Terri Lively

Getting Patients to Care: From Booking to Follow-Up to Oral Health Engagement, Here Are Some Things That Work. Image credit: © hedgehog94 – stock.adobe.com


It is no secret that getting patients to care physically and emotionally is challenging for any dental practice. Today, we explore booking and follow-up tactics and oral health engagement tips that any dental practice can use.

Tactic #1: Leverage the Functionality of Your Dental Office Communication System

One way to get patients to care—at least regarding their physical presence—is through technology. Your dental office communication system has different features that connect various parts of the practice, enhancing patient scheduling, communication between staff and patients, and overall dental care processes.

For example, automated appointment reminders reduce no-shows and cancellations, improving scheduling efficiency. Telehealth and teleconsultation advancements allow for remote assessments, saving time for both patients and dental professionals. Patient portals offer secure access to records, treatment plans, and communication with the practice. Electronic health records (EHRs) provide immediate access to patient records, ensuring the dental team is well-prepared for each visit and elevating the patient experience.

Practice management software integrates all these tools, creating a unified system for dental office operations. It enables efficient scheduling, integrates EHRs, automates reminders, and fosters direct patient communication while ensuring data security. By utilizing practice management software, dental practices can create a seamless, patient-centric communication system, enhancing the overall quality of care.

Dental hygiene educator and international speaker Katrina Sanders, RDH, agrees that clear communication is essential. Sanders is a periodontal hygienist who often treats the various stages of gum disease. If the patient has a condition that requires multiple treatments and ongoing maintenance, she says it's best to establish that when they get started. Otherwise, patients tend to think of periodontal treatment as one-and-done.

Additionally, Sanders encourages leaving the scientific language out of the conversations. Most patients do not respond appropriately to it. However, setting up the condition and procedure as a disease you are treating makes patients more receptive to ongoing care. Sanders often tells patients that she hopes to move them from a state of active disease to a stage of remission.

"I love using the word' remission.' It aligns with the AAP [American Academy of Periodontology] staging and grading guidelines," Sanders explains. "So now I'm telling the patient, 'I want to put you back into remission, and if I can get you back into remission, then our next step is to continue working together to keep you in remission.'"

Sanders says that the idea of a partnership is integral to getting patients to care. She also ensures that she takes a full medical history to get the full picture of the patient's overall health. Then, she can see if the patient is at an elevated risk for disease showing up in different ways, whether that is from chronic issues with general health, medications the patient takes, or the patient's age. She explains that these factors can potentially complicate the work she and the patient are doing together.

Moreover, it is important to emphasize that some oral health conditions persist beyond the initial treatment. A common misstep Sanders sees in this conversation is that post-treatment instructions often focus on the immediate management of the first one or two weeks after treatment. However, she says it is important to communicate that the dental team needs to see the patient back to see if the body responds favorably to treatment.

However, the conversation should not feel scripted. Sanders thinks that scripts get in the way of genuine conversation.

"A lot of times when we talk about communicating with our patients," Sanders explains, "We feel like we have to have a script like we have to do all the talking to educate them and to bring awareness to them. And I'll tell you, I love a good script. I'm a theater kid. I grew up reading scripts, but scripts are for the theater. They are not for communicating with human beings about a customized approach."

Tactic #3: Book the Appointment as Soon as Possible.

Speaker and educator Jeffrey Lineberry, DDS, AAACD, owner of the Carolina Center for Comprehensive Dentistry in Mooresville, North Carolina, thinks setting the schedule at the time of diagnosis is key. Sanders agrees, adding that the same policy applies to surgical follow-up appointments.

"No patient should ever leave an active surgical situation without the next appointment set," Sanders says. "If we know the patient is going to be sedated, we schedule that reevaluation before the patient undergoes treatment."

In his practice, they start by showing the patient photos and telling them what they are seeing in the image. Once the patient decides to treat the condition, the team repeats the diagnosis and treatment plan for charting, and Dr Lineberry confirms and asks the patient if they have any questions.

After answering any patient questions, Dr Lineberry sends the assistant and hygienist with the patient to communicate the diagnosis and treatment plan to the scheduler. He finds that having the people with the patient in the room for the conversation creates a sense of community for the patient, which makes it easier to move forward with the treatment plan.

After booking the appointment, the scheduler confirms with the patient. Dr Lineberry has the team tell patients how long the appointment will be and that the time scheduled is set aside for the patient. So, if they need to cancel or reschedule, the scheduler asks them to give them 48 hours' notice. Dr Lineberry says that knowing the time is scheduled specifically for them makes patients assign more value to the appointment—and also makes them more likely to show up.

But What About Getting Them to Care About Their Oral Health?

Getting people to fix a problem with their oral health is one thing; getting them to care about how the problem occurred could be quite another. Patient engagement about their oral health and the patient's role in it is a challenge in any dental practice.

