Just lately, a member of our group, Martha Szczepulski (additionally RDH), met with Steve Pardue, Managing Member at Raise Oral Care, the corporate at the back of the improvement of FluoriMax (2.5% Sodium Fluoride Varnish) and Benefit Arrest (Silver Diamine Fluoride).
Here’s a abstract in their dialogue. We are hoping this may increasingly can help you combine those extremely efficient in-offices caries control therapies.
FLUORIMAX
Why is there most effective 2.5% NaF in FluoriMax?
Research going again to the Nineteen Nineties display that even in a colophony, the fluoride uptake (bioavailability) could be very equivalent between 2.5 and 5% formulations. Subsequently, it’s best to make use of the bottom share that produces efficient effects. (1)
How a lot hydroxyapatite is in FluoriMax?
3%. This is a supply of calcium and phosphate. Alternatively, at this share there is not any actual receive advantages to a typical mouth, and possibly a miniscule receive advantages to a affected person with xerostomia. True receive advantages is from the sodium fluoride.
How lengthy does FluoriMax stay within the oral hollow space?
It stays till it’s got rid of.
Roughly 90% of the uptake is throughout the first 4 hours, the following 24 hours as much as 10%.
That is secure because of the small amounts being carried out. 1 drop = 0.1mL, so a beneficiant 3 drop dose could be 0.3mL.
In a learn about by means of Dr Beltran, printed in JADA in 2000, the blood plasma ranges of fluoride after FluoriMax software had been not up to a normal toothpaste software. (2)
What’s dewaxed meals grade shellac?
Shellac is a herbal product this is constituted of a resinous secretion discovered on timber, made by means of a bunch of bugs known as Kerria lacca. The secretion, known as lac, is subtle into meals grade shellac, among different shellac merchandise.
You’ll have observed shellac because the glossy coating on an Advil or a Chicklet.
The place will have to I practice FluoriMax?
The advice is to use to the buccal surfaces in a skinny layer the place it acts as a reservoir. This reservoir works perfect as a skinny layer. A thick layer is much less bioavailable and is much more likely to slough off and be swallowed. A skinny layer is extra comfy and extra bioavailable.
FluoriMax can also be carried out on a lesion or close to a lesion – the fluoride ions can be transported by way of saliva into the lesion regardless.
For max uptake, particularly in sufferers with xerostomia, be sure you practice to tooth in shut proximity to the submandibular glands (buccal and lingual sextant 5). This saliva is extra liquid and facilitates fluoride ion transportation. Close to the parotid glands could also be just right, however this saliva is most often extra ropey and does no longer facilitate shipping in addition to the extra liquid saliva from the submandibular glands.
In serious xerostomia, sipping a tumbler of water over the hour after the applying would assist building up fluoride uptake – this is able to give you the important water to assist in fluoride ion transportation.
Is there a distinction within the particle dimension of FluoriMax fluoride?
Sure. Standard fluoride debris are within the vary of 150 microns (until the producer generators them first). FluoriMax has micronized debris – the fluoride debris are milled and sifted to fifteen microns and smaller. That is finished for 2 causes. With smaller debris there’s extra floor space, so subsequently better bioavailability. Secondly, smaller debris keep in suspension longer (even supposing it’s all the time really helpful to shake the bottle prior to software to reach a fair distribution of debris in suspension prior to dishing out)
Are there any substances that sufferers can have an hostile impact to within the FluoriMax?
To our wisdom no. Some other folks declare a response to shellac, however this has no longer been substantiated by means of medical literature.
What are prime depth therapies with FluoriMax?
Those are 3 programs in 5-7 days. This has been finished in outreach paintings in different international locations to maximise mineralization in a brief time period publicity and not using a followup to be had.
What are pointers for buying the most productive out of the product software and protecting the bottle blank?
At all times shake the bottle 10-15 seconds – not up to that and also you would possibly not get the optimum suspension and consistency. FluoriMax is runnier than standard colophony varnish and that may be a just right factor as it spreads very skinny and calls for much less product.
At all times dispense with the bottle vertical. If the applicator tip will get sticky, wipe off extra with alcohol. If the dispenser is truly clogged, you’ll take away the cap and rinse with water. If the orifice is plugged, you’ll open it with a pin. You’ll additionally ask for extra dishing out caps from Oral Science.
ADVANTAGE ARREST
Will have to I practice FluoriMax after making use of Benefit Arrest?
There are two techniques to use Benefit Arrest. You’ll practice and make allowance to air dry for 60 sec. Or you’ll practice and instantly position a layer of FluoriMax over the AA to seal it in and make allowance for optimum penetration. The second one measure is perfect to make use of in scenarios of low affected person compliance. It is going to additionally make the aftertaste much less steel.
It’s unknown whether it is awesome to use FluoriMax over Benefit Arrest however it’ll beef up arrest charge.
Is Benefit Arrest secure for comfortable tissues (subg and sophistication V programs)?
Benefit Arrest has a pH of 10 which means that it isn’t caustic to sound comfortable tissues. It is going to dry and blanche tissue quickly, however this isn’t damaging or painful.
Benefit Arrest will motive inflammation in wounded tissue. It isn’t damaging however can also be delicate. Utility of Benefit Arrest isn’t really helpful in a case of ulcerative gingivitis if the applying would contact comfortable tissue.
What about striking Benefit Arrest in deep lesions?
Benefit Arrest will penetrate 2-2.5mm into enamel construction – penetration varies in every enamel and lesion.
Benefit Arrest can also be carried out in all carious lesions as much as and together with oblique pulp capping. Direct pulp cap is contraindicated. If there is not any proof of pulpal involvement or publicity (similar to drainage or fistulas), Benefit Arrest can also be carried out. When it’s positioned close to pulp, it’ll inspire pulp to shrink. Silver can pass into the pulp in oblique pulp cap, however this isn’t adverse to the pulp or enamel.
