Academy of Dental Resources' San Francisco PowerPoint presentation 2011

DDS, CNC, ND “ Sweet Success with Xylitol” Thank You CSPD! San Francisco April 9 th 2011 DDS, CNC, ND

My Contact Information
[email_address]
208-478-5437

Sucrose sugar is the standard for comparison “ sugar substitutes” Attempt to duplicate the taste And some functional properties

Sucrose “ Sugar” on food ingredients labels, ordinary table sugar, cane sugar, beet sugar disaccharide 12-carbon

Glucose (D-glucose, dextrose, corn sugar, blood sugar, monosaccharide, 6-carbon) Fructose (fruit sugar) monosaccharide, 6-carbon)

M altose (malt sugar) disaccharide, 12-carbon) Glucose (D-glucose, dextrose, corn sugar, blood sugar) monosaccharide, 6-carbon)

Maltodextrin Oligosaccharide 3 – 19 glucose units

Starch Polymer, Polysaccharide, Amylose 200 – 1000 glucose units

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)

Sweeteners
Bulk -- Functional Properties
Sugars (mono- and di-saccharides)
Polyols (Sugar alcohols)
Intense -- High Potency
Artificial
Natural

Sweeteners
Intense (High potency super sweeteners)
Aspartame (200x)
Sucralose (600x)
Saccharine (400x)
Acesulfame Potassium (Ace K) (200x)
Licorice (glycyrrhizin) (30-50x)
Stevia (steviosides, reboudisides)(300x)
Neotame (up to 13,000 x)

Sugar “-ose” by Other Names
“ ose” ending (major dietary sugars are sucrose, glucose, fructose, lactose)
Syrup (sugars dissolved in water)
Corn syrup
HFCS High Fructose Corn Syrup
Starch (processed and cooked)
Maltodextrin

Corn Syrup Water, glucose High Fructose Corn Syrup Glucose converted to fructose by enzymes Water, glucose, fructose (42-95%)

Fructose
Fast sugar
Most water soluble
Liver metabolic bottleneck
Maillard reaction rapid non-enzymatic browning

Glycation
Non-enzymatic glycosylation
Maillard Reaction: Modification of protein =browning
Leads to formation of (AGE’s Advanced Glycation End-products)

AGE’s
Toast
Glycated hemoglobin (diabetes)
Hba1c test
Collagen -- wrinkles

Why is sucrose so harmful? Energy Acid Food storage

Sugar Increases the Bugs

Watch for “Hidden Sugar” Cough Drops Chewable vitamins Breath mints Fruit juices Dried fruits Sports Drinks Syrup medicines

But Don’t Forget the Obvious

Too Much Sugar

Way to Much Sugar Germs Sugar Acid Plaque

Way Way Way to Much Sugar … . But

On Teeth It is all just Sugar

American Heart Association Recommends less than 100 calories from added sugars (6.2 sugar cubes) per day for adult women

From sugar cane or sugar beets It’s all just Sugar

Conflicts of Interest
Spry Dental – Consultant 2001-2004
My Xylitol
www.myxylitol.com
Academy of Dental Resources
www.adrdental.com
Designs for Health
www.designsforhealth.com

Professional Education
Dental Practice 1978-1995 General 1997-present Children only
Education
General Dentist – Practice limited to Kids
CCN – Certified Nutritional Consultant
NART – Nutrition Autonomic Response Testing
ND – Naturopathic Doctor
ACIMD American College of Integrative Medicine and Dentistry
Publications
Practical Application of Xylitol
Finnish Dental Journal Supplement 1,2006

My Personal Xylitol History
Fall of 1999 Dr. Russ Misner
KlearChoice Chewing Gum
2001-2003 Xlear Dental Consultants
2002 Developed ToothGel
2004 Created ADR Xylitol CE Course
2005-2007 Patent pending gels and TP’s
2004-2009 Office Implementation
2011 Orthodontic Module Release

Our Xylitol Journey Begins 1999 Dr. Larry Bybee Dr. Russ Misner

KlearChoice
1999-2000
They packaged the gum with our label
We spoke with individual dental offices
Pretty soon we were moving 500-600 tubs a month

Xylitol Consultants
2001
Teamed with Xlear
15-20 Dental show per year
Tons of fun but a lot of travel

Toothgel 2002
Formulated in Dr. Misner’s Kitchen
= + Calcium Glycerylphosphate Xylitol + +

Today's Packaging

ADR
CE Course on Xylitol
DVD’s
Manual
Forms CD
Brochures

Orthodontic Module Release all 2011 (I Hope  )

Sweet Success with Xylitol

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.

