By Lee Ann Brady, DMD 

One of the most common ways that we temporize a patient who is having maxillary anterior implant dentistry is with an Essix retainer. Some patients will wear it 24 hours a day and others for less. Hopefully they are taking it out to rinse, brush, and floss, but the reality is they are wearing a removable device that covers all of the tooth surfaces for a lot of hours every day, and we’re increasing their risk of caries, decalcification, and gingivitis. 

In addition to discussing the normal oral hygiene to be done at home, in our practice, we typically dispense a product like Clinpro 5000 from 3M or MI Paste from GC America. These are high calcium and fluoride products that provide fluoride treatments inside the Essex retainer. 

• If a patient is sleeping in the Essix, the instructions are to brush and floss the teeth and then use a toothbrush to spread a little bit of Clinpro or MI Paste on the inside of the retainer before going to sleep. 
•  If they are not wearing the Essix during sleep, the instructions are the same but to wear the Essix for up to an hour every evening before removing it to go to sleep. 

If the patient’s caries risk is high, I prefer using 10% carbamide peroxide gel instead of Clinpro or MI Paste. This is the active ingredient we us in perio trays to help prevent gingivitis. This is also the means by which patients can whiten their teeth while wearing an Essix retainer. 

To prevent damage to the Essix, instruct patients to rinse it with cold water and, when not wearing it, to store it in the provided container.  

Over the years I have visited many offices and found every office has a special “hideaway” reserved for the new technology that the doctor is going to implement that never happens. I just looked over an article by Dr. Lou Shulman in Dental Products Report that reviews a multitude of technology options available to us. I was surprised to note the number of doctors who stated that they do not plan to purchase three specific tech areas that we have found to be significant in increasing our production, quality of care, and positive patient reaction. Based on our practice experience, these three items will very quickly provide a return on your investment when you integrate them into your practice.

Voice Activated Software

We have been using Dentrix VoicePro, a voice-activated perio charting and clinical note dictation, for over 15 years. Our hygiene staff would quit if we took it away. We do a full perio charting on every re-care appointment. This software makes it quick and easy, AND the patient hears the numbers and pays attention. There are numerous other features, but the perio charting is worth the price and learning curve. In today’s environment, the system eliminates the need for added staff as a recorder or the constant picking up and putting down of pens or probes.

Intraoral Scanner

We are using iTero and love it. We have had a CAD/CAM system for years and use it routinely. However, if you are doing any aligners or sleep appliances you will love the scanner. Your patients are so appreciative that you no longer have to have them sitting with “goo” in their mouths. There is a learning curve, but it is not too steep. The accuracy of the images is excellent. The unit will not let you send a poor impression to the lab. The cost of a scanner is far less than CAD/CAM. Your lab loves getting your impressions electronically. Your patients are fascinated by your ability to image their teeth with ease and accuracy. Our staff has quickly adapted to the use of the scanner and loves it.

Soft Tissue Laser

The price of soft tissue lasers has dropped dramatically. We were relatively early adopters of the soft tissue laser. We use ours for soft tissue shaping in crown and bridge, desensitization, and soft tissue periodontal procedures. We have had near-zero post-operative complaints in any of these procedures. The desensitization of teeth is amazingly quick and easy. All of our hygiene staff has been trained in laser use and feels that was worth the effort. Patient acceptance of soft tissue laser in hygiene/periodontal procedures is very high.

We try to be at or near the leading edge of the technology curve, not the “bleeding edge,” and we expect technology to have long term value as well as a rapid payback. These items have proven to be time savers, improve our quality of care, and are recognized by our patients as adding value to the experience in our office.

It used to be a challenge for me to help patients who came in with recurrent aphthous ulcers, lichen planus or erosive lichen planus, burning mouth, burning tongue, or geographic tongue that was uncomfortable. I’d worry about the pharmaceutical reactions of prescription options such as prednisone, steroid mouth rinses, and lidocaine rinses. Now, that challenge is greatly reduced due to the success we have had treating these problems with nonprescription topical antioxidants. 

There is a group of nonprescription topical antioxidant products that I rely on weekly from PerioSciences. These products not only promote healing but also provide significant relief from soft tissue pain, xerostomia, and burning sensations in the mouth. This is PerioSciences’ AO ProVantage line of mouthwashes, gel, and toothpaste. They are without a doubt the best products I have come across in my career for oral medicine applications. They were developed by dental scientists and other researchers and contain two antioxidants from the skin of apples. The products are marketed to help with a number of things in addition to oral wound healing, for example, to treat superficial gingivitis and to maintain patients who are at advanced risk of perio inflammation.  

In my practice, I have two patients who have chronic erosive lichen planus. We discovered that the application of the AO ProVantage gel to a lesion, four or more times a day, allows the body to heal the lesion. Within three to four weeks, the lesion is gone completely. After lesions are gone, my patients stop using the gel and start using AO ProRinse three to four times a day to prevent the outbreak of another erosive lesion. If they get another lesion, they go back to using the gel. The mouth rinse has reduced the number of outbreaks for these patients, and having these products on hand, has allowed my patients to successfully manage outbreaks on their own. 

I have lots of older patients who suffer with burning mouth or burning tongue. AO ProRinse mouth rinses have worked well for them. Some of my patients have severe dry mouth in association with the burning—some with Sjogren’s syndrome, some with Lupus disease. We start them on the hydrating formula of AO ProRinse, and they rinse their mouths four to six times a day with remarkable results. It’s also been of great value to my patients going through chemotherapy to keep their mouths hydrated and comfortable.  

The PerioSciences products are nonprescription and now readily available via Amazon. Once introduced to the products and given guidance, my patients have found it easy to determine when to start using the products and how often to use them. Topical antioxidants are just one more example of industry breakthroughs I am grateful to have in my clinical toolkit and widely available to patients.