Download Anti Cavity Protocol

The Smile Secrets
Anti-Cavity Program
Our incredible Anti-Cavity Program is a protocol designed to go far, far beyond the traditional “brush & floss
and pray you don’t get cavities” routine. Dr. Chellis is committed to providing you the knowledge and a new kind
of “oral chemotherapy” to help you stop the continuous cycle of cavities!
It has long been known that our genetics, the type and frequency of foods and drinks that we consume, as well
as the regularity and effectiveness of our at-home oral health care (tooth brushing, flossing and tongue cleaning)
all play a large role in determining the susceptibility of our teeth to decay. What is new is the fact that the
dentistry now has several new “magic weapons” of anti-microbial oral chemotherapeutic agents that all work
together to provide you with the means to help yourself to a healthy mouth, including “Xylitol,” the all-natural lowcalorie sugar substitute that actually starves the cavity-causing bacteria to death!
What Causes Cavities and How Do I Prevent Them?
Cavities or Dental "Caries" is a bacterial infection on the teeth, specifically an infection of the biofilm on the
teeth. When the teeth’s biofilm is infected with cavity-producing bacteria, the biofilm becomes acid-producing
(low pH) and can cause cavitation (or holes in the teeth, commonly known as “cavities”). Dental Caries is a
pandemic, infectious multi-factorial complex biofilm disease leading to demineralization, cavitation and ultimately
loss of the teeth. Historically, it has been the most complex and difficult disease to diagnose and treat! We now
know that it is preventable.
The latest research on the caries infection has now identified a few key concepts:
•
This infection is not due to a specific bacterium, it is a biofilm disease and there are now 32 identified
strains of bacteria, any combination of which may cause cavities in an individual.
•
It’s all about pH! An acidic pH is the strongest influence that determines whether these cavity-producing
bacteria will produce holes in your teeth—how acidic, what frequency of acidity, and for how long?
•
pH of 7.0 is neutral (the pH of water). Any number less than 7.0 is acidic (battery acid has a pH of 1.0)
and any number higher than 7.0 is alkaline (Drano has a pH of 13.0). At pH of 6.7, just below neutral,
demineralization of the dentin and cementum of the teeth begins to occur. At pH of 5.5, enamel begins
to demineralize. In an oral biofilm, at pH 4.7, within 30 minutes, all healthy bacteria are gone and then
only the acidogenic (acid-producing) and acidouric (capable of growing in an acid environment) bacteria
can survive. Once they get control of the biofilm, they keep a low pH for long periods of time and they
alter the healthy bacteria (that we’ve long thought of as “good”/protective) and turn them into cavityproducing bacteria within 30 minutes!
A biofilm is a structured community of bacteria embedded within a self-produced matrix and attached to a living
or inert surface. Anytime there is a fluid, a surface, and bacteria, there will be a biofilm. This occurs everywhere
in nature. As any species of bacteria establishes itself in the biofilm it may undergo as many as 84 genetic
mutations and become more resistant to antibodies, antibiotics and antimicrobials, up to 1,000 times more
resistant! A diseased oral biofilm is one in which there is a population shift from normal oral bacteria to the acidproducing (cavity-causing) bacteria that cause dental cavities. (See http://en.wikipedia.org/wiki/Biofilms for
more information about biofilms.)
So, Filling cavities doesn't stop the disease of dental caries? No, filling cavitations does not remove the cavitycausing/pathogenic bacteria from the rest of the mouth, only the hole that is filled. Treatment must include
addressing the bacterial infection by replacing a bad biofilm with a biofilm that is not acid-producing.
It is now known that there are 32 different bacteria identified as contributing to the caries process that generate
acids from carbohydrates that you eat. The level of infection that causes damage to teeth depends on multiple
factors. Acids generated by these bacteria diffuse into the subsurface of the enamel and dissolve calcium and
phosphate, which then diffuse out of the tooth. This process is called demineralization.
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If not halted, the continued loss of subsurface mineral will eventually cause the surface to cave-in or cavitate,
thus forming a “cavity.” Once cavitated, a restoration is needed.
However, here’s the good news: the presence of healthy saliva will provide buffers, extra calcium and
phosphate to reverse the early damage caused by demineralization. To do this repair, the salivary buffers must
first neutralize the acid and stop the demineralization. When the calcium and phosphate concentrations become
greater outside the tooth than inside, they will diffuse back into the tooth. This reversal of the demineralization
process is called remineralization.
