Is Flossing the Best Way to Prevent Dental Disease?

Overview

The dentist’s mantra is to “brush and floss” but is flossing useful or could other protocols keep teeth cleaner and healthier? Flossing has devotees who trust it is the only way to oral health, but where did their emphatic belief originate, and what if they are wrong? We have no science to support flossing (even multiple times a day) as a method of preventing caries. Maybe we will look back in 50 years and laugh at the concept of cleaning teeth with a length of string. Dr. Ellie thinks it is time to lay the flossing parrot to rest, empower patients with new ideas, and help more people enjoy disease-free dental visits!

Ultimate Oral Health

Patients believe dentists know how to prevent cavities, yet many compliant patients end up with cavities and gum disease. Presumably dentists follow their own advice, but it’s no secret that plenty of dental professionals experience recession, caries, root canals and periodontal problems, and need fillings, extractions, bridges or implants. Some argue that people don’t follow directions, but this cannot excuse the damage dentists and hygienists experience.

Perhaps you believe fillings age, enamel thins, and teeth darken naturally, but what if the problem is our method of tooth care? What if brushing and flossing are inadequate to protect teeth against the ravages of life? Cochrane Database shows weak, unreliable evidence that flossing and brushing can reduce plaque at 1-3 months, and no studies indicate effectiveness of flossing and brushing to prevent caries.

Facts

seniors missing teeth

The Surgeon General’s Report in 2001 shows an epidemic of decay in 2 year olds, 70% of teenagers have fillings, and one in two 30 year olds has compromised periodontal health. By age 65 , 178 million Americans are missing teeth and over 35 million Americans are edentulous. The number of partially edentulous is expected to rise to 200 million over the next 15 years.

Patients enjoy dental visits when they feel empowered, but become fearful if they constantly need treatment or loose teeth for reasons they don’t understand. Perhaps it’s time to question the advice we offer patients and ask why, if caries and periodontal disease are preventable, don’t our strategies lead more people to ultimate oral health?

Fixing Damage

Imagine a handyman repairs a floor in your home. Every few years you call him to fix the work he has previously done. With each repair the project becomes more complicated, until eventually he tells you the entire floor must now be replaced. You are grateful for the excellent repairs and pay a substantial charge. Imagine when you discover the water faucet that is responsible for the damage, was never shut off.

It is unfortunate for elderly patients to recount their lifetime of dentistry, describing fillings, crowns, bridges, dentures, and full mouth implants they dutifully accepted. These patients visited regularly, paid their dues, yet their teeth deteriorated year after year. They were told they had aging fillings, thinning enamel, bite problems, and recession – conditions beyond help. But is this the truth? Obviously fillings and cleanings do not stop disease, but is there a way to control deterioration? The American Academy of Pediatric Dentistry recognizes the preventive benefits of xylitol, yet most dentists are not familiar with the protocol for effective xylitol use.

An ounce of prevention

“A stitch in time saves nine” and obviously prevention is more effective before damage. As permanent molars erupt, the strain of bacteria that colonizes the fissures will dominate the mouth, which explains the importance of a healthy mouth ecology at the time of molar eruption. If a baby’s mouth is colonized with 1798398 (1)healthy bacteria, the child will have less caries, and ideal prevention should begin before a baby is born.

Evidence Based Reviews show xylitol significantly reduces Streptococcus mutans, over 6 months. In a Scandinavian study, mothers with high titers of Strep mutans chewed xylitol gum during pregnancy, and for two years after giving birth. Xylitol reduced cariogenic bacteria transferred to the babies and the outcome was 70% less caries for these children. Other studies show wiping xylitol onto erupting teeth gives additional and extended protection. In 2002 Peter Milgrom, University of Washington, showed that with adequate dosage (6-10 grams) and frequency (5 exposures a day) 98% of Strep mutans can be eliminated with xylitol.

A search of randomized controlled trials, meta- analyses, clinical trials and systematic reviews, suggests interventions should occur in the first years of a child’s life. The strategy of adjusting mouth flora can be applied to older children and adults with equal success. Xylitol can reduce plaque on teeth, mucous membranes, tongue, and saliva and reduce calculus, limit caries, and make plaque slippery so it is easier for patients to clean their teeth.

Flossing

Hygienists admit that only 5% of us can floss properly, and studies show even the most skilled only remove 45% of plaque with brushing and flossing. Xylitol provides an easy solution to help patients become more effective with oral care, and prevent bacterial transmission from person to person: something particularly useful for families with a history of poor teeth.

The great news is that xylitol is delicious and there are many ways for children and adults to enjoy it. Xylitol fits most life-styles and can work for every pocket book. Xylitol crystals can be eaten off a spoon, added to water as an after- or between-meal drink, wiped on teeth, or used to protect the elderly, special needs children, or those on a budget. Xylitol mints, gum and candies come in various flavors, textures and price ranges, and because they work, this approach is exciting for families. Patient need products sweetened with 100% xylitol and not mixed with cheaper artificial sweeteners (like sorbitol), since this can limit remineralization.

The Game Changer

Patients have a right to be confused and wonder if dental disease is a mystery, a phenomenon, or bad luck. Oral health’s impact on general health makes it unacceptable to allow disease to fester, hidden by cosmetic restorations, or at a sub-clinical level, controlled by hygiene appointments.

