Fluoride Varnish

Fluoride varnish is a highly concentrated form of fluoride that is applied on to tooth surfaces with a brush.  It is 5% sodium fluoride except Enamel Pro Varnish which is formulated to deliver ACP (Amorphous Calcium Phosphate).  Varnish is packaged in pre-measured uni-dosage form.  Some varnish contain saccharin or aspartame for artificial sweetness but there are other products sweetened with neutral sugar like xylitol, which has shown to reduce dental caries.  Gluten free varnish is also available for patients with gluten sensitivity. 

Prevention of root caries: a literature review of primary and secondary preventive agents. Special Care in Dentistry. 2013
This study reviewed and summarized the effectiveness of root caries preventive agents: fluoride, chlorhexidine, xylitol, amorphous calcium phosphate (ACP), sealants, saliva stimulators, or silver diamine fluoride.  38% silver diamine fluoride was the best choice in preventing dental caries, however, silver diamine fluoride has not been approved by the FDA for clinical use in the United States.  The next best choice to prevent root caries was application of a 22,500ppm(5%) Sodium Fluoride Varnish every 3 months.

GUM Technique Deep Clean

GUM Technique Deep Clean toothbrush is designed to clean 2.8mm into the sulcus, along the gingival margins and interproximal spaces with the Extremely Tapered Bristles (ETB).  Its unique bristle design also allows multi-level cleaning that the combination of bristles effectively clean below the gumline and exposed tooth surfaces. Angles of bristles allow enhanced interproximal penetration and cleaning by striking the surface in different directions.  

Link to GUM

Image chart of the comparison between GUM Technique Deep Clean, Colgate 360, Oral-B Indicator toothbrush

Laboratory efficacy of three compact toothbrushes to reduce artificial plaque in hard to reach areas. American Journal of Dentistry. 2011
This study compared the GUM Compact Head, GUM Technique Deep Clean, and Oral-B Indicator toothbrushes on plaque reduction in difficult to reach areas.

FireFly Fluoride Foam Toothpaste

Firefly Fluoride Foam Toothpaste is a new form of a toothpaste that is designed for kids.  Unlike traditional toothpaste, light and foamy formula is squirted directly into the mouth rather than on the toothbrush.  Firefly Fluoride Foam Toothpaste stops spills, leaks, and dried up toothpaste mess on counter and sinks. This is a new and fun way to get kids involved in toothbrushing that can help develop regular brushing routine at a young age.  
Firefly also produces best-selling Firefly light-up timer toothbrush.  
Go to Dr. Fresh

Comparing the effects of brushing with a new gel-to-foam dentifrice to brushing with regular fluoride control dentifrices on viable bacteria levels in saliva. American Journal of Dentistry. 2009
This study compared level of bacteria in the mouth after brushing with regular a toothpaste and a foam type dentifrice.  There were no significant differences was indicated between the two dentifrices.

Tom's of Maine Toothpaste

In 1995, Tom's of Maine Natural Toothpaste with Fluoride received the ADA's Seal of Acceptance.  Tom's of Maine manufactures toothpastes that are free of artificial colors, synthetic sweeteners, preservatives, additives, synthetic flavors and fragrances.  Sodium monofluorophosphate is included for caries prevention and use finely ground calcium carbonate as mild abrasive.  

Tom's of Maine Clean and Gentle toothpaste does not include SLS(sodium lauryl sulfate).  A gentle ingredient called glycyrrhizin(derived from licorice root) is added for natural low foam.  SLS-free toothpaste is a common recommendation for people who frequently get canker sores. 

Link to Tom's of Maine

Denture Brush

Biofilm build up on dentures just like they do on natural teeth.  Dentures need to be cleaned regularly to prevent gingival inflammations or fungal and bacterial infections.  Denture brush bristles are stiffer than regular toothbrush to effectively scrubs off debris, plaque and stains.  I don't recommend my patients to use toothpaste when cleaning their dentures.  The abrasives in toothpaste can scratch the surface of dentures allowing bacteria to colonize on the rough surfaces. Also, rough surfaces of dentures will collect more stains and it would be hard to remove.

