Academy of Dental Resources' San Francisco PowerPoint presentation 2011

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  • Motivational music should be playing at this time. Put slide up 10 minutes before the presentation. Welcome everyone and thank them for inviting me to San Francisco Since this is a pediatric meeting and we all treat children I believe that it is appropriate to have fun. At home I call these lunch and learn and laugh, but since it is obviously after lunch… today it will simply be Learn and laugh. If you would like a copy of this presentation I will be happy to send it to you for free all you need to do is send me an email and ask me to send it to you.
  • Here is my contact information. Begin the transformation to the wig and jacket What is the common issue that brought us all here today. Well some of you may be here to learn about xylitol, while others are here because your boss said you need to be here, while others came because a friend wanted them to be here. I thought a lot about this and I finally decided that the reason we are all here is because of one thing and that one thing is Sugar. So I thought that it would be appropriate to show our appreciation to sugar by singing a song. Now the words will be on the screen so everyone and sing along. Now if you don’t want to sing then simply clap to the music, but singing is always fun
  • Maroon Sports coat and tambourine What is the one thing that draws us all to Change to the Big Chief Sugar after the song.
  • Need the big chief sugar tee-shirt here. WOW!! That was fun. This is the top of the heap, the sweet killer of tooth enamel, the dark knight of sweet seduction. We are addicted to it’s sweet taste. But What is it? Is it a drug a nutrient and what effect does it have on the human body? First lets find out what it is
  • DEMO… Here is Sucrose a disaccharide 12 carbon made up of fructose and glucose. Acid bacteria MS use sucrose for energy and leave acid as a waste product, and store excess sucrose as glucans and fructans. The term glycan refers to a polysaccharide (many) or oligosaccharide (a few)
  • Have everyone dig into their bag and get out a glucose and a fructose and snap them together – you have just made sucrose. When you break it up you get Glucose and Fructose Have them put the thumb of their right hand into the opening on the left hand Energy, Acid and Storage
  • Maltose is a disaccharide made up of 2 glucose units
  • Oligosaccharide Oligo(few) saccharide(sugar): A carbohydrate molecule composed of 3–20 monosaccharides. Generally, free oligosaccharides do not quantitatively constitute a significant proportion of naturally occurring carbohydrates. (McGraw Hill’s Access Science Encyclopedia) Have the audience join arms.. They are making oligosaccs until they get over 19 and then you are making polysaccs
  • Amylose is linear chain (made up of glucose units); amylopectin is branched starch and amylose every 2K to 200k glusose units; glycogen (body starch) same composition but every8-12 units is highly branched. A polymer is a large molecule (macromolecule) composed of repeating structural units. These subunits are typically connected by covalent chemical bonds. Polysaccharide – Storage… Starch Structural…Cellulose
  • The Sugar plus hydrogen (h2) = the polyol Lactose- disaccharide…galactose (milk sugar) and glucose A starch hydrolysate is constituted by chains of propoxylated (demulsify emulsions to obtain the desired oil/water solubility) glucose of which the terminal groups are hydrogenated. It is prepared by subjecting a milk of starch to propoxylation followed by hydrolysis of the starch ether thus obtained and hyrogenation of the resulting syrup, or by subjecting a milk of starch to hydrolysis, subjecting the syrup thus obtained to hydrogenation followed by propoxylation, which step of propoxylation may be effected in the presence of an anion exchange resin. The starch hydrolysates are useful as thickeners for the food industry or for suspending agents for pharmaceutical products.
  • Monos – Fructose, Glucose, Sucrose is a disacc
  • There is a lot of discussion as to whether these intense sweeteners are good for us or harmful to us. Personally the only on that I use is Stevia and Licorice. Aspartame – controversial due to release of methanol – will increase insulin Sucralose – Trichlorinated sucrose, use as direct replacement in all recipies that call for sucrose (sugar) Saccharine – bitter metallic after taste used with Aspartame to sweeten soft drinks … Benzoic sulfimine sulfur to nitrogen double bond Ace K – combined with Asp and sucralose in drinks to give a more sugar taste. Does have and after taste Glycyrrhizin – limit 100-200mg per day Lingering taste in the mouth, candies, pharmaceuticals Stevia – Herb Sweet leaf (rebaudiana) slower onset and longer duration Neotame - is the new kid on the block 13000X chemically similar to aspartame, lower cost of production, after taste like other artificial sweeteners. Metabolized by products esters and methanol much less than aspartame
  • Why include starch and maltodextrin? They are polysaccharides – polymers comprised of linked sugars. They are storage sugars for bacteria
  • Honey, maple syrup, agave are mostly mixtures of glucose and fructose.
  • Maillard – reaction between reducing sugar and amino acid and is used to create many different flavors in cooking The Maillard reaction also occurs in the human body. It is a step in the formation of advanced glycation endproducts . Need some toast The total state of oxidative and peroxidative stress on the healthy body, and the accumulation of AGE-related damage is proportional to the dietary intake of exogenous (preformed) AGEs, the consumption of sugars with a propensity towards glycation such as fructose [17] and galactose. [18]
  • HemaglobinA1c test is based on the long term formation of the modified proteins in the red blood cell. The modification of the collagen protein is an AGE and manifests as wrinkles.
  • Provides energy to MS bacteria Waste product is Acid plaque It is a great food storage for bacteria
  • What are going to do about it? Let the dirty bugs take over? From the back of the room that may look like dust on the screen but those are bugs. Sugar increases the bugs and the then the acid comes
  • A point worth emphasizing is that sugar used between meals can be the most damaging for the teeth.
  • Nothing hidden about this sugar
  • Tooth decay is a process of enamel demineralization by acids created from sugar over time. Cavities are holes in teeth that have been acid-attacked by the decay process.
  • Even starchy foods are readily broken down to simple sugar and converted to plaque acid. Ordinary table sugar – Sucrose – is the most harmful. Remember Sugar is stored by the bacteria
  • DEMO…. Sugar cubes Breakfast toast 4 cubes, coffee and sugar 2 cubes, orange juice 4 cubes or a bagel and cream cheese 4 cubes.Lunch soda 5 cubes Dinner… Potato 5 cubes, rolls 6 cubes, Snack bag of chips 5 cubes, soda 5 cubes, yogurt 6 cubes
  • Switch back to Suit for the next part of the presentation
  • Need to get the legal qualifiers out of the way first and then we can get down to the fun stuff.
  • How did this all begin well in 1999 my Partner Dr. Russ Misner came to me and ask me if I thought that we were making a difference with our patients. Did I think that our patients were having fewer cavites when they came for their recall
  • 1999 Russ asks me if I think that we have more or less decay in our practice than we did 5 years ago. My answer was more. Then he asked have you ever heard of xylitol and my response was yes. Johnathon Wright newsletter talking about xylitol. We noticed that the company was in Orem Utah only a 3 hour drive.
  • Here was our original label
  • As you can see we were in the gum business the Xylitol gum business. Then one day in 2001 we get a call from VP of Xlear and they wanted us to come down and talk to them about our business. To make a long story short when we left there we were Xlear dental consultants and we agreed to go to 15 dental trade show per year and talk to dentist about Xylitol gum. And talk we did. We travelled all over the country ….. And
  • During our travels we decided that we needed a product for infants and toddlers so we called Xlear and spoke to them about our idea and asked to send us a few basic products and we would see what we could come up with.
  • As this was actually done in Dr. Misners kitchen. We mixed and mixed tasted and squeezed the gel until we thought we had a pretty high content xylitolgel ane we sent it back to Xlear for the finishing touches and to make a batch of samples for us to use in the office.
  • Well in 2004 our contract ended and we decided to start company that would help educate the dentists about xylitol
  • Four Partners.. Dr. John Peldyak, Dr. Eric Johnson, Dr. Russ Misner and Dr. Bybee
  • There is a companion DVD with this manual. Tell the story of making the DVD… Buhl Idaho, green screen… Had to stop when the train was going by. The most frustrating thing that I ever tried it took me an hour to do the first slide.. I was trying to read my notes and hold perfectly still for the filming. Hey it is hard for me to stand still. Finally a got upset and turned off my notes and talked to the camera for 200 slides and we were finised in another tow hours.
  • Looks like a big city setting in the background… gotta a love a green screen
  • Product recommendation brochure
  • Xylitol education
  • Xylitol education DVD
  • Office forms
  • ADR is the professional website
  • ADR has been working on this for almost 2 years.. Our resident orthodontic expert Dr. Eric johnson is working feverishly putting on all the finishing touches and he has to put up with Dr. Misner and I pushing to get it done.
  • Switch to Xylitol T-Shirt…. Sweet Success with Xylitol on the Back. Bigger Chief Xylitol
  • We’ve all heard about shifting concepts and beliefs, but what do we mean when we say it. Today I will explain what it means to me and then you will have an opportunity to experience it for yourselves.
  • Reframing is an example of a paradigm shift. We want to tell show and do to our patients so they are better equipped to take care of their own oral health
  • Illicit accustomed
  • What we are really talking about is a Paradigm shift and our resistance to it.
  • Get 20 volunteers to come on stage Pick up the white envelope Put it in your right hand Hold it above your head Now move it to your left hand Now open the envelope You have just witnessed the ease of Shifting Your Paradigms so lets begin. For those in the audience DEMO…for paradigm shift
  • Looks like sugar
  • Most dietary carbohydrates are based on a 6-carbon saccharide unit. Xylitol is a 5-carbon “non-glucose” polyol. Xylitol will carry calcium according to Dr. makinen
  • Virtually no after taste Most dietary carbohydrates are based on a 6-carbon saccharide unit. Xylitol is a 5-carbon “non-glucose” polyol. c5h12O5 Xylitol will carry calcium according to Dr. makinen
  • Possible contamination otherwise the toxicity could be attributed to overwhelming the mtabolic capacity and hyperosmolarity. Too much too quick
  • Xylitol is sweet enough to be used directly as a sugar replacer without the need to add an intense sweetener.
  • I believe that this is what we all would like to see. Beautiful children with happy smiles. Our role as dentists should be to have a practice without decay and we should educate ourselves so we can provide our parents and patients with information to allow them to create a zero decay environment. Unrealistic? Maybe but those that want less decay it is possible.
  • They say it just falls out of the sky in Lead
  • There is so much that they have to pile it up on the side of the roads
  • Because of its bright white color Lead sometimes looks like the Santa’s North Pole. If we could just get santa to make the candy canes with Xylitol that he leaves in the stockings
  • Here you see a couple of workers clearing the Xylitol from the Plant managers home
  • A job well done and she is still smiling…
  • No Matter how you stack it Xylitol is good for your Teeth.
  • Change to a Dental Smock
  • General – Plaque is plaque, Plaque is bad, everyone has it, get rid or it, Bacteria are bad kill the little buggers, drill and fill recheck in 6 months Specific – Different plaque have different ecologies, some are worse than others, diagnosis is essential to identify risk, Modify the plaque, some bacteria are useful just get rid of the pests, address the problem and test to make sure the pests are gone.
  • Aggregate of microorganisms of cohesion and adhesion Polysaccharides, proteins, Form on living and nonliving surfaces Multi species Extremely hard to eliminate Are physiologically distinct from planktonic cells of the same organism.. Because they share different information with-in the biofilm
  • Plaque DEMO…. Planktonic bacteria… Blow up your balloons… Free floating have them bounce them around. BioFilm… it is the same bacteria they have just invited a few friends over a lifetime get together. MS Bacteria in a biofilm. Bring out the biofilm Xylitol Bacteria
  • Planktonic v biofilm have the audience stand and then jump up and down and then have them join arms or have the front row blow up balloons and bounce them around the room.
