Medically Manage Your Mouth-Optimal Home Oral Care

First and foremost, don’t ignore any blood in the sink! Blood means that inflammation is present, infection causes inflammation, blood means there is an avenue for bacteria to enter your bloodstream.

These oral bacteria significantly contribute to diseases like heart attacks, Alzheimer’s Disease, Pre-term labor and stillbirths, autoimmune diseases and some cancers!

Your Mouth is Like a Fish Tank

Chris Kammer, DDS, past president of the American Academy for Oral Systemic Health (AAOSH) compares our mouth to a fish tank.

“Think of the saliva as water in a fish tank. Think of your teeth as stones in the fish tank. You could polish (and floss) the stones until they were perfectly clean, but if the water in the tank were dirty, the stones would immediately get dirty again.”

Dr. Kammer’s point is that cleanings by your hygienist are important, and flossing is good, but more important is to create an environment of clean saliva by promoting the growth of healthy, good bacteria, and eliminating the bad bacteria.

Healthy bacteria are less adherent to your teeth, making them easier to brush away.

Healthy saliva will allow gum inflammation to heal, and will help close off the connection between your mouth and the rest of your body. It will also strengthen and protect the enamel on your teeth. The return on your effort will be very tangible:

• Reduced tooth plaque and promote easier professional cleanings
• Reduce your risk of tooth decay and other diseases of your teeth and gums.
• Fewer unplanned trips to the dentist to treat breakdown and disease!
• Most importantly, you may significantly reduce your risk of several systemic diseases influenced by periodontal infections.

Optimal Home Oral Hygiene

The number of over the counter (OTC) oral health products is head spinning. I have been on a mission to find the best combination of products to promote a healthy oral environment.

Early in my collaboration with dental professionals I simply suggested using Listerine (alcohol free) in addition to flossing and brushing with a sonic toothbrush.  I’ve watched countless blood measures of cardiovascular inflammation in my patients plummet. LpPlac2 is that blood test, and is approved by the FDA to assess a person’s risk for heart attacks and strokes.  Periodontal infection is one of the few conditions that causes it to rise.

Some patients have not improved as briskly as others, and saliva testing has shown an incomplete improvement in high risk bacteria. That is likely because of suboptimal home oral care.

I have been fortunate to have met and interviewed many of the leaders in mouth-body care. Taking their advice, and adding my medical insight, I recommend the following system.

The System 

There are 2 components to my optimal home oral hygiene regimen. The first is “killing the enemy” of high-risk mouth bacteria that cause gum infections. The other component is to replace the dead bacteria with healthy good bacteria.

Flossing is good, but if you have crystal clear fish tank water, keeping the spaces between your teeth and gums clear of infection and debris with flossing will be less time consuming. Your dentist or hygienist will tell you whether your efforts are adequate. Individual needs will vary.

My methods are not a substitute for regular (at least twice a year) prophylaxis and oral exam with your dental professionals.

1. Kill the Enemy- Brushing, Flossing, and Mouth Rinses

There is scientific basis for this simple regimen, so please follow the specific order, and not rinse your mouth with water between the steps. It only takes about 5 minutes and ideally should be done twice daily. You could literally prevent Periodontal disease and significant systemic disease with a daily 10 min. investment!

1. Scrape with a tongue scraper for 10-15 seconds.
2. Rinse with CloSYS or ProFresh (chlorine dioxide mouth rinse) for 60 seconds.
3. Floss or use an interdental pick. This breaks up the film that high risk bacteria hide behind.
4. Brush with a preferred (non- abrasive or non -whitening toothpaste) for 2 minutes (see below).
5. Rinse vigorously with alcohol free Listerine for 30-60 seconds.
6. Rinse with Act 0.05% Anti-cavity neutral sodium fluoride rinse for 60 seconds.

Notes:

• Tongue scraping is very important. Teeth comprise only 22% of the surface area of our mouth. Reach as far back as you can because over 80% of all bad breath originates from anaerobic bacteria on the back of the tongue that emit volatile sulfur compounds! If you have difficulty with gagging, I suggest you try thisgagging desensitization protocol.
• Gargle when you use CloSYS or ProFresh, and Listerine since they are killing bacteria. Again, many bacteria thrive on the back of your tongue.
• Don’t eat or drink for 30 min. after this system is completed. It is ideal at bedtime.
• Soak your tongue scraper and toothbrush in Listerine for 30 seconds after brushing to disinfect them.

Are mouth rinses potentially dangerous?  

There have been concerns raised by some that the alcohol from Listerine is drying and can potentially increase your risk of oral cancer. That is why I recommend the alcohol-free variety.

Another concern has been raised that we need the bacteria to make nitric oxide, an important chemical for arterial health. Some physicians have expressed a concern that if we use mouth rinses to kill oral bacterial, it could raise our blood pressure and impact risk for cardiovascular disease. Unfortunately, these physicians are not recognizing that there is strong evidence that several high-risk oral bacteria are actually causes of heart attacks and even Alzheimer’s disease.

