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Clear aligners are gaining popularity due to their discrete look and comfortability over braces. This article reviews the effectiveness, results, and treatment methods involved with clear aligner therapy. It also addresses the side effects of clear aligners. Clear aligners are advantageous due to their esthetic appearance, their ability to allow easier oral hygiene, less pain, and fewer emergency visits. However, they may be more expensive than traditional braces and they're very dependent on patient cooperation. They also may not be appropriate for every case of malocclusion. There are two methods to creating clear aligners: a manual approach using wax impressions or CAD-CAM technology using intraoral scanners. This study shows that the displacement driven system of moving teeth is not as effective at moving teeth and their roots than braces. The force drive system uses attachments on the teeth to get them in the desired position. There is little previous research on the efficacy of clear aligners, which makes it difficult to determine if they're right for a patient. This study is neither in favor nor against clear aligners. It is good at comparing and contrasting aligners and braces.

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This article compares the difference in image quality of a hand held x-ray device (NOMAD) and a wall unit. It also compared the quality of x-rays after different operators exposed the device; dentists, dental students, and dental assistants. The wall mount unit has been the most common design for many years and is more typical than hand held x-ray devices. This study showed that hand held x-ray devices and wall mounts produced the same quality of images. The difference in quality was due to the operators that were exposing the device. This article was neither for nor against hand held x-ray units.

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This article summarizes the importance of safety and decision making when using hand held x-ray units, such as the NOMAD. Because these units became popular in the 1990's it's crucial for older practicing dental professional to be up-to-date on the qualifications needed to use a hand held x-ray device. It's important to keep the ALARA principle in mind when considering which x-ray unit to use, hand held or wall. Lastly, the type of patient should be reflected on when deciding which device to use. Hand held x-ray units are optimal for immobile patients, such as those in nursing homes, jails and prisons, or even hospital emergency rooms. Conventional wall units are more appropriate for typical dental settings. This article was supportive of hand held x-ray units when used for non-dental-clinic based patients.

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This article explains the purpose of a hand held x-ray device, specifically, the NOMAD. It was invented by Clark Turner who came up with the idea when speaking with his dentist. The NOMAD is particularly helpful when working on elderly, children, immobile, and sedated patients. A hand-held device is more expensive than a wall mounted tube head, but the NOMAD can be moved between operatories, which eliminates the need for more than one wall x-ray setup. The downfall of the first NOMAD model was that it was 8 lbs, making it heavy for the operator, so they created a 5 lbs model in 2008. Overall, this article is in favor of hand held x-ray devices and celebrates the innovation they bring to dentistry.

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The NOMAD is a hand held x-ray device that is battery operated, cordless, and portable. It resembles a trigger gun that can be exposed with the press of a button.

https://www.youtube.com/watch?v=nBuJ_wIa0As
https://www.youtube.com/watch?v=f0VKzbgcTPc

Advantages: One advantages is that the NOMAD can be moved between operatories and offices. This is important when serving patients that are immobile or do not have transportation to a dental office. Next, the operator can stay in the room while exposing the film or sensor because it is battery powered and doesn't need be to plugged in. This allows the operator to monitor the patient while exposing them,  which limits the amount of retakes due to receptor or tube head movement. Lastly, the amount of radiation it gives off is within the limits of maximum permissible dose for the employee taking the x-ray, which is crucial for operator safety.

Disadvantages: These devices have a misconception that they expose the employee to more radiation than a wall-mounted tube head would. This has been proved false, but only when used correctly following all instructions and conditions. Another disadvantage is the cost. The NOMAD retails for ~$8,000. This is more expensive than a wall-mounted tube head x-ray at ~$4,000, which is about half the price. There is also a learning curve amongst hand held x-ray devices. They're not as common as wall mounts and are not taught in many schools. Lastly, if the operator is out of the office while using the device, it could run out of battery. If the charger is not close by, it would be rendered useless.

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Because obtaining a salivary sample is less invasive than obtaining a blood sample, salivary testing is becoming more popular in dentistry to monitor diseases, drugs, hormones, oral diseases, caries activity, and more. Saliva is an important bodily function that can reflect our emotions, hormones, neurological state, and nutrition. Salivary testing is relatively cheap and there are easy methods to obtain a diagnosis. It is also safer for clinicians because blood draws can expose them to communicable diseases. The ways its used in dentistry are:

a) The first exam of a new patient to detect their risk of dental caries

b) To assess the effects of restorative treatment

c) In elderly patients with recession and receiving medication

d) In patients with xerostomia or other syndromes that affect salivary rate

When children or babies are being monitored, their caregivers are sometimes the ones getting the salivary analysis because the bacteria can be transferred between one another. This article supports the use of upcoming technology through the use of salivary testing in dentistry.

