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Keeping Your Mouth Squeaky Clean
New Products That Can Help

by Shirley Gutkowski, RDH, BSDH

Periodontal (gum) disease has been called the sixth complication of diabetes (in addition to eye, kidney, nerve, foot, and cardiovascular complications) because so many people with diabetes have it. Having high blood glucose raises the risk of developing periodontal disease, and periodontal disease tends to raise blood glucose levels. So clearly, making an effort to brush, floss, and have regular dental checkups is important when you have diabetes.

However, sometimes these efforts just don’t seem to be enough, and a little more help is needed. This is particularly true when a person has dry mouth, or a lower-than-normal amount of saliva. Normally, saliva protects the teeth and gums by diluting the acids that are excreted by bacteria in the mouth and that are also present in foods and beverages. Saliva additionally contains minerals such as calcium, phosphate, and fluoride that are necessary for rebuilding the teeth and keeping the enamel strong. It also helps you chew and swallow food. When there is not enough saliva to perform these functions, a person’s risk of tooth decay, gum disease, and other mouth infections rises.

There are many causes of dry mouth — some avoidable, and some not. Dry mouth is a common side effect of many prescription and nonprescription drugs. It is a symptom or side effect of numerous medical conditions, including diabetes. It can be a side effect of some medical treatments, such as radiation for cancer treatment. It can also be caused by dehydration, smoking or chewing tobacco, or prolonged breathing through your mouth.

While many people are well aware that they have dry mouth, not everyone who has it notices it. However, if you cannot eat a cracker without drinking water, or if your dentist or dental hygienist tells you you have dry mouth, you are at the same heightened risk of tooth decay as someone who is bothered by the dryness.

There are some time-tested home remedies for dry mouth, including sipping water or sugarless drinks throughout the day, chewing sugar-free gum, and using a humidifier at night. It may also help to avoid alcohol, tobacco, and drinks containing caffeine, which can dry out the mouth even more.

In recent years, researchers have developed a number of products to help increase the amount of saliva in the mouth and to counteract the negative effects of not having enough. This article describes some of the newer products to come onto the market, as well as some others still in development. While many are aimed primarily at consumers with dry mouth, they can all be used by anyone who wishes to step up their home dental care and lower their risk of tooth decay and gum disease.

Xylitol
Sucking on a piece of hard candy can cause you to secrete more saliva and make your mouth feel moister, but sucking on candy sweetened with sugar or most other caloric sweeteners increases the amount of acid in your mouth and raises your risk of tooth decay.

A better option, and one that may actually improve your oral health, is to suck on candy or to chew gum sweetened solely or primarily with xylitol. Xylitol is a type of sugar alcohol that has a minimal effect on blood glucose level. (Sugar alcohols are a type of carbohydrate that are incompletely broken down and absorbed by the body. They contain neither sucrose nor alcohol.) While ingesting too much xylitol can cause diarrhea, regular use of products containing it has been shown to decrease plaque buildup on teeth, which should lower the risk of periodontal disease. Xylitol has also been shown to increase collagen formation, which means it has the potential to strengthen the fibers that hold teeth in place. And a recent study in rats additionally showed that rats that drank water with xylitol in it had increased bone density, making xylitol a potential candidate for the treatment of osteoporosis (weak, porous bones that are prone to fracture).

Studies suggest that ingesting a total of 6–10 grams of xylitol per day — divided into 3–5 smaller doses — lowers the risk of cavities. So far, chewing gum containing xylitol after each meal appears to be the best way to administer xylitol for oral health benefits. Gum must be chewed for about five minutes to get the full dose of xylitol. Other products that are made with xylitol include candies, syrups, mouth sprays, and toothpaste.

Some product labels list the amount of xylitol per serving, while others do not. Look for products with xylitol listed as the only sweetener or as one of the first three ingredients. As the popularity of xylitol rises, some companies are putting tiny amounts into many products just to have it on the list of ingredients. Two brands of gum that are sweetened with 100% xylitol are Spry and B-Fresh, which are widely available in retail health-food and specialty supplement stores. These and other brands are also sold on the Internet.

A different type of product sweetened with 100% xylitol is Xylimelts, which are “domes” of xylitol mixed with vegetable gums that dissolve slowly in the mouth. For convenience, they are formulated to stick to a molar or to gum tissue next to a molar. The domes contain 500 milligrams of xylitol, which is released over an hour or so as they dissolve. The maker of Xylimelts recommends using at least four domes per day after meals and snacks to get maximum benefits. The domes can be purchased over the Internet at www.amazon.com and www.dentaldepot.com and may be available in some retail stores.

The makers of Xylimelts caution that they should not be given to children under five because they pose a choking hazard. Similarly, many experts advise against giving chewing gum to children under four for the same reason. Researchers at the University of Washington in Seattle have been testing whether eating xylitol-sweetened gummy candies several times a day helps to prevent tooth decay in school-age children (grades one through five). However, the American Academy of Pediatrics recommends keeping both hard and sticky candy away from children under four, so these may not be appropriate for younger children, either.