  • Figure 3. Cartoon depicting biofilm formation.  Biofilms usually occur when one bacterial species attaches specifically or non specifically to a surface, and then secretes carbohydrate slime (exopolymer)  that imbeds the bacteria and attracts other microbes to the biofilm for protection or nutritional advantages.
  • Bring out the balloons with the xylitol in them
  • You can see here that xylitol reduces plaque according to Soderling’s studies considerably more than gum alone
  • Xylitol can block the initial colonization by strep mutans. Xylitol acts as a carrier for calcium and promoted optimal mineralization of new enamel.
  • Frequency, consistency and timing are more important than total amount.
  • Health begins with what we breathe, and what we put in our mouths. We need to protect the oral nasal gateway. Xylitol will help Nasal spray keeps the air clear and the gum and mints keep the bad bugs out of the mouth
  • Why is dental health so important? It is easier to prevent dental disease than to treat it. Since Xylitol removes plaque there will be less irritation at the gum
  • Xylitol reduces acid and acts as a carrier for calcium. Repeated exposure to xylitol weakens the most harmful mouth germs.
  • Glucose has a Glycemic Index of 100. Xylitol has a Glycemic Index of 7. Xylitol provides a steady flow of energy with no rebound hypoglycemia below baseline. Early on, xylitol was used as a premium natural sweetener in the diabetic diet.
  • A few reminders --
  • Don’t eat the Yellow Xylitol
  • Lots of xylitol in liquid on an empty stomach can cause gastrointestinal discomfort. Dental protection only requires small amounts, about one rounded teaspoon per day, Tolerance to increasing amounts builds up over a few weeks..
  • With that much Xylitol and that much water…..that nice lady is in trouble So Don’t over do it !!!!
  • Xylitol provokes an insulin reaction in dogs leading to rapid drop in blood sugar. Give glucose. We hired a mamma bear in a white coat to help protect our animal friends from xylitol and I was able to get a few pictures of her teaching techniques so that I could share them with you. .
  • Stay away from the xylitol, its not good for you.
  • Thanks for listening, I want you to be safe
  • Your are awesome Mamma bear
  • Time for a break
  • Alt Tab to Jump drive and start the movie. With the jump drive open move it to the presentation screen in preparation. Then all that needs to be done is to double click the movie, when finished minimize and go on with the presentation.
  • … over a period of time. Xylitol can stop this decay process by weakening the germs and remineralizing the teeth. Straw Microscope DEMO!! How many non Dentists are in the audience. I am going to show what the dentist sees when they look in and see a cavity. Focus on the cavity.. Now we are going to take a trip inside that lesion I wanted to get everyone a microscope but it would have been a little too expensive so what I want you to do is use the next best thing. Dig into your bag and find the straw.
  • This is a little out of focus so roll up a piece of paper or simple roll your hands over each other and we will look a little closer and bring it into focus
  • Bacteria in the plaque… This is the biofilm. Notice the entanglement of several different bacteria. And finally
  • Now we can actually see the bacteria and the enamel surface. Why are MS so important? 1. It is the caries bacteria 2. They form sticky plaque and produce acids efficiently. Having high levels of Mutans Streptococci is an important but less clear risk factor for early childhood caries. So with that in mind lets look at the process of caries to cavities
  • Caries is considered the process of Dental Decay and indicates to the practitioner whether or not there is evidence of that process in the mouth and helps the Dentist formulate a treatment plan consistent from one patient to the next.
  • Cavities on the maxillary anteriors and Caries on the mandibular anteriors
  • This slide shows the several stages of the caries process and cavitation
  • There is a constant struggle or “tug-of-war” between damaging and protective factors.
  • Xylitol tips the balance in our favor by supporting protective factors. The enamel surface is in dynamic flux between losing and gaining minerals.
  • Tooth decay is a process. Cavities are the result of bacterial acids.
  • Anemia – We took blood samples on 300 kids that we took to the hospital and 75% of the kids were low iron. Raised in a smoke environment
  • Gingival inflamation
  • Talk about Xlear Nasal wash maintaining patent airway
  • Tooth decay is a process. Cavities are the result of bacterial acids.
  • Heart Plaque relationship
  • Xylitol V. Sorbitol
  • CHX/GUM/Prevident Slides 19-30
  • Note puffy gingival margins.
  • Rx list. Xylitol can help.
  • Have the patient chew a paraffin pellet for 3-5 minutes. Spit into a cup Measure saliva at the end of time period and divide by the time to determine ml/min of stimulated flow Levels ≥ 1.0 ml/min is standard and lowers the risk for oral disease Level ≤ .7 ml/min is below normal and is a higher risk for oral disease Level ≤ .1 ml/min is referred to as xerostomia and is a very high risk for oral disease
  • You can see here that xylitol reduces plaque according to Soderling’s studies considerably more than gum alone. Xylitol Gum was more effective at reducing plaque than non xylitol gum
  • Cost of the unit is about $400. And the cost of each test will run you about $20.
  • Salivary flow rates are quite important and should be done as often as you can. With observation and practice you will begin to see what lack of salivary fo\\low has on the oral invironment and bacterial growth.
  • Dentocult is now the gold standard in clinical trials for assessment of MS colinization.
  • Time to talk about moms and babies
  • Some of you may be familiar with this ph graph, showing consumption of sugar, resultant ph drop then gradual change back to neutral ph Stefan’s curve shows how saliva acid drops after the first meal of the day, then saliva production removes the acidity of the mouth, remineralizes the tooth, drop for lunch, drop for dinner etc It is of course the ph drop we wish to avoid as this is when demineralisation of the teeth occur Chewing gum speeds thiss ph change, returning the mouth to a neutral state reducing demineralisation time .
  • Having high levels of Mutans Streptococci is an important but less clear risk factor for early childhood caries. Caries can occur after all without Mutans Streptococci and more studies are needed to confirm just how significant a risk the bacteria is. This is where the importance of a whole food diet and eating real food and getting the sugar consumption down will make a difference. Sugar removes minerals from the body. Reduce sugar intake and save your teeth and your general health.
  • Having high levels of Mutans Streptococci is an important but less clear risk factor for early childhood caries.
  • Xylitol Plaque is safer on the teeth.
  • Xylitol can carry calcium.
  • Finnish mother-child study (Söderling & Isokangas): Could xylitol consumption of the mother affect transmission of MS? 195 mothers participated; the Xylitol group used xylitol gum with 6-7 g xylitol/day during child's age 3-24 mo (Control F- varnish and chlorhexidine). The children received no additional prevention.
  • % colonization of MS bacteria when mothers chew xylitol gum at 0, 3, 6 month intervention. The numbers certainly vary from study to study but in all three it is obvious that there is less colonization when moms chew gum.
  • Demonstrate xylitol gel in pacifier. Xylitol gel is safe to swallow. First teeth should erupt into clean, non-acid xylitol environment.
  • What we need to remember is Caries is an infectious disease; Having ms does increase the risk of caries occurrence in the future There is also the proposed window of infectivity for MS, the times of a child when these bacteria are passed on If MS have colonized the teeth before the age of 2 yrs, the risk of caries occurence in the future becomes high and the earlier they colonise the greater the risk
  • Within Finland’s mother-child study: the child’s risk of having mutans streptococci colonisation in the dentition was 5-fold in the Control group as compared to the Xylitol group
  • Xylitol and calcium gel in pacifier is safe to swallow.
  • Finnish mother-child study: At the age of 5 years the need of restorative treatment was 71% lower in the Xylitol group compared to the Control The results of the 10-year-old children in line with the earlier ones (Laitala, thesis 2010)
  • Best time to get xylitol on teeth is during eruption. Xylitol blocks early MS colonization and mineralizes new enamel.
  • This chart shows the percent of colonization of strept mutans in the children of the mothers in the various groups
  • Next step is to begin brushing with xylitol gel. Soft brush is safe.
  • Lightly-flavored gel contains xylitol and calcium, and is safe to swallow.
  • Chlorhexidine was used as the disinfectant.
  • Through kissing, food tasting, etc. Make sure mother has germs under control.
  • This little 8 year old was in tears when I spoke to her about her teeth. The kids at school teased her and called her chocolate teeth.
  • She cried again…but this time tears of joy!! I cried Too. What a beautiful story
  • Isokangas P, Alanen P, Tiekso J, Makinen KK: Xylitol chewing gum in caries prevention: a field study in children. J Am Dental Assoc 1988; 17: 315-320. Isokangas P, Tiekso J, Alanen P, Makinen KK: Long-term effect of xylitol chewing gum on dental caries. Comm Dent Oral Epidemiol 1989; 17 200-203. Isokangas P, Makinen KK, Tiekso J, Alanen P: Long-term effect of xylitol chewing gum in the prevention of dental caries: A follow-up five years after termination of prevention program. Caries Res 1993; 27: 495-498. Peldyak John DMD, Makinen Kauko K PhD: Xylitol for Caries Prevention. Journal of Dental Hygiene Volume 76 Number IV Fall 2002; pp. 276-285.
  • Xylitol is probably the most enjoyable decay prevention in the market place. Recommend xylitol to your patients, parents and grandparents
  • Xylitol is portable prevention.
  • This product came on the market in 2005 and 2006 and as MLM company
  • Check the labels make sure that you are recommending 100% xylitol to your patients
  • Ideally, use products that are 100% sweetened with xylitol for best results.
  • Brush teeth twice a day, see dentist twice a year, avoid sweets – and use Xylitol after meals and snacks.
  • Blast them with powerful chemicals? But biofilms such as dental plaque are comprised of more than one specific type of germ. About 600 types have been identified, many are useful but only a couple dozen are harmful. Biofilms learn to protect themselves from attack – (frontal assault). Harsh drugs & chemicals can harm us and eventually make bugs stronger.
  • Instead, we can work with nature and make the uninvited guests (acid germs) increasingly uncomfortable.
  • Outsmarting them at their own game. The bad ones leave. Xylitol makes them slicky instead of sticky and down the shoot they go.
  • Xylitol will not let them back in.
  • Over time, plaque exposed to xylitol becomes less adhesive, less acidic, less inflammatory and less harmful.
  • Xylitol is a naturally sweet carbohydrate found in many fruits and vegetables.
  • The base of the pyramid is the most difficult to manage but will have the largest and the greatest change in oral health. As you go up the pyramid there is less effect but easier to administer and manage.
  • Anything that effects the immune system Toxins.. Smoke, anemia Things that come in boxes that can sit on the shelf are products. Fresh real food, then frozen, dehydrated, canned, boxed
  • When you eat like this You get happy teeth This is a little upside down to what you may have recommended by the USDA When you eat grains and breads use fats (butter, or coconut oil, oil olive to slow down the sugar affect of the carbohydrate) Grass fed and grass finished meats are better for you.. Higher omega 3 content Choose organic when possible not because of the higher nutrient value but because of fewer pesticides and herbaside and fertalizers.
  • When you eat like this you get acid rain and a very sad tooth This is the SAD almost all refined carbohydrates… very little fiber and little fat.
  • Remember sugar adds energy, acid and storage for bacteria
  • There are several places that you can purchase nutritional information and brochures. We believe the whole food supplements are of greater benefit because they are made from real food.
