Traffic congestion toggled with tight daily schedules sets in motion the potential for road rage when sitting behind the steering wheel. Aggressive driving habits not only strike the careless commuter who is late for work, but also the mother on her cell phone driving the kids to school in the mini-van who is having “a bad day.” The American Automobile Association reports that the incidence of road rage has been increasing about 7 percent every year since first being tallied in 1990. The AAA’s advice for avoiding road rage is to not drive aggressively in a queue of traffic, but to drive defensively. The association also suggests that many traffic confrontations may best be handled by just moving out of the path of an aggressive driver, preventing unwanted loss of tempers.
Likewise, when the oral environment is under an aggressive acid attack, cautious avoidance and steering clear of those dangerous acidic confrontations will best prevent unwanted tissue demineralization and destruction.
Hygienists see first-hand the damage oral acids have on teeth. Patients put their mouths into unwanted acid situations, placing tissues up against dangerous roadblocks constantly. Poor self-care and dietary habits force the oral environment into compromising situations. Bacteria that are innate to the mouth process the fermentable carbohydrates and sugars (churning them to dissolving acid). When not adequately mollified, these acidogenic bacteria colonies drain the vital components of calcium and phosphates from the tooth structure. This weakening of the structure is commonly known as demineralization.
Keep in mind, healthy saliva acts as the buffering traffic light for the plaque acids. During the educational process, hygienists bring the patient up to speed on the relationships the saliva plays towards calming a hostile oral environment. Luckily, products address the need to help our patients buffer the acids and avoid an oral collision. One such product, MI Paste by GC America, contains Recaldent, an ingredient that provides relief when the tissues are losing vital minerals. Recaldent will release phosphates and calcium ions (penetrating into the enamel of teeth) when the mouth is faced with an acidic condition. Remember, both calcium and phosphates are needed for the natural remineralization (repair) of the enamel.
Neutralizing a hostile environment
Many different aggressive forces provoke acid attacks on the enamel. Some of the hostile conditions are caries activity, enamel erosion, and xerostomia, to name just a few. When the hygienist and doctor partner for repair of the distressed surfaces, the patient will benefit from antibacterial therapies using minimally invasive concepts. With beginning caries (non-cavitated) and white spot lesions, apply medicaments that incorporate Recaldent (creams or chewing gums) and topical applied fluorides (in presence of adequate salivary flow). These solutions have been shown to effectively remineralize those early lesions, halt the damage, and help to stabilize the environment.
Surface erosion brought on by chemical and mechanical issues (aggressive brushing techniques, eating disorders, gastro reflux, etc.) may be protected by applying remineralizing medicaments as topical coatings. In-office professionally dispensed products containing Recaldent aid patients in self care. Creams are easy to maneuver chairside with a consistency that allow the material to be delivered directly by gloved fingertip to areas of need. Furthermore, education instructs the patient on the benefits of favorable ingredients found in the products.
Mi paste application
Mineral-rich saliva assists products in achieving full acid-shielding potential. Without adequate salivary flow (xerostomia), the necessary calcium and phosphates are not readily available to develop the nourishment and remineralization of the surface. Products that stimulate saliva production are beneficial.
Medication induced xerostomia
The Biotene line of products by Laclede addresses many needs for patients suffering from a dry mouth and may be dispensed in the office or found over the counter. The mild mouthwash, which comes with a flip nozzle, is antibacterial, alcohol-free, and soothing to the tissues. Having your patients regularly chew the dry mouth gum aids in saliva stimulation and acts as an acid neutralizer. The dry mouth toothpaste (containing fluoride and sweetened with xylitol) combats oral dryness using active salivary enzymes. Oralbalance gel, spread onto the tongue at bedtime, will help “mouth breathers” by acting as a lubricant that keeps needed rich saliva elements available for remineralization.
One may also find the oral gel works well chairside for the xerostomia patient during the regular cleaning. Coat the back of the mouth mirror with this product and easily slide the mirror (used as a retractor) over the delicate cheek and tongue during their recare visit. Patients will thank you for it!
Simply put, to resist the acid challenge, the enamel must become acid resistant. It is desirable to have ingredients found in products that bind to oral plaque pellicle and tissues. When this binding process occurs, the levels of phosphate and calcium in the saliva are at a protective level for longer durations, calming the oral environment.
Topical applications of remineralizing products may form a less penetrable surface for the acid attacks. When challenged, the acid bypasses the reinforced surfaces and searches for susceptible (unprotected) sites instead to attack.
Recaldent, xylitol, and fluoride are desirable recommendations for individuals who are caries prone or have active caries. The recommendations generally are made after the hygienist and doctor discuss which patients would benefit from an ingredient, or combination of those ingredients, and establish an early caries protocol. Remember, what works well for one patient won’t always work on another, so flexibility on recommending products may, in fact, be a trial-and-error process to find out what will work best for an individual’s success. Perhaps a Recaldent product application would benefit, and be better tolerated by, the younger child with rampant decay than a dose of tummy-turning fluoride gel, which might be accidentally swallowed. The crown and bridge patient with temporomandibular dysfunction might struggle with chewing gum regularly, but a lubricating gel could be a better measure to take. Luckily, the dental community has a more wide range of available products for repair and prevention then ever before. Put a stop to acid demineralization and aggression, and give the green light to protective products.
Karen Kaiser, RDH
Ms. Kaiser has been in the dental field since 1986. She graduated from St. Louis, Mo., Forest Park hygiene program in 1994 and practices in Illinois at the Center for Contemporary Dentistry. Ms. Kaiser authors articles, presents, and can be reached at At Your Fingertips: hygiene [email protected].
