4. Sealants—one of the most difficult procedures to do well

      A. Statistics

           1. 70 percent of caries in primary teeth occur interproximally

           2. Retentiveness in broader and shallower grooves is not as predictable

      B. Sealants on permanent teeth- the Robert Feigel technique

           1. We always use a rubber dam to isolate and keep dry

           2. We use topical anesthetic for placement of clamps

           3. Cleaning of grooves is done by air abrasion

           4. Etching is brief

           5. Prime and Bond is used to increase flow of filled sealant material

           6. UltraSeal material is our material of choice

      C. Air abrasion

           1. Cleans grooves better than anything I’ve used

           2. Partially etches teeth while cleaning, enhancing bond strength

           3. May expose carious pits that are not otherwise visible

5. Patient Napkins—hands-free information

      A. Hands-free information at the chair

      B. Advantages

           1. No need to check charts or computers

           2. Codes can convey information without speaking

               a. Patient name

               b. Procedures to be done

               c. Latex allergies

               d. Any other codes you may determine

6. Denovo matrix bands—a very simple matrix band system

      A. Come in a kit with varying sizes

      B. Re-usable

      C. Very fast for placement

      D. Requires wedges

7. Toy Tower

8. Silver Diamine Fluoride

      A. Recently approved by the FDA for reducting tooth sensitivity

      B. Can be used for retarding progression of decay

      C. Indications

           1. Mecially compromised patients

           2. Patients with extreme caries risk

           3. Non-candidates for conventional care

           4. Stabilization until final care is possible

           5. Minimal access-to-care populations

      D. Procedure

           1. Cover areas to avoid staining

           2. Drop SDF into dappen dish

           3. Remove saliva

           4. Isolate other tissues

           5. Air dry affected areas

           6. Dip microbrush into dappen dish

           7. Apply for 1 minute (when possible)

9. Patient traditions—another way to connect with patients

      A. We give a book for high school graduation

      B. Photographs at every cleaning visit

10. Office Handouts-- Assures that parents know what you’ve said

      A. When self-generated, handouts will reflect your exact words

      B. Advantages of handouts

           1. Some people learn best by visual cues

           2. If a handout is marked, patients are three times more likely to keep it

11. SonicFill—a bulk-fill composite technique

      A. Unique delivery system

           1. Handpiece creates sonic energy to make material flowable

           2. Material is injected directly into prep        

           3. When activiation is ceased, the composite returns to high viscosity

      C. Advantages over conventional composites

           1. Marginal adaptation due to initial flowability

           2. Low shrinkage         

           3. Depth of cure          

12. Heighten Your Sense of Gratitude—your non-fiscal “pay”

      A. This comes in many forms

      B. Advantages

           1. Government does not tax it

           2. You keep it forever

          3. Can lead to surprising long-term results

13. Valo Light—a high intensity and fast curing light

      A. LED curing light in the wavelength of 395-480nm

      B. Very light weight and cordless

      C. Speeds appointments for short-attention span children

14. Alasticks-- a simple technique for simplifying strip crowns

      A. Isolate with rubber dam with individually punched holes (small)

      B. Place orthodontic alasticks by stretching over teeth with two pieces of floss

           1. Retracts gingival tissues

           2. Hemorrhage control

           3. Leave facial floss to facilitate removal of alastick

      C. Caries removal

           1. Slow speed round bur

           2. Place glass ionomer in deep areas (also increases retention)

      D. Minimal prepping incisal and axial walls with 169 fissure bur

      E. Fit strip crowns

           1. Must trim away “cuff”

           2. Crowns should fit snugly

           3. Place vent holes in MI and DI line angles

           4. Fill 1/2- 2/3 full with restorative material (Filtek Supreme Ultra A1D)

           5. Place over tooth

           6. Wipe away excess material and light

           7. Removing strip crown form

               a. Course disk to remove incisal edge of crown form

               b. Sharp instrument (Hollenbeck) to “unzip” lingual of crown form

               c. Hemostat to remove entire form

               d. Finish with disks

           8. Remove alasticks by pulling them toward labial over the crowns

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