Reframing From “manage the damage or drill and fill” to health promotion and self care decay prevention From helpless victim to proactive self-care

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.

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

Why Xylitol?
Tastes good
Delightful sugary taste
Cooling effect
It works
Helps prevent dental caries
and upper respiratory infections

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

x ylitol

Sorbitol (polyol) 6-carbon Xylitol (polyol) 5-carbon

Xylitol (polyol) 5-carbon

When
1891 – Emil Fischer
1950 – Identified in Human Metab.
1963 – Approved by FDA for special dietary purposes
1969 – Used intravenously in Australia
1970-1988 Studied Safe for Teeth
1990-Present Reduces Dental Decay

Properties

Relative Sweetness

Other Xylitol Properties
Hydrophilic – Draws Moisture
Increases Salivary Flow
Decreases acid strength in the Mouth
Low Glycemic Index (Diabetic Safe)
Yeasts and Fungus Can’t Grow in Xylitol
Cooling and Refreshing

Xylitol Is Hydrophilic

Cooling and Refreshing

Xylitol Is
Non- Cariogenic: Does not cause cavities
Cariostatic: Arrests or Halts the decay Process
Anti-Cariogenic: Can reverse the caries Process and Repair Incipient Decay

Things To Remember
Xylitol Tastes Good, Like Sugar
Lower Calorie = Less Weight
Lower Glycemic = Weight Loss
Can Replace All or Part of Your Sugar
Good For Teeth
Prevents Tooth Decay
Prevents Ear Infections
Too Much = Laxative Effect

I only Ate the Parts with Xylitol YUMMY

Xylitol can help keep them smiling!

Where
Finland – From Wood
China – From Corn Stocks
USA – New Source Discovered Very Recently in Lead North Dakota

Xylitol Harvest

Wow! Xylitol is Everywhere

Xylitol Wonderland

Plant Mangers Home

Xylitol Makes You Smile

No Matter How you Stack it Xylitol is Good for Teeth

Things To Remember
Good For Teeth

Dental Caries Process
General Plaque Hypothesis
Specific Plaque Hypothesis
Ecological Plaque Hypothesis

Dental plaque is a biofilm: attach, multiply, organize, adapt
Organized, diverse multi-specie microbial community in a polymer matrix
Biofilms less susceptible to antimicrobials

Bacterial competition – more than 600 varieties
Acidic conditions favor harmful bacterial communities (only about two dozen harmful)
“ Acid Germs” tolerate acid
“ Acid Germs” process sugars and generate acid
Repeated sugar/acid cycles demineralize teeth and select for harmful “Acid Germs”

Plaque
Planktonic
Free Floating
Single Cell
Easier to remove
Bio-film
Organized Community
Hard to kill
1000X Antibiotics

Biofilm Development

Why is sucrose so harmful? Energy Acid Food storage

Polysaccharide
Intracellular
Food Storage
Give them Xylitol
Gorge them
Wear them out
Extracellular
Plaque
Acid Formation
Give Them Xylitol (Slicky instead of Sticky)

Xylitol Keeps Unwanted Bugs Out

Effects of xylitol on plaque…
Xylitol is not easily metabolized by Bacteria
Non-Cariogenic
Cariostatic
Anti-Cariogenic
Reduces MS levels
Söderling et al., 1997

Effects of xylitol on plaque: "xylitol-plaque" is thinner than regular plaque, contains less adhesive polysaccharides courtesy of Eva Soderling

Tooth Eruption
Xylitol Enhances Early Mineralization.
Xylitol Inhibits Initial Colonization by MS.
An Opportunity To Establish Long-Term Protection

How much? How often?
It depends.
Daily range is between 4 grams (teaspoon) and 12 grams (tablespoon).
Use at least 3 times each day.
Strive for 5

