A handout compiled by:
Alan Baer, MD; Athena Papas, DMD, PhD; Mabi Singh, DMD, MS; James J. Sciubba, DMD, PhD
Diet
Eat sugary foods only during a regular meal. Eliminate dietary sugar (e.g., sucrose, glucose, and fructose) intake between meals, both in terms of snacks and beverages. Purchase “sugar-free” snacks and candies (not “sugarless,” which often contain “less” sugar rather than no sugar!). These sugar-free snacks contain sweetening agents that do not cause dental caries, such as xylitol, sorbitol, saccharin, aspartame, or sucralose. There is evidence that the use of a xylitol-containing gum or candy four to five times a day for 5 minutes after meals and snacks can reduce caries-producing bacteria.
Do not sip on carbonated beverages (e.g. a can of soda) between meals. The acidity of the beverage cannot be buffered without food and this prolonged fermentable carbohydrate and acidity in the mouth promotes dental decay. Should you drink, drink quickly (including juices). Try to consume juices that are fortified with calcium and fluoride and rinse with water afterwards.
Avoid alcohol and caffeine since these beverages are acidic and can promote caries. Stop smoking since it can aggravate dryness of the mouth.
Dental Care
Brush and floss regularly and use fluoride daily. Your teeth should be cleansed at least twice daily using a soft bristled electric toothbrush and mildly flavored (avoid strong minty flavor) low-abrasive toothpaste. Choose “dry mouth” toothpastes. They do not contain sodium lauryl sulfate, a chemical in most regular toothpastes which may contribute to the formation of canker sores. Avoid whitening toothpastes or smokers toothpaste when using regular toothpaste (since these contain abrasives).
Floss between all adjoining teeth at least once daily to adequately remove dental plaque. Carry a travel toothbrush and toothpaste with you to work and brush after meals and snacks. Do not brush immediately after consuming acidic beverages or food (lot of food and fruits, including salad dressings, are acidic). Instead rinse mouth with plain water or low fluoride containing rinse (e.g. ACT) and brush after half an hour.
If you are at low-to-moderate risk of caries, you should use a 0.05% sodium fluoride mouth rinse (available over the counter, such as ACT or Colgate Fluorigard) for 1-2 min. daily, before sleep. Hold the sodium fluoride rinse in your mouth for at least one minute before expectorating.
If you are at high risk of caries, your dentist or physician should prescribe 1.1% neutral sodium fluoride toothpaste (such as Prevident 5000 or SF 5000) to be used once daily in place of your regular toothpaste. Prescription fluoride toothpastes can be applied with a toothbrush and left in place for two to three minutes before expectorating. Do not swallow the prescription fluoride toothpaste. No food or beverage should be consumed for at least 30 minutes after fluoride application. Alternatives include fluoride gels and foams, which are applied through the use of custom-fitted plastic mouth trays (made by your dentist). The tray is held in the mouth by biting. Application generally takes about four minutes, and you should not rinse, eat, smoke, or drink for at least 30 minutes after application. It is easiest to use these trays before bed each night.
Your dentist may opt to give you fluoride treatments at your dental office visits, using a high-concentration fluoride gel, foam or varnish. These applications can be repeated every 3-6 months .
In addition to fluoride, calcium has a remineralizing effect on dental enamel. Several agents deliver calcium and phosphate to the tooth surface to help reverse demineralized areas. These are particularly good to use if you have begun to develop incipient caries or white spot lesions on your teeth.
There are currently three types of calcium remineralizing agents on the market.
- Calcium phosphopeptide and amorphous calcium phosphate (Recaldent®; GC MI Paste with Recaldent® and fluoride MI Paste Plus, Trident gum with Recaldent®)
- Calcium sodium phosphosilicate (Novamin®; Dr. Collins Restore and Remineralizing Toothpaste)
- Amorphous calcium phosphate (liquid calcium in Arm and Hammer Enamel Care Toothpaste)
These products vary in their application. The MI paste Plus is applied in the evening after brushing with a fluoride toothpaste. A generous layer is applied to the tooth surfaces (either with a cotton swab, gloved finger, or custom tray) and left on for 3 minutes. The Arm and Hammer and Dr. Collins’ products are used in lieu of regular toothpastes.
Your dentist may also prescribe mouth rinses that can reduce oral discomfort and the formation of dental caries. These include rinses that elevate the pH of your oral cavity (e.g baking soda rinses or Carifree spray), reduce the concentration of bacteria and candida (e.g. chlorhexidine), or soothe the lining of your mouth (e. g. supersaturated calcium phosphate).
The frequency of dental visits depends on your risk of dental caries and may require visits every 3 months. Dental X-rays may also be required more often if you are at higher risk of dental carious lesions.
Denture Care
Take your dentures out before going to sleep and soak them overnight. Acrylic appliances should be soaked in a sodium hypochlorite solution, and metal dentures should be soaked in chlorhexidine.
If you have candida, your dentures should be soaked overnight in Nystatin.
Stimulation of Saliva Flow
Increasing salivary flow helps to retard dental decay. This can be achieved by chewing sugar-free gum, sucking on lozenges (e.g. Numoisyn and Salese) or sugar-free candies, or taking certain medications. Snacking on carrots or celery may also help. Products that contain xylitol can help reduce the risk for dental decay (e.g. Numoisyn and Salese lozenges, Biotene gum, diabetic candies). Pilocarpine (Salagen) and cevimeline (Evoxac) are prescription medications that stimulate saliva production.
Minimize the use of medications that can cause a dry mouth. Many of these are prescription medications (such as anti-depressants, muscle relaxants, and anti-spasmodics for overactive bladders and bowel cramps). Talk with your physician as to whether these types of medications can be discontinued. Some over-the-counter medications can also cause a dry mouth, such as anti-histamines and decongestants.
Salivary Substitutes
Artificial saliva or saliva substitutes can be used to replace moisture and lubricate the mouth. These substitutes are available commercially and come in a variety of formulations including solutions, sprays, gels and lozenges. In general, they contain an agent to increase viscosity, such as carboxymethylcellulose or hydroxyethylcellulose, minerals such as calcium and phosphate ions and fluoride, preservatives such as methyl- or propylparaben, and flavoring and related agents.
Oral Candidiasis
Patients with a dry mouth are at risk for oral candidiasis, particularly the erythematous form. Signs of this include painful fissures at the labial commissures (i.e. corners of your mouth), burning mouth, and sore red mouth (especially the tongue). This requires treatment with an antifungal agent (such as nystatin or clotrimazole). Most of the prescription products used for oral candidiasis contain lactose and other sugars that can aggravate the formation of dental caries if used repeatedly. Thus, your physician may choose to prescribe a vaginal nystatin tablet for use in the mouth, a specially formulated buccal tablet (e.g. Oravig), or a troche compounded by a pharmacy with artificial sweeteners.