Don’t blame fillings, worn enamel, weak teeth, or patients themselves, because most dental damage is caused by acidity. Acidity can be from drinks, from the breakdown of sugars (that become acids) or from acidic saliva in the mouths of the elderly, during hormonal imbalance, from stress or depression. A dry mouth exacerbates problems, but xylitol can balance mouth acidity and help patients avoid cariogenic, erosive, and other problems. Xylitol can eliminate the reason for tooth damage, prevent progressive destruction, and stop the never-ending sequence of repairs that get larger and more complicated each time. Let’s “turn off the faucet” before restorative, orthodontic, or cosmetic procedures, and allow oral health to be sustained – not deteriorate – year after year.

Important Home Care

Most patients are delighted at the idea of trying to reverse their problems before dentists start drilling, filling or scaling teeth.

If you subscribe to the belief that teeth age, cavities happen, and periodontal disease is for life, what is there to lose? Many dentists do not believe dental disease is preventable, and some cannot imagine repair by remineralization. Cavities take at least a year to form, and such cavities can remineralize (with correct protocols) in 4-6 months. A successful home care regimen can ignite a positive interest in oral care and will empower people to feel more successful.

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BBC World Service

For more on the flossing debate, listen to Dr. Ellie on a recent BBC World Health radio interview: https://ultimateoralhealthguide.com/2013/02/21/to-floss-or-not-to-floss-dr-ellies-interview-with-the-bbc/

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For more information on oral health and xylitol, please visit all of Dr. Ellie’s web-sites:


Zellies.com – learn more & order your Zellies Xylitol & the Complete Mouth Care System
Dr. Ellie.com – a great resource for learning more about oral health & Dr. Ellie
Dr. E Oral Health Coaching – articles, resources and videos to help you learn more

Join the conversation online on the Zellies Facebook page!



Categories: Acidity, Cavities, Prevention, Remineralization, Xylitol

Tags: , , , , , , , , , , ,

51 replies

  1. I had read in some of your earlier writing that flossing might not be helpful, so I stopped some time back. The gums under my lower front teeth, which are very close, had always felt sore no matter what I tried, or how carefully I brushed or flossed. Things are much more comfortable now. 🙂

  2. What do you think about oil pulling? I have been reading this is good for oral health.

    • I have explored oil pulling and believe it is beneficial and may be a way to self-heal diseased gums. I believe coconut oil may be the best oil to use, and you have to keep it in your mouth for at least 15 minutes every day. It appears that gum problems will be improved over 12-16 weeks- but this will only work if you can dedicate adequate time to doing this each day. The problem is that it is not very pleasant to do, and it is difficult to decide what to do with your expectorate after “pulling”. The oily residue can clog your drains, kill grass, and is pretty disgusting. I also worry that oil puling may be too aggressive for some mouths – especially women. When I tried it, it made my teeth sensitive in a matter of days – so I stopped.

      I think that Closys, the first rinse that I recommend in the Zellies Complete Mouth Care System, must work in a similar way to this. Closys appears to be able to combat gum disease in a unique way. The difference is that Closys appears to do what oil pulling does – but in one minute – twice a day, and you can spit it down the drain! When patients with periodontal disease use my system of care, we can usually see healing and resolution within 2 months – yes, complete resolution.

      There are a couple of other important things to mention for curing gum problems: 1) Diet and digestive health are vital to the regimen. If your gut is unhealthy, then you will not be absorbing needed minerals and antioxidants. This means your gums will not be getting the nutrients they need to heal. 2) Check your toothbrush is clean, stored away from any toilet, and use a clean brush to massage gums around teeth when you brush – to stimulate healthy circulation.

      • I bought and devoured your book, and then went looking for the elements of your system. It has proved more difficult than anticipated. I’ve stocked up on Xyla candies, and am consuming them religiously after I eat anything and before going to bed.

        I tried to get hold of Closys… the maker and all their suggested online resellers, Walgreens, several Pharmacy sites, refuse to ship it outside the USofA… so not to Canada. Must be dangerous material 🙂

        Amazon.com says it cannot ship to my address in Ottawa, Canada.
        Amazon.ca has a re-seller called USASuperstore that will sell a 32-ounce bottle of Closys Rinse for $73 (yes, one U$13 bottle for seventy-three bucks Canadian). Seriously?

        The two Canadian sources that are mentioned in the Dr. Ellie site do not carry it except a sample size kit 4-oz size from mywellcare.ca with Closys toothpaste, and spray, etc., and none found at all on the other site wellmart.ca. The Dr. Ellie site also suggested looking for Retardex (the Brit version?) instead. None found at any site.
        I tried the suggested British sites, like Boots, and THEY don’t have Retardex anymore, either. Instead, they try to substitute “UltraDEX”, which is some kind of peroxide/bleaching rinse.

        One of the Canadian sites presented a Canadian replacement for Closys, which was Oravital CDLx rinse. I fell for it and ordered some bottles. Mistake.

        When I received it, I finally got a good look at the ingredients. Citric acid figures prominently. I tested the pH and it practically burnt the litmus paper it was so acidic.
        Seriously… the litmus paper I used starts out yellow, and when wetted with reagent, it shows color from yellow (acid… pH 5.5 ) to very dark blue (basic… pH 8.0) – I dipped it in the CDLx and the paper turned dark orange (a color it isn’t supposed to know about) and curled as though trying to escape the acidic horror.