Getting patients to care about their dental health also means empowering them with knowledge. Effective communication in a dental practice involves ensuring that patients understand the information provided. Often, a gap exists between what the dentist explains and the patient comprehends. Patients typically do not retain new information after hearing it once. Technology-facilitated communication and building relationships are essential but not usually enough to ensure comprehension.

The "Rule of 7" suggests at least seven exposures to new information are necessary for retention. Therefore, providing patients with resources they can review at their own pace, such as brochures or app-driven instructional videos, helps bridge this gap. These resources enhance patients' understanding of dental procedures and conditions, leading to better dental outcomes.

Dr Lineberry says getting people engaged in their overall health requires determining what they value and what their currencies are. By slowing down and discovering why they are doing what they are doing, what past experiences have influenced this behavior, and what misconceptions they may or may not have, you can engage with patients in a real conversation about oral health.

"There's an old saying, 'People don't care how much you know until they know how much you care," Dr Lineberry continues. "That's where you start figuring out things. The bottom line is that in this busy world, we all know that most people breeze over stuff, and it's in and out to get things done, and some patients need that type of interaction. But also, there are a lot of patients who have stories, and they need to be heard."

Discovering where patients are regarding their engagement with their oral health means avoiding assumptions and asking open-ended questions. The answers patients provide allow the clinician to go deeper into relationship building, which will lead to trust.

For example, instead of asking patients if they are flossing daily, ask them what they do at home to maintain their oral health. Dr Lineberry says reframing the question this way allows patients to answer you without simply telling you what they think you want to hear.

"It's about going there in a deep, deep-seated question and staying in the question and finding out, really connecting with patients on a higher level," Dr Lineberry says.

Sanders agrees that you will encounter varying levels of dental IQ in your chair. Some patients grew up going to the dentist every 6 months and value routine care, while others did not. The amount of exposure to oral health information also varies, leading to different ideas and understandings of how to approach oral health care.

Therefore, she thinks it essential to discover what type of patient you have in front of you and what their goals are for oral health. Then, the patient starts the conversation, and the clinician can guide them.

"We have to know what that goal is, and we have to remind our patients that we are with you alongside those goals, whatever that might be," Sanders says.

Additionally, Sanders thinks that dental professionals should be a bit more assertive regarding their continuing education and practice investments with patients. Many patients are interested in wellness and want to know that their dental team can help them in that area.

"Patients want you to tell them that you are reading the research and what you're giving to them is the newest research as you have it," Sanders says. "Dentistry shies away from that sometimes."

Sanders says there is an opportunity for dentistry as a collective to be more confident in how they share recent findings with patients and how that changes their approach to patient care.

For example, Sanders thinks explaining to patients that you take the full medical history is important because of the connections between oral health and overall health. Many patients might not know about those connections yet and how their genetic and family history plays a role in their risk for disease. As a periodontal hygienist, Sanders wants to know of any risk or history of systemic conditions that could complicate their gum disease. This conversation and awareness make their gum disease more relevant to the patient.

"Patients want innovation. They want the research. They want to know that you are looking at them as a unique individual, not as your 10 o'clock patient who's here to complete these CDT codes today," Sanders says. "And that's a reasonable patient who wants to trust what you're putting in front of them."

Optimizing Your Dental Office Communication Systems. Spear Review RSS. Published January 25, 2023. Accessed June 7, 2024. https://www.speareducation.com/spear-review/2024/01/optimizing-dental-office-communication-systems

Articles

We explore the challenges of getting patients in the chair for necessary care and how to overcome them. We also look into how to ensure patients care more about their role in essential care for their oral health. 

Getting Patients to Care: From Booking to Follow-Up to Oral Health Engagement, Here Are Some Things That Work

Chairside CAD/CAM Materials: What Are the Pros, Cons, and Indications. Image credit: © andrey gonchar – stock.adobe.com

Recent research indicates the material chosen affects the success of the treatment, so a familiarity with the strength and esthetic properties of the various available materials is essential. We explore the pros, cons, and indications of today's chairside CAD/CAM materials.

A Brief History of the Evolution of Chairside Materials

Materials have been changing since CAD/CAM first started producing restorations. For example, in September 1985, Mörmann placed the first chairside ceramic restoration using the CEREC 1 system with CAD/CAM technology at the University of Zurich Dental School. The initial material, Vitablocs Mark I, was a fine particle feldspar-based ceramic. It was replaced in 1987 by Vitablocs Mark II, a high-glass content ceramic, which remained the sole material until 1997. That year, 3M ESPE introduced Paradigm MZ100 blocks (3M ESPE), made of highly filled ultrafine silica ceramic particles in a resin matrix. Then, in 1998, ProCAD evolved into IPS Empress CAD, composed of 40% infiltrated leucite glass, enhancing strength and esthetics. In 2003, 3M ESPE launched Paradigm C, a 30%-by-weight leucite block. Three years later, Ivoclar Vivadent introduced IPS e.max CAD, a lithium disilicate ceramic known for its structural and aesthetic properties. In 2007, Sirona Dental Systems released CEREC Block, similar to Vitablocs Mark II, but with varied shading options.

