Glass Ionomers for Your Pediatric Patient

You're listening to the Dr. Phil Klein Dental Podcast from VivaLearning.com. Welcome to the show. I'm Dr. Phil Klein. Today we'll be discussing glass ionomer and resin -modified glass ionomer products and the advantages of each for pediatric patients. Our guest is Dr. Carla Cohn, a partner at a private surgical clinic in Canada and clinical instructor in pediatric dentistry at the University of Manitoba. Dr. Cohn lectures internationally on prevention. and pediatric dentistry for the general dentist. Dr. Cohn, it's a pleasure to see you again on Dental Talk. Thank you very much. It's a pleasure to be here. We talked offline about things in Canada. You still have those challenges with the vaccine, and you're kind of still in a lockdown, aren't you? We are still in a fairly locked down situation. The vaccine is rolling out. There's been good uptake, but it's slow. And we are all in COVID fatigue here, let's say. It's a long time. Yeah, I could imagine. Yeah, I mean, it's long for everybody, but they've kind of opened it up here in Texas. So we're going to restaurants. Most people are not wearing masks. Most of us are vaccinated already, but Canada is a little bit different. I wish you the best and hope that things move quickly over there. Thank you. So this is an interesting topic. There's no question many of us know that glass ionomers are kind of the material for children, for pediatric dentistry, but we want to get a little bit deeper into that today if we can. So to begin, maybe you can define for our audience the different types of glass ionomer products that are out there. and the advantages of each, you know, within a reasonable amount of time, because we have a couple of questions we want to ask you. And this includes, of course, self-cure glass onomer, resin -modified glass onomer, and glass onomers that are used for cements. Sure. It's a good question because we talk about glass ionomers in general, and that really umbrella is several different products that are all used for several different things. And so a self-cure glass ionomer is a material that cures on its own, and we'll often refer to that as a pure glass ionomer. And that has a lot of great uses, sometimes even as a temporary material. Resin modified glass ionomers, as the name implies, have a resin component to it. So you have both a self-cure and a light cure component to this material. And we would use that one in more of situations where we would want to have a more definitive restoration for our pediatric patients. And then it gets even a little bit more confusing because we use glass ionomers as cements, but really the true name of glass ionomer is a glass ionomer cement. So we have our glass. ionomer cement restoratives. And then we have our glass ionomers that we use as cements for things like stainless steel crowns. And if you do any amount of treating children, you'll know that this is something that we use very frequently in our practices with a lot of success for many, many, many years. And I know that there are a lot of dentists that use glass ionomer for adult patients as well. I mean, my daughter just had a molar restored. And she used a reinforced glasonomer, which, you know, she was a little bit carries prone in that area. So I talked about it with the dentist, me being an endodontist. I know a little bit about this stuff, not as much as he did, but we agreed to put a glasonomer in her and she's 27. So it's not only pedo kids. So what makes the useful properties of glasonomer and resin-modified glasonomer work particularly well for pediatric patients? So as you just alluded to, they have good properties for high caries risk areas or high caries risk patients because they will release fluoride. which we don't need to go into all of that. I think we're all pretty familiar with the good properties of fluoride. But also, the glass ionomers, resin-modified glass ionomers, are a hydrophilic material. So when we have a patient where we can't control the saliva or the patient's tongue or their cheek, kids that are moving and are not always the stillest of our patients, we want to use a material that is going to be able... withstand that wet environment. And we have so many patients or so many dentists that are so much more comfortable using things like our composite resins. They don't even think about using glass ion or resin-modified glass ion. Let's talk about minimally invasive dentistry. And, you know, we're in the midst of a pandemic. Well, even I was going to say we're coming out of the pandemic, but not so much for Canada right now and other parts of the world as well. UK, India, and Japan, they're all going through it. But the minimally invasive dentistry part of it and the non-aerosol dental restorative procedures that we do, it appears that glass on them and resin modified glass on them are kind of ideal for these procedures, right? So they're kind of driving those products. Can you tell us a little bit about that? Yeah, absolutely. So the... Glass counters and resin modified glass counters, because they have that fluoride component and a reparative component to it, we can use it more confidently in minimally invasive dentistry. So when we have situations where we cannot remove all decay, so when we were really in the heat of the pandemic and we didn't want to have any aerosolization at all, and we were using spoon excavators to remove decay, well, that's not... entirely effective, certainly not as effective as our hand pieces are. And so putting in a glass ionomer gives us that added confidence of being able to have the fluoride release and the reparative effect of it. And I like to think of our glass ionomers as, you know, when we used to put IRM, if you're of that age where you used to put IRM in as a temporary, now we would want to put in a glass ion. or resin-modified glass ionomer because it has that much more strength to it, it has the reparative abilities, and it has that hydrophilic component to it. But the other thing that glass ionomer in particular has become very useful for, and we've realized this even more so during the pandemic, is when we're using silver diamine fluoride. So whether you're using silver diamine fluoride on its own or whether you're using the silver diamine fluoride potassium iodide, the Revastar product from SDI, when we want to restore