Cosmetic, Implant , General Dentist in Smithtown Long Island, NY. This blog has been created to bring up all oral health topics and dental treatment. I welcome any discussions of any dental topics or dental treatments that are important to you. Videos and articles can be found on my website, www.WeCaterToCowards.com. I look forward to helping and using my personal experiences in dentistry in the past 15 years in all aspects of dentistry. Talk to you soon.
These common foods can help hide halitosis
at least for a short while.
By Beth W. Orenstein | Medically reviewed by Niya Jones, MD, MPH
Maybe you shouldn’t have had those raw onions with your hamburger at lunch, because now you're faced withbad breathall afternoon. Many people find they can’t hide what they ate because certain foods linger in their systems, causing bad breath. Onions and garlic are probably the most common and most well-known instigators of bad breath, or halitosis, but there are others.
The issue with foods like onions and garlic is that they contain pungent oils that get carried through your bloodstream to your lungs. When you breathe out, the pungent leftovers are exhaled too.
Fortunately, just as eating certain foods can cause your breath to be unpleasant, other foods can help mask bad breath — for a time. “It will only be temporary,” notes Gerald P. Curatola, DDS, clinical associate professor at the New York University College of Dentistry and an oral health and wellness expert for The Dr. Oz Show. The following foods could provide relief for an hour or two, until you are able to attack the underlying cause — odor-producing bacteria in your mouth.
Bad-Breath Busters
Foods that can help mask bad breath include:
Parsley. Parsley is probably one of the most well-known ways to treat bad breath. Its oils are what do the trick. Likewise, spearmint and cinnamon can help mask bad breath. Some other herbs and spices that work for the same reason are coriander or cilantro, tarragon, eucalyptus, rosemary, and cardamom. ·
Green tea. Green tea contains catechin, a powerful antioxidant that can fend off bacteria — remember, bacteria causes the unwanted odor. ·
Yogurt. Some studies have shown that the live active cultures in yogurt help reduce bad breath, Dr. Curatola says. If the yogurt has probiotics (good bacteria), it can overpower the bad, foul-smelling bacteria. ·
Apples and pears. “Fruits help with the production of saliva, which is essential to nourishing and rebalancing the natural oral ecology of the mouth,” Curatola says. ·
Oranges, melons, and berries. These fruits in particular are rich in vitamin C. Vitamin C not only is helpful for keeping bacteria in check, but also helps combat gum diseases and gingivitis, which also can cause bad breath. ·
Celery, carrots, and cucumbers. These crunchy munchies encourage the production of saliva, the bacteria rinse agent. ·
Almonds and other nuts. They work like fruits and vegetables. “The fiber-rich content of fruits, vegetables, and nuts also acts like ‘tiny toothbrushes’ on teeth and has been shown to keep odor-causing bacteria from staining teeth,” Curatola says.
More Ways to Mask Bad Breath
Other ways to treat halitosis:
Drink water. You want to keep your mouth moist. Water rinses out your mouth, and it's generally good for your system.
Chew sugarless gum. It not only masks the odor but also promotes the production of saliva, which helps rinse your mouth of harmful plaque and bacteria, explains Kimberly Harms, DDS, a dentist in Farmington, Minn., and a spokeswoman for the American Dental Association.
·
Pop some breath mints. Like eating sprigs of parsley or other herbs, sucking on breath mints will mask the odor for at least a little while, Dr. Harms says.
Be sure the gum and mints you choose are sugarless. Sugar creates plaque, and you could be adding to the problem if you chew on sugary sweets or gum.
Practice Good Dental Hygiene
Food is really only a temporary solution to any bad breath problem. Most important, practice good oral hygiene. Brush your teeth for at least two minutes twice a day and floss daily. If bad breath is a problem, be sure to brush your tongue as well — that's where odor-causing bacteria like to live, especially at night when your mouth is dry. Make certain to get regular dental checkups.
If bad breath is a persistent problem, talk with your doctor. It could be a sign of something other than the onions you had at lunch.
Evaluating Your Options for Replacing Missing Teeth
Economic aspects: Comparing the Cost of Implants to Fixed Bridgework
Consider this scenario: if you lose a single tooth, the two most common methods of tooth replacement are a tooth supported bridge or an implant supported crown. The American Dental Association (ADA) reports that bridges last an average of 10 years. Clinical studies indicate that implants are over 95% successful for 20+ years. Therefore, a conservative cost breakdown over 20-25 years may look like the chart below.