So, what does that mean to you today? You have options for your chairside CAD/CAM restorations. Restorative chairside options now include:

Polymethyl methacrylate (PMMA)-based materials

Zirconia-reinforced lithium silicate ceramics

Following is a summary of the types of materials available today that includes some of their advantages and disadvantages:

A Breakdown by Class of Chairside CAD/CAM Materials

Feldspathic Ceramics and Leucite-Reinforced Ceramic Blocks

 are the first generation of chairside CAD/CAM materials used before 1990, such as the Vitablocs Mark II mentioned above and CEREC Blocs. Known for their high translucency and esthetic appeal, this class of materials is popular. However, Feldspathic and leucite-reinforced ceramic blocks also require significant tooth preparation and are weaker than newer materials.

Lithium Disilicates and Zirconia-Reinforced Lithium Silicates

 represent advanced glass ceramics with improved resistance qualities. Lithium disilicate, such as IPS e.max CAD, offers high resistance (over 350 MPa) and excellent esthetics. It requires a 2-stage firing cycle to reach full strength (over 440 MPa). Zirconia-reinforced lithium silicate (ZLS) is a newer generation of materials, introduced in 2012, that features smaller crystals and added zirconia for enhanced strength, making it suitable for various restorations.

 has exceptional strength (500–1200 MPa) and biocompatibility. Zirconia is ideal for crowns, implant abutments, and small bridges due to its minimal plaque retention and low wear on opposing teeth. Despite its advantages, zirconia requires specific processing techniques due to its resistance to conventional acid etching.

Hybrid Ceramics or Resin Matrix Ceramic Materials

 combine the esthetics of ceramics with the strength and flexibility of composite resins. These materials include nanoceramic resin blocks, which have a high ceramic filler content (up to 80%), and polymer-infiltrated ceramic network (PICN), which combines ceramic (86%) with composite resin (14%). Hybrid ceramics are easier to mill, require fewer heat cycles, and offer good bending resistance, making it possible to use them at thinner thicknesses.

Acrylic Resin, specifically polymethyl methacrylate (PMMA),

 is pre-polymerized without fillers. Some clinicians value it because it produces fewer voids, reduces shrinkage, and shortens chairside time, making it an efficient choice for creating long-term temporary prostheses.

A 2023 review of the evolution of CAD/CAM materials in prosthodontics examined the properties of the different materials in the literature. Their findings are summarized below:

Fracture Toughness of Chairside CAD/CAM Materials: 

Materials with high Fracture toughness (KIC)are more resistant to fractures and last longer. Researchers found that fired or crystallized glass ceramics have the highest KIC values. Non-fired glass ceramics have much lower KIC. Other researchers noted that thermocycling, or repeated heating and cooling, reduces the fracture toughness of resin-based materials but does not affect leucite and lithium disilicate ceramics.

Impact of Toothbrushing on Surface Properties

CAD/CAM composite materials are flexible, which helps them absorb stress and resist fractures. These materials are made under high pressure and temperature, making them more uniform and less porous than regular resin composites. This manufacturing process makes them easier to machine and repair. However, abrasive particles in toothpaste can increase surface roughness and reduce gloss, affecting their appearance and longevity. Some composites showed higher wear resistance and gloss and lower roughness after brushing. Rough surfaces can lead to bacterial build-up, which can cause cavities and gum inflammation.

The edges of dental restorations can wear down and lose support, leading to fractures, sensitivity, plaque build-up, and cavities. Edge force tests measure how stable the edges are. Researchers found significant differences in edge strength between 1-mm and 2-mm thick plates, with failures like cracking and chipping. The researchers noted that LiSi Block had high resistance to chipping due to its fine, dense crystals.

Smooth and polished surfaces reduce bacterial build-up, prevent chipping and fractures, and improve strength. Researchers found that roughness after polishing was similar, whether done chairside or in a lab. Ceramics wore down less than resin composites but caused more wear to opposing teeth. Polishing increased surface roughness and hardness more than glazing. Manual finishing and polishing with glazing paste were the most effective for reducing roughness and achieving high gloss in glass ceramics.

Elastic constants like bulk modulus, Poisson's ratio, shear modulus, and Young's modulus describe how materials respond to stress. These properties depend on the material's structure and composition. Researchers found higher Poisson's ratios for zirconia and glass ceramics, while Enamic had Young's modulus three times higher than Lava Ultimate. Increased load affected stress distribution in crowns made from polymer-matrix composites more than those made from glass ceramics.

