Clinically, I’ve been in the same dental practice for over 30 years.  That affords me an opportunity to have long standing perspectives on so many patients.

I’ve made several observations about patient care through the years:

• Many patients think little about how nutrients in their diet influence health versus disease on the teeth and supporting structures

• Few patients connect the dots between pathogens that live in the mouth, and pathogens that influence disease at distant organs in the body and the influence oral health has on their current health

• A surprising number of otherwise intelligent patients settle for inadequate oral hygiene habits everyday

• A shocking number of patients present with elevated blood pressure readings. Way more than can be explained with white coat syndrome

Few of these observations with patients create immediate urgency the patient notices, yet all of these observations yield fertile ground for meaningful education and motivation to influence healthier outcomes long term

Another observation yielding an opportunity to influence outcomes has to do with the slow but steady wear on the cervical areas of patient’s teeth. It has been my experience that the vast majority of these lesions are asymptomatic, and in many cases have not even been noticed by the patient. You don’t have to look inside very many mouths to see evidence of abfractions, abrasion, attrition and erosion. And, if you’ve been looking inside the same mouths consecutively through the years, you can observe continued wear of enamel and exposed dentin.

As clinicians, what should we do? Should we document the lesions? Should we inquire about dietary, bruxisum and over-brushing influences? Is there anything we should consider to prevent further wear? Yes! Often there are dietary influences that drop the pH for extended and repeated periods of time that contribute to erosion and wear, so dietary recommendations for higher pH products and less frequent exposures to low pH products is a great place to start. Examining patient’s oral hygiene habits with the advantage of disclosing solution applied to vulnerable cervical areas often reveals a dual problem: over-scrubbing, yet in-effective techniques to remove sticky biofilm – both of which can make wear considerably worse over time. Additionally, recommending low-abrasive toothpastes can help protect areas already exposed to abrasion. Looking at occlusal forces and wear facets can also give us clues about patient’s bruxism patterns and recommendations for minor orthodontic interventions and/or appliances can help reduce further wear.

However, interventions often stop just short of providing a treatment that can shield vulnerable lesions already present from on-going wear. For the last several years in my practice, I have been pro-actively seeking out vulnerable cervical lesions that are asymptomatic, and providing a treatment that essentially provides a barrier to protect from further wear. If the lesions are sensitive, it’s a win/win since it is also a powerful desensitizer, but why wait until the lesions worsen or become symptomatic? Patients appreciate an intervention that shields the surface from additional wear, is easy to apply, and lasts up to 3 years prior to needing a re-application. The product I’m using to protect lesions from further wear is Shield Force Plus (SFP) by Tokuyama.

Once lesions have been identified and patients have been educated regarding diet and/or habits to modify, the next few steps are easy. Close-up intraoral images to allow patients to see images of tooth wear/erosion almost creates urgency to commit to a protective treatment even in the absence of sensitivity. Upon educating the patient that left exposed and untreated, lesions have a high potential to progress (see Figure 1). Patients are eager to have a protective layer of Shield Force Plus applied which literally becomes a shield to prevent worsening of the lesion. The site or sites needing protection are coated with SFP with a micro brush for 10 seconds, air-dried for 10 seconds, and sealed with a UV light for 10 seconds. Time to identify the opportunities, educate the patient about the benefits of Shield Force Plus and apply it literally encompasses only a couple of minutes. Once applied, re-application is recommended on a 2 to 3-year basis for continued protection of vulnerable surfaces.

Figure 1. Erosive wear on lingual surfaces