Dental Tribune USA

There’s no dentistry like no dentistry

By Shirley Gutkowski, USA
September 17, 2009

The title sounds arrogant coming from a dental hygienist. What if it came from one of the premiere dental schools in the United States or from two of the most noted caries researchers, University of Pacific’s Dr Doug Young or Dr Kim Kutsch? That’s the message from the World Congress of Minimally Invasive Dentistry (WCMID), and it doesn’t mean there’s no reason for dentists to be around. It means there’s just nothing like an intact tooth, and everything we do to repair it comes in at a distant second place.

For clinicians to understand the true meaning of the phrase, they have to really own a few things — such as germs are small, so small that a margin is not a margin, it’s a canyon.

Finding out why enamel breakdown is occurring must come first; the time of watching and waiting before taking action is over. Remineralization therapies have made it easier to digest the idea that any prosthesis is inferior to the natural tooth.

Novamin, Recaldent and xylitol are adjuncts to fluoride and allow clinicians to follow the science of fluoride workings.1 For instance, fluoride works best on the broad or smooth surfaces of the teeth, although a hefty majority of decay starts in the pits and fissures,2 and clinicians continually use fluoride as the only topical to lessen decay incidence.

No longer.

At the WCMID meeting this past summer, a new paradigm was offered: dental decay is not a bacterial disease; it is a pH disease.3 Bacteria will not survive in an alkaline environment, so it’s no wonder they’re only found in mouths with low pH — the chicken/egg dilemma. The chemical reaction that occurs in a low pH can be altered by forcing the pH upward. Recaldent does this by releasing amorphous calcium and phosphates during an acid challenge.4

Xylitol can increase pH when used as a sweetening agent in gum and candies, over and above the pH increase of chewing paraffin, as shown in a group session of a hands-on workshop.5 This does not include the damaging effects of xylitol on biofilm construction, cell walls and strep metabolism.6

The science of Novamin also effectively increases pH as oral acids melt away the crystals.7 Today Novamin is found in a number of home and professional products.

So really look at your practice. Do you believe there’s more to oral care than the 45 degrees on the toothbrush, the C of the floss and more fluoride?

Call a cavity a hole, call a filling a prosthesis and call on all of your education to help those who can be taught and take the burden off those who cannot.


1. Dental Health Foundation. Selected Findings and Recommendations from the California Oral Health Needs Assessment of Children, 1993–1994. Report at:
2. Guidelines on the use of Pit and Fissures Sealants in Paediatric Dentistry: an EAPD policy document. Accessed September 2, 2009
3. WCMID, August 13, 2009, San Francisco.
4. The effect of casein and calcium containing paste on plaque pH following a subsequent carbohydrate challenge. Caruana PC, Mulaify SA, Moazzez R, Bartlett D. J Dent. 2009 Jul;37(7):522–6. Epub 2009 Apr 29.
5. Florida National Dental Conference, June 14, 2009. Advanced Warning: Caries, Cancer, and Occlusion, Shirley Gutkowski, RDH, BSDH, FACE.
6. In vitro susceptibility of established biofilms composed of a clinical wound isolate of Pseudomonas aeruginosa treated with lactoferrin and xylitol. Ammons MC, Ward LS, Fisher ST, Wolcott RD, James GA.Int J Antimicrob Agents. 2009 Mar;33(3):230–6. Epub 2008 Nov 1.
7. Potential agents to control enamel caries-like lesions. Rehder Neto FC, Maeda FA, Turssi CP, Serra MC. J Dent. 2009 Oct;37(10):786–90. Epub 2009 Jun 18.

About the author

Shirley Gutkowski, RDH, BSDH, FACE is a CareerFusion coach, speaker and author of books in The Purple Guide series. CareerFusion, LLC is a yearly retreat for clinicians interested in evolving their health-care careers out of the treatment room. The retreat is four and a half days of intensive personalized training in all facets of career evolution.

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