Four Great Reasons For Prep Scrubs
One of the most common questions I get is about the use of a category of materials we refer to as prep scrubs, prep wetting agents or desensitizers. The question is usually do they actually make a difference, and are they worth the cost. The answer is “yes” and “yes”.
There are 4 things we are trying to accomplish: prevent sensitivity, antimicrobial activity, moisten dentin for bonding, reduce bond degradation over time. The prevention of sensitivity is caused in two ways. The first is the inclusion of HEMA in products like Gluma from Kulzer. The HEMA occludes the dentinal tubules and prevents fluid movement that triggers a pulpal response. The second is the anti-microbial activity of either glutaraldehyde (GLUMA) or chlorhexidine (Consepsis by Ultradent). Fewer bacteria left behind int he dentin means lower chances of a pulpitis that causes sensitivity or the ultimate need for a root canal.
Both chlorhexidine and glutaraldehyde also minimize the production of MMP’s (Matrix Metal Proteinases) the biologic process responsible for bond degradation. This means our bonded restorations last longer before we see marginal breakdown, leakage and secondary caries. The last function is to moisten the dentin to allow optimal penetration of the primer in our dentin adhesives. This means better hybrid zone development and better bonds and sealing of dentinal tubules.
So the answer to do they have benefit is a resounding yes. I have used Gluma on every tooth I have prepared for many years. I consider it extremely cost effective as I am not sure how to put a price on greater restorative longevity and less patient dissatisfaction due to sensitivity or post operative issues. The true cost should be about $2 a prepared tooth if dispensed properly, so that’s hard to argue with.
2 thoughts on “Four Great Reasons For Prep Scrubs”
I’ve searched scholar.google.com, but I can’t find a trial that directly compared 2% CHX vs Gluma. I love my Clearfil bonding agent and I don’t have problems with tooth sensitivity. So from a bacterial and bonding perspective alone, is Gluma superior to CHX? Clinician’s Report advises two 1-minute applications of Gluma. The manufacturer recommends one 1-minute application. How long do we need to wait for Gluma?
I am not personally familiar with any research that compares Chlorhexidine to Glutaraldehyde head to head. There are many studies that look at the efficacy of each individually and what they do, and their impact on bonding etc. Glutaraldehyde and Chlorhexidine have the same 3 mechanisms of action. I don’t know that one is better then the other. The 4th mechanism of action is from the HEMA in Gluma, and this is desensitization. There are not chlorhexidine prep scrubs that contain this. I apply one coat of Gluma, and then blot dry, I do not rinse it off, and therefore I do not wait. This is also not the manufacturer’s recommendations.