This course describes the impact dental professionals have beyond the oral cavity through a discussion of novel concepts of periodontal disease. Topics covered include: bacterial invasion of the gingiva, gingivitis details, oral-systemic connections, risk factors, periodontal maintenance, total inflammatory burden, and providing individualized periodontal care through bacterial DNA testing.

Program Format Note: This program is offered in both a Text based format (PDF) and an Audio Video Webinar format (Interactive).

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Endodontic treatment has evolved greatly over the last two decades and has a high success rate when performed apropriately. The goal of endodontic treatment is the three dimensional cleansing, shaping, and obturation of the canal space from the canal orifice to the minor constriction of the apical foramen. It is generally considered that the single most important success factor in endodontic treatment is root canal preparation — the cleansing and shaping of the root canals prior to obturation. The mechanical shaping of root canal systems has been accomplished with a wide variety of methods and instruments. Canal instrumentation by hand was the first technique to be implemented and is still used today. Rotary nickel titanium (RNT) files became commercially available in the early 1990s for canal enlargement, and today RNT methods predominate in the developed world and among specialists. The use of RNT has enabled more centered canal preparations and fewer canal aberrations during preparation compared to previous techniques, and is efficient, systematic and safe when used appropriately. Depending on the design of RNT files, they can be more or less efficient and more or less resistant to breakage. File fracture can be the result of the properties of the alloy itself, and/or the clinician’s technique. RNT files are available as traditional ground nickel titanium files and as twisted files (TF). TF are the first RNT that can be efficiently and safely used as a single file technique, and offer different physical properties to traditional ground RNT. Regardless of the method and technique selected, the clinician must use an appropriate technique and great care when performing endodontic procedures.

Abrasion of teeth involves an abnormal mechanical process that results in enamel, dentin and cementum being worn away over time. Susceptibility to abrasion is increased in the presence of erosion of the surface of the tooth, which results in softening of the tooth structure. Professional dental care is aimed at preventing disease and restoring oral health for patients with oral disease. The appropriate use of professional and home use oral care products is required to achieve these objectives. Careful selection of polishing techniques is required by the dental clinician to ensure optimized stain removal, polishing and preservation of surface integrity, and the oral care regimen recommended to patients for home care must also consider the risk of abrasion.

Root canal treatment is necessitated by endodontic disease, which is, in turn, a product of bacteria. Thus, the detection, management, and elimination of bacteria are of primary importance to the dental clinician. Every RCT procedure begins with a thorough diagnosis, including a complete clinical and radiographic examination. Following that, treatment of root canal systems consists of two phases: cleaning and shaping the access cavity to the canal, followed by its obturation. There are generally accepted sizes and shapes for the access cavity depending on the location of the tooth in question, but every case has its own unique requirements. The most common mistake in this stage of the process is to make the access cavity too small. Irrigants are essential when it comes to dissolving tissue, flushing bacteria, and cleaning the canal. Sodium hypochlorite (NaOCl) is the most widely used, often in combination with ultrasonic activation, although other irrigants, such as chlorhexidine and electrolyzed oxidized water, have their benefits as well. The second half of RCT, obturation, minimizes empty space inside the canal system and seals the canal. A monoblock of obturating material is recommended for a proper seal. Without this, even the best RCT procedure is undone. This article also includes a case study.

Researchers have developed multiple tooth-colored restoratives in the search for a material that has optimal strength, esthetics, handling properties and a preventive function. Materials currently available include glass ionomer-based materials, composite-based materials, compomers, giomers, and the use of nanotechnology for composites and nanoionomers. Each offers benefits for the individual patient case.

The widespread use of latex products in barrier infection control products has resulted in an increasing number of allergic reactions in patients and healthcare workers. There are several types of immune responses to latex that can occur, including life-threatening anaphylactic shock. Tests can determine whether or not a person is sensitive to latex, and the type of immune response. Latex sensitivity is particularly prevalent in healthcare workers and patients with Spina Bifida. If latex sensitivity is suspected in a patient or healthcare worker, alternative products that are latex-free must be used.

