Poor or wrong home care product routine.
Many individuals have been taught since they were children to “brush and floss your teeth twice a day to keep the dentist away.”
While this is excellent advice, and removing food debris and some of the plaque buildup from your teeth is important, it does create one question: how many infections/diseases are treated back to health with either a piece of string or a short handle plastic stick with bristles on the end? While mechanical removal of debris and plaque should not be ignored, the chemotherapeutic agents being brushed with, rinsed with, etc., are the actual therapy agents that have the ability to alter the oral biofilm and ultimately influence oral health. For example, a high/extreme-risk caries patient with severe decay, low saliva flow, and bacterial imbalance who has been regularly brushing and flossing is not going to suddenly get healthy if they increase their current brushing and flossing regimen from twice a day to 4 times a day. Simply put, if the products and home care routine they were using were working…well, it would have worked.
Most patients receive little to no guidance from their dental professionals regarding products they should be using at home, and the supermarket aisle is awash with products that can “do everything” and products that are “recommended by 4 out of 5 dentists.” The most common advice routinely offered to dental patients is to “brush and floss more.” For many patients, this advice can be frustrating, especially when they are already brushing and flossing regularly but still have cavities.
Most preventive dental practices that sell professional dental therapeutic products earn less than 1% of their annual revenue from product sales. If a dentist has chosen to carry and sell a product in their office, they have chosen it due to its potential to help their patients.
On the other hand, offices that are serious about recommending proper patient-specific product therapies are often met with equal frustration from patients. These patients often mistakenly believe the practitioner is just trying to “push products to make money.” The reality is that dental practices do not earn much, if any, profit from selling professional dental products, and few, if any, dental practices choose the products they wish to recommend to their patients based on “profitability.” Most preventive dental practices that sell professional dental therapeutic products earn less than 1% of their annual revenue from product sales. If a dentist has chosen to carry and sell a product in their office, they have chosen it due to its potential to help their patients. Dental ethics prevents dental practitioners from “upselling” or “pushing” medical therapies on patients that are not indicated. If a patient has received a CAMBRA homecare recommendation, it should be taken very seriously.
The balance among disease indicators, risk factors, and protective factors determines whether dental caries progresses, halts, or reverses. Dr. John Featherstone, of the University of California, San Francisco School of Dentistry, introduced the concept of the caries balance in 2002 while performing a caries risk assessment clinical trial on close to 13,000 patients. The concept and clinical trial have since been validated. In basic terms, in order to reverse the progression of dental caries, a patient must “outweigh” their disease indicators and risk factors with protective factors specific to their needs. For some patients, the disease progression is so great that it is a challenge to reverse the trend and can take substantial time and effort to tip the balance toward health.
A proper home care program is simple. It is designed to counteract the risk factors specific to each patient with products the patient is willing to purchase and use as directed by their dental professional and weights their individual “caries balance” (See Figure 8) toward health. Unless there is a contraindication, the recommended products should contain some or all of the known caries therapy agents (See Figure 9) such as pH neutralization, therapeutic levels of xylitol and fluoride, remineralization agents like nanoparticles of hydroxyapatite, as well as a broad-spectrum oxidizing antibacterial agent if a biofilm imbalance exists. Other recommendations should include a reduction of all modifiable risk factors. (Some examples would be CTx4 Treatment Rinse, CTx3 Rinse, CTx3 Gel, CTx2 Spray.)