Oral Health Recommendations:

1. Follow a strict home care protocol.
a. Use an oral irrigator (the Water Flosser by WaterPik or the HydroFloss) (studies show that it can disrupt bacteria and biofilm up to 6 mm below the gum line). This helps reduce the number of bacteria in the mouth as well as freshen the breath. We recommend gradually dialing up to the highest setting on the irrigator. However, at first, start at a low setting then move the dial up a little each week as it can be tolerated.
b. Place a capful of disinfecting solution into the water basin of the water flosser, such as:
i. Closys Oral Health Rinse
ii. Tooth & Gum Mouth Rinse
iii. Sodium Hypochlorite (1 teaspoon of Clorox bleach diluted in at least 4 oz of water).  https://www.wellnessdentalcare.com/973/is-diluted-clorox-bleach-mouthrinse-safe/
c. Use an electric ultrasonic brush twice daily.
Recommend brushes: Philips Sonicare; Waterpik; JetPik. The JetPik combines an ultrasonic brush with a water flosser.

2. Oral exposure of 1-2 grams of xylitol daily (in any of its various forms), spread out throughout the day, especially after meals and snacks.
Zellies is a popular, all natural, xylitol gum/mint that we recommend. (Zellies.com)

3. One daily serving of an oral probiotic (e.g. Evora Pro tablets (available at Amazon) dissolved in the mouth to support the good oral bacteria. The bacteria of the mouth are opportunistic. If you build up the good bacteria, you make it harder for the bad disease-causing bacteria to survive, because they are fighting for the same nutrients. Kefir is a fermented milk product (cow, goat, or sheep milk) that tastes like a drinkable yogurt and contains high levels of vitamin B12, calcium, magnesium, vitamin K2, biotin, folate, enzymes, and numerous probiotics.

4. If you are still having a problem with plaque build-up at the gum line, a Sulca-brush would be highly recommended. https://www.sulcabrush.com/

5. Flossing is also very valuable, but we recognize that most patients are not vigilant enough with their flossing to depend on it.