Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 23

Let's Talk About That

Dr. Patrick Turley Interviews
Dr. James Zahrowski
Editor's Note: It is my honor and pleasure to introduce Dr. Patrick Turley as the new section editor of
the "Let's Talk About That" column. He is a former
chairman of the orthodontic department at UCLA
School of Dentistry and past president of the PCSO.
Dr. Turley is also a board certified orthodontist and
is nationally and internationally recognized. Please
welcome Dr. Turley!
Dr. Patrick K. Turley
Editor, Let's Talk About That
Manhattan Beach, CA

Dr. Jim Zahrowski
Tustin, CA

For this issue of the Bulletin, I had the pleasure of
talking with Dr. Jim Zahrowski, who is not only an
orthodontist but also a pharmacist. Because Dr.
Zahrowski has such a unique background, I have
asked him to give us his perspective on pharmacology in orthodontics.
Prior to dental school, Dr. Zahrowski earned a
Bachelor of Science from the University of California Riverside and a Doctor of Pharmacy from
the University of Southern California. He served
as the Director of Pharmaceutical Services at the
UCLA Neuropsychiatric Institute. Following dental school at Oregon Health & Science University,
he pursued his orthodontic training at UCLA,
where he also received a Master of Science in
Oral Biology.
Dr. Zahrowski is a Diplomate of the American
Board of Orthodontics and serves on the Critical
Review Panel as an evidence-based reviewer for
the American Dental Association. He is an expert
reviewer for the AJO/DO, The Angle Orthodontist,
The Journal of Pain, and the Journal of Public
Health Dentistry. Dr. Zahrowski practices orthodontics in Tustin, CA, and is a lecturer in the UCLA
Section of Orthodontics.
Patrick Turley (PT): The prevention of white spot
lesions and enamel decalcification is of the highest priority for orthodontists. Aside from the permanent esthetic deficiency that results, nothing
hurts the confidence of the parent and referring
dentist more than having permanent marks on
the teeth "as a result of braces." What pharmacology agents are available to help prevent this, and
how should they be used?

Fall 2017  PCSO Bulletin

Jim Zahrowski (JZ): Dr. Turley, thank you for
the invitation to talk about pharmacology in
orthodontics.
Most patients in my practice who develop decalcifications are non-compliant. Therefore, the ideal
prevention of decalcifications should not require
compliance. The ADA has good evidence that
applying fluoride varnish every three to six
months prevents dental decay by 20% to 70%.
Random controlled split-mouth orthodontic
studies have found fluoride varnish, applied every
three months, decreases decalcification formation by 40% to 70 %.1,2 I am an advocate for fluoride varnish every three months (alternating with
six-month dental visits). The application is easy:
paint the tooth around the bracket. The varnish
dries white in 30 seconds; the patient should not
eat or drink for 30 minutes and may brush and
floss normally that night. Decalcification prevention is always better because fluoride varnish
has been shown to be less effective in lessening
decalcifications (~10%) when it is already present.3
PT: Although patients have different susceptibilities to developing enamel decalcification, might
medications a patient is taking increase that risk?
JZ: Yes, medications that dry out tissues or limit
salivary flow. One major group of medications is
anticholinergics. Many common medications
taken in the teenage group - such as antihistamines and some antidepressants - have anticholinergic properties. Also, isotretinoin, which is
taken orally for acne treatment, slows the secretion of salivary flow. Patients who take medications or have a disease that decreases salivary
flow should practice good oral hygiene, rinse
with water frequently, and receive supplemental
topical fluoride to help prevent caries and decalcifications.
PT: The prevention of bacterial endocarditis as
the result of dental treatment has long been a
topic of discussion in dentistry. Many years ago,
a California orthodontist was sued for failing to

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Fall 2017