  • There are approximately 60 known elements and probably hundreds of unknown elements that the body needs to function optimally. It obtains these nutrients from the food we eat; (proteins, fats, complex carbohydrates, fiber, and concentrated Whole Food Supplements), the water we drink, the air we breathe, the sunshine we enjoy, and those elements that the body can manufacture when given the proper materials. What we know about the human body doubles every 3 years. Keep reading about nutrition and share what you know with your parents, patients and staff
  • We have spent tens of thousands of dollars over the past 8 years to learn more about health and nutrition. Here is the short list and what we have discovered
  • To maintain maximum freshness when freezing your own veggies, freeze directly in water don’t pre-heat
  • Xylitol education brochures, educate your patients and parents to the benefits of Xylitol. Allow them to take control of there oral health.
  • Change to a Dental Smock
  • Oral hygiene is extremely important. This how we do it in our office. I will now break them down 1 by 1
  • We Start with a 4 page report card. Sequence of presentation
  • Front Page Low, Mod, High Normal, Local, General Ortho, Oral Surgeon, endo, Perio, nutritionist, TMJ, Medical Doc, Other
  • Categories of examination
  • Inside cover addresses our findings during the exam.
  • It also defines why we need to see them back for their recall. This helps us when we are speaking to the parent on the phone. We scan this document into the computer and when the recall person is calling they can look up this document and let the parent that we need to schedule their child for an exam and prophy and also to check and monitor their spacer, #14’s ectopic eruption etc.
  • Xylitol in all
  • These are the tools that we use to speak to and educate our parents and patients during the new patient exam.
  • Betadyne is usually done in the office every 3 months on high risk population Chlorine Dioxide – gums and bad breath.. Sulfur forming bacteria
  • Thank them for their attention and for the opportunity to speak to them. For those that might have slept through the presentation I have a 4 minute motivational slide show for a quick review. Set up the Rocky review compliments of my daughter Kirstin.
  • When ms and lb use xylitol for there food source there cell wall no longer is sticky.
  • Catherine Hayes reviewed all the literature
  • Academy of Dental Resources' San Francisco PowerPoint presentation 2011

    1. 1. DDS, CNC, ND “ Sweet Success with Xylitol” Thank You CSPD! San Francisco April 9 th 2011 DDS, CNC, ND
    2. 2. My Contact Information <ul><li>[email_address] </li></ul><ul><li>208-478-5437 </li></ul>
    3. 3. Sugar
    4. 4. Sucrose sugar is the standard for comparison “ sugar substitutes” Attempt to duplicate the taste And some functional properties
    5. 5. Sucrose “ Sugar” on food ingredients labels, ordinary table sugar, cane sugar, beet sugar disaccharide 12-carbon
    6. 6. Glucose (D-glucose, dextrose, corn sugar, blood sugar, monosaccharide, 6-carbon) Fructose (fruit sugar) monosaccharide, 6-carbon)
    7. 7. M altose (malt sugar) disaccharide, 12-carbon) Glucose (D-glucose, dextrose, corn sugar, blood sugar) monosaccharide, 6-carbon)
    8. 8. Maltodextrin Oligosaccharide 3 – 19 glucose units
    9. 9. Starch Polymer, Polysaccharide, Amylose 200 – 1000 glucose units
    10. 10. Sugar alcohols are reduction products of sugars MonoSaccharides Di or Poly Saccs Sugar Glucose (dextrose) Fructose (fruit sugar) Galactose Xylose (wood sugar) Maltose (malt sugar) Sucrose (table sugar) Lactose (milk sugar) Starch Hydrolysate Polyol Sorbitol Mannitol Galactitol Xylitol Maltitol (glu-sorbitol) Isomalt (glu-mann/sor) Lactitol (glu-galactose) HSH (hydrogenated SH)
    11. 11. Sweeteners <ul><ul><li>Bulk -- Functional Properties </li></ul></ul><ul><ul><li>Sugars (mono- and di-saccharides) </li></ul></ul><ul><ul><li>Polyols (Sugar alcohols) </li></ul></ul><ul><ul><li>Intense -- High Potency </li></ul></ul><ul><ul><li>Artificial </li></ul></ul><ul><ul><li>Natural </li></ul></ul>
    12. 12. Sweeteners <ul><li>Intense (High potency super sweeteners) </li></ul><ul><ul><li>Aspartame (200x) </li></ul></ul><ul><ul><li>Sucralose (600x) </li></ul></ul><ul><ul><li>Saccharine (400x) </li></ul></ul><ul><ul><li>Acesulfame Potassium (Ace K) (200x) </li></ul></ul><ul><ul><li>Licorice (glycyrrhizin) (30-50x) </li></ul></ul><ul><ul><li>Stevia (steviosides, reboudisides)(300x) </li></ul></ul><ul><ul><li>Neotame (up to 13,000 x) </li></ul></ul>
    13. 13. Sugar “-ose” by Other Names <ul><li>“ ose” ending (major dietary sugars are sucrose, glucose, fructose, lactose) </li></ul><ul><li>Syrup (sugars dissolved in water) </li></ul><ul><li>Corn syrup </li></ul><ul><li>HFCS High Fructose Corn Syrup </li></ul><ul><li>Starch (processed and cooked) </li></ul><ul><li>Maltodextrin </li></ul>
    14. 14. Corn Syrup Water, glucose High Fructose Corn Syrup Glucose converted to fructose by enzymes Water, glucose, fructose (42-95%)
    15. 15. Fructose <ul><li>Fast sugar </li></ul><ul><li>Most water soluble </li></ul><ul><li>Liver metabolic bottleneck </li></ul><ul><li>Maillard reaction rapid non-enzymatic browning </li></ul>
    16. 16. Glycation <ul><li>Non-enzymatic glycosylation </li></ul><ul><li>Maillard Reaction: Modification of protein =browning </li></ul><ul><li>Leads to formation of (AGE’s Advanced Glycation End-products) </li></ul>
    17. 17. AGE’s <ul><li>Toast </li></ul><ul><li>Glycated hemoglobin (diabetes) </li></ul><ul><ul><li>Hba1c test </li></ul></ul><ul><li>Collagen -- wrinkles </li></ul>
    18. 18. Why is sucrose so harmful? Energy Acid Food storage
    19. 19. Sugar Increases the Bugs
    20. 20. Watch for “Hidden Sugar” Cough Drops Chewable vitamins Breath mints Fruit juices Dried fruits Sports Drinks Syrup medicines
    21. 21. But Don’t Forget the Obvious
    22. 22. Too Much Sugar
    23. 23. Way to Much Sugar Germs Sugar Acid Plaque
    24. 24. Way Way Way to Much Sugar … . But
    25. 25. On Teeth It is all just Sugar
    26. 26. American Heart Association Recommends less than 100 calories from added sugars (6.2 sugar cubes) per day for adult women
    27. 27. From sugar cane or sugar beets It’s all just Sugar
    28. 28. Conflicts of Interest <ul><li>Spry Dental – Consultant 2001-2004 </li></ul><ul><li>My Xylitol </li></ul><ul><ul><li>www.myxylitol.com </li></ul></ul><ul><li>Academy of Dental Resources </li></ul><ul><ul><li>www.adrdental.com </li></ul></ul><ul><li>Designs for Health </li></ul><ul><ul><li>www.designsforhealth.com </li></ul></ul>
    29. 29. Professional Education <ul><li>Dental Practice 1978-1995 General 1997-present Children only </li></ul><ul><li>Education </li></ul><ul><ul><li>General Dentist – Practice limited to Kids </li></ul></ul><ul><ul><li>CCN – Certified Nutritional Consultant </li></ul></ul><ul><ul><li>NART – Nutrition Autonomic Response Testing </li></ul></ul><ul><ul><li>ND – Naturopathic Doctor </li></ul></ul><ul><ul><li>ACIMD American College of Integrative Medicine and Dentistry </li></ul></ul><ul><li>Publications </li></ul><ul><ul><li>Practical Application of Xylitol </li></ul></ul><ul><ul><li>Finnish Dental Journal Supplement 1,2006 </li></ul></ul>
    30. 30. My Personal Xylitol History <ul><li>Fall of 1999 Dr. Russ Misner </li></ul><ul><li>KlearChoice Chewing Gum </li></ul><ul><li>2001-2003 Xlear Dental Consultants </li></ul><ul><li>2002 Developed ToothGel </li></ul><ul><li>2004 Created ADR Xylitol CE Course </li></ul><ul><li>2005-2007 Patent pending gels and TP’s </li></ul><ul><li>2004-2009 Office Implementation </li></ul><ul><li>2011 Orthodontic Module Release </li></ul>
    31. 31. Our Xylitol Journey Begins 1999 Dr. Larry Bybee Dr. Russ Misner
    32. 32. KlearChoice <ul><li>1999-2000 </li></ul><ul><li>They packaged the gum with our label </li></ul><ul><li>We spoke with individual dental offices </li></ul><ul><li>Pretty soon we were moving 500-600 tubs a month </li></ul>
    33. 34. Xylitol Consultants <ul><li>2001 </li></ul><ul><li>Teamed with Xlear </li></ul><ul><li>15-20 Dental show per year </li></ul><ul><li>Tons of fun but a lot of travel </li></ul>
    34. 35. Toothgel 2002 <ul><li>Formulated in Dr. Misner’s Kitchen </li></ul>= + Calcium Glycerylphosphate Xylitol + +
    35. 36. Today's Packaging
    36. 37. ADR <ul><li>CE Course on Xylitol </li></ul><ul><li>DVD’s </li></ul><ul><li>Manual </li></ul><ul><li>Forms CD </li></ul><ul><li>Brochures </li></ul>
    37. 45. Orthodontic Module Release all 2011 (I Hope  )
    38. 46. Sweet Success with Xylitol
    39. 47. Changing Ideas and Concepts In a learning environment you don’t need to agree with anything that is said…. We learn from each other by listening and doing, NOT from argument.
    40. 48. Reframing From “manage the damage or drill and fill” to health promotion and self care decay prevention From helpless victim to proactive self-care
    41. 49. We sometimes find ourselves changing our mind without any resistance or heavy emotion, but if we are told we are wrong we resent the imputation and harden our hearts. We are incredibly heedless in the formation of our beliefs but find ourselves filled with an illicit passion for them if someone should rob us of their companionship. It is obviously not the ideas themselves that are dear to us but our self esteem that is threatened.
