Xylitol For Caries Prevention

February 20, 2012

Bacteria that are responsible for tooth decay need sugar to survive.  They use sugar in many forms as their energy source and reproduce rapidly.  Most sugars such as sucrose, lactose, and fructose feed bacteria and help them to reproduce.  In metabolizing these sugars, bacteria release harmful acids that can damage tooth structure. These acids can be produced for up to 30 minutes following each sugar exposure from food or beverages. Take a moment to think about how many times throughout the day something containing one of these sugars passes by your lips.

Fortunately, there is alternative sweetener that will not contribute to process of caries formation and can help reverse demineralization with regular use. Xylitol is an organic sugar alcohol derived mainly from birch wood trees, although it can be derived from other plant sources as well.  Xylitol will inhibit bacterial growth and will keep pH from dropping to acidic levels when used in place of other sugars and sweeteners. Furthermore, the use of gums and mints may stimulate salivary flow which buffers acid and naturally  remineralizes our teeth.

Many commercial products will combine different types of sugar alcohols for different reasons, however, only products sweetened primarily with xylitol have been shown to have the greatest anticariogenic effect.  Look for xylitol first in the list of ingredients in chewing gums and mints.  The optimal usage of a xylitol containing product for dental health is 5 times per day.  This can be in the form of toothpastes, mouth rinses, and breath sprays, or in chewing gums and mints.  Ideally, the use of xylitol products should be spread out over the course of a day, and when possible, should be used instead of any conventionally sweetened products, and not at the same time as other sweeteners. Xylitol gums and mints are particularly helpful to use throughout the day for those that suffer from dry mouth, or after meals and snacks when brushing and flossing can’t be done right away.

You can find a wide range of both food and dental products containing xylitol at just about any health food store and many general grocery and drug stores.  At Loving Family Dental we offer Spry mints which are a best seller in three delicious flavors: peppermint, lemon, and berry.  We encourage you to try these and other xylitol products which will promote your dental health.

Patients are always asking what toothpaste they should be using. With so many products available over the counter, and now a huge organic and natural health industry boasting miraculous benefits and convincing testimonials it is hard to know what’s best for you. And indeed, what’s best for YOU is the key.  I have no one recommendation for everyone, because each of you may have a different set of needs to address.  I’ll go over all of that, but first lets talk about getting clean…

Bacterial plaque is forming on our teeth every minute of every hour of every day. The good news is that if you catch the plaque early on before it hardens into tartar, it can be easily be removed by mechanical means alone. That means just the act of brushing, rubbing, and wiping with your brush and floss, toothpicks, or other dental hygiene aids you may have on hand is all that is needed to remove plaque and disrupt bacterial colonies.  The act of disrupting the bacterial colonies and interfering with their adherence to your teeth and gums is what getting clean is all about. So you see, you don’t actually need any toothpaste to clean your teeth.

What you do need toothpaste for are for the ingredients contained therein which may have some therapeutic value. There are only two key ingredients that I really concern myself with when it comes to recommending a toothpaste to my patients.  They are fluoride for cavity prevention, and potassium nitrate for treatment of dentinal hypersensitivity.

Fluoride is the single most effective agent in preventing tooth decay. It replaces hydroxyapatite crystals in the enamel that have been damaged by acids and forms a newer, stronger fluorapatite crystal. Enamel that is made up substantially of these fluorapatite crystals is the strongest naturally occurring tooth structure and is the most resistant to decay.

Potassium Nitrate is the active ingredient found in toothpaste preparations that are indicated for sensitive teeth.  Just underneath the enamel, we all have a layer of tooth structure called dentin which can be highly sensitive . It is made up of a series of tubules where at its innermost core lies a nerve.  Fluid moves back and forth in these tubules in response to stimuli and cause the nerve to depolarize, thereby sending your brain a message of pain.  Sometimes there are areas of our teeth that are devoid of sufficient enamel or cementum to cover and insulate this dentin layer and we are left with sensitive areas of our teeth.  This type of sensitivity most often presents as cold,sweet,or tactile sensitivity with no lingering pain after the stimulus is gone. The potassium nitrate builds up in these tubules over time with repeated use and sedates the nerve by inhibiting nerve depolarization . You should confirm with your dentist that there are no other reasons for your sensitivity that may require treatment.

All other ingredients you may find in toothpaste have only marginal benefits, and sometimes can cause adverse effects. Whitening toothpastes can be effective in cleaning surface stains but they will not whiten the overall shade of your teeth. The added abrasivity in whitening toothpaste may exacerbate sensitive teeth. Tartar control toothpastes demonstrate only sub clinical benefits and may cause soft tissue irritation. Ingredients like baking soda and salt may help to raise the pH in you mouth and buffer acids but their effects are very brief. Hydrogen peroxide and triclosan are antibacterial ingredients but they have little residual action after rinsing. Many natural and organic preparations contain herbal extracts and essential oils which may be soothing, helpful in reducing bacteria, and pleasant tasting but have not been tested or approved by the FDA. I read through a disclaimer recently on a website for a line of natural dental products that I feel is worth quoting one sentence in particular. It reads “We have no competent or reliable scientific evidence to suggest that the testimonialist’s experience is due to the use of our products.” That’s a pretty powerful statement in my opinion; I can see why its only stated in very fine print.

So, here is my final answer.  Use what you like.  Simple as that.  My only request is that you use a toothpaste that contains fluoride to help with cavity prevention.  If your teeth are sensitive, please try a sensitivity toothpaste with potassium nitrate in it because it usually works. When you find something that you like, whether it is because you like the texture and flavor of it, or because you feel assured knowing that it is organic and all-natural, or if for any other reason you just believe in the health benefits of a particular product, you will probably spend more time brushing and will do it more consistently. Discuss any concerns you may have with your dentist or hygienist and they will help you find a product that best suits your needs. Otherwise, enjoy trying different products, and know that the best product is the one that is used every single day.

From Your Hygienist

January 16, 2012

As your dental hygienist, I care about your dental health and want to contribute to your experience as a patient of Loving Family Dental, and to your overall dental health awareness.  Stay tuned and keep informed by our new segment of dental hygiene posts on lovingfamilydental.wordpress.com. I will be covering various topics pertaining to dental and oral health such as dental caries and dietary considerations, oral hygiene consumer products, the latest on periodontal disease diagnosis and treatment, and any other topics you may be interested in.  Please feel free to comment and ask questions that can be addressed at my next post. In the meantime, brush and floss everyday and think about what your dental health means to you.