Staining & Aging Dependent Changes in Color

Surface finishing affects texture and roughness, which impacts color stability when exposed to colored drinks and aging. Researchers found that coffee caused the most significant color changes, with these changes increasing over time. There were substantial differences in color stability between resin-based and lithium silicate/disilicate materials. Lithium disilicate or feldspar-based ceramics had the best color stability because of their high density, while polymers were more prone to absorbing pigments from staining solutions.

Research Indicates Different Materials Succeed in Various Ways

Various dental restorations, including anterior teeth inlays, onlays, veneers, and posterior crowns, require different chairside CAD/CAM materials. Each one in the assortment offers distinct advantages for where clinicians use them in the oral cavity.

For example, feldspathic ceramics are primarily used in the anterior arch because they look good. In contrast, lithium disilicate and zirconia are ideal for the posterior region due to their ability to endure significant occlusal forces.

With all of these options for chairside CAD/CAM dentistry available, knowing the indications for each class of materials is helpful.

 include feldspathic and leucite-reinforced ceramics, known for their excellent esthetics. They are ideal for high-impact esthetic restorations such as veneers, crowns, partial crowns, and cavitary restorations.

Lithium disilicate, zirconium oxide, and lithium silicate-reinforced ceramics

 offer high optical properties with various shades and translucency levels. They work for monolithic restorations like veneers, inlays, onlays, endocrowns, and crowns for both anterior and posterior teeth. Lithium disilicate is also suitable for small bridges in the anterior region. One can also use them for implant abutments despite limited clinical evidence. Lithium disilicate and zirconia are not ideal for bridge infrastructures but can be esthetic layers over ceramic or metal frames.

 restorations can be milled chairside for crowns or small bridges (up to 3 units). Polished zirconia is less abrasive than other ceramics but has limited esthetics due to low transparency. Its microstructure impacts translucency and mechanical properties, with smaller grains enhancing translucency but reducing resistance to low-temperature degradation.

 is great for temporary restorations lasting six months to one year. It is easy to mill and suitable for all types of temporary prostheses, including veneers, inlays/onlays, crowns, and bridges.

 is easy to mill and offers greater mechanical resistance than standard PMMA. It is suitable for veneers, inlays/onlays, crowns, and bridges and has a flexural strength of 80 MPa.

 mimic natural tooth characteristics in flexure, compression, and abrasion, making them suitable for single-tooth restorations or small bridges, especially in the posterior area. They are indicated for veneers, inlays/onlays, crowns, and bridges. However, their polymer matrix wears faster than ceramic, making them more abrasive to antagonists.

, a mixture of resin and ceramic, represent a new category of chairside CAD/CAM materials. These polymer-containing materials result in smoother crowns and less chipping at the margins after milling. The microstructure and crystalline phase of the material significantly influence its clinical performance, mechanical properties, and esthetics.4Additionally, hybrid ceramics provide good flexural resistance and support more conservative treatment approaches.

 works for veneers, inlays/onlays, crowns, and implant prostheses, particularly in the posterior area due to limited gradient shades, with esthetics achieved through make-up.3Nanoceramics offer advantages over conventional blocks, such as superior mechanical properties, better machinability, and smoother milled margins.

The bad news is that there is no universal chairside material that you can pick up for all restorative cases. Instead, you choose from several available materials, and they all have their advantages and disadvantages. If you like definitive evidence about clinical performance, there is more bad news; all the materials have limited, long-term clinical data, so they need more studies, per multiple researchers.

The good news is that you have choices that will enhance the restoration and your clinical outcomes—and a lot of information is available to help you choose the right one for the job.

Paulsos, B. et al. (2023) Evolution Of CAD/CAM Materials In Prosthodontics: A Review, IOSRJournals.org. Accessed June 3, 2024. https://www.iosrjournals.org/iosr-jdms/papers/Vol22-issue9/Ser-5/E2209053542.pdf

Jivanescu, Anca & Ille, Codruta & Rotar, Raul. 2024. Chairside CAD/CAM Restorations. 10.5772/intechopen.114090

Lambert H, Durand JC, Jacquot B, Fages M. Dental biomaterials for chairside CAD/CAM: State of the art. 

Eskandarion S, Neshandar M, Rokhshad R. Classifications and Properties of Materials for Chairside Computer-Aided Design/Computer-Aided Manufacturing Dentistry: A Review. 

What materials you use for restorative work affects your results. We explore the pros and cons of the types of materials available and the indications of today's chairside CAD/CAM materials. 


Chairside CAD/CAM Materials: What Are the Pros, Cons, and Indications 

Fixing Social Media-Led Mishaps: How to Help Patients Who Hurt Themselves Following an Online Trend | Image Credit: © Yeti Studio - stock.adobe.com

Social media provides excellent access to many fun things, from enjoying cat videos to marveling at epic fails. Unfortunately, it also provides access to health misinformation that spreads rapidly.

Today, we explore the challenges many clinicians face in combating the damage of social media’s health misinformation and offer practical tips that can get patients the answers they seek from a reliable source.