that, you need to put over a pure glass ionomer. And so that will then... repair the lesion, it'll arrest the caries, and it will fill lesions. So these products have become even more popular because attention has been called to the fact that, hey, we should be doing things more minimally invasively and non-aerosol during the pandemic. And then we're realizing that this is actually good for our patients. This is good for our kids. You know, the less invasive we have to be, the better it is for them. The great pure glass ionomers or self-cure glass ionomers that we have available to us are from VOCO, and those are the Ionostar Plus or the Ionostar Molar is their brand name, and the resin-modified glass ionomers are the Ionolux. So whether you're using these as a temporary measure, whether you're using these as a... a definitive, minimally invasive measure, it's important to choose that right situation and the right material. So when you're using silver diamine fluoride, give us a brief overview of the process of putting that in. How much decay is present? What's a typical location on the tooth where you use that? How long does it stay on? And then how do you cap it off with a glass anomer? Yeah, well, you know, I know we have a time limit here. I could probably talk for an hour on this. So I'm going to give you kind of the brief version of it. But silver diamine fluoride, the evidence shows us that if we're able to place silver diamine fluoride on twice, that's the best evidence for the best carries arrest. But even if we can only place it on once. So say you have a child come into your office and you know you're not going to see that child again. You rub the silver diamine. fluoride on and it's it's literally a drop that you're rubbing on with a micro brush whether you do again whether you're doing this just silver diamond fluoride or with a potassium iodide which will help to mask the darkness because the silver diamond fluoride is going to turn the caries dark and and so so this is great for arresting the caries but then it leaves a lesion that's not filled and the procedure that we do is actually called a smart procedure silver modified atraumatic restorative technique, where we then cover that silver fluoride with a pure glass ionomer. And then that becomes, sometimes it can become a definitive restoration. Sometimes that's just a temporary restoration until we are able to go back in to that tooth. Now, I mean, there's so many aspects to this that, you know, the details that make this successful. But, you know, a couple of things to keep, in mind are we don't want to have a lesion that's deep enough that's invading the pulp because silver fluoride and pulp don't get along together so you need to be far enough away from the pulp because the silver fluoride will penetrate and you also need to have an asymptomatic tooth i wouldn't want to put this on any any tooth that that is you know symptomatic or has a fistula or you know certainly it's not useful for for anything like that but if you've got somebody that's coming in and you need to treat them quickly and efficiently and you don't have a very long time to get in there and do this, this is an ideal procedure that saves a lot of people from the endodontist, no offense. We don't want to see these patients if we don't have to. So you mentioned some glass ionomers by VOCO. What is it about those that you like? I'm a big VOCO fan. They make excellent materials that really handle so, so well in many categories. But glass ionomer... particular, the pure glass ionomer or the self-cure glass ionomer, their brands are the Ionostar Plus or the Ionostar Molar. So we would use those in situations on top of silver fluoride that I was just speaking of. If we want to have a more definitive restoration, then we would use a resin-modified glass ionomer. And their product is an Ionolux, is what that one is called, a light-cured resin-modified glass ionomer. If we want to know that we are using a good quality product, then these are definitely go-tos for those glass minerals. They come in individual packages. So we've got that sterility that we are even more acutely aware of now than we were 18 months ago. So you have the little foil packet and you rip it open right before you're ready to use it. So you know that everything is nice and sterile. The prevailing use for glasonomer, or I should say composite in North America, among North American dentists, is really a restorative material. I mean, that's how they see it. And the glasonomer is not considered a traditional restorative material. But for those that are practicing general dentistry or even pediatric dentists, what would you say to that? GI and RMGI are not for traditional restorations. How would you answer that? you know let me begin that by just pointing out too that Glass ionomers were the start of VOCO's company many years ago. This is what they started with, and it's very popular in Europe to be using glass ionomer as a modified glass ionomer, much more popular than it is in North America. We have a love affair with composite as a restorative material, and it's a great restorative material too, of course, but I think that we have not given the respect to our glass ionomers that perhaps they deserve. There's plenty of evidence out there that shows the longevity of glass ionomer and resin -modified glass ionomer over composite restorations or over amalgams as using them as definitive restoratives. The thing that you need to be aware of is that when you're using these materials, they are not as strong as composite. So I wouldn't want to use pure glass ionomer in a stress -bearing area. Resin-modified glass has more strength. So in a conservative restoration on a child, I would definitely be confident using resin-modified glass ioners. Now I have ways that I use these materials that give them some added advantage and some added strength. You know, I'll place over top of them not just the the glaze or the varnish that would be more commonly accepted to place over top of these materials that helps to decrease washout and increase strength and on and on. But I'll put over top of it an actual layer of flowable and that layer of flowable will act as a sealant and seal in the entire restoration. Thanks a lot, Dr. Cohn. And I wish you the best. Thank you. Thank you so much for having me. It's always a pleasure. Take care.