Front Line Innovations – Aerosol Management Part 3
Research has shown COVID-19 is transmitted through aerosols. To combat this the CDC recommends aerosol management practices for dental offices. In the last of a three-part blog series Dr. McAllister Castelaz, the dental director at Horizon Health Services Ivor Dental Center shares how aerosol management coupled with minimally invasive dentistry is reshaping dental care. View parts one and two of the blog series.
In parts one and two of the aerosol series I shared how to communicate with patients about what aerosols are, and some of the changes I am taking in my dental office. In this last blog, I’ll share techniques that I am using that are less aerosol-generating and less invasive. These are techniques I used before COVID-19 and continue to utilize when they are clinically appropriate. I emphasize with these patients that the success of these techniques can be enhanced by following good home care including brushing at least twice a day with a fluoridated toothpaste, flossing once a day, consuming a low-sugar, low-acid diet, and other traditional at home preventive measures. You can learn more about the principles of minimally invasive dentistry in this blog.
Silver Diamine Fluoride
Silver diamine fluoride, or SDF, is a topical treatment that can be used on both children and adult teeth to halt decay. Traditional fluoride varnish is a well-established primary, preventive measure to guard teeth against decay. When fluoride comes in contact with our teeth, such as through varnish application by the dentist, it becomes incorporated in the structure of our teeth which makes our teeth more resistant to the bacteria that cause decay. SDF has an additional benefit that if the tooth has already begun to decay, it can halt that process, making it significantly stronger than traditional fluoride varnish. Applying SDF is a short process, requires minimal materials, and can easily be incorporated into another appointment. It is important to understand that the SDF application does not indicate that the tooth may never need a filling, however it can slow the process until that time occurs. Additionally, SDF has a side effect that any area of the teeth where there is active decay will become discolored and permanently stained black. For this reason, some patients may opt to have a traditional filling placed over the SDF at a later date if esthetics are a concern.
Atraumatic Restorative Techniques
Interim restorative technique (IRT), atraumatic restorative technique (ART), or the similar silver diamine modified atraumatic technique (SMART) are methods that emphasize the use of hand instruments and fluoride releasing material to restore decaying teeth, rather than removing decay and damaged tooth structure with a handpiece, which requires numbing agents, produces a lot of aerosols, and is relatively invasive. Conversely, approaching a decayed tooth utilizing IRT, ART, or SMART is less invasive and less aerosol producing, and still treats the decay. Each technique has slight differences but all three produce fewer aerosols than a traditional filling. This article discusses the differences between IRT and ART. Notably, the SMART technique follows the same methodology as ART with the addition of SDF to the protocol.
The Hall Technique is a method of placing a stainless-steel crown on a primary pediatric tooth that has severe decay. Traditionally, when a pediatric tooth requires a crown, it is numbed, all decay is removed, and the tooth is prepared to accommodate space for the stainless-steel crown. The Hall Technique bypasses most of these steps. No local anesthetic is applied to the tooth and no preparation or removal of decay is performed. Instead, an oversized stainless-steel crown is filled with cement and is placed over a decaying tooth thus sealing the decay in the tooth.
Dentistry is changing in response to the COVID-19 pandemic. I am confident that we can meet these changes head-on with innovation and fresh ideas. While aerosol management is top of mind to reduce the risk of COVID-19 transmission in dental settings, I hope that all of us in the dental community consider other changes that will continue to move our profession forward so that we can provide evidence-based, effective care for our patients.
Video tutorials of techniques
- Youtube: SDF Application
- Youtube: ART technique part 1, ART technique, part 2
- Youtube: SDF SMART Filling Tutorial
- Youtube: SMART Hall Crown Technique
- Youtube: Hall Crown Technique without SMART