Today's clinician is extremely dependent on the handpiece to sustain a smooth-running practice. The handpiece is an incredibly sophisticated device that requires a diligent maintenance protocol to keep it running properly and safely; routine, repeated heat sterilization has the most adverse effect on the dental handpiece. Perhaps due to this dependency on handpieces, combined with the damage resulting from repeated routine sterilization and teh need for consistent maintenance, the handpiece has earned an undeserved reputation for excessive breakdowns. The dental team can keep handpieces functioning smoothly longer, and maximize the return on the significant investment the dentist has made in handpiece technology, through appropriate maintenance procedures. Careful selection from repair options is also required.

Modern general anesthesia and conscious sedation procedures are predictable, effective, and safe with appropriate patient selection, drugs and techniques. The use of conscious sedation in dentistry in office-based settings continues to increase. Nitrous oxide is the most commonly used inhalation anesthetic (sedative) used in dentistry, and has withstood the test of time with an excellent safety record. It reduces anxiety, pain, and memory of the treatment experienced, and is a valuable component of the armamentarium available to clinicians.

All dental procedures provide an opportunity to transmit infectious pathogens directly or indirectly between patients and workers. The pathway of disease transmission between people is referred to as the “chain of infection,” and infection control programs focus on breaking this “chain.” This educational course addresses hand hygiene, instrument processing, environmental asepsis, and use of personal protective barriers relative to breaking the chain of infection, undertaking sequenced processes of cleaning prior to disinfection or sterilization, and using appropriate products correctly. Single-dose and disposable products as alternatives to bulk or re-usable items and their roles in addressing the goals of safety and efficiency are also considered.

Autism can severely impair the patient’s ability to communicate, interact with others and maintain normal contact with the outside world. Symptoms can range from very mild to very severe. One in 150 individuals is diagnosed with autism, with more than 24,000 children diagnosed each year. There is as yet no definitive etiology for autism. It is important that dental professionals seek out patients with autism and be able to recognize the signs and symptoms of autism spectrum disorders, both to refer patients to appropriate medical care, if necessary, and to enable dental treatment of these patients. Treating patients with autism can be both challenging and rewarding for dental professionals. It is crucial to introduce the patient to the dental environment and patient-appropriate care in a slow and gentle manner that builds trust and cooperation. Caries risk must be part of the initial assessment, and it is important that both the parent/caregiver and patient be introduced to a viable home care regimen that is tailored to the patient with autism.

Appropriate infection control in the dental office setting is essential to prevent the transmission of diseases. In California, the regulations on minimum infection control are administered by the California Dental Board. This course will address the potential routes of transmission for pathogens, the chain of infection and how this can be broken. Personal protective equipment, immunizations, instrument processing, and the treatment of clinical contact and housekeeping surfaces are discussed, as well as the treatment of sharps, dental unit water lines and impressions.

The current approach to dental caries focuses on modifying and correcting factors to favor oral health. Caries management by risk assessment (CAMBRA) is an evidence-based approach to preventing or treating dental caries at the earliest stages. Caries protective factors are biologic or therapeutic measures that can be used to prevent or arrest the pathologic challenges posed by the caries risk factors. Best practices dictate that once the clinician has identified the patient’s caries risk (low, moderate, high or extreme), a therapeutic and/or preventive plan should be implemented. Motivating patients to adhere to recommendations from their dental professionals is also an important aspect in achieving successful outcomes in caries management. Along with fluoride, new products are available to assist clinicians with noninvasive management strategies.

Infection prevention is a key process in the dental office for the protection of patients and dental healthcare workers. The cycle of infection prevention is aimed at breaking the chain of infection, achieved by following a rigorous process with a series of clearly-defined steps. Only if the process is followed can there be an assurance of adequate infection control in the dental office setting.