Social media has changed how people of all ages seek and exchange health information. A 2022 study in the 

 reports that as many as 75 percent of people go online for health information worldwide.

Going to social media for health information has a few concerns. First, while these online sources can provide credible evidence, some use clickbait titles and sensationalized content to attract readers. Also, businesses pay for ad placement on YouTube and other platforms, which affects how content is pushed to viewers and influences what users see and in what order. Additionally, product videos, which have a specific agenda regarding their message, are typically shorter than educational ones, and research indicates shorter videos get more views than longer ones.

The volume of searching combined with the popularity of sensationalized and promoted videos that are product- rather than education-focused, creates a breeding ground for health misinformation.

Inaccurate or misleading health-related assertions lacking scientific backing are not just a nuisance. They are a serious threat, posing significant challenges to public health efforts.

Jason Goodchild, DMD, vice president of clinical affairs at Premier Dental Products Company, says the problem is compounded by the general public's easy access to dental equipment and materials online. Anyone can buy dental equipment without a license on auction sites and other online retailers, from curing lights to drills to curettes and explorers, among other dental tools and materials. This access takes DIY dentistry to a whole new level, he says.

“It’s amazing what you can buy off the internet without being a dentist,” Dr Goodchild says.

What Are Some Examples of These Social-Media-Led mishaps?

In dentistry, the prevalence of misinformation has escalated, with articles promoting homemade remedies and incorrect dental advice gaining traction.

compiled by the University of Pennsylvania UPenn School of Dental Medicine

Some social media influencers advocated for patients to file down uneven teeth in the anterior with an emery board, usually used to file fingernails.

Multiple influencers have claimed that oil pulling or swishing with oil, such as coconut oil, for 10 to 20 minutes will protect your teeth from decay.

Many people have DIY solutions for teeth spacing problems, from wrapping rubber bands around the anterior teeth to closing a diastema to putting on or removing brackets and wires.

compiled a list of dental misinformation that they, too, found online:

Using household cleaning products to whiten teeth: 

TikTok user @theheatherdunn advocated using pieces of Mr. Clean Magic Eraser to whiten teeth, dismissing potential dental concerns.

 A TikTok user wrapped her front teeth with elastic hair ties to close a gap, risking tooth loss and gum inflammation.

Making prosthetic teeth and partial dentures with art supplies:

 TikTok users molded InstaMorph beads into prosthetic teeth, which are not FDA-certified for dental use.

 Some individuals file their teeth into narrow pegs for crowns or veneers, risking permanent damage.

 Users glued vampire fangs to their teeth with toxic adhesives, ignoring the risks of permanent damage.

Bleaching and Flossing with Unusual Materials:

 Users applied hydrogen peroxide directly to their teeth for whitening and promoted flossing with human hair, demonstrating a disregard for dental safety and professional advice.

So, What Should You Do If a Patient Comes in with DIY Dentistry?

In some cases, there might be trauma involved, so the first order of business is to stop the damage. The International Association of Dental Traumatology has guidelines that can help. (View their guidelines for fractures and luxation in 

Dr Goodchild is thankful he doesn’t treat many DIY dentistry mishaps in his operatory. He suspects that part of the reason he doesn’t is that the people who undertake these DIY or social-media-led treatments do so because they don’t have a relationship with a dentist.

However, he does have patients who tell him about something they saw online, and they ask him questions about it. Dr Goodchild considers this an excellent opportunity to open a dialogue about some dental treatments his patients might want to know more about. It also allows Dr Goodchild to communicate that addressing these concerns in the dental office is much safer and healthier than at home without dental training.

Additionally, these discussions give patients an idea of what these treatments might cost. Dr Goodchild thinks that patients do not always know what is possible in modern dentistry treatment or how affordable some solutions are. He says that having these one-on-one discussions about oral health or cosmetic concerns, and setting proper expectations about the financials can provide the information the patient needs to make a better-informed decision.

“If the patient has rough edges on their teeth or wants to make the edges smoother or a little straighter and is looking to use an emery board to fix it at home, I wish they knew they can also do that painlessly and properly at the doctor’s office. Sometimes, I don’t charge for something as easy as that,” Dr Goodchild says.

Additionally, Dr Goodchild says that some people don’t realize that following these trends can cause significant and irreversible damage to their oral health.

“As obvious as it is to us in the dental profession, a lot of people don’t realize that enamel doesn’t grow back,” he says.

Dr Goodchild explains to patients that if they file too much enamel off the edge of their tooth, it’s not coming back. Or, if they damage the root or aggravate the gums with DIY orthodontics, there can be pain and discomfort, and the trauma caused can jeopardize the tooth's health. Moreover, he tells them that the treatments to correct damage caused by DIY dentistry can be costlier than the initial treatment would have been and will require more time at the dentist’s office, which the DIY dentist was trying to avoid.