Therefore, my very strong recommendation is to develop a strategy to both kill the bad bacteria and replace them with good bacteria by creating a healthy oral environment and consider using oral probiotics to repopulate the mouth with healthy bacteria.

If you are concerned about using the chemicals in mouth rinses, another very effective and natural method of disinfecting your mouth from the bad bacteria is a system called PerioProtect that can be offered by your dentist. The system can also whiten your teeth without using harsh chemicals!

Choosing a Brush:  Studies suggest that sonic brushes as made by Phillips and Oral B are best because they extend their reach beyond the tip of the bristles and loosen the plaque biofilm more completely.  If you use a traditional manual brush, make sure the bristles are soft and the head of the brush isn’t too big, so that you can reach all surfaces.

Most important is to brush where your teeth meet the gums.  Rinse your brush in Listerine for 30 seconds when done, and store the brush upright in a cup, so the bristles can dry

Why Use CloSYS or ProFresh?  The chlorine dioxide ingredient in both products offers 2 benefits.  It complements Listerine by more effectively killing the oxygen hating anaerobic bacteria.  Focus on bathing your back teeth and tongue. This is where anaerobic bacteria live, and deeper pockets usually form around your back teeth first.

Why Use Listerine and a Fluoride Rinse “Chaser”?  This antiseptic mouth rinse complements the chlorine dioxide rinse in killing bacteria.  Any of the alcohol-free colors/flavors that say “antiseptic” are preferable.  Follow it immediately with the neutral sodium fluoride rinse (example ACT) because Listerine is acidic and dries your mouth.  Acidity and dry mouth are the main causes of tooth decay, especially in older adults.

Act Anti-Cavity 0.05% Fluoride Rinse:  This non-prescription (neutral sodium fluoride) rinse will moisten your mouth, neutralizes the pH acidity, strengthen your enamel.  It is especially helpful at bedtime when the solution coats your teeth while.

sleeping.  Do not swallow the fluoride.

A fluoride rinse is particularly helpful for children, but only once they are old enough to spit it out.

2. Create a healthy oral environment for the growth of good bacteria

Once you’ve killed the enemy of high-risk disease-causing oral bacteria with mouth rinses, PerioProtect, or periodontal treatments with your dental team, you’ve left a void that must be filled. If you don’t fill it with healthy bacteria the bad bacteria will come right back!

Creating a healthy oral environment:  

• Rinse your mouth with water after eating. Many foods are acidic and fuel the growth of high-risk bacteria.
• Many medications cause dry mouth. A dry mouth also promotes the growth of disease-causing bacteria.
• Avoid tobacco, nicotine and other toxic substances.
• Use oral probiotics.

Xylitol:

The regular use of 100% xylitol is a very effective way to prevent gum disease and tooth decay.

Xylitol is a non-sugar sweetener. It’s very low glycemic index of 7 makes it the ideal sweetener for diabetics. Humans don’t actually use insulin to metabolize it!

Originally extracted from birch bark, xylitol now mainly comes from corn cobs. American Indians chewed on sticks made from birch bark, which is likely why their dentition was surprisingly good. Military dentists provide xylitol to troops in the field who often aren’t able to brush regularly.

Xylitol works by killing the bad bacteria. The disease causing bacteria are able to ingest xylitol, but they are not able to use it for food. Therefore, they starve themselves to death! Xylitol promotes the growth of good bacteria, which are not as adherent to teeth, so are more easily brushed and flossed off.

You can find 100% xylitol at many health food stores and online, including on our Fullscript site that many of you use.

 
Important pearls about xylitol: 

• The bacteria mix produced by consuming xylitol is less adherent to teeth, so it brushes off more easily.
• Xylitol can whiten teeth. A film of bacteria can accentuate staining substances like coffee and red wine. Stains brush away when the more sticky bad bacteria are eliminated.
• Studies show that 6-10 g must be consumed daily to receive the beneficial effects. More is not likely dangerous, just not shown to be more effective.
• Xylitol must be consumed frequently over the course of a day, preferably 5-6 times per day. Gum, breath mints, and a granular form for drinks make this easy.
• Xylitol effectively neutralizes an acidic meal or drink, so consuming it after meals and snacks is perfect.
• Purchasing100% xylitol without significant other ingredients is important. Other ingredients can reduce its effect.
• Keep xylitol away from your dog. It can be deadly!

There is very little downside to xylitol consumption. Some people get some mild gastrointestinal symptoms like gas. Most find this gas resolves with continued use.

Probiotics: Probiotics are good bacteria packaged in a pill. Probiotics are increasingly being used to improve the health of our lower intestine. Similarly, using them to populate our oral cavity can both suppress the growth of bad bacteria and promote the production of nitric oxide the important chemical for cardiovascular health previously discussed.

Talk to your dental professionals about the best option for you. I’ve included an option on our Fullscript site.