Prevora Blog

Over the last couple of weeks during my meetings with our Partners in Prevention clinics there have been some questions around the length of Prevora therapy that seem to be on the minds of a few of the clinics. In order to address these questions I had a Q&A session with Dr John (Jack) Symington and asked him how he would proceed. Dr Symington is Professor Emeritus in Oral Surgery at the University of Toronto.

Q: What is the ongoing treatment regimen for Prevora after the patient has received the initial 4 applications in the 2 month span?

 A: The treatment regimen for each patient is going to be slightly different as it will need to address the individual’s specific risk factors. Some patients will be at higher risk of root caries due to the risk factors of gum recession, xerostomia, periodontal disease, poor oral hygiene and lack of manual dexterity. Clinical judgement on the part of the dental professional will need to be used and a more aggressive or passive treatment regimen may be better suited for a particular patient. However with that said there are some guidelines that can be followed.

After four applications of Prevora the chlorhexidine acetate (chx) can remain in the microtubules of the dentin for more than 42-60 days (6-8 weeks) which will help to combat the bacteria within the biofilm on the tooth surface. This is the rationale for the 4 applications within a short time span to maximise the concentration of chx and as a result control re-growth of the bacteria.

Six months after the final initial treatment of Prevora the efficacy starts to diminish due to the decrease in the concentration of chx. It is for this reason that the patient should receive an additional application of Prevora at this time.

At one year (12 months after the initial treatment) the dental professional must use their clinical judgement as to how many treatments the patient will receive at this time (1-4). The determining factor is the number of new caries that the patient has experienced over that 12 month period.

Examples of treatment regimens:

If the patient has no new caries and was previously experiencing 3-4 over the course of 12 months then a single application would be used at the 12 month recall appointment and then observe that patient’s progress over the next 6 months.

If the patient has no new caries at 6 months but then has new root caries at 12 months then it would be prudent to treat with 4 applications and observe again in 6 months.

With Prevora’s 41% reduction rate for root caries the process of minimizing the amount of new caries that develop is something that may have to be observed over the course of a few years. An example would be if a patient exhibits 5 new caries in the year prior to treatment it is possible that this could be reduced to 3 new caries in the first year of the treatment. Then by year 2 of the treatment the number of root caries could be down to 1 or less.

As with any treatment it is important to manage the expectations of the patient and to speak to them about the disease and how this course of action will benefit them and improve their oral health.

I hope that all of you will find this discussion beneficial and if you have any comment please feel free to pass them along

Take care,
Tyler

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Hello,

As most of you are aware the International Association for Dental Research (IADR) held their General Session last week here in Toronto at the Metro Toronto Convention Centre. This session included symposia and poster presentations by researchers from around the world.

From the General Session we will be making a couple of blog posts. One will discuss the impact of psychiartric medication on oral health status as presented by Dr Tina Papas of Tufts University. The other will discuss the collaboration between dentistry and medicine when dealing with oral and systemic health, which was presented by Dr Bill Costerton of the University of Southern Calironia.

Also we at CHX Technologies were very happy to host a reception at the University Club on July 2nd in conjuction with the IADR Session, and I would like to take this opportunity to thank all of those people who attended the reception and made it a very enjoyable evenning.

Take care,
Tyler

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At the recent International Association of Dental Research (IADR) meeting held in Toronto, Dr. Tina Papas (Tufts University School of Dental Medicine, Boston) presented the results of a nine month study on the changes in oral health status in patients taking psychiatric medications compared to patients who were taking medications known to cause xerostomia (dry mouth). It is well known that many psychiatric drugs such as those used to treat anxiety, depression and those with an effect on the autonomic nervous system all have a xerogenic (drying) effect. Medications that cause dry mouth have been shown to contribute to a higher caries rate.

In her abstract Dr. Papas was able to demonstrate in a population of 653 patients that psychiatric drugs led to a significantly higher increase in periodontal attachment loss and recession and a significantly higher increment of caries than even drugs known to cause xerostomia. This is despite having acceptable oral hygiene habits and receiving regular dental visits.

This reinforces data by Rindal published in 2005 (Community Dentistry and Oral Epidemiology, 33:74-80) demonstrating that for patients taking antidepressants the restoration rate is an amazing 60% higher than for those taking no medication at all.

Clearly, understanding a patient’s medical history and specifically the use of psychiatric drugs could be critical in identifying this risk factor for caries and assist in the development of preventive treatment strategies.

See the link below for the abstract of Dr Papas’ presention

IADR Session 1513 Changes in Oral Health Status in Volunteers on Psychiatric Medications

Take Care,
Tyler

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At the recent meeting of the International Association of Dental Research (IADR) in Toronto, one of CHX Technologies Regulatory and Clinical Affairs officers, Holly Byrd, attended one of the many sessions and was kind enough to provide us with a post about this session.

An important symposium was held on July 3rd: “How do Medicine and Dentistry Collaborate on Oral/Systemic Health?” (Sponsored by Johnson & Johnson Oral Healthcare). The presentation included Dr. Bill Costerton of the University of Southern California, talking about the role biofilms play in oral and systemic health.

Dr. Costerton, known as the “father of biofilms” after coining the term in the late 1970’s, describes biofilms as a group of bacteria that colonize a surface. Once believed to be responsible for over 65% of infections, the National Institutes of Health now estimates biofilms to be associated with 80% of infections. Biofilms are mobile cultures that have been found in such areas of the body as the inner ears, lungs, implanted medical devices and tooth surfaces (in the form of plaque). Biofilms are 1000x more resistant to antibiotics than monocultures. Dr. Costerton believes that the explanation for the high resistance to antibiotics is due to a sticky slime that is secreted by the bacteria, which acts as a protective barrier for the biofilm. This slime makes up the majority of the biofilm composition and is responsible for allowing passing monocultures to attach to existing colonizations. When a biofilm has grown to capacity, it has the ability to shed bacterial members to other parts of the body, including the bloodstream. These bacterial members can colonize in a new area of the body and create a large biofilm, similar to the one they originated from, creating an infection. This may explain the high burden of Streptococcus mutans on diseased heart tissue as reported by Nakano et al.

K. Nakano et al, “Detection of Cariogenic Streptococcus mutans in Extirpated Heart Valve and Atheromatous Plaque Specimens”, Journal of Clinical Microbiology, v.44, 2006, pp. 3313-3317.

Dr. Costerton gave a very informative and thought provoking presentation on the link between medicine and dentistry with respect to oral and systemic health. See the link below for an article about Dr. Costerton.

http://blogs.uscannenberg.org/annenbergfiles/2007/11/usc_professor_offers_fresh_loo.html

Holly
CHX Technologies
Regulatory & Clinical Affairs

We would like to hear your thoughts about this presention and how these two displicines of the health care system collaborate so feel free to add your comments to this post.

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