Even with partial insurance reimbursement, the cost of a tooth supported bridge is more expensive long term. The total cost over 20-25 years or more could be significantly higher than shown above. And with an implant supported crown, the adjacent teeth are not compromised so that additional treatment is not necessary. Consider too, the concept of amortization — the process of decreasing or accounting for the cost over the period of time they are likely to last.
Implants may seem more expensive initially. But for patients who are candidates, not only are they a better treatment choice, they will last longer, possibly a lifetime, thereby making them the ideal choice and most cost effective option long term. As we shall see in part two when we guide you through the marketing hype, well planned implants most often require a team approach in assessing whether they're right for you. Placing implants and attaching crowns to them require precision procedures and techniques.
Requires healing time before permanent tooth replacement
Advantages of Bridges
Esthetic, functional, predictable, reliable
Less costly
Requires less time for final result
Disadvantages of Bridges
Requires enamel removal of adjacent teeth
If adjacent teeth have crowns, they must be redone
Tooth decay is potential problem
Root canal treatment may be required if nerves are affected
Greater tendency for gum disease
Less longevity than implants
Friday, March 3, 2017
TOP 10 FOODS FOR YOUR TEETH
Our teeth are irreplaceable and we cannot do without them. Did you know that eating the right foods can do as much good for you as regular brushing and flossing? Did you realize that some food and drink will not only help keep your teeth in shape, but also feed them, too? Snack on some fruits and vegetables while Dental.net counts down the top 10 foods to benefit your dental health.
Top 10 Foods for Your Teeth:
1. Green Tea has a well-deserved reputation for providing many benefits. With teeth, green tea offers up natural antioxidant compounds prevent plaque from accumulating, therefore reducing the risk of cavities and bad breath. Some green teas also contain fluoride that can further prevent tooth decay – check the label before you buy.
2. Dairy products such as milk and yogurt are low in acidity and sugar making them great choices to quench your thirst or have as a healthy snack. This is good news for both tooth erosion and tooth decay. Milk is rich in calcium, which means you are fortifying teeth and bones while refueling during the day.
3. Cheese is another dairy product with significant dental benefits. Being high in phosphate and calcium, cheese promotes healthy teeth. It also balances the pH in your mouth, produces more saliva, rebuilds tooth enamel and kills the bacteria that cause tooth cavities and gum disease.
4. Fruit is great for your teeth especially when eaten in whole, raw form. It keeps down plaque and massages your gums. Choose the fruits rich in Vitamin C, which holds our body cells together. If you are short of Vitamin C, your gums may become tender and more susceptible to gum disease.
5. Vegetables are another good idea if you are trying to build a good foundation for your teeth. Broccoli, carrots, sweet potato and pumpkin are rich in Vitamin A from which tooth enamel forms. If you eat them raw you will get more Vitamin A, as well as clean your teeth and massage your gums.
6. Onions are rich in powerful anti-bacterial sulphur compounds, which kill the bacteria that harm your teeth and gums. If you can stand the stinky side effects, eat onions raw for best results.
7. Celery is another great friend of the dentist. Eat it raw and it will not only massage your gums, but clean your teeth. It will also induce the production of more saliva that will neutralize the bacteria that cause cavities.
8. Sesame Seeds, which are best combined with bread and rolls, dissolve plaque and help build tooth enamel. The tasty seeds are also rich in calcium, which will keep your teeth and jawbone healthy.
9. Proteins like beef, chicken, eggs and turkey are rich in phosphorus. Calcium combines with phosphorus and Vitamin D to produce our teeth and bones. Make sure you get enough protein to keep your teeth healthy, and reduce decay.
10. Water is not only the gift of life. When you rinse with water, it cleans your mouth so that your saliva can nourish your teeth, hydrate your gums, and help wash away trapped food particles that can create plague.
We hope you’ll be able to eat your way to dental wellness by making better food choices that will build up a strong foundation.