        The CDLx instructions say to swish for a minute, spit, then leave the mouth undisturbed for at least half an hour; no eating or rinsing. If I’m to believe Dr. Phillips’ book – and I do – that would kill my teeth in just a few applications.

        So, why are Closys and/or Retardex so hard to get?

        Anybody wanna buy four bottles of CDLx, cheap? I think you can use it to etch your concrete basement floor before painting…..

        Has anybody in Canada found a reliable supplier for Closys? (or Retardex?)
        Dr. Ellie should follow up those links on her site, and remove the two outdated Canadian ones, and maybe add some new ones if there are ANY reliable suppliers of an acceptable rinse.

        Please? 🙂
        Pretty please with Xylitol on it?

        • Dr Ellie here – and we will check those links and try to find some information about Closys and what we can do to help!

          • As mentioned elsewhere, I ordered one of your kits, plus 4 toothbrushes, and it came to something like $103 dollars with the cheapest offered shipping method… and that’s with the US and Canadian dollars hovering within a few cents of par.
            Not long after that, the delivery guy arrived at my door and demanded an additional $27 for Customs brokerage. I don’t know what item in the kit triggered a tarif. I’ve bought tons of products from the US, and had ’em shipped here by mail and by courier, without customs costs. I wonder if somebody in the fulfillment department wrote a description of the shipment that caused the customs goons to jump on that parcel.

            Anyway, ONE small bottle of ACT and ONE bottle of CloSys, plus four silver-impregnated toothbrushes ended up costing me $130 dollars. That can’t happen again. (I’m not counting the Crest or the Listerine, which are available here.)

            If Zellies can break out the CloSys and ACT and sell them separately for us in Canada, that would be a big help. ANOTHER big help would be if Zellies shipping department could get a bit of coaching on the terminology to use on the shipping documents that will NOT invoke Canada Customs.

            Even better would be some replacements for both CloSys and ACT that we can buy here. Are there any Canadian Dentists or Hygienists on this forum who:

            a) have accepted the gospel according to Dr. Ellie 🙂 and
            b) could evaluate some rinses from Canadian suppliers or resellers that would properly substitute for CloSys (or Retardex), and for ACT ??

            I’ve sent e-mail to the CloSys vendor, asking why their product has become unavailable in Canada, but got no response.
            Maybe the Canukistan government has stricter disclosure laws for product labelling, and the CloSys people don’t want to reveal that much detail? But still, they could ship small quantities across the border for individual consumption, without needing to comply with Canadian labelling requirements.

        • the box of ultraDEX says it is new name and same formula as retarDEX.

          • The UK site where I found it listed peroxide as one of the UltraDEX ingredients. What does yours say?
            Also, what part of the world do you live in?

            I’d hate to pay for shipment of liquids from the UK if I can get it closer.

          • Talking to myself…
            The ingredients list on the Amazon UK site: says

            Active ingredients: iQ+ ActiveOxi Technology powered by Stabilised Chlorine Dioxide and Sodium Fluoride.IngredientsAquaTrisodium PhosphateSodium MonofluorophosphateCitric AcidSodium ChloriteSodium Bicarbonate

            So, that’s different from what I first saw.

            Anyway, that list hardly looks dangerous, so I have to wonder why it’s so hard to get in Canada… especially given that it formerly WAS available here.

            I suspect bureaucratic malfeasance of some sort.

            • buddy of mine told me that the reason closys no longer sells in Canada is because of the dual language labeling requirements. Closys doesn’t want the inconvenience/cost of having to label their products in english and french.

        • I live just north of Toronto, and I just purchased Closys from Amazon.com — they delivered to Canada, no problem. For just under $88.00 CAD, I bought four 32-oz (946 ml) bottles — should do me for many months! Now I have to buy some ACT fluoride rinse . . .

          • Thanks for the update – this seems like a solution. Zellies has also put Closys and other individual components of our system for sale on our website. I don’t know how that will work for shipping to Canada – but we are prepared to give this a try for you and our customers in the US. We also have our Listerine Pumps back in stock – just in case anyone is looking for the pumps that fit the 1.5 liter bottles!

  3. I have always followed the traditional advice to floss and so do. I have only just discovered your information, which makes sense to me, however I have one question. When I floss I notice there are 3 places which catch food. The floss pulls out chunks of food from those areas. I can’t imagine leaving it there would be good – it would encourage more bacterial growth I presume. What are your thoughts on this?
    Thank you in advance,
    Tiff

    • I have no problem with flossing per se – and it is a great way to dislodge bits of food that get stuck between teeth.

      The purpose of my argument is to warn people that flossing cannot protect their teeth from cavities or gum disease. I believe there are far more effective ways to eliminate plaque (by loosening plaque with xylitol and washing it away with a good mouth rinse) and that good nutrition, a clean toothbrush and digestive probiotics will do far more to heal gum problems than floss can.

      The reason I like to debate flossing is to bring attention to this “accepted dental mantra” . Most patients know that flossing is promoted to the exclusion of other (more scientific) tactics that research has shown to be more effective solutions. I hope things will change, but I cannot understand why dentistry is so slow to teach parents about wiping xylitol on erupting teeth to prevent cavities in baby teeth. Let’s teach things that really work, and stop spending valuable chair-side time teaching patients things that are difficult, time consuming, messy and ineffective!

