says Sarah Thiel, RDH, CEO and co-founder of 

. “Their gums look amazing, and I don’t have to do a lot during the appointment.”

	Patients also can tell the difference when they switch to electric, Thiel says, but they won’t experience the benefits unless you provide them with the proper education and guidance. Once they understand what it can mean for their oral health as well as their overall health, most patients will be happy to make the extra investment in their smile.

	Electric toothbrushes offer patients a variety of advantages, no matter their oral condition, says Tina Clarke, RDH. These brushes do the work for them, with many even featuring a timer to ensure patients brush for a full two minutes, as well as a pressure indicator light to let patients know when they’re brushing too hard and possibly damaging their gums. Clarke describes it as brainless brushing; all patients have to do is move the brush from tooth to tooth, whether they’re using Phillips Sonicare brushes that penetrate deep below the gum line to disrupt the bacterial environment or round Oral-B brush heads that oscillate in a half-circle motion to remove biofilm from the tooth surface. 

	“A lot of people are in a hurry and do a drive-by in the mouth,” says 

. “Electric toothbrushes give us a better chance of accomplishing what we need to do as hygienists, and that’s reducing inflammation, removing plaque and reducing hypersensitivity.”

	Thiel recommends electric toothbrushes to every patient she sees. She always notices issues in the mouth that an electric brush can help improve, she says, including recession and sensitivity from improper brushing and gingivitis from not brushing at all.

	Electric toothbrushes are also great options for children, especially if they have braces, Thiel says.

	“Parents are spending a lot of money on orthodontic work, and if kids don’t brush correctly, they’ll end up with white boxes where the brackets are,” Thiel says. “That can only be fixed by putting on a crown, which can be pretty frustrating.”

	Elderly patients with dexterity issues can also benefit from electric toothbrushes, Thiel says. Many older patients can’t move their hands the way they need to, so if they use a manual brush, they’re likely leaving plaque behind. An electric version cleans their teeth for them, so as long as they get it close to where it needs to be, it’s going to remove plaque and help prevent problems.  

	Educating your patients on their options

	When you recommend a power toothbrush to your patients, they’re going to want to know if it’s really worth the extra money, Turchetta says. After all, not only are the brushes themselves more expensive, so are the replacement heads they’ll need to buy every few months. Be prepared for patients to ask about the differences between the $50 and the $200 models-especially if you recommend a brush that falls on the higher end of that price range. It’s your job to educate patients about why one version is better for their particular oral health situation than another. 

	“Most patients are concerned about cost. Electrics brush at 30,000 strokes per minute while a manual is only 200 strokes. I give them a choice. Do they want $30,000 or $200? That usually seals the deal right there,” says Ethel Hagans, RDH. “I also tell them anything that helps their teeth outlast them is a worthwhile investment. An electric toothbrush is only a fraction of what it costs to complete a deep cleaning or scaling and root planing.”

	Clarke talks with patients about their current oral health care status, their home care routine, and how using a power toothbrush can remove biofilm and promote a healthy smile.

Emerging research: Toothbrush type found to influence bacterial growth

	“Electric toothbrushes help with stain removal, which is attractive to patients who really want a bright, white smile,” Clarke said. “And even with their phenomenal power, these brushes are still very gentle on the gums. If patients have recession, they can just place the brush on the tooth without using a scrubbing action. So I base the education on the patient’s ultimate goals and desires.”

	To educate her patients, Thiel says she gives a demonstration chairside. She lets them put the power brush in their mouth so they can feel how it’s different than a manual brush. Once they see how easy it is to use and how cleaner their mouth feels, most patients are sold and want to know how they can get one of their own.  

	While many hygienists are strong electric toothbrush supporters, that doesn’t mean they don’t see the benefits the manual versions provide. Turchetta typically recommends one of each to her patients. That way, if they can’t afford an electric or just don’t want one, they can still purchase a toothbrush that will help improve their oral health.

	Manual toothbrushes are inexpensive and travel-friendly, Turchetta says, and that means patients have no excuse to skip brushing. They come in different angles, different grips and with a variety of bristles. When recommending a toothbrush, Turchetta always thinks about not only what’s best for the patient’s oral condition, but what that patient will actually use. Buying any toothbrush, electric or manual, doesn’t do much good if patients don’t want to pick it up as part of their home care routine.  

	“It goes back to asking what we are dealing with. Would the patient benefit from a smaller toothbrush head or an electric toothbrush? If they’re doing a good job brushing manually, maybe we stick with that but use a different style of bristle,” Turchetta says. “You have to look at your goal. If you want to reduce inflammation, how are you going to do that? If you want gums to be gently massaged, how are you going to do that? We have to do our homework.”  

	How can you learn more about the seemingly endless options that are available? Turchetta recommends getting team members involved. Ask everyone to buy a different manual brush, and then sit down together to analyze them. Determine the type of patients each brush would benefit the most, and then commit to recommending those brushes chairside. Make this a fun team-building project, and engage with your patients by posting the results on social media.

