By Amber Auger, RDH, MPH
The loss of enamel is a common problem in everyday dental practice, and studies indicate that one in eight adults experience hypersensitivity.1 Numerous factors can lead to loss of enamel, such as grinding, clenching, abfraction, abrasion, and erosion.
As clinicians, we understand that despite the current state of patients' oral health, most are concerned about the color of their teeth. The role of the clinician is to properly educate patients on protecting the enamel on a daily basis, and to boost enamel protection during whitening treatments. An effective office whitening protocol should include a remineralization agent with a high fluoride content that can neutralize the pH and has cariostatic properties. I recommend Remin Pro (VOCO).
Remin Pro is a water-based cream that contains calcium and phosphate (hydroxyapatite), fluoride, and xylitol.2 This combination of ingredients has been shown to effectively repair enamel while aiding in caries prevention.3 Unlike other remineralizing agents, Remin Pro does not contain milk proteins, and it is equipped with a high concentration (1,450 ppm) of fluoride, which allows the paste to offer therapeutic effects. It is effective at reducing root surface sensitivity in a short time, and it provides relief to patients with mild to severe cases of recession or abfraction. The cream is silky smooth, spreads easily, and is offered in pleasant flavors. The inclusion of highly-concentrated fluoride makes it ideal for caries prevention in high-risk patients.2
Remin Pro can be applied with a brush, finger, or in custom trays for a 30-minute duration. If the sensitivity is moderate to severe, the patient should wear the tray overnight. When applying Remin Pro with a brush or finger, apply the cream directly onto the site-specific locations that are experiencing sensitivity. Following the application, the patient should not drink or eat for a minimum of 30 minutes.
During orthodontic treatment, advise patients to apply a pea-sized amount of Remin Pro with a toothbrush or swab onto the enamel surface. Instruct the patient to distribute excess cream in his or her mouth with the tongue. The remineralizing cream should remain in the mouth as long as possible (clinical results have shown at least three minutes) for optimum results. After the patient has completed the treatment, instruct him or her to expectorate the excess without rinsing, eating, or drinking for at least 30 minutes for the most beneficial treatment.2
Establishing an effective whitening protocol encourages patients to implement therapeutic products that will protect their enamel. Whether for daily protection to aid in the balance of pH, decay, root sensitivity, or for use during whitening treatment, products such as Remin Pro should be recommended as adjunctive therapy. It is important to choose products that are not thick in consistency because this can trigger a gag reflex. Remin Pro offers the correct consistency to promote compliance of overnight and daily use, while providing great tasting flavors such as strawberry, melon, or mint.2
Implementing Remin Pro into a patient's homecare regimen aids in decreasing the patient's risk of decay and sensitivity, and it smooths the enamel surface after whitening to ensure dental tubules are protected.4 Selecting products with proven clinical studies that require few steps to implement is essential to patient compliance.
Using trays to combat sensitivity
When using Remin Pro in custom trays, take an alginate impression and fabricate custom Essix trays, then demonstrate how the patient will effectively use the product at home. Instruct the patient to place a small amount of paste into the trays, preferably a pea-size amount on each sextant of the upper tray. Advise the patient to use a cotton swab to evenly disperse the paste to ensure full tooth coverage. Depending on the size and number of teeth, additional paste may need to be added.
Gently dry the top teeth if excessive saliva is present and insert the tray onto the maxillary arch, being careful not to drop or tilt the tray. Instruct the patient to follow the same procedure for the mandibular arch. When patients use whitening trays with professional gels, instruct them to use them overnight for the night prior, day of treatment (if not wearing overnight), and the following evening. When implementing a remineralizing cream for patients with a high risk of caries, suggest they implement it one or two nights a week overnight or three to four times a week for 30-minute durations.
Equipping patients to participate in their own remineralization program reinforces chairside caries prevention education and enables them to reduce their risk of decay. RDH
Amber Auger, RDH, MPH, is a hygienist with experience in multiple clinical settings, including facilities abroad. Amber obtained a master's degree in public health from the University of New England and a bachelor's in dental hygiene from the University of New Haven. She holds a part-time position at an elite dental office in Boston, and is chief of clinical technology for Jameson Management. Amber is co-owner of Spin C.E. where participants receive continuing education while enjoy a challenging indoor cycling class. Amber Auger is a key opinion leader for several dental companies, a professor, a published author, and can be contacted at [email protected].
1. Cunha-Cruz J, Wataha JC, Heaton LJ, et al. The prevalence of dentin hypersensitivity in general dental practices in the northwest United States. Journal of the American Dental Association (1939). 2013;144(3):288-296.
2. The Dental Advisor. Clinical Evaluations: Remin Pro. 2016. Available at: https://www.dentaladvisor.com/evaluations/remin-pro/. Accessed November 6, 2016.
3. Li L, Pan H, Tao J, et al. Hydroxyapatite (HAp) for Biomedical Applications. 2015.2008;18:4079-4084, Pg 139-142. ISBN: 9781782420330.
4. VOCO. Remin Pro. Protective Dental Care with Fluoride and Hydroxyapatite. http://www.hambaarst.ee/share/file/pdf/voco/Remin_Pro.pdf. Accessed November 14, 2016.