What occurs after I use Benefit Arrest then instantly position a tumbler ionomer restorative cement?
In case you practice Benefit Arrest and wish to do a direct GI placement:
Practice it as commonplace, then rinse and dry (don’t dessicate). You’ll position the GI however some silver can be drawn into the GI, so staining of the GI will happen. That is most effective an esthetic fear. It does no longer lower the bond energy. For max bond energy, a polyacrylic acid is also carried out both prior to or after the Benefit Arrest (then rinse and dry, don’t dessicate) for optimum bond energy. If the use of polyacrylic acid step, it’s possible you’ll understand a slight foam on software of the acid and that is commonplace.
Methods to keep away from GI staining with direct placement of GI (no enamel construction polish or elimination)?
To keep away from staining, this can be a two-appointment procedure. On first day, practice Benefit Arrest as commonplace. After 24-72 hours (longer is best), position the GI restorative as same old. This system is named the two day SMART (Silver Changed Atraumatic Resin Methodology).
Methods to keep away from staining with gentle treatment merchandise?
Please notice: Mild curing will “turn on” stain of all Benefit Arrest, if it is on sound or decayed enamel construction. Useful ways to keep away from staining are:
After placement of Benefit Arrest, do a 2-3 2d gentle treatment to watch if Benefit Arrest has stained an esthetic space, then polish that away. Then you’ll continue with recovery. A couple of further issues to imagine:
- An opaque GI or resin base can be utilized on the base of the recovery to masks gray enamel construction. Translucent composite may just display extra gray via it.
- In bonding methods known as “Self etch” the place the etch, high and bond are in a single bottle, the bond is weaker than in non self etch methods. There’s nonetheless bond energy however you would possibly not wish to use this in prime compression spaces, and many others.
How incessantly will have to Benefit Arrest be carried out?
Believe your affected person behavior and assess the hardness of the lesion.
Sufferers with deficient oral hygiene and prime consumption of cariogenic meals would possibly want indefinite reapplication of Benefit Arrest each and every 3-6 months.
Sufferers with just right oral hygiene and occasional to reasonable consumption of cariogenic meals will have to have a minimum of two programs. Then re-evaluate the lesion and imagine making use of each and every 6 months or yearly to care for arrest.
How a lot of the lesion is arrested with the applying?
The primary software can arrest 70-75% of the lesion. The second one software can arrest 90-95% of the lesion. (2016 learn about)
Do you wish to have to rinse or no longer rinse after Benefit Arrest placement?
Both is okay. If no rinse, it’s possible you’ll wish to blot web site after placement to take in extra SDF (to reduce style)
“I heard RivaStar doesn’t stain. Why will have to I take advantage of Benefit Arrest?”
Information about RivaStar vs Benefit Arrest:
RivaStar has a pH of 13 – it’s caustic to comfortable tissues and will have to no longer contact comfortable tissue. AA has a pH of 10, which isn’t caustic. It’s going to quickly dry and blanche tissue however it isn’t damaging to the tissue.
RivaStar value according to software is 2-Thrice that of Benefit Arrest.
RivaStar is advertised for use underneath GI magnificence I restorations. On this software, it’ll no longer stain as a result of it’s necessarily sealed in and the product was once simply positioned at the ground of the recovery. Alternatively, if SDF and KI are used on my own, or the margins of the recovery include SDF and KI, the KI will cut back and decelerate the staining, nevertheless it does no longer inhibit the staining. The staining will most probably display up inside a month.
Finally, when SDF stands on my own, this can be a very efficient caries inhibition agent. When SDF and KI are mixed, there’s a nearly part lower in potency. Caries inhibition is considerably much less within the presence of SDF and KI mixed. (3)
My conclusion
FluoriMax supplies the similar coverage as a traditional varnish, however with a number of primary benefits: Higher bioavailability, which means that decrease share of fluoride is needed. The applying is straightforward, product is skinny and delightful, and sufferers can consume and drink instantly. Sufferers that experience prior to now mentioned “no” to varnish love FluoriMax.
Benefit Arrest is a minimally invasive intervention this is extensively utilized in pediatric and geriatric care. Whilst you will need to inform sufferers and caregivers concerning the lesion converting colour, I to find affected person acceptance is prime. Many caregivers of prone sufferers and other folks with monetary obstacles are relieved when they’re given an reasonably priced, non-invasive choice that can arrest decay.
For dental hygienists which might be striking GIs, maximum restorations with SDF plus KI will inevitably flip darkish, a minimum of across the edges. The use of SDF with KI on my own will flip darkish over the years, and the caries arrest homes are considerably decreased within the presence of KI. And finally, any lesions which might be subg or on the gingival margin can’t be sufficiently remoted for comfortable tissue coverage. You could wish to price extra for SDF and KI to get better product value.
References
1. Seppä L, Results of sodium fluoride concentrations on teeth remineralization in vitro. Scand J Dent Res 1988;96:304-309.
2. Beltrán-Aguilar ED, Goldstein JW, Lockwood SA. Fluoride varnishes. A assessment in their scientific use, cariostatic mechanism, efficacy and protection. J Am Dent Assoc. 2000 Might;131(5):589-96. doi: 10.14219/jada.archive.2000.0232. PMID: 10832252.
3. Zhao IS, Mei ML, Burrow MF, Lo EC, Chu CH. Impact of Silver Diamine Fluoride and Potassium Iodide Remedy on Secondary Caries Prevention and Enamel Discolouration in Cervical Glass Ionomer Cement Recovery. Int J Mol Sci. 2017 Feb 6;18(2):340. doi: 10.3390/ijms18020340. PMID: 28178188; PMCID: PMC5343875.