Intermediate Restorative Material (IRM)
Intermediate Restorative Material is a sedative material placed on a tooth to reduce pain from irritated or inflamed pulp — the blood vessels and nerves in the center of a tooth. IRM calms the pulp and reduces the chance that saliva or bacteria will leak into the tooth and irritate the pulp in the future.
IRM is placed directly into the tooth often without any drilling. One of the most common types of IRM is zinc oxide and eugenol. This contains oil of cloves.
Intermediate restorative material (IRM) is a zinc oxide and eugenol cement that has been reinforced with the addition of an acrylic resin. IRM has been extremely effective in Skilled Nursing Facilities as a mid- stage non-invasive pain-management material.
IRM treatment is considered an intermediate measure, and often is used in elderly or disabled patients who can’t tolerate sitting in a dentist’s chair long enough to receive a regular filling. IRM may also be used for a patient who has a traumatized tooth and needs immediate relief.
Strength properties of IRM include low solubility, abrasion resistance and excellent sealing properties. This will often slow or stop the progression of decay and help the patient feel better. It also may allow the tooth time to recover and lay down secondary dentin, sometimes eliminating the need for more invasive treatment.
Fluoride varnish is a highly concentrated form of fluoride which is applied to the tooth’s surface, by a dentist, dental hygienist or other health care professional, as a type of topical fluoride therapy. It is not a permanent varnish but due to its adherent nature it is able to stay in contact with the tooth surface for several hours. It may be applied to the enamel, dentin or cementum of the tooth and can be used to help prevent decay, remineralize the tooth surface and to treat dentin hypersensitivity.
Numerous clinical trials conducted in the past 25 years have examined the efficacy of fluoride varnishes in preventing dental caries. Tewari and associates reported that after 2.5 years, the fluoride varnish resulted in a higher percentage of caries reduction than did the 2 percent sodium fluoride solution and the 1.23 percent acidulated phosphate fluoride gel.
The concentration of fluoride in varnishes is much higher than that of acidulated phosphate fluoride (APF) gels or other topical fluorides. However, due to the sticky form of the varnish and the small amount used per application, risk of ingestion and toxicity is very low. Less than 0.5 ml of varnish is usually required to coat the teeth in most patients.
MI Paste is the only product for professional use containing the active ingredient RECALDENT™ (CPP-ACP), a special milk-derived complex of casein phosphopeptide(CPP) and amorphous calcium phosphate (ACP) that binds calcium and phosphate to tooth surfaces, plaque and surrounding soft tissue. Calcium phosphate is highly insoluble, however the peptides are able to maintain the calcium and phosphate in an ionic form, preventing the formation of insoluble calcium phosphate and therefore enabling calcium and phosphate ions to enter the tooth matrix and remineralize areas of hypomineralized enamel. Furthermore, the peptides bind to the surface of the tooth, and to the bacteria surrounding the tooth, presenting a reservoir of ionic calcium and phosphate at the tooth surface.
MI Paste is a water-based, sugar-free creme that is applied directly to the tooth surface or oral cavity. MI Paste with RECALDENT™ (CPP-ACP) restores the oral mineral imbalances that cause demineralization by replacing minerals while improving saliva flow and fluoride uptake as well as soothing sensitive surfaces – making it an ideal treatment for relieving dry mouth caused by certain medications, buffering acids produced by bacteria and plaque and providing a topical coating for patients suffering from erosion, caries and conditions arising from xerostomia.
Reynolds and colleagues reported that CPP-ACP binds readily to the surface of the tooth, as well as to the bacteria in the plaque surrounding the tooth. In this way, CPP-ACP deposits a high concentration of ACP in close proximity to the tooth surface. The authors proposed that under acidic conditions, this localized CPP-ACP buffers the free calcium and phosphate ions, substantially increasing the level of calcium phosphate in plaque and, therefore, maintaining a state of super-saturation that inhibits enamel demineralization and enhances remineralization.
10% PVP Iodine
Povidone Iodine, or PVP Iodine, is a wide-ranging antiseptic that may be used in the treatment of periodontitis. It may be considered one of the most potent antimicrobial substances available. It is also known to be effective against viruses. This is a notable characteristic, because viruses connected to the development of periodontal disease can be resistant to alternate antimicrobial substances like chlorhexidinexli.
Another important aspect of PVP Iodine worth noting is that bacteria are not known to grow resistant. In addition, its effectiveness is not lessened by any other type of established bacterial resistance. It is also available at relatively low costs.
One study by Kotsilkov et al. found that 10% PVP Iodine was extremely effective in treating periodontal disease. In the areas treated, there was increased attachment, reduced probing depth, and less inflammation when compared with those not treatedi.
The effects of PVP Iodine may be even more astounding when used with a root scaling plan and regular cleaning of the oral cavity. One double-blind study looked at this very relationship, and found that a regimen that included scaling and root planning along with subgingival irrigation of PVP Iodine lead to a 95% or more decrease in pathogen counts within 44% of pockets 6 mm or greater. This was compared to pockets that were treated with only one method. Those pockets saw the 95% result in only 6-13% of subjectsxlii.
Doxycycline is an antibiotic used to treat a variety of infections. When used in tandem with other oral health care procedures, it can be used as an effective tool to fight periodontal disease, and its harmful side effects.
It can be ingested by use of a capsule, or implanted by a dentist directly into the infected gum pocket. Many studies have shown the positive outlook for patients who incorporate doxycycline into their periodontal health regimen.
