In the last post, we discussed factors that increase risk for decay (recap: lack of quality saliva, frequent snacking, poor diet, oral appliances, and inadequate homecare).
In this post, we take a look at the other side of things: protective factors. With your understanding of how decay forms and the risk factors contributing to decay, you can likely guess some of them! Note: they are not listed in any particular order. I consider #6 to be most important.
Xylitol is a sugar alcohol (polyol) that is naturally found in fruit and vegetables. It is also manufactured from xylan-rich plant material, such as birch and beechwood. It is relevant to our discussion because it is a sugar that one of the main cariogenic bacteria (Streptococcus mutans) cannot ferment. This means that it does not contribute to decay, and in fact may help prevent decay!
How it works:
- Bacteria spend energy to take in the xylitol, metabolize the xylitol without gaining any energy, and then use energy expel the xylitol again.
- The bacteria waste energy trying to process the xylitol and gain nothing from the effort (also, no acid is produced)! This process essentially starves the bacteria and thus inhibits their growth. Anyone dieting wishes it were possible to lose weight from eating!
- Inability to ferment xylitol also reduces the adhesion of S. mutans to our teeth
How do you use xylitol?
- Optimal inhibition of S. mutans growth by xylitol occurs with its total daily consumption of 5-6 g at a frequency of 3 or more times per day
- The recommended length of exposure time is approximately 20 min
- Available in: gum, lozenges, candy tablets, syrup, mouth rinse, and toothpaste.
- Because research suggests the need for long-term contact and long-term use, GUM is the most common medium
- Do not exceed 40 grams/day, as high doses may result in diarrhea (bacteria in the colon have no problem metabolizing xylitol)
2. Stimulate Saliva Production
Have you noticed that you salivate more when you think about food or are in the process of chewing? Chewing action stimulates salivary flow, and you already know why this is favorable.
How to do this: Simple! Chew sugarless or xylitol gum. NEXT!
3. Raise Intraoral pH
Saliva naturally contains bicarbonate, which buffers acid. Therefore, it logically follows that we can use sodium bicarbonate (baking soda), to increase the pH and buffering capacity in our mouths and help suppress overgrowth of cariogenic bacteria. This can be especially helpful for patients who cannot chew gum.
How to use:
- Dissolve 1 tsp of sodium bicarbonate in a cup of water (about 8 oz) and swish vigorously/spit. Do not swallow! Ingestion of sodium bicarbonate will lead to production of carbon dioxide in the stomach, causing gastric discomfort.
- The buffering effect lasts for about 1 hour.
- This does not taste good! What I have done after using baking soda is brush my tongue with a bit of toothpaste after and spitting.
Arginine is one of the 20 amino acids. Oral microbes metabolize arginine and as a result, alkaline molecules are produced. These molecules can counter acid that may be present in the plaque.
Side benefit: arginine is also associated with providing relieve from tooth sensitivity
Despite abundant research demonstrating the benefits of arginine, there are a limited number of products available. Here are the couple available in the US at this time:
- Tom’s of Maine – Rapid Relief Sensitive
- BasicBites Soft Chews
You knew this one already, but do you know WHY?
- Fluoride enhances remineralization and demineralization resistance.
- This is really the reason fluoride leads to lower decay rates and is heralded as one of the most successful preventive health measures in the history of dentistry.
- When fluoride is present (i.e. from varnish, gel, toothpaste, mouth rinse, etc.), it can combine with calcium to form calcium fluoride. Calcium fluoride adsorbs to the tooth surface and provides a reservoir of fluoride on the enamel.
- When fluoride is present during remineralization, it can be incorporated in tooth structure to form fluorapatite. Fluorapatite is more resistant to dissolution in the presence of acid.
- When fluoride is present in the enamel fluids, it adsorbs strongly to the surface of the apatite crystals and protects against dissolution.
- There is also extensive literature demonstrating fluoride’s antimicrobial effects.
- i.e. inhibition of bacterial enzymes, acidification of bacterial cytoplasm, inhibition of bacterial uptake of carbohydrates, and inhibition of bacterial carbohydrate metabolism.
- However, these effects are only at high concentrations of fluoride. Therefore it seems that the antimicrobial effects of fluoride, although well proven, do not actually contribute to the clinical anti-caries effect of fluoride.
6. Good Oral Hygiene (last but certainly NOT least!)
This is the most obvious one, whether you've read the previous posts or not. All I will say here is that we have got to mechanically disrupt the biofilm!
Also, FLOSS FIRST and rinse, then brush. And floss 1x/day and brush 2x/day. I know, you already knew that, and didn't read this post to be lectured on brushing and flossing!