      Thanks so much for your question – and, by the way – you may want to wait a while before you tell your hygienist that you have lost your confidence in flossing!

      • Thank you so much for your prompt reply. Again, it makes a lot more sense than the “accepted dental mantra”!
        One more question if I may – I live in Australia and we can’t get Crest toothpaste here, so what should I look for in a toothpaste so that it won’t do more harm than good? Or, are you familiar with another brand that may be a good substitute?
        Thanks again.

      • I pretty much stopped flossing when I had extensive orthodontic work done, but I replaced my previous flossing habit with regular use of WaterPik – I call it my deck stripper/pressure-washer. 🙂
        In six years, I’ve encountered only two occasions that the WaterPik wouldn’t blast trapped food bits loose. The orthodontist and assistants, and my regular dentist and hygienist thought I was doing fine.

        I also find it does a better job than flossing in hard-to-reach places, and around my small lingual retaining wire. It was indispensable when I still had a mouthful of braces.

        I now like to run a bucket through the WaterPik before I start the Dr. Ellie routine.

  4. Thanks for the great post! I have two questions – one concerning flossing, and the other about xylitol.

    I completely recognize the value of your approach – promoting a more global system of flora and ph management of the mouth, and I see the absurdity of thinking that flossing and brushing alone can make a dent here. However, as someone with crowded teeth, I do find that flossing is an effective way to remove pieces of food that are stuck there. I do follow your system with excellent compliance, but the liquid flossing doesn’t remove these bits of food (which start to smell awful after a day or two). So my first question is this: For someone with crowded teeth, if flossing is the only way to remove physical matter from between the teeth, wouldn’t you say that flossing would be extremely important for them to maintain a healthy mouth?

    My second question is about the various modes of xylitol delivery. I personally use granular xylitol: I eat a bit off a spoon and let it sit in my mouth and mix with my saliva. I’ve also heard you recommend dissolving it in water and drinking the water. In this case, how does the xylitol actually deliver its effects? Doesn’t it need to be in the mouth for a relatively prolonged period of time? I keep imagining that if you just drank a solution of xylitol, it would go straight down your throat and not have time to do its magic.

    Finally, you may find this recent study fascinating:

    http://blogs.discovermagazine.com/80beats/2013/02/19/ancient-tooth-plaque-reveals-dietary-decline

    • Thanks for some great questions! I think as you use xylitol and the Zellies Complete Mouth Care System, you will find your gum health will improve and despite crowded teeth, you will eventually find less accumulation of food. There is no harm in flossing in a healthy mouth – and the best time is prior to using the mouth care regimen, morning and night.

      There are two main uses for xylitol – (1) to protect and strengthen teeth and (2) to adjust the oral flora and reduce plaque:
      1) Xylitol alkalizes the mouth by generating mineral-rich saliva. This helps put minerals into teeth to strengthen and repair them. Zellies mints and gum appear to stimulate the best flow of saliva for this purpose, but granular xylitol from a spoon is an option. You are correct that xylitol dissolved in water will not be useful to alkalize the mouth, and will not strengthen teeth in the way that the mints and gum can. The reason I suggest xylitol in water is as an adjunct to Zellies mints and gum. This method reduces the cost for those on a budget and also ensures patients get enough xylitol daily. If patients put a teaspoon xylitol in water this will give them the minimum dose, which can be supplemented by mints and gum eaten after meals and snacks to protect and strengthen teeth.

      2) Xylitol can adjust mouth bacteria and make plaque easier to remove if you consume sufficient xylitol daily. The kind of xylitol does not matter, but the dose must be between 5 and 10 grams daily (preferably in small divided amounts). Used like this, xylitol will gradually eliminate plaque bacteria from teeth (about 5 weeks) from the tongue and mouth (about 10 weeks) and from saliva (about 6 months). For bacterial adjustment, studies show that it does not matter if the xylitol is in water, as a mint, gum or as xylitol from a spoon. The important factor is to reach the minimum dose of 5 grams a day – and the ideal time to minimize plaque is at the conclusion of meals and snacks.

      I appreciate the link you sent me. I will try to write a post about why I believe we have so much oral disease today. I believe it is a bigger problem than diet alone. I blame transmission (parents to baby; spouse to spouse), Caesarian section births (protective flora enter a baby’s mouth during birthing), the influence of bad and infected toothbrushes (ever since pigs-hair brushes in the 1800s), infection from toilet plumes (as we moved out-houses inside), transmission after WWI and WWII (infection from the trenches), and the damage of ineffective dental education (perpetuated by financial “stakeholders”). Thanks again – I appreciate your interest in oral health!

  5. I have non-fluoridated water do you recommend me asking my dentist for a high fluoride toothpaste?

    • My chapter on Fluoride in Kiss Your Dentist Goodbye, explains in detail why drinking water with fluoride is not a preventive strategy. Adding fluoride to water began in the 1930s and there are many concerns with drinking fluoridated water – something I never recommend. On the other hand, dilute sdoium fluoride, brushed or rinsed over the outside of adult teeth daily, can make teeth stronger, brighter and less easily damaged. In this way fluoride in paste and rinses can prevent cavities by hardening the outside of teeth, and you spit it out – you don’t consume it.