Frequency more important than amount
Strive for five uses each day
After each meal and snack
Toothpaste morning and night

Mouth & Nose
Xylitol reduces bacterial adhesion in the mouth (oral care products) & nose (nasal spray)
Xylitol enhances natural defenses
Where Health Begins

Dental Disease & Health
Studies show a correlation between poor dental health and cardiovascular disease
Many systemic health problems averted with good dental health

Xylitol supports our natural defenses by promoting protective factors stimulates saliva increases salivary pH promotes remineralization suppresses acid bacteria such as mutans strep (MS)

Glycemic Index Xylitol supplies a steady flow of energy Adapted from SS Natah et al Am J Clin Nutr (65) 1997

Xylitol’s Role in Diabetes
Good Taste-Refreshing and Cooling
Displacing Equal Amounts of Fast Sugars
Low Glycemic Index
Fewer Calories – Zero Net Carbs
Lowers Serum Fatty Acid Levels
No Known Harmful Effect on CNS, Hormones

Safety

Don’t overdo a good thing

This is Overdoing It

This is Too Much!!

Don’t Eat the Yellow Xylitol

Don’t make lemonade

Xylitol Is Hydrophilic

Who Can Use Xylitol
Orthodontic Patients
Adults and Elderly
Persons with Disabilities
Persons with Dry Mouth
Athletes
Increases Fat Utilzation
Fights Muscle Fatigue
Everyone Except mans best friend

Don’t give to dogs

Hey Dogs Xylitol is NOT for YOU!

Good Doggie

Thanks for Keeping Me Safe

Make New Friends with Xylitol

Protecting Man’s Best Friend From Xylitol is exhausting Break Time

Xylitol Review

Susceptible Tooth Attacked and Demineralized By Acid Made by Germs From the fermentation of sugars Decay Process: result is cavities – holes in the teeth

Mutans streptococci on enamel

De-Mineralization (Caries v. Cavities)

Caries? Cavities?
Caries is the disease process initiated predominately by the Strept Mutans bacteria
Cavities are the result of the caries disease process

Caries vs. Cavities
Caries
Process
Presence of Bacteria
Mutans Strept
Lactobacillus
Low Salivary Flow
Low Salivary ph
Gingival Bleeding
Cavities
Physical manifestation of the caries process

Cavities Caries

Caries to Cavities Progression
1- Healthy Tooth
2- White Spot Lesion The
Caries Process
3- Caries Process with
Cavitation
4- Filling with Caries
Process and Cavitation
5- Continued
Demineralization and
Undermined Enamel
6- Fractured Tooth
1996-2002 production by Douglas Bratthall

Damaging vs. Protective
Sugar and Fermentable Carbohydrate
Acid
Xerostomia
Virulent “Acid” Bacteria
Xylitol
Neutral, alkaline pH
Saliva
Calcium, Fluoride
Non-Acidogenic Bacteria

Damaging vs. Protective Factors Demineralization Remineralization

Tooth decay progresses when damaging factors prevail over protective factors More demineralization than remineralization

Risk Factors

Factors of Dental Disease
A pH of 6.3 to 6.7 is a cautionary environment
A pH of ≤6.2 is a red light (Non-stimulated salivary flow).
GBI > 3-4 Primary or Permanent
OHI of Poor or Fair
High def – dMf – DMF
Negative Periodontal Assessment
Localized or Generalized Gingivitis or worse
Salivary Flow rate of <0.7 ml/min
History of Cavities or Periodontal problems
Active Caries Process Noted (Staining) (Diagnodent)

High Risk Factors of Decay for Kids
Systemic Diseases
Compromised Immune System
Mouth Breathing
Use of Xlear Nasal Wash to maintain patent airway
Gums Bleed when Brushing
Sweetened Medicines
Family members with Cavities
Insufficient Fluoride in non fluoridated areas
Irregular Dental Visits
Deep unsealed teeth – Primary and Permanent
Bottles and Sippy Cups filled with milk and sugary liquids
High intake of fermentable high density Carbs between meals
Raisins – Cereals - Sugar treats between meals
History of ECC
History of Fillings