Essential oils
Essential oils — oils extracted from the leaves, stems, flowers, and other parts of plants — have been added to dental products for decades and have been found to be effective at lowering the amount of bacteria in the mouth. Listerine, for example, contains the essential oil components thymol, eucalyptol, and menthol.

For people with dry mouth, however, products containing essential oils may taste too intense, because there’s not enough saliva in their mouths to dilute the product. An obvious solution would be to lower the amount of essential oils in these products to make them tolerable, but because products such as mouthwash and toothpaste are held in the mouth for such a short time, this is not an option. For essential oils to be effective at lowering bacteria levels, they must be used at a high concentration for a short time or a low concentration for a long time.

Some newer products overcome this problem by using materials that can be held in the mouth for a long period while essential oils are slowly released. Two such products from the Nuvora company are Salese and Dentiva. Both are lozenges containing essential oils and xylitol that are designed to take more than an hour to dissolve. Salese is specifically marketed for use by people with dry mouth and contains ingredients to make the mouth feel more slippery. They are currently sold online at http://store.nuvorainc.com.

Recaldent
Recaldent is a milk-derived protein that can be used to supply the teeth with calcium and phosphate and to combat acidity in the mouth. Its use may strengthen tooth enamel and decrease tooth sensitivity. Recaldent is found in Trident Xtra Care and Trident White sugar-free chewing gums. (It may be called “calcium casein peptone-calcium phosphate” in the ingredients list found on gum packaging.) Trident Xtra Care also contains xylitol, while Trident White does not.

Recaldent is also the active ingredient in MI Paste, a product currently available only through dental offices. Your dentist or hygienist may apply MI Paste to your teeth during routine cleaning appointments with a polishing cup, a custom tray, or simply a Q-tip or gloved finger. At home, the paste can similarly be applied with a cotton swab or finger. It should be left on the teeth for three to five minutes, after which any excess can be spit out or swallowed, but users are advised not to rinse their mouths with water.

Recaldent does not contain lactose, so it is safe for people who are lactose intolerant, but it should not be used by people with a milk allergy.

Sugar-free chewing gum
Regular sugar-free chewing gums are gaining respect in many dental circles, including the American Dental Association. In 2007, the association gave its Seal of Acceptance to three Wrigley chewing gums, Orbit, Eclipse, and Extra, based on the finding that the physical action of chewing sugar-free gum for 20 minutes after eating stimulates saliva flow, helping to prevent cavities by reducing plaque acids and strengthening teeth. In October 2008, the ADA’s Council on Scientific Affairs followed up by giving the ADA Seal to Cadbury products Trident, Dentyne Ice, and Stride sugar-free gums.

Other functional ingredients
In 2008, Wrigley reformulated its Eclipse gums and mints to contain Magnolia bark extract, which is believed to act as an antimicrobial (or “germ killer”). According to the company, the extract kills bacteria associated with bad breath after the gum has been chewed for about five minutes.

Another ingredient that is expected to be added to chewing gum soon is NovaMin, a compound that delivers calcium and phosphate to the teeth for tooth remineralization. NovaMin is currently used in Oravive and Restore brand tooth and dental care products, as well as in some products that are dispensed only by dental offices.

Researchers at the UCLA School of Dentistry have teamed up with the makers of sugar-free candy products to create a lollipop containing licorice root extract. For centuries, people in multiple cultures have chewed licorice root, and the researchers found that a compound in it kills the bacteria responsible for tooth decay. The lollipops are currently being sold under the name Dr. John’s Kavidy Kops Lollipops with Glylic, through the Web site www.drjohns.com. Recommendations are to have one lollipop in the morning after breakfast and another before bed for 10 consecutive days. This 10-day regimen should be repeated two to four times per year for continued benefits. (Note that lollipops in general are not considered safe for young children because the sticks could pierce their throats if they were to fall on them.)

Some ordinary beverages with no special ingredients added have also been shown to have positive effects on oral health. Studies on oolong tea show that it slows the growth of bacteria associated with dental decay and also reduces the amount of acid produced by bacteria in the mouth. Ordinary cranberry juice also makes it harder for bacteria to attach to plaque in the mouth. This is beneficial because unlike bacteria that has become part of plaque, unattached bacteria do not produce enough acid to cause problems.

A helping hand
Daily brushing and flossing to break up plaque is still your best weapon against tooth decay and gum disease. But now there are an increasing number of products that can add to your efforts without requiring extra time spent at the bathroom sink. If you’re not sure whether a product might be helpful for you, ask your dentist or dental hygienist. But don’t be surprised if you heard about it before they did; these days, the innovations are coming so fast and furious it’s hard for anyone to keep track of them all.

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