For the dental community, the increasing life span of the average person means patients who require more dental health care for a longer period of time. As gingival recession is a condition that only worsens with age, its contribution to dentinal hypersensitivity cannot be ignored. Statistics show that approximately one-third of the nearly 78 million American adults, the baby boomers, over age 60 are at risk for recession in one or more teeth. With the impending flood of dentinal hypersensitivity cases that are likely to result from this demographic, the treatment of dental hypersensitivity is more important than ever. This course will discuss factors contributing to and treatment methods for dentinal sensitivity.

Dentists are obligated to document and report suspected cases of abuse in all states, and dental hygienists are similarly obligated in some, but not all, states. The obligation is not to prove abuse or neglect, just to report what is suspected. Each state has different regulations on mandatory reporting for healthcare and other professionals, as well as specific reporting requirements for private citizens. It is essential that dental professionals know the potential signs and symptoms of the various types of abuse, are able to identify these, and understand the mandatory requirements for reporting in the state(s) in which they live and practice. It is by identifying, documenting and reporting abuse that victims can be protected and perpetrators prevented from continuing abusive practices and patterns.

Dental caries and periodontal disease are among the most prevalent diseases known to man. Both are associated with the bacteria contained in dental biofilm. Dental biofilm is complex, with a well-organized structure. Up to 500 bacterial species have been identified in dental biofilm. Studies have shown that plaque accumulates rapidly on clinically plaque-free teeth. For oral and systemic health, the development and maturation of dental biofilm should be impeded and the dental biofilm needs to be regularly and meticulously removed. Removal and reduction of biofilm can be by mechanical means or mechanical and chemical means, and disclosing agents enable visual identification of plaque. Current chemotherapeutics in general do not effectively penetrate thick biofilm, underscoring the importance of the identification and rigorous mechanical removal of the dental biofilm.

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.

Dentinal hypersensitivity has been referred to as one of the most painful and chronic dental conditions, with a reported prevalence of between 4% and 57% in the general population and a higher prevalence in periodontal patients. It may also occur as a result of, or during, dental treatment. Clinicians must screen for dentinal hypersensitivity and diagnose by exclusion, determine appropriate treatment, and provide treatment and preventive recommendations. Consideration should also be given to treating dentinal hypersensitivity associated with dental treatment. Traditional treatments have included adhesive resins, fluoride varnishes, HEMA,iontophoresis, gingival grafts and desensitizing dentifrices. Other technologies include the use of bioglass particles,ACP, as well as 8% arginine and calcium carbonate paste.

Upon completion of this course, the dental professional will be able to do the following: list intentional and unintentional sources of systemic fluoride, list and describe caries risk factors and the ADA recommendations for in-office topical fluorides corresponding to different risk levels, list and describe the considerations involved in selecting in-office and home-use topical fluorides, list and describe the various home-use topical fluorides available and the clinical efficacy of each.

Upon completion of this course, the clinician will be able to do the following: Discuss the current status of caries, gingivitis, and periodontal disease in the United States, list the dental implications associated with inadequate/ineffective interdental plaque control, recognize the clinical signs of infrequent interdental plaque control and identify patients who are at a high risk for periodontal diseases, and recommend appropriate interdental cleaning methods and devices for specific patient needs, and explain the necessity of interdental plaque control as part of the patient’s complete self-care program.

Overall goal: The purpose of this article is to provide dental professionals with information on risk assessment, preventive and treatment options that will further the practice of a medical model and minimal intervention dentistry.

The essential elements of an office-based program and issues to be considered to encourage compliance with general preventive and post-procedure instructions are key for patient compliance and oral health. Factors in compliance include age, sex, socioeconomic status, patient satisfaction, systemic health and attitudes. Careful selection and recommendation of oral hygiene aids, dentifrices and rinses may help to increase patient compliance.

Bruxism is a parafunctional occlusal activity, that may exist as either sleep bruxism or awake bruxism. Bruxers have more noticeable signs of dental attrition, abfractions, and occlusal pits on their natural teeth than other patients. Clinical approaches to managing bruxism can be categorized as acute, preventive and chronic, with the approach depending on the patient’s signs and symptoms. Preventive intervention is required if a patient presents with tooth wear. A primary preventive approach in the treatment of bruxism is the fabrication and utilization of a nightguard.

Orthodontic treatment is widely recognized for its results. By accepting orthodontic treatment, patients usually commit to two to three years of active therapy. Increases in plaque retention in orthodontic patients lead to an increased incidence of decalcifications. Almost all fixed applicance orthodontic patients experience moderate gingivitis and, to varying degrees, oral irritations. Even with attention to oral hygiene procedures, patients are at risk. Consideration of the use of antibacterial mouthrinses may be warranted for these patients. Oral irritations cause pain and impede oral hygiene—medications in the form of pastes, gels, liquids, and rinses can help relieve pain and, depending upon the medication used, may also promote healing. Patient selection, education, and adherence to oral hygiene measures, together with adjunctive preventive, palliative, and curative care, will not only help patients have a more comfortable experience, but will also increase the likelihood of both functional and aesthetical success.

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.

Twenty-six million people in the United States are living with chronic kidney disease (CKD). As the baby boomer generation continues to mature, medical procedures extending life improve,and with pharmacology advances, this number will increase. With an increased number of patients living with CKD seeking dental treatment, will the dental healthcare provider be prepared to provide treatment to patients living with renal disease-induced anemia, and with secondary hyperparathyroidism and its effects on bone metabolism and the cardiovascular system? Many providers are familiar with providing palliative treatment for xerostomia, but how do you recommend palliative treatment for someone who is on strict fluid and dietary restrictions, such as patients living with end stage renal disease? Diabetes and hypertension are the two greatest causes of kidney disease. Dental providers should be knowledgeable about the different stages of renal disease and different treatments associated with this condition, and be prepared to address oral complications of renal disease. The dental healthcare provider must become more familiar with the impact of periodontal disease on renal disease, specific medical challenges and become proficient in collaborating with medical healthcare providers to provide dental treatment to these patients.

Tobacco use continues to have a personal impact on individuals as well as having a public health impact. Tobacco use results in systemic conditions that include cardiovascular disease, lung disease, and numerous types of cancer, and is the single largest cause of death in the United States. With respect to oral health, it is associated with an increased risk of oral cancer and other mucosal lesions, periodontal disease, impaired healing, and caries. In addition, exposure to environmental smoke (secondhand smoke) is associated with oral and systemic diseases that include caries, cardiovascular and lung disease, and periodontal disease. Educating and advising patients on tobacco cessation, and referring them or implementing a program, helps patients stop using tobacco and improve their health.

Science has identified three factors involved in decay: pathogenic bacteria, poor dietary habits and xerostomia. The Caries Balance Theory states that caries is the outcome of the complex interaction of pathologic and protective factors. The caries process involves demineralization and remineralization of teeth. Caries management requires risk assessment. For patients at risk, preventive therapies available include the use of antimicrobials, fluorides, xylitol, calcium and phosphate products, baking soda products and glass ionomers.