Shannon Pace Brinker, CDA, CDD

	Chairside dental assistants play essential roles in dental practices and often spend quality time with patients to educate them about dental procedures and proper oral health home care. In this capacity, the nature of the chairside assistant’s interaction with patients provides ideal opportunities for these dental professionals to introduce new treatments and services that the practice offers that could be of interest and benefit to them. Chairside dental assistants are also well positioned to recommend home oral health products that patients could purchase directly from the practice to enhance their home care efforts.

These patient education discussions and home care recommendations are based on the patient’s individual oral health needs and the specific dental problems with which they present. These may include high caries risk, tooth sensitivity and/or enamel wear and erosion, among other conditions.

	Caries is a far-reaching oral health problem that affects individuals of all ages. Caries result from the infiltration of harmful bacteria in the mouth, particularly around natural teeth and around and under restorations.

 Specifically implicated in the caries process are 

 To reduce plaque and harmful bacteria levels in the mouth as well as to prevent, reduce, and/or eliminate the risk factors for developing caries, the use of fluoride toothpastes and varnishes, along with calcium, phosphate and fluoride for tooth remineralization, have been advocated.

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	Tooth (i.e., dentin) sensitivity can be a complex problem that has been attributed to multiple factors. Generally defined as an exaggerated chronic irritation and sharp pain of an individual’s tooth or teeth in response to eating certain foods and/or drinking certain beverages (e.g., cold, hot, acidic), tooth sensitivity may result from the permeability and fluid movement in open and exposed dentinal tubules.

 Stimuli that cause a change in dentin fluid flow stimulate intra-dental nerve fibers through a mechanoreceptor response, leading to pain.

 Gingival recession is considered a leading cause of exposed dentin and a predisposing factor for tooth sensitivity.

The use of dentifrices containing potassium nitrate have been shown successful in reducing patients’ tooth sensitivity,

 and immediate and long-lasting relief of tooth sensitivity has been achieved by occluding, sealing and plugging open dentin tubules.

	Tooth and enamel wear naturally occurs as part of the aging process, and loss of tooth structure and enamel can affect a patient in several ways. The effects of tooth and enamel wear include changes in a tooth’s shape, surface and color, occlusal discrepancies and tooth sensitivity.

 Categories of tooth wear are erosion (i.e., caused by dietary and/or digestive acids; characterized by slick, glossy lingual and buccal surfaces on the maxillary incisors, or as a halo effect on the palatal surfaces of exposed dentin); attrition (i.e., caused by natural chewing forces or pathological bruxing; characterized by worn occlusal surfaces); and abrasion (i.e., caused by contact between teeth and another object such as from brushing, chewing hard foods or objects).

 Depending on the extent of tooth and enamel wear, treatment may require direct or indirect restorations. However, tooth and enamel wear may be preventable with dietary modifications, protective nightguard use, application and use of fluoride, and the use of casein phosphopeptide (CPP).

	A new, easier, at-home approach to prevention and treatment

	To help patients prevent, repair and/or manage these oftentimes interrelated dental problems at home, chairside dental assistants can recommend a recently introduced dentifrice (MI Paste

 ONE, GC America Inc.) that combines the caries prevention of sodium fluoride (i.e., 1,100 ppm), the sensitivity relief of potassium nitrate and the enamel remineralization of 10% Recaldent™ (CPP-ACP) in one toothpaste. MI Paste ONE is a toothpaste designed to replace patients’ current products, providing the same preventative and reparative capabilities as MI Paste Plus

, but in a single application. As part of the MI Paste

 family of products, MI Paste ONE is a safe, natural and effective way for dental assistants to help patients strengthen their teeth, protect their enamel, experience near-instant sensitivity relief, and remineralize tooth structure for a better-looking smile.

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	Now, rather than brushing their teeth first and then applying MI Paste

 or MI Paste Plus, patients simply brush with MI Paste ONE. Each time patients brush for two minutes with the cool mint-flavored MI Paste ONE, they’ll be effectively cleaning their teeth without harsh abrasives or sodium lauryl sulphate. They’ll also simultaneously be applying the ideal combination of bio-available calcium, phosphate and fluoride to help protect and repair tooth structure - the same levels contained in MI Paste Plus - all in one easy step.

 ONE’s multiple benefits are its naturally derived milk protein, casein phosphopeptide (CPP), and amorphous calcium phosphate (ACP), both of which deliver bio-available minerals and neutralize acid challenges. CPP-ACP promotes remineralization while simultaneously inhibiting demineralization when it contacts, combines with and stabilizes fluoride, creating the ideal source of ions for building fluorapatite - a key component of natural tooth structure.

 MI Paste ONE delivers a combination of CPP-ACP and fluoride directly to the teeth, including tooth lesions. Pastes and toothpastes containing a combination of CPP-ACP and fluoride have been shown effective in remineralizing enamel lesions, including white spot lesions.

	Additionally, because the CPP-ACP in MI Past ONE neutralizes acid in the oral environment caused by bacteria, it thereby helps to buffer at-risk teeth from acid assaults and prevent cavities. In fact, research has shown that the combination of fluoride and CPP-ACP is effective in significantly reducing the damage to teeth caused by acid attacks, particularly in the case of permanent teeth.

 CPP-ACP also penetrates into biofilms and enamel and binds to tooth surfaces to localize bio-available minerals like fluoride, making MI Paste ONE ideal for use by patients suffering from hypersensitivity, caries risk, white spot lesions, sensitivity from whitening, dry mouth syndrome, and tooth erosion and wear.