    42. 50. We like to continue to believe what we have been accustomed to accept as true and the resentment aroused when doubt is cast upon any of our assumptions leads to seek out every manner of excuse to continue clinging to them. The result is that much of our so called reasoning consists in finding arguments to go on believing as we already do. James Harvey Robinson
    43. 51. DEMO
    44. 52. Why Xylitol? <ul><li>Tastes good </li></ul><ul><ul><li>Delightful sugary taste </li></ul></ul><ul><ul><li>Cooling effect </li></ul></ul><ul><li>It works </li></ul><ul><ul><li>Helps prevent dental caries </li></ul></ul><ul><ul><li>and upper respiratory infections </li></ul></ul>
    45. 53. What is Xylitol? Carbohydrate with uncommon structure Five carbon atoms Found in small amounts in a wide variety of fruits and vegetables Metabolic intermediate Used as a substitute for sugar
    46. 54.                                                         x ylitol
    47. 55. Sorbitol (polyol) 6-carbon Xylitol (polyol) 5-carbon
    48. 56. Xylitol (polyol) 5-carbon
    49. 57. When <ul><li>1891 – Emil Fischer </li></ul><ul><li>1950 – Identified in Human Metab. </li></ul><ul><li>1963 – Approved by FDA for special dietary purposes </li></ul><ul><li>1969 – Used intravenously in Australia </li></ul><ul><li>1970-1988 Studied Safe for Teeth </li></ul><ul><li>1990-Present Reduces Dental Decay </li></ul>
    50. 58. Properties
    51. 59. Relative Sweetness
    52. 60. Other Xylitol Properties <ul><li>Hydrophilic – Draws Moisture </li></ul><ul><li>Increases Salivary Flow </li></ul><ul><li>Decreases acid strength in the Mouth </li></ul><ul><li>Low Glycemic Index (Diabetic Safe) </li></ul><ul><li>Yeasts and Fungus Can’t Grow in Xylitol </li></ul><ul><li>Cooling and Refreshing </li></ul>
    53. 61. Xylitol Is Hydrophilic
    54. 62. Cooling and Refreshing
    55. 63. Xylitol Is <ul><li>Non- Cariogenic: Does not cause cavities </li></ul><ul><li>Cariostatic: Arrests or Halts the decay Process </li></ul><ul><li>Anti-Cariogenic: Can reverse the caries Process and Repair Incipient Decay </li></ul>
    56. 64. Things To Remember <ul><li>Xylitol Tastes Good, Like Sugar </li></ul><ul><li>Lower Calorie = Less Weight </li></ul><ul><li>Lower Glycemic = Weight Loss </li></ul><ul><li>Can Replace All or Part of Your Sugar </li></ul><ul><li>Good For Teeth </li></ul><ul><li>Prevents Tooth Decay </li></ul><ul><li>Prevents Ear Infections </li></ul><ul><li>Too Much = Laxative Effect </li></ul>
    57. 65. I only Ate the Parts with Xylitol YUMMY
    58. 66. Xylitol can help keep them smiling!
    59. 67. Where <ul><li>Finland – From Wood </li></ul><ul><li>China – From Corn Stocks </li></ul><ul><li>USA – New Source Discovered Very Recently in Lead North Dakota </li></ul>
    60. 68. Xylitol Harvest
    61. 69. Wow! Xylitol is Everywhere
    62. 70. Xylitol Wonderland
    63. 71. Plant Mangers Home
    64. 72. Xylitol Makes You Smile
    65. 73. No Matter How you Stack it Xylitol is Good for Teeth
    66. 74. Things To Remember <ul><li>Xylitol Tastes Good, Like Sugar </li></ul><ul><li>Lower Calorie = Less Weight </li></ul><ul><li>Lower Glycemic = Weight Loss </li></ul><ul><li>Can Replace All or Part of Your Sugar </li></ul><ul><li>Good For Teeth </li></ul><ul><li>Prevents Tooth Decay </li></ul><ul><li>Prevents Ear Infections </li></ul><ul><li>Too Much = Laxative Effect </li></ul>
    67. 75. Dental Caries Process <ul><li>General Plaque Hypothesis </li></ul><ul><li>Specific Plaque Hypothesis </li></ul><ul><li>Ecological Plaque Hypothesis </li></ul>
    68. 76. Ecological Plaque Hypothesis <ul><li>Dental plaque is a biofilm: attach, multiply, organize, adapt </li></ul><ul><li>Organized, diverse multi-specie microbial community in a polymer matrix </li></ul><ul><li>Biofilms less susceptible to antimicrobials </li></ul>
    69. 77. Ecological Plaque Hypothesis <ul><li>Bacterial competition – more than 600 varieties </li></ul><ul><li>Acidic conditions favor harmful bacterial communities (only about two dozen harmful) </li></ul><ul><li>“ Acid Germs” tolerate acid </li></ul><ul><li>“ Acid Germs” process sugars and generate acid </li></ul><ul><li>Repeated sugar/acid cycles demineralize teeth and select for harmful “Acid Germs” </li></ul>
    70. 78. Plaque <ul><li>Planktonic </li></ul><ul><ul><li>Free Floating </li></ul></ul><ul><ul><li>Single Cell </li></ul></ul><ul><ul><li>Easier to remove </li></ul></ul><ul><li>Bio-film </li></ul><ul><ul><li>Organized Community </li></ul></ul><ul><ul><li>Hard to kill </li></ul></ul><ul><ul><li>1000X Antibiotics </li></ul></ul>
    71. 79. Biofilm Development
    72. 80. Why is sucrose so harmful? Energy Acid Food storage
    73. 81. Polysaccharide <ul><li>Intracellular </li></ul><ul><ul><li>Food Storage </li></ul></ul><ul><ul><li>Give them Xylitol </li></ul></ul><ul><ul><ul><li>Gorge them </li></ul></ul></ul><ul><ul><ul><li>Wear them out </li></ul></ul></ul><ul><li>Extracellular </li></ul><ul><ul><li>Plaque </li></ul></ul><ul><ul><li>Acid Formation </li></ul></ul><ul><ul><li>Give Them Xylitol (Slicky instead of Sticky) </li></ul></ul>
    74. 82. Xylitol Keeps Unwanted Bugs Out
    75. 83. Effects of xylitol on plaque… <ul><li>Xylitol is not easily metabolized by Bacteria </li></ul><ul><li>Non-Cariogenic </li></ul><ul><li>Cariostatic </li></ul><ul><li>Anti-Cariogenic </li></ul><ul><li>Reduces MS levels </li></ul>Söderling et al., 1997
    76. 84. Effects of xylitol on plaque: &quot;xylitol-plaque&quot; is thinner than regular plaque, contains less adhesive polysaccharides courtesy of Eva Soderling
    77. 85. Tooth Eruption <ul><li>Xylitol Enhances Early Mineralization. </li></ul><ul><li>Xylitol Inhibits Initial Colonization by MS. </li></ul>An Opportunity To Establish Long-Term Protection
    78. 86. How much? How often? <ul><li>It depends. </li></ul><ul><li>Daily range is between 4 grams (teaspoon) and 12 grams (tablespoon). </li></ul><ul><li>Use at least 3 times each day. </li></ul><ul><li>Strive for 5 </li></ul>
    79. 87. How much? How often? <ul><li>Frequency more important than amount </li></ul><ul><li>Strive for five uses each day </li></ul><ul><li>After each meal and snack </li></ul><ul><li>Toothpaste morning and night </li></ul>
    80. 88. Mouth & Nose <ul><li>Xylitol reduces bacterial adhesion in the mouth (oral care products) & nose (nasal spray) </li></ul><ul><li>Xylitol enhances natural defenses </li></ul>Where Health Begins
    81. 89. Dental Disease & Health <ul><li>Studies show a correlation between poor dental health and cardiovascular disease </li></ul><ul><li>Many systemic health problems averted with good dental health </li></ul>
    82. 90. Xylitol supports our natural defenses by promoting protective factors stimulates saliva increases salivary pH promotes remineralization suppresses acid bacteria such as mutans strep (MS)
    83. 91. Glycemic Index Xylitol supplies a steady flow of energy Adapted from SS Natah et al Am J Clin Nutr (65) 1997
    84. 92. Xylitol’s Role in Diabetes <ul><li>Good Taste-Refreshing and Cooling </li></ul><ul><li>Displacing Equal Amounts of Fast Sugars </li></ul><ul><li>Low Glycemic Index </li></ul><ul><li>Fewer Calories – Zero Net Carbs </li></ul><ul><li>Lowers Serum Fatty Acid Levels </li></ul><ul><li>No Known Harmful Effect on CNS, Hormones </li></ul>
    85. 93. Safety
    86. 94. Don’t overdo a good thing
    87. 95. This is Overdoing It
    88. 96. This is Too Much!!
    89. 97. Don’t Eat the Yellow Xylitol
    90. 98. Don’t make lemonade
    91. 99. Xylitol Is Hydrophilic
    92. 100. Who Can Use Xylitol <ul><li>Orthodontic Patients </li></ul><ul><li>Adults and Elderly </li></ul><ul><li>Persons with Disabilities </li></ul><ul><li>Persons with Dry Mouth </li></ul><ul><li>Athletes </li></ul><ul><ul><li>Increases Fat Utilzation </li></ul></ul><ul><ul><li>Fights Muscle Fatigue </li></ul></ul><ul><li>Everyone Except mans best friend </li></ul>
    93. 101. Don’t give to dogs
    94. 102. Hey Dogs Xylitol is NOT for YOU!