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The accuracy rate for salivary analysis at detecting gum disease is very high. Gingivitis and periodontal disease progress when bad bacteria is not properly removed with at home oral hygiene and/or professional dental visits. To perform a salivary analysis, the patient swishes saline in their mouth and spits it into a tube to analyze the bacteria in the sample. Saliva samples are easy to obtain because they're not invasive and comfortable for the patient. This new tool is important in the dental world because gum disease can be treated more easily when there is an early prognosis. If the gingivitis has not progressed to periodontal disease yet, it can even be reversible. This article approves the use of salivary testing for the detection of gum disease by dental professionals.

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This article is written in sponsorship with MD Periodontics, a perio-implant company in Beverly Hills, California. It explains to their potential patients what oral DNA/salivary testing is and the purpose of it. It says that, "The saliva test tells doctors which type of bacteria is associated with your gum disease". After assessing the bacteria contents in the patient's saliva, the doctor can apply specific antibiotics to the gingival margin before performing SRP. If the results show high levels of bacteria, the patient is at a greater risk of periodontal disease, which is crucial for the providers to know. The advantages of DNA tests listed in this article are that they're less invasive than blood tests, results don't take as long as blood tests, there no need for x-ray exposure, and many more. This article supports the use of DNA salivary testing in dentistry.

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Salivary testing is a relatively new tool used in dentistry. It consists of testing the saliva on the tongue, cheeks, and gingival pockets using different methods. When testing the tongue and cheeks, a cotton tip applicator is swabbed against the area being monitored. When testing the gingival pockets, paper points are inserted along the areas with higher probing depths. The saliva is then taken to a lab and analyzed for the components and bacterial makeup.

https://www.youtube.com/watch?v=nWrd0g6D1Ys

Advantages: Salivary testing is very useful in determining the bacterial cause of gingivitis and/or periodontal disease. When the bacteria is narrowed down, a rinse is then prescribed that is either antibacterial or anti-fungal. Its' also relatively cheap and noninvasive, unlike blood testing.

Disadvantages: Not many insurances cover the cost of salivary testing because it is relatively new to dentistry. Because it's a newer concept and less known, insurance companies are more hesitant to offer coverage. It is also time consuming as it adds more procedures to check off during a typical 1 hour hygiene appointment.

Pricing: Salivary analysis ranges from $80-$120. This makes it more accessible for the patients, especially those with low income or no dental insurance coverage.

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Kerry Lepicek, RDH

75% of the population has periodontitis

the majority is unhealthy, the minority is healthy

5 steps:

Diagnosis/Assessment: perform the salivary, tongue, and biofilm testing

Treatment: prescribe antibiotic/anti-fungal rinses or cream based on bacteria type and amount

-pill form of antibiotics can upset the stomach, cause yeast infections, prevent the consumption of alcohol, affect different medications

Evaluation of treatment: 4 weeks after treatment you should reevaluate the patient, 30-40 min appt, complete perio charting, papillary bleeding score at appt

Maintenance Rinses: smart mouth rinse is OTC, sodium chloride works with gram negative, anaerobic bacteria, good for gingivitis pt and stage 1 or 2 perio pt

Monitor: educate patient, treat their infected spouse, educate on OHI, daily rinses

Tests the saliva, tongue, and biofilm. They put 5 paper points into the gingiva.

VSC (volatile sulfur compounds): gas resulting from bacteria when it metabolizes the protein in the oral cavity

Not all bad breath is the same: methyl mercaptan, hydrogen sulfide, dimethyl sulfide

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Lasers are an up-and-coming technology that is being used in dentistry. They've been in this field since the 1990's which is relatively new compared to other tools. They have not been granted the approval from the American Dental Association Seal of Acceptance, but are approved by the FDA. Currently, dental professionals are using lasers to care for tooth decay, gum disease, teeth whiten, and perform biopsies. The laser delivers energy in the form of light to the source it's treating. Some advantages of laser use in dentistry mentioned in this article are: less pain than drills, reduce anxiety in some patients, minimize bleeding and swelling, and they may preserve more tooth structure during restorative procedures. Despite these benefits, lasers do come with some drawbacks. A few of them are: they can't be used on teeth that have already been restored with fillings, crowns, or bridges, they don't eliminate the need for anesthesia, and they're quite expensive. This article supports the use of lasers in dentistry, but it also does not fail to mention the disadvantages that come with them.