Eruption Period – Early Mixed Dentition

Eruption Period – Late Mixed Dentition

High Risk Factors of Decay for Adults
Systemic Diseases
Compromised Immune System
Mouth Breathing
Gums Bleed when Brushing Orthodontic Appliances
White spot lesions or incipient lesions on X-Rays
Sporadic Dental Visits
Failing Restorations
High Family Caries Rate
Disease
Poor Dexterity
Inadequate Fluoride Use
Frequent Intake of Fermentable High Density Carbohydrates
More than two cavities in the last year or active caries.
Use of Chewing Tobacco
Xerostomia by itself or with Exposed Root Surfaces
Radiation Therapy

Tooth decay progresses when damaging factors prevail over protective factors More demineralization than remineralization

The Caries Risk Test aids in establishing Risk
Inactive/No Disease:
(Caries -) (Cavities -) Low Risk
Post-Manifest Disease:
(Caries -) (Cavities +) Moderate Risk
Pre-Manifest Disease:
(Caries +) (Cavities -) High Risk
Manifest Disease:
(Caries +) (Cavities +) High Risk

Caries Risk Levels 1 & 2
Level 1 Inactive No Disease (Caries -) (Cavities -)
Anticipatory Guidance
Home Care and Regular Dental Check-ups
Level 2 Post-Manifest Disease (Caries -) ( Cavities + )
Maintain suppression of caries process
Restore Lesions

Caries Risk Levels 3 & 4
Level 3 Pre-Manifest Disease ( Caries+) (Cavities -)
Arrest Caries Process prior to Cavitation
Level 4 Manifest Disease ( Caries +) (Cavities + )
ART Arrest and Restore
Caries Removal, Mutans Cultures, Anticipatory guidance
Counseling / Instruction
Restoration or Other

Non-active disease caries risk level L1: Low Risk
Complete Oral Hygiene and Place Sealants if indicated.
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.
Recommend and prescribe appropriate fluoride containing products or have available for purchase.
Reduce or eliminate fermentable high density carbohydrates between meals. We believe this makes good nutritional sense for the whole body.
Evaluate their ability to maintain mechanical plaque control and make appropriate suggestion, i.e., mechanical tooth brush and other oral hygiene aids.
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.
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

Non-active disease caries risk level L2: Moderate Risk
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.
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.
Recommend or prescribe appropriate fluoride containing products or have available for purchase.
Have the patient reduce or eliminate fermentable high density carbohydrates (p. 99) especially between meals. This makes good nutritional sense for the whole body.
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.

Active Disease Caries Risk Level L3 or L4: High Risk
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.
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.
Recommend or prescribe appropriate fluoride containing products or have available for purchase.
Treat the active caries disease process as a bacterial infection with an antimicrobial agent, (105-107) xylitol, and fluoride products.
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.
Maintain appropriate follow-up and retesting until the patient or the parents are engaged in managing the disease.

Before and After
Results obtained in our office with Xylitol

100% Xylitol Gum Only Before After 1 Week

100% Xylitol Gum Only Before After 3 Weeks

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

100% Xylitol Gum and Chlorhexidine Before After 1 Week

100% Xylitol Gum and Chlorhexidine Before After 2 Weeks

AJS 2-26-2003 Initial examination with oral hygiene and xylitol recommendations

AJS 3-4-2003 After using xylitol for one week

WF 2-26-2003 Inadequate hygiene for fixed orthodontic appliances

WF 3-11-2003 Improvement after two weeks of Xylitol Hygiene

Periodontics
Xylitol hygiene can benefit patients with gingivitis or periodontitis.
Regular Xylitol use helps reduce plaque quantity.
Plaque becomes less adhesive, less acidic, less inflammatory, and less harmful than sucrose plaque.
Xylitol helps block re-emergence of cariogenic organisms during periodontal therapy, such as after full-mouth disinfection.