      When you combine a good topical fluoride ( in toothpaste and rinse) with Zellies xylitol products, you can prevent and even reverse cavities. I have never seen a strong fluoride toothpaste work. My recommendations are always Crest Cavity Protection Paste and ACT anti cavity rinse, along with the Zellies Complete Mouth Care System.

      If you have “soft” teeth – it is likely caused by something acidic. This can be something in your diet ( most often something that you drink). Sometimes problems are caused in a dry mouth or if you have acidic saliva. The secret is to protect your teeth from acidity and keep acidic things to mealtimes, finishing every meal or snack with Zellies mints or gum. Check our booklet and learn how to use Zellies Complete Mouth Care System to turn your oral health around!
      Here is link to the booklet that explains the details HERE

  6. thanks for the thorough and thoughtful reply!

  7. I am interested in your system. But i am wondering about the cloysies and listerine are they necessary? I already have my xylitol i am gonna get crest and act soon. Is the listerine for tooth health or gum health? Wouldnt the xylitol kill the bad bacteria enough without listerine?

    • Each element of this system works to perform one (or more) important tasks. Each step is integrated with the next one in a way that makes sense from a biochemistry understanding. My book, Kiss Your Dentist Goodbye is an overview (in detail) and it explains why you need these various components and how they relate to each other. In a nutshell – the rinses work like the components of a skin care regimen ( I hope you are a lady or a guy who is familiar with skin care routines!) Closys is like a “deep cleanser”, Listerine is like a “toner/astringent”,and ACT is like “moisturizer”.
      Of course this is not exactly what they do – but this should give you the general idea and why they are not “all the same”.
      If you have gum problems or cavities these rinses and the toothpaste will work together to stop plaque forming, reduce inflammation, strengthen enamel and make teeth smoother and cleaner. With a sensible daily regimen using xylitol to protect teeth, you will eliminate disease and likely reverse much of the damage ( gum disease and cavities). The caveat is that you must PROTECT teeth from mouth acidity as much as possible. Xylitol can help do that – but you also have to keep drinks to mealtimes as much as possible and avoid long spells of acidity or dry mouth.

  8. I have a cuspid and bicuspid that are so close that dental floss is useless for removing food particles. Some time ago, I discovered that if I hold a Zellie’s toothbrush at just the right angle so I can brush across the space with the single row of longer bristles, the problem can be solved.

  9. I sent an email but hope it is OK to post here also. My questions relate to some of the ways that we use xylitol for my son and whether we’re getting the most benefit.

    1) My son’s molars seem to have deep grooves. After snacks like cheesy crackers, I can see remains of the snacks packed in his molars. Usually when I see this, I try to give him a xylitol gum instead of mint simply because I feel like maybe the gum can “dislodge” some of the packed in food. I wonder if there is any difference. When there is food packed into the molars, can you explain how xylitol can get “underneath” the food to protect the teeth? And what if that food is still there after the xylitol mint is done?

    2) I also wonder if the length of time of contact of a mint or gum in our mouth effects how effective it is. The gum flavor lasts a few minutes, after which my son promptly spits it out. The mint can last several mins in his mouth. Does that mean he’s getting more benefit from the mint because of the prolonged contact with xylitol?

    3) our dentist suggested that we wait 15 minutes after meals before xylitol. Would you agree? is there an optimal time after meals versus eating xylitol immediately afterward?

    4) sometimes at night, we get my son ready for bed shortly after dinner. So he may still be finishing up his mint as we’re about to brush his teeth. Is it OK to brush his teeth right after he finishes the xylitol? are we cancelling its benefits? or should we wait for some time for the xylitol to do all its work before brushing his teeth (with ACT).

    5) an old filling (placed prior to xylitol) on one of the front baby teeth came out after several months and the dentist recommends refilling it because the dentin is exposed. If he currently has no cavities, and we are vigilant in using xylitol, is there a danger if we leave this untreated and don’t have it refilled even though the dentin is exposed?

    Thank you for taking the time to answer all these questions! We truly appreciate all the work you are doing to educate us!

    • Hi Ella – I will take your questions in the order that you sent them!

      1. Deep grooves in teeth are not in themselves a problem ( and they can be useful as you will see if you read on….)It is the kind of bacteria that live in these grooves that matters! I know we like the idea of “clean” teeth but there is no such thing in the human mouth! Just like your digestive tract – our mouths contain hundreds of kinds of bacteria – and only a couple of them are bad guys. Our ideal is to ensure that a child’s mouth is populated with healthy bacteria before adult molars erupt so that healthy bacteria will pack the grooves of new molar teeth.
      When healthy bacteria occupy these grooves they dominate and fight off harmful germs that may want to cause cavities. It appears from research that whatever kind of bacteria enter molar grooves first, are tenacious and difficult to change, usually dominating the mouth flora (flora = the mix of bacteria in your mouth). Instead of being too concerned about food in the grooves – we need think about the kind of bacteria in them. Healthy bacteria are protective and do not produce acids and so they do not cause cavities. It will take you 6 months to effect this change with xylitol.
      On the other hand, carbohydrates in the mouth feed unhealthy bacteria. The longer sugars and carbohydrates linger, the more chance that harmful bacteria will grow. So the secret is to end every meal with foods that have are no carbohydrates or sugars ( like a piece of cheese or rinse your mouth with water) and then enjoy some Zellies as the perfect ending!