Researchers at the University of Hawai’i (UH) at Mānoa will examine tissue samples from women who experienced preterm labor for the presence and type of oral bacteria. According to the researchers, oral bacteria that cause dental caries can be transmitted through the bloodstream from the mouth to other parts of the body, including the placenta, and contribute to the development of serious systemic diseases.
“The first step of our project will be working in the lab, analyzing samples of placentas to determine the presence of any oral bacteria, and, if so, what type is identified because there are many different types of oral bacteria,” said principal investigator Maureen Shannon, a UH Mānoa professor and Frances A. Matsuda Endowed Chair in Women’s Health.
“Based on what we find, the second step will be working with our research team to design and conduct an intervention study to decrease the transmission of maternal oral bacteria to other parts of the body as well as reduce transmission of the bacteria to the women’s infants,” Shannon said.
About 40% of pregnant women experience caries, which are associated with preterm labor, preterm birth, and low birth weight. The overall goal of the research is to reduce dental disease in mothers so they won’t experience pregnancy complications like preterm labor and birth or pass the cavity-producing bacteria on to their infants and children.
“We are committed to conducting research that can have a beneficial clinical impact for Hawai’i mothers and their keiki [children],” said Shannon.
Native Hawaiian, Pacific Islander, and Filipino women have the highest rates of dental disease in Hawai’i, according to the university. By identifying the presence and type of oral bacteria found in placental tissue, the researchers hope to increase understanding about the way oral bacteria can contribute to the development of preterm labor. Determining the type of bacteria also can help in developing clinical interventions to reduce the rates of pregnancy complications and other diseases associated with caries.
Patients who are receiving cancer therapy often have changes in the mouth. This information can help you understand possible side effects of cancer treatment, including tips for mouth care that may help prevent or minimize these changes.
Introduction to mouth care:
Chemotherapy affects rapidly dividing cells. Cancer cells and some normal cells, such as those lining the mouth, the gastrointestinal tract, bone marrow cells, and hair cells, divide rapidly.
Chemotherapy cannot tell the difference between normal cells and malignant cells and sometimes injures both. Chemotherapy may lower your white blood cell count, platelet count, and red blood cell count. This is known as bone marrow suppression (another name is myelosuppression). This makes you more at risk for infection and/or bleeding.
If there is pre-existing dental infection such as cavities, abscesses, or gum (periodontal) disease, the infection may become worse. In addition, your gums may bleed easily if they are irritated or swollen.
Chemotherapy may also cause mouth sores (mucositis). These sores usually heal in one to two weeks; however, more serious ulcers may become infected with bacteria or yeast that are commonly found in the mouth. Irritation from sharp teeth or fillings may worsen the condition. Medications to prevent sores and help with discomfort are available and can be prescribed for you.
As a comfort, ask for ice chips or sugar free popsicles to suck on while you are receiving chemotherapy. Research has shown this may decrease mouth sores by 60 percent.
If you receive radiation therapy to your head or neck:
Radiation therapy is often used to treat individuals with cancer of the head and neck. It is delivered to the head and neck area to destroy cancer cells but unfortunately, some normal cells are injured as well. During radiation treatment, patients may also experience mouth sores. This usually lessens within a couple of weeks after therapy ends. Unlike chemotherapy, radiation therapy has long-term side effects in the mouth. The most common side effect is dry mouth (xerostomia). Xerostomia is a result of radiation injury to the salivary glands. It means the salivary glands produce less saliva and the saliva is thicker. The normal protective effect of saliva on the teeth is lost and there is an increase in oral bacteria that cause cavities. Also, plaque and tarter deposits occur faster, which places you more at risk for cavities and gum disease.
Another side effect of radiation treatment to the head and neck is severe bone infection. This is caused by a decrease in the blood supply to the bones of the head and tissue of the neck during radiation treatment. These changes result in slow healing from infection, trauma or especially when teeth are removed soon after radiation therapy. Restorative and preventive dental care is very important to avoid infection.
To prevent infection and tooth decay, it is very important to see your dentist early in your treatment and to continue good mouth cleaning daily. Outlined below are helpful suggestions for mouth care inpatients undergoing cancer treatment.
