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czeqm8



Joined: 24 May 2006
Posts: 125

PostPosted: Tue Mar 20, 2007 2:59 pm    Post subject: bulemia Reply with quote

If a patient is an active uncontrolled bulemic, would you recommend trays with flouride then MI paste as a daily supplement? What other recommendations would you give?

Is there any protocol that would be best?

Here is my typical protocol for patients (copy of the actual slip we give patients) with a high caries rate. Should I just use this protocol for bulemics?

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Flouride Appliance Instructions

In efforts to prevent future dental problems, we are recommending fluoride appliances for you. Please follow the directions closely for best results.

1) Rinse for 2 minutes with low level fluoride (0.25% ACT Rinse) from your local store.
2) Only spit, do not dilute with water.
3) Place a thin layer of MI paste evenly throughout the appliance and leave for at least 5 minutes.
4) Only spit, do not rinse.
5) No eating or drinking for 30 minutes.

Continue this routine daily for one month. After one month the instructions change.

1) Use high strength fluoride gel for one minute in appliance.
Steps 2,3,4, and 5 remain the same.

Do this indefinitely. The analogy we use is weeds in the lawn. If you stop spraying and taking care of the lawn the weeds return.

Flouride Appliance Rationale

We do not recommend the high fluoride levels immediately. High fluoride is effective in disturbing bacterial metabolism, but it has a negative on the remineralization and sealing of beginning stages of decay. This means that with a high flouride concentration you are remineralizing the top of the demineralization and leaving the deeper enamel still porous. MI paste is not fluoride. It is a high concentreation amorphous calcium and phosphate. We use MI paste with low level fluoride to attempt remineralization of the deeper portions of decalcified areas. Flouride on its own does not aid in remineralization. It helps the formation of more acid resistant tooth structure (hydroxyflourapatite). If there is a deficit of calcium and phosphate in the saliva, or the local acid challenge is such that it overwhelms the natural buffering capacity of the saliva, then demineralization in the areas of plaque accumulation will occur. Having high levels of amorphous calcium and phosphate in the local environment means it becomes absorbed into the natural biofilm that can be found on the teeth. The fluoride, calcium and phosphate becomes a local source of remineralization potential. This is something that toothpaste just cannot do on its own.
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john kanca



Joined: 14 May 2005
Posts: 6341

PostPosted: Tue Mar 20, 2007 7:08 pm    Post subject: Reply with quote

That's very reasonable, Matt.

I will also recommend antacids following events to neutralize the pH.
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d2thdr



Joined: 16 Oct 2005
Posts: 402
Location: Cincinnati, Ohio

PostPosted: Wed Mar 21, 2007 5:13 am    Post subject: Reply with quote

john kanca wrote:
That's very reasonable, Matt.

I will also recommend antacids following events to neutralize the pH.


JK,
with the specific ingredients in, say a TUMS, are you not providing aid for a more acidic and destructive environment with all the sugar? Would water not be more beneficial at increasing the pH?

And Matt,
Have you ever looked at the Carifree system? We have recently started it, and are just getting to the point of re-evaluation of patients on recall.
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john kanca



Joined: 14 May 2005
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PostPosted: Wed Mar 21, 2007 6:29 am    Post subject: Reply with quote

d2thdr wrote:
john kanca wrote:
That's very reasonable, Matt.

I will also recommend antacids following events to neutralize the pH.


JK,
with the specific ingredients in, say a TUMS, are you not providing aid for a more acidic and destructive environment with all the sugar? Would water not be more beneficial at increasing the pH?

And Matt,
Have you ever looked at the Carifree system? We have recently started it, and are just getting to the point of re-evaluation of patients on recall.


There are sugar free antacids. Sorry- should have been clearer.
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JKesling



Joined: 24 Oct 2005
Posts: 77
Location: Boise, Idaho

PostPosted: Wed Mar 21, 2007 7:05 am    Post subject: Reply with quote

Hi Dennis,

How have your patients been responding to the Carifree system? Are they skeptical? What do you charge for use of the Carifree system?

Thanks,

Jeff
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czeqm8



Joined: 24 May 2006
Posts: 125

PostPosted: Wed Mar 21, 2007 9:16 am    Post subject: Reply with quote

john kanca wrote:
d2thdr wrote:
john kanca wrote:
That's very reasonable, Matt.

I will also recommend antacids following events to neutralize the pH.


JK,
with the specific ingredients in, say a TUMS, are you not providing aid for a more acidic and destructive environment with all the sugar? Would water not be more beneficial at increasing the pH?

And Matt,
Have you ever looked at the Carifree system? We have recently started it, and are just getting to the point of re-evaluation of patients on recall.


There are sugar free antacids. Sorry- should have been clearer.


Anyone know the brand name of some sugar free antacids?
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Matt Brink
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czeqm8



Joined: 24 May 2006
Posts: 125

PostPosted: Wed Mar 21, 2007 9:16 am    Post subject: Reply with quote

d2thdr wrote:
john kanca wrote:
That's very reasonable, Matt.

I will also recommend antacids following events to neutralize the pH.


JK,
with the specific ingredients in, say a TUMS, are you not providing aid for a more acidic and destructive environment with all the sugar? Would water not be more beneficial at increasing the pH?

And Matt,
Have you ever looked at the Carifree system? We have recently started it, and are just getting to the point of re-evaluation of patients on recall.


Never heard of it. Tell me more.
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d2thdr



Joined: 16 Oct 2005
Posts: 402
Location: Cincinnati, Ohio

PostPosted: Thu Mar 22, 2007 6:46 am    Post subject: Reply with quote

czeqm8 wrote:
d2thdr wrote:
john kanca wrote:
That's very reasonable, Matt.

I will also recommend antacids following events to neutralize the pH.


JK,
with the specific ingredients in, say a TUMS, are you not providing aid for a more acidic and destructive environment with all the sugar? Would water not be more beneficial at increasing the pH?

And Matt,
Have you ever looked at the Carifree system? We have recently started it, and are just getting to the point of re-evaluation of patients on recall.


Tomorrow, although on DT, Shannon McGee is a good source....he's been doing it longer than I have.

Never heard of it. Tell me more.

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d2thdr



Joined: 16 Oct 2005
Posts: 402
Location: Cincinnati, Ohio

PostPosted: Fri Mar 23, 2007 5:24 am    Post subject: Reply with quote

Matt,

Carifree is more for caries control. I will not argue with your protocol for post-bulemic episodes except to say that in chasing down a lot of info on any OTC rinse, everything is acidic. I believe that you commented to that point on DT a while ago (October??).

http://www.carifree.com/

In a nutshell, the system has 2 parts:
1. Testing for high count presence of bacterial colonies and whether nature of that colony is primarily cariogenic (S. mutans;
2. Initial 2 week "medicinal" rinse (NaOCl & Fl) in a basic pH (about 11, I believe), followed by a maintainance rinse of Fl (0.5% NaFl) with a pH of 10. I forget, and website isn't filling me in.
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bj



Joined: 15 May 2005
Posts: 320

PostPosted: Tue Mar 27, 2007 10:15 pm    Post subject: Reply with quote

I too have been interested in Carifree but haven't got around to studying it.
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