2.3 Mineral and Antimicrobial AgentsXylitolOral health professionals can recommend products containing xylitol, such as gum or mints, for patients at high or very high risk for dental caries.23,24 For xylitol to be effective, patients must consume a total of 5 g in small increments throughout the day. Xylitol has an anticariogenic effect through its antimicrobial action on MS in saliva and has been shown to reduce the probability of MS transmission from mother to child.25–28 Saliva stimulation from chewing sugar-free gum after eating may also contribute to the anti-caries effect. AntimicrobialsChlorhexidineEliminating or controlling carious infection with antimicrobials is only effective following removal of active caries.29 Chlorhexidine rinses are effective in decreasing MS in patients with high bacteria counts.6 Chlorhexidine rinses should be prescribed after removal of carious lesions is complete. Products containing chlorhexidine have a strong taste that some people dislike, and many substances, including fluoridated toothpaste, neutralize the active ingredient. In addition, long-term use of chlorhexidine may cause staining of teeth. If a chlorhexidine regimen is prescribed for patients at high or very high risk for dental caries, oral health professionals need to explain how to use the rinse and inform patients about its side effects. Chlorhexidine rinses are contraindicated for children under age 12 and for people sensitive to alcohol, because alcohol is used as a preservative. Adults must supervise the use of chlorhexidine in adolescents (ages 12 or older). Brushing with chlorhexidine (i.e., repeatedly dipping a toothbrush in chlorhexidine and brushing the teeth until it as been applied to all the teeth) has been shown to be as effective as rinsing and can be offered as an alternative method of use.30,31 Chlorhexidine is also available as a varnish or a gel, and it may be more effective when applied in these forms than when used as a rinse.31–36 |
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