Volume 8 • 2021 • Issue 1

Patients who use methamphetamine are also a group that can benefit from treatment with SDF. “I want to stabilize their caries right away,” says Dr. Nový. In one case, where a tooth had a lot of decay and he worried that a patient would need a root canal, Dr. Nový used SDF and then put a glass ionomer filling on top. “I explained what I had done, that the SDF chemically cauterized the cavity,” he says. “As far as I know, the tooth never became symptomatic.” What’s new? P11-4 “A few years ago, cariologists began to get excited about the P11-4 molecule,” says Dr. Nový. P11-4 is a synthetic, pH controlled self-assembling peptide and can be used to regenerate enamel-like crystals. When it’s applied to the tooth surface, it diffuses through the surface layer into the lesion body and starts to self-assemble, which generates a scaffold that mimics the enamel matrix. Calcium phosphate, present in saliva, forms enamel-crystals around the new matrix. “Imagine a pothole in a road and someone puts a liquid in it that turns into rebar and then the rain fills in the pothole and it becomes a solid street surface,” says Dr. Nový. P11-4 is available commercially in North America. “Most dentists who use it, apply it to early enamel lesions. There isn’t a lot of evidence yet about how it might work for deep lesions, but I’m hopeful it might be a good tool in that context as well,” says Dr. Nový. Dr. Nový started to use P11-4 to remineralize teeth and then used a laser-based instrument to measure calcium and phosphate levels. In some cases, calcium and phosphate levels went up 50%. The philosophy “I have the luxury of being able to practise in an environment where I control the payment system and the care delivery. So I can combine the highest levels of evidence with some novel therapeutics,” says Dr. Nový. “My clinical team can ask: How should we be treating tooth decay using the best possible science?” The pandemic has disrupted the way that most dentists work. For Dr. Nový, it provides an opportunity to discover treatments most appropriate to the needs of patients in changing times. “I got a fortune cookie recently and altered it slightly so it reads, ‘Go above and beyond your duty, your patients may benefit from it,’” says Dr. Nový. “And that begs the question for me, what treatments have the best evidence? And to me the list includes: fluoride, SDF, chlorhexidine varnish and sealants.” References 1. Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán- Armstrong S, Nascimento MM et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. J Am Dent Assoc . 2018 Oct;149(10):837-849.e19. 2. Ruby J, Barbeau J. The buccale puzzle: the symbiotic nature of endogenous infections of the oral cavity. Can J Infect Dis. 2002 Jan;13(1):34-41. 3. ten Cate JM. Remineralization of caries lesions extending into dentin. J Dent Res . 2001 May;80(5):1407-11. To hear more from Dr. Nový, visit CDA Oasis: bit.ly/34fRKo7 [E] A cavitated lesion treated with silver diamine fluoride, compared to the same lesion after being restored with glass ionomer. Second visit (a few weeks after SDF was applied to a cavitated lesion) At the end of the second visit with glass ionomer restoration placed S upporting Y our P ractice 31 Issue 1 | 2021 |