    95. 103. Good Doggie
    96. 104. Thanks for Keeping Me Safe
    97. 105. Make New Friends with Xylitol
    98. 106. Protecting Man’s Best Friend From Xylitol is exhausting Break Time
    99. 107. Xylitol Review
    100. 108. Susceptible Tooth Attacked and Demineralized By Acid Made by Germs From the fermentation of sugars Decay Process: result is cavities – holes in the teeth
    101. 111. Mutans streptococci on enamel
    102. 112. De-Mineralization (Caries v. Cavities)
    103. 113. Caries? Cavities? <ul><li>Caries is the disease process initiated predominately by the Strept Mutans bacteria </li></ul><ul><li>Cavities are the result of the caries disease process </li></ul>
    104. 114. Caries vs. Cavities <ul><li>Caries </li></ul><ul><ul><li>Process </li></ul></ul><ul><ul><li>Presence of Bacteria </li></ul></ul><ul><ul><ul><li>Mutans Strept </li></ul></ul></ul><ul><ul><ul><li>Lactobacillus </li></ul></ul></ul><ul><ul><li>Low Salivary Flow </li></ul></ul><ul><ul><li>Low Salivary ph </li></ul></ul><ul><ul><li>Gingival Bleeding </li></ul></ul><ul><li>Cavities </li></ul><ul><ul><li>Physical manifestation of the caries process </li></ul></ul>
    105. 115. Cavities Caries
    106. 116. Caries to Cavities Progression <ul><li>1- Healthy Tooth </li></ul><ul><li>2- White Spot Lesion The </li></ul><ul><li>Caries Process </li></ul><ul><li>3- Caries Process with </li></ul><ul><li>Cavitation </li></ul><ul><li>4- Filling with Caries </li></ul><ul><li>Process and Cavitation </li></ul><ul><li>5- Continued </li></ul><ul><li>Demineralization and </li></ul><ul><li>Undermined Enamel </li></ul><ul><li>6- Fractured Tooth </li></ul>1996-2002 production by Douglas Bratthall
    107. 117. Damaging vs. Protective <ul><li>Sugar and Fermentable Carbohydrate </li></ul><ul><li>Acid </li></ul><ul><li>Xerostomia </li></ul><ul><li>Virulent “Acid” Bacteria </li></ul><ul><li>Xylitol </li></ul><ul><li>Neutral, alkaline pH </li></ul><ul><li>Saliva </li></ul><ul><li>Calcium, Fluoride </li></ul><ul><li>Non-Acidogenic Bacteria </li></ul>
    108. 118. Damaging vs. Protective Factors Demineralization Remineralization
    109. 119. Tooth decay progresses when damaging factors prevail over protective factors More demineralization than remineralization
    110. 120. Risk Factors
    111. 121. Factors of Dental Disease <ul><li>A pH of 6.3 to 6.7 is a cautionary environment </li></ul><ul><li>A pH of ≤6.2 is a red light (Non-stimulated salivary flow). </li></ul><ul><li>GBI > 3-4 Primary or Permanent </li></ul><ul><li>OHI of Poor or Fair </li></ul><ul><li>High def – dMf – DMF </li></ul><ul><li>Negative Periodontal Assessment </li></ul><ul><ul><li>Localized or Generalized Gingivitis or worse </li></ul></ul><ul><li>Salivary Flow rate of <0.7 ml/min </li></ul><ul><li>History of Cavities or Periodontal problems </li></ul><ul><li>Active Caries Process Noted (Staining) (Diagnodent) </li></ul>
    112. 122. High Risk Factors of Decay for Kids <ul><li>Systemic Diseases </li></ul><ul><li>Compromised Immune System </li></ul><ul><li>Mouth Breathing </li></ul><ul><ul><li>Use of Xlear Nasal Wash to maintain patent airway </li></ul></ul><ul><li>Gums Bleed when Brushing </li></ul><ul><li>Sweetened Medicines </li></ul><ul><li>Family members with Cavities </li></ul><ul><li>Insufficient Fluoride in non fluoridated areas </li></ul><ul><li>Irregular Dental Visits </li></ul><ul><li>Deep unsealed teeth – Primary and Permanent </li></ul><ul><li>Bottles and Sippy Cups filled with milk and sugary liquids </li></ul><ul><li>High intake of fermentable high density Carbs between meals </li></ul><ul><li>Raisins – Cereals - Sugar treats between meals </li></ul><ul><li>History of ECC </li></ul><ul><li>History of Fillings </li></ul>
    113. 123. Eruption Period – Early Mixed Dentition
    114. 124. Eruption Period – Late Mixed Dentition
    115. 125. High Risk Factors of Decay for Adults <ul><li>Systemic Diseases </li></ul><ul><li>Compromised Immune System </li></ul><ul><li>Mouth Breathing </li></ul><ul><li>Gums Bleed when Brushing Orthodontic Appliances </li></ul><ul><li>White spot lesions or incipient lesions on X-Rays </li></ul><ul><li>Sporadic Dental Visits </li></ul><ul><li>Failing Restorations </li></ul><ul><li>High Family Caries Rate </li></ul><ul><li>Disease </li></ul><ul><li>Poor Dexterity </li></ul><ul><li>Inadequate Fluoride Use </li></ul><ul><li>Frequent Intake of Fermentable High Density Carbohydrates </li></ul><ul><li>More than two cavities in the last year or active caries. </li></ul><ul><li>Use of Chewing Tobacco </li></ul><ul><li>Xerostomia by itself or with Exposed Root Surfaces </li></ul><ul><li>Radiation Therapy </li></ul>
    116. 126. Tooth decay progresses when damaging factors prevail over protective factors More demineralization than remineralization
    117. 127. The Caries Risk Test aids in establishing Risk <ul><li>Inactive/No Disease: </li></ul><ul><ul><li>(Caries -) (Cavities -) Low Risk </li></ul></ul><ul><li>Post-Manifest Disease: </li></ul><ul><ul><li>(Caries -) (Cavities +) Moderate Risk </li></ul></ul><ul><li>Pre-Manifest Disease: </li></ul><ul><ul><li>(Caries +) (Cavities -) High Risk </li></ul></ul><ul><li>Manifest Disease: </li></ul><ul><ul><li>(Caries +) (Cavities +) High Risk </li></ul></ul>
    118. 128. Caries Risk Levels 1 & 2 <ul><li>Level 1 Inactive No Disease (Caries -) (Cavities -) </li></ul><ul><ul><li>Anticipatory Guidance </li></ul></ul><ul><ul><ul><li>Home Care and Regular Dental Check-ups </li></ul></ul></ul><ul><li>Level 2 Post-Manifest Disease (Caries -) ( Cavities + ) </li></ul><ul><ul><li>Maintain suppression of caries process </li></ul></ul><ul><ul><ul><li>Restore Lesions </li></ul></ul></ul>
    119. 129. Caries Risk Levels 3 & 4 <ul><li>Level 3 Pre-Manifest Disease ( Caries+) (Cavities -) </li></ul><ul><ul><li>Arrest Caries Process prior to Cavitation </li></ul></ul><ul><li>Level 4 Manifest Disease ( Caries +) (Cavities + ) </li></ul><ul><ul><li>ART Arrest and Restore </li></ul></ul><ul><ul><ul><li>Caries Removal, Mutans Cultures, Anticipatory guidance </li></ul></ul></ul><ul><ul><ul><li>Counseling / Instruction </li></ul></ul></ul><ul><ul><ul><li>Restoration or Other </li></ul></ul></ul>
    120. 130. Non-active disease caries risk level L1: Low Risk <ul><li>Complete Oral Hygiene and Place Sealants if indicated. </li></ul><ul><li>Recommend xylitol sweetened dental products (Tooth Gel, Chewing Gum, Mints, Toothpaste, Mouth Rinse, and/or tooth gel as a Saliva Replacer) and have them available for purchase. </li></ul><ul><li>Recommend and prescribe appropriate fluoride containing products or have available for purchase. </li></ul><ul><li>Reduce or eliminate fermentable high density carbohydrates between meals. We believe this makes good nutritional sense for the whole body. </li></ul><ul><li>Evaluate their ability to maintain mechanical plaque control and make appropriate suggestion, i.e., mechanical tooth brush and other oral hygiene aids. </li></ul><ul><li>Suggest concern for the need of disease control for immediate and close family members to decrease the probability of transmission, i.e., if other members of the family have a high propensity for dental disease it may be only a matter of time until everyone shares the problem. </li></ul><ul><li>Maintain appropriate follow-up and/or testing to be confident that the patient or the parents are engaged in managing to maintain the non-disease state </li></ul>
    121. 131. Non-active disease caries risk level L2: Moderate Risk <ul><li>See that the necessary mechanical dental treatment such as fillings, sealants etc. are rendered. This will remove the source of possible re-infection locally in their mouths. </li></ul><ul><li>Recommend appropriate xylitol sweetened dental products (Tooth Gel, Chewing Gum, Mints, Toothpaste, Mouth Rinse, and/or tooth gel as a Saliva Replacer) and have available for purchase. </li></ul><ul><li>Recommend or prescribe appropriate fluoride containing products or have available for purchase. </li></ul><ul><li>Have the patient reduce or eliminate fermentable high density carbohydrates (p. 99) especially between meals. This makes good nutritional sense for the whole body. </li></ul><ul><li>Evaluate their ability to maintain mechanical plaque control and make appropriate suggestion, i.e., mechanical tooth brush and other oral hygiene aids. </li></ul><ul><li>Suggest concern for the need of disease control for immediate and close family members to decrease the probability of transmission, i.e., if other members of the family have a high propensity for dental disease it may be only a matter of time until everyone shares the problem. </li></ul><ul><li>Maintain appropriate follow-up and/or testing to be confident that the patient or the parents are engaged in managing to maintain a non-disease state. </li></ul>
    122. 132. Active Disease Caries Risk Level L3 or L4: High Risk <ul><li>Treat the disease process (caries) and the necessary mechanical dental treatment (cavities) such as fillings, sealants etc. Note: Prior to placement of orthodontic appliances make sure that the disease process is under control. </li></ul><ul><li>Recommend appropriate xylitol sweetened dental products (Tooth Gel, Chewing Gum, Mints, Toothpaste, Mouth Rinse, and/or tooth gel as a Saliva Replacer) and have available for purchase. </li></ul><ul><li>Recommend or prescribe appropriate fluoride containing products or have available for purchase. </li></ul><ul><li>Treat the active caries disease process as a bacterial infection with an antimicrobial agent, (105-107) xylitol, and fluoride products. </li></ul><ul><li>Have the patient reduce or eliminate fermentable high density carbohydrates (p.99) especially between meals. We believe this makes good nutritional sense for the whole body. </li></ul><ul><li>Evaluate their ability to maintain mechanical plaque control and make appropriate suggestion, i.e., mechanical tooth brush and other oral hygiene aids. </li></ul><ul><li>Suggest concern for the need of disease control for immediate and close family members to decrease the probability of transmission, i.e., if other members of the family have a high propensity for dental disease it may be only a matter of time until everyone shares the problem. </li></ul><ul><li>Maintain appropriate follow-up and retesting until the patient or the parents are engaged in managing the disease. </li></ul>
    123. 133. Before and After <ul><li>Results obtained in our office with Xylitol </li></ul>
    124. 134. 100% Xylitol Gum Only Before After 1 Week
    125. 135. 100% Xylitol Gum Only Before After 3 Weeks
    126. 136. Xylitol Reduces Bacterial Regrowth After Oral Disinfection Hildebrandt GH, Sparks BS. Maintaining mutans streptococci suppression with xylitol chewing gum. J Am Dent Assoc. 2000;131:909-916 | 3 Months
    127. 137. 100% Xylitol Gum and Chlorhexidine Before After 1 Week
    128. 138. 100% Xylitol Gum and Chlorhexidine Before After 2 Weeks
    129. 139. AJS 2-26-2003 Initial examination with oral hygiene and xylitol recommendations
    130. 140. AJS 3-4-2003 After using xylitol for one week
    131. 141. WF 2-26-2003 Inadequate hygiene for fixed orthodontic appliances
    132. 142. WF 3-11-2003 Improvement after two weeks of Xylitol Hygiene
    133. 143. Periodontics <ul><li>Xylitol hygiene can benefit patients with gingivitis or periodontitis. </li></ul><ul><li>Regular Xylitol use helps reduce plaque quantity. </li></ul><ul><li>Plaque becomes less adhesive, less acidic, less inflammatory, and less harmful than sucrose plaque. </li></ul><ul><li>Xylitol helps block re-emergence of cariogenic organisms during periodontal therapy, such as after full-mouth disinfection. </li></ul>
    134. 144. Dry Mouth <ul><li>Many Prescription Drugs Cause Dry Mouth </li></ul><ul><li>Uncomfortable </li></ul><ul><li>Lack of Saliva Leads to Caries </li></ul><ul><li>Root Caries </li></ul>
