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.
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
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.
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
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!
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?