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Conquering the caries epidemic (from the hygiene operatory): A guide to implementing the latest oral health adjuncts

July 21, 2016
Amber Auger, RDH, offers a guide to implementing the latest oral health adjuncts in the dental hygiene operatory.

By Amber Auger, RDH, MPH

The American Dental Hygienists' Association defines the role of a dental hygienist as a dynamic one, which includes the roles of educator, clinician, advocate, manager, and researcher. We serve as oral health 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 antianxiety 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, which are now on the rise.1 In order to conquer the risks associated with our patients' systemic and behavioral factors, clinicians need to make use of the latest in their armamentarium for patient home care.

Probiotics-The use 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

Spry Dental Probiotics work 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 Stix and allows the patient simply to 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.4 For best results, avoid chewing the tablet and allow it to naturally melt in the mouth. EvoraPro use demonstrated whiter teeth, fresh breath, 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 scaling and root planing 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 in preventing dental decay. High-risk patients include periodontal patients, orthodontic patients, and patients with poor-to-fair home care.

Nasal sprays-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 breathe through their mouths, they are left with dried, erythemic gingivae; 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 disease.5 Through the use of adjunctive nasal spray therapies, we can reduce the risk of patients' mouth breathing and promote proper nose breathing.

Ocean Saline Nasal Spray is indicated for those who suffer from allergies, cold/flu, sinusitis, those who live in dry and cold climates, and those who have overall heavy congestion. This spray is also recommended for patients who use a CPAP machine or suffer from sleep apnea. Active ingredients include sodium chloride (0.65%), phenylcarbinol, and benzalkonium chloride solution.6

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

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

Oral rinses-In 2014, the makers of Listerine, Johnson and Johnson, sold $588.7 million in mouthwash!8 Most hygienists cringe at the thought of patients rinsing with active ingredients such as alcohol, as it exacerbates the dry-mouth epidemic. Hundreds of products claim 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, he or she will not benefit from the product, because the patient 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, triclosan-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 adhering to 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.

SalivaMax is a FDA-cleared prescription-strength rinse that is indicated for xerostomia, mucositis, and hyposalivation. SalivaMax is a partial substitute for natural saliva that moistens, lubricates, and cleans the oral cavity.11 Patients swish with SalivaMax, and it can be administered several times per day, depending on the dry mouth severity.11

For SalivaMax, fill out a prescription form for the patient and fax it in to the concierge pharmacy that fills SalivaMax. If the patient has commercial insurance coverage, the patient will receive product within two to four days and with the manufacturer coupon program it will be no cost to the patient. If the patient does not have commercial insurance, a free trial will be sent to the patient to experience the benefits of the product. You can get your SalivaMax prescription form at www.salivamax.com

  • 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 him or her of the benefits of the product and why it is important to their specific oral health. Contact the manufacturer 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 with which they are presenting. Evaluating a product through research and taste testing will allow clinicians to offer more custom recommendations to meet the needs of patients. Dental hygienists are educators and innovators by nature; therefore, it is time to rise to the call to create a progressive recare visit to meet the specific needs of our patients on an individual basis. RDH

Amber Auger, RDH, MPH, is a hygienist with more than six years of experience in multiple clinical settings, including facilities abroad. This experience has allowed her to educate dental hygiene students and coach dental teams on periodontal systems to optimize practice growth. She holds a part-time position at an elite dental office in Boston, and is an advisor for Jameson Management. Auger obtained a master's degree in public health from the University of New England and a bachelor's in dental hygiene from the University of New Haven. She specializes in pediatric education, periodontal education, and continues to create progressive systems. Auger is a key opinion leader for several elite dental companies, a published author, and can be contacted at [email protected]


1. Herper M. America's Most Popular Mind Medicines. Forbes website. http://www.forbes.com/2010/09/16/prozac-xanax-valium-business-healthcare-psychiatric-drugs.html. Published September 17, 2010. Accessed May 2, 2016.
2. Maekawa T, Hajishengallis G. Topical treatment with probiotic Lactobacillus brevis CD2 inhibits experimental periodontal inflammation and bone loss. Journal of Periodontal Res. 2014;49(6):785-791. doi:10.1111/jre.12164.
3. Spry Dental Probiotics. Xlear website. http://www.xlear.com/store/spry-dental-defense/dental-probiotics/natural-blueberry-dental-probiotics.html. Accessed May 2, 2016.
4. EvoraPro. EvoraPro is different than anything in your arsenal. Oragenics website. http://www.evorapro.com/about-evorapro-oral-probiotics/. Accessed May 2, 2016.
5. Surtel A, Klepacz R, Wysokieska-Miszczuk J. (Article in Polish) The influence of breathing mode on the oral cavity. PubMed: Pol Merkur Lekarski. 2015;39(234):405-7.
6. Ocean Nasal Spray. Valeant Pharmaceuticals website. http://www.oceannasalcare.com/saline-nasal-products/saline-nasal-spray. Accessed May 2, 2016.
7. Xlear. Products you'll love. 2016. Xlear Inc. website. http://www.xlear.com. Accessed May 2, 2016.
8. Statista. Leading mouthwash and dental rinse vendors in the United States in 2014, based on sales (in million U.S. dollars). Statista website. http://www.statista.com/statistics/195533/leading-us-mouthwash-vendors-in-2012-and-2013-based-on-sales/. Published 2015. Accessed May 2, 2016.
9. CloSYS. The difference. Rowpar Pharmaceuticals website. Published 2016. https://www.closys.com/. Accessed May 2, 2016.
10. Xlear. Spry Cool Mint Natural Oral Rinse. Xlear Inc. website. http://www.xlear.com/store/spry-dental-defense/xylitol-mouth-wash/cool-mint-natural-oral-rinse.html. Published 2016. Accessed May 2, 2016.
11. SalivaMAX. SalivaMAX Supersaturated Calcium Phosphate Rinse. What is it? Forward Science website. http://www.salivamax.com/?gclid=CjwKEAjw9Zu5BRCS_OuVibujhQ0SJAD7t4KrPftiGSaW8dK3bU-szeV5zIIWJAd5_uUKXr0aeHwgnBoCYaTw_wcB#!product/aboutPage. Published 2016. Accessed May 2, 2016.