Before treatment with chemotherapy or head and neck radiation
See your dentist so that (s)he may identify potential sources of dental infection or irritation. Teeth with severe infection or those that may cause problems during or after therapy should be removed (extracted). Extractions should be done at least one week before the start of chemotherapy or radiation therapy to provide enough time for proper healing. Teeth with cavities should be restored with fillings. A thorough cleaning and scaling of teeth should be done to remove tartar (calculus). All sharp areas should be smoothed to prevent unnecessary irritation. Procedures that may be included in the first dental visit are:
Dental examination and x-rays
Dental cleaning
Impressions for fluoride trays. Fluoride trays are custom-fitted soft plastic trays that are used to apply fluoride. Fluoride is used to help prevent the formation of cavities.
Oral hygiene instructions:
brush three times a day with a soft toothbrush
floss daily
apply fluoride gel to teeth with custom tray twice daily
eat a nutritionally balanced diet, low in sugar
During treatment with chemotherapy or head and neck radiation
During treatment it is important to adhere strictly to your mouth care plan. If your mouth is sore, some of the following tips may help:
Use a soft toothbrush or a sponge applicator such as a toothette to brush your teeth.
Don't floss if it causes bleeding when your platelet count is low.
Wear dentures only for meals.
Rinse your mouth with warm salt water or baking soda and water (a teaspoon of either dissolved in eight ounces of warm water).
Avoid commercial mouthwashes because they contain alcohol that may burn your mouth.
If your doctor prescribes both an antibacterial rinse (Peridex) and an antifungal rinse or lozenge (nystatin), do not take them together because they will not work as well. Separate them by at least one hour.
To prevent discomfort when eating, you may apply Viscous Xylocaine to your mouth, especially before meals. Viscous Xylocaine can be swished and spit out or it can be applied directly to a specific area with a cotton tipped applicator. Other topical anesthetics are available at your pharmacy. Ask your doctor or nurse about specific products.
Pain medicine may also be used. Tylenol or stronger pain medication may help reduce oral pain. If taken half an hour before meals it may be more comfortable to eat. It is important to avoid using aspirin or non-steroidal medication (Advil, Motrin) products while on chemotherapy since they may cause bleeding problems.
Do not smoke cigarettes, cigars, pipes, or chew tobacco and avoid drinking alcohol. These are all very irritating and drying to a sore mouth.
Avoid spicy food and food that is difficult to chew. Citrus and tomato juice may irritate your mouth when you have mouth sores.
Dry mouth (xerostomia) can be helped by drinking plenty of fluids throughout the day.
Drink at least eight glasses of water or juices daily.
Avoid caffeinated beverages as the caffeine may increase mouth dryness.
Artificial saliva can be tried and is available in most pharmacies. You may find that chewing sugarless gum or sucking on sugarless candy is helpful. Coating your lips with a lip balm such as Vaseline or Chapstick will help prevent them from cracking. A cool mist humidifier will add moisture to your room.
Fluoride treatments are important during and after radiation treatments to the head and neck area. They should be done twice daily by using soft trays that are custom made for you by your dentist.
Fluoride treatment is performed as follows:
Brush your teeth with a fluoride toothpaste
Place approximately four drops of fluoride gel into the tooth depressions in the plastic tray and spread it with a cotton swab. Gel-Kam is a common fluoride gel. If Gel-Kam irritates your teeth or gums you may find that Prevident is less irritating.
Place trays in your mouth and keep them in for a full five minutes. Try not to swallow any fluoride. Remove trays and do not rinse your mouth or take any food or drink for one hour.
Rinse the tray. Repeat this routine twice a day.
It is important to call your doctor:
If your mouth pain increases and you are unable to control it with your pain medicine.
If you are unable to eat or drink because of severe mouth sores.
If you have a fever.
If you have bleeding that is difficult to control.
If you have any difficulty swallowing.
After treatment with chemotherapy or head and neck radiation
When therapy ends, you need to continue with good dental care in order to keep your teeth and gums healthy. Your salivary glands will be making less saliva and you will still be at risk for developing cavities and gum disease.
You will need to have:
Dental visits with scaling and cleaning at least three times a year.
Continued fluoride treatments with fluoride trays twice a day.
A nutritionally balanced diet, low in sugar.
If any dental extraction becomes necessary it is important that your dentist talk with your oncology team who are familiar with your treatment.
Mouth dryness may continue after therapy. Salivary flow will gradually increase, but may not completely return to normal. To add moisture to your mouth it is helpful to:
Carry a water bottle to wet your mouth as needed.
