Caries Prevention

It's a pH problem...

Reviewed By: Rebecca Comstedt, RDH, BS

Date: September 19, 2019

 

Our enamel lose calcium and phosphate when the pH is 5.5 or less; cementum is closer to a pH of 6. There is some variation among individuals.

“Dental Caries; a pH Mediated Disease” CDHA Journal, Winter 2010

Demineralization and remineralization

There are always new products being introduced, here are some of the newer products and active ingredients to look for.

Phocal™ fluoride disks are designed to treat interproximal incipient decay

Silver Diamine Fluoride is a great way to arrest decay at any stage.

Novamin® raises pH and has anti-inflammatory properties (NOTE: Generally not available in the US)

Recaldent™ (CCP-ACP)increases fluoride uptake (Ex. MI Paste®)

SensiStat reduces sensitivity (Ex. Preclude and Denclude, no longer available)

Amorphous Calcium Phosphate (ACP) improves enamel smoothness

Rennou™ organic extract from cocoa beans (Ex. Theodent™ toothpaste)

In 2017, MI Paste® released MI Paste ONE, a one step toothpaste that doesn’t require a separate toothpaste first.

 

Anti-Fluoride patient? MI Paste® has a fluoride free option. Theodent™ is a new toothpaste that contains rennou™ (an ingredient from the cocoa bean), and is fluoride free. There are numerous products (rinses and toothpastes) available to neutralize pH without fluoride. Recommending Xylitol or Erythritol products may help reduce biofilm and raise pH.

Just like treating Periodontal Disease, we cannot treat all patients the same when it comes to preventing decay.

There are a variety of reasons a patient’s pH will be low. Did you know that within biofilm communities, the pH can vary? Etiology of root caries is often different than interproximal decay.

Three big reasons we see decay are: the bacteria present, an oral environment that remains acidic for too long, or loss of our natural protective factors (saliva). Read the article linked above (“Dental Caries; a pH mediated disease”) for more treatment options depending on the diagnosis.

Challacombe Scale of Clinical Oral Dryness

Read more here // Assigns a number of 1 (mild dryness) to 10 (severe) with some therapeutic considerations and recommendations

1 // Mirror sticks to buccal mucosa

2 // Mirror sticks to tongue

3 // Frothy saliva

4 // No saliva pooling on the floor of mouth

5 // Tongue shows generalized shortened papillae

6 // Altered gingival architecture

7 // Glassy appearance of oral mucosa

8 // Fissured tongue

9 // Cervical caries (more than two teeth)

10 // Debris on palate or sticking to teeth

PATHOGENS

Strep mutans are the “cavity causing bacteria.”

Candida albicans (yeast) is implicated in rampant childhood caries

There are salivary tests to determine your load of S mutans and C albicans.

Salivary Testing

CariScreen // evaluates biofilm activity in a 1 min, chair side test

Ivoclar CRT Bacteria // measures SM and LB, 48 hour test

Ivoclar CRT Buffer // evaluates salivary buffering in 5 minutes

Saliva Check Buffer // evaluates quality, buffering and pH of saliva

Saliva-Check SM // measures SM

OraVital® Salivary Test // tests for SM and Candida albicans

ACIDIC PRODUCTS

  • Listerine (and other alcohol rinses)
  • Sparkling water
  • Cough drops
  • Soda
  • Alcohol
  • Artificial sweeteners
  • Syrup medications
  • Bread and crackers
  • Sugar (“-ose”)

BASIC PRODUCTS

  • Basic Bites® Soft Chews
  • Hard Cheese (raises oral pH)
  • Arginine rich foods (quickly raise oral pH)
  • Tom’s Rapid Relief has Arginine
  • Xylitol (should be one of the first three ingredients)
  • Ice Chips® (xylitol mints)
  • Saliva Max
  • Elevate’s Allday Dry Mouth Spray
  • Nutrasal

pH strips are an easy and affordable way to assess the current pH of your patient’s mouth. Perhaps implement pH testing during the assessment phase of the prophy appointment.

ph20h created an App to educate patients about their oral pH!

Important Vitamins to help heal your teeth

Vit D // have levels checked, if below 40 ncg/ml, supplement

K 2 // 200 mcg per day of Mk4 and MK7

Vit A // or try Fermented Cod Liver Oil

Magnesium Citrate // 300 mg per day (generally taken at night)

LOSS OF PROTECTIVE FACTORS

  • Dry Mouth
    • Consider testing the quality/quantity of saliva
    • Many medications reduce salivary flow (Anti-depressants, ADHD, allergies meds, to name a few)
  • Poor Home Care
    • PlaueHD™ (disclosing toothpaste)
    • Xylitol gum/mints/spray,
    • Oral probiotics (ProBiora™, Plaque HD™)
    • More frequent recare
    • May need D4346 cleaning code (depending on health of gums)

NEED MORE INFORMATION?

Subscribe to Carrie Ibbotson’s YouTube channel and her website (www.oralhealthcoaching.com)

For more information on reducing cavities in kids, read “More Chocolate, No cavities. How Diet Can Keep Your Kid Cavity-Free“, by Dr Roger W. Lucas, DDS.

Plan a Lunch and Learn from a Representative of any of the products you want to learn more about.

Current Research and Controversies

Bacteria colonization and strains of bacteria… Can we permanently change our oral microbiome?