Dry Mouth
Many Prescription Drugs Cause Dry Mouth
Uncomfortable
Lack of Saliva Leads to Caries
Root Caries

Factors Affecting Salivary Flow
Pharmaceuticals
Radiation Therapy
Water Intake
Xylitol

The caries controlling/preventing effect of xylitol is not based on saliva stimulation only

Effects of xylitol on plaque…
Xylitol is not easily metabolized by Bacteria
Non-Cariogenic
Cariostatic
Anti-Cariogenic
Reduces MS levels
Söderling et al., 1997

Staff Responsibilities
Assess and Record
pH
Salivary Flow
Gingival Bleeding Index
Debris Index
Calculus Index
Calculate Oral Hygiene Index
Brushing and Flossing Instructions

Caries Risk Test
Provide a basis for evidence based Care
Provide a basis for customized Treatment
Evaluation
Findings
In Office Treatment
Dental Practice
Home Care Measures
At Home
In cooperation with the Polyclinic for Preventive Dentistry, Erfurt, Dental School, Friedrich-Schiller University of Jena, Germany VIVADENT

Caries Risk Test
Based on Clinical Judgment
Great Parent/Patient motivator
Confirms clinical diagnosis
Ivoclar/Vivadent incubator
Test Kit – CRT Bacteria Standard
Salivary Flow Rate
Mutans Strep Lactobacillus

Mutans Strep ≥ 100,000 Colony Forming Units Caries Risk Test

Lactobacillus ≥100,000 Colony Forming Units Caries Risk Test

Gold Standard in Clinical Trials (MS) Growth medium Bacitrasin SM-strips Paraffin Ten tests Flossette

Mother – Child Transmission
What do the Clinical Trials Show

Stefan’s Curve Breakfast Lunch Dinner Snacks

Mutans streptococci

Why are mutans streptococci (MS) so important?
The caries bacteria
MS form sticky plaque and produce efficiently acids
Mutans streptococci on enamel

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

The effects of xylitol on MS are based on its 5-carbon structure
Clinical studies support the idea that MS is targeted by xylitol (Vadeboncoeur et al., 1983; Loesche et al., 1984)
The MS counts remain low as long as the use of xylitol lasts
Xylitol

Effects of xylitol on mother-child transmission of mutans streptococci SWEDEN FINLAND

, February 2011) Japan Finland Sweden Finnish, Swedish, Japanese Studies (Courtesy of Eva Soderling Feb. 2011

Protect Your Child with Xylitol – It’s Pretty Cool Stuff Protected Child

Xylitol gel in pacifier for baby Mother uses xylitol chewing gum

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

Transmission of mutans streptococci
The timing of the window of infectivíty can differ in different populations (Florio et al., 2004)
Factors affecting the transmission:
The mutans counts of the "infecting" person (>100 000 per ml saliva – common!)
Number of daily saliva contacts
Individual susceptibitily of the child (Smith et al., 1998), mode of delivery (Li et al., 2005)
courtesy of Eva Soderling

If we can reduce the risk of this transmission could we lower tooth decay in children?
Lets look at some of the Studies to find out.

Finland:Effects of xylitol on mother-child transmission of mutans streptococI YES!

Wow! This is good!

Finland: Effects of xylitol on childhood caries Isokangas et al., 2000 Caries occurence until 5 yrs YES!

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!

Soft Banana brush with xylitol gel

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!

She likes it!

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!

Baby gets cariogenic bacteria from mother Mothers who use xylitol transmit non-cariogenic microflora

With All this Xylitol Your Teeth are Safe

XYLITOL’S Role in Re-mineralization

Remineralization / Cosmetic Enhancement Invention Hypomineralized areas on #8,9 Status before any treatment Status immediately following treatment Example # 1 Treatment Time: 5-7 minutes

Status before any treatment Status immediately following treatment Example #2

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.

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.

Photos illustrating possible treatment process ~ Slide 1 of 2 Status before any treatment Slight microabrasion of surface

of 2 Chemical Etch Status immediately following treatment

Initial Condition

Same Day After In Office Treatment

“ Xylitol gum enhanced remineralization reduced plaque and improved gingival health.”
Steinberg LM, Odusola F, Mandel ID: Remineralizing potential, and plaque and
anti-gingivitis effect of xylitol and sorbitol sweetened chewing gum Clinical
Nutrition (supplement) 1995 pp. 275-283.