Most of the commonly performed tasks in dentistry have benefited from the development of modern dental adhesives, which are used for a wide range of applications. Dental adhesives enable minimally invasive dentistry. It is believed that dental adhesives can reinforce weakened dentin or enamel, reduce marginal staining, reduce microleakage, and may also reduce postoperative sensitivity when used appropriately. The resin-based adhesive systems developed to date can be categorized as one of two types: etch-and-rinse (total-etch) adhesive systems and “selfetch” adhesive systems. Both systems result in a unique interface at the juncture of tooth surface and adhesive. In the last decade, most new developments in dental adhesives have been focused on simplifying the components required for the bonding systems and improving performance of the resulting self-etching adhesives. Enamel bonding is superior with etch-and-rinse adhesive systems, while self-etch systems may be more suitable for restorations with large areas of dentin. Careful consideration of several factors is essential in selecting an adhesive system.

The esthetics, strength and longevity of composite restorations are prime considerations for clinicians and patients. In order to select a composite shade and chairside technique, an understanding of the influence of dental anatomy and light on color/shade is necessary, as is knowledge of the desired physical attributes and technique options available. Current composites offer reliable esthetic solutions, improved physical attributes and simplified solutions.

Temporization has become an increasingly common procedure, and may be required short-term or as an interim medium-term step. Excellent provisional restorations are a key component for the clinical success of definitive fixed restorations. Temporization requires consideration of the complexity of the case, length of time the provisional restoration is required, and esthetics. Indirect techniques offer reduced chairside time in comparison to direct techniques. Options for direct temporization have increased in recent years with the introduction of new materials and techniques.

Oral irritations and ulcerations occur frequently in the general population. Recurrent aphthous ulcers (RAU) are the most common. There are three types of RAU — minor, major and herpetiform, the most common being minor aphthae. The exact etiology of RAU is not known. Systemic and local factors, as well as infectious agents, have been proposed. Certain medications and foods are associated with oral ulcerations, and chemicals such as sodium lauryl sulfate (SLS) contained in dentifrices have also been implicated. RAU also occur in more serious systemic diseases and where appropriate patients should be referred for screening and medical care. Treatment of recurrent aphthous ulcers is palliative, based on the severity of the lesions. Both topical and systemic medications are available. Nutritional and oral hygiene advice should also be given, and if patients are sensitive to SLS, a low-dose SLS or SLS-free dentifrice should be recommended.

Dental erosion is a prevalent condition that occurs worldwide. It is the result of exposure of the enamel and dentin to nonbacterial acids of extrinsic and intrinsic origin, whereby mineral loss occurs from the surface of the tooth. The most frequently affected areas are the palatal surface of maxillary incisors and the occlusal surface of the mandibular first molars in adolescents. Characteristic early signs of dental erosion include smooth and flat facets on facial or palatal surfaces, and shallow and localized dimpling on occlusal surfaces. Early intervention is key to effectively preventing erosive tooth wear. Effective prevention of dental erosion includes measures that can avoid or reduce direct contact with acids, increase acid resistance of dental hard tissues and minimize toothbrushing abrasion.

 Dentinal hypersensitivity is characterized by a short, sharp pain in response to stimuli. Dentinal hypersensitivity, which is more commonly seen in adults in the 20- to 40-year-old age group, has several etiological factors. Gingival recession and enamel loss both contribute to the prevalence of this condition, resulting in the exposure of dentin. Dentinal hypersensitivity is believed to occur due to the movement of fluid within the dentinal tubules occuring in response to thermal, chemical, tactile and evaporative stimuli, in accordance with Brännström’s Hydrodynamic Theory. Treatment options include in-office procedures and homeuse, self-applied products that are aimed at either occluding the dentinal tubules or preventing neural transmission and thereby blocking the pain response.

