Table 4

Recommended guidelines in the prevention of xerostomia related dental decay. (Modified after Newbrun95 101)

1Personal dental plaque measures
Twice daily cleaning of the teeth by use of a toothbrush (if an electric toothbrush is used, professional instruction is needed), dental floss, or interdental brush, and fluoride containing dentifrice.
2 Dietary instruction
Limit the use of between meals intake of sugary foods, candies, and sugar containing beverages. Encouraging the use of non-cariogenic sweeteners such as aspartame, saccharin, acesulfam K, sorbitol or xylitol. The last two sugars are not separately available as sweeteners.
3 Office fluoride therapy
At the initial visit at the dental office application of a high concentration fluoride agent, either a neutral fluoride gel for 4 minutes in a tray or a fluoride varnish directly onto the dentition. Varnishes can be applied simply by a small handbrush. As the application frequency is an important factor in determining efficacy, a four times per year application frequency is recommended.
4 Office chlorhexidine therapy (optional)
At the initial visit a 1% chlorhexidine gel for 5 minutes or a high concentration chlorhexidine varnish can be applied.
5 Home use fluoride therapy
A weekly to daily application of a neutral fluoride gel in a custom fitted tray. The application frequency depends on the severity of caries susceptibility. For patients who cannot tolerate a gel, a daily 0.05% sodium fluoride rinse for one minute is an alternative. The use of acidulated phosphate fluoride gels in patients with (severe) oral dryness is not recommended because of the dental erosive effects of these gels.
6 Home use chlorhexidine therapy (optional)
As complementing therapy, thus not as an alternative, with fluoride application chlorhexidine rinses can be used. However, the indication is limited to the number of Streptococcus mutans in saliva: >1×106 counts/ml saliva. If the number cultivable counts of S mutans exceeds the limit 1×106 a twice daily rinse can be used during one minute for two weeks. Because of the bioavailability of fluoride in rinses, chlorhexidine should not be used simultaneously with fluoride in one solution.