Latest Trends and News

Latest trends or news of specialty including upcoming meeting-

Silver Nitrate/ Silver Diamine Fluoride to Treat Ongoing Caries

Silver nitrate and silver diamine fluoride are inorganic materials with germicidal and remineralization properties.  When applied to caries lesions, they prevent further decay. With a microbrush, it is applied to the caries lesion, after which fluoride varnish is used to seal the area.  The chemical hardens and disinfects the cavity, preventing further decay. While successful, this treatment is not aesthetically appealing. Silver nitrate causes the cavity to become gray/brown in color.  However, seeing as many cavities form along molar teeth, it is often not visible. Additionally, it does not affect the permanent teeth.

Kovanase: http://www.kovanaze.com ; http://www.noneedles.com

Kovanase is a needle-free nasal anesthetic, appropriate for children weighing more than 40kg.  Delivering metered dosage to the nasal canal, it is a less-invasive alternative to palatal injections that can illicit fear.  It is a cocktail of Oxymetazoline and Tetracaine. Tetracaine is an ester anesthetic that promotes blockage of sodium channels, while oxymetazoline is a decongestant, promoting adrenergic receptors and vasoconstriction.  It’s anesthetic properties are effective for teeth #A through # ad anesthetizing the palate and the pulp. However, it’s anesthetic properties are limited to dentition and don’t effect the lips.

Referrals to Myofunctional Therapists

https://www.colgate.com/en-us/oral-health/basics/mouth-and-teeth-anatomy/myofunctional-therapy-its-all-in-the-tongue-1215

• What is it? Myofunctional therapy is a program of exercises targeting facial muscles of mastication and swallowing.  This promotes proper breathing, talking and eating. This helps prevent issues such as speech impediments, various forms of sleep-discorded breathing and narrow palates that ineffectively house the tongue.  Pediatric dentists can incorporate myofunctional therapists into their office or refer patients to said therapists.
• What does it address? Myofunctional exercises strengthen the tongue and other areas of the oropharynx (muscular tissues lining the mouth and throat).  The oropharynx (opening of the mouth into the pharynx) helps us maintain an open airway during sleep. If these muscles are weak, airway collapse is highly probable and can result in snoring.  While snoring may seem benign, overtime it can cause irreparable damage to associated tissues and can eventually lead complete blockage of airways (can eventually lead to sleep apnea). Finally, it can be economically beneficial to parents.  Improper tongue movement can negatively impact tooth alignment. So, the proper tongue movement established by myofunctional therapy can help prevent the need for orthodontic treatment and its associated costs.

• Why are many children (and adults) myofunctionally deficient?  Evolutionarily speaking, the viscerocranium of the human species is shrinking.  Epigenetic factors associated with the Industrial Revolution have led to underdeveloped mandibles, longer faces and smaller airways.  These factors include increased consumption of processed foods (including simple sugars and fatty foods), increases in sedentary lifestyles, increases in consumption of softer foods (especially introduced to infants) and decreases in breast feeding.  
• Myofunctional Therapy can help with other Ailments:
• Headaches
• Nail biting
• Temporomandibular Joint Pain
• Gastrointestinal Issues
• Neck Pain
• Tongue-tie
• Tethered Oral Tissues (TOTs)
• Research: “The Importance of Orofacial Myofunctional Therapy Before and After CO2 Laser Frenectomy in Achieving Optimal Orofacial Function” – Wuertz, et al,- 2018
• https://dentalsleeppractice.com/case-report/the-importance-of-orofacial-myofunctional-therapy-before-and-after-co2-laser-frenectomy/
• images are from this paper (images show girl  before and after Frenectomy and subsequent Myofunctionaly therapy)

Myobraces

https://myobrace.com/en-us

Myobrace is a “no-braces orthodontic approach”.  Like myofunctional therapy, It addresses poor oral habits that misalign teeth.  This utilizes the concept that poor myofunctional habits ,like improper jaw development, thumb-sucking, mouth-breathing and tongue-thrusting are largely responsible for the misalignment of teeth.  Myobraces are ideal for children ages 3 to 15. It involves a series of oral appliances that must be worn overnight and for 1-2 hours during the day. It promotes nose breathing, correct tongue posture, proper swallowing patterns and closed lips (thereby preventing mouth breathing, especially at night.  Nose-breathing is physiologically ideal)

It promotes:

• Proper occlusion

Proper Jaw Development

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• Larger Arches
• Optimal Facial Development
• Prevents improper swallowing patterns

Many oral issues are irreversible after permanent dentition, so treatment should be considered as early as possible.  Because these appliances allow the tongue to rest in the correct position (on the palate behind maxillary anterior teeth), they help the child’s jaw grow wider and to its full potential, so that there is sufficient room for the teeth.  This ideally promotes proper alignment, without the need for braces.

Four Stages of Myobraces:

1. Habit Correction
2. Arch Development
3. Dental Alignment
4. Retention