It is important to have a clear picture of how a child is changing dentally and skeletally throughout his or her growth period. In fact the American Association of Orthodontists recommends that every child have an orthodontic examination by the age of seven. The early treatment examination in the mixed dentition enables the practitioner to identify problems at an early stage, and to determine when to commence treatment and/or refer patients to an orthodontist. Things to look for during a mixed dentition examination include crowding of permanent teeth, excessive overjet or overbite, missing primary teeth needed or space maintenance, supernumerary teeth, skeletal discrepancies, habits, airway problems, and eruption path problems.

In order to meet the challenges of safety, time management and asepsis, the dental health care provider must have a plan for infection control, including the use and care of dental instruments and disposables. Following the basic CDC guidelines can help to significantly reduce the risk of microbial transmission. After the patient is dismissed, the operatory must be prepared for the next patient, including the treatment of surfaces and instrument processing. There is a variety of methods available to properly reprocess instruments. Choosing a system that minimizes risk, maximizes productivity and preserves instruments is essential.

Tooth extraction or tooth loss can often result in both alveolar ridge resorption and soft tissue collapse. Preservation of bone volume and soft tissue height at the time of tooth extraction is an important procedure that can facilitate implant placement and ensure that proper restorative goals are met. Proper management of extraction sites at the time of tooth extraction can reduce or eliminate the future need for advanced ridge augmentation procedures prior to implant placement. In addition, poor extraction site management may lead to esthetic and functional prosthetic complications.

When compared to their ancestors, composite restorative materials possess superior physical properties, come in a full range of vital shades and opacities, and polish to a gloss-like luster. Many of these materials are considered universal, suitable for both posterior restorative and esthetic anterior applications. Several factors have contributed to current trends in restorative and cosmetic dentistry. The latest advances in adhesive and restorative materials have led to the ability to use less invasive treatment modalities to yield highly esthetic and durable restorations, and the combination of minimally invasive techniques and modern biomimetic restorative materials has proven to be the state-of-the-art solution for practitioners and patients. Whereas early brands of composite offered only “body” shades based on the Vita shade guide and appeared dull and dense, contemporary materials offer an expanded range of shades and varying opacities designed specifically for layering of direct restorations. Recognizing the distinction in thickness, color and morphology of natural dentin and enamel, it is necessary to replicate these histological tissues in composite restorations. This requires the use of composite formulations that are optically similar to each layer, and sculpting these materials replicates the morphology of each in the area being restored.

Water fluoridation heralded the use of fluoride as an anti-caries agent. Since that time, both systemic and topical fluoride have become available and the use of fluorides has contributed greatly to reducing the level of caries seen in the population. Systemic fluoride supplements are available as tablets and drops, for use in accordance with the recommendations on fluoride supplement dosing.Vehicles for topical fluorides include in-office fluoride varnishes, gels, and foams, and home-use fluoride dentifrices, rinses and prescription products. The primary mechanisms of action involved with the use of topical fluorides are the prevention of demineralization and promotion of remineralization, by ensuring the ready availability of intra-oral fluoride.

Considerations in selecting an appropriate in-office and home-use topical fluoride protocol for individual patients include the patient's age, caries risk level, exposure to fluoride from all sources, and the current recommendations on professionally-applied topical fluorides. Other important considerations include product efficacy and safety, the patient's dental status as well as compliance with brushing and age-appropriate use of fluoride toothpaste, and clinician and patient preferences.

Chronic hand and wrist pain that can affect quality of life, productivity or career longevity is experienced by between 40 and 70 percent of dental professionals. Given that fewer dental professionals fully recover from hand pain than they do from neck, shoulder or elbow pain, it is imperative that injury be prevented. There are a number of risk factors for carpal tunnel syndrome that must be considered, as well as research-based ergonomic interventions. The use of ergonomic equipment and implementation of prevention techniques outside the operatory can help to reduce work-related pain and extend the career of the dental professional.