	MI Paste ONE is easy to use since its two-in-one application (e.g., fluoride toothpaste, CPP-ACP) is achieved with tooth brushing. In fact, patients brush twice a day with a pea-sized amount of MI Paste ONE instead of regular toothpaste for two minutes, expectorate and do not rinse. They should refrain from eating for 30 minutes. The cool, refreshing mint flavor is also favorable for patients.

	MI Paste ONE demonstrates a consistency similar to regular toothpaste and spreads well in the mouth during brushing. Its excellent and mild foaming characteristics help to reduce discomfort after brushing, even without rinsing. Because MI Paste ONE is designed to be gentle to teeth, it does not contain harsh abrasives or sodium lauryl sulphate. However, its foaming action and fine abrasive particles (Relative Dentin Abrasivity [RDA] of 64) achieve higher cleaning efficacy than competitive products.

Read more: GC America to fund research on dental materials for aging populations

	For patients prone to sensitivity, high caries risk, and enamel wear and erosion, MI Paste ONE is a two-in-one product that could replace their current toothpaste for daily brushing. Based on its efficacy for recommended at-home tooth cleaning, combined with its potent anti-cavity, desensitizing and remineralization effects, chairside dental assistants can feel confident recommending MI Paste ONE to patients in their practice as an ideal alternative to their regular toothpaste to help improve their oral health. What’s more, making MI Paste ONE readily available for purchase in your practice helps promote its use for proper oral health care by eliminating the need for them to travel elsewhere for it.

	1. Zero DT, Fontana M, Martínez-Mier EA, Ferreira-Zandoná A, Ando M, González-Cabezas C, Bayne S. The biology, prevention, diagnosis and treatment of dental caries: scientific advances in the United States. 

	2. Medjedovic E, Medjedovic S, Deljo D, Sukalo A. Impact of fluoride on dental health quality. 

	3. Reynolds EC. Anticariogenic complexes of amorphous calcium phosphate stabilized by casein phosphopeptides: a review. 

	4. Cartwright RB. Dentinal hypersensitivity: a narrative review. 

	6. Cummins D. Dentin hypersensitivity: from diagnosis to a breakthrough therapy for everyday sensitivity relief. 

	7. Ajcharanukul O, Kraivaphan P, Wanachantararak S, et al. Effects of potassium ions on dentine sensitivity in man. 

	8. Haywood VB, Cordero R, Wright K, et al. Brushing with a potassium nitrate dentifrice to reduce bleaching sensitivity. 

	9. Bartlett, DW. The role of erosion in tooth wear; aetiology, prevention and management. 

	10. Lussi A, Hellwig E, Zero D, Jaeggi T. Erosive tooth wear: diagnosis, risk factors and prevention. 

	11. Barbour ME, Rees GD. The role of erosion, abrasion and attrition in tooth wear. 

	12. Jo SY, Chong HJ, Lee EH, et al. Effects of various toothpastes on remineralization of white spot lesions. 

	13. Robertson MA, Kau CH, English JD, et al. MI Paste Plus to prevent demineralization in orthodontic patients: a prospective randomized controlled trial. 

	14. Mielczarek A, Gedrange T, Michalik J. An in vitro evaluation of the effect of fluoride products on white spot lesion remineralization. 

	15. Zawaideh FI, Owais AI, Mushtaha S. Effect of CPP-ACP or a Potassium Nitrate Sodium Fluoride Dentifrice on Enamel Erosion Prevention. 

Articles

MI Paste ONE is a gentle, two-in-one product designed to prevent caries and rebuild tooth enamel. 


How to improve patients’ oral health in one step

	Appropriate infection control procedures must be performed to ensure patient and team safety. Following the Centers for Disease Control and Prevention guidelines for infection control can prevent or reduce the risk of disease transmission to patients and DHCP. The Organization for Safety, Asepsis and Prevention (OSAP) recommends classifying clinical surfaces into three categories: touch surfaces, such as chair switches, dental instruments, equipment controls and handles, dental materials, drawer handles, containers, computers, pens, and telephones; transfer surfaces, including surfaces touched by contaminated instruments and handpiece holders and instrument trays; and splash, spatter and droplet surfaces, which are primarily countertops. 

	Spray disinfectants and pre-moistened disinfectant wipes are available for surface cleaning and both are equally effective as a broad-spectrum disinfectant specifically designed for use in dental facilities. The first spray pre-cleans to remove surface residue and reduce contaminants, allowing the second spray to effectively disinfect. Following the preliminary cleaning step, an adequate amount of disinfectant should be applied so the surface remains wet for the manufacturer’s required contact time. Always read the product label and follow its instructions for use.

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	When using disinfectant wipes, use one wipe to pre-clean the surface thoroughly, then discard. Use a second wipe to disinfect. This two-step process should be performed every time to prevent compromising. Depending on the microorganisms and other factors (e.g., humidity and temperature), pathogens can survive on surfaces for extended periods of time. Laboratory studies show that HBV remains viable on surfaces for at least one week at room temperature in dried blood, while Mycobacterium tuberculosis can survive for multiple weeks.

	Long recognized as a pioneer in infection control, 

 COEfect™ MinuteWipes and MinuteSpray provide reliable and consistent infection protection for discerning dental professionals.

	COEfect MinuteWipes can be used to effectively clean and disinfect dental operatories, sterilization bays and other potentially contaminated areas in less time compared to products with longer “kill rates” or outdated formulations.
	This one step, laboratory-tested surface disinfectant features an ethanol-base, low-toxicity and a non-fragrance. The larger 9 inch by 7 inch size and unique polyester nonwoven spunlace material combine to effectively spread the disinfectant solution and absorb excess bioburden, making it ideal for infection control protocol. COEfect MinuteSpray can also be used to clean and disinfect contaminated surfaces, instruments and equipment in dental operatories. With a one-minute “kill time” for 25 pathogens, the spray also features an ethanol base and low toxicity. When used in combination with COEfect MinuteWipes, or by itself, COEfect MinuteSpray is an effective component of dental practice infection control protocol.