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Diode lasers are being used in dentistry to treat hypersensitivity, tooth decay, gum disease, and even whiten teeth. Laser procedures are classified into two groups: hard tissue and soft tissue. The dentition makes up the hard tissue, and the gingiva makes up the soft tissue. For hard tissue procedures, lasers can detect cavities, prep teeth for fillings, and treat tooth sensitivity. For soft tissue procedures, lasers can reshape gum tissue, crown lengthen, perform frenectomies, and remove soft tissue folds. In addition to these hard and soft tissue procedures, lasers can also remove benign tumors, treat obstructive sleep apnea, treat TMJ disorders, regenerate nerves, and treat cold sores. In terms of dental insurance, usually the insurance will cover the procedure being done despite what method is used (drill or laser). The benefits of laser usage include a potential for less sutures, minimized bleeding, a possibility of no anesthesia needed, lower chance of bacterial infections, faster wound healing, and less damage to surrounding oral structures. A few disadvantages of laser use can include pulp injury, still needing to use a drill, risk of gum injury, and not being able to use them on amalgam. This article does support the use of lasers in dentistry but also makes it a priority to mention the drawbacks that come with them.

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LASER is an acronym that stands for Light Amplification by Stimulated Emission of Radiation. Lasers use energy from light to create a beam of radiation that can cut through things. Lasers can be powerful or gentle depending on its power and the intended use. They have been used in dentistry since 1994 and are becoming more and more popular. Lasers are divided into two groups: hard tissue and soft tissue. The hard tissue lasers are used to cut enamel, dentin, cementum and bone. The soft tissue lasers are used in procedures that involve the gingiva and other soft tissues. The three main types of lasers used in dentistry are erbium lasers, carbon dioxide lasers, and diode lasers. Erbium lasers are used for hard tissue procedures. Carbon dioxide lasers are beneficial to remove soft tissue in a timely manner, however, they are powerful and cause damage to hard tissue as well as cost a lot of money. Diode lasers are mainly used for teeth whitening, impressions, reshaping gingiva, and other procedures. This article suggests the use of lasers in dentistry and goes in depth about the different kinds and what they're used for. It also mentions the drawbacks which is important.

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Diode lasers are used in dentistry for many procedures. Dental hygienists can use them when performing SRP to rid the periodontal pockets of harmful bacteria. Laser therapy treatment is quick and easy and should take the hygienist roughly 4-5 minutes for all four quadrants. Lasers can also be used for aesthetic purposes, teeth whitening, crown lengthening, restorative procedures, and much more.

https://www.youtube.com/shorts/C0pBGZ63Jyk

Advantages: One benefit to laser therapy is that it's relatively quick. The dental hygienist can use the laser on the entire mouth in 4-5 minutes. This is crucial during a 60 minute appointment. Laser therapy is also rather cheap for the patient. Once the dental office purchases the laser, they can charge around $30-$40 per patient for laser treatment.

Disadvantages: A disadvantage of laser therapy is that they're somewhat expensive for an office to purchase. The Biolase lasers range from $10,000-$15,000. Another con of laser use is that it's relatively new and not many patients are familiar with the concept. This might cause the patients to decline laser therapy when it's offered to them.

Pricing: Lasers range anywhere from $500- $100,000 depending on what it is intended to be used for. A laser used in dental hygiene is cheaper than a laser used in restorative or diagnostic dentistry.

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All diode lasers produce heat.

The wavelength is the determining factor for what the laser will do. "What is the primary chromophore? What will it be the most attracted to?"

All lasers are attracted to pigment.

Power: the amount of energy delivered to tissue

Pulsing: how the power is delivered

With a diode laser, you must have an initiated tip to cut. Even if the power is increased to the maximum, if you have an uninitiated tip, it won't cut.

Because the laser is attracted to pigment, it seeks out the damaged cells because they're more pigmented than the healthy ones.

The lasers are good for hemostasis, can control bleeding.

The nominal-ocular hazard distance is 5 feet for Biolase lasers. Some other lasers are 15 feet.