      2. Try to get at least 5 exposures to xylitol each day – after meals, snacks and drinks, but don’t worry about how long these mints remain in the mouth. It is the “xylitol sugar” that does the work – and it works quickly. In 2001 Dr. Milgrom at U. Washington showed that it doesn’t matter how you eat xylitol – but frequency and the total daily amount is important ( and you want 6-10 grams per day in small divided amounts).

      3.I have to assume this was mis-spoken, since the sooner you stop any acidic damage after a meal, the better for teeth. There is no advantage in waiting – why let your teeth deteriorate for 15 minutes? Also bacteria proliferate after meals – so this is the time to “feed” them xylitol and stop them from growing!

      4.I don’t have an answer to this question – but I don’t think it matters – although that is my educated guess – not based on science!

      5. I don’t know how old your son is, nor how serious this cavity was before it was filled. If this is a permanent tooth – which I am assuming – you may want to have it assessed soon. If you prevent danger from cavity bacteria and any acidity in his mouth is controlled with xylitol, there is no risk of the cavity progressing. If you are using the Zellies Complete Mouth Care System you may want to wait a few months and then ask a dentist to check the situation again.

      Thanks so much for great questions, Ellie

      • Dear Dr. Ellie,

        As a follow up to my post of before, I had mentioned that an old filling (prior to when we began xylitol) on one of the front baby teeth came out after several months and the dentist recommended refilling it because the dentin was exposed and it didn’t look as if his permanent teeth were close to coming in (he is a young 5 year old). This was recommended back in late January, and I delayed having anything done at the time. He had no cavities at that January checkup and I believed that since we were using xylitol rather diligently (6-10g over 3-5 exposures/day) there would be no harm in the delay and perhaps we could take a wait and see approach regarding re-doing the filling.

        We went back in this week for a follow up check and the dentist informed me that his filling had to be re-done (and was) because there was some further decay on the dentin of the tooth. I was very surprised. She said that dentin is much softer and more vulnerable as a result. However, what concerned me is that we have now been using xylitol diligently for over 6 months. in January he was cavity free and I thought that by this time, the bacteria in his entire mouth would be healthy bacteria and there would be no risk for decay if we continued using xylitol (plus brushing 2xs/day with ACT). So I’m just a little confused and wondering if that means that there is still “bad” bacteria in his mouth or if his is a case of very aggressive bacteria that will take longer (how much longer?) to rid? And how in 3 months time does decay develop when xylitol is being used? Do things just differ because it’s dentin versus enamel?

        So, I have to admit that I was glad she did the filling on his tooth, but any thoughts you have would be greatly appreciated!! Thank you again for all your time!!
        Ella

        • Hi Ella. Assuming that the dentist is correct (maybe he’s just trying to sell his product), then it would be a cavity case most definitely. Make sure you’re getting real 100% xylitol (does it turn acidic in your mouth? because it shouldn’t). Or maybe it’s the acidic foods or ACT (I suspect the sorbitol in it). One thing is sure – the teeth are crying out be mineralized.

  10. Loved the book, thanks!

    I just started your protocol a week ago and my gum recession seems to be worsening. I feel in shock because my teeth already look better, but I don’t understand why my gums would be worsening. I’m using the Act sensitive formula because I thought it was better with zylitol, but now I see it has sorbitol near the top of the ingredients. Could this be the cause? I’m following everything else perfectly. I feel helpless about this gum recession, it’s been there for a while and my dentist hasn’t offered any help.

    Thank-you for your thoughts.

    • Thanks for your message. I’m glad you liked my book! I believe I should have made more mention about the importance of getting the exact products for use in the Zellies Complete Mouth Care System. The system is like a cake recipe – and if you substitute bread flour for cake flour you will bake a very different cake! Hopefully when you get the exact products and use them with the exact method, you will see wonderful results!

      Gum health depends on several things that may surprise you:
      1. Diet and your nutrition ( consider using a multi-vitamin, eating healthier, get lots of fresh veggies and maybe take a probiotic).
      2. Avoid contact with peroxide ( whitening) or baking soda ( even as a cleaner for your toothbrush).
      3. Avoid damaging your gums by flossing. ( I suggest you take a flossing holiday for at least 2 months and see if this helps.)
      4. Brush your gums every time – aiming to massage them! Forget “tooth” brushing and concentrate on giving your gums a wonderful massage with a nice-design and clean toothbrush. I am not a fan of electric brushes because they are hard to manage. You want to stimulate a flow of blood in your gums – massaging them both on the outside of your teeth ( a little above the place where gums and teeth meet) and don’t forget to do the inside as well as the outside gums. It should feel wonderful when you have finished cleaning your mouth in this way………..try it and let me know what you think!
      Here are some tips and suggestions for using the Zellies Complete Mouth Care System – HERE

      • Wow, thanks for the reply, you are the most amazing dentist ever making time for so many people!

        I just tried your toothbrush and it felt great for massaging the gums.