While social media offers valuable educational resources, the abundance of false material impedes efforts to prevent and manage chronic diseases, including oral health issues. Dentists and dental organizations must address this challenge by providing accurate, evidence-based information and promoting patient oral health literacy.

echoes this sentiment. The research team concluded that oral healthcare professionals are responsible for educating patients on the importance of fact-checking articles before relying on them for oral-health-related information.Moreover, the research team suggests that dentists should prioritize staying on top of these social media trends to address misconceptions about oral healthcare with patients.

Some dentists have taken the initiative to make science-based educational videos to counteract misinformation. Dr Goodchild thinks that many of these videos are high-quality and well-executed. He also recognizes that producing quality content takes time, so he appreciates the efforts of those clinicians who have undertaken the task of providing a counterpoint.

“It helps with balanced reporting,” Dr Goodchild says.

Dental professionals can also promote accurate information and empower patients to distinguish between credible and misleading content. Confirming the credibility of dental health content requires attention to several elements, like verifying sources and ensuring the publishers don’t have a conflict of interest. Perhaps most importantly, clinicians should encourage their patients to come to them with questions about DIY dental treatments they saw on the internet.

Dr Goodchild also thinks that if patients want help, most dentists will find a way to help them. He jokes that he sometimes gives away too much dentistry because it feels good to help people when possible. However, these gifts have a way of coming back full circle, he says, through referrals and life-long relationships.

“If nothing else, you have good rapport with patients,” Dr Goodchild says, “so they talk to you and don’t go online looking for DIY solutions.”

1. Ruiz M, Kabani F, Cotter J. A review of the effects of oral health media hype on clients' perception of treatment. 

. 2022;56(1):31-38. Published 2022 Feb 1.

2. Alhomsi A, Aldoss H, Aljoujou AA, et al. Exploring How People Interact With Dental Misinformation on Social Media: A Cross-Sectional Study. 

. 2024;16(3):e56625. Published 2024 Mar 21. doi:10.7759/cureus.56625

4. 7 dangerous dental trends from TikTok. 

7 dangerous dental trends from TikTok | Delta Dental

5. Bourguignon C, Cohenca N, Lauridsen E, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dent Traumatol 2020;36(4):314-330. https://doi.org/10.1111/ edt.12578.

6. Ruiz M, Kabani F, Cotter J. A review of the effects of oral health media hype on clients' perception of treatment. 

. 2022;56(1):31-38. Published 2022 Feb 1 

Let’s explore the challenges of patients consuming health misinformation on social media and offer practical tips to help them find out what they want to know from a reliable source.

Fixing Social Media-Led Mishaps: How to Help Patients Who Hurt Themselves Following an Online Trend

Remineralization and Early Lesion Treatments: What Are Some Options to Consider? | Image Credit: © Infinite Gallery - stock.adobe.com / Generated with AI

Dentists often have to choose whether or not to drill into a tooth when they see an early lesion. These decision trees are complicated and influenced by many factors.

However, if an early lesion is detected and operative treatment is not performed, “monitoring” or “watching” the lesion is likely insufficient to provide the best outcome for the tooth.

Remineralization of tooth structure is a conservative but active plan to manage early lesions. Today, we look at the goals of remineralization and the products that can help get you there.

When acid attacks the tooth's enamel, acid made of H+ ions seeps into it and dissolves its most soluble salts, like carbonate apatite and non-stoichiometric apatite crystals, creating the lesion boundary. The lesion boundary moves forward as the damage advances, creating high levels of calcium and phosphate ions in the tooth. These dissolved ions exit the tooth, following a concentration gradient where they can bind with fluoride at the surface and form a new, dense layer of minerals.

Adding new minerals to a damaged tooth to fill holes strengthens the tooth. However, remineralization requires calcium and phosphate ions from an outside source to fill the gaps in the damaged enamel, which needs these concentrations to be higher than what's already in the damaged area. These ions move into the tooth through tiny holes and spaces. However, it is essential to get this flow just right; if they are too concentrated, they block the holes in the tooth's surface, preventing more ions from entering.

Various studies show fluoride improves enamel remineralization. However, when dealing with dental decay, any treatment aiming to remineralize teeth should adhere to 2 important principles:

Controlling dental plaque is imperative for success.

Fluoride use in remineralizations can either stop existing cavities from getting worse or slow down the development of new ones.

Nathaniel Lawson, DMD, Ph.D., assistant professor and director of the Division of Biomaterials at the UAB School of Dentistry, says if a lesion has not yet been cavitated, remineralization is the most conservative treatment to attempt, as long as the patient or their caretaker can perform it. However, he says determining when cavitation occurred is a little more challenging for interproximal and occlusal pit caries.

In the cases where Dr Lawson undertakes remineralization, he likes the home hygiene approach. There are a couple of reasons for this.