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This article reviews the ability of clear aligners to correct severe cases of malocclusion with premolar extraction. Often times, when the patient experiences severe crowding of their anterior teeth, their dentist will decide to extract their premolar(s) to give the other teeth more room to move. This study researched how well this treatment would work with clear aligners instead of the traditional route of braces. After the study, it was found that treatment with braces was much faster. Also, braces were better at fixing occlusal contacts and moving teeth buccolingually than the clear appliances were. It's difficult for the clinician to tell how well treatment will turn out for the patient because it's dependent on the patient's compliance with their aligners. This article supports the use of clear aligners in mild or moderate cases but does not when treatment time is important or exact movement of teeth. It also states that more studies need to be done before we can be sure that aligners are the more superior orthodontic appliance.

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This article compared the effectiveness between clear aligners and traditional braces therapy. It states that patients often prefer clear aligners over braces because of the comfort and esthetics of it. Clear aligners are able to be removed and when placed on the teeth, are hardly noticeable. Despite this advantage, it was speculated that they may not work as well as braces. This article reviewed 8 papers that reviewed the effectiveness of clear aligners. It showed that they did not produce "adequate occlusal contacts, controlling teeth torque, increasing transverse width and retention", although, it was found that clear aligner treatment did not take as long as treatment with braces. The 2-week interval of aligners may be too short to preserve the alveolar bone and braces were better at preventing bone resorption. This study shows the reader the disadvantages and advantages of clear aligners, however, it is more in favor of braces.

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Clear aligners are an orthodontic appliance used to fix malocclusions of teeth. They serve the same purpose of braces in that they can improve the health and esthetic of the dentition. Children, adolescents, and adults can all go through clear aligner treatment. Aligners should be prescribed by a dentist that is part of the AAO (American Association of Orthodontists) to ensure proper treatment and movement of teeth.

https://www.youtube.com/watch?v=Cu1Cz3lAcwI

Advantages: The main pro of clear aligners vs. braces are that they're less noticeable. They can also be removed when eating, drinking, and performing oral hygiene. Also, the average treatment time for clear aligners is, on average, less than braces.

Disadvantages: The main con of clear aligners is that they cannot fix every type of malocclusion. They are adequate for mild or moderate cases, but for severe cases, braces must be prescribed. Another disadvantage is that they can be removed so if the patient is noncompliant with wearing them, their treatment will take longer.

Pricing: The cost of clear aligners and braces are virtually the same. Both range from $3000-$8000 depending on the length and severity of treatment needed. Both braces and clear aligners could be covered by insurance companies, but like everything else, it's not always guaranteed.

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This article reviews the benefits of periodontal endoscopy during nonsurgical periodontal therapy. It evaluated the outcome of therapy with and without an endoscope and compared bleeding on probing sites greater than or equal to 4 mm, clinical attachment level, pieces of calculus, and treatment time per tooth. Because periodontal disease is the number one reason of tooth loss, it's important that clinicians are doing a thorough job, and an endoscope can help achieve that. With a periodontal endoscope, the hygienist uses it to view subgingival hard deposits before scaling them. The results of this study showed that clinical attachment loss, periodontal disease, and bleeding on probing improved significantly with or without an endoscope. However, treatment time per tooth increased as well as amount of tooth surface with hard deposits. This article neither accepts nor declines the use of periodontal endoscopes during SRP treatment. There needs to be more research on the tool to be certain it's beneficial for the patient and clinician.

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This study was done in 2014 by two professors of dental hygiene at the University of Minnesota. They tested the pain level of patients when using the periodontal endoscope versus a periodontal probe while detecting calculus. The reason for this study is that periodontal endoscopes are relatively new to the dental field, so it's important to understand a patient's experience while using them. They had 30 participants in this study, which included those 18 and above that were receiving SRP. After treatment, they had their patient fill out a survey expressing the pain they felt during the procedure. There was a significant difference in pain felt with the periodontal probe versus the periodontal endoscope. "Overall, 75% of subjects said the level of pain felt was less with the periodontal endoscope than the probe, and 16.7% thought the two felt very similar". This shows that the use of periodontal endoscopes during SRP is beneficial for the patient. This article is in support of periodontal endoscopes during calculus detection.

