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Practice Solutions: VOCO by Parag R. Kachalia, DDS

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by Parag R. Kachalia, DDS
Dr. Parag Kachalia is the vice chair of simulation, technology and research at the University of the Pacific's Arthur A. Dugoni School of Dentistry. He is a fellow of the American Dental Education Association's leadership institute, is a researcher, and a published author in the areas of digital dental photography, digital fixed prosthodontics, and financial management. He has lectured internationally in the areas of adhesive dentistry, cosmetic dentistry, photography, CAD/CAM technology, fixed proshthodontics, and new concepts within local anesthesia and diagnostic technologies. He maintains a private practice geared toward restorative dentistry with his wife and fellow Pacific alum Dr. Charity Duncan.




Each and every month in practices around the world, numerous patients hear the dentist say the word, "watch."

Generally speaking, this term is used when a clinician sees an early cavitation or an area of erosion. The question should be asked, "What does the clinician expect to happen to the dentition during the watching period?"

The clinician generally has the patient's best interest at heart, and does not want to surgically treat an area before he or she believes it is justified. In order to truly move dentistry forward, we must think critically about changing this watch-and-wait paradigm. Dentistry should move toward an active-management approach, in which clinicians—along with their team members—evaluate a patient as an individual and decide if surgical or chemical intervention is needed when a cavitated lesion or an area of erosion is discovered.

Thankfully, products are on the market that allow remineralization of tooth surfaces. Historically, remineralization focused primarily on fluoride. However, today we can combine the advantages of fluoride with xylitol and nano-hydroxyapatite in a simple paste.

VOCO's Remin Pro contains all three ingredients to allow for easy application by both members of the dental office as well as the patient.

Key ingredients and benefits
Fluoride
Through numerous studies, fluoride has proven to be an agent that helps to both prevent caries and change damaged tooth structure into a more acid-resistant fluorapatite. Traditional enamel is demineralized when exposed to a pH of 5.5, and dentin demineralizes at a pH below 6.7.

However, fluorapatite can take a more significant acid challenge and does not demineralize until the pH reaches 4.5 in the oral cavity. Remin Pro contains about 1,450ppm of fluoride compared to 1,000ppm in over-the-counter toothpaste.

Xylitol
Xylitol is a natural sweetener that tends to be more forgiving to the dentition compared to sugars such as sucrose. Over the years, the literature has been mixed as to whether xylitol can also aid in remineralization of enamel and dentin, and the literature has shown that approximately 6 grams of xylitol must be consumed per day to show remineralization benefits.

Regardless of the efficacy of remineralization, the clear benefit of xylitol is that it decreases the growth of bacteria such as strep mutans—and possibly lactobacilli—and increases the production of saliva. This mechanism allows for less acid to be produced and creates a more favorable oral environment for sustained health.

Nano-hydroxyapatite (nHAP)
Nano-hydroxyapatite can be thought of as the special sauce in Remin Pro. The beauty of nHAP is that, because of its small molecular size, it has the ability to penetrate deeper into demineralized enamel and dentin. This molecule has the ability to fill enamel irregularities, as well as provide a surface sealing to dentin on exposed root structure.

The resulting smooth surface makes the adhesion of dental plaque much more difficult. The secondary benefit is that the visual increase of tooth gloss becomes apparent. In addition, in a recent in-vitro study published in the Journal of Dental Research, biofilm actually enhanced nHAP's ability to reduce demineralization effects. Penetrating biofilm can be very difficult and the fact that nHAP can work in the presence of this biofilm is very promising for dentistry.

Cases
Patients who show signs of erosion or decay are routinely prescribed Remin Pro to help mitigate the destructive process.

In case No. 1, a man presented with a dentition that has been completely free of decay for more than 40 years. Unfortunately, while he has been decay-free he has been battling gastric esophageal reflux for many years, and an extensive amount of enamel and dentin loss is now present. In conjunction with ultimate restorative care, disease management was also of paramount importance. A custom splint was fabricated to deliver Remin Pro and to help slow down the erosive process.

In case No. 2, a patient presented with rampant decay on a significant number of facial surfaces due to extensive soda consumption. This patient's treatment consisted of restoring the cavitated lesions with resin, and managing the demineralized areas with Remin Pro.

No single magic bullet exists that can solve the issues we see with erosion and caries in our patient population. However, products like Remin Pro by VOCO allow clinicians to positively influence the oral environment and actively manage the disease process, instead of taking a "watch and wait" approach.


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September 2025
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