Drink at least eight glasses of water or juices per day.
Keep caffeine at a minimum.
Avoid alcohol and tobacco products.
Moisten foods with gravies or sauces.
Chew sugar free gum or suck on sugar free sour drops.
Try artificial saliva.
Ask your physician, dentist or nurse to recommend commercial products that are available for dry mouth.
Use a cool mist vaporizer.
Dentures should be made or relined about six months after treatment to allow for changes in your mouth. There should be no pressure areas which could result in irritation to your mouth.
Taste changes during the first six months following radiation therapy are common. You may find a decrease in taste and an altered taste sensation. These changes may result in a decrease in appetite. It may help to:
Try different foods, if they are not agreeable, you can try again at another time.
Add various herbs and mild spices.
Avoid adding extra salt if you have high blood pressure.
Add liquid food supplements to increase caloric intake until your appetite returns. Ask your nurse or see one of our dietitians for more suggestions.
Weigh yourself frequently until weight stabilizes.
Blackberries could play a role in the prevention and treatment of gum disease.
That's according to new research1 published in the Journal of Periodontal Research, which shows the antibacterial properties of blackberry extract could help to prevent or aid in the treatment of gum disease, which, if left untreated, may result in tooth loss.
Natural extract from blackberries have previously been linked with blocking the spread of cancer cells, and, when measured against blueberry, raspberry, red currant, and both cultivated and wild strawberries, blackberries showed the greatest total antioxidant capacity.
Blackberries join a growing list of foods that could help prevent oral health problems. Strawberries and green vegetables have been linked to reducing the chance of developing oral cancer, while other studies have discovered fish and fish oil can fight gum disease.
Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, thinks the research highlights the importance of indulging in a healthy, balanced diet.
Dr Carter says: "Having a balanced diet rich in vitamins, minerals and fresh produce to provide anti-oxidants is something we should all be striving to achieve. It can help to prevent a number of oral health problems including gum disease and oral cancer, not to mention potential heart problems too. Given we are only a few days into the new year, if you have not adopted a New Year's resolution it is well worth considering improving your diet.
"Although the study is promising, it is important to remember that any use of blackberries in preventing and treating gum disease should be as well as maintaining a good oral hygiene routine. Prevention is a really important word when it comes to oral health and it is fairly easy to keep on top of. It does not take up too much time or a lot of money, yet it is surprising how many people actually forego basic oral hygiene principles, including brushing for two minutes twice a day.
"Gum disease and tooth decay are both totally preventable by following a simple daily routine. The earlier you learn this the better. Brushing your teeth two minutes twice a day using a fluoride toothpaste, visiting the dentist regularly, as often as they recommend, and cleaning in between teeth using interdental brushes or floss will really help to develop good oral health. Having a healthy, balanced diet with at least five portions of fresh fruit and vegetables a day and cutting down on how often you have sugary foods and drinks will benefit both the health of your mouth and body."
Good oral hygiene must take place before, during, and after
placement of dental implants to ensure the health of the implant.
Patients are concerned about what kind of maintenance their
implants will require. Do they brush and floss their implants like
regular teeth? Does food get underneath the fixed implant bridge
or prosthesis? Patients look to their hygienists to address these
concerns and help them with an individualized home-care routine.
The tissue surrounding the implant should appear pink, firm, and keratinized
with no signs of infection. The peri-implant soft tissues (permucosal seal) that separates the connective tissues surrounding the implant from the outside environment should be keratinized tissue . The absence of keratinized tissue has been documented to be more susceptible to pathogenic bacteria thus leaving the implant vulnerable to peri-implant disease. The success of the implant depends directly on the health of this seal, and the hygienist's goal is to educate the patient on how to obtain keratinized tissue and maintain a healthy permucosal seal.
Figure 1: Keratinized tissue surrounding the implant. Courtesy of Dr. Robert Horowitz
This reinforces the point that home-care must begin immediately and, if
possible, before the implant is placed to maintain a healthy field and for optimal healing.
Once the implant is exposed to the environment, loaded (occlusal forces)
and restored a salivary pellicle is formed followed by bacteria with the formation of biofilm. The elimination of 85% of plaque/biofilm on a daily basis is critical to the overall health of the implant.
