Every dentist/hygienist has had a patient that you know had braces not by how straight their teeth are, but by those little white, chalky demineralized spots on their teeth. I often wondered, why didn't the orthodontist do something about that in the first place? Then I look at the patient's plaque control without braces, and realize the ball is in my court now! That is why I have tried to implement a tooth remineralization protocol. Dr. Ellie Phillips is the daughter of one of my patients, and she wrote a book called Kiss You Dentist Goodbye. I read her book about a year ago, and it really inspired me to look deeper into remineralization of teeth. She gave some excellent points, and some not so good points, but all in all it is a very good read. She visited my office not too long ago when she was in town to see her mother. At the end of her book she spelled out a patient care plan that included rinsing with a fluoride mouthwash BEFORE you brush. She felt that acids throughout the day had weakened the outer tooth structure enough for the toothbrush to remove the outer surface when brushing. She also felt that using a fluoride containing mouthwash before brushing would sufficiently harden this weakened enamel enough to help prevent it from damage. I am personally not aware of how many seconds it would take to have a fluoride mouthwash harden a days worth of acid erosion on the outside of your teeth, but if you think about it, it makes sense to at least try and harden it before brushing your teeth. One of the points I did not like in her book was her view on flossing. In the book, I felt it came off like she didn't promote flossing at all, but after talking with her I understood it was more that she didn't want to discourage non-flossers from following her plan. Flossing is good if you do it correctly, and do not damage your gingiva (gums). Unfortunately, and I had to agree with her, most patients do not floss correctly in the first place. They just pop the floss through the contacts as fast as possible. They do not push the floss against one tooth and then pull it against the other to cut the accumulated plaque. Just pop, pop, pop, and your done! Next Dr. Ellie instructs to brush your teeth thoroughly. She promotes her own website's toothbrush, but as long as the bristles are soft, and the toothbrush head is not too large to reach all the surfaces of the teeth, then I don't think it really matters which brand you use. The toothpaste she wants you to use is the simplest formula possible with fluoride, like original Crest. After brushing she wants you to use TWO different mouthwashes. The first post-brushing mouthwash is the antiseptic Listerine. The second is a sodium fluoride mouthwash ACT. One kills germs but is acidic (melts your teeth), and the other strengthens your teeth. I have to admit, I'm not really crazy about this process. Many points are good and should be followed, but others, not so much. I actually like the part about a pre-rinse with fluoride mouthwash. I do want my patient to floss even though most do not do it correctly. If they get used to flossing, who is to say that with a little training from one of our office's excellent hygienists, they would not do it better? There are many advanced toothpastes on the market today that contain more than just fluoride that can be used for remineralization. The one I recommend and have been using myself is Sultan's Topex Renew toothpaste. It has a new formula containing NovaMin that has proven to remineralize tooth structure very well. Listerine? No way! I don't care if it received the ADA seal of Approval, I don't like it. Kills bacteria by the million, it does, but that is not important if you brush and floss. Beside, doing so will kill off your normal good bacteria and leave room for the bad guys to grow. There is nothing wrong with ACT mouthwash. All of these "Oral Hygiene Plans" made me want to come up with my own protocol:
Cape Dental Care Remineralization Protocol:
- Brush your teeth in the morning with Smart Mouth® fluoride toothpaste and rinse with Smart Mouth® mouth wash (for 12 hours of fresh breath).
- Eat a xylitol mint or chewing gum after each meal or shack (at least 5 exposures per day)
- Before going to bed:
- Take any prescription medications you normally take before bedtime with water
- Scrape your tongue with a tongue scraper if you have one.
- Rinse with PerioMed fluoride mouthwash (Rx strength from your dental office)
- Floss. Use a proxibrush and floss threaders if you have been instructed to so by your hygienist/doctor
- Brush with a soft toothbrush using Sultan's Topex Renew toothpaste (Rx strength from your dental office)
- Chew a xylitol mint or sprinkle some xylitol into your mouth
- Use a pea sized amount of MI Paste on your finger and then wipe it onto your tongue. Use your tongue to spread the paste over all your teeth
- Go to bed!