        I think you were clear in the book to use the right rinses, but when I saw the ingredients I got scared because the act has sorbitol and saccharine. And you stated not to use sorbitol, and I believe saccharine is carcinogenic. But is it ok in the rinses?

        Also, could bacteria contribute to gum recession?

        Thanks again,

        Heath

  11. @Kevin: I use Xyla granulated xylitol here, but I threw out $$$ worth of Xyla candies when I read the ingredients, one of which was citric acid. The old Ricochet [sp?] candies were wonderful with simple ingredients. But the company that made Ricochet candies got bought out by another company. The new company changed the name to Xyla and changed the ingredients to mostly junk.

    • You could have sent those xyla candies to me!

      Seriously, i saw the inbredients. I use them anyway, for empirical reasons – I test my saliva while eating the candy, and shortly afterward, and it’s always nicely basic, between 7.4 and 7.8.

      Dark chocolate is good that way, too. At least, the Lindt Excellence 85% cocoa chocolate bars have a good effect on my mouth pH, in addition to being really good chocolate.

      • Kevin, I might have (depending on where you live), but I was so aggravated that the nice little Riccochet product I had been using so happily had been ruined — plus I thought it tasted terrible — that I just pitched it all. Something that I do enjoy, is Xylichew gum. You might check that out. I also like something called “FragMints,” although they are just broken up into little pieces, so it’s hard to know how much xylitol one is using. Cheers!

      • Hey Kevin. Greeting from QC. You can find ACT Anticavity at Vitacost.com. No custom fee by the way.

        Also, did you request shipping from Fedex? Maybe that’s how you got the additional charges for the custom fees. FeDex charges processing fees (plus taxes and other misc.) if your shopping total exceeds 40USD.

        I also have WaterPik here and I agree with you on its usefulness in dislodging stuffs. But be careful though, it might causes your gum to recede if you switch to high pressure and use it for a long period of time. I would suggest using cold water in the tank to minimize the “gum blazing” effect. Personally I prefer rinsing, both with your head up and your head down.

        As for Closys, I don’t have a replacement for it yet. My understanding is that Closys does 2 things:

        1) Neutralize the mouth
        2) Soften the plaques

        For 1), a teaspoon of xylitol after meal would replace that. And for 2). Rinsing 10 times before brushing does that too. So I don’t really feel that Closys is necessary.

        • I’m happy that so many people have made suggestions to help people in Canada trying to use the system. My feelings are the same about the WaterPik – use it very carefully. I recommended stopping if you have pockets that are healing – because they seem to heal better WITHOUT it! ( very counter-intuitive!)

          Closys does far more than neutralize the mouth. I think I gave this impression in my book – but Closys is wonderful to get rid of germs involved in serious decay or gum/periodontal disease. These bacteria are anaerobic – and Closys is able to disrupt and dislodge them. Closys also appears to help gum healing – and I even recommend Closys after extractions. Don’t underestimate the difference it makes when you use the entire system – xylitol is great – but it’s effect is very different from Closys.

  12. I have a question about Closys. Is it possible their “recipe” is inconsistent? I had a bottle a while back that left a kind of metallic taste in my mouth most of the day. But it WORKED. Now I have a bottle that is pretty much tasteless and it doesn’t seem to be getting on top of the problem, although I’m doing the same thing, as far as I can tell.

  13. I’m 65 years old and my teeth have been going to hell most of my life. I don’t know to what extent heredity has to do with it, but all of the males and many of the females in my family have had false teeth by the time they turned forty. In a concerted effort to stop the damage, I’d increased my flossing (once a day) and brushing (twice a day) over the past five years. I get cleanings twice a year, and spend more than I should at the dentist. I possess more fillings and crowns than most of the people I know. Now because of arthritis, my hands are not working that well, and it’s become increasingly more difficult and painful to floss.

    I was bouncing around the Internet looking for flossing alternatives when I found references to Dr. Ellie Phillips and floss vs. mouth rinses studies.

    I read some of the studies then went to Dr. Ellie’s blog. I decided to commit to her treatment and prophylaxis plan. Part of my reasoning was her commitment to people having healthy teeth. I did not have to buy the book to learn the plan, the information was free on her website. And she doesn’t make a bunch of money off proprietary stuff. She has a site that sells “Zellies,” but let’s you know that xylitol mints and gum are available elsewhere.

    Bought the book (Kiss Your Dentist Goodbye) and all my rinse stuff and xylitol gum. I quit flossing the end of February 2013 because what she said makes sense to me, and I was looking for a flossing out (but I do miss the post floss feeling).

    I went to my first cleaning June 6th (my last cleaning was November 14, 2012). I normally get 15 minutes of ultrasound cleaning for plaque removal but received none at this visit. When I asked the hygienist why no ultrasound, she said because she found very little plaque. Said my gums were very healthy and some of my pockets had become shallower. This is the best visit to a dentist since high school and I just started this regime a little over three months ago. I’m a happy boy!

    • PS. I also eat 10 to 20 grams of cinnamon xylitol mints a day as I like the taste. I know it’s more than needed, but it keeps me from snacking on other things.

  14. HI Dr Ellie

    I live in New Zealand and started using your system 4 weeks ago. I love it! i am hoping my gum recession will stop and make them grow again. Now the only thing i have noticed is that my teeth have become sensitive. Is it because i am using the Waterpik in addition to the system? As i read in another post you suggested a flossing holiday and i must admit i don’t like food stuck in my teeth.