XYLITOL’S Role in Maintenance

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

Elements of Management
Date
Eruption Periods
Salivary ph
GBI - Gingival Bleeding Index
Decayed, missing, filled
DI/CI – Debris Index/Calculus
OHI - Oral health Index
BFI/Pro-Flo Brushing, Flossing Instructions/ Prophy
Caries Risk
Periodontal Condition
Photographs
CRT/SF Caries Risk Test/ Salivary Flow
CRT Mutans Strep/Lacto Bac
100% Xylitol Chewing Gum
100% Xylitol Product Reco’s
Fluoride Reco’s
CHX – Chlorhexidine
Nutritional Information
Treat Cavities
Follow-up Treatment Date
Referral

Maintenance
Regular xylitol use should be encouraged as a routine healthy habit, a continuing part of a normal oral hygiene regimen.
“ The best use of xylitol is as an addition to other oral hygiene recommendations.”
Peldyak, John DMD; Makinen, Kauko K. PhD: Xylitol for Caries Prevention. Journal of Dental Hygiene Volume 67 Number IV Fall 2002, pp. 276-285.

How To Use Xylitol
“ Xylitol should be used immediately after every meal and snack.
3-5 Times a Day
Gum or Mint should be used for at least 3-5 minutes
Can be Used at any other time you desire.
Peldyak, John DMD; Makinen, Kauko K. PhD: Xylitol for Caries Prevention.
Journal of Dental Hygiene Volume 67 Number IV Fall 2002, pp. 276-285.

Long-term effect of xylitol.
When Used for 2 Years
Cavity Reducing Effect lasts for 3-5 Years
Peldyak John DMD, Makinen Kauko K PhD: Xylitol for Caries Prevention.
Journal of Dental Hygiene Volume 76 Number IV Fall 2002; pp. 276-285.

Who Can Use Xylitol
Orthodontic Patients
Adults and Elderly
Persons with Disabilities
Persons with Dry Mouth
Athletes
Increases Fat Utilization
Fights Muscle Fatigue
Everyone Except Dogs

Caries process successfully managed when
Salivary Mutans stays low.
No gingival inflammation.
Caries excavation complete, lesion appearance changed (arrested).
Patients or Parents of patients engaged in managing disease.

Historical factors for low risk.
Opposite of high risk factors
Dental health awareness.
No cavities within the last year or two.
Regular dental visits.
History of few cavities in the rest of the family.
For adults and children no tobacco use.
Good regular use of fluoride products.
Adequately restored surfaces on a minimal number of teeth no foiling or creeping restorations.
Deep pit and fissures are sealed.
Low dietary intake of Fermentable High Density Carbohydrates.
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.

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.

Would You Like To Significantly:
Decrease Decay In Your Mouth?
Decrease Decay In Your Kids Mouths?
Decrease Decay In Your Grandkids Mouths?

Benefits of Xylitol for Patients
Effective
Convenient
Enjoyable
Result is improved cooperation and excellent oral hygiene
Xylitol on a picnic… Xylitol at the big game

Product Types

Product Types Toothpaste Oral Rinse Dental Cleansing Gel Mints Gum Moisturizing breath freshener

Spiffies Infant Wipes

Banana Brush

Joint Venture Product

Joint Venture

Ultradent

Old way

Find a Bug Use a Drug

New Way With Xylitol

Show ’em the door Makes plaque Slicky instead of Sticky

Slam it shut Xylitol Lives Here

Xylitol blocks the tooth-damaging factors

Xylitol Features
Sweet, cooling, no aftertaste
Naturally-occurring in human metabolism
Low calorie (40% less than sugar)
Low Glycemic (about 10% of Glucose)
Low insulin usage to metabolize
No Maillard reaction
Slows stomach emptying – increases satiety (feelings of fullness)
Energy source (Used in IV Nutrition)
Enhances Calcium absorption
Helps prevent tooth decay
Helps prevents ear and upper respiratory infections

Things To Remember
Good For Teeth

Frequency more important than amount
4 to 12 grams (teaspoon is 4 grams)
6 to 10 pieces of gum/day
Active Strep Mutans infections in adults require at least 6 grams (8 or more pieces of gum)
Aim for five uses each day
After each meal and snack
Toothpaste morning and night

Use 100% Xylitol Products

Xylitol Keeps Them Smiling

5 Levels of Caries Control
Remineralization
Disinfect
Oral Hygiene
Xylitol
Environment

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

Whole Food – Level 1
Diet – Real Food
Less Processed Products
Supplements
And Environment
Toxins
Air
Water
Stress
Change in habits and life style