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Periodontal endoscopes are used by hygienists to remove subgingival calculus more easily. This article compares the outcome of SRP with a periodontal endoscope, and the outcome of SRP without an endoscope for 12 months. There were 25 patients with stage II or III periodontitis that were included in this study. Scaling and root planing was performed by the same hygienist but they used an endoscope on one half of the mouth and no endoscope on the other half. All SRP were performed at 3-month intervals for 12 months. The results showed that periodontal endoscopes significantly improved the clinical attachment level in maxillary teeth with multiple roots, however, teeth with only one root showed a lower percentage of improved sites. Also, multi-rooted teeth on the mandible showed more improvement with clinical attachment levels using only loupes with the SRP and not the endoscope. This article is neither in favor nor against periodontal endoscopes. It does an excellent job of showing the results of the study to the reader in an unbiased way towards periodontal endoscope therapy.

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Periodontal endoscopes are small cameras that can be inserted into the gingival sulcus of periodontal pockets to see calculus, biofilm, and other things. These are useful when performing SRP to be certain all calculus has been removed, especially in deep pockets where tactile sensitivity is the only tool available.

https://www.youtube.com/watch?v=EQGJhu4ntv8

Advantages: The biggest advantage of a periodontal endoscope is that it is able to view calculus buildup along the tooth root where it's not visible. The alternative to endoscopes is flap surgery, which patients typically want to avoid if possible.

Disadvantages: A disadvantage of periodontal endoscopes is that they're very expensive. It must be used routinely in order for it to pay off for the office.

Pricing: Periodontal endoscopes are an investment, but can be worth the money, especially if you work at an office that sees a high amount of periodontally involved patients. One endoscope is estimated to be around $37,000.

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Artificial intelligence technology is becoming more and more popular amongst the dental field. It's especially used in endodontic procedures to study the anatomy of the root canal being treated, measure working lengths of the canal, and diagnose abnormalities along the root. Artificial intelligence refers to "when the computer imitates analytical functions such as 'learning and problem solving'". AI can produce outcomes that are extremely efficient and accurate. Artificial intelligence has been adapted to assist in oral and maxillofacial surgery, prosthetic dentistry, orthodontics, forensic odontology, and even bioprinting. These specialities of dentistry will benefit greatly from having AI work in unison with the dental team. This article supports the use of artificial intelligence in dentistry and acknowledges the impact it has on the industry.

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Within the last 20 years, artificial intelligence has grown and developed immensely for the healthcare field. In dentistry, it can help identify "normal and abnormal structures, diagnose diseases and predict treatment outcomes". Artificial intelligence allows computers and machines to do tasks that was once only possible by humans. AI can be used in the dental field to detect caries on radiographs. In a study, it viewed 3000 radiographs and was able to detect the cavities with a 75-93% accuracy rate. There are uses for artificial intelligence in orthodontics, periodontics, endodontics, and oral pathology detection. One concern with AI is the confidential patient information needed for it to work and be accurate. Although some systems claim to be secure, there is some hesitancy when it comes to sharing personal information. Artificial intelligence should be viewed as an assistance, not a replacement, for dental professionals. This article supports the use of AI in dentistry while also noting the aspects of it that are not as ideal.

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Artificial intelligence is new technology that is able to copy human behavior in an intelligent way. AI can be used in dentistry to "improve the accuracy and efficacy of dental diagnosis, provide visualized anatomic guidance for treatment, simulate and evaluate prospective results, and project the occurrence and prognosis of oral diseases". This technology can be used to perform the same tasks as medical professionals but in a shorter amount of time. In the 1970's, people were worried that AI would take away jobs in the medical field, but that is currently not the truth. It's used to compliment healthcare workers and make their jobs more efficient. The artificial intelligence used in dentistry is almost 100% virtual. It's used to differentiate between oral pathologies, assess risk factors, and evaluate treatment plans and their outcomes. In dentistry, AI is used in oral and maxillofacial surgery, cariology and endodontics, periodontics, prosthodontics, TMJ disorders, orthodontics, and many other areas. One concern with artificial intelligence is its inability to have empathy and emotions. This is crucial in the healthcare field for patient approval. This article goes in depth about the advantages of artificial intelligence but also lists the reasons why it may not be the answer in all situations.

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Artificial intelligence is a tool that can replicate intelligent human behavior to produce results that are consistent and efficient. It can be used in conjunction to the healthcare and dentistry fields. Artificial intelligence uses algorithms to solve problems in the same way humans do. With AI progressing and becoming more popular, it is important to be familiar with the concept so that we are able to explain it to our colleagues and patients.

https://www.youtube.com/watch?v=ufegWH7F54c

Advantages: Artificial intelligence can make the job of dentists much easier by diagnosing and locating things that they may have missed during an exam. It can detect caries, abnormalities, and other things on radiographs. It's beginning to be integrated into many dental software programs so it is more familiar to dental employees.

