Richard B. Evans, D.D.S.

Managing Dental Disease as an Infectious Disease

We recommend this approach when we identify the oral signs and symptoms of periodontal disease, caries (tooth decay) and loss of tooth structure (white enamel lesions, dentin cavities, restorations, and periodontal inflammation) that are caused by common oral pathogens. Once identified we work with you to modify your diet, your habits and then come up with a treatment plan which may include compounds used to kill pathogenic bacteria to control the disease. This probiotic approach removes the pathogens from the oral environment; thereby, treating the infection rather than waiting for the caries (cavity) or periodontal disease to occur. We work together to treat the cause rather than the effect (damage).

 

Xylitol:

Xylitol is a natural sugar that cariogenic bacteria (Streptocossus mutans and Lactobacillus sp.) ingest, but cannot metabolize it. They die and lose the ability to attach to teeth and oral tissues. This greatly reduces the formation of plaque. Xylitol’s presence alters the total oral bacterial environment and decreases the risk of decay. It also blocks the attachment of bacterial plaque that is an etiological factor in periodontal disease. It is effective in stopping the transmission of cariogenic bacteria from mother to child. Xylitol in solution is also effective for Otitis Media (middle ear inflammation) and S. mutans infections in the ear, nose and throat.

Xylitol is found in many gums, mints, candies, raw granules for cooking, Oral Balance Products, toothpastes, sprays, mouthwashes, and time releases lozenges. Chewing gum is more effective because it stimulates saliva that naturally remineralizes the enamel of the teeth. Trident Gum has xylitol & Recaldent. Dr. John’s Candies and Spry Products have a lot of xylitol containing products.

Caution: People with TMJ problems should not chew gum. Denture wearers have a difficult time with chewing gum. Xylitol is toxic to dogs and some pets. In excess amounts, it can cause diarrhea in humans.

Rx: 2 sticks of gum (6-10 grams a day) for 5 minutes or suck on xylitol candy or mints 3-4 times a day to be therapeutic.

 

Chlorhexidine:

Chlorhexidine is bacteriocidal (kills cariogenic bacteria) and leaves a protective film on the teeth for up to 12 hours. Caution: It can stain teeth.  Do not use chlorhexidine and fluoride within two hours of each other.

Rx: Chlorhexidine (0.12%) Oral Rinse. Brush the affected area (gumline of the teeth) 1-2 times a day for one week every month. This way it creates less stain on the teeth.

Extreme Risk Patients:

Rx: Chlorhexidine (0.12%) Oral Rinse. Brush the affected area (gumline of the teeth) 1-2 times a day for 2-3 months.

 

Hydrogen Peroxide:

Can break down biofilm and is bacteriocidal when used in PerioProtect Trays. Can be used in irrigation devices.

 

Sodium Hypochlorite (Clorox):

It is an effective bacteriocidal as a rinse but it does have an odor and taste.

Rx: 1 teaspoon in a tall glass of water, rinse every other day for 1 month every 2-3 months to elinimate oral bacteria effectively.

Rx: ½ teaspoon in reservoir of irrigation device.

 

Recaldent:

It can remineralize decalcifying enamel (white spot lesions or initial non-cavitated caries). It enhances bonds (synergistic) with fluoride, protects against enamel and root erosion, reduces hypersensitivity due to bleaching, recession or xerostomia. It has a buffering capacity against acids.

Products:

MI Paste

Trident White Gum

 

ACP/Recaldent/NovanMin:

These all contain some form of calcium phosphate that reduces sensitivity and restores enamel.

MI Paste

Toothpaste:

Arm & Hammer Enamel Care

Arm & Hammer’s Mentadent replenishing white

Restore

Oravive

Trident White Gum

Enamel Pro Varnish

Prophy Paste:

MI Paste

Relief ACP Oral Care Gel (Discus Dental)

 

Probiotics:

The herbal formula Glylic is derived from Chinese Licorice root plant and eliminates the S. mutans population for 3-6 months. It is contained in Dr. John’s Kavity Kops lollipops.

Rx: Dr. John’s Kavity Kops Lollipops

Dissolve 1 lollipop after breakfast and 1 lollipop after dinner for 10 days.

Repeat every 3-6 months.

 

Fluoride:

Fluoridex

Prevident 5000

Fluoride Varnish (every 6 months) – Enamel Pro Varnish

In office fluoride treatment (Rinse or Trays)

 

OTC Tooth Pastes & Mouthwashes:

Listerine kills bacteria but has alcohol

Oral Balance products have enzymes and xylitol. Use for patients with dry mouths.

Tom’s of Maine Toothpaste, Natural, Clean & Gentle, has no Sodium Laurel Sulfate compounds which can cause dryness and irritation. Patients with frequent

recurrent cold sores should try a non laurel sulfate toothpaste.

 

PerioProtect:

Is a deliver system of various medicaments. Can break down biofilm and is bactericidal.

 

Xerostomia (dry mouth):

Fluoride

MI Paste for sensitivity, buffering and protection from acid erosion and S. mutans

Dr. John’s Kavity Kops lollipops for S. mutans population control.

Oral Balance

Salese Lozenges (Xylitol, bicarbonate. Xathan Gum, oils and zinc) for 1-2 hours of buffering.

Tooth Erosion:

Baking Soda or Baking Soda Toothpastes: Use if erosion is occurring or if vomiting (bulimia) or acid reflux (GERD) is suspected.

MI Paste