Sonny Spera, DDS

Keeping Blood Under Control in Restorative Procedures. Image credit: © Ultradent

Dentistry, in a controlled environment, is not so bad. Take a clinician with minimal experience and confidence, and in the absence of aggressive tongues, large cheeks, and overactive salivary glands, the dentist’s clinical results most likely will be positive and predictable.

Life, sadly, does not always present us with such ideal and controlled environments. Although the examples above are difficult enough, the biggest challenge is dealing with blood. It’s believed that 47.2% of adults in the United States have some form of gum disease. Therefore, blood is quite common in our workspaces.

The inflammation associated with this incredibly common disease leads to challenges with visibility, contamination, and marginal isolation. It ruins our restorations, carries bloodborne pathogens, destroys our impressions and scans, and can easily transform our work day in the operatory into one full of stress, frustration, and unpredictability. Simply put, blood is the bad guy.

Fortunately, there are several solutions that, when added to a restorative dentist’s armamentarium, can control blood in the working field. These include but are not limited to:

highly effective; destructive and expensive up front

 difficult, time-consuming, cost-effective

not always effective; time-consuming, expensive

variably effective; convenient, cost-effective

Most dentists would agree that a combination of the above strategies may be needed due to the diverse clinical scenarios we encounter. Situations often arise involving high levels of uncontrollable bleeding, which require potentially all of the above. On the other hand, a clinician may encounter a small amount of bleeding which requires the quickest, most cost-effective, and convenient option.

Ultradent, a highly respected materials and equipment company, is known for its broad and diverse catalog. It has long been relied upon for high-level tissue management with products such as ViscoStat hemostatic and Ultrapak retraction cord. One of their most effective, but lesser utilized hemostatic agents is Astringedent X.

Astringedent X is a 12.7% iron solution, which Ultradent says is its most powerful hemostatic agent. It is designed for even the most difficult cases of uncontrolled bleeding, along with typical everyday cases. Ultradent says it provides rapid and profound hemostasis.

Catapult Education, a bureau of dental educators and clinical leaders, was asked to test this hemostatic option in their day-to-day clinical domains. Astringedent X was sent to 16 dentists, the majority of whom perform mostly restorative procedures. All of the participating dentists use the hemostatic options listed above to maintain control over bleeding. They used the product with crown preps and class II, III, and V restorations. They used it with deep margins and in the presence of periodontal inflammation. Some used the product in preparation for final impressions and scans, both in the anterior and posterior.

The Catapult evaluators noted a few features of Astringedent X that stood out. First, it is dispensed via Ultradent’s Dento-Infusor tip, which has a unique array of brush tips. This was very well-received by Catapult evaluators; 94% found application using the tip was helpful. They found it less wasteful and more convenient to use than a cotton pellet or microbrush.

The majority of evaluating dentists had the opportunity to use Astringedent X in areas where there was significant bleeding. These would be areas in which most clinicians would have to revert to less convenient, more time-consuming, or more costly methods to achieve desired hemostasis. For example, the bleeding would normally be so excessive that they would have to use a diode laser. To really put this product to the test, the evaluators used Astringedent X in the most difficult areas of hemostasis. An impressive 81% of these clinicians noted that it was just as or more effective at controlling bleeding. Remarks included, “It was very fast acting and controlled bleeding quite well” and “Hemostasis was immediate! The product was excellent.” One evaluator even commented that this was the “best product available for controlling excessive bleeding.”

Keeping Blood Under Control

Although Astringedent X earned glowing feedback from its evaluators in terms of effectiveness, there were negative comments, primarily concerned with viscosity. Astringedent X possesses less viscosity than typical hemostatic agents such as ViscoStat. As a result, more of the product is expressed with the same amount of finger strength on the syringe. Almost all of the evaluators experienced this and realized that a learning curve must be met before being able to avoid overexpression of the product.

I had the opportunity to use Astringedent X in my office. I also conferred with another Catapult clinical evaluator, Ankur Gupta, DDS, who has a general dentistry practice near Cleveland, Ohio. Both of us put Astringedent X to the test by using it in a heavily bloody situation, and we were very impressed with how it performed. My assistant had remarked on several occasions that “this stuff is magical.” Dr Gupta shared that he had never used or heard of Astringedent X prior to the product review, but after having a chance to evaluate it, he told me that he now uses it almost every day. We agreed that it was runnier than expected, but that didn’t really bother either of us after getting the hang of it.

To receive the Catapult vote of confidence, a product must attain a higher than 90% overall satisfaction in effectiveness. Astringedent X clearly met such criteria. For this author, it is rare for a product to go from unheard of to being used every day. This is one such product. Congratulations to Ultradent for successfully providing another tool to make our lives as clinicians easier, less stressful, and more enjoyable.