	Help your patients find the right toothbrush

	For many patients, electrics toothbrushes are the best option. They make brushing easier, and patients love how they make their mouths feel.

More from the author: Does oral rinse REALLY matter?

	Finding the right brush that gives patients a clean, fresh mouth will help them understand the benefits of maintaining their oral health, Hagans said. Not only will that make their appointments easier, but once they experience a healthier mouth, it might prompt them to invest in more cosmetic options down the road. They’ll put more value in their oral health care and the services dental practices have to offer.

	“Using electric toothbrushes is a proven proactive approach for our patients’ health,” Turchetta says.   “Make it a priority to invest the time to find out which toothbrush is their best fit. Compliance won’t be an issue and the result is healthy teeth and tissue.”

Our experts weigh the pros and cons of each type of toothbrush. 

Are electric toothbrushes REALLY better than manual toothbrushes?

	Until recently, there hasn’t been much talk about or interest in CAM technology and its place in the dental digital workflow. Jordan Greenberg of FOLLOW-ME! Technology North America, developers of hyperDENT CAM software, discusses why that’s changing.

	How did you first become interested in dentistry?

	Jordan Greenberg: My dad, Ross Greenberg, owned and operated a dental lab near Chicago my whole life, so I always had an interest in the profession. I joined the dental business with a focus on digital technology, as my father and I started SureFit Milling Center in 2006. At this company, I handled the digital production of our zircona, wax and PMMA restorations. I also worked as the Product Manager at DATRON, which specializes in equipment for the in-house machining of implant bars and abutments. Now, I’m the Managing Director at 

, the U.S. subsidiary of FOLLOW-ME! Technology Group GmbH. This is the company that develops, supports and services 

	Why is CAM software an important part of the digital workflow?

	JG: CAM software has been the unsung hero of the digital dental industry since the first milled coping came off a machine. Why? As much as new machines and design software features drive new applications and materials, CAM software is the glue that holds the entire 

 process together. It translates your 3D design files into a language the mill can understand. If a lab or milling center is having trouble with milling times, tool breakage or finish quality, these are all issues that can be addressed in the CAM software.

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	However, people have only recently started to ask questions about CAM. Until now, this software was typically part of a closed system or a pre-configured system with each element chosen by a distributor, so labs and milling centers rarely made a conscious decision regarding CAM. We’re very familiar with this situation, because hyperDENT was the toolpath generating software within the KaVo, 3M and Amann Girrbach systems.

	Why is CAM becoming a recognizable CAD/CAM element?

	JG: I can think of a few main reasons: 1. Labs are starting to figure out ways to identify problems on their own, 2. They’re evaluating new ways to increase efficiency in their workflow, and 3. They’re looking for ways to differentiate their digital product offerings from other labs and milling centers.

	Regarding the first point, with a closed system, you’re limited by the features developed by the system manufacturer. Now users are exploring new solutions on their own. We receive a lot of requests like, “I want better occlusal detail and you can’t add a smaller tool into my machine” or “I want to start using a new material but my existing templates can’t mill it properly.” They’re starting to ask, “where in the process is my problem, why am I experiencing this problem, and what can I do to achieve the results I desire?” On the other hand, with system configurators that have chosen an open CAM solution, they are not just fixing the issues for their customers, but they’re helping them understand where these problems exist and how their adjustments will fix them.
	I’m also seeing customers evaluating new ways to increase efficiency in their workflow. As the connecting piece between the design and milling processes, the CAM component can become a bottleneck if it’s not easy to use, efficient and high performance (with regard to calculation time).

	As for the last point, CAM is the most effective place to customize your milled products. For example, most crowns are designed with a high level of occlusal detail-so why does this not automatically translate to a milled part with the same detail as the design? The limitation exists in the diameter of your smallest tool or the parameters in your milling strategy that define the final depth of cut. Both of these elements are accounted for in the CAM software.

	What should labs look for in CAM software?

	JG: Above anything else, lab owners tend to gravitate toward a product that’s easy to use. And at FOLLOW-ME! we understand this, which is why the user interface in hyperDENT V8, released earlier this year, was simplified. However, it also needs to be efficient. Not only do calculation times need to be fast, but the toolpaths that are generated must be efficient for the machines to produce parts in an acceptable timeframe while maintaining quality standards.

	Another required feature of CAM software is its ability to expand and adapt to the changing needs of a lab or milling center. Labs should not assume their initial machine and CAM purchase will handle all their milling needs down the road. However, if the CAM software is modular and can integrate new materials or applications easily, the machine can also adopt these new demands without a significant change in hardware or machine features. For this reason, hyperDENT Compact was developed as our base product with a high cost/performance ratio for labs that want to mill simple crown and bridge applications. Then, when their needs grow and new machines or functionality is needed, we can upgrade them to hyperDENT Classic or add the Denture Module, Abutment Creator, Grinding Module or Template Creator.

	How has CAM technology advanced in recent years?