According to the report from CDC, statistics between 2005-2008 indicated that 23% of adults aged 65 and over had lost all of their teeth.

The needs of denture-brushing in geriatrics. Gerodontology. 2012
This study reports that oral hygiene in geriatric population is often neglected,  This is largely due to the lack of education in the geriatric population or their care givers.  The study also reports the decreased level of biofilm present on denture after brushing and explained the need and importance of denture brushing to maintain oral health and general health.

Tongue Brushing or Scraping?

Tongue cleaning is recommended by ADA to remove oral bacteria collected in the back of the tongue that contributes to halitosis.  The tongue has millions of tastes of buds that trap debris and bacteria so it is important to keep it clean daily! 
Tongue cleaning with a toothbrush is one way to clean the tongue but the height of the toothbrush head may restrict reaching all the way to the back of the tongue.  A tongue scraper has a low profile head with ridges allowing to scrape the length of the tongue in three or four overlapping strokes to clear debris and plaque.  

Effectiveness of mechanical tongue cleaning on breath odor and tongue coating. International Journal of Dental Hygiene. 2010
Tongue brushing or scraping reduce halitosis!

The comparative evaluation of the effects of tongue cleaning on salivary levels of mutans streptococci in children. International Journal of Dental Hygiene. 2012
This study showed that the tongue brushing and scraping demonstrated significant reduction in salivary mutans streptococci.

Biotene

Link to Biotene.com
Biotene is indicated to be used in patients with dry mouth symptoms.  Xerostomia is caused by reduced salivary flow in the mouth which can lead to enamel/dentin demineralization, increased caries, periodontal disease, mucositis, or halitosis.  Xerostomia is a common side effect experienced by patients taking medications.  Also, it is caused by radiation therapy, autoimmune disease, diabetes, or sleep apnea.  Biotene moisturize and lubricate dry oral tissues with saliva substitutes and stimulate saliva flow in the mouth.  

Xerostomia is often exacerbated when patient uses a toothpaste that contains SLS(sodium lauryl sulfate) or alcohol-base mouthwash.  

Evaluation of the clinical efficacy of Biotene Oral Balance in patients with secondary Sjogren's syndrome. Rheumatology International. 2012

This study found that Biotene improved salivary flow and was effective in alleviating the dry mouth symptoms in patients with Sjogren's syndrome.  

The Period-Aid toothpick holder

Link to The Perio-Aid website

This is a great product! Toothpicks are inexpensive and easy tool to remove interproximal plaque.  The Perio-Aid holds a toothpick at the proper angle and length to be used in different interproximal splaces.  

Efficacy of plaque removal by two types of toothpick. Oral Health and Preventive Dentistry. 2008

Toothpicks are effective in removing plaque whether its round or triangular shaped! 

Recommendation by dental staff and use of toothpicks, dental floss, and interdental brushes for approximal cleaning in an adult Swedish Population. Oral Health and Preventive Dentistry. 2010

This study compared the plaque level reduction between the use of toothpicks, dental floss, and interdental brushes.  The largest plaque reduction was produced by the interdental brush (83%), followed by toothpicks (74%) and dental floss (73%).  

ACT mouthrinse

ACT mouthrinse contains 0.05% sodium fluoride which is the highest concentration of sodium fluoride rinse available over the counter.  Since most ACT does not contain alcohol, I often recommend ACT for patients suffering from xerostomia caused by medication use, radiation therapy, or use of CPAP for the treatment of Sleep Apnea.

Link to the website

A listing of therapeutic and cosmetic mouthrinses. Dimensions of Dental Hygiene. 2010

Research Article:
The 48 month increment of root caries in an urban population of older adults participating in a preventive dental program. Journal of Public Health Dentistry. 1993
The study results showed that the daily use of the fluoride mouthrinse(ACT) significantly increased the number of reversed carious lesions.

Crest 3D Whitestripes

I have many patients ask me about whitening products and what over the counter product that I can recommend.  There are just so many products available on the shelves, it is hard to keep up with each item's effectiveness.  Crest 3D whitening system is one of the leading products on the market and there are 5 different whitening strips that are sold in stores.  I was looking for each product's active ingredient and whitening chemical concentrations on the web but they were nowhere to be found.  So I had to call Crest Customer Service(1-800-395-8423) to request the information. 

