A breakdown of the common myths, best practices, and best ingredients to help your orthodontic patients develop and maintain good oral health.  

February marks National Children’s Dental Health Month. To learn more about the common myths of oral care and what orthodontists should do to ensure their adolescent patients’ oral health during treatment, Orthodontic Products spoke to Kami Hoss, DDS, MS, an expert in pediatric oral care, who completed his residency in orthodontics and dentofacial orthopedics at the University of Southern California. Hoss, who is the founder of The Super Dentists, a multi-specialty pediatric dentistry and orthodontic practice in Southern California, is the author of If Your Mouth Could Talk: An In-Depth Guide to Oral Health and Its Impact on Your Entire Life. He also developed SuperMouth, a custom mouth care system for pediatric oral care.

Orthodontic Products: How does oral health connect to one’s overall health? 

Kami Hoss, DDS, MS: As the gateway to the body, the mouth’s health impacts almost every part of our overall health and prosperity. Oral health (from both microbial, and growth and development perspective) can impact fertility and health of pregnancy, timing of birth, airway and oxygen intake, sleep, school performance, nutrition, mental health, many systemic diseases, and longevity.

OP: You have written a book on oral health. Why did you decide to focus on this aspect of dental care? 

Hoss: After nearly 30 years working in dentistry, it was obvious that the way we view oral health as a society is wrong and must change. For most, poor oral health can cause “just some cavities” which the dentist can fill, or some “crooked teeth” which the orthodontist can straighten. To them oral health is not a big deal. So, I thought it was time I put all this information in one book and help to educate the public about how their oral health and the oral health of their children impact so many areas of their lives.

OP: When it comes to oral care, what are the most common myths? 

Hoss: Cavities are no big deal! Baby teeth don’t matter because they’ll fall out anyways! All toothpastes and mouthwashes are basically the same! We should kill 99.99% of the germs in our mouths! Children shouldn’t see an orthodontist until all permanent teeth erupt! Children shouldn’t see a dentist until they’re about 3 years old!

OP: When it comes to younger patients undergoing orthodontic treatment, what are the biggest oral health concerns that orthodontists should be thinking about and educating patients/parents about during treatment?

Hoss: It’s always important to educate the parents (and the public in general) about the critical role a healthy mouth plays in a person’s quality of life, overall health, happiness, prosperity, and longevity. Once parents realize the critical role their children’s oral health plays in their lives, the $7,000 (or so) investment in their orthodontic treatment would seem like a no-brainer.

OP: Are there tools that can help orthodontists better identify/track/maintain a patient’s oral health during treatment? 

Hoss: Just as orthodontists learn how to be great clinicians, we also need to educate ourselves about various oral care products