Beginning and Ending CWT

Hello, Dr. Ellie.

I’ve been on your Clean White Teeth program for a little over a month with good results. Now I have some questions about starting and stopping.

Background: My teeth themselves are in excellent condition, as I’ve been a diligent brusher all my life no cavities since age 8 (45 years ago!). Nevertheless, about ten years ago my dental hygienist noticed on taking probe readings that I had lots of pockets measuring 4s or 5s, and a few 7s or 8s on the left side, both top and bottom. I was referred to a periodontist who did a perfunctory cleaning and quickly recommended a surgery on the left side that cost $1,200. It stopped the progress of the disease but left me with permanent root exposure and pain to the touch.

When the periodontist recommended a second surgery I took leave of him and instead began to rinse am and pm with Listerine. My dentist suggested Sensodyne for the sensitivity, the use of an interdental brush, and four professional cleanings per year.

So at the time when I learned of your program, my home routine was as follows.

1. Brush with Sensodyne.
2. Hit spaces with the interdental brush (am) or floss (pm).
3. Rinse with Listerine.

This was effective in shrinking the remaining pockets to mostly 2s and 3s. But as I drink a mug of tea each morning with breakfast, I observed a rapid buildup of stains between visits. These didn’t concern my dentist, for they don’t cause decay and are easy to clean each time, but they’re unattractive.

Almost immediately on starting the CWT program I noticed a decisive drop in sensitivity even though I had set Sensodyne aside I’m now able to push the interdental brush into those spaces without going through the roof, indeed I hardly feel it at all and as time goes by the staining isn’t building up as it did before. Haven’t yet had a regular checkup, though, and am looking forward to the reaction.

Questions:
1. Should I continue with the interdental brushes? Searches of the “Ask Dr. Ellie” blog turn up no comments of yours on that point. The theory as explained to me is that the little brushes disturb bacteria so they can’t colonize and multiply in the pockets. To zap them with Listerine while still dispersed seemed sensible to me.

2. If xylitol in part aids deeper remineralization of enamel, might it be a good idea for a newcomer to the CWT program to start with xylitol for a few months, and add ACT only once this deeper restoration has taken place? That is, can having ACT on the surface actually impede the more foundational work of saliva + xylitol? Should ACT be a finishing layer rather than a concurrent treatment? Or is the Listerine + ACT combo required in addition to xylitol to achieve a drastic reduction in bacteria early on?

3. Is your program meant to be used indefinitely, or only for, say, six months until restoration has taken place? Should it be viewed as an emergency measure? I ask because none of the products is inexpensive. Is there a lower maintenance dose of xylitol, for example, that would sustain a bacteria-free environment once established? Need one go on using Listerine and ACT both am and pm, or might pm be enough?

-R

Dear R,

I am sorry that you caught me during a busy time and that it has taken me so long to reply.
Thank you for your message. I want to answer your excellent questions:

1. Should I continue with interdental brushes?
If your mouth chemistry is balanced by eating sufficient xylitol and if the xylitol has eliminated sticky bacteria of plaque, then interdental brushes becomes less important. I often suggest my program to people who cannot or do not want to floss or use these brushes. These people appear to achieve great results just by using my rinsing program. On the other hand, flossing and brushing should not cause problems unless you think this action may stop the gums growing back into the spaces between the teeth. I cannot comment on this idea since I do not know of any clinical trials to show if gums will regrow if you cease flossing and brushing.

2. If xylitol aids deeper remineralization of enamel, might it be a good idea for a newcomer to the CWT program to start with xylitol for a few months, and add ACT only once this deeper restoration has taken place?

As far as I understand the chemistry of teeth there would be no barrier created by the use of ACT. ACT simply makes the outer crystals grow larger and more perfect in shape. Remineralization to the deeper layers is about transfer of minerals through this “honeycomb” of crystals. These crystals are surrounded by a liquid even the largest and most perfect ones. The idea of teeth being fabricated from crystals is foreign to most people many of whom appear to view teeth as a row of pebbles in their mouth!

3. Is your program meant to be used indefinitely, or only for, say, six months until restoration has taken place?
I have used this program for many years and am delighted to have avoided dental treatments.

4. Should it be viewed as an emergency measure?
For anyone who has cavities, or who fears gum surgery, or who has bleeding gums, stained teeth or sensitivity I would start this program today!

5. The products are expensive:
Even a small amount of Closys will help lift debris from teeth but you can economize of the amount of Closys used each time. Toothpaste and Listerine can be purchased quite inexpensively and in volume. If ACT seems expensive the amount you need is not as much as the manufacturers would like you to use! Cut the “dose” in half but double the time you keep it in your mouth for maximum benefit.

6. Is there a lower maintenance dose of xylitol that would sustain a bacteria-free environment once established?
Zellies are convenient and the best tasting way to eat xylitol. You could get two teaspoons of granular xylitol and dissolve this in water for a less expensive way to keep taking 6.5 grams daily . You could sip this xylitol liquid each day. You could also mix and match these ideas. Finally you could ask family and friends to buy you Zellies for your next birthday!

7. Need one go on using Listerine and ACT both am and pm, or might pm be enough?

The answer to this question depends on your own “risk factors”: your personal chance of dental disease starting again. If you have acidic saliva, a dry mouth, or if there are people around you with gum disease that could infect you etc. etc. For protection you would continue. If you had no risk of getting any dental disease I guess you could worry less and reduce the number of times a day.

If I were you, I would pay close attention for bleeding gums. This is a first sign of gum disease.
If you ever see your gums bleeding when you brush you must react quickly. If you control the first stage of bleeding gums you will prevent the pocketing stage from happening.

I view Closys as a way to clean up existing gum problems. I view Listerine as preventing future problems.

Research shows that Listerine can control the plaque bacteria for twelve hours even the company suggests using Listerine every twelve hours. Maybe the xylitol will take care of you …….. but I like guarantees! Of course you can try it out and see what happens but even if it works for a while, remember that your risk factors can change. We all get more prone to gum disease as we age, live under stress etc.

Final word: please make sure to clean your toothbrush every day in a little Listerine wash off and dry before storage. Never keep your toothbrush in a bag or use any kind of toothbrush case or cover. Your brush needs to air dry before you use it again.

I hope these replies are not too late!
Wishing you a very Happy New Year,

Ellie



Categories: Remineralization, Sensitivity, Xylitol

Tags: , , , , , ,

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