IST – Interim Stabilization Therapy – Part 2

IST - Interim Stabilization Therapy

In continuing with my research regarding the long-term viability of IST, as per an extensive literature review that was completed by the Region of Peel in May of this year:

I offer the following “Key Messages” developed by the team:

  1. Interim Stabilization Therapy/Atraumatic Restorative Treatment are effective as a single surface temporary restoration for dental caries, on both primary and permanent teeth.
  2. High viscosity glass ionomer cements should be used as the material of choice for Interim Stabilization Therapy/Atraumatic Restorative Treatment.
  3. While the quality of evidence is weak in this area, the use of Interim Stabilization Therapy/Atraumatic Restorative Treatment may be beneficial in aiding with client-provider rapport and building client self-esteem.

As a public health organization, Peel Public Health (PPH) is mandated by the Ontario Public Health Standards (OPHS) to provide oral health programming to applicable populations.

The OPHS was recently updated, including the Healthy Smiles Ontario Program (HSO) protocol which now includes offering IST/ART to clinically eligible, preventive service stream enrolled children and youth.

The new HSO protocol mirrors the same parameters that I must adhere to for providing IST:

  • When access to permanent restoration is not immediate or practical
  • When there are no medical contraindications
  • When the client consents to the treatment
  • When any of the following apply:
  • There is reasonable risk of further damage to the tooth structure
  • The pulp is not exposed
  • The client is in discomfort or is experiencing difficulty in eating
  • The discomfort is due to recent trauma, fracture or lost dental restoration
  • The client has not received any medical/dental advice that would contraindicate placing a temporary restoration
  • It is in the client’s best interest to proceed

Hopefully, as this therapy becomes better utilized, we will begin to compile data supporting its long term viability.

In conclusion, I applaud the commitment of our public health institutions to offer this treatment for our underserviced and disadvantaged youth, but I am truly concerned about the lack of similar care for our at-risk adult population.

Hopefully, this treatment will be seen as a viable solution for them as well!

I welcome your feedback. You can connect with me via email or telephone, leave a comment right here on the site or join in the conversation on Facebook and Twitter.

Until next time,

Kathleen

IST – Interim Stabilization Therapy

IST- Interim Stabilization Therapy King City

IST stands for Interim Stabilization Therapy.

“IST provides temporary care for decayed teeth and teeth affected by trauma, to relieve pain and reduce the risk of further damage to the tooth structure until the client can gain access to care from a dentist.”

IST was introduced by the Ontario Region First Nations and Inuit Health Branch, Children’s Oral Health Initiative (COHI). In August 2010, the region’s COHI team identified the need to provide a caries control procedure similar to that of Atraumatic Restorative Treatment (ART), which is provided by COHI Health Canada dental therapists in all regions other than Ontario and Quebec.

What is the Difference Between IST and ART?

What differentiates IST and ART is that the IST protocol does not allow for the manual removal of decayed tooth structure, which is within the scope of practice of Dental Therapists but not Dental Hygienists. What is particularly wonderful about the IST though, is that we “are” allowed to provide a temporary filling to a broken-down tooth without using freezing or a drill!

How Does IST Shape Up as a Long-Term Solution?

After taking an Interim Stabilization Therapy course a number of years ago, I began providing these temporary fillings on an emergency basis for my patients until they were able to get to a dentist and have a proper filling done. Interestingly, many of my patients that are without dental insurance did not go to a dentist after to have the filling re-done, so I have had a chance to observe the long-term retention of my IST fillings! Since many are still in place, this has led me to do some research into this form of treatment to see how IST shapes up as a longer-term solution!

Rather than re-invent the wheel, I actually found a study done by the Region of Peel in May of this year whose Research Question was:

What is the effectiveness and recommended use of Interim Stabilization Therapy (IST)/Atraumatic Restorative Treatment (ART) for temporary tooth restoration?

According to the study a grey literature search was conducted that identified fourteen documents, but since I did not know what a grey literature search was I offer this Wikipedia definition before continuing:

What is Grey Literature?

Grey literature are materials and research produced by organizations outside of the traditional commercial or academic publishing and distribution channels. Common grey literature publication types include reports (annual, research, technical, project, etc.), working papers, government documents, white papers and evaluations. Organizations that produce grey literature include government departments and agencies, civil society or non-governmental organisations, academic centres and departments, and private companies and consultants.