Hygienists can prepare patients by providing home-care recommendations
based on the individual treatment case. This begins with post-surgical home-care guidelines to ensure the patient feels comfortable and confident until they return for routine implant maintenance. Always verify recommended guidelines with the implant surgeon's recommendations.
Figures 2a, b: Placement of an implant. Courtesy of Keystone Dental
Knowledge of the implant titanium surface is necessary to fully understand
what oral hygiene recommendations and products to present to patients. After 1990, a definite switch from smooth titanium alloy surface to a rougher implant surface transpired, which has proven to accelerate osseointegration. The addition of surface coatings to create roughness with plasma spraying, grit blasting, and etching has also proven to raise the bone-to-implant contact and accelerate osseointegration.
To help the patient protect their implant(s), their investment, patients need
to be aware of the following key points on choosing safe home-care products. First the product (for example, toothpaste or gel) needs to be low-abrasive to not scratch the surface of any exposed surfaces of the implant (exposed threads, for example). Avoid dentifrice with stannous fluoride, sodium fluoride (APF >3.0), baking soda, stain removers, and smoker's toothpaste.
Companies are researching low–abrasive dentifrices that are effective yet safe for implants, natural teeth, and completely edentulous implant patients (Colgate, Procter & Gamble, and Rowpar among others). Ramberg et al. reported that Colgate Total in a double-blind, randomized, parallel-group clinical (in vivo) trial with 59 participants concluded that brushing with Colgate Total twice daily reduces bleeding on probing adjacent to implant sites in a three- and six-month period with proven results of reducing plaque bacteria to help prevent peri-implant disease.
Secondly, products should not irritate the permucosal seal,9 or corrode and/or
etch the titanium.10-11 A high fluoride concentrate of > 3.0 sodium fluoride, combined with a low PH, will remove the oxide layer on implants and can make the titanium surface anti-corrosive. Once this layer is removed, the implant is prone to corrosion. Stannous fluoride can cause etching, roughness on implants, and their esthetic restorations.
Figures 3a, b, c: Interproximal brushes. Courtesy of Hager Worldwide
What toothbrushes and interdental products are best to use with implants?
Several studies have been conducted regarding what type of toothbrush is most
effective for implants. The results show no significant difference between sonic,
electric, or manual toothbrushes. The main focus needs to be on adaptation to the prosthesis and the patient's dexterity. Instruct the patient to brush the implant(s) twice daily to remove bacterial plaque with a low-abrasive dentifrice. A soft toothbrush should be used ; options include a manual brush, electric, or sonic brush (examples include Oral-B Triumph, Sonicare, and Waterpik Sensonic Plus), Sulcabrush, or end-tuft brush.
Figures 4a, b: Examples of implant floss. Courtesy of Hager Worldwide and Sunstar Americas
Nylon coated interdental brushes/ proxabrushes are also an excellent
alternative to clean especially tight and hard-to-reach areas around implants and prostheses. Nylon only interdental brushes (no metal wire) are necessary to prevent scratching the implant or prosthesis. The interproximal brushes such as I-Prox P or I-Prox Plus work extremely well and can be dipped in non-alcohol antimicrobial rinse or gel. It is extremely important to brush under, around, and in the peri-implant crevice circumferentially
Floss
There are many types of floss on the market, and generally it is highly
recommended to use unwaxed tape or implant-specific floss in order to protect the tissue surrounding the implant. Alternatively for a bar-retained prostheses, full fixed retained prostheses, or wider interproximal spaces, a floss threader or a specialized floss that has a built-in threader is necessary.
Figure 5a: Insert floss on mesial and distal. Courtesy of Dr. Peter Fritz
To floss the implant, use dental tape and insert the floss in contacts on both
sides of the implant. Wrap in a circle and crisscross in front, switch hands, and move in a shoe-shine motion into the peri-implant crevice, which is highly susceptible to inflammation /peri-implant disease due to biofilm.
In addition, antimicrobial mouth rinses may be recommended, especially
if inflammation is present or if the patient has dexterity problems, and difficult-to-reach areas. If the patient is prone to inflammation, the use of an antimicrobial rinse, in conjunction with a rubber tip stimulator, may be recommended to inactivate bacteria substantive.
