Questions from a Dentist

The following are questions from a dentist and Dr. Ellie’s responses in Red
I have been recommending Trident with Xylitol for my dry mouth patients for years. I also contains Sorbitol, and I know you do not like it. What is wrong with it?

–>Sorbitol nullifies the remineralizing effects of xylitol – so you don’t get cavity repair. On the second or third stick of gum – plaque strep mutans are able to process sorbitol and use it as an energy source to grow and multiply. Often patients who eat a lot of sorbitol have gingivitis, plaque and acid reflux. The correlation makes me feel that acid reflux symptoms in some cases may be from a kind of acid producing bacteria in the esophagus – but I can’t prove this. Symptoms often go away when patients switch to 100 percent xylitol products. Flavor cannot last as long in a pure xylitol gum. Flavors only attach to these artificial sweeteners – plus they are cheaper – which explains why companies use them.

Do you like Ice Cubes Gum. It has Xylitol and Mannitol.

–>Mannitol can give people bad gastric discomfort, gas and bloating at very low doses. Same thing with sorbitol. This kind of gastric discomfort is not found with xylitol. If anyone thinks they are sensitive – just advise a very small dose of xylitol directly after meals.

When you say “rinse” with the mouth washes, how long with each one, is it just a quick swish or what, need answer for each wash.

–>Closys is like a bath for the periodontal ligaments. 1-2 minutes is not excessive for someone who is battling gingivitis or perio problems. A healthy mouth may need less time. Anyone wanting to lighten teeth and reduce stains – use Closys 1-2 minutes for a little longer effect. Bad breath – go for the 1-2 minutes.

Listerine is “liquid floss” and you only need one vigorous swish – swished in and out between the teeth – as if the liquid were doing the flossing. 30 secs is enough – this is a rinse being used for cleaning and to quickly eliminate gingivitis – but we must not forget it is acidic in the mouth. (Listerine has a pH of 4.2)
ACT rinse is “moisutrizer” / “tooth lotion” /a soothing and healing rinse. AT LEAST 30 seconds – but longer for someone with an acidic mouth, someone under stress, with hormone imbalance, diabetic, or with a dry mouth, or fragile, eroded teeth. Anyone with cavities should aim for 1-2 minutes of ACT rinse since this will give more healing. This rinse will make teeth smoother, more comfortable, shiny and more acid- resistant.
At what depth do you consider inter proximal decay too deep to try to recalcify. Also how do I determine the same question about root decay, say at the margin of a crown? How long does it usually take?

–>As far as I know there are no documented studies that use xylitol, fluoride and antibacterial rinses. This complete system is quite incredible in my experience. We need to start documenting results.

I have little problem using this system to HALT the disease. Then check in 4-6 months. If the retake of the X rays show mineralization – and no progression – then try another 6 months. In geriatric patients, who did not have caries treated, if the caries process has halted – secondary dentin will form and block tubules – so I am not concerned. I think sensitivity is the method of deciding what to fill and when to wait. You need a willing patient of course.

Thanks for your nice answer to my earlier questions. I am always very anxious to learn anything that will help my patients. I hate doing anything to the natural tooth, it always starts a pattern of up keep and usually some type of decline. Margins do not stay perfect even if they start perfect. I want to produce healthy mouths, not repaired mouths.

Please keep teaching me!

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