	JG: In some cases, CAM development is a reactive process-driven by a new CAD software functionality. We add new features to our existing platform as the market requires. This was the case when angled screw channels became available from CAD developers. However, FOLLOW-ME! differentiates itself by proactively pursuing trends in the market as well. In these cases, we provide a certain functionality before the need exists, and our software can be used as a tool to develop the rest of the CAD/CAM process.

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	For example, we created a denture-specific module because we identified a significant interest in the milling of digital dentures. At that time, there wasn’t a complete process or workflow for these types of parts. However, as CAD developers began to include the option to design dentures with their software, hyperDENT users already had the ability to create optimized templates for milling these parts. This allowed users to calculate dentures four-to-six times faster and mill them in half the time or less. If we hadn’t created the denture-specific toolpaths to mill these parts before the need arose, our customers would be limited by these longer calculation and milling times like other CAM software is subjected to.

	What do you see in the future of CAM technology?

	JG: CAM technology will continue to evolve with the growing demands of our industry. This will include development on both ends of the spectrum, from an easy-to-use CAM solution that can be operated from the simplicity of a touch screen monitor, to hybrid solutions that work in conjunction with other digital technologies like printing.  
	We have a new version of hyperDENT PracticeLab that completes the whole CAM process in four clicks or less. There’s a lot of background intelligence built into the program to ensure this process remains as simple for the end user as possible. It’s already built into some new milling machines on the market, and is run from the touch monitor on the unit itself. It’s a true plug-and-play system, but uses our standard hyperDENT technology for performance and stability.  

	We have also developed a hyperDENT Hybrid module that caters to high production milling centers. It includes nesting technology for laser sintering of titanium and chrome cobalt bars, which are then transferred to a milling machine for the finishing of implant interfaces and screw channels. It uses the efficiency of printing and the accuracy and finish of milling in one module.

Jordan Greenberg of hyperDENT explains how CAM software has come into its own. 

What CAM software really does

Dr. Will Jones Began using Denstply Sirona Restorative’s Prime&Bond Elect at his practice in Brentwood, Tennessee, about 1½ years ago. He first tried the universal dental adhesive because he liked the fact that he could use it to selective etch or to completely etch the tooth, and that it came from a trusted company he’s enjoyed working with in the past.

Now, he uses the adhesive every day for a variety of restorations-and continues to achieve what he describes as extremely good results.

How did you first hear about Prime&Bond Elect universal dental adhesive?

Through my rep. I tried it and it seemed to work really well. Once I brought patients back and checked their fillings six months and a year later, I realized 

 was working better than our other bonding agent.  

What do you like most about Prime&Bond Elect?

The handling capabilities are fantastic. I’ve had great success with minimal microleakage, and post-op sensitivity from bonded crowns and direct restorations has minimized significantly since I began using Prime&Bond Elect. I use it for all of my direct and indirect restorations, which includes fillings, crowns, inlays and onlays. I basically use this adhesive on anything that’s bonded. It’s great because you don’t have to worry as much about microleakage and post-op sensitivity, leading to better results for the patient. I really enjoy working with this product and don’t plan on changing.

Trending article: Why better adhesion means happier patients

How does Prime&Bond Elect compare to other adhesives you’ve used in the past?

The old generation bonding agents were multiple bottle, so you had to mix them. There was also an issue when companies tried to add an etching component. It just didn’t work out very well. With Prime&Bond Elect, you can do either-or. We etch the tooth, but you can opt to not etch the tooth and it works just as well. I like that the adhesive gives you versatility. You can do whatever you want and you can use the same bottle, which keeps inventory low.

You don’t need to have multiple bottles for different procedures anymore. You can use Prime&Bond Elect for everything and achieve great results.

I just find they make quality products. I’ve always really enjoyed working with their rep and all of their products. They don’t take shortcuts. They’re focused on changing the way dentistry is done and making it easier for both clinicians and their patients.

How does Prime&Bond Elect benefit the patient?

The patients who have had fillings before notice they don’t experience as much post-op sensitivity, which they appreciate. They also notice the taste. Prime&Bond Elect has a much more pleasant flavor than some of the other bonding agents we’ve used. Patients no longer complain about the gross, chemical taste. That’s a huge patient benefit.

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It definitely saves me time. Not having to mix multiple bottles together and not having to buy multiple bottles for different procedures is a huge time saver. Plus, Prime&Bond Elect has a shorter working time than other systems.

Why would you encourage other dentists to use Prime&Bond Elect?

If they’ve had any clinical issues with post-op sensitivity or microleakage, or if they’re sick of having multiple systems in their office for multiple procedures, they should try Prime&Bond Elect. This product offers dentists a fantastic way to simplify their inventory while also providing an excellent result for the patient.

One clinician’s take on Dentsply Sirona Restorative’s Prime&Bond Elect.

How Prime&Bond Elect helps one practitioner simplify restorations

	Dr. Jason Olitsky, CEO of Smile Stylist, has used Ivoclar Vivadent’s Tetric Evo Line of products for years.