	The CPS evaluation team, consisting of 10 practices, received four canisters of the COEfect MinuteWipes and MinuteSpray by GC America. Each dental assistant used the COEfect Minute Wipes & Minute Spray in more than 300 infection control procedures and were all first-time users. All assistant evaluators stated they use both wipes and sprays for disinfection. When asked what was most important to them in a surface disinfectant, all reported kill time and smell.

	The evaluation team commented that the COEfect MinuteWipes have heavy perforations in three areas. Connection for the wipes are at both ends and the middle, which helps to aid in the removal of one wipe at a time to cut down on wasted materials. This was effective in the reduced number of wipes used. When asked about the saturation, every team member commented the wipes contained enough moisture of material to clean all areas needed, but they always combined the wipes with the COEfect MinuteSpray. The biggest applaud from the evaluation team was the container. Having a lid that will not pop off when compressed allows the wipes to not dry out and be wasted. Seven of the evaluators commented they have found their new brand of wipes and would continue to order the product in their practices.

The CPS Evaluation Team awarded these infection control products a 4-diamond rating.

A review of COEfect MinuteWipes and MinuteSpray

	In the dental practice, personal protective equipment and clothing, including face masks, eyewear, gowns and jackets, are essential for not only preventing contamination of street clothing, but most importantly for protecting the skin against exposure to blood and bodily fluids. Personal protective equipment creates a barrier between dental professionals’ skin and the mucous membranes of their eyes, nose and mouth that effectively limits exposure to the pathogens and potential diseases that they encounter every day.

	Even though the use of dental dams and high-velocity air evacuation can minimize droplets, spatter and aerosols, dental professionals must still wear personal protective equipment as a barrier. Gowns, lab coats and/or jackets are also required during procedures when there is the possibility for splatter and spray of blood, saliva and other potentially infectious fluids and material.

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	Additionally, protective eyewear with solid side shields or a face shield should be worn during procedures that produce splashes or sprays of blood or bodily fluids in order to protect the mucous membranes of dental professionals’ eyes from contacting microorganisms. Patients can also benefit from protective eyewear, which can shield their eyes from the spatter created during various dental procedures.

 Floral Face Masks from EcoBee are 100 percent latex-free and provide ASTM Level 2 protection (i.e., >98% BFE and PFE @ 0.1 micron). Yet, the CoolSilk® lint-free and dye-free inner layer of the exclusive Quad-Fold Design provides 15 percent more breathing volume. Front-facing indicators ensure the BeeSure facemasks are worn correctly to achieve maximum performance and protection, while the proprietary RoundEdge™ corners and cushioned earloops ensure added comfort. With a fun and friendly hibiscus floral print, the BeeSure Floral Face Masks from EcoBee are available in boxes of 50, with eight boxes per case. They are available in five different colors with floral designs in plumeria, orchid, daisy, hibiscus and fern.

	Contemporary Product Solutions recently conducted an evaluation soliciting the opinions of 17 dental assistants for more than 400 uses, from various practices around the United States and Canada after using the BeeSure Floral Face Mask by EcoBee.

	Ninety-three percent of the CPS Evaluation Team said the fit of the BeeSure Floral Face Mask by EcoBee was excellent. The CPS Evaluation team appreciated the comfort and ability to place the facemask under the chin and over the nose due to the four folds in the face mask. Ninety-two percent commented that the BeeSure face mask had such a snug fit, they had little to no fogging of their safety glasses or loupes. Ninety-eight percent of the evaluators said they loved the silk feeling of the mask and enjoyed wearing it without the feeling their face was being scratched or irritated like some of the other face masks on the market. Ninety-nine percent of the evaluating dental assistants loved the colors and would like to order the BeeSure Face to match their lab coats. Several assistants commented that the facemask had great filtration and was easy to breathe through compared to the mask they were ordering for their practice. One assistant said they have a “green” practice and this was a perfect fit for the décor.






An evaluation of the BeeSure Floral Face Masks.

An evaluation of the BeeSure Floral Face Masks

	According to the Centers for Disease Control and Prevention (CDC), each day about 2,000 workers in the United States experience a job-related eye injury that requires medical treatment.

	About one-third of these injuries are treated in hospital emergency departments, and more than 100 of these injuries result in 

Occupational Safety and Health Administration (OSHA)

 states that in the United States each year, thousands of people are blinded from work-related eye injuries that could have been prevented with the proper selection and use of eye and face protection. Eye injuries in the United States alone cost more than $300 million per year in medical expenses, worker compensation and lost production time.

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	Data from the CDC indicates that the majority of these eye-related injuries result from small particles or objects striking or abrading the eye. Examples of small particles include metal slivers, dust, cement chips and wood chips that are ejected by tools, wind-blown or fall from above a worker. Larger objects may also come in contact with the eye or face, or a worker may run into an object, causing blunt force trauma to the eyeball or eye socket. Chemical and thermal burns to one or both of the eyes are also common.

	Dentistry is not immune to these eye-related injuries. In fact, dental staff members are prone to such eye injuries as particles abrading the eye, chemical and thermal burns, and ocular exposure as a result of inadequate eye protection. In both the health care sector and society as a whole, ocular health is becoming increasingly important because undetected and untreated ocular conditions and injuries can lead to vision loss and blindness.