Subgingival implementations were paired with debridement in one study analyzing the effect on thirty subjects with what was deemed “severe” periodontitis. Every week for four weeks subjects endured the removal of plaque and additional oral health care directions like brushing teeth.
Those who had 6 months of subantimicrobial doxycycline treatment and pockets equal to or greater than 7 mm saw a reduction of 3 mm after 9 months. This compared with only 1.42 mm for the control group. In those with pockets of 7 mm or more, 40% saw a reduction of 4 mm and 55% saw a reduction of 3 mm .
Another study analyzed the specific effect of this treatment on the elderly population. Seniors 65 and older who had detachment 5 mm and over and probing depth of 4-9 mm were involved. Every subject was treated with scaling and root planning and some received subantimicrobial dose of doxycycline (SDD) twice daily. When compared with the placebo, the group treated with SDD saw statistically significant reductions in probing depth by the 9th month.
Doxycycline can have a very positive effect on oral health when used in conjunction with other health care practices such as debridement and scaling and root planning.
Xylitol is a naturally occurring sweetener that may be used as a sugar substitute. Studies have shown that this substance can be used to limit or prevent cavities. It is considered to be as sweet as traditional table sugar, and has several medical benefits. For one, it does not require insulin to metabolize, and therefore, can be a mainstay in a diabetic dietxlvi.
The second derived health benefit affects the oral cavity. Products that contain Xylitol, such as chewing gum or candy substitutes, have been shown to reduce caries. This was true among children and adult populationsxlvi. This may be due to the increased salivary flow and the non-fermentable qualities it exhibits in the presence of bacteria.
There is evidence that Xylitol can decrease bacterial levels while simultaneously decreasing their adhesivityxlvii. Three studies that spanned 6 months found that Xylitol was found to decrease bacterial levels in plaque.
One study by Milgrom et. al saw a relationship between increased dosages of Xylitol and decreased levels of bacteria when studying the effect of Xylitol in the chewing gum form while treating Mutans streptococcil. They deduced that the optimal dosage of Xylitol ranged from 6.88 grams to 10.32 grams due to a “plateau effect” that was eventually observedl.
Due to its natural health benefits and absence of harmful effects, Xylitol can be a viable option for preventing tooth decay. It can also be used often and regularly.
Chlorhexidine is a dental rinse used to treat gingivitis and periodontitis. It can reduce inflammation and bacterial levels in the oral cavity. When used, the rinse can also fight against plaque build-up and further deter its formation.
It can also be applied topically as a chlorhexidine gluconate. One study found that when applied in this form, it fully prevented any plaque formation. This study also observed the effects of a 0.2 percent solution of chlorhexidine. They found that when used twice daily, it was an effective means of preventing plaque formation as well.
Another study examined the effects of chlorhexidine in the geriatric population. They analyzed the optimal dose and frequency that should be used within this demographic. When chlorhexidine was used in the absence of any other oral health care practices, there was a positive effect on oral conditions. There was also a subsequent decrease in risk for periodontal disease and tooth decay, an important effect to note due to the prevalence of these conditions among the elderly.
ATRAUMATIC RESTORATIVE TREATMENT
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SEDATIVE FILLINGS (Intermediate Restorative Material)
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Aimutis WR. Bioactive properties of milk proteins with particular focus on anticariogenesis. J Nutr 2004;134(4):989S–995S
Guggenheim B, Schmid R, Aeschlimann JM, Berrocal R, Neeser JR. Powdered milk micellar casein prevents oral colonization by Streptococcus sobrinus and dental caries in rats: a basis for the caries-protective effect of dairy products. Caries Res 1999;33
10% PVP IODINE
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Hoang T, Jorgensen MG, Keim RG, Pattison AM, Slots J. Povidone-iodine as a periodontal pocket disinfectant. J Periodontal Res. 2003 Jun;38(3):311-7.
Novak MJ, Johns LP, Miller RC, Bradshaw MH. Adjunctive benefits of subantimicrobial dose doxycycline in the management of severe, generalized, chronic periodontitis. J Periodontol. 2002 Jul;73(7):762-9. PubMed PMID: 12146536.
Mohammad AR, Preshaw PM, Bradshaw MH, Hefti AF, Powala CV, Romanowicz M. Adjunctive subantimicrobial dose doxycycline in the management of institutionalised geriatric patients with chronic periodontitis. Gerodontology. 2005 Mar;22(1):37-43. PubMed PMID: 15747897.
Peldyak J, Mäkinen KK. Xylitol for caries prevention. J Dent Hyg. 2002 Fall;76(4):276-85. Review. PubMed PMID: 12592919.
Soderling EM. Xylitol, mutans streptococci, and dental plaque. Adv Dent Res. 2009;21(1):74-8.
Mäkinen KK, Isotupa KP, Mäkinen P-L, Söderling E, Song KB, Nam SH, et al. (2005). Six-month polyol chewing-gum programme in kindergarten-age children: a feasibility study focusing on mutans streptococci and dental plaque. Int Dent J 55:81–88.
Merikallio MC, Söderling E (1995). Xylitol as a plaque-control agent in military conditions. Mil Med 160:256–258.
Milgrom P, Ly KA, Roberts MC, Rothen M, Mueller G, Yamaguchi DK (2006). Mutans streptococci dose response to xylitol chewing gum. J Dent Res 85:177–181.
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