	He started with Tetric EvoCeram and Tetric EvoFlow, and though he was happy with those materials, decided to try 

 Bulk Fill once they were available. He liked the idea of the simplified technique the bulk fill materials offered and that he could easily incorporate them into his armamentarium.

	The bulk fill materials soon became his go-to options for posterior restorations. Here, he tells us why.

	What Dr. Jason Olitsky says about Tetric EvoCeram Bulk Fill and Tetric EvoFlow Bulk Fill

	I used Tetric EvoFlow with Tetric EvoCeram Bulk Fill before Tetric EvoFlow Bulk Fill was available because I like to use a flowable liner under complete restorations. Then 

 introduced Tetric EvoFlow Bulk Fill, which I love. Now, I use the two bulk fill products together in two increments. I can fill a 4 mm depth of cure with Tetric EvoFlow Bulk Fill and 4 mm with Tetric EvoCeram Bulk Fill. With 8 mm, I can fill just about anything in two layers.

	Some clinicians subscribe to a flowable liner as part of their posterior restorations and some go right to the restorative. You could choose to use only the Tetric EvoCeram Bulk Fill as a single restorative material or use it as a finishing layer. I subscribe to the flowable liner, but I’ve always used it sparingly because I was worried about shrinkage stress on the teeth. With Tetric EvoFlow Bulk Fill, I can place a layer up to 4 mm thick and have a void-free restoration on the X-ray. It’s also self-adapting and flows against the proximal bands and walls of the cavity preparation’s sealing margins.  

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	These materials offer many benefits for our patients. A lot of other posterior bulk fill restoratives finish gray or dark, which isn’t esthetic. Tetric EvoFlow Bulk Fill features Aessencio technology, or the ability to increase opacity post light polymerization. The initial enamel-like translucency allows deeper penetration of light during polymerization and hence high depth of cure, but at final cure it’s the same opacity as dentin. So when you place the liner, you’re replacing the dentin layer of the tooth. Then when you put the enamel layer on top with Tetric EvoCeram Bulk Fill, you get a more esthetic result.

	Patients are usually happy if the restoration isn’t grey or brown and is close to their natural tooth color. With Tetric EvoCeram Bulk Fill, you can select from three universal shades and get really close to the patient’s natural dentition. The material has a chameleon-like effect with nice blending at the margins. Patients can’t see the fillings, which makes them happy.  

	Timing is another benefit. Using any type of bulk fill takes less chair-side time. I’d say it saves me several minutes per restoration. It also minimizes sensitivity for the patient. Using the right bulk fill material enables us to decrease shrinkage stress.

	Patients also get more predictable results. In dentistry, one of the things we want as providers is predictability. We want to know the restoration will look good and that the patient will feel good. Bulk fill products give you that predictability.

	Tetric EvoCeram Bulk Fill is easy to shape and polish and offers plenty of working time under ambient light. You have extra time to shape and sculpt the composite before the final cure.

	We do a lot of Class II fillings. That’s the bread and butter of dentistry. When we walk into the room to look at radiographs at the six-month recall, we want to give ourselves a pat on the back for providing our patients with the best work possible. These two materials, when we use them together, give us void-free restorations and nice margins. It makes you feel good as a dentist.

One dentist on the benefits of using these products together.

I Use That: Tetric EvoCeram Bulk Fill and Tetric EvoFlow Bulk Fill from Ivoclar Vivadent

	Dr. AJ Sekhon opened a startup practice earlier this year, and from the beginning he was pretty confident he’d install A-dec cabinetry in his new office.

	He’d used A-dec equipment in the past and had experienced first-hand the quality the company provides. And when he saw the new A-dec InspireTM dental furniture line for the first time during a tour at the company’s headquarters, he knew without a doubt it was the perfect choice. Here’s why:

	What first attracted you to the A-dec Inspire line?

	It’s really modernized and it’s more efficient than any other cabinetry I’ve seen. And the esthetics are amazing. Everyone compliments me and my team on how great the cabinets look. But they’re also functional. There are different ways you can modify the cabinets. Everything is modular, so you can change things and technicians can fix things without much hassle, and that really appealed to me. It’s easy to operate and efficient, and if anything goes wrong it’s easy to fix.

	How do the cabinets make you more efficient?

	My system is 12 o’clock so everything is right there at the touch of a button. We have the digital touchscreen control panel in the back, which makes functionality smooth. We can push buttons on the presets to get everything into position the way we want it. We have a timer for impression material and all the cords and wires tuck away. Everything is standalone, which I think is pretty sleek.

More from the author: I Use That: Oraqix gel 

	I’ve worked at other practices and installed custom cabinets from a sub-contractor at my other office, so I’m used to all different types of dental equipment and cabinetry. None of it has the same functionality as Inspire, like cleaning lines or having a certain light switch or a tray that moves a certain way. Even being able to pull out the side compartments is great. We don’t have to get up and move around the patient; everything is right there within reach. You can customize the cabinets the way you want to use them and in the end that makes you more efficient.