“I use 5000ppm fluoride toothpaste for this effort, rather than regular toothpaste, which is 1000ppm,” Dr Lawson explains. “I use this treatment because it is easy for the patient to obtain, meaning they can buy it from my office or get it from a pharmacist, and it is easy to use. They use it just like regular toothpaste.”

Studies have shown fluoride treatments, like rinses, can significantly increase remineralization effects on nearby areas affected by cavities compared to other methods. Fluoride varnish can be a valuable addition to preventive care for adult patients, potentially avoiding surgical intervention in those at lower risk for cavities. Community-based studies have found that biannually applying acidulated phosphate fluoride gel can reverse early cavities.

In addition to fluoride, non-fluoride compounds like casein phosphopeptide (CPP) have shown promise in remineralizing tooth surfaces. CPP stabilizes calcium phosphate in solution, allowing high concentrations of calcium and phosphate ions to penetrate subsurface lesions and promote enamel remineralization. Studies have confirmed that CPPs can effectively promote remineralization of early enamel lesions.

When it comes to remineralization agents, with or without fluoride, the desirable characteristics include:

The chosen remineralizing agent should quickly add minerals to the tooth surface, even if it means losing some.

It should rapidly change the deposited minerals into a stronger type called fluorapatite.

To finish the remineralization process, the agent should quickly spread over the tooth surface and into any areas below.

This process should happen even in patients at high risk for cavities.

So, What Are Your Options for Remineralization Therapy?

There are quite a few, it turns out. Dr Lawson thinks clinicians could also consider other options than high-fluoride toothpaste, which include:

 This product has an even higher concentration of fluoride than high-fluoride toothpaste, around 22,000 ppm, and is applied every 6 months.

Calcium-phosphate gels (e.g., MI Paste): 

These gels contain the ions present in the mineral of teeth (hydroxyapatite).

This option has become popular. Some laboratory trials on these products indicate they can remineralize similarly to fluoride toothpaste.

 This product from Young Innovations contains peptides to help rebuild enamel with embedded ions that are present in saliva.

 To be clear, Dr Lawson points out that this method is not remineralization; instead, it involves replacing missing mineral content with resin.

 also provides a helpful summary of many options for remineralization therapy, starting with an overview of acidated fluoride products.

, including mouth rinses, gels, and foams, are available. Dental materials manufacturers developed these products to address a limitation of traditional fluoride treatments in remineralization therapy. High-concentration fluoride products often lead to surface-zone remineralization, leaving the deeper parts of the lesion untreated. By lowering the pH of the fluoridated vehicle, such as mouth rinse, or gel, mineral ions can penetrate deeper into the lesion, enabling full remineralization. The low pH environment also encourages calcium and fluoride release from bacterial sources, further enhancing remineralization.

 employs self-assembling peptides (P11-4) to regenerate early caries lesions. In this innovative approach, applying the P11-4 monomers to early caries lesions means they permeate the micro-pores of the lesion and organize themselves into a 3D matrix (scaffold) under high ionic strength conditions. This scaffold then attracts calcium phosphate from saliva, serving as a template for forming new hydroxyapatite crystals around the matrix. Essentially, this process initiates biomimetic mineralization, facilitating the regeneration of enamel and dentin. Remineralization of the treated lesion typically requires several weeks to complete.

 incorporates the amino acid arginine into toothpaste formulations, typically at a concentration of 1.5%. This toothpaste also contains insoluble calcium carbonate and 1450 ppm fluoride as sodium monofluorophosphate, tailored for remineralizing early caries lesions and preventing new ones. When used, arginine undergoes deamination by saliva enzymes, producing ammonia, which increases oral pH, promoting remineralization and reducing plaque pathogenicity. The fluoride ions from sodium monofluorophosphate and calcium from calcium carbonate further enhance remineralization.

Functionalized tricalcium phosphate (TCP) technology

 is in toothpaste and fluoride varnishes. These products enhance remineralization through improved formulations and the addition of calcium to complement fluoride. Milling β-tricalcium phosphate with organic materials protects the calcium oxides in TCP, allowing coexistence with fluoride ions without premature interactions. Organic materials, such as surfactants, carry the calcium to the tooth surface, where saliva activates it, releasing calcium and fluoride for remineralization.

 in toothpaste, sealants, composites, and barrier coats. These fillers utilize a ligand exchange mechanism to release and recharge fluoride ions, providing sustained fluoride release influenced by acidity. They also release various other ions at high concentrations, such as aluminum (

. This multi-ion release capability imbues materials containing SPRG fillers with several therapeutic effects, including pH modulation to neutral or weak alkaline conditions, which is ideal for lesion remineralization. The released fluoride and silica promote apatite formation in oral fluid like saliva, while Sr2+ may enhance tooth acid resistance by converting hydroxyapatite to strontiumapatite.