Figure 5b: Crisscross floss and move in shoe-shine manner. Courtesy of Dr. Peter Fritz
Oral irrigators/Water Flossers
It is highly recommended for patients to use oral irrigators for the
reduction of plaque/biofilm, inflammation, and hard-to-reach emergence profiles around implants13,14 .Instruct the patient to use a nonmetal tip one to two times daily, and, if inflammation is present, add a diluted non-alcohol antimicrobial rinse (chlorine dioxide or chlorhexidine gluconate).
Studies using oral irrigators with implants for oral hygiene reveal that
Waterpik Water Flosser is the only oral irrigator to date to be proven safe and effective with dental implants. A study was conducted to compare rinsing with 0.12% CHX to using a Waterpik oral irrigator with 0.06% CHX. The irrigation group using the soft rubber tip (PikPocket Tip, ) at lower pressure was 87% more effective in reducing bleeding and three times more effective in reducing gingivitis than the rinsing group.
Another study of oral irrigation and floss revealed that the Waterpik Water
Flosser with the standard tip with three bristle filaments (Plaque Seeker Tip, see opening page) used at medium pressure around implants was 81% more effective in bleeding reduction compared to 33% using floss.16 These specialized tips are very effective for implants and to deliver anti-microbial rinse around difficult-to-reach prostheses (All-on-4, full-fixed prosthesis, for example) in a prevention of peri-implant disease.
Figures 6a, b, c: From left to right, Waterpik Ultra Water Flosser, Waterpik PikPocket Tip, and Waterpik Traveler Water Flosser
Water irrigation in conjunction with diluted non-antimicrobial rinse has proven
to be extremely helpful for full-fixed and removable prostheses to remove daily biofilm and prevent inflammation if used on a daily basis. Waterpik makes a compact Traveler Water Flosser unit, which is my personal favorite to recommend ensuring patients continue their home-care routine at home and away .
Stimulators
Stimulators are coming back into vogue with implants and regenerative
procedures. Remember healthy keratinized tissue is the key to a healthy permucosal seal surrounding the implant. Stimulators are the ticket to achieve this, particularly in full-fixed, supra-structure implants, as well as implants that retain over-dentures (bar-retained implants). Examples of stimulators are rubber tip stimulators producted by multiple manufacturers and Soft Picks by Sunstar Americas .
Figures 7a, b: Examples of stimulators. Courtesy of Dr. John Remien & Sunstar Americas
Instruct the patient to place the tip of the rubber-tip stimulator so it lays flat
against the gum tissue, not poking in the tissue, with pressure roll to massage and stimulate the tissue. The tissue will blanch or change to a lighter color when the correct pressure is applied.
A generalized home-care routine for implants is listed in Table 2 to be
modified to individualize the patient's home-care routine. For an All-on-4 full-fixed case, add the use of a water irrigator unit twice daily with a non-alcohol antimicrobial mouth rinse in 1:10 dilution to the home-care guidelines.
For removable prosthesis, the patient should use the guidelines in Table 3.
Note that a specific denture cleaner may be recommended for the overdenture. Plaque and bacteria can also accumulate on the inside of the overdenture, causing wear to the attachments and oral–systemic health complications for the patient. Educate the patient on how to do a visual check for attachments (O-rings, locator caps, and clips) and the importance of these attachments for retention. If attachments are worn or missing they will need to be replaced. O-rings and locator caps should be replaced once a year and clips as needed.
Hygiene tip: Note the color and attachment type (O-ring, locator or clip) and
record in the patient's chart .
Figure 8: Note the color and attachment. Courtesy of Salvin Dental Specialties
For implants with peri-implant disease, mucositis, and/or implantitis, follow
the home-care guidelines, but add antimicrobial therapy. Use Soft Picks, interdental, end-tuft or Sulcabrushes dipped in non-alcohol antimicrobial rinse or CHX gel (compounded by compound pharmacies). "Soak" or apply the antimicrobial to the infected area twice daily and continue with this protocol until three to six week re-evaluation.
This article gives the latest home-care products available currently;
however, the technology and implantology is constantly changing. Research and evaluate home-care products that are safe with clinical research done on implants. Patients rely on their dental professionals for recommendations on what products to use and to present them with a safe daily home-care routine.