    If you could let me know your thoughts that would be great.

    Thanks
    Roheeni

    • Instead of thinking you need to clean your teeth better, think more about promoting a healthy biofilm – because this is most likely your problem. Promoting biofilm involves protecting your mouth from things like peroxide and baking soda, and also too much acidity. This also involves your diet and nutrition, so digestive probiotics can be useful too.

      Sensitivity often develops when people over-do “cleaning” their teeth. Two or three uses of the system per day is maximum. Ensure you have the correct products – particularly Crest Cavity Protection paste and do not use water to rinse between the steps.
      After meals, you can use water to rinse away food particles or use Zellies gum, even for a minute because two these things will clean up your teeth and also promote a healthy biofilm. Remember that Zellies are the cornerstone of this system – and strive for five times per day.

      • HI

        Thank you so much for the prompt response! yes i have only been using your recommended products and they are great, just wish we got them in New Zealand off the shelf! i will increase the Zellies intake and include more alkaline foods in my diet. i had my teeth cleaned two weeks before starting your system and they have never looked this good! Can’t wait for the 6 month mark when they measure my gum recession again. Will keep you posted!

  15. I am 70 years old and have been diagnosed as having Gum disease with some 7,8,& 9 pockets. I am told to floss twice a day and use electric toothbrush, none of which seems to help after doing the quandrant scaling and maintenance very two months. Two of my back molars have been removed on the right side and now the dentist tells me nothing can reach my deep pockets, that I can never drink anything but water (good luck–I teach and conduct culinary tours and wine tasting is a big part) and even a water flossing pik connected to shower will not help. Dentist wants to do 4 crowns which will cost $4,000 even with my insurance. I only make $700 a month and cannot afford the work. I am really discouraged thinking nothing can be done. Any thoughts?

    • My life has been centered on helping turn gum disease around – but it takes a little effort and a complete understanding of new ideas. The health of your gums is determined by the quality of your immune system.
      Begin by getting your digestive health under control ( and I suggest daily Garden of Life digestive probiotics, improve your diet as much as possible, and supplement at least for a month or two with whole-food derived vitamin supplements). Instead of giving up (or worrying about what you eat at meals or snacks) protect your mouth after everything you eat or drink with one or two Zellies mints or gum. The xylitol alkalizes your mouth and stops damage from the acidity of drinks.
      You will want to use the specific mouth washes discussed on my website http://www.drellie.com – it is a program called the complete mouth care system and it can reverse pocketing in about 3 months ( no flossing even necessary). I’d love to help you turn this around, and it is not difficult – but it takes discipline while you are reducing these pockets. The pockets are filled with anaerobic bacteria that can damage your body and your brain – so this is far more important that deciding about crowns, saving money, or aesthetics. Your life depends on getting rid of this disease! Start now and you will notice improvements in a matter of days!
      Here is a link to the system on the site

  16. HI Dr Ellie

    i sent you a post a couple of months ago re sensitivity on the system. i took your tips with additional zellies doses and i don’t have the problem any more!! I also make sure i have enough probiotics each day in my diet by drinking raw milk and taking Cod Liver Oil.

    Aside from all this i just want to say THANK YOU as your system is amazing. My front bottom 4 teeth were pretty transparent and now they are almost back to normal!! On the 6th March my gums were measured for their recession and i need to make a follow up appointment in July and am pretty sure there is a huge improvement as my teeth feel way stronger. I started your system on the 25th March so it is going to be almost three months and for the first time in my life am looking forward to going to the dentist.

    i also had my clean in March and this is the first time i see no tartar build up behind the bottom front teeth. AMAZING!!!!! I can’t wait to see what the results will be after 6 months and a year and how the gum recession improves over time.

    i follow your system 100% and to any one out there if you in doubt, trust the system. If you stick to it 100%, it definitely works. Since the system i have the tendency to not want to eat outside of normal meal times any more as i hate my teeth not having that clean feeling. Sure it has caused an overall improvement in my diet!

    I live in New Zealand so ordered all my Zellies directly from your Website and i haven’t looked back!

    I still where my bite splint at night but i make sure i keep it totally sanitised each day after brushing it with some Crest Toothpast. Is there anything else i should be doing to keep it clean?

    Thank you once again and i will keep you posted re my recession issue!

    Roheeni

  17. Flossing my teeth is very painful i have tightly spaced teeth but been trying for months. According to my dentist it will get better and if i don’t – I will have heart problems an tooth decay. I recently found evidence that flossing has very poor result and not beneficial to anybody! My question is, what should i do to prevent plaque and gum disease? I’m very confused! Please help Thank you!

    I read above about xylitol – where can i find candies n gums that have that in it without the artificial substitute? I brush twice a day and use act restoring mouth wash.

    • When a hygienist brushes and flosses perfectly – they will only remove 45% plaque. With some xylitol after every meal, snack, and drink – you can reduce plaque by 98% in 6 months. Zellie’s mints and gum are made with non-GMO, soy-free, gluten-free, and vegan ingredients, they are made in the U.S. with nothing artificial ( http://www.Zellies.com).
      Try the Complete Mouth Care System – ( which does not recommend ACT restore – just regular ACT). Check out the details Here:

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