Hand hygiene is important for the protection of patients and healthcare workers, and the Centers for Disease Control and Prevention issued recommendations in 2003 that specifically includes guidelines for hand hygiene in dental settings. Several options exist for hand hygiene prior to nonsurgical dental procedures, and the selected method may vary according to the level of contamination, the desired antimicrobial activity and the type of procedure. The most significant difference between hand hygiene for routine procedures and for surgical procedures is the need for persistent antimicrobial activity in products used for surgical hand antisepsis. Appropriate selection of products as well as appropriate hand care helps prevent adverse effects related to hand hygiene in the dental setting. Selecting the products that suit the types of procedures performed in a given practice, and the needs of the healthcare personnel in that practice are important considerations. It is likely that a combination of soap, alcohol-based hand sanitizer and lotions will be required to meet the needs of all individuals.

 Dental handpieces and burs are among the most frequently used mechanical devices in dentistry. Handpieces have evolved from primitive cutting tools introduced in the nineteenth century to highly efficient and sophisticated devices. Traditional handpieces are either air-driven or electrically driven. A more recent introduction utilizes technology from both air-driven and electric handpieces, and includes a control mechanism to adapt torque to clinical situations. Burs for dental procedures typically are fabricated from tungsten carbide or diamond particle coatings, with ceramic and zirconia burs also available. Bur designs include many configurations and sizes, with bur selection depending on the type of procedure, the clinician’s preference and the bur’s overall effectiveness. The selection of an appropriate handpiece and appropriate burs is key for the safe and effective removal of dental hard tissues and caries in an efficient manner that also maximizes ergonomics for the clinician and minimizes patient discomfort. Handpieces and burs become contaminated during dental procedures. To prevent any risk of cross-infection from these devices, all handpieces and burs should be heat sterilized between patients in accordance with the recently published, updated guidelines from the Centers for Disease Control and Prevention.

Reflecting improvements in oral health as well as changes in treatment modalities and patient expectations and preferences, the majority of current baby boomers in the United States will retain their natural teeth for life. The impact of an extraction varies with location, and options may include saving the tooth through endodontic treatment or extracting the tooth and placing an implant. Both implant therapy and endodontic therapy have good success rates. With both endodontic and implant therapy, success factors and considerations include the patient’s systemic and oral health, choice of materials, and technique used. A patient’s general health status may dictate which treatment is appropriate, overriding other factors. Considerations include medication use, infection risk and more generally the patient’s ability to withstand the treatment. Oral health considerations include caries experience, periodontal health, alveolar bone, occlusal load and bruxism, parafunctional habits, health of the remaining dentition, and the presence of or need for fixed prostheses. Determination of the appropriate treatment requires careful consideration of these and potential outcomes, with the patient participating in the process.

Government agencies regulate and make recommendations on instrument processing and occupational safety. There are a number of requirements and necessary steps involved in instrument processing, including preparation, cleaning and packaging of instruments for sterilization. The use of cassettes reduces the risk of exposure injuries for the operator, while simplifying and streamlining the process. There is a variety of instrument sterilizers for dental office settings including steam sterilizers (autoclaves), chemiclaves and dry heat sterilizers. Each has different features, advantages and disadvantages that must be considered when selecting sterilization equipment for your practice. Monitoring sterilization processes for sterility assurance requires the regular use of mechanical, chemical and biological indicators to assure that these processes and the equipment are providing effective sterilization. Sterility assurance monitoring must be documented to show compliance with regulations governing your practice.

Lasers were first conceived of almost a century ago and were introduced into dentistry in 1989. Several types of dental lasers are now available, with the diode laser being of particular interest for the orthodontic clinician. It is now possible to treat many soft tissue conditions that present as challenges in orthodontics and can impact the overall aesthetic outcome, and to treat these more easily. Before using lasers, it is necessary to understand how they work, the steps involved in setup, precautions that must be taken (such as eye protection), and troubleshooting steps. Periodontal considerations must also be known and understood. Soft tissue procedures that can benefit from use of a diode laser include frenectomy, gingival recontouring, the removal of hypertrophic tissue, and exposure of a partially erupted tooth.