An intact enamel surface is significant because it prevents bacteria, which are too large to diffuse through the
enamel, from getting into the tooth. If demineralization is not stopped, the surface will eventually cavitate. All
forms of cavities (cavitated and pre-cavitated) should be thought of as “symptoms of the caries disease process
itself, with the real cause of the tooth damage being the result of bacterial infection, poor dietary habits and
altered saliva. Thus, the treatment should focus on treating the disease, not just repairing the symptoms by
restoring teeth.
Whether the demineralization or remineralization process “wins” depends on several factors, some safe or
protective, and some bad or pathogenic. These factors continually tip the Caries Balance one way or another.
The BAD factors include:
The SAFE factors include:
B
Bad Bacteria
S
Saliva and Sealants
A
Absence of enough saliva
A
Antimicrobials
D
Dietary habits that are poor
F
Fluorides and
E
Effective Diet
The bad or pathogenic factors include the acid-producing bacteria, salivary dysfunction (altered flow rate,
texture, or chemical makeup), and poor dietary habits including frequent snacking.
The safe or protective factors include adequate amounts of healthy saliva, baking soda products, sealants,
antimicrobial agents, xylitol, fluoride and bio-available minerals and an effective diet (types of foods and
frequency of intake.) Saliva is possibly the most important factor because it contains so many items needed for
health: calcium, phosphate, salivary antibacterial agents, enzymes, acid buffers and protective proteins.
Many new scientifically formulated products are available to add to traditional dental products to create an
arsenal of weapons to effectively combat the disease of dental caries. No longer do our Smile Secrets guests
have to passively accept that they will always have “soft teeth” or live in fear of their next dental checkup!
Baking soda products neutralize acids in the mouth. Antimicrobial agents such as chlorohexidene, iodine, and
xylitol create a new oral chemotherapy. Toothpastes, gels and gum provide bio-available minerals of calcium
and phosphate to tip the caries balance in favor of remineralization. And last, but not least, a healthy diet,
including a reduced frequency of snacking, is needed for a healthy caries balance.
The sweetest chemotherapy ever: Xylitol!
The most exciting recent development in treating tooth decay has been the recent research about the
chemotherapeutic power of Xylitol, an all-natural sugar substitute, added to your normal diet. Simply by adding
6-10 grams per day of Xylitol, you can actually kill the Streptococcus mutans bacteria, which is one of the main
known bacteria that cause tooth decay. In addition, limit (as much as you can) your intake of “regular” sugar
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and carbohydrates, and especially control the frequency of intake of these! (It is much better to drink a Coke or
a cup of coffee all at once, than to sip slowly on it for hours! It is hard to believe, but every sip refuels the acid
production for several more hours!) And by all means, brush, rinse with water, use a pH elevating spray, or
chew xylitol gum or mints after you consume sugary or carbohydrate foods or drinks.
Today’s dentistry includes treating the underlying cause of the disease, the very bacteria that cause tooth
decay. Like any other disease that can be spread from human to human (ex: strep throat, the flu, or even a
common cold) the bacteria that cause cavities can be spread from person to person, so not only will we start by
helping you, you may want us to test and treat others in your social circle with whom you are in close contact.
What is Xylitol?
Pure xylitol is a white crystalline substance that looks and tastes like sugar. It is an all natural substance, made
from the bark of the white birch tree or from corn cobs and is a natural sweetener found in many fruits and
vegetables. On food labels, xylitol is classified broadly as a carbohydrate and more narrowly as a polyol.
Because xylitol is only slowly absorbed and partially utilized, a reduced calorie claim is allowed: 2.4 calories per
gram or 40% less than other carbohydrates.
Xylitol has been used in foods since the 1960’s. It is a popular sweetener for the diabetic diet because it tastes
like sugar but has 1/3 fewer calories and it has a low glycemic index of 7.0. In the U.S., xylitol is approved as a
food additive in unlimited quantity for foods with special dietary purposes.
Over 25 years of testing in widely different conditions confirm that xylitol is the best sweetener for teeth. Xylitol
use reduces tooth decay rates both in high-risk groups (high caries prevalence, poor nutrition, and poor oral
hygiene) and in low risk groups (low caries incidence using all current prevention recommendations). Sugar free
chewing gums and candies made with xylitol as the principal sweetener have already received official
endorsements from six national dental associations.