    135. 145. Factors Affecting Salivary Flow <ul><li>Pharmaceuticals </li></ul><ul><li>Radiation Therapy </li></ul><ul><li>Water Intake </li></ul><ul><li>Xylitol </li></ul>
    136. 146. <ul><li>The caries controlling/preventing effect of xylitol is not based on saliva stimulation only </li></ul>
    137. 147. Effects of xylitol on plaque… <ul><li>Xylitol is not easily metabolized by Bacteria </li></ul><ul><li>Non-Cariogenic </li></ul><ul><li>Cariostatic </li></ul><ul><li>Anti-Cariogenic </li></ul><ul><li>Reduces MS levels </li></ul>Söderling et al., 1997
    138. 148. Staff Responsibilities <ul><li>Assess and Record </li></ul><ul><ul><li>pH </li></ul></ul><ul><ul><li>Salivary Flow </li></ul></ul><ul><ul><li>Gingival Bleeding Index </li></ul></ul><ul><ul><li>Debris Index </li></ul></ul><ul><ul><li>Calculus Index </li></ul></ul><ul><ul><li>Calculate Oral Hygiene Index </li></ul></ul><ul><li>Brushing and Flossing Instructions </li></ul>
    139. 149. Caries Risk Test <ul><li>Provide a basis for evidence based Care </li></ul><ul><li>Provide a basis for customized Treatment </li></ul><ul><ul><li>Evaluation </li></ul></ul><ul><ul><ul><li>Findings </li></ul></ul></ul><ul><ul><li>In Office Treatment </li></ul></ul><ul><ul><ul><li>Dental Practice </li></ul></ul></ul><ul><ul><li>Home Care Measures </li></ul></ul><ul><ul><ul><li>At Home </li></ul></ul></ul>In cooperation with the Polyclinic for Preventive Dentistry, Erfurt, Dental School, Friedrich-Schiller University of Jena, Germany VIVADENT
    140. 150. Caries Risk Test <ul><li>Based on Clinical Judgment </li></ul><ul><li>Great Parent/Patient motivator </li></ul><ul><li>Confirms clinical diagnosis </li></ul><ul><li>Ivoclar/Vivadent incubator </li></ul><ul><li>Test Kit – CRT Bacteria Standard </li></ul><ul><li>Salivary Flow Rate </li></ul>Mutans Strep Lactobacillus
    141. 151. Mutans Strep ≥ 100,000 Colony Forming Units Caries Risk Test
    142. 152. Lactobacillus ≥100,000 Colony Forming Units Caries Risk Test
    143. 153. Gold Standard in Clinical Trials (MS) Growth medium Bacitrasin SM-strips Paraffin Ten tests Flossette
    144. 155. Mother – Child Transmission <ul><li>What do the Clinical Trials Show </li></ul>
    145. 156. Stefan’s Curve Breakfast Lunch Dinner Snacks
    146. 157. Mutans streptococci
    147. 158. <ul><li>Why are mutans streptococci (MS) so important? </li></ul><ul><li>The caries bacteria </li></ul><ul><li>MS form sticky plaque and produce efficiently acids </li></ul>Mutans streptococci on enamel
    148. 159. Xylitol consumption decreases amounts and the adhesivity of MS. Mutans streptococci of habitual xylitol consumers are easily shed to the saliva. Söderling et al., 1991; Trahan et al., 1992 courtesy of Eva Soderling
    149. 160. <ul><li>The effects of xylitol on MS are based on its 5-carbon structure </li></ul><ul><li>Clinical studies support the idea that MS is targeted by xylitol (Vadeboncoeur et al., 1983; Loesche et al., 1984) </li></ul><ul><li>The MS counts remain low as long as the use of xylitol lasts </li></ul>Xylitol
    150. 161. Effects of xylitol on mother-child transmission of mutans streptococci SWEDEN FINLAND
    151. 162. , February 2011) Japan Finland Sweden Finnish, Swedish, Japanese Studies (Courtesy of Eva Soderling Feb. 2011
    152. 163. Protect Your Child with Xylitol – It’s Pretty Cool Stuff Protected Child
    153. 164. Xylitol gel in pacifier for baby Mother uses xylitol chewing gum
    154. 165. Caufield et al., 1993 The window of infectivity for mutans streptococci Caries as an infectious disease: Early colonisation of mutans streptococci (caries bacteria) increases the risk of caries occurence in the future! courtesy of Eva Soderling
    155. 166. Transmission of mutans streptococci <ul><li>The timing of the window of infectivíty can differ in different populations (Florio et al., 2004) </li></ul><ul><li>Factors affecting the transmission: </li></ul><ul><li>The mutans counts of the &quot;infecting&quot; person (>100 000 per ml saliva – common!) </li></ul><ul><li>Number of daily saliva contacts </li></ul><ul><li>Individual susceptibitily of the child (Smith et al., 1998), mode of delivery (Li et al., 2005) </li></ul>courtesy of Eva Soderling
    156. 167. <ul><li>If we can reduce the risk of this transmission could we lower tooth decay in children? </li></ul><ul><li>Lets look at some of the Studies to find out. </li></ul>
    157. 168. Finland:Effects of xylitol on mother-child transmission of mutans streptococI YES!
    158. 169. Wow! This is good!
    159. 170. Finland: Effects of xylitol on childhood caries Isokangas et al., 2000 Caries occurence until 5 yrs YES!
    160. 171. Yum!
    161. 172. Mother’s Dental Care Soderling E, IsokangasP, PienhakkinenK, Tenovuo J. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res. 200;79:1885-9 Chlorhexidine YES!
    162. 173. Soft Banana brush with xylitol gel
    163. 174. When Mothers Use Xylitol, Children Have Fewer Cavities Isokangas P, Soderling E, Pienikakkinen, Alanen P. Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0-5 years of age. J Dent Res. 2000;79:1885-9 YES!
    164. 175. She likes it!
    165. 176. Xylitol Reduces Bacterial Regrowth After Oral Disinfection Hildebrandt GH, Sparks BS. Maintaining mutans streptococci suppression with xylitol chewing gum. J Am Dent Assoc. 2000;131:909-916 | 3 Months YES!
    166. 177. Baby gets cariogenic bacteria from mother Mothers who use xylitol transmit non-cariogenic microflora
    167. 178. With All this Xylitol Your Teeth are Safe
    168. 179. XYLITOL’S Role in Re-mineralization
    169. 180. Remineralization / Cosmetic Enhancement Invention Hypomineralized areas on #8,9 Status before any treatment Status immediately following treatment Example # 1 Treatment Time: 5-7 minutes
    170. 181. Status before any treatment Status immediately following treatment Example #2
    171. 182. Status before treatment. # 8, 9 are to be treated. Note generalized demineralization on maxillary posteriors that will not be professionally treated. Example #3 - Slide 1 of 2 Status of # 8,9 immediately following professional treatment. Please note no change to hypo-mineralized areas in Maxillary posteriors.
    172. 183. Slide 2 of 2 5 months after initial professional treatment to # 8,9. Patient was instructed to use an at-home solution daily. Please note remineralization effects of home solution on maxillary posteriors.
    173. 184. Photos illustrating possible treatment process ~ Slide 1 of 2 Status before any treatment Slight microabrasion of surface
    174. 185. Slide 2 of 2 Chemical Etch Status immediately following treatment
    175. 186. Initial Condition
    176. 187. Same Day After In Office Treatment
    177. 188. <ul><li>“ Xylitol gum enhanced remineralization reduced plaque and improved gingival health.” </li></ul><ul><li>Steinberg LM, Odusola F, Mandel ID: Remineralizing potential, and plaque and </li></ul><ul><li>anti-gingivitis effect of xylitol and sorbitol sweetened chewing gum Clinical </li></ul><ul><li>Nutrition (supplement) 1995 pp. 275-283. </li></ul>
    178. 189. XYLITOL’S Role in Maintenance
    179. 190. Medical Model Medical Model information Adapted from A Comprehensive Review of Pediatric Dentistry Manual , San Diego September 2002. Diagnosis Treat Caries Treat Cavities Maintenance Home / Professional Health Caries+ Cavities + Cavities - Caries - Cavities - Cavities + L1 L2 L3 L4 L4
    180. 191. Elements of Management <ul><li>Date </li></ul><ul><li>Eruption Periods </li></ul><ul><li>Salivary ph </li></ul><ul><li>GBI - Gingival Bleeding Index </li></ul><ul><li>Decayed, missing, filled </li></ul><ul><li>DI/CI – Debris Index/Calculus </li></ul><ul><li>OHI - Oral health Index </li></ul><ul><li>BFI/Pro-Flo Brushing, Flossing Instructions/ Prophy </li></ul><ul><li>Caries Risk </li></ul><ul><li>Periodontal Condition </li></ul><ul><li>Photographs </li></ul><ul><li>CRT/SF Caries Risk Test/ Salivary Flow </li></ul><ul><li>CRT Mutans Strep/Lacto Bac </li></ul><ul><li>100% Xylitol Chewing Gum </li></ul><ul><li>100% Xylitol Product Reco’s </li></ul><ul><li>Fluoride Reco’s </li></ul><ul><li>CHX – Chlorhexidine </li></ul><ul><li>Nutritional Information </li></ul><ul><li>Treat Cavities </li></ul><ul><li>Follow-up Treatment Date </li></ul><ul><li>Referral </li></ul>
    181. 192. Maintenance <ul><li>Regular xylitol use should be encouraged as a routine healthy habit, a continuing part of a normal oral hygiene regimen. </li></ul><ul><li>“ The best use of xylitol is as an addition to other oral hygiene recommendations.” </li></ul><ul><li>Peldyak, John DMD; Makinen, Kauko K. PhD: Xylitol for Caries Prevention. Journal of Dental Hygiene Volume 67 Number IV Fall 2002, pp. 276-285. </li></ul>
    182. 193. How To Use Xylitol <ul><li>“ Xylitol should be used immediately after every meal and snack. </li></ul><ul><li>3-5 Times a Day </li></ul><ul><li>Gum or Mint should be used for at least 3-5 minutes </li></ul><ul><li>Can be Used at any other time you desire. </li></ul><ul><li>Peldyak, John DMD; Makinen, Kauko K. PhD: Xylitol for Caries Prevention. </li></ul><ul><li>Journal of Dental Hygiene Volume 67 Number IV Fall 2002, pp. 276-285. </li></ul>
    183. 194. Long-term effect of xylitol. <ul><li>When Used for 2 Years </li></ul><ul><li>Cavity Reducing Effect lasts for 3-5 Years </li></ul><ul><li>Peldyak John DMD, Makinen Kauko K PhD: Xylitol for Caries Prevention. </li></ul><ul><li>Journal of Dental Hygiene Volume 76 Number IV Fall 2002; pp. 276-285. </li></ul>
    184. 195. Who Can Use Xylitol <ul><li>Orthodontic Patients </li></ul><ul><li>Adults and Elderly </li></ul><ul><li>Persons with Disabilities </li></ul><ul><li>Persons with Dry Mouth </li></ul><ul><li>Athletes </li></ul><ul><ul><li>Increases Fat Utilization </li></ul></ul><ul><ul><li>Fights Muscle Fatigue </li></ul></ul><ul><li>Everyone Except Dogs </li></ul>
    185. 196. Caries process successfully managed when <ul><li>Salivary Mutans stays low. </li></ul><ul><li>No gingival inflammation. </li></ul><ul><li>Caries excavation complete, lesion appearance changed (arrested). </li></ul><ul><li>Patients or Parents of patients engaged in managing disease. </li></ul>
    186. 197. Historical factors for low risk. <ul><li>Opposite of high risk factors </li></ul><ul><li>Dental health awareness. </li></ul><ul><li>No cavities within the last year or two. </li></ul><ul><li>Regular dental visits. </li></ul><ul><li>History of few cavities in the rest of the family. </li></ul><ul><li>For adults and children no tobacco use. </li></ul><ul><li>Good regular use of fluoride products. </li></ul><ul><li>Adequately restored surfaces on a minimal number of teeth no foiling or creeping restorations. </li></ul><ul><li>Deep pit and fissures are sealed. </li></ul><ul><li>Low dietary intake of Fermentable High Density Carbohydrates. </li></ul><ul><li>In Children no history of Early Childhood Caries, no or little history of medicines high in sucrose or syrup, no fluids in bottle or sippy cups that contain any form of sugar especially between regular feedings or left in bed with bottle or allowed to carry the vessel around except with water. </li></ul>
    187. 198. Carbonated drinks are the single biggest source of refined sugars in the American diet. According to dietary surveys, soda pop provides the average American with 7 teaspoons of sugars per day, out of a total of about 20 teaspoons. Teenage boys get 44 percent of their 34 teaspoons of refined sugars a day from soft drinks. Teenage girls get 40 percent of their 24 teaspoons of sugars from soft drinks. Because some people drink little or no soda pop, the percentage of refined sugars provided by pop is higher among actual drinkers.