	When I planned my office, I didn’t want anything attached to the chair. So when patients sit down, they don’t feel constrained by the dental chair or overwhelmed with all the dental equipment around them. They never see me or a team member in front of them changing water or anything else. Everything is behind them. After the procedure, patients are impressed. They feel more open, and the cabinetry helps us do that. That’s what I appreciate about it.
	Every day I find something new and cool that I didn’t even know was a function of the package. The attention to detail is very sound. A-dec really did their homework and it paid off.

	The cabinet utilizes swing-out shelves with arms to position things like an endo motor or an implant motor. The endo motor is attached to the arm. I can bring it out or tuck it into the cabinet, leaving it out of sight, and everything is still connected. In other practices I’ve worked at, the endo motor would be in a cumbersome position in the sense that you have the motor on the side or the cord draped on your legs. In this case, the arms and little features make everything clean, well contained and easy to access. I can feed wire through the back of the cabinet, attach and plug it in so it looks like part of the cabinetry. I can plug things in, like my camera battery pack, to the USB port and leave them there to charge. And everything is customizable so you can modify after the fact.

	Why would you encourage other dentists to invest in the Inspire line?

	You can modify the cabinets and keep the esthetics, and the cabinets are beautiful. The cabinets have that “wow” factor and when patients see them, they know you’re investing in their experience at the dental office. They can feel the quality and they appreciate that.

One dentist’s take on the A-dec Inspire cabinetry line. 

Double take: "...it’s more efficient than any other cabinetry I’ve seen."

	Chances are, your patients don’t think much about oral rinses and the many benefits they provide. Sure, they might swish with their go-to rinse for a few seconds after they brush, but if they’re not using the right rinse for their oral condition for the proper amount of time, it isn’t doing them much good. 

	While popular over-the-counter options might be enough for some of your patients, others need rinses that address specific health conditions such as rampant caries and dry mouth. That’s where you come in. Asking the right questions and assessing your patients’ health will help you determine the best rinse to recommend, and educating them about why they need that rinse will make them much more likely to comply.

	“It’s all based on the patient’s needs,” says Tina Clarke, RDH. “Look at health history, do a risk assessment and talk with patients to find out what they’re experiencing. Find out what their issues are and talk to them about why they’re having those issues, whether it’s because of medication they’re taking, their diet, their genetic makeup or a systemic disease. Then, let them know there’s a rinse that can help them relieve that issue.”

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	Of course, it’s important to make sure patients understand that rinses, while they offer many benefits including plaque reduction and fresher breath, aren’t all they need to keep their mouth healthy. Oral rinses are part of a wellness package kit that also includes brushing, flossing/interdental brushing and chewing gum, notes

. When they understand the role these products play and the importance of including the right rinse in their home care routine, your patients’ oral health will start to improve.  

	Oral rinses aren’t one size fits all, Turchetta says. They come in many varieties and offer different benefits, which is important for everyone on the dental team to understand. To determine the best rinse for patients, address their current state of oral health. Understand what the ultimate goal is and how the rinse will help them get there. Think about their caries risk, find out if they’re dealing with hyper sensitivity, ask if halitosis is a concern, determine their risk for gum disease and ask them what medications they’re taking.

	Once you determine the rinse that’s best for their condition, educate patients on the benefits they can expect when they use that rinse. Sarah Thiel, RDH, CEO and co-founder of CE Zoom, likes to recommend a general rinse and tells patients about its ability to kill the bacteria that causes plaque buildup. There are also fluoride rinses, both over-the-counter and prescription, for patients who are cavity prone, have a lot of decay or have an acidic diet.

	When treating patients with periodontal disease, Thiel often reaches for an antiseptic oral rinse, which, when used in conjunction with scaling and root planing, helps kill bad bacteria.

	There are also antimicrobial rinses that fight infection and reduce inflammation, Clarke notes. These come in over-the-counter options and prescription versions such as chlorhexidine gluconate. They also work well as pre-procedural mouth rinses to reduce patient bacterial load and infectious aerosol particles in the dental operatory.

	Finally, there are rinses for patients experiencing dry mouth caused by health conditions or medications they’re taking. Ethel Hagans, RDH, recommends this type of rinse to some of her patients. There are many options out there, Clarke says, and all of them work to relieve the symptoms of dry mouth and prevent the problems the condition causes, including decay.

	“I need to get the patient fit, so it’s like I’m the coach at the gym,” Turchetta notes about choosing the right rinse for her patients. “They want to get from point A to point B. I need to get them into an oral fitness regimen with the right kit. They might want to use a whitening mouth wash as an adjunct, and that’s great, but I might tell them they need to use chlorhexidine gluconate first and here’s why.”