The posterior restorative material of choice depends on the individual clinical situation and patient. Amalgam has a long history of use and clinical success. Esthetic restorations are increasingly in demand, and include glass ionomers, compomers and composite resins. Fluoride release is a desirable attribute in a restorative material, as are wear resistance, low polymerization shrinkage and low polymerization stress. Recently, technologies have been incorporated into composite resins that lower polymerization shrinkage and stress.

Dental professionals are at risk for noise-induced hearing loss. Often, individuals are not aware that they have hearing loss - their first complaint and the reason they seek a hearing evaluation may in fact be tinnitus. The dental office environment subjects dental professionals to noises associated with handpieces and ultrasonics as well as other dental equipment. Handpieces must be well maintained to reduce the level of noise emanating from them. Hearing protection devices can be used to help prevent hearing loss. Several types are available, and musician's earplugs may be particularly useful as they reduce noise while still enabling the individual to hear and communicate with others.

In the United States in 2007, over 34,000 new cases of oral cavity and oropharyngeal cancer will be diagnosed. The single greatest risk factor for oral cancer in the United States is the use of tobacco. A strong association has been found between oral and oropharyngeal cancer and the presence of HPV in oral tissues. The five-year relative survival rate is estimated at 59.1% overall for oral and pharyngeal cancers diagnosed during 1996–2003. An estimated 85% of oral premalignant and malignant lesions present clinically as leukoplakias. Early detection of oral cancer is complicated by the fact that many lesions in their earlier stages may be completely asymptomatic, and the detection of suspicious lesions is increased through regular screening of patients. Historically, unaided visual examination, palpation, and radiographs were available for oral cancer screening. In recent years, screening technologies have become available that supplement the visual examination. If suspicious lesions are found during the screening procedure, the lesion must be biopsied or the patient referred to a specialist for further evaluation. The ability to identify lesions and to predict which lesions will undergo malignant transformation would facilitate early diagnosis and subsequent disease management tailored to the individual patient. The ultimate goals are to reduce both mortality and morbidity, and to improve patients’ quality of life.

Orthodontic diagnosis must be performed thoroughly prior to orthodontic treatment planning. A number of steps are involved in the diagnostic process, all of which must be performed to reach an accurate diagnosis. The overall steps involved include the patient interview/ consultation, clinical examination and use of diagnostic records. Only after these steps have been performed and analyzed can a treatment plan be developed for the individual patient.

Periodontal disease is more prevalent and more severe in smokers than in nonsmokers. The host response in smokers is altered by a number of factors including increased gingival crevicular fluid, adhesion molecules and genetics. In addition, smokers are poor healers compared to nonsmokers and their response to periodontal therapy can be compromised which can result in continued progression of periodontal disease, or the need for more treatment.

Periodontal disease occurs in the presence of pathogenic bacteria — periodontopathogens or periodontal bacteria — in a susceptible host. The overall objectives of periodontal therapy are to halt disease progression, reduce pocket depths and, ideally, obtain clinical attachment gains. Following active periodontal therapy, periodontal maintenance is key for long-term positive clinical outcomes, involving both in-office maintenance and meticulous home care. Professional care is required to remove subgingival biofilm and deposits, and to prevent periodontal disease progression. The goal of daily oral hygiene procedures for periodontal maintenance is to remove dental biofilm before it matures so as to prevent the development of gingivitis and a mature subgingival plaque. One of the main issues in periodontal maintenance is patient compliance. Consideration should be given to techniques and protocols that aid compliance, and care should be taken to address each patient’s ability and willingness to perform daily oral hygiene as well as to address root caries risk and prevent unwanted sequelae.

The most frequently administered drugs in dentistry are local anesthetics. These provide relief from pain during procedures, leaving inconvenient residual numbness that takes some time to wear off following completion of dental procedures. Recently, a new drug has been approved for acceleration of the reversal of soft-tissue local anesthesia in patients age 6 and older. This new drug adds a new dimension to the pain management armamentarium of dentists.