	Conventionally, safety organizations such as Organization for Safety, Asepsis and Prevention (OSAP) and OSHA have judiciously focused on preventing the spread of infection, which has led to marginal education regarding the eye-related injury risks associated with dental practice.

	Both OSHA and OSAP have specific guidelines for eye protection to prevent the spread and infection of bloodborne pathogens and diseases, but neither organization has standards acknowledging the risk of eye injuries. Similarly, the CDC recommends the use of protective eyewear for dental and health care professionals to protect the mucous membranes of the eyes from contact with microorganisms, but not against 

. Further consideration is necessary to address eye injuries in dental practice and preventative measures to reduce the number of eye injury incidences.

 that are prone to experience ocular injuries and problems as they perform their daily dental work. A study completed by 

 found that eye problems were the third most frequently reported occupational health problem among dentists. In a 

 73 percent reported ocular incidences, with amalgam and sodium hypochlorite (NaOCl) as the most frequently associated foreign bodies involved in ocular accidents. Another 

. found that 43 percent of orthodontists in the United Kingdom reported instances of ocular injury in their practices, with the majority occurring during debonding or trimming acrylic.

	In addition to these generalists and specialists, dental laboratory procedures can result in 

 due to projectiles or exposure to harsh chemicals or heat. Patients can also be susceptible to eye injuries during dental procedures. 

found that while 84 percent of dental school restorative clinics in the United States had safety glasses available for patients, only 77 percent required usage during restorative procedures.

All dental professionals and patients are thus at risk for eye injuries due to the activities involved in dental treatments.

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	For example, any dental procedures involving high speed rotary instrumentation (180,000 rpm to 500,000 rpm) generate debris that can travel at 

 Without protective means, such debris, including amalgam, tooth enamel, calculus, pumice and broken dental burs, may find its way into the eyes of the dental practitioner, team member, laboratory technician or patient. If these small objects are projected and strike the orbit, injuries of varying severity can occur.

 can significantly increase the probability of injuring the eyes of the operator as the foreign body locates itself in the conjunctival sac or the cornea, causing lacrimation, reddening of the eyeball and acute pain.

More severely, if the debris deeply penetrates the eye, it may result in a perforation of the cornea and a consequent injury to the lens.

	Depending on the type of material, drilling, polishing and finishing can also lead to foreign particles entering the air and potentially the eye. Due to the complex nature of dental materials, these particles can lead to chemical burns in the eye as well.

	In addition to debris contacting the eye, 

 has also become an increasing concern in dentistry because of the use of ultraviolet and blue light to cure or polymerize various dental materials, including composite resin, bonding agents and sealants. Exposure to radiation can also occur during laser treatments and X-rays. 

 can lead to phototoxic and photoallergic reactions in the eyes and skin of operators as well as patients. 

 can damage the cornea, lens and retina. Protective eyewear is necessary to safeguard the eye from debris, chemicals, radiation and any other foreign bodies that can potentially injure the practitioner, team member or patient. 

	The best practices for preventing eye injuries in the dental practice are safety shields and glasses worn correctly. However, among dental professionals, the use of protective eyewear varies.

revealed that the frequency of using protective eyewear among the dental personnel was 36.7 percent. 

surveyed general dental practitioners and found that 48 percent had experienced ocular trauma or infection, which occurred during a variety of procedures, and 75 percent of these injuries resulted from not wearing eye protection.

Of those surveyed, 87 percent of practitioners reported wearing eye protection routinely, but their choice of protection was not always adequate and not worn for all procedures.

	Debris enters the eye using one of three routes: frontal entry, sideways entry or bottom gaps. Frontal entry occurs when debris travels perpendicular to the practitioner’s face, and typically any type of glasses protects the eyes from this route of entry. With sideways entry, debris travels tangential to the face, and side shields on protective eyewear can protect the patient and practitioner from this type of entry.

 Finally, debris travelling vertically or tangential to the face may contact the eye through bottom gap entry or the space between the glasses and the mask of the practitioner.

Thus, the current dental mask and eyewear combination for protecting the eyes of the dental care provider is inadequate protection.

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	Although some team members and practitioners may use their prescription glasses for protective eyewear, these are not recommended due to the many gaps that give way to potential debris, resulting in eye injury. Appropriate safety goggles or glasses should fit comfortably over street eyewear, providing satisfactory protection without impairing the fit of the prescription glasses. Suitable safety goggles, glasses or shields should have thick frames that cover the side of the face and the top and bottom of the glasses to ensure that debris cannot come in contact with the eye. Face shields are an alternative option that ensure complete protection and avoid the gap between the glasses/goggles and the mask.

	Additional protective glasses are necessary for any radiation exposure treatments. The practitioner, patient and dental team members should wear glasses that filter UV light during light curing and polymerization. Various colored plastic glasses and hand shields are available that effectively protect the eyes from 

Glasses are also available to protect the eyes from laser radiation (i.e., Holmium-YAG lasers, Diode 810nm lasers, etc.). Finally, safety glasses are necessary during radiographs to avoid radiation exposure during X-rays. It is important to notify the patient and dental team members when radiation-specific protective glasses/goggles are necessary to ensure that the patient and dental professionals are adequately protected throughout the treatment.

		Clean reusable eyewear between patients and disinfect whenever visibly soiled.

 with solid side shields during any patient-care activities that can generate debris, radiation, or splashes or sprays of blood or bodily fluids.

		Educate your patients about why protective eyewear is important and require them to use it during any procedures that can generate debris, radiation or splashes or sprays of blood or body fluids.

		Utilize radiation specific glasses (i.e., UV light, lasers, radiation) for the patient, practitioner and team member.