	Finding the right rinse for your patients goes beyond determining their condition and what might work best; it’s also important to find a rinse patients will actually use, Turchetta says. If a rinse doesn’t taste good or contains ingredients patients are leery of, such as alcohol, they’re not going to use that rinse once they get home. Know the ingredients in the rinses you routinely recommend and be prepared to answer common patient questions, such as how long do I need to use the rinse, how long should I swish with the rinse, how long should I wait to eat after using the rinse, what flavors does it come in and does it contain fluoride.

	“Look at it from their world, not our world,” Turchetta says. “Think about the benefits for the patient. They want to know if it’s it easy to use, is it going to taste good, can they use it even if they don’t have dexterity and what it’s going to help them with. It’s a different story from what we think is the benefit and what our patients will see as the benefit.”

	At the end of every appointment, Thiel spends about 15 minutes educating patients about what she found during the exam. She talks about the benefits of rinses during this time, but also makes sure patients understand rinsing alone simply isn’t enough.

	“After you brush and floss, there’s still bacteria floating around in the mouth. The oral rinse kills it,” Thiel observes. “A lot of people don’t understand how many bugs live in their mouth. If they did, they would want to rinse every day to clear that out. I make sure patients understand that and then I talk with them about different types of mouth rinse based on their situation.”

More from the author: A review of the Bein-Air Tornado Handpiece

	Hygienists should be the ones educating patients about oral rinses, Turchetta says, not pharmacists, which seems to be happening more and more. Talk to patients about their oral fitness and encourage other team members to do the same. When you get everyone on the team involved, patients will have much better results.  

	“I’m big on co-diagnosis and knowing what products are recommended in your office,” Turchetta says. “For example, many hygienists don’t see a lot of implant cases until they’re done. I prefer to sit down with the assistant and say ‘Hey, this patient has active gum disease and this is what I would use to control it. If you could relay that message we’ll have better success with the implant.’”

	It’s also a good idea to give out free samples if you can, Hagans says, especially when you’re recommending over-the-counter rinses. Patients can feel overwhelmed by all the options in the mouth rinse aisle and might forget which one you recommended. If you give patients a sample to take home, they’ll have a chance to use the rinse before they buy it, and can even bring it with them when they go shopping.

	With the right education, Hagans notes most patients are open to using rinse to improve their oral health. And if the hygienist is excited about the product and the benefits it provides, patients are more likely to follow through.

	“If patients know what the problem is and why the problem exists, I have found nine times out of 10 they want to address it,” Clarke says. “But if you tell them to use something and they don’t understand why you’re recommending it, your patient acceptance rate goes way down.”

	When patients add the right oral rinse to their home care regime, you’ll notice the difference during their next exam, Clarke says. During that visit, be sure to talk with patients about their progress and how the rinse is working for them. Point out the positive results and encourage them to continue the good habits they’ve developed. Reinforce why rinsing matters and continue to deliver that message during every appointment.

	“You want to have a good conversation with your patients. They need to use the rinse regularly for it to make a difference, so follow-up is important,” Clarke notes. “And these rinses really do help. I’ve seen a huge difference in gum tissue after patients have started using an antimicrobial rinse. It’s not a cure-all, but it’s an adjunctive therapy that assists in reducing gingival inflammation. Rinses are a really nice way to help patients get their mouth back to healthy.”

Hygienists weigh in on rinse use-and what you should tell your patients. 


Does oral rinse REALLY matter?

	When the team at VITA first began developing ENAMIC CAD/CAM blocks, they set out to create the most tooth-like material possible.

	They wanted to provide dentists and their patients with a material that mimics natural dentition-in both strength, elasticity and esthetics. That was no easy task, but after more than a decade of research and development, ENAMIC

 was finally ready for prime time in 2013.

	The product was so successful that VITA released another option a few years later in 2016: ENAMIC IS (Implant Solutions). This was a natural extension of the product line, giving CAD/CAM dentists the ability to provide their patients with a material that replicates natural tooth characteristics and is both force absorbing and beautiful in just a few hours, said Jim McGuire, CDT, and director of education and technical support for VITA North America.

Related reading: I Use That: Zirc Crystal HD Mouth Mirrors 

	Dr. Daniel Butterman of Colorado has been using ENAMIC IS since it was first launched, and said it offers more resiliency than other products on the market-which is key to successful implant dentistry.

	“I’ve been placing implants for 18 years, so I’ve seen the evolution of the materials,” Dr. Butterman says. “You used to see fractures and failures because a screw would get loose or too much force would cause the porcelain on a PFM crown to fracture. So we made the screws more rigid and started turning to stronger materials like zirconia. The problem is when people bite too hard the force has to go somewhere. Because the materials are so strong now, more force is placed on the bone, and that could lead to bone loss and failure. The ideal material is more resilient and takes on some of that force to protect the bone.”

	VITA ENAMIC and now VITA ENAMIC IS provide doctors and patients with the tooth-inspired, durable restorative options they’re after. Here’s a closer look at the material and why you might want to consider incorporating it into your practice.

