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The elderly and dental tooth creams: Creams help protect enamel and control sensitivity

Nov. 15, 2016
Dr. William Paveletz reviews tooth creams for how they control sensitivity in elderly patients.

By William Paveletz, DMD

Let's face it. Getting older is an uphill battle these days. Open a magazine or turn on the television and we're exposed to a multitude of products and procedures that claim to give us a more youthful appearance. The same is seen in the dental profession. Trying to reverse the effects of long-term use and abuse of our patients' teeth is one of the many challenges we dental professionals experience when consulting with our patients. Patients inquire about how to make their teeth straighter, whiter, or appear healthier, without considering the consequences those procedures can have on the health of their tooth structure.

This is especially noticeable in our growing geriatric population, where the effect of aging is apparent in the oral cavity. Years of exposure to highly acidic foods or liquids and malocclusions take their toll on the dentition.

In treating these individuals, the hygienist should be conscious of sensitive areas of the mouth that can be exacerbated with dental instruments. Patients will normally inform the clinician of these areas of sensitivity. Fluoride varnishes and dental creams are two weapons that dental professionals can offer patients to combat sensitivity. Erosion of the enamel and dentin frequently contributes to complaints of temperature sensitivity.

The use of products such as Remin Pro from VOCO can help with sensitivity. They can also improve several other issues that affect the aging population. Elderly patients are susceptible to tooth and soft-tissue erosion caused by years of medication use. These medications can lead to xerostomia. In addition, we have a growing number of aging people changing their appearance by undergoing orthodontic treatments and whitening procedures.

Hygienists should educate patients about the chemical process of whitening agents. These agents cause the opening of dentinal tubules, which can cause sensitivity and dehydration of the tooth structure. A dental cream treatment can restore the water balance in the tooth and produce a noticeably smooth and pleasant feeling to the teeth.

Using a dental cream during a clear-tray orthodontic procedure, where the dentist may need to perform interproximal reduction, can help a patient recover much quicker. The topical dental cream's properties reduce the irritation caused by the rotary and hand filing performed during this procedure.

As for use in traditional orthodontic treatment, dental creams function in a much different fashion. Their chemical impact helps prevent and block the decalcification marks that sometimes occur when bracketing is applied to the enamel surface.

Impact of medications

Let's address the issue of medication usage by patients and how this affects their oral environment. There are over 400 medications that can cause xerostomia, creating a dry, parched feeling in the mouth. Most of these medications have an antiadrenergic/anticholinergic effect, meaning they block certain functions of the body's systems that help promote watery secretions from glands, such as saliva.

Studies show that dry mouth can create problems with swallowing, chewing, and dental decay. As dental professionals, it's important to familiarize ourselves with a few of the common types of medications that can lead to oral dryness.

Alpha and beta blockers used in the treatment of hypertension may lead to dry mouth. Research has found that calcium channel blockers can inhibit saliva secretions. Other studies show that antimuscarinic drugs that counter muscular spasms that contribute to urinary frequency may affect the body's ability to secrete saliva. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MOAIs), which are sometimes used to treat Parkinson's disease, have reportedly caused decreased production of saliva. In addition to these groups, some antihistamines, antibiotics, antidiarrheal drugs, gastric medications, and some pain medications have been linked to dry mouth.

For patients using any of these medications, the hygienist or dentist should introduce a dental cream into the daily protocol to control sensitivity and protect the teeth.

Components of dental cream

Let's look at how a dental cream such as Remin Pro actually works. Remin Pro combines three components-nano-hydroxyapatite (calcium and phosphate), fluoride, and xylitol-for effective protection against demineralization and erosion. The three components are described below.

Nano-hydroxyapatite-Many studies have shown that nano-hydroxyapatite fills superficial enamel lesions, tiny irregularities, and the dentinal tubules that are a result of erosion on the tooth surface. Bacterial plaque cannot readily adhere to a smooth tooth surface. This filling and smoothing action of nano-hydroxyapatite causes remineralization and the tooth becomes naturally reinforced.

Fluoride-Fluoride applied to enamel and dentin is converted into the more stable and acid-resistant fluorapatite through contact with saliva. The delivery of 1,450 ppm of fluoride contained in Remin Pro strengthens the tooth and creates resistance to acid attacks that may occur in the mouth.

Xylitol-The last piece in Remin Pro's matrix is xylitol, a sugar substitute that's been proven to have natural cariostatic properties. Unlike artificial sugar substitutes (saccharine, aspartame, and sucralose), this material cannot be converted into harmful lactic acid by cariogenic bacteria. The inclusion of xylitol in Remin Pro significantly reduces the conversion of cariogenic bacteria and metabolic byproducts of lactic acid in the mouth.

Dental creams can boost the saliva's ability to restore normal pH levels by neutralizing acids and strengthening the tooth structure. To determine who can benefit from a dental cream, always take a complete medical history, ask leading questions regarding patients' ongoing treatments, and be aware of the prescriptions they are taking.

Dental creams can be an extremely helpful tool in the treatment of sensitivity or to prevent demineralization due to orthodontic treatment. Encouraging patients to use dental creams daily can help preserve existing tooth enamel and ensure that their dental treatment is sensitivity free.

The daily use of dental creams strengthens patients' teeth, protects them from the harmful effects of highly acidic drinks and foods, and protects them during dental procedures performed by their dentists and hygienists. RDH

William Paveletz, DMD, is a graduate of Temple University School of Dentistry. He completed his AEGD residency at University of Pittsburgh Dental School and continued postgraduate work in prosthetics at University of Pittsburgh Dental School. He is one of VOCO America's clinical educators, and he speaks nationally to dental retailers, dental societies, and teaching institutions. He has a passion for restorative dentistry with an emphasis on biocompatibility and holistic dentistry. His hands-on workshops focus on topics such as dental hygiene, esthetic dentistry, fixed and removable prosthetics, and nano technology.