	Although eye injuries occur every day, utilizing protective glasses, goggles, face shields and radiation-specific eyewear can help to avoid most injuries. Patients in the dental practice must be educated about why protective eyewear is important and when to use it. Team members and dental practitioners must be proactive in maintaining eye protection to avoid eye injuries and their complications. 

Dental professionals need to take extra precaution to protect their eyes during their daily work. 

The career-ending injury no one talks about

	According to the Centers for Disease Control, oral health care professionals should wear gloves to prevent their hands from becoming contaminated when touching mucous membranes, saliva, blood or other possibly infectious materials. Wearing protective gloves also reduces the chance of transmitting microorganisms on the hands to patients during dental procedures.

	However, wearing protective gloves does not eliminate the need for dental professionals to perform proper hand hygiene. Hands should be washed immediately before putting gloves on and immediately after removing them. Small, imperceptible defects may be present; the gloves may tear during use and bacteria can rapidly infiltrate underneath the gloves. Therefore, gloves should be changed as soon as possible if they are punctured or otherwise compromised.

	Some gloves used by dental professionals, such as nonsterile and nonsterile examination gloves and sterile surgical gloves, are considered medical devices that are regulated by the Food and Drug Administration (FDA).
	It’s important to remember that certain dental solutions, including glutaraldehyde, hydrogen peroxide and alcohol, may weaken glove materials, especially latex, vinyl, nitrile and other synthetics.8-10 Other dental material-related chemicals that could negatively affect gloves include acrylic monomer, eugenol, varnish, acid etch and dimethacrylates.

More from the author: Achieving ideal proximal contacts with IPR Strips

	Evaluation of the Cranberry Crave Nitrile Power Free Gloves

	Free of powder and latex, the Cranberry Crave Nitrile Powder-Free Examination Gloves from Pro2 Solutions feature an advanced synthetic nitrile formulation. They offer superior comfort with the addition of lanolin and multivitamins, including A, B12, C, D3, E and K1. Cranberry Crave nitrile gloves provide barrier protection while helping to minimize dry skin irritation. Available in five sizes (XS, S, M, L and XL), the Cranberry Crave nitrile gloves from Pro2 Solutions are packaged in a 200 Space Saver Pack to maximize storage space and efficiency.
	Contemporary Product Solutions recently conducted an evaluation soliciting the opinions of 17 dental assistants for more than 1,400 uses from various practices around the United States and Canada after using Cranberry Crave by Pro2 Solutions.

Dental Assisting Evaluators found Cranberry Crave Nitrile Gloves to be noticeably thinner than existing brands of nitrile gloves, providing an excellent tactile sense. The softness and flexibility of the material enhance fit and comfort. Ninety-eight percent of the evaluating team found the enhancement of having multivitamins was unheard of by most dental assistants and loved the fact that the company was thinking about their skin and wear. Forty-six percent said they loved having the choice of so many sizes. One practice said their dentist tried on the medium glove and asked that they order some of the gloves for them after the review.

	Twenty-four percent of the evaluators said that because of the glove feeling like silk to their hands, they had to go down a size. Eighty-one percent of consultants found the Cranberry Crave gloves by Pro2 Solutions to be better than other nitrile gloves they have used in the past. Ninety-three percent of the CPS team of evaluators would switch and 98 percent would recommend them to a colleague. All loved that the gloves come in a 200 glove box that Pro2 calls their super saver, which cut down on storage and packaging waste.

	When asked what changes or additions they recommend for this product, 93 percent of evaluators said the only change would be to make the gloves available in various colors and have an addition flavor or scent. On the 5-point diamond scale, dental team members who evaluated the Cranberry Crave by Pro2 rated it, on average, a 98.9, which gives this product a 5 Diamond CPS Rating.

An evaluation of the newest powder free nitrile glove from Pro2 Solutions.

Superior comfort with Cranberry Crave gloves

	Achieving ideal proximal contacts is of paramount importance to ensuring complete marginal seating of crowns, veneers, inlays/onlays and contouring direct composite restorations. Interproximal contacts that are too tight can result in incomplete marginal seating of full-coverage restorations, extrusion of adjacent teeth and crowding of anterior teeth. Patients may subsequently experience discomfort, hypersensitivity and recurrent marginal decay.

	Additionally, interproximal reduction may be required when patients are undergoing orthodontic treatment with either clear aligners or esthetic brackets (e.g., Invisalign

). In such instances, it is imperative that the interproximal enamel be stripped without creating sharp corners or subgingival ledges.

	Precisely establishing ideal interproximal contacts facilitates optimal oral hygiene, long-term gingival health and restorative stability. However, creating interproximal contacts that represent what exists in nature can be difficult. After utilizing traditional interproximal reduction methods, confirming the presence of adequate clearance may be difficult to ascertain with flossing.

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	What can greatly enhance interproximal reduction efforts is using a clinically proven method for determining and adjusting proximal contacts that incorporates a system of innovative strips (e.g., ContacEZ IPR Strips). This approach enables ideal proximal reduction and stripping to be achieved accurately and with minimal time and effort. As a result, crowns and other indirect restorations can be completely seated, and patients can experience enhanced comfort and functionality after definitive cementation, direct composite placement and/or during orthodontic bracket/aligner therapy.

The ContacEZ IPR System promotes safe and accurate interproximal enamel stripping utilizing flexible diamond strips that curve and conform to the natural contours of the teeth. This maximizes patient comfort and safety, without creating sharp corners or sub-gingival ledges. Ergonomically designed for single-handed use, the ContacEZ IPR strips provide optimal tactile control and will not remove excessive enamel. ContacEZ IPR strips are effective for anterior and posterior areas and will not injure (i.e., cut) lips or gums. Not only do ContacEZ IPR strips save valuable chair-time and promote efficiency, but their central opening facilitates maximum visual perception.