Adapted from the book: From Here to Longevity by Dr. Mitra Ray Ph.D. with Patricia Cannon Childs

Saliva Calcium Phosphorus Xylitol Gum

Adapted with permission from the book: From Here to Longevity by Dr. Mitra Ray Ph.D. with Patricia Cannon Childs

S. Mutans

Essential Nutrient Needs of Our Bodies
Macro Nutrients: Air, Water, Protein, Fats, Carbohydrates, and Fiber.
Micro Nutrients: Vitamins, Minerals, Essential Fatty Acids, Amino Acids,
Enzymes, Pre and Pro Biotics.

What We’ve Learned
What you eat affects the health of your mouth, body, and life
That it is best to avoid sugar, white flour products, vegetables oils, and trans-fats
That it is best to drink pure filtered water and eat fresh proteins, fresh vegetables, and salads
That it is better for you to eat foods less processed food
That it is best for you to eat foods closest to their natural state
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.

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.

Food to Choose (Organic)
Home grown in your own garden or pasture
Fresh picked (Farmers Markets)
Fresh frozen
Fresh as it can be in grocery store meat, fish, and produce section

Xylitol – Level II

Things To Remember
Good For Teeth

Oral Hygiene – Level III
Cleaning, x-rays, Exam, Fluoride
1. Report Card Presentation
2. Findings
3. Reason for follow-up
4. Objective Data and assessment
5. Provider Recommendations

1. Report Card
Cavity Risk
Gum Health
Referral

2. Dental Exam Findings
Dental Needs
Head and Neck
Intro Oral Soft Tissues
Intra Oral Teeth
X-Rays

3. Follow up Care - Recall
Preventative Care
Early Cavity Detection
X-Rays for Cavity Detection
Monitor Eruption
Monitor Stained Areas
Monitor Spots between Teeth
Soft Tissue Check
Monitor Spacers
Check Crowns/Fillings

4. Objective Data and Assessment
Date
Eruption Period
pH
Bleeding Gums
Plaque
Oral Hygiene Instruction
Cleaning and Fluoride
Gum Disease
Cavity Risk

5. Provider Recommendations
Daily Xylitol
Daily Fluoride
Professional Care

Oral Disinfection – Level IV
Perioguard - Chlorhexidine
Betadyne – Povidone Iodine
CloSysII – Chlorine Dioxide

Remineralization – Level V
Ionizable minerals
Calcium Lactate
Calcium Citrate
Calcium Glycerol Phosphate
Fluoride
Listerine, Act, Fluoguard….
Prevent 5000

Slide Show Review Thank You

Quotes

Xylitol Is:
Non-Cariogenic:
Does not contribute to the caries disease process.
Cariostatic:
The caries disease process does not occur in the presence of
Xylitol.
Anti-Cariogenic:
The caries disease process may be reversed through appropriate exposure to Xylitol.

Xylitol is Anti-Cariogenic
“ The highest caries reduction rates were observed in subjects using Xylitol.”
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.

“ 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.”
Hayes, Catherine D.M.D D.M.S c: 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.

Xylitol is non-acidogenic and non-cariogenic.
Xylitol is essentially non-fermentable and therefore cannot be converted to acids by oral bacteria.
Xylitol can be left on teeth overnight and not cause any damage.
All from Peldyak John DMD: Xylitol Sweeten Your Smile ; Advanced Developments, Inc. Mt. Pleasant, MI p.8.

How Safe is Xylitol
“ In the amounts needed to prevent tooth decay (less than 15 grams per day), Xylitol is safe for everyone.”
Peldyak, John D.M.D, Xylitol Sweeten Your Smile Advanced Developments, Inc. Mt Pleasant, MI 48804-1010.
“ Xylitol with adaptation is well tolerated and safe to levels of at least 90 grams/day, with no subjective or objective adverse findings.”
Brin M, Miller ON: The safety of oral xylitol in: Sugars in Nutrition Sipple HL (ed) Academic Press New York 1974 pp. 591-605.
.