Xylitol is an Effective part of your Anti-Cavity Program
Studies using xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic
reduction in new tooth decay, along with arrest and even some reversal of existing dental caries. Xylitol provides
additional protection that enhances all existing prevention methods and potentiates the effects of fluoride when
used in combination. This xylitol effect is long-lasting and possibly permanent. Low decay rates persist even
years after the trials have been completed.
Xylitol is Natural
Xylitol is right here, inside, already. Our bodies produce up to 15 grams of xylitol from other food sources using
established energy pathways. Xylitol is not a strange or artificial substance, but a normal part of everyday
metabolism.
Xylitol is widely distributed throughout nature in small amounts. Some of the best sources are fruits, berries,
mushrooms lettuce, hardwoods, and corn cobs. However, one cup of raspberries contains less than one gram of
xylitol and xylitol is usually found in the peeling or rind, so getting the therapeutic dose for combating dental
decay is difficult without supplementation of gum, mints or sugar replacement.
No sweetener should be consumed in bulk and the same is true for xylitol. The laxation threshold of xylitol is
higher than other polyols however; it is not even approached by the small dosages needed for dental protection.
In the amounts needed to prevent tooth decay (less than 15 grams per day), xylitol is safe for everyone.
Xylitol is Convenient and Enjoyable
Xylitol can be conveniently delivered to your teeth via chewing gum, tablets, or even candy. You can implement
your xylitol program anywhere, anytime. It fits right in with the most frantic schedules. You don’t need to change
your normal routine to make room for xylitol!
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Some health regimens require iron willpower, discipline, and commitment. But xylitol tastes so good that it
becomes automatic. Children love it! Nagging is minimized.
How to use Xylitol
It is not necessary to replace all sweeteners to get the dental benefits of xylitol. Look for xylitol sweetened
products that encourage chewing or sucking to keep the xylitol in contact with your teeth. The best items use
xylitol as the principal sweetener.
How much is enough?
Studies show that 6 to 10 grams of xylitol per day are very effective. It’s easy to keep track of your xylitol intake.
The "all xylitol" gums contain about one gram of xylitol in each piece. The "all xylitol" mints contain about 1/2
gram of xylitol in each piece. You could begin with as little as one piece of gum or two mints four times a day for
a total of four grams. It is not necessary to use more than 15 grams per day as higher intakes yield diminishing
dental benefits.
Excessive use of xylitol may cause a mild laxative effect. Begin using small doses at first and then increase
over time to work up to the target dose of 6-12 grams per day.
How often should I use Xylitol?
If used only occasionally or even as often as once a day, xylitol may NOT be effective, regardless of the
amount. Use xylitol at least three, and preferably 5 times every day.
As always, “Timing is Everything”
Use immediately after eating and clearing the mouth by swishing with water, if possible. Between meals, replace
ordinary chewing gum, breath mints, or breath spray with comparable xylitol products.
A dental therapeutic dose can be easily reached, for example, Rinse morning and night with CariFree
Maintenance rinse, (3 grams/dose), brush morning and night with Xylitol and fluoride toothpaste, sweeten your
coffee or tea at breakfast with xylitol as a sugar substitute, and dissolve 2 mints (1 gram) in your mouth after
each snack or meal.
Be cavity-free for life! Fight cavities the easy way!
Visit your Smile Secrets Dental Professionals Team regularly and you can stop the cycle of tooth decay!
As a convenience to our clients, we have some Xylitol products available here in the office so you can
get started right away:
XyloSweet Xylitol Granules
(Sugar substitute) for baking or sweetening drinks/cereal/fruit:
10 count individual packages, 4
grams each
1 pound package
$1.00
$6.00
2 pound reusable canister
$13.00
5 pound package
$24.00
Also for your convenience and for your ongoing cavity protection, Visit CariFree at www.carifree.com or Epic
Dental at www.epicdental.com Both companies will auto-ship your desired supplies right to your home!
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Anti-Cavity Basics and Products available to help you:
(Feel free to discuss this with your Smile Secrets Team)
1.
Continue traditional, effective daily Oral Hygiene, removing all plaque (including effective tooth brushing, flossing and tongue cleaning. Note: 80% of the oral bacteria accumulate on the posterior 1/3 of the tongue!)
Brush 2 x day Floss 1 x day Tanga Tongue Cleaner 1 x day Use Technology aids: Sonicare Toothbrush 2.
Determine your cavity-­‐forming bacterial levels (risk for decay) at least annually, quarterly if you are at risk, with a simple in-­‐office CariScreen Saliva Test with the CariScreen meter.