    188. 199. Would You Like To Significantly: <ul><li>Decrease Decay In Your Mouth? </li></ul><ul><li>Decrease Decay In Your Kids Mouths? </li></ul><ul><li>Decrease Decay In Your Grandkids Mouths? </li></ul>
    189. 200. Benefits of Xylitol for Patients <ul><li>Effective </li></ul><ul><li>Convenient </li></ul><ul><li>Enjoyable </li></ul><ul><li>Result is improved cooperation and excellent oral hygiene </li></ul>Xylitol on a picnic… Xylitol at the big game
    190. 201. Product Types
    191. 202. Product Types Toothpaste Oral Rinse Dental Cleansing Gel Mints Gum Moisturizing breath freshener
    192. 203. Spiffies Infant Wipes
    193. 206. Banana Brush
    194. 207. Joint Venture Product
    195. 208. Joint Venture
    196. 210. Ultradent
    197. 211. Enjoy
    198. 212. Old way
    199. 214. Find a Bug Use a Drug
    200. 215. New Way With Xylitol
    201. 216. Show ’em the door Makes plaque Slicky instead of Sticky
    202. 217. Slam it shut Xylitol Lives Here
    203. 218. Xylitol blocks the tooth-damaging factors
    204. 219. Xylitol Features <ul><li>Sweet, cooling, no aftertaste </li></ul><ul><li>Naturally-occurring in human metabolism </li></ul><ul><li>Low calorie (40% less than sugar) </li></ul><ul><li>Low Glycemic (about 10% of Glucose) </li></ul><ul><li>Low insulin usage to metabolize </li></ul><ul><li>No Maillard reaction </li></ul><ul><li>Slows stomach emptying – increases satiety (feelings of fullness) </li></ul><ul><li>Energy source (Used in IV Nutrition) </li></ul><ul><li>Enhances Calcium absorption </li></ul><ul><li>Helps prevent tooth decay </li></ul><ul><li>Helps prevents ear and upper respiratory infections </li></ul>
    205. 220. Things To Remember <ul><li>Xylitol Tastes Good, Like Sugar </li></ul><ul><li>Lower Calorie = Less Weight </li></ul><ul><li>Lower Glycemic = Weight Loss </li></ul><ul><li>Can Replace All or Part of Your Sugar </li></ul><ul><li>Good For Teeth </li></ul><ul><li>Prevents Tooth Decay </li></ul><ul><li>Prevents Ear Infections </li></ul><ul><li>Too Much = Laxative Effect </li></ul>
    206. 221. How much? How often? <ul><li>Frequency more important than amount </li></ul><ul><li>4 to 12 grams (teaspoon is 4 grams) </li></ul><ul><li>6 to 10 pieces of gum/day </li></ul><ul><ul><li>Active Strep Mutans infections in adults require at least 6 grams (8 or more pieces of gum) </li></ul></ul><ul><li>Aim for five uses each day </li></ul><ul><li>After each meal and snack </li></ul><ul><li>Toothpaste morning and night </li></ul>
    207. 222. Use 100% Xylitol Products
    208. 223. Xylitol Keeps Them Smiling
    209. 224. 5 Levels of Caries Control <ul><li>Remineralization </li></ul><ul><li>Disinfect </li></ul><ul><li>Oral Hygiene </li></ul><ul><li>Xylitol </li></ul><ul><li>Environment </li></ul>
    210. 225. Environment, Whole Food and Whole Food Supplements Xylitol protocols and Products Office Oral Hygiene Program Oral Disinfection Remineralization Ease of Management Effect on Oral Health Least Most Easy Hard
    211. 226. Whole Food – Level 1 <ul><li>Diet – Real Food </li></ul><ul><ul><li>Less Processed Products </li></ul></ul><ul><li>Supplements </li></ul><ul><li>And Environment </li></ul><ul><ul><li>Toxins </li></ul></ul><ul><ul><li>Air </li></ul></ul><ul><ul><li>Water </li></ul></ul><ul><ul><li>Stress </li></ul></ul><ul><ul><li>Change in habits and life style </li></ul></ul>
    212. 227. Adapted from the book: From Here to Longevity by Dr. Mitra Ray Ph.D. with Patricia Cannon Childs
    213. 228. Saliva Calcium Phosphorus Xylitol Gum
    214. 229. Adapted with permission from the book: From Here to Longevity by Dr. Mitra Ray Ph.D. with Patricia Cannon Childs
    215. 230. S. Mutans
    216. 232. Essential Nutrient Needs of Our Bodies <ul><li>Macro Nutrients: Air, Water, Protein, Fats, Carbohydrates, and Fiber. </li></ul><ul><li>Micro Nutrients: Vitamins, Minerals, Essential Fatty Acids, Amino Acids, </li></ul><ul><li>Enzymes, Pre and Pro Biotics. </li></ul>
    217. 233. What We’ve Learned <ul><li>What you eat affects the health of your mouth, body, and life </li></ul><ul><li>That it is best to avoid sugar, white flour products, vegetables oils, and trans-fats </li></ul><ul><li>That it is best to drink pure filtered water and eat fresh proteins, fresh vegetables, and salads </li></ul><ul><li>That it is better for you to eat foods less processed food </li></ul><ul><li>That it is best for you to eat foods closest to their natural state </li></ul><ul><li>That it is essential to support your nutrition with concentrated whole food supplements, because the foods we consume today are not as nutrient dense as they were 100 years ago. </li></ul>
    218. 234. To Summarize: We believe that whole food nutrition , as close to the natural state that one can obtain, supplemented by the use of concentrated whole food supplements is the essential foundation for a healthy mouth and body.
    219. 235. Food to Choose (Organic) <ul><li>Home grown in your own garden or pasture </li></ul><ul><li>Fresh picked (Farmers Markets) </li></ul><ul><li>Fresh frozen </li></ul><ul><li>Fresh as it can be in grocery store meat, fish, and produce section </li></ul>
    220. 236. Xylitol – Level II
    221. 239. Things To Remember <ul><li>Xylitol Tastes Good, Like Sugar </li></ul><ul><li>Lower Calorie = Less Weight </li></ul><ul><li>Lower Glycemic = Weight Loss </li></ul><ul><li>Can Replace All or Part of Your Sugar </li></ul><ul><li>Good For Teeth </li></ul><ul><li>Prevents Tooth Decay </li></ul><ul><li>Prevents Ear Infections </li></ul><ul><li>Too Much = Laxative Effect </li></ul>
    222. 240. Oral Hygiene – Level III <ul><li>Cleaning, x-rays, Exam, Fluoride </li></ul><ul><ul><li>1. Report Card Presentation </li></ul></ul><ul><ul><li>2. Findings </li></ul></ul><ul><ul><li>3. Reason for follow-up </li></ul></ul><ul><ul><li>4. Objective Data and assessment </li></ul></ul><ul><ul><li>5. Provider Recommendations </li></ul></ul>
    223. 242. 1. Report Card <ul><li>Cavity Risk </li></ul><ul><li>Gum Health </li></ul><ul><li>Referral </li></ul>
    224. 243. 2. Dental Exam Findings <ul><li>Dental Needs </li></ul><ul><li>Head and Neck </li></ul><ul><li>Intro Oral Soft Tissues </li></ul><ul><li>Intra Oral Teeth </li></ul><ul><li>X-Rays </li></ul>
    225. 245. 3. Follow up Care - Recall <ul><li>Preventative Care </li></ul><ul><li>Early Cavity Detection </li></ul><ul><li>X-Rays for Cavity Detection </li></ul><ul><li>Monitor Eruption </li></ul><ul><li>Monitor Stained Areas </li></ul><ul><li>Monitor Spots between Teeth </li></ul><ul><li>Soft Tissue Check </li></ul><ul><li>Monitor Spacers </li></ul><ul><li>Check Crowns/Fillings </li></ul>
    226. 247. 4. Objective Data and Assessment <ul><li>Date </li></ul><ul><li>Eruption Period </li></ul><ul><li>pH </li></ul><ul><li>Bleeding Gums </li></ul><ul><li>Plaque </li></ul><ul><li>Oral Hygiene Instruction </li></ul><ul><li>Cleaning and Fluoride </li></ul><ul><li>Gum Disease </li></ul><ul><li>Cavity Risk </li></ul>
    227. 249. 5. Provider Recommendations <ul><li>Daily Xylitol </li></ul><ul><li>Daily Fluoride </li></ul><ul><li>Professional Care </li></ul>
    228. 252. Oral Disinfection – Level IV <ul><li>Perioguard - Chlorhexidine </li></ul><ul><li>Betadyne – Povidone Iodine </li></ul><ul><li>CloSysII – Chlorine Dioxide </li></ul>
    229. 253. Remineralization – Level V <ul><li>Ionizable minerals </li></ul><ul><ul><li>Calcium Lactate </li></ul></ul><ul><ul><li>Calcium Citrate </li></ul></ul><ul><ul><li>Calcium Glycerol Phosphate </li></ul></ul><ul><li>Fluoride </li></ul><ul><ul><li>Listerine, Act, Fluoguard…. </li></ul></ul><ul><ul><li>Prevent 5000 </li></ul></ul>
    230. 254. Slide Show Review Thank You
    231. 255. Quotes
    232. 256. Xylitol Is: <ul><ul><li>Non-Cariogenic: </li></ul></ul><ul><ul><li>Does not contribute to the caries disease process. </li></ul></ul><ul><ul><li>Cariostatic: </li></ul></ul><ul><ul><li>The caries disease process does not occur in the presence of </li></ul></ul><ul><ul><li>Xylitol. </li></ul></ul><ul><ul><li>Anti-Cariogenic: </li></ul></ul><ul><ul><li>The caries disease process may be reversed through appropriate exposure to Xylitol. </li></ul></ul>
    233. 257. Xylitol is Anti-Cariogenic <ul><li>“ The highest caries reduction rates were observed in subjects using Xylitol.” </li></ul>Hayes, Catherine D.M.D. D.M.Sc: The effect of Non-Cariogenic Sweeteners on the Prevention of Dental Caries: A review of the evidence Journal of Dental Education October 2001/Vol.65/No. 10pp. 1106-1109.
    234. 258. <ul><li>“ Studies are remarkably consistent, in the terms of the magnitude of the effect observed as well as the consistent demonstration of the superiority of Xylitol compared to sorbitol in decreasing the risk of dental caries.” </li></ul><ul><li>Hayes, Catherine D.M.D D.M.S c: The effect of Non-Cariogenic Sweeteners </li></ul><ul><li>on the Prevention of Dental Caries: A review of the evidence Journal of Dental </li></ul><ul><li>Education October 2001/Vol.65/No. 10pp. 1106-1109. </li></ul>
    235. 259. <ul><li>Xylitol is non-acidogenic and non-cariogenic. </li></ul><ul><li>Xylitol is essentially non-fermentable and therefore cannot be converted to acids by oral bacteria. </li></ul><ul><li>Xylitol can be left on teeth overnight and not cause any damage. </li></ul><ul><li>All from Peldyak John DMD: Xylitol Sweeten Your Smile ; Advanced Developments, Inc. Mt. Pleasant, MI p.8. </li></ul>
    236. 260. How Safe is Xylitol <ul><li>“ In the amounts needed to prevent tooth decay (less than 15 grams per day), Xylitol is safe for everyone.” </li></ul><ul><li>Peldyak, John D.M.D, Xylitol Sweeten Your Smile Advanced Developments, Inc. Mt Pleasant, MI 48804-1010. </li></ul><ul><li>“ Xylitol with adaptation is well tolerated and safe to levels of at least 90 grams/day, with no subjective or objective adverse findings.” </li></ul><ul><li>Brin M, Miller ON: The safety of oral xylitol in: Sugars in Nutrition Sipple HL (ed) Academic Press New York 1974 pp. 591-605. </li></ul>.
