Prevora Blog

Hi everybody,

Recently we received a question from a patient through the Prevora website asking about what steps they can take in order to comply with the treatment protocol of Prevora. Below is their question and the response that they received.

Question: How do I care for my teeth throughout this process? Are there foods or liquids I should avoid? What about smoking, kissing or coffee?

You asked about care of your teeth while under protection with Prevora. That’s easy:

• Avoid brushing your teeth 24 hours after a Prevora application — let the coating bond to your teeth and do its job
• Avoid flossing for 3 days after a Prevora application ¾ again, in order to not remove the coating from in between your teeth
• Resume brushing your teeth with a new tooth brush to avoid contaminating your mouth the bacteria on your old tooth brush
• Avoid hard foods (a crusty roll, an apple) in the first 4 hours after treatment-you don’t want to remove the coating that was just put on the teeth
• Avoid sugary or acidic drinks (Coke, coffee, lemonade, orange juice) until 4 hours after treatment.

And that’s it. Otherwise, you can follow your regular diet and oral hygiene.

As for Smoking? That’s a risk factor for tooth decay at the gum line which scientists are just beginning to understand. Essentially, smoking shrinks the gums and exposes your tooth’s roots to the bacteria which puts them at risk.

Kissing? Always encouraged, even during Prevora!! But you raise an interesting point. The bacteria that causes tooth decay is communicated from mother to child when the child is very young. This cross-infection is minimal, however, after early childhood this doesn’t take place because our oral ecology becomes too complex later in life, to allow for it. There are no studies that I am aware of, to show that kissing amongst adults or amongst parents and their older children, leads to tooth decay.

As for coffee, as listed above you want to avoid drinking it immediately after your application of Prevora but within a few hours you can have that much needed cup of Joe.

Thanks again for the great questions.
Take care

Tyler

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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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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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