Articles

Catapult evaluators tested Ultradent’s Astringedent X’s ability to put control back in the clinician’s hands during restorative treatments. 

Keeping Blood Under Control in Restorative Procedures

Toothpaste Tackles Tough Preventive Pediatric Care


Treating children is a challenge for most dentists. Although many general clinicians treat young patients, most would agree that adequate decay removal, consistent isolation, and proper bonding of a long-term restoration are some of the most difficult tasks in their children’s repertoire. Thus, the best solution is to prevent decay from occurring in the first place.

There are many over-the-counter and prescription products that all claim to prevent decay, and most can make this claim because they include fluoride. GC America, a leader in the development and dispensation of high-quality dental products, introduced MI Paste

 ONE in 2018 as a unique preventive option that combines ions of calcium, phosphate, and fluoride. Much market research was done on the product, and it continues to be highly regarded. Its limitation, however, was that it did not have some of the features that make toothpaste appealing to children. Products that are tasty and appealing must also have great efficacy. Those that combine both properties are the ones that can really have a marked impact on dispensation and usage in general and pediatric offices.

Catapult is an organization that consists of more than 50 clinicians spread throughout Canada and the United States. As a company, manufacturers pay a fee for their product to be evaluated and what we deliver are truthful, independent answers from surveys that we develop with them. We have had many products that have either had to be altered before hitting the market or simply never arrived because of our openly honest evaluations. In this way, Catapult assists the manufacturer to avoid potentially releasing a faulty product, or simply a product that needs refinement. Lastly our clients are omnipresent in the industry, small to large, no favoritism, simply reviewing the latest products in our practices.

Currently, our panel has recommended the following brands and products: Crest, Pronamel, Colgate, MI Paste ONE Kids, Colgate PreviDent, Clinpro 5000 (prescription), Common Sense Teeth Cleaning Powder (for fluoride-free patients), Sensodyne, FluoriMax, and Supersmile.

With the plethora of fluoride-based products available on the market, we are challenged with respect to what we recommend and how it will be received. It is important to have a product we can stand behind that will also appeal to patients. So often, on the popular show 

, the sharks ask, “Does it satisfy a need?” When evaluating new products, we must ask not only that question but also “Will it be useful, well received, and replace a current product?”

GC America has developed a product for kids called MI Paste

 ONE Kids, which delivers fluoride in a more appealing way while preserving some of the foamy consistency most consumers equate with a “good clean feeling” after using.

The evaluators at Catapult Education clinically reviewed and tested the 3 flavors of MI Paste ONE Kids: blue raspberry, cotton candy, and bubblegum (33% each). The product was said to have a “pleasant but not overwhelming taste,” and 1 commenter said, “I tried all 3 and loved them myself!” When it came to consistency, it was found to spread well in the mouth during brushing as well as to apply on a toothbrush. All evaluators found the ease of use and foaming quality—very important factors when selecting a toothpaste for children—to be good or excellent. They also stated that it was “creamy,” “very easy to use,” and easy for children to use.

And what about that clean, fresh feeling after brushing, the other quality hallmark if we are to have a product that children and adults will endorse? Most (78%) of evaluators rated the product as excellent or good.

Evaluators also found the flavor, smell, packaging, and cow image to be good or excellent 75% of the time, while 78% of them considered the kid-friendly labeling as favorable. The instructions were “great” with “fresh packaging.” The smell was overwhelmingly acceptable, noted as “pleasant” and “very appealing.” In one instance, the evaluator said that “kids loved the flavors.” The favorite almost across the board with children was cotton candy, with blue raspberry coming in third. However, adults seemed to prefer blue raspberry.

When asked about overall experience, 78% of evaluators rated it as good or excellent. One said the product had “a nice consistency” and another said that having “flavor options for any dental supplement for kids is a plus.”

When asked the million-dollar question—Would you replace your recommendations with MI Paste ONE Kids?—more than 75% said they would and would use it for daily brushing. One said, “My 9-year-old daughter loved every flavor and gave a big thumbs-up! She is so picky with flavors, so that is huge! She made a little video to share!” Another said, “I would recommend it as an option. Win-win, fluoride and calcium.”

This product can replace most of the currently recommended toothpastes for children. According to evaluation results, it more than satisfies the need for a tasty, foamy dentifrice that has fluoride and is useful for pediatric patients.

Due to the overall positive feedback from Catapult evaluators, it is a pleasure to award GC America the Catapult Vote of Confidence

New product designed especially for children earns excellent reviews.