The first major active ingredient introduced into modernday, over-the-counter dentifrices was fluoride. Since then, dentifrices have been developed with ingredients offering anti-plaque/anti-gingivitis, anti-halitosis, whitening or desensitizing benefits, or a multiplicity of benefits. Given the range of dentifrices currently available, and their differences, a recommendation is important; this should be based on the individual patient’s specific needs and desires and the scientific support for a dentifrice.

Endodontic treatment is a predictable procedure with high success rates. Success depends on a number of factors, including appropriate instrumentation, successful irrigation and decontamination of the root canal space to the apices and in areas such as isthmuses. These steps must be followed by complete obturation of the root canals, and placement of a coronal seal, prior to restorative treatment. Several irrigants and irrigation systems are available, all of which behave differently and have relative advantages and disadvantages. Common root canal irrigants include sodium hypochlorite, chlorhexidine gluconate, alcohol, hydrogen peroxide and ethylenediaminetetraacetic acid (EDTA). In selecting an irrigant and technique, consideration must be given to their efficacy and safety.

Success rates for endosseous dental implants are high. While historically implants were of standard lengths and diameters, implants increasingly became available that were shorter or longer and with wider or narrower diameters, as well as with varying macro-geometric designs. Anatomical considerations may exist that  require either adjunctive treatment prior to implant placement or, instead, the placement of short implants. Recent research has found that length, macro-geometric design and diameter influence the amount of bone that osseointegrates due to differences in surface area, as well as the distribution of forces and resulting stresses. With appropriate selection, high success rates can be enjoyed for both long and short implants where indicated.

Recent exiting discoveries place dentists at the forefront of engaging their patients in potentially life-saving therapies derived from a patient's own stem cells located in deciduous and permanent teeth. Adult stem cells, including dental stem cells, have the potential, like bone marrow-derived stem cells and adipose-derived stem cells, to cure a number of diseases.
In medicine, stem cell-based treatments are being used and investigated for conditions as diverse as Parkinson's disease, neural degeneration following brain injury, cardiovascular disease and autoimmune diseases. Stem cells will be used in dentistry for the regeneration of dentin and/or dental pulp, biologically viable scaffolds will be used for the replacement of orofacial bone and cartilage, and defective salivary glands will be partially or completely regenerated.
Dental stem cells can be obtained from the pulp of the primary and permanent teeth, from the periodontal ligament, and from associated healthy tissues. Exfoliating/extracted deciduous teeth and permanent teeth extracted for orthodontic treatment, trauma or dental implant indications are all readily available sources of dental stem cells. The harvest of these dental stem cells results in minimal trauma. Dental professionals have the opportunity to make their patients aware of these new sources of stem cells that can be stored for future use as new therapies are developed for a range of diseases and injuries.

Modern-day mouthguards and oral applications have been used since the early 20th century. They are currently in use for protection against athletic injuries; the treatment of TMJ, bruxism and sleep apnea; and athletic performance enhancement. The American Dental Association and the American Academy of Pediatric Dentistry both recommend the use of protective mouthguards to help prevent sport-related injury. The treatment of burxism was, in fact, the first use of modern mouthguards and was followed by customized designs for protection of the oral structures and to treat specific conditions. More recently there has been a resurgence of interest in athletic performance mouthguards, which have been found in a number of studies to improve reaction time, muscle strength and sensory functions. The purpose of a mouthguard dictates the materials and designs most suitable for optimal results.

Cone beam computerized technology (CBCT) offers 3-dimensional visualization and more complex and more accurate imaging compared to analog and digital radiographs. It is an accurate tool for many clinical oral-maxillofacial indications, with lower radiation doses than computerized tomography. The clinician must determine the risk:benefit of imaging for each patient. Clinicians are rapidly realizing the significant advantages of CBCT imaging. Factors to consider in determining whether to purchase a CBCT device or to refer patients to imaging centers include cost, training, time required to generate images and reports, data transmission and storage, and responsibility for interpretation and pathology review.