	The yellow IPR Starter strip is a 0.06-mm single-sided, extra-fine diamond strip with a serrated edge to safely and easily open the contact. The red IPR Opener strip is a double-sided, 0.12-mm medium diamond strip for gently opening the contact and reducing enamel on two teeth. The ContacEZ dark blue IPR Widener is a coarse 0.15-mm double-sided diamond strip for efficiently widening interproximal spaces and reducing enamel. The green IPR extra-widener is a double-sided, 0.20-mm coarse diamond strip for safely widening interproximal spaces further for ideal alignment.

	In addition, optional strips can help further reduce and enlarge interproximal areas. Among them are a serrated 0.10-mm Clear IPR single-sided opener, which features medium fine diamond grit for reducing enamel on the proximal surface of one tooth; a 0.12-mm medium-coarse diamond cyan IPR Single-Sided Widener strip for further reducing interproximal enamel on the surface of one tooth; a 0.25-mm purple IPR double-sided coarse diamond super-widener that also further widens the interproximal space between two teeth; and a brown 0.30-mm IPR double-sided coarse diamond mega-widener that creates an extra-wide interproximal space between two teeth.

	Some of the evaluators reported that they found that utilizing the ContacEZ to be a simple and smooth process. Of those surveyed, 82 percent stated that they were either extremely likely or very likely to purchase the ContacEZ for their practice. Several commented that the two grips provided exceptional handling properties, making it easy to grasp and access small spaces. One of those surveyed also commented that the flexible design allows the operator to polish the restoration easily, mimicking the contour of the tooth.

	The evaluators were asked about their favorite feature of this product, and 50 percent of evaluators stated the ease of use, followed by 25 percent who said size of the strips. In addition to ease of use, the ContacEZ is also autoclavable, making it reusable and cost-effective.

	When asked for clinical tips while using ContacEZ, one evaluator stated, “It is so simple to use, I am not sure anyone would need any tips.” Others surveyed commented that these strips were ideal for Class IV restorations, and another suggested using an assorted pack of strips to determine a preference in grit. Additionally, when asked about suggestions for improvements, they would love to have a larger multiple pack for greater supply purchase.

	The ContacEZ IPR Strips represent an efficient tool for thoroughly finalizing restorations that is reusable for increased efficiency and ease of use. Of those surveyed, 93 percent stated that they would recommend this product to a team member or other professional. On the 5-point diamond scale, dental team members who evaluated the ContactEZ rated it, on average, a 4-diamond rating.

An evaluation of the IPR Strip System from ContacEZ.

Achieving ideal proximal contacts with IPR Strips

	Dental professionals continuously seek over-the-counter (OTC) products they can recommend that can enhance their patients’ compliance with at-home oral hygiene maintenance to prevent cavities, as well as prevent and improve gingival irritation.

Toothpastes are among such products and, since the first commercially available toothpaste was launched in the late 1800s, they have evolved considerably in terms of their ingredients, how they’re dispensed and their oral health benefits.

	In fact, tooth brushing with dentifrices that contain fluoride is one of the most essential aspects of good oral hygiene home care. Brushing with toothpastes that contain fluoride helps to prevent tooth decay and reduce gingivitis by removing plaque, as well as cleaning and whitening the teeth by removing stains. When bacteria have access to the sugars and starches in foods and drinks, acid is produced that attacks the tooth and causes tooth decay. Dental plaque also irritates gingival tissues, leading to gingivitis and red, swollen and bleeding gums. If not reversed, periodontitis can develop.

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 is effective in reducing dental caries, and effective in controlling gingivitis. In fact, studies have demonstrated that an advanced stannous fluoride dentifrice effectively provides reductions in gingival inflammation and gingival bleeding after two months of tooth brushing. Toothpaste containing stannous fluoride has been shown to give statistically significant plaque reductions from baseline in whole mouth, gumline, and interproximal accumulated overnight plaque after three and six weeks of brushing.

	Additionally, the percent increase in surface microhardness measured on enamel surfaces after treatments with a toothpaste containing stannous fluoride was found to be significantly enhanced. Other research has also supported the use of a toothpaste containing stannous fluoride for protecting against erosion, showing results that were significantly better than a broad range of dentifrice formulations. Creating an acid-resistant barrier on enamel represents a potentially superior means for delivering protection against dietary erosive acid challenges, and research has confirmed that a toothpaste with stannous fluoride deposits a barrier layer onto the enamel surface, beginning with the first use of the product; that the barrier is enhanced with ongoing use; and that the barrier is retained on the enamel surface for hours after product use.

	Therefore, to deliver an advanced over-the-counter product for preventing cavities and gingivitis, Procter & Gamble introduced Crest Pro-Health, the first and only leading dentifrice accepted by the American Dental Association to protect against sensitivity, plaque, gingivitis and cavities while also providing the benefits of whitening and fresh breath. Containing two powerful ingredients- therapeutic stannous fluoride to protect against gingivitis, plaque, cavities and sensitivity; and sodium hexametaphosphate, a stain-fighting ingredient- Crest Pro-Health toothpastes deliver comprehensive protection for patients’ teeth. 

	To help encourage greater product use and patient compliance, a new addition to the Crest Pro-Health toothpastes was recently introduced in a different formulation. With a smooth, gentle foaming action, new Crest Pro-Health Clean Mint provides a great brushing experience while offering better enamel protection against acid erosion compared to regular toothpaste formulations. It contains optimized stannous fluoride for protection, as well as zinc citrate for gentle stain removal and prevention. A recent evaluation conducted by Contemporary Product Solutions solicited the opinions of dental team members after they offered the new Crest Pro-Health Clean Mint toothpaste in their practices.

