I have had several patients w moderate to severe demineralization and really would like to help them as best I can. Some have chalky white patches that are soft and even brushing will leave little grooves in the tooth. A few others have almost every surface as dark yellow and chalky texture. I’m thinking that most of the enamel has been worn, eroded off and this is dentin? I can apply a fluoride varnish and recommend our Rx fluoride toothpaste, but I feel like it’s not enough to make a difference I can usually determine what causes it w each pt and recommend a few changes to prevent further demineralization. Any advice would be very much appreciated.
When patients present with this much active demineralization the first thing is to educate them on why it’s happening (plaque full of bacteria sitting on tooth with acidic bi-products- like lemon juice- causing tooth to wear away: or something like this) and how to fix it, by better home care, fluoride toothpaste, and fluoride rinse. You can only give them the tools to help themselves, it’s up to them to follow through. It sounds negative but if a patient doesn’t even brush before a dental appointment, they most likely aren’t going to be very compliant with home care. If it’s through to the dentin the dentist doing the exam should have noticed this and may need to place restorations. Again, you can only give them the tools! If you still have any books from school there should be good information there (like Principles of Dental Hygiene by Wilkins). I hope this helps!
Agreed MI paste, oral hygiene instructions and an explanation for whats the cause. Motivating the pt to be compliant with the MI paste is the real tricky part because its usually non compliance that gets them demineralized teeth.
Take intraoral photos of the areas and show them what you see. Of course that won’t work on everyone but it might scare a few patients straight. MI paste, Prevident, or Clinpro seem to work to some extent but if the demineralized area has already broken through the enamel and to the dentin then it will need a rrestoration.
Education, prevident booster 5000 toothpaste. Three month re care hygiene appointments and MI paste at night. I tell them to place the MI pate in fluoride trays, retainers, or invisalign if they have them and wear it overnight.
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