Periodontal disease is progressive and episodic in nature, with tissue destruction resulting from the host response to bacterial antigens and irritants. Risk factors encompass systemic influences, external influences, intrinsic factors and local factors. An individual patient’s responsiveness to treatment also depends on the host response and the presence of risk factors. Adjunctive systemic and/or local therapy can positively impact periodontal therapy. Considerations in determining which to select include clinical preference and efficacy.

Early tooth-colored restorative materials were weak and only suitable for anterior teeth. Over time, composites were developed that offered improved properties enabling their use in posterior teeth where subject to occlusal loading and forces of mastication. Secondary caries is the main reason for failure of both amalgam and composite restorations. Amalgam restorations offer ease-of-use but poor esthetics. In the case of composite restorations, minimizing polymerization shrinkage, wear and discoloration increase the longevity of these restorations. Posterior composite resins offer excellent esthetics, the main driver for patients who prefer composite fillings.

The prevalence of periodontal disease and estimates of provided treatment are indicative of treatment needs. Current technology offers standardized probing, automated charting, risk assessment, differential diagnosis and suggested treatment plans, as well as enabling clinicians to involve patients in the process. Patient awareness and treatment acceptance can be encouraged with full evaluation, a consistent protocol and message, and through the use of technology.

 Tooth whitening removes intrinsic and extrinsic staining. Many tooth-whitening options are currently available, including in-office treatments and home-use products that can be office-dispensed or purchased over the counter. Each type of treatment has its own advantages and disadvantages. Management of potential side effects such as tooth sensitivity and gingival irritation must be considered and managed if necessary. Tooth whitening is safe, effective and desired by patients in our esthetically conscious society.

Following the discovery that fluoride plays a role in the prevention of dental caries, professional topical fluorides were developed. Traditionally, fluoride gels and, later, fluoride foams were used in the US and Canada. More recently, fluoride varnishes were introduced first in Canada, and then in the US where they are cleared for use as desensitizing agents. The use of fluoride varnishes for caries prevention is ‘off-label’ in the US. A recent publication by the ADA Council on Scientific Affairs recommends the use of fluoride varnish or fluoride gel for professional topical fluoride treatments, with the choice depending on patient age and risk category. Due to insufficient evidence, foams are not recommended for professional topical fluoride treatment and there is no evidence to support rinses. Fluoride gel and varnish have both proven to be effective, with only varnish recommended in the under-6 age group. Evidence-based treatment requires that the clinician assess a patient’s risk level prior to treatment, which can be done with formal risk assessment tools such as CAries Management by Risk Assessment (CAMBRA) and the Caries Assessment Tool (CAT).

Dental plaque is a complex biofilm consisting of a polysaccharide matrix containing bacteria, voids and nonvital material of bacterial origin. Both cariogenic and periodontopathic bacteria reside in dental biofilm (plaque). While other factors must also be present for caries or periodontal disease to exist in a patient, without these bacteria neither bacterial disease will occur. The primary goal of toothbrushing is to remove the dental biofilm present on and adjacent to the teeth, thereby removing the bacteria associated with caries and periodontal disease; use of a dentifrice while brushing helps remove plaque and will also deliver agents to the tooth surface. Manual, powered and sonic brushes have all been shown to be effective and safe for the removal of plaque, when used appropriately. Selecting or recommending oral hygiene aids involves a number of considerations, including effectiveness, cleaning ability, ease of use and likely compliance.

Dental professionals commonly review health histories listing medications that identify patients with a diagnosis of acid reflux. It is important that dental professionals identify patients with acid reflux and recommend appropriate dental therapies to protect the long-term health and dentition. Acid reflux is associated with a demineralization action resulting in dental enamel erosion. Dental therapy if required, and oral hygiene advice. Dental professionals are also in a position to identify untreated patients with acid reflux and should refer these patients to a physician.