Grey literature may be made available to the public, or distributed privately within organizations or groups, and may lack a systematic means of distribution and collection. The standard of quality, review and production of grey literature can vary considerably. Grey literature may be difficult to discover, access, and evaluate, but this can be addressed through the formulation of sound search strategies.

I will continue with my findings next month in my blog, but in the meantime, if you or someone you know has an emergency and can’t get to a dentist, please remember that we dental hygienists may also be able to help!

I welcome your feedback. You can connect with me via email or telephone, leave a comment right here on the site or join in the conversation on Facebook and Twitter.

Until next time,

Kathleen

Mouth Breathing: What’s Breath Got to do With It?

mouth breathing diagram

I have written about “mouth breathing” a number of times over the years but I have become increasingly concerned as of late as I realize that more and more of the patients that I see are breathing this way!

I have long known that there are both oral and systemic health problems that are a result of this abnormal way of breathing.  Because I consistently observe the disconnect between the dental and medical profession in this area, I have decided to become better informed about;

“What’s Breath Got to do with it?”

Continue reading

Bee Propolis Reduces Tooth Sensitivity

bee propolis reduces tooth sensitivity

I am always on the lookout for more natural solutions to oral health care problems and this week I came across a study that was published in 2014 in The Journal of The Indian Society of Periodontology that concluded:

Propolis was more effective than 5% potassium nitrate in relieving dentinal hypersensitivity and had an immediate and sustained effect.

According to this study, the all-natural propolis was actually found to be “better” than the potassium nitrate.  I am very familiar with potassium nitrate as it is the most common de-sensitizing ingredient found in most over-the-counter de-sensitizing toothpastes on the market today. While it does work for most people by reducing symptoms I am concerned that it does not address the root cause of tooth sensitivity!  While I really feel that this should always be our goal; healing the tooth instead of masking the symptoms, there are times when temporary relief is the most immediate concern! Continue reading

Is Drinking Lemon Water Bad For Your Teeth?

10010433 - lemon water with fresh lemons and green plants

I have had an unusually large number of patients come in for their dental appointments lately complaining of sensitive teeth!  The first question I always ask is:  “Have you started drinking lemon water”?

While many well-meaning naturopathic doctors even recommend it to their clients instead of coffee, I am quite concerned that they have not also counseled these people on the possible side-effects of this daily habit to their teeth. Continue reading

New Study Indicates that Wi-Fi Could Increase Mercury Exposure from Dental Amalgams

23133811 - transmitter wi-fi on white background (done in 3d)

The Journal of Neuroimmunology recently published a study entitled “Effect of radiofrequency radiation from Wi-Fi devices on mercury release from amalgam restorations,”

Thankfully, I follow Sayer Ji’s, Green Med info website and because of this, became aware of the study. My good friend Karen Armstrong, who also follows Sayer, kindly sent me the link to this information as well, a sure sign that this was something I had to write about! Continue reading

World Mercury Project Announces $100,000 Reward

world mercury project

On Tuesday, February 15th 2017, a unique and unfortunately obscure press conference took place in Washington D.C. announcing the following challenge by The World Mercury Project in conjunction with Robert F. Kennedy Jr. and Robert De Niro:

“We hereby issue a challenge to American journalists (and others) who have been assuring the public about the safety of mercury in vaccines.  We will pay $100,000 to the first journalist, or other individual, who can point to a peer-reviewed scientific study demonstrating that thimerosal is safe in the amounts contained in vaccines currently being administered to American children and pregnant women”. Continue reading

I Got a Canary for Christmas!

canary-systemA dream came true for me this year, when due to a number of serendipitous events I ended up with a Canary for Christmas!

While our family has enjoyed a number of these heavenly songbirds as family pets over the years, this “Canary” is not an actual bird but a new technology.  Like the proverbial “canary in the coal mine”, this Canary is also used to detect subtle changes thereby preventing future problems.

The Canary System

Known as The Canary System, “it is a precise, low-powered laser based instrument that detects the presence of cracks and tooth decay before they are large enough to appear on dental x-rays.  When placed on the tooth, a low-powered, pulsating laser light is shone on the tooth during a 3 second scan.  Measuring the crystal structure of the tooth, the laser light can penetrate below the tooth surface and permit detection of tooth decay as small as 50 microns (20 times smaller than a millimeter) and as deep as 5mm from the tooth surface”.

