Protecting complex restorative dental work

A considerable amount of time, effort and money goes into complex restorative work including crowns or bridges. Patients, often after past caries experience, and other risk-related behaviors such as poor oral hygiene or a sugary diet, end up needing a substantial amount of dental work to stabilize their oral health. While many of the risk factors which have caused the dental disease may have been addressed prior to commencing complex restorations, the work doesn't end there.

Especially for older patients, as their oral environment changes, maintaining this complex restorative work can be challenging. Difficulties include home care and sub-gingival restorative margins, the risk of root caries associated with exposed roots caused by gingival recession and, for some patients, reduced manual dexterity that negatively impacts their ability to deliver pristine oral hygiene. They also may have never known how best to care for their teeth in the first place! These can all lead to the dreaded secondary caries which can be difficult to treat and can ultimately end in tooth-loss. This is clearly not an outcome that is desired, and your patient has already invested a lot of time and money to improve their oral health.

So how can we help these patients to protect their complex work? The following are suggested and recommended by leading dental authorities^1,2,3:

1. Give detailed oral hygiene coaching, including how to maintain oral health around difficult restorative margins, by performing twice-daily brushing and using interdental cleaning aids daily, such as floss or interdental brushes;
2. Consider recommending a high strength fluoride, for example Neutrafluor 5000 Plus*, which contains 5000 ppm fluoride (1.1% sodium fluoride). High fluoride toothpaste use in patients with an elevated risk of dental caries is recommended in the guidelines from the Australian Dental Association¹., the American Dental Association² and the International Caries Classification and Management System³;
3. In addition, consider in-surgery application of 5% sodium fluoride varnish such as Duraphat Varnish^ for those who are at risk of dental caries;
4. The American College of Prosthodontics has also published Clinical Practice Guidelines for the Recall and Management of Tooth-borne restorations, which contains guidance and provides recommendations for the different types of complex restorative work your patient may have such as fixed prostheses and removable prostheses. This guidance is helpful both in terms of oral hygiene and products to recommend, but also the frequency of dental recall to monitor the restorative work both you and your patient have invested in.

Ensuring the long term success of complex dental work and protecting the patient's investment will help to avoid having dissatisfied patients and improve their oral health for the future.

1. https://www.adelaide.edu.au/arcpoh/dperu/fluoride/Guidelines_for_use_of_fluorides_in_Australia__update_2019.pdf
2. https://www.ada.org/resources/research/science-and-research-institute/evidence-based-dental-research/caries-management-clinical-practice-guidelines/evidence-based-clinical-practice-guideline-on-nhttps://www.iccms-web.com/uploads/asset/59284654c0a6f822230100.pdfonrestorative-treatments-for-caries-lesions
3. https://www.iccms-web.com/uploads/asset/59284654c0a6f822230100.pdf

*Neutrafluor 5000 Plus Toothpaste

Sodium Fluoride 11.05mg/g

Dental caries preventative for individuals at high risk for caries, when used as part of a preventative regimen recommended by a dental professional or doctor.  Use daily in place of a regular toothpaste.  Apply a thin ribbon of toothpaste to soft small toothbrush.  Brush teeth thoroughly for 2 minutes and then spit out.  For best results, refrain from eating, drinking or rinsing for 30 minutes.

Not for use in patients with known allergies or hypersensitivity to any of the ingredients of Neutrafluor 5000.  Allergic reactions have been rarely reported with the use of fluoride toothpastes.  

^Duraphat Varnish

Sodium Fluoride 50mg/mL

Prevention of caries. Treatment of sensitive teeth. Not for use in patients with hypersensitivity to any ingredients in Duraphat, ulcerative gingivitis, stomatitis and bronchial asthma.  Not for systemic treatment.  Do not swallow.  33.8% ethanol content. Avoid use in pregnant or lactating women

Neutrafluor 5000 Plus (Restricted Medicine - NZ).  Duraphat Varnish (Prescription Medicine -NZ).  Please refer to the full product information before recommending.  Available from Colgate-Palmolive upon request.  Colgate-Palmolive Pty Ltd.  420 George St, Sydney, NSW AU.  Colgate-Palmolive Ltd.  45 Knights Rd, Lower Hutt, NZ