Link to Crest

A comparison chart of Crest Whitestrips

Research Articles:

Effects of hydrogen peroxide bleaching strips on tooth surface color, surface microhardness, surface and subsurface ultrastructure, and microchemical composition. Journal of Clinical Dentistry. 2006

I have patients ask me about if whitening their teeth will damage the teeth.  This article concluded that bleaching with hydrogen peroxide whitening strips does not cause structural changes on teeth.

A randomized controlled trial of home tooth-whitening products. American Journal of Dentistry. 2007

This study found that 6% hydrogen peroxide whitening strips provided better whitening result than 18% carbamide peroxide whitening gel.  Also, test subjects preferred the whitening strips than whitening gel and rated whitening strips higher for the amount of whiteness improvement, whitening satisfaction, and overall impression.

Remineralization: CSP (calcium sodium phosphosilicate)

The second generation of calcium phosphate technology is made by NovaMin Technology Inc.  This remineralization product has substantial independent controlled studies to prove its worthiness in this new remineralization market.  NovaMin is a combination of calcium, sodium, phosphorous, and silica, which binds to the tooth.  This product elevates oral pH to the 7.5 to 8.5 ranges, which is ideal for remineralization, allowing the calcium and phosphorous ions to enter the demineralized tooth surface.  When calcium sodium phosphosilicate is contacted by saliva or water, hydroxyl carbonate apatite is formed, the same as tooth structure.  Studies show NovaMin hardens enamel two times better than 5,000ppm fluoride toothpaste.  It also enhances fluoride uptake by 50% and can be found in products with 5,000ppm fluoride.  

NovaMin is found in many products including Sultan Healthcare's Topex Renew toothpaste, Dentsply's NuPro NuSolutions prophy paste and Nupro NUSolutions remineralizing and desensitizing toothpaste, OMNI's SootheRX Therapy, Oravive Tooth Revitalizing Paste (which has no fluoride content) and OSspray's Sylc air polish powder, which is 100% NovaMin.  Sylc does not contain aluminum-an alternative for clinicians who are concerned about breathing many of the air polisher powders on the market.  From RDH Magazine

Remineralization: Recaldent (CPP-ACP)

Casein phosphopeptide, CPP is a milk protein that, when added to ACP, has stabilizing qualities.  This combined product, casein phosphopeptide and amorphous calcium phosphate (CCP-ACP) is known as Recaldent.  The combination of CPP and ACP gives the product a longer exposure time(substantivity) on the teeth compared to ACP alone.  CCP-ACP needs an acid challenge to release the calcium and phosphate ions that will buffer the saliva pH to neutral (6.5 to 7.4) to remineralize teeth. CCP-ACP is released during acid challenges raising the oral pH to 7.  CCP-ACP is found in MI Paste (GC America) and Trident Extra Care gum.  MI Paste Plus includes the addition of 900ppm fluoride forming calcium phosphate fluoride, CCP-ACFP.  The addition of fluoride to Recaldent has shown improved remineralizing properties over CCP-ACP alone.  

A useful feature of MI Paste is its slippery quality that xerostomia patients may find soothing and can be used throughout the day and night.  The non-fluoride version is perfectly safe for all age groups.  MI Paste Plus has 900 ppm fluoride so it should not be used in children under age six due to the risk of fluoride ingestion.  Recaldent should not be used by those allergic to milk proteins or benzoate preservatives.  From RDH Magazine

Atridox (Doxycycline hyclate10%)

Atridox is a locally applied antibiotic that is placed into periodontal pockets. A liquid syringe and powder syringe is mixed together before use. 

                                                             Link to website

Local Delivery of Atridox(Doxycycline gel) as Adjunctive in Management of Chronic Periodontitis.Suez Canal University Medical Journal. 2008

Comparative Evaluation of Subgingivally Delivered 10% Doxycycline Hyclate and Xanthan-based Chlorhexidine Gels in the Treatment of Chronic Periodontitis.Journal of Contemporary Dental Practice. 2008