	ENAMIC is comprised of a structured ceramic matrix that combines the positive characteristics of a ceramic with the resiliency of a polymer, McGuire says, making it look and act more like a natural tooth. The ceramic structure gives the material the stiffness, wear resistance and load bearing properties it needs, while the polymer provides force distribution for heavy loads in both posterior and anterior natural tooth or implant supported indications. The dual-network structure also allows for a less invasive technique and can be milled out as thin as 1 mm for posteriors.

	The team at VITA was the first to develop this type of matrix structure, which presented some challenges. They had to achieve a matrix that allowed the polymer to be introduced and interconnected with the ceramic, create a homogenous material, and then determine a way to predictably reproduce the matrix and the ENAMIC material in a production facility.

	What they came up with is a material that’s about 86 percent ceramic and 14 percent polymer, making it the only truly structured ceramic with polymer on the market, McGuire says. He describes the creation as similar to a DNA strand, with polymer interwoven between the ceramic scaffolding.

	“The ceramic reinforces the polymer and the polymer absorbs the energy from patients chewing before it overloads the ceramic structure,” McGuire says. “Plastic deformation occurs, helping to prevent catastrophic failure that is often observed in traditional glass-ceramic restorations.”

	ENAMIC’s resiliency, or force absorbing properties, makes it an ideal solution for implants, which is why VITA created the IS version. The IS block features a pre-drilled hole so it easily connects to the implant’s abutment adapter base, McGuire said. Clinicians can use ENAMIC IS as a single screw-retained restoration or to fabricate a custom implant abutment with more traditional cement-retained restorative material to be bonded to the ENAMIC abutment.

	“There’s no built-in resiliency with implants because they’re static,” McGuire says. “ENAMIC is uniquely suited to be an implant material because of its resiliency, force distribution, load bearing capability and toughness.”
	ENAMIC is an especially attractive option when clinicians feel there is more potential for an implant to become overloaded, Dr. Butterman said. This might be the case when a patient has a strong bite or is a heavy bruxer. The material absorbs the force in these situations, protecting the implant and the bone surrounding it.

	ENAMIC IS gives clinicians the ability to deliver a high-quality implant restoration in a single appointment, which is another quality that attracted Dr. Butterman to the material. Before, patients would come in for impressions and then have to return a week later when the crown was ready. Now, because ENAMIC mills so quickly, he can use his CAD/CAM system the way he always intended: to provide patients with same-day dentistry.

	“For the dentist, it’s easy to say I want to see the patient for a 15- to 20-minute appointment for imaging, but it’s very different for the patient,” Dr. Butterman says. “For that short appointment, our patients might have to take off an entire day of work or hire a babysitter. There are so many issues that come into play that make this easy appointment very difficult for our patients. If we can eliminate that extra step and take one appointment away so they don’t have to use vacation time, patients are thrilled with that. Nobody wants to wait, and nobody needs to wait anymore because the workflow has improved so much.”

	Using materials like ENAMIC IS in the digital workflow also gives clinicians more control over how much pressure is put on the tissue and how deep the margins are, Dr. Butterman says. One problem dentists and patients have dealt with in the past is excess cement. The margins in these restorations are often deep and difficult to see, and that makes it common for harmful cement to be left behind. The fact that Dr. Butterman can control the process digitally and see the margins better makes cement cleanup much easier.

Trending article: Roland's latest mills certified to work with three VITA materials 

	“The total control that we have over every aspect of it really makes for a much better restoration,” Dr. Butterman says. “And we’re much less likely to cause damage to the implant because extra cement was left behind.”
	The material is also easy to adjust if contacts are too tight, Dr. Butterman says. That isn’t the case with other materials; he has to start over if his contacts are off. Enamic has a resin component, so he can always add material if he needs to. It’s also possible to add any necessary color changes right in the patient’s mouth-even years later.

	Patients love ENAMIC IS because it feels and acts like a natural tooth, McGuire said. It can also be milled very thin, 1 mm within the occlusion and 0.3 mm facially for anterior veneers in support of less invasive tooth preparation that help reduce patient sensitivity and chair time.

	“It’s truly a tooth replacement material,” McGuire says. “Dentists like that when they mill the material the definition of the margins is dead on. It mills beautifully at very thin cross sections without losing its marginal integrity. The milling properties provide for very sharp and defined marginal edges in support of esthetic blending into the tooth structure. It’s easy to work with and because of its unique structure it mills very quickly.”

	And once it’s milled, unlike other machineable materials, there’s no post processing other than polishing, McGuire says. There’s no need to put the restoration in the furnace, enabling dentists to focus more on patient care. Though for best esthetic results, Dr. Butterman does recommend taking a few minutes to stain and glaze the restoration.
	Overall, ENAMIC  IS gives Dr. Butterman another option for implants, and one with the ability to absorb pressure to prevent bone loss. It also saves him time, usually 20 to 30 minutes per restoration.

	“Now we have a material that absorbs forces better. That makes me sleep better at night,” Dr. Butterman says. “And the fast processing time and the fact we can deliver the restoration in a single appointment makes my patients sleep better. It’s another material in the tool belt that adds some nice advantages that weren’t there before. The resiliency and processing time are the two big ones for me.”