“ Xylitol gum enhanced remineralization reduced plaque and improved gingival health.”
Steinberg LM, Odusola F, Mandel ID: Remineralizing potential, and plaque and
anti-gingivitis effect of xylitol and sorbitol sweetened chewing gum Clinical
Nutrition (supplement) 1995 pp. 275-283.

Xylitol’s Main Side Effect
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
Dr. John Peldyak DMD in his book “ Xylitol Sweeten Your Smile ”; Advanced Developments, Inc. Mt. Pleasant, MI. 48804-1010, 1996, pp.5-6.

Xylitol Studies Chart, outline and references 1-15 are courtesy of Dr. John Peldyak Mt. Pleasant Michigan.

References www.ADRdental.com

Turku, Finland (1) -- Xylitol (67g/day) replaced dietary sugar (sucrose), 1
Turku, Finland (2) -- Xylitol (6.7g/day) was used only in chewing gum.1
Soviet Union -- Control group also had more severe “deep” lesions and pulpitis.2
French Polynesia -- Both control group and xylitol group received basic oral hygiene with fluoride toothpaste. ³
Hungary -- The xylitol group also had lower caries rate than a group which received fluoride.4, 5
Montreal, Canada -- Chewing gum contained a mixture of xylitol and sorbitol.6, 7
Ylivieska, Finland -- Comprehensive prevention program was improved by the addition of xylitol gum. Long-term benefit of xylitol was established.8-10
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
Stann Creek -- Five year follow-up of Belize trial demonstrated lasting benefit of xylitol use.13
Dayton -- Supragingival root surface caries were studied.14
Estonia -- Xylitol candy was as effective as xylitol chewing gum in reducing caries.15

Galiullin AN: Evaluation of the caries-prevention action of xylitol . Kazan Med. J 1981:67:16-18.
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.
Scheinin A, Banóczy J, Szóke J, et al: Three-years caries activity in institutionalized children. Acta Odont Scand 1985; 43:327-347.
Scheinin A, Mäakinen KK: Turku sugar studies I-XXI. Acta Odont Scand 1975; 33:suppl 70, 1-348.
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.
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.
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.

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
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.
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.
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.
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.
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.
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.
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.

Turku, Finland (1) -- Xylitol (67g/day) replaced dietary sugar (sucrose), 1
Turku, Finland (2) -- Xylitol (6.7g/day) was used only in chewing gum.1
Soviet Union -- Control group also had more severe “deep” lesions and pulpitis.2
French Polynesia -- Both control group and xylitol group received basic oral hygiene with fluoride toothpaste. ³
Hungary -- The xylitol group also had lower caries rate than a group which received fluoride.4, 5
Montreal, Canada -- Chewing gum contained a mixture of xylitol and sorbitol.6, 7
Ylivieska, Finland -- Comprehensive prevention program was improved by the addition of xylitol gum. Long-term benefit of xylitol was established.8-10
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
Stann Creek -- Five year follow-up of Belize trial demonstrated lasting benefit of xylitol use.13
Dayton -- Supragingival root surface caries were studied.14
Estonia -- Xylitol candy was as effective as xylitol chewing gum in reducing caries.15

Galiullin AN: Evaluation of the caries-prevention action of xylitol . Kazan Med. J 1981:67:16-18.
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.
Scheinin A, Banóczy J, Szóke J, et al: Three-years caries activity in institutionalized children. Acta Odont Scand 1985; 43:327-347.
Scheinin A, Mäakinen KK: Turku sugar studies I-XXI. Acta Odont Scand 1975; 33:suppl 70, 1-348.
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.
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.
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.

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
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.
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.
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.
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.
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.
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.
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.

Findings
“ Xylitol was clinically proven to be Non-Cariogenic.”
Scheinin A, Mäkinen KK: Turku sugar studies I-XXI Acta Odontologica Scandinavia 33 (suppl 70): 1975

Findings
“ Results suggest… that high-xylitol content chewing gum usage can retard or arrest rampant dentine caries.”
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

Academy of Dental Resources' San Francisco PowerPoint presentation 2011

by ADR Dental on Apr 04, 2011

Accessibility

Categories

Tags

Upload Details

Usage Rights

1 Embed 27

Statistics

Academy of Dental Resources’ San Francisco PowerPoint presentation 2011 — Presentation Transcript