Conquering the Caries Epidemic from the Hygiene Operatory

The hygienist’s guide to implementing the latest oral health technologies

August 27, 2016

Originally Published On:

RDH Magazine

The American Dental Hygiene Association defines the role of a dental hygienist as a dynamic one including the role of educator, clinician, advocate, manager, and researcher. We serve as oral heath detectives through evaluation of the oral cavity; defining our patients risks of caries, periodontal disease and systemic disease. An estimated 250 million prescriptions are written for anti-anxiety medications yearly.~~1  The increase of prescription medication impacts the once “lower risk” young adults as they are more likely to experience dry mouth and dental caries are on the rise. In order to conquer the risk associated with our patients systemic and behavioral factors, clinicians need to utilize the latest armamentarium for patient home care.

The utilization of products, such as oral probiotics, that destroy caries and periodontal pathogens is essential to promoting our patients oral health. Probiotics are the microorganisms that are found naturally in the human body and are beneficial to health. To obtain optimal oral health, there needs to be a balance between the “good” bacteria and “bad” bacteria.~~2

Probiotics originate from the “good” bacteria known as Lactobacillus, Bifidobacterium and Streptococcus. After a short period of consuming the probiotic, the healthy bacteria then multiplies and destroys the cariogenic, or bad, bacteria in the saliva.~~2 Dental Probiotics works to enhance saliva formation and prevent bad bacteria from sticking to the teeth and gums.~~3 Spry has created an effective way to administer probiotics to our patients with a small, easy to carry package. The package looks much like a Pixy Stick™ and allows the patient to disease.~~5 Through the utilization of adjunctive nasal spray therapies, we can reduce the risk of patient’s mouth breathing and promote proper nose breathing.

Ocean Saline Nasal Spray is indicated for those with simply activate the tasty blueberry probiotic by swishing it in the mouth for 30 seconds and then swallowing.~~3

EvoraPro Oral Probiotic uses a ProBiora3 blend to target tooth and gum health.~~4 The probiotics are released as the tablet dissolves in the mouth.~~4For best results, avoid chewing the tablet and allow it to naturally melt in the mouth. EvoraPro use demonstrated whiter teeth, fresh breathe and improved oral health in clinical studies.~~4

Suggested Protocol: Implementation of a periodontal protocol that has the patient use the probiotics in the chair after SCRP or a periodontal maintenance appointment can be a game changer for the patient. Packing the Spry Probiotic stick in the lunch bag of children with orthodontics or a high rate of decay, is a fun way to engage youth to preventing dental decay. High risk patients include, periodontal patients, orthodontic patients and patients with poor-fair homecare.

Another condition in need of an effective office protocol is mouth breathing. As dental professionals, we know how important nose breathing is to warm and filter the air we breathe.~~5 When our patients are breathing through their mouths, they are left with dried, erytemic gingiva, chapped lips and malocclusion.~~5 Therefore, children who are mouth breathers are more likely to have chronic muscle tension around the oral cavity that can lead to a narrowing of the maxillary arch.~~5

The narrowing of the maxilla can lead to poor occlusion, most commonly type II, and periodontal allergies, cold flu, sinusitis, dry and cold climates and overall heavy congestion. This spray is also recommended for patients who use a CPAP machine or suffer for sleep apnea. Active ingredients include Sodium Chloride (0.65%), Phenylcarbinol, Benzalkonium Chloride Solution.~~6

Xclear Nasal Spray is indicated for hyperosmotic solution that helps dry runny noses, made from all natural ingredients, can be used in conjunction with other allergy medicine and is non-addictive which allows it to be used as often as needed.~~7 Xclear is safe for all ages, mouth breathers and oral appliance wearers. This is the only nasal spray with Xylitol and comes in a wide variety of product sizes allow for convenience while traveling. Active ingredients include purified water, xylitol, saline and grapefruit seed extract.~~7

Suggested protocol: Administer nasal spray to patient prior to cleaning to allow patient to breathe through their nose while providing prophylaxis. This will allow the clinician to be more effective as the rate of foggy mirror decreases and gag reflux decreases.

In 2014 the makers of Listerine, Johnson and Johnson, sold 588.7 million dollars in mouthwash!~~8 Most hygienists cringe at the thought of patients rinsing with active ingredients like Alcohol, as they exasperate the dry mouth epidemic. There are hundreds of products claiming to provide relief for dry mouth, however it comes down to one important factor: compliance. If the product doesn’t taste good and feel good in the patient’s mouth they will not benefit from the product because they will not consistently use it.

CloSYS Silver is the latest addition to the CloSYS oral care line. CloSYS silver offers fluoride among the powerful active ingredients of Chlorine dioxide, which promotes a healthy Ph while killing harmful bacteria.~~9 Unlike competitors, CloSYS offers gluten-free, sulfate-free tricolscan- free, and dye-free products. The formula is perfect for patients with sensitive mouths that could benefit from a rinse without an overwhelming taste.~~9 Additional options supply a mint dropper for controlling a mint flavor, which allows for optimal compliance.

Spry Oral Rinse contains xylitol to actively inhibit bacteria from harboring onto the enamel surface and gums. Spry Oral Rinse works to increase salivary flow while inhibiting bacteria from producing acids, therefore keeping the mouth in a more balanced, healthy state.

Saliva MAX is available by prescription only. SalivaMAX is provided in single use packets and are mixed with 1 oz. of water to create a supersaturated calcium phosphate rinse.11Patients swish with SalivaMAX, and it can be administered several times per day, depending on the dry mouth severity.~~11

Suggested Protocol: Provide a sample of the product to the patient by administering the product while in the chair. While the patient is swooshing with the rinse inform them of the benefits of the product and why it is important to their specific oral health. Contact the manufacture to provide patient samples and coupon packs that demonstrate the distributors of the product.

Young adults are now experiencing higher rates of decay and dry mouth due to prescription drugs.~~2 We need to address the increased risks of our patients and provide progressive solutions to the oral conditions they present with. Evaluating a product through research and taste testing will allow clinicians to provide more custom recommendations to meet the needs of the patient. Dental Hygienists are educators and innovators by nature, therefore it is time to rise to the call to create a progressive re-care visit to meet the specific needs of our patients on an individual basis.


~~1Harper, Matthew. Forbes. America’s Most Popular Mind Medicines. Available at: Accessed May 2, 2016.

~~2Maekawa T, Hajishengallis G. Topical treatment with probiotic Lactobacillus brevis CD2 inhibits experimental periodontal inflammation and bone loss. Journal of periodontal research. 2014;49(6):785-791. doi:10.1111/jre.12164.

~~3Spry Dental Probiotics. Accessed May 2, 2016.

~~4Evapro. About EvoraPro. Available at: Accessed May 2, 2016.

~~5Surtel A1, Klepacz R2, Wysokińska-Miszczuk J, The incidence of breathing mode on the oral cavity. PubMed: Pol Merkur Lekarski. 2015 Dec;39(234):405-7. Accessed May 2, 2016.

~~6Ocean Nasal Spray. OCEAN Saline Nasal Spray. 2016. Available at: Accessed May 2, 2016.

~~7Xclear. Products You’ll Love. 2016. Available at: Accessed May 2, 2016.

~~8Statista. Leading Mouth Wash. 2015. Available at: Accessed May 2, 2016.

~~9CloSYS. 2016. Available at: Accessed May 2, 2016.

~~10Xclear. Spry Rinse. 2016. Available at: Accessed May 2, 2016.

~~11SalivaMAX. 2016. Available at:!product/aboutPage. Accessed May 2, 2016.