How ENAMIC IS is being utilized by CAD/CAM dentists to replicate natural tooth characteristics.

I Use That: VITA ENAMIC IS

	After nearly 35 years as a dentist, Dr. Gary Nelson has had the opportunity to try out a variety of different handpieces-but nothing as impressive as the Tornado handpiece from Bien-Air.

	Here’s why he loves this air-driven handpiece, and the benefits it’s brought to his practice. 

Why did you decide to try the Tornado handpiece? 

	The salesman stopped by the practice and gave me the opportunity to try it for a week with no expectations to purchase. If I didn’t like it, I could just send it back. I knew the handpiece was high-quality and made with Swiss engineering, so I said why not? After trying it, I thought wow, this is the best handpiece I’ve ever used in my 34 years of working as a dentist. This handpiece is really a step above.

Related reading: An inside look at the Tornado handpiece from Bein-Air Dental

What do you like most about the Tornado? 

	First, the intensity of the light enables me to see every detail in the tooth. The smoothness of the cutting, the torque, the precision and the lack of vibration is better than anything I’ve ever seen. It also has a sleek look and an ergonomic design that’s as comfortable as any handpiece I’ve ever used.

What are the main benefits for your practice?

	Anything that’s as smooth as this handpiece is when preparing teeth for a restoration is going to save time, and it’s going to be less physically draining on the dentist. It’s a very powerful handpiece that quickly removes tooth structure, which means there’s less pressure needed on my side to prep teeth. It reduces my fatigue at the end of the day because it’s so smooth and easy to handle.

	The noise level is less than my other handpieces. My patients don’t ever comment about this handpiece being irritating to their ears while I’m working on them.  

Related reading: Applying Bien-Air's Tornado handpiece in your practice

	If I can see better than I’ve ever been able to see before because of the quality of the light, then my patients are going to get a better restoration. And they won’t be in the chair as long because the procedure will be accomplished more quickly. 

	I also think the smoothness and power of the handpiece decreases irritation in the nerve, making the experience more pleasant for patients. They seem to feel less sensitivity because the handpiece preps so precisely and so accurately.

Why would you encourage other dentists to try the Tornado handpiece?

	It allows dentists to do better restorative density and patients appreciate us using the best technology available. I’ve been in dentistry 34 years and I’ve tried an awful lot of handpieces. I would say this air-driven handpiece comes the closest to having the power and torque of an electric than anything I’ve ever used before. 

One practitioner describes his experience with the handpiece.

A review of the Bein-Air Tornado Handpiece

	When Dr. Scott Barbee finds a high-quality, well-researched product he likes, the pediatric dentist doesn’t see the need to switch. That’s why he’s been using TPH Spectra universal composite from Dentsply Sirona in his Kentucky-based practice for the last several years.

	Here’s a look at the benefits this composite brings to both his patients and his practice.

	We had a Dentsply Sirona representative come to our office and present on TPH Spectra. After her demonstration, we took the time to review the research. We were impressed with the universal composite’s low shrinkage after curing and its optimal wear strength, so we decided to try it out for ourselves. Once we tried TPH Spectra, we fell in love with its ease of use and its extremely easy finishing and polishing properties. The results we received were nothing short of fantastic, which made the switch to TPH Spectra a no-brainer.

	Being a pediatric dentist, I am only willing to purchase products that are easy to use and that have superior esthetics. TPH Spectra provides these properties both in the anterior and in the posterior. I am able to place TPH Spectra with ease and provide results that both parents and my patients love. Hearing patients say things like “I can’t tell where the filling is” speaks volumes to me and my team members.

Related article: 5 ways composite advances can change your workflow

	My staff members enjoy working with TPH Spectra as well. The universal composite doesn’t stick to their instruments and they are able to finish their work with a smoothness that patients like. I, as well as the hygienist, notice the composite’s durability in the mouth.  

	TPH Spectra is a durable product. This is noted in the mouth and on X-rays throughout the life of the restorations we place at Barbee Dental. We have seen restorations months and even years later that look as dense and void-free as the day we placed them. Just yesterday I saw a patient who I treated years ago. Back then, I used TPH Spectra on an anterior tooth that was damaged after an injury. The patient was back in my office to have the tooth fixed, but only because he was hit in the mouth again. That was the only reason. This shows the durability is pretty good. I’ll definitely use TPH Spectra again for this case.

	The results TPH Spectra has given us over the years has made me and my team believers in this product. We know it works, we know it lasts and we know we will continue to purchase TPH Spectra. We follow the research and make sure the products we use work well. Once I find something that works, I’m not switching. For me to switch, you have to prove a product is superior to what I’m using, and right now I haven’t found anything that’s better in my hands. At Barbee Dental, we strive to do quality work with superior products and we have found that in TPH Spectra.

One dentist on the benefits this universal composite has brought to his practice.