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	In terms of periodontal therapy home care maintenance, Crest Pro-Health Clean Mint toothpaste provides anti-plaque and anti-gingivitis benefits that can be attributed to the optimized antibacterial activity of stannous fluoride, which is more bioavailable. The anti-microbial mechanism-of-action of stannous fluoride involves killing bacteria, but its main mechanism-of-action is interfering with the metabolic activities of bacteria so that they produce less by-products, including lipopolysaccharides. This in turn leads to a reduction in bacterial proliferation and plaque.

	For anticavity protection, topical fluorides as well as fluoride toothpaste are usually recommended by dental professionals for high caries risk patients. As part of good oral hygiene home care, Crest Pro-Health Clean Mint toothpaste provides patients with fluoride in a stannous fluoride formulation that has also been proven to create a protective barrier against acids as well as to reduce the level of overnight plaque on the teeth. With continued use, patients experience plaque reductions and significant reductions in gingival bleeding, and because of the enhanced anti-microbial efficacy and pleasant clean mint taste, users also notice a significant breath freshening effect.

	Dental professionals use a variety of products and methods (i.e., in-office, at-home and over-the-counter) for maintenance whitening treatments. Most recommend at-home whitening products as the follow-up regimen for patients who want to maintain the shade they achieved from whitening. With Crest Pro-Health Clean Mint toothpaste, dental professionals can provide a product that can help to maintain whitening by removing stain while also improving oral health. Crest Pro-Health Clean Mint toothpaste is a good option for oral hygiene home care in periodontal maintenance and other patients, anti-cavity protection and sensitivity. 

	Overall, Crest Pro-Health Clean Mint toothpaste is an over-the-counter toothpaste that can help patients achieve and maintain a healthier smile. Although patient acceptance and compliance can be difficult to obtain, with a pleasant-tasting dentifrice like Crest Pro-Health Clean Mint, patients can enjoy brushing and receive effective plaque removal, gingival health benefits, and excellent whitening maintenance results.

	Faller RV, Eversole SL, Saunders-Burkhardt K. 

Protective benefits of a stabilised stannous-containing fluoride dentifrice against erosive acid damage.

. Anticaries potential of a stabilized stannous-containing sodium fluoride dentifrice. 

. Assessment of the effects of a stannous fluoride dentifrice on gingivitis in a two-month positive-controlled clinical study. 

. In-office study to evaluate the effects of a stabilized stannous fluoride dentifrice and an advanced manual toothbrush regimen on gingival health and plaque accumulation in Mexican adults. 

	Khambe D, Eversole SL, Mills T, Faller RV. 

Protective effects of SnF2 - Part II. Deposition and retention on pellicle-coated enamel.

Contemporary Product Solutions presents its review on this new toothpaste flavor.

A review of Procter & Gamble’s Crest® Pro-Health™ Clean Mint

	Although tooth whitening is establishing itself as a popular dental treatment, several factors must be considered when selecting the ideal whitening solution. The factors include patient lifestyle, tooth discoloration, compliance ability and tooth sensitivity.

	With the ever-increasing patient demands for whitening options (increased comfort, convenience, effectiveness, etc.), dental manufacturers have created an array of whitening systems to meet these requests. As a result, dentists must determine the appropriate whitening solution that also matches the patient’s lifestyle and desired results, in combination with their clinical situation and overall oral health. With many factors to consider, selecting a whitening treatment can be challenging and overwhelming.  

	Introduced in the 1800s, in-office whitening was the primary choice for dentist-prescribed tooth whitening.

 However, the development of home-applied tray bleaching in the 1980s changed the field of tooth whitening dramatically.

 Unlike in-office treatments that require dental professionals to perform the procedure, at-home whitening is dentist dispensed and individually applied, significantly reducing the cost. With at-home whitening, patients are now able to whiten their teeth, following their dentist’s instructions, at their own convenience. 

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	Today, most dentists still offer these two types of whitening treatments, although with advancements in research the whitening materials have significantly evolved. In-office whitening uses a powerful bleaching agent (e.g. hydrogen peroxide, carbamide peroxide, sodium percarbonate peroxide) to effectively whiten teeth in a single office visit. While using the same potent bleaching material, at-home whitening contains a lower concentration of the active ingredient to whiten teeth.

 When supervised by a dentist, at-home or in-office peroxide bleaching has been shown to be safe and effective.

Another challenge in determining the appropriate whitening treatment plan is choosing the ideal whitening gel. Carbamide peroxide is the most common active ingredient in whitening materials, dissociating into hydrogen peroxide and urea.

 It is ideal for at-home whitening because of its slow breakdown during oxidation. Unlike hydrogen peroxide-which releases its whitening power almost instantly-carbamide peroxide releases about 50 percent of its whitening power in the first two hours and can remain active for up to eight hours.

	Therefore, the duration of exposure time and bleaching agent concentration directly affect the diffusion of hydrogen peroxide through the dentine and the efficacy of the whitening treatment.

 Thus, dental supervision is essential to ensure proper concentration and application time to avoid complications and side effects from whitening (gingival irritation, tooth sensitivity, minimal whitening results, etc.). 

Continue to page two to learn about why professional supervision is key...

	During the initial whitening consult, dentists should complete a thorough oral examination and evaluation with pre-operative photographs. With this information the dentist can monitor the tissues (hard and soft) throughout treatment to ensure the patient responds ideally to the whitening gel and no damaging effects occur, such as tooth demineralization or gingival irritation. 