Q: How does the CariScreen meter work? A: Acid-­‐producing (cavity-­‐causing) bacteria must work extremely hard to maintain their own cell’s neutral pH within an acidic biofilm. Therefore, they must use 100 times the amount of ATP (energy) as normal body cells. The CariScreen meter measures the level of ATP (in units of Relative Light Units or “RLU”) in the biofilm which quantifies patient's oral bacterial loads. When adenosine triphosphate (ATP) is brought into contact with the unique liquid-­‐stable luciferase/luciferin reagent within the CariScreen Swab sampling device, light is emitted in direct proportion to the amount of ATP present. The CariScreen meter measures the amount of light generated and provides information as to the level of contamination within seconds. LOW RISK = AT RISK = < 1500 RLU's of ATP
1501-­‐9999 RLU's of ATP
Re-­‐test at appropriate intervals (90 days, 180 days, or annually, depending on your own specific oral environment) 3.
Commit to a consistent Anti-­‐Cavity Program, and then re-­‐test your risk periodically.
4.
Use Fluoride toothpaste:
Use Over-­‐The-­‐Counter (OTC) Baking Soda Toothpaste with Bio-­‐Available minerals for recalcification to Neutralize Acids: Arm & Hammer Enamel Care Mentadent Replenishing White Toothpaste Use 2 x daily for low-­‐risk adults and all children (until 18 months after last permanent tooth has erupted, except wisdom teeth) or until approximately by age 13 For all high risk patients, adults only, consider replacing an OTC toothpaste with a Prescription Strength Toothpaste: Prevident 5000 Booster
Control Rx
For kids, and adults at low risk, use a Fluoride Toothpaste with Xylitol (available in our office) Squigle Toothpaste(Peppermint)
Epic Toothpaste(Spearmint)
For kids, and adults, ask for a Fluoride “Cavity Shield” Varnish Application while you are here in our Office, getting your teeth cleaned. Beginning at age 1 Ending at age 101! Smile Secrets Anti-Cavity Information and Protocol
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5.
Use Xylitol after each Snack or Meal:
Use Mints, Gum, or Oral pH-­‐neutralizing Spray with xylitol, if you can’t brush right away.
Use Xylitol Sugar Substitute (Available in our office or at stores like PCC) Use it In your coffee or tea, bake with Xylitol, use on your cereal or fruit, or mix it in your breakfast Smoothie.
6.
Use Daily Anti-­‐Cavity Mouth rinses: (We will help you determine what’s appropriate for you with the CariScreen saliva test) CariFree Treatment Rinse (pH 10) CariFree Maintenance Rinse (pH 8) Re-­‐Test bacterial levels/risk every 3 months if you are AT RISK, and annually if you are at LOW RISK. Repeat Treatment Rinse if indicated , alternating with Maintenance Rinse and then re-­‐testing until healthy biofilm is re-­‐established (This may take 3-­‐4 cycles). 7.
For extra protection in problem areas, Use Remineralizing “MI Paste” with Recaldent (CCP-­‐ACP), to: desensitize exposed tooth roots remineralize early carious “white spots” protect teeth with braces protect newborn’s newly erupted teeth Use MI Paste on your toothbrush along with your regular toothpaste or apply with your fingertip to specific areas daily. 8.
For those with dry mouth issues at night or day, use Saliva stimulants: the healthy, cavity-­‐inhibiting ways to re-­‐moisturize your mouth. Use CariFree Boost Spray or TheraSpray with xylitol and elevated pH. These antimicrobial moistening sprays counteract cavity-­‐producing bacteria and the low pH produced after every snack. They are ideal for people who suffer from dry mouth, Xerostomia or Sjogren’s Syndrome. The elevated pH helps to protect the teeth against decay by neutralizing the acid. The sprays fit conveniently in a purse or your pocket. And just a few sprays after a snack help to protect your teeth, moisten your mouth and freshen your breath. 9.
Modify your Diet: especially by decreasing the frequency of intake of Sodas, Sugar, Carbohydrates, and Sticky foods such as Raisins, & Caramels. Use snacks known to decrease cavities, like Cheese or chewing Gum or Mints sweetened with xylitol. 10.
