- Diet
- Eliminate dietary sugar (e.g., sucrose, glucose, and fructose) intake between meals, both in terms of snacks and beverages.
- Purchase “sugar-free” snacks and candies (not “sugarless,” which often contain “less” sugar rather than no sugar!). These sugar-free snacks contain sweetening agents that do not cause dental caries, such as xylitol, sorbitol, saccharin, aspartame, or sucralose. There is evidence that the use of a xylitol-containing gum or candy four to five times a day for 5 minutes after meals and snacks can reduce caries-producing bacteria an that xylitol increases saliva production. Aspartame, on the other hand, tends to dry the mouth.
- Do not sip on carbonated beverages (e.g. a can of soda) between meals. The acidity of the beverage cannot be buffered without food and this prolonged fermentable carbohydrate and acidity in the mouth promotes dental decay. Should you drink, drink quickly (including juices). Try to consume juices that are fortified with calcium and fluoride and rinse with water afterwards.
- Avoid alcohol and caffeine since these beverages are acidic and can promote caries.
- Stop smoking since it can aggravate dryness of the mouth.
- Dental hygiene
- Practice scrupulous oral hygiene. Brush and floss regularly and use fluoride daily. Your teeth should be cleansed at least twice daily using a soft bristled electric toothbrush and mildly flavored (avoid strong minty flavor) low-abrasive toothpaste. Choose “dry mouth” toothpastes. They do not contain sodium lauryl sulfate, a chemical in most regular toothpastes which may contribute to the formation of canker sores. Avoid whitening, tartar control, or smokers toothpastes since these contain abrasives. For the first 30 seconds, use the dry brush and brush the lingual (inside) surface of your teeth, then moisten toothbrush and apply a dry mouth toothpaste (e.g. Biotene, Pronamel, CloSYS, Orajel, Sensodyne) and brush for 1.5 minutes.
- Floss between all adjoining teeth at least once daily to remove dental plaque. Carry a travel toothbrush and toothpaste with you to work and brush after meals and snacks. Do not brush immediately after consuming acidic beverages or food (lot of food and fruits, including salad dressings, are acidic). Instead rinse mouth with plain water or low fluoride containing rinse (e.g. ACT) and brush after half an hour.
- If you are at low-to-moderate risk of caries, you should use a 0.05% sodium fluoride mouth rinse (available over the counter, such as ACT or Colgate Fluorigard) for 1-2 min. daily, before sleep. Hold the sodium fluoride rinse in your mouth for at least one minute before expectorating.
- If you are at high risk of caries, your dentist or physician should prescribe 1.1% neutral sodium fluoride toothpaste (such as Prevident 5000 or SF 5000) to be used once daily in place of your regular toothpaste. Prescription fluoride toothpastes can be applied with a toothbrush and left in place for two to three minutes before expectorating. Do not swallow the prescription fluoride toothpaste. If dental caries develop in spite of daily use of topical fluoride, a soft acrylic carrier can be constructed for nighttime use of fluoride gels.
- Visit your General Dentist every 3 months for cleanings and any dental treatments
- Sonicare toothbrush 3 times a day
- Place the head of the toothbrush on each tooth for 10 seconds. Be sure to brush both the front and back of the tooth. Lift and go to the next tooth. Be sure not to put a lot pf pressure on the tooth or the gums as this may cause recession..
- Brush your tongue for 1 minute. Brush the tongue in strokes from back to front.
- Prescription Strength Fluoride Toothpaste (e.g. Prevident 5000)
- Brush with at least once a day (at night), spit but do not rinse after brushing OR brush with regular toothpaste and apply a dime/pea size amount on the finger/Q-tip and directly apply to your teeth.
- At other times of the day, consider mixing equal parts Tom’s Rapid Relief Sensitive (fluoride-free) toothpaste with your favorite over-the-counter fluoride-containing toothpaste. The Tom’s product contains 8% arginine bicarbonate/calcium carbonate, which helps neutralize the pH on the dental surface. This promotes deposition of calcium and phosphorus into open dentinal tubules, thereby decreased dental sensitivity and protecting the dental surface from erosion. Spit but do not rinse after brushing.
- Fluoride varnish every 3 months (can be done at your general dentist’s office)
- Directions after application:
- No drinking for 15 minutes
- No eating for one hour
- No brushing until bedtime or for at least 6 hours
- Directions after application:
- MI Paste Plus (Topical creme with calcium and phosphate)
- Use before bed, 30 minutes after prescription fluoride toothpaste
- Put a dime/pea size on finger or Q-tip
- Rub around teeth and all around inside of mouth/tongue
- Leave on and go to bed
- Line inside of night guard or bleaching tray for sleep if accessible
- BioSal, SalivaMax, Caphosol Rinse, NeutraSal or Baking Soda Rinse 3 times a day
- BioSal, SalivaMax, Caphosol and NeutraSal are each supersaturated calcium phosphate rinses that help relieve dry mouth and associated mucositis (inflammation of the oral lining). Use as directed on box. Bio-Sal is an excellent product that is not expensive. The Biosal can be purchased from Amazon (30 packets for $13.00).
- Baking soda rinse can be made by mixing 1 tsp of baking soda and pinch of salt in 8 oz of water. Rinse your mouth with it and then spit out.
- Denture Care
- Take your dentures and other dental appliance out before going to sleep and disinfect them overnight in a commercially-available denture cleanser (e.g. Polident) or water. Dishwashing liquid and water can also be used for cleaning along with gentle brushing with a soft-bristled toothbrush. Whichever method, rinse thoroughly in water before re-inserting in the morning. Avoid using toothpaste on dentures as it is abrasive to denture teeth.
- Night guards, however, can be inserted before bed. They can be cleaned with water and a toothbrush, but do not use a denture cleanser. They do not need to be stored in water when not in use.
- To remove concretions from the denture/appliance, place them in full strength white vinegar for at least 10 minutes, and brush gently to remove the mineralized material. Repeat as needed until the denture surface is clean and smooth.
- Wash your denture cup on the top rack of your dishwasher once a week.
Oral candidiasis
Oral candidiasis is an infection resulting from overgrowth of fungal micro-organisms normally present in the oral cavity. Candidiasis may result from a recent illness, course of antibiotics, chronic use of a steroid inhaler, other steroid use, smoking, denture use, and dry mouth. Dentures that have been relined with a soft temporary material are particularly susceptible to candida overgrowth. Symptoms of candidiasis include a painful mouth, sometimes with a burning sensation, and sensitivity to spicy or acidic foods. In addition, there may be redness and cracking of the corners of the lips and a white coating on the back of the tongue.
Treatment of oral candidiasis in the setting of dry mouth generally requires anti-fungal medication, taken as either a daily pill or as a topical treatment, in the form of a troche (which is allowed to dissolve in the mouth) or a solution (which is swished around in the mouth before swallowing). These are prescribed by your physician or dentist. Please note though, that nystatin suspensions contain sucrose.
During treatment for oral candidiasis, it is important to disinfect your toothbrush and dentures/dental appliances every night. Soak them overnight in either undiluted white vinegar rinsing them thoroughly with water before inserting them into the mouth, or a nystatin suspension 500,000 units/5 ml (available by prescription from your physician or dentist). If you get recurrent candida infections of the mouth, it may be necessary to disinfect your dentures in nystatin as a daily practice as a preventive measure.