Opalescence PF is a flexible and customizable solution for your practice's whitening needs.After the initial assessment, determining the types of discolorations will help identify the appropriate whitening solution. With three classifications-intrinsic, extrinsic or internalized-tooth stains vary in their ease of removal. Extrinsic stains are localized on the tooth surface or within the pellicle layer by reaction between sugars and amino acids, or acquired from other external elements.

 Intrinsic stains, such as those from tetracycline or fluorosis, are found within the dentine, and result from systemic or pulpal origin.

 They are the most difficult type of stains to remove. Similarly, internalized stains are also located in the dentine, but result from extrinsic stains entering the dentine via tooth defects, such as cracks on the tooth surface.

	Although in-office treatment is ideal for a variety of tooth discolorations, darker stains (e.g. dark yellow and black teeth or stains from tetracycline and fluorosis) can be challenging to whiten, requiring more than one bleaching application.

 Used in conjunction with in-office treatment, at-home whitening can provide the ideal supplement to treat tougher stains. 

	At-home whitening is also effective as a standalone treatment and a practical alternative to in-office whitening. Effective at treating most discolorations, at-home whitening is still under dental supervision and monitoring. At-home whitening provides a cost-effective solution for those who can’t afford in-office treatment or for those who prefer the convenience of whitening at home. Dentist-dispensed at-home whitening minimizes risks involved in whitening such as uneven results, enamel damage or hypersensitivity, because the systems are supplied by dentists, who can diagnose any problems or special needs, plan the appropriate treatment and fabricate the customized tray used to apply the whitening gel.

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While ideal for patients who desire to whiten their teeth on their own schedule, complications still occur with dentist-dispensed at-home whitening. Problems with patient compliance can arise due to discomfort and inconvenience. Poorly fitted trays can inhibit proper application of the whitening gel to the tooth surface, reducing the effectiveness of the hydrogen peroxide. Patients can have difficulty applying the material, especially if the gel is too thin. During whitening, some patients report discomfort as the tray moves or gel migrates out of the tray and onto gingival tissues. The discomfort can be exacerbated if the taste of the gel is unappealing.  

	Patients may also complain of increased sensitivity during and after whitening treatments. This side effect may be caused by changes of fluid in the dentinal tubules. Specifically, too much fluid moves out of the teeth during whitening, causing dehydration that leads to oral pain. Some whitening gels add water to their solution to ensure proper hydration. The addition of fluoride and potassium nitrate has also been shown to reduce tooth sensitivity.

 The application of fluoride also makes the teeth less susceptible to caries,

 and leads to fewer hazardous effects on the enamel mineral content.

	Further, as hydrogen peroxide degrades throughout the whitening process, it can create a more acidic environment that leads to potential tooth structure damage.

 Some whitening gels have an initial acidic pH, which can further favor demineralization of tooth enamel.

 Lower pH environments can lead to increased tooth sensitivity, gingival irritation, and bacteria growth. Adding buffers to the whitening gel ensures a basic or neutral pH. 

The right solution for different patients

	Ultradent Products has developed a system of at-home whitening treatments, Opalescence PF, that is cost-effective and reduces sensitivity and discomfort. Its unique formula allows for complete customization. With four different carbamide peroxide concentrations, dentists can tailor whitening treatments to an individual’s expectations, extent and type of tooth discoloration, and likelihood of compliance. 

	When determining the treatment plan for at-home whitening, dentists consider concentration, duration, application and desired results based on the patient’s type and extent of tooth discoloration. Opalescence PF is ideal for at-home treatments because of its versatility and customization depending on the patient’s desired results and clinical condition.

Available in four carbamide peroxide concentrations (10, 15, 20 and 35 percent), Opalescence PF requires wear times ranging from 30 minutes to overnight. Opalescence PF is effective in removing discolorations due to congenital, systemic, pharmacologic and traumatic factors, as well as those resulting from fluorosis and tetracycline. The lower doses are suitable for patients who want to wear the whitening trays overnight or who demonstrate extra sensitive teeth. Higher concentrations are more appropriate for quicker results and those patients who have less availability to apply the whitening gel and wear the whitening tray. Dental professionals can therefore customize whitening treatments in terms of both concentration and duration to fit a patient’s schedule, lifestyle, and degree of tooth discoloration.

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	In addition to versatility, Opalescence PF provides practical solutions to many of the common complications associated with whitening and at-home treatments. The safe and effective whitening gels include potassium nitrate and fluoride to reduce sensitivity and strengthen enamel. The gel also contains 20 percent water to prevent dehydration. Opalescence PF also contains buffers to maintain a neutral pH, thereby preventing an acidic environment and damage to the tooth structure. 

	Using a customized whitening tray, the Opalescence PF system promotes even application of the whitening gel and continuous contact between the gel and tooth structure throughout treatment. An easy syringe delivery improves the efficiency for loading the tray. The sticky, viscous formula helps keep the gel and tray in place, preventing the solution from migrating during treatment, thereby improving patient comfort, which helps patient compliance. Opalescence PF is also available in three flavors-mint, melon and regular-improving taste and comfort. 

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	With Opalescence PF, dentists can provide their patients with a proven whitening solution for at-home treatment. Effective in treating even the toughest of stains and discolored teeth, patients can complete the whitening treatments safely and efficiently following the dentist prescribed plan at their own convenience. The ideal tool to customize whitening treatments for all types of patients to fit their lifestyle, and with customized tray application and a thick, viscous gel, Opalescence PF is designed to reduce sensitivity, enhance comfort and improve patient compliance. 

An evaluation of Opalescence, a whitening system from Ultradent Products.