Disadvantages: Artificial intelligence is able to share patient data but does not take into account patient privacy. Because it's not a real human brain, it cannot be at fault for possibly putting patient health information into the wrong hands. Another disadvantage is that people are skeptical about it replacing dentists and other health professionals.

Pricing: Artificial intelligence software can range anywhere from $10,000 to $100,000 based on its capabilities and purposes.

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Sleep apnea is an "extremely common condition characterized by periods of nocturnal apneas and/or hypopneas, which if left untreated may result in excessive daytime sleepiness, impaired cognition, and increased risk of cardiovascular comorbidities". Luckily, this condition can be treated by CPAP machines, weight loss, positional therapy, surgery, and myofunctional therapy. Myofunctional therapy is a type of treatment performed by dentists and speech therapists that uses muscular facial exercises to correct tongue placement and oropharyngeal muscular tone. There is currently no protocol for specific exercises performed but most involve a 3-7 week course with sessions that are between 15 and 30 minutes long. Some activities included are tongue elevation and extension, and lip, cheek, and oropharyngeal exercises. Myofunctional therapy is used in patients that cannot tolerate a CPAP machine or those that are not seeing adequate results from one. This article supports the use of myofunctional therapy and goes into depth about the purpose of it as well as how it's used.

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This study analyzes the effects of myofunctional therapy in children with sleep apnea and sleep bruxism. Craniofacial deformities and hypotonia are known to be risk factors for sleep breathing disorders like sleep apnea. These types of disorders cause the muscles around the head and neck area to grow abnormally and causes irregular oral movements. When this happens, the child's head stretches forward creating an anterior craniocervical angle. Orthodontics cannot totally fix this issue and muscle therapy is needed to retrain the muscles causing the issue. In this study, after myofunctional therapy was undergone by participants, about 50-62% of adults and children had corrected oral habits, an improvement in breathing during sleep, and balancing of the mouth and face. This article somewhat supports the use of myofunctional therapy, however, it states that there is limited data on the topic and a lacking number of studies to prove the effectiveness of the therapy.

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This article states that there are many treatment options for sleep apnea, but myofunctional therapy has shown success in 4 out of 5 patients by anatomic intervention. Myofunctional therapy has been around since 1918 and has shown improvement in breathing, facial appearance, and growth of the mandible to aid in airway dilation. This type of treatment uses isometric and isotonic exercises of the lips, tongue, soft palate, and lateral pharyngeal wall. This consists of pronouncing oral vowel sounds continuously or intermittently as well as tongue exercises that require the patient to move the tongue against the superior and lateral surface of the teeth as well as the hard palate. They also perform lip exercises that target the orbicularis oris and buccinator in addition to lateral jaw movements. The results of the study showed that myofunctional therapy decreases snoring and sleepiness in both adults and children. This study supports the use of myofunctional therapy and does a great job at explaining the specific exercises it involves.

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Myofunctional therapy involves a series of facial muscle exercises to improve face symmetry, sleep apnea, snoring, and function of the tongue.

https://www.youtube.com/watch?v=65tlxqQ4A3A

Advantages: The benefits of myofunctional therapy are ongoing. It can improve sleepiness, facial symmetry, occlusion, breathing, snoring, sleep apnea, and more.

Disadvantages: The main disadvantage of myofunctional therapy is the cost and duration. It can be expensive because a trained dentist has to provide the treatment and it won't be beneficial to only do one session. It's usually a series of sessions and can last anywhere from 4 months to a year.

Pricing: Myofunctional therapy can range anywhere from $80-$500 per session depending on where you're receiving treatment and the experience of the therapist. It's important to ask how many sessions you'll need and multiply that number by the price per session.

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This article studies the effectiveness of oral irrigation devices in removing subgingival or supragingival plaque in patients with generalized gingivitis. It studied 5 different groups and required them all to brush 2x/day but each use a different adjunct such as oral irrigation with water and chlorhexidine digluconate or rinsing with the solution. It states that plaque removal from interproximal areas is significant because bacteria that causes gingivitis and periodontitis is especially found here. Oral irrigation adjuncts have been around since 1962 and it can be used to deliver water or antibacterial agents supragingival or subgingival into the sulcus. They're great for reaching posterior teeth with fixed appliances like crowns and bridges. This study showed that an oral irrigator with CHX in higher concentrations had more of an effect in reduction of gingival inflammation that low concentrations of CHX mouthrinsing.