    237. 261. <ul><li>“ Xylitol gum enhanced remineralization reduced plaque and improved gingival health.” </li></ul><ul><li>Steinberg LM, Odusola F, Mandel ID: Remineralizing potential, and plaque and </li></ul><ul><li>anti-gingivitis effect of xylitol and sorbitol sweetened chewing gum Clinical </li></ul><ul><li>Nutrition (supplement) 1995 pp. 275-283. </li></ul>
    238. 262. Xylitol’s Main Side Effect <ul><li>Xylitol is very hydrophilic and a side effect may be slight gastric distress and slight osmotic diarrhea. Consider starting with a slight dose then increasing or informing the patient if they have any problem to cut back for a while and build up to level recommend as tolerated </li></ul>Dr. John Peldyak DMD in his book “ Xylitol Sweeten Your Smile ”; Advanced Developments, Inc. Mt. Pleasant, MI. 48804-1010, 1996, pp.5-6.
    239. 263. Xylitol Studies Chart, outline and references 1-15 are courtesy of Dr. John Peldyak Mt. Pleasant Michigan.
    240. 264. References www.ADRdental.com
    241. 265. <ul><li>Turku, Finland (1) -- Xylitol (67g/day) replaced dietary sugar (sucrose), 1 </li></ul><ul><li>Turku, Finland (2) -- Xylitol (6.7g/day) was used only in chewing gum.1 </li></ul><ul><li>Soviet Union -- Control group also had more severe “deep” lesions and pulpitis.2 </li></ul><ul><li>French Polynesia -- Both control group and xylitol group received basic oral hygiene with fluoride toothpaste. ³ </li></ul><ul><li>Hungary -- The xylitol group also had lower caries rate than a group which received fluoride.4, 5 </li></ul><ul><li>Montreal, Canada -- Chewing gum contained a mixture of xylitol and sorbitol.6, 7 </li></ul><ul><li>Ylivieska, Finland -- Comprehensive prevention program was improved by the addition of xylitol gum. Long-term benefit of xylitol was established.8-10 </li></ul><ul><li>Belize -- Chewing gum sweetened exclusively with xylitol was more effective in preventing caries than sorbitol or xylitol-sorbitol mixtures. Sucrose gum increased caries incidence.11, 12 </li></ul><ul><li>Stann Creek -- Five year follow-up of Belize trial demonstrated lasting benefit of xylitol use.13 </li></ul><ul><li>Dayton -- Supragingival root surface caries were studied.14 </li></ul><ul><li>Estonia -- Xylitol candy was as effective as xylitol chewing gum in reducing caries.15 </li></ul>
    242. 266. <ul><li>Galiullin AN: Evaluation of the caries-prevention action of xylitol . Kazan Med. J 1981:67:16-18. </li></ul><ul><li>Kandelman D, Bär A, Hefti A: Collaborative WHO xylitol field study in French Polynesia. 1. Baseline prevalence and 32 month caries increment. Caries Res 1988; 2:55-62. </li></ul><ul><li>Scheinin A, Banóczy J, Szóke J, et al: Three-years caries activity in institutionalized children. Acta Odont Scand 1985; 43:327-347. </li></ul><ul><li>Scheinin A, Mäakinen KK: Turku sugar studies I-XXI. Acta Odont Scand 1975; 33:suppl 70, 1-348. </li></ul><ul><li>Scheinin A, Pienihäkkinen K, Tiekso J, Banóczy J, et al: Collaborative WHO xylitol field studies in Hungary. VIII. Two-year caries incidence in 976 institutionalized children. Acta Odont Scand 1985; 43:381-387. </li></ul><ul><li>Kandelman D, Gagnon G: Clinical results after 12 months from a study of the incidence and progression of dental caries in relation to consumption of chewing gums containing xylitol in school preventive programs. J Dent Res 1987; 66:1407-1411. </li></ul><ul><li>Kandelman D, Gagnon A: A 24-month clinical study of the incidence and progression of dental caries in relation to consumption of chewing gums containing xylitol in school preventive programs. J Dent Res 1990; 69:1771-1775. </li></ul>
    243. 267. <ul><li>Isokangas P Alanen P, Tiekso J, Mäkinen KK: Xylitol chewing gum in caries prevention: a field study in children. J Am Dent Assoc 1988; 17:315-320 </li></ul><ul><li>Isokangas P, Tiekso J, Alanen P, Mäkinen KK: Long-term effect of xylitol chewing gum in the prevention dental caries. Comm Dent Oral Epidemiol 1989; 17:200-203. </li></ul><ul><li>Isokangas P, Mäkinen KK, Tiekso J, Alanen P: Long-term effect of xylitol chewing gum in the prevention dental caries: A follow-up five years after termination of a prevention program. Caries Res 1993; 27:495-498. </li></ul><ul><li>Mäkinen KK, Bennett CA, Hujoel PH, it al: Xytiltol chewing gums and caries rates: a 40-month cohort study. J Dent Res 1995; 74 1904-1913. </li></ul><ul><li>Mäkinen KK, Hujoel PH, Bennett CA, Isotupa KP, et al: Polyol chewing gums and caries rates in primary dentition: a 24 month cohort study. Caries Res 1996; 30:408-417. </li></ul><ul><li>Mäkinen KK, Allen P, Bennett CA, et al: Stabilization of rampant caries: polyol gums and arrest of dentin caries in two long-term cohort studies in young subjects. Int Dent J 1995; 45: 93-107. </li></ul><ul><li>Mäkinen KK, Pemberton D, Mäkinen P-L et al: Polyol-combinant saliva stimulants and oral health in Veterans Affairs patients--an exploratory study. Spec Care Dent 1996; 16:104-116. </li></ul><ul><li>Alanen P, Isokangas P, Gutmann K: Xylitol candies in caries prevention: results of a field study in Estonian children. Community Dent Oral Epidemiol 2000; 28:218-224. </li></ul>
    244. 268. <ul><li>Turku, Finland (1) -- Xylitol (67g/day) replaced dietary sugar (sucrose), 1 </li></ul><ul><li>Turku, Finland (2) -- Xylitol (6.7g/day) was used only in chewing gum.1 </li></ul><ul><li>Soviet Union -- Control group also had more severe “deep” lesions and pulpitis.2 </li></ul><ul><li>French Polynesia -- Both control group and xylitol group received basic oral hygiene with fluoride toothpaste. ³ </li></ul><ul><li>Hungary -- The xylitol group also had lower caries rate than a group which received fluoride.4, 5 </li></ul><ul><li>Montreal, Canada -- Chewing gum contained a mixture of xylitol and sorbitol.6, 7 </li></ul><ul><li>Ylivieska, Finland -- Comprehensive prevention program was improved by the addition of xylitol gum. Long-term benefit of xylitol was established.8-10 </li></ul><ul><li>Belize -- Chewing gum sweetened exclusively with xylitol was more effective in preventing caries than sorbitol or xylitol-sorbitol mixtures. Sucrose gum increased caries incidence.11, 12 </li></ul><ul><li>Stann Creek -- Five year follow-up of Belize trial demonstrated lasting benefit of xylitol use.13 </li></ul><ul><li>Dayton -- Supragingival root surface caries were studied.14 </li></ul><ul><li>Estonia -- Xylitol candy was as effective as xylitol chewing gum in reducing caries.15 </li></ul>
    245. 269. <ul><li>Galiullin AN: Evaluation of the caries-prevention action of xylitol . Kazan Med. J 1981:67:16-18. </li></ul><ul><li>Kandelman D, Bär A, Hefti A: Collaborative WHO xylitol field study in French Polynesia. 1. Baseline prevalence and 32 month caries increment. Caries Res 1988; 2:55-62. </li></ul><ul><li>Scheinin A, Banóczy J, Szóke J, et al: Three-years caries activity in institutionalized children. Acta Odont Scand 1985; 43:327-347. </li></ul><ul><li>Scheinin A, Mäakinen KK: Turku sugar studies I-XXI. Acta Odont Scand 1975; 33:suppl 70, 1-348. </li></ul><ul><li>Scheinin A, Pienihäkkinen K, Tiekso J, Banóczy J, et al: Collaborative WHO xylitol field studies in Hungary. VIII. Two-year caries incidence in 976 institutionalized children. Acta Odont Scand 1985; 43:381-387. </li></ul><ul><li>Kandelman D, Gagnon G: Clinical results after 12 months from a study of the incidence and progression of dental caries in relation to consumption of chewing gums containing xylitol in school preventive programs. J Dent Res 1987; 66:1407-1411. </li></ul><ul><li>Kandelman D, Gagnon A: A 24-month clinical study of the incidence and progression of dental caries in relation to consumption of chewing gums containing xylitol in school preventive programs. J Dent Res 1990; 69:1771-1775. </li></ul>
    246. 270. <ul><li>Isokangas P Alanen P, Tiekso J, Mäkinen KK: Xylitol chewing gum in caries prevention: a field study in children. J Am Dent Assoc 1988; 17:315-320 </li></ul><ul><li>Isokangas P, Tiekso J, Alanen P, Mäkinen KK: Long-term effect of xylitol chewing gum in the prevention dental caries. Comm Dent Oral Epidemiol 1989; 17:200-203. </li></ul><ul><li>Isokangas P, Mäkinen KK, Tiekso J, Alanen P: Long-term effect of xylitol chewing gum in the prevention dental caries: A follow-up five years after termination of a prevention program. Caries Res 1993; 27:495-498. </li></ul><ul><li>Mäkinen KK, Bennett CA, Hujoel PH, it al: Xytiltol chewing gums and caries rates: a 40-month cohort study. J Dent Res 1995; 74 1904-1913. </li></ul><ul><li>Mäkinen KK, Hujoel PH, Bennett CA, Isotupa KP, et al: Polyol chewing gums and caries rates in primary dentition: a 24 month cohort study. Caries Res 1996; 30:408-417. </li></ul><ul><li>Mäkinen KK, Allen P, Bennett CA, et al: Stabilization of rampant caries: polyol gums and arrest of dentin caries in two long-term cohort studies in young subjects. Int Dent J 1995; 45: 93-107. </li></ul><ul><li>Mäkinen KK, Pemberton D, Mäkinen P-L et al: Polyol-combinant saliva stimulants and oral health in Veterans Affairs patients--an exploratory study. Spec Care Dent 1996; 16:104-116. </li></ul><ul><li>Alanen P, Isokangas P, Gutmann K: Xylitol candies in caries prevention: results of a field study in Estonian children. Community Dent Oral Epidemiol 2000; 28:218-224. </li></ul>
    247. 272. Findings <ul><li>“ Xylitol was clinically proven to be Non-Cariogenic.” </li></ul>Scheinin A, Mäkinen KK: Turku sugar studies I-XXI Acta Odontologica Scandinavia 33 (suppl 70): 1975
    248. 273. Findings <ul><li>“ Results suggest… that high-xylitol content chewing gum usage can retard or arrest rampant dentine caries.” </li></ul>Mäkinen KK, Mäkinen PL, Pape HR.: Stabilization of rampant caries: polyol gums and arrest of dentine caries in two long-term cohort studies in young subjects. Int. Dent J 1995b; 45:93-107

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