Canary Number

Using a complex algorithm, The Canary System converts the information obtained into a Canary Number on a scale from 0 to 100.  The lower the number the healthier the enamel, the higher the number the higher suggestion of cracks and tooth decay.

There are a quite a number of evidence-based, peer-reviewed studies to support this new technology.  In fact, an independent clinical study led by Dr. Ben Amaechi at the University of Texas Health Science Center in San Antonio, released on March 18, 2015, found The Canary System “to exhibit superior performance compared to bitewing radiography for the detection of proximal caries”.

To put this simply for the public; The Canary System is more accurate than check-up x-rays!  And in case you did not realize this yet, there is no radiation!

I have wanted to have this technology in my office for the last 4 years so that we are able to monitor remineralization therapy; the healing of teeth.   I do believe that our teeth are no different than any other part of the body.  Given the raw materials that they need and stopping the behavior that caused the problem in the first place, if it is not too advanced, we can reverse and repair the damage.  Now, we have an objective way to measure that healing.

I have signed-up for a webinar this afternoon to help me better understand how to use this wonderful, new technology and how I can incorporate it into my daily clinical practice.  Hopefully, as The Canary System becomes more widely used and accepted, it will become a standard of care in all dental offices.

I welcome your feedback. You can connect with me via email or telephone, leave a comment right here on the site or join in the conversation on Facebook and Twitter.

Until next time,

Kathleen

Giving Up Coffee for Better Health

Young woman drinking coffee in urban cafe

I know that there are quite a number of scientific studies that support drinking coffee, and I for one, have often fallen back on them to justify my daily consumption of that ethereal cup of Joe!  Fortunately, a happenstance situation recently caused me to re-evaluate this habitual practice and to consider giving up coffee!

I typically drank one cup a day–a big cup mind you–and this, first thing in the morning, and I guess if I am honest, I have done this most of my adult life.  On special occasions though, and if I was dragging my butt mid-afternoon, then I would often have a cappuccino or a latte.  We have a wonderful Saeco machine here at home that allowed me this luxury if I felt like indulging.

Lately though, I have toyed with the idea of quitting when observing the throngs of people walking around with their oversized Starbucks in hand looking like permanent appendages.  My reaction these days is; be very afraid of what the masses are doing!  More important than this though, is that nagging feeling that anything I can’t do without on a daily basis may be vying for classification as an addictive behavior, and this really concerned me.

Some 6 weeks ago my convictions were put to the test when I contracted a bout of stomach flu gratis my granddaughter.  I could not tolerate even the smell of a cup of coffee let alone drink it and within 3 hours I had a raging headache that lasted the better part of the day.  I had heard that this is a normal reaction when a coffee drinker is deprived of his java jolt but it frightened me!

“Anything that can cause my body to react so negatively within a couple of hours of not having it can’t be good”!

I decided that day, that since I had already gone one day without coffee, it would be a good time to try a couple of weeks and see what happened.

I must admit, I did not have any expectations and I purposely tried not to look for physical changes so that I could be more objective about how my body was responding.  One cup a day… how bad could that be?

Well for me, and I always need to preface with this intro, it has made a huge difference!

I noticed immediately the first week that I had begun to dream every night!  I don’t ever remember dreaming like this my entire adult life!  I have surmised that I must be in a deeper sleep than I usually am and hence, able to not only dream, but remember them as well.  I am also happy to report that so far, they have all been good dreams… no nightmares!

I have also noticed that I am experiencing some very minor hot flashes.  These are not the debilitating ones I used to get when I was 50 and going through menopause – that by the way, stopped when I quit drinking alcohol – more like little twinges, that seem to me, to be an indication that my hormones are re-balancing.

Lastly, I am definitely sleeping better in general!  I now have full-nights where I don’t even get up to go to the bathroom!  If good sleep is as healing as they say, then I am really helping my body to rest and rejuvenate.

Do I miss my coffee… you bet I do!  Am I happy I quit… absolutely!

I welcome your feedback. You can connect with me via email or telephone, leave a comment right here on the site or join in the conversation on Facebook and Twitter.

Until next time,

Kathleen

Professional Reactions to My Last Blog on Flossing

58986866 - young woman flossing teeth in front of mirror

I had wondered when I published last month’s blog on flossing if anyone would respond to the picture that we chose to accompany the article.  As I had hoped, a number of Dental Hygiene colleagues responded to the CDHA (my blog posts appear on their site), to alert them of the mistake that I had made.  I was notified of such and here is the truth.. Continue reading