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This article is based on a study of 90 participants who were diagnosed with gingivitis. They were split into two groups consisting of oral hygiene with a toothbrush only and an oral irrigator in combination with a toothbrush. To determine the efficacy of the adjuncts, they looked at sites with BOP after 4 weeks, 8 weeks, and 12 weeks. Before clinical examination, all participants in the study were asked to fast and not perform any oral hygiene for 12 hours. There was also one single clinician that did the evaluations so it was not biased. The results of the study show that oral irrigation in combination with toothbrushing is significantly more effective than toothbrushing alone when looking at plaque scores and health of the gingiva. It also showed that the participants who used oral irrigators had good compliance rates as well as safety of the oral adjunct. This article supports the use of oral irrigators in improving gingival health and plaque removal.

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This article reviews a study of oral irrigators on 6 year olds. This age group was chosen because it states that parents should be performing oral hygiene on their children until they're at least 8 years old. Because of dexterity issues and lack of fine motor skills, it was recommended that oral irrigators be used in this study as an adjunct to toothbrushing. It then studied the effectiveness of an oral irrigator that combines brushing, flossing, and rinsing into one. This article stated that oral irrigators are "children friendly, time-saving, and parent supervision is not required". The results showed that "there was a significant difference observed in the plaque scores before and after the brushing in modified oral irrigation group". This article supports the use of oral irrigators in children. This is great to know that they're not just beneficial for adults.

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Oral irrigators are devices that contain a cord, insert tip, and reservoir that can be filled with liquid. They're meant to perform plaque and bacterial removal from in between the teeth and gingival margin with a stream of high-pressure water or mouth rinse.

https://www.youtube.com/watch?v=3N47lZ6Cro4

Advantages: Waterpiks can penetrate into the sulcus 6 mm whereas mouthrinse only penetrates 2 mm and floss 3mm. Oral irrigators are also great for patients with dexterity issues as it doesn't take as much fine motor skill to use like floss. They can be used for patients with implants, dentures, braces, crowns, and other oral appliances.

Disadvantages: Oral irrigators are a more expensive form of interproximal oral hygiene at ~$100 whereas floss only costs about $1-$5. There is also a learning curve with these and take some practice to get proper plaque and bacterial removal.

Pricing: Oral irrigators can range between $50-$200 depending on what brand and model you purchase.

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Transcutaneous electric nerve stimulation, also known as TENS, "is a non-pharmacological method which is widely used by medical and paramedical professionals for the management of acute and chronic pain in a variety of conditions". It can be used in dentistry during procedures to manage pain and for maxillofacial conditions. During transcutaneous electric nerve stimulation, electrical current is sent across the skin surface through electrodes to stimulate superficial nerves and provide local pain relief. TENS can be used at many different intensities and frequencies depending on the need. This article does a great job of explaining the use of TENS in dentistry and mentions the advantages as well as the disadvantages of the device.

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Transcutaneous electrical nerve stimulation is a device that sends electrical stimuli through the central nervous system to activate descending inhibitory neurons and reduce acute or chronic pain. It can be useful in treating TMJ disorders, post-operative pain, increase salivary secretions, and produce local anesthesia in children. It uses pulsating current from direct current in an electrical outlet or from a battery. There are different variations of TENS therapy which include conventional, acupuncture-like, and intense. Dental professionals have used transcutaneous electrical nerve stimulation in pediatric patients while performing extractions and root canals with amazing results and pain management. An advantage is that there are no medications involved that can produce adverse effects and the patient can administer the device themselves. Some disadvantages are that TENS is not indicated for use in patients with pacemakers, bleeding disorders, or pregnancy. It is also ineffective in TMD pain that is associated with recent trauma, surgery, or metabolic diseases. This article supports the use of TENS in dentistry in multiple instances.