, such as Novamin™, does not contain fluoride. Sodium monofluorophosphate is added separately, risking premature calcium and fluoride reactions to form calcium fluoride (CaF2), which may hinder fluoroapatite formation. Innovators incorporated fluoride, strontium, potassium, and zinc to create fluoride-containing bioactive glass toothpaste. This step enables the simultaneous delivery of Ca2+, PO43−, and F− ions in appropriate amounts for fluoroapatite formation without CaF2 formation. Originally, dentifrice formulations used bioactive glass formulations to treat dentin hypersensitivity by forming a surface layer of hydroxycarbonate apatite on teeth, occluding dentinal tubules. Fluoride-containing bioactive glass serves as a remineralizing additive, releasing fluoride, strontium, zinc, and potassium ions for caries remineralization, prevention, and bactericidal properties. These products release fluoride over 12 hours, forming more stable fluorapatite, aiding in remineralization and acid resistance.

Nanohydroxyapatite-containing toothpaste and oral rinses,

 designed for remineralization and caries prevention, contain nanohydroxyapatite (nHAP) ranging from 5-20%, tailored for remineralization, caries prevention, or dentin hypersensitivity treatment. Other calcifying toothpaste and oral rinses combine nHAP with fluoride for remineralization and caries prevention or with stabilized chlorine dioxide for whitening. Nanohydroxyapatite, a biocompatible material, fills micropores in early caries lesions, acting as a template for remineralization by attracting calcium and phosphate ions from oral fluids and promoting crystal growth. When combined with fluoride, nHAP lowers bioavailable fluoride concentration, with NaF being a slight concern compared to sodium monofluorophosphate.

 has gained attention as a caries-preventive agent. A 38% SDF solution effectively arrests coronal caries. In randomized clinical trials, annual applications of SDF halted more active initial caries and reduced new caries formation compared to quarterly applications of NaF varnish. SDF not only arrests caries progression but exhibits antimicrobial properties and an affinity for tooth tissue's mineral and organic components.

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)

 and fluoride-containing CPP-ACFP, found in products like Tooth Mousse and MI Paste, are designed to promote enamel remineralization and prevent tooth decay. These nanocomplexes bind to tooth surfaces and dental plaque, increasing the concentration of bioavailable calcium and phosphate ions in the oral biofilm. This process aids in remineralization and alters the dynamics of demineralization-remineralization events, effectively preventing caries development. Studies show that these nanocomplexes can penetrate early caries lesions, releasing calcium and phosphate ions to fill crystal voids and form hydroxyapatite or, in the presence of fluoride, fluorapatite. Clinical evidence strongly supports their remineralizing efficacy, making them valuable tools in dental care for combating early caries and promoting overall enamel health.

 enhances plaque-calcium concentrations. In a caries clinical trial, combining it with sodium monofluorophosphate (SMFP) in toothpaste proved more effective than SMFP alone, suggesting its role in elevating plaque-calcium levels.

is another active ingredient featured in oral hygiene products. Research suggests that theobromine exhibits comparable remineralization effects despite being 71 times less concentrated than fluoride. It's proposed that theobromine enhances apatite crystallite size and crystallinity in the presence of saliva.

Remineralization options are abundant. In some cases, remineralizing might be the best option, providing a conservative way to treat the early stages of disease.

1. Carey CM. Remineralization of Early Enamel Lesions with Apatite-Forming Salt. 

2. González-Cabezas C, Fernández CE. Recent Advances in Remineralization Therapies for Caries Lesions. Advances in Dental Research. 2018;29(1):55-59. doi:10.1177/0022034517740124

3. “Early Carious Lesions Treatment Considerations.” AADC Permissions Committee. Available at: 

https://s3.amazonaws.com/amo_hub_content/Association1002/files/AADC%20Position%20Statement_%20Early%20Carious%20Lesions-%20Treatment%20Considerations.pdf

4. Daruich PM, Brizuela M. Remineralization of Initial Carious Lesions. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: 

https://www.ncbi.nlm.nih.gov/books/NBK573067/

5. Amaechi, Bennett. (2015). Remineralization Therapies for Initial Caries Lesions. Current Oral Health Report. 2. 10.1007/s40496-015-0048-9.

Let's take a look at the goals of remineralization and what products can get you there for those early lesion cases you want to treat before you have to drill and fill them.


Remineralization and Early Lesion Treatments: What Are Some Options to Consider?

Patient disappointment with whitening treatment manifests in many ways. Maybe the patient is subtle, using body language or subconscious signals, like the set of the patient’s mouth when they first see the results or an almost undetectable squint of their eyes.

You can also detect disappointment in phrases like, “Oh, I thought it would look different than this,” or “Is it going to get brighter after I leave?”

Disappointment could also appear in a rant on social media or in a less-than-flattering online review.

Regardless of how you hear about it, disappointment with whitening treatments is never the outcome you want. We explore ways to avoid patient disappointment with whitening treatments in your dental practice.

We explore ways to avoid patient disappointment on the back end of teeth whitening treatments by managing unrealistic patient expectations on the front end. 