Visit your Smile Secrets Dental Team Regularly for: Oral Hygiene Coaching Restocking of your supply of Anti-­‐Cavity CariFree Maintenance Rinse. Re-­‐testing your Bacterial levels with the CariScreen to determining your current risk. Professional Application of Chemotherapeutic Medicines And to just to say “Hi!” to your Smile Secrets Dental Team, who want to help you to be healthy and cavity-­‐free! Smile Secrets Anti-Cavity Information and Protocol
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Understanding the pH Scale: The lower the pH, the more acidic it is. Products below a pH of 5.5 cause demineralization of the enamel of the tooth. Demineralization allows the Calcium and Phosphate ions to “leak out” of the tooth, softening its structure. Products below a pH of 6.5 cause demineralization of the dentin and cementum of the tooth. Acids
Demineralization
Remineralization of the tooth can occur when the pH is neutral or higher than 7. The saliva contains Calcium and Phosphate ions, which can then diffuse back into the tooth structure, when the pH is neutral or higher. Bases
Remineralization
Neutral
[H+ ions]
pH:
Examples
1 X 100
0
Hydro Chloric Acid
1 x 10-1
1
Battery Acid, Stomach acid
1 x 10-2
2
Lemon, Lime and Cranberry Juices, Coke, Pepsi
1 x 10-3
3
Vinegar, Apple & Grapefruit juices, Nestea, Mountain Dew
1 x 10-4
4
7-Up, Root Beer, Beer, Tomatoes
1 x 10-5
5
Rainwater, Pickle juice, Black Coffee, Pepto Bismol
1 x 10-6
6
Milk, Egg yolks, Urine, Coconut Milk
1 x 10-7
7
Pure water, Human Blood, Dawn Dish Soap, Tea
1 x 10-8
8
Egg whites, Sea Water, CariFree Maintenance Rinse
1 x 10-9
9
Baking soda, CariFree Boost, CariFree Oral Neutralizer Gel
1 x 10-10
10
Tums® antacids, CariFree Treatment Rinse
1 x 10-11
11
Ammonia, Milk of Magnesia
1 x 10-12
12
Mineral lime - Ca(OH)2, , Liquid Plumber, Soapy Water
1 x 10-13
13
Drano®, Lye, Oven Cleaner
1 x 10-14
14
Sodium Hydroxide
pH of Common Mouth Rinses available OTC
Crest Pro Health
Listerene Antiseptic
Oral B Anti-Bacterial
Oral B Fluoride
Breath Rx
Biotene
Peridex
Scope
Listerene Whitening
Colgate Neutra Fluor 900
Act Kids
Act Restoring Mouthwash
Act Freshening
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4.24
4.27
4.61
4.70
4.77
5.34
5.46
5.55
5.66
5.98
6.36
6.56
6.59
Suggested Protocols for Guests who have a LOW Risk or who are AT Risk:
Suggested 12-­‐month Protocol for Guests who have a LOW RISK of Cavities: (including guests who have gum recession) Daily Floss Low Risk Suggested 12-­‐month Protocol for Guests who are AT Risk for Caries (including clients with dry mouth and those over the age of 70 with gum recession): AT Risk $ 6 Daily Floss $ 7 Daily Brushing with Rx-­‐strength Prevident 5000 Booster Fluoride Toothpaste (4 x 15 bottles) Daily use of Tanga tongue cleaner (1-­‐time purchase) $ 15 Daily use of Tanga tongue cleaner (1-­‐time purchase) $ 15 Annual Caries Risk Testing $ 15 Quarterly Caries Risk Testing (4 x $15) $ 60 N/A Quarterly Treatment Rinse until CariScreen < 1500 (2-­‐8 x $35/pckg) $ 70-­‐ $ 280 Daily CariFree Maintenance Rinse $ 168 12-­‐15 bottles $ 144 -­‐ $ 180 Daily Brushing with OTC Baking Soda Toothpaste Daily CariFree Treatment Rinse Daily CariFree Maintenance Rinse 16 bottles Quarterly application of Fluoride Varnish (“Cavity Shield” Total Cost per day Annual Cost $ 192 N/A Quarterly application of Fluoride Varnish (“Cavity Shield”) 64 Total Cost per day cents/day $ 235 Annual Cost $ 6 $ 60 $ 60 $ 1.23 – $ 1.71/day $ 451 – $ 625 CariFree conversions and estimated usage:
10 ml = 2 teaspoons, or 0.34 ounces.
CariFree Treatment Rinse: 4+ 4 oz mixed together daily and used twice daily@ 10ml per use = 11.5 day
supply. (Note: expires 2 weeks after opening bottles)
CariFree Maintenance Rinse: 16 oz divided by 10 ml = a 23 day supply if used twice a day; or a 45 day supply,
if used once a day. (Note: expires 6 weeks after opening bottle)
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