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This study reviewed the use of transcutaneous electrical nerve stimulation on dental-professionals with work-related pain. Of the 47 dental professionals in the study, 24 of them received transcutaneous electrical nerve stimulation in a high-frequency and 23 received placebo stimulation. The TENS unit was applied to the levator scapulae and trapezius muscles for 60 minutes to the treatment group and was also applied to the control group but not turned on. The results showed that transcutaneous electrical nerve stimulation was effective in minimizing musculoskeletal pain in dental professionals. However, the study was too short of a duration and long-term studies are needed to know the true effects of TENS in dental clinicians. This article supports the use of transcutaneous electrical nerve stimulation for healthcare workers with musculoskeletal symptom disorders.

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Description: Transcutaneous electrical nerve stimulation, also known as TENS, is a method of pain relief that uses electrical current to activate nerves and decrease acute or chronic pain.

https://www.youtube.com/watch?v=pbJNd7TZUhk

Advantages: TENS can be an alternative to local anesthesia, which many patients are afraid of. Also, when the nerve stimulation is done, there is no post-op anesthesia so the patient is not numb when they leave their appointment. TENS can also be self-administered by the patient which makes them more compliant of the procedure.

Disadvantages: It should not be used in patients that are mentally impaired because it relies on patient communication. It can also not be used on patients with pacemakers because it can interfere with their function. Because TENS has not been FDA approved, it cannot be used in pregnant patients because the side effects are unknown.

Pricing: The devices can be sold OTC and are sold for $30-$100 for at-home use. When having the procedure done during dental treatment, it can sometimes be covered by insurance, depending if the insurance company deems it medically necessary or not. When not sold OTC, they can cost around several thousand dollars.

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This article talks about the use of Velscope, a brand of oral cancer screening device, that can detect oral cancer at earlier stages than a conventional oral exam (COE) alone. The objective of the study was to determine the accuracy of oral cancer screening devices in detecting oral cancer. This study included 30 participants that already had suspicious oral lesions detected clinically. At the follow-up appointment, the Velscope was used with its autofluorescence examination abilities to detect the histology of the oral lesions. It was found that 24 of the patients had loss of fluorescence, but was retained in 6 patients. This study showed that the Velscope cannot be reliable in predicting oral cancer by itself, but is useful when used in conjunction with COE.

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This research article studies 250 participants that have a history of using chewing tobacco. The clinician used the Velscope screening device to view loss of fluorescence and then a biopsy was taken of the site. Devices that screen for oral cancer are significant in the field of dentistry because "The incidence of oral cancer worldwide is approximately 3% of all malignancies and this is creating a remarkable health problem". Usually, by the time the cancer is detected, it's at a late stage and prognosis is not hopeful. Early diagnosis of oral cancer can increase the survival rate by 80%, which is crucial for the patient. Of the 110 patients that underwent biopsy after fluorescent examination, 89 of them had neoplastic changes that were evidence of oral cancer. This study supports the use of Velscope in detection of oral cancer, but it should not replace EO/IO exams and biopsies and be used in conjunction with them.

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Velscope is an oral cancer screening device that uses fluorescence to detect oral lesions. Benign (non cancerous) lesions appear fluorescent under the Velscope light and malignant (cancerous) lesions appear dark or lack fluorescence. This tool can also be used to detect fungal, bacterial, and viral lesions, which is a great advantage when treating oral health conditions. Also, Velscope is useful amongst oral healthcare providers when performing a biopsy. The clinician can use the fluorescent technology to more accurately choose the site of biopsy. This type of "examination is a simple, cost-effective, and noninvasive easy-to-use technique". This study supports the use of Velscope oral screening devices when used alongside clinical examinations.

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Velscope is an oral cancer screening tool that can detect malignant lesions with fluorescent light. This tool is used in conjunction with EO/IO exams and during biopsies to assess the correct incision site. It's an easy, cost-effective way for clinicians to provide adequate oral assessments for their patients.

https://www.youtube.com/watch?v=XgKsN6uOAHU

Advantages: There are many pro's to this device, such as low maintenance, quick disinfection, painless, and easy to use. It's also cheap compared to other dental equipment and the procedure can be covered by insurance.

Disadvantages: A big disadvantage of the Velscope is that it has been known to show false positives. This means that it could imply a malignant lesion where there isn't one. Accuracy is important with these kinds of diagnostic tools because an oral cancer diagnosis is a big deal and very frightening.

Pricing: The retail value of the Velscope is $1995.00. This is relatively cheap for dental equipment. Some insurance plans will cover the cost of it at 75-100% but a deductible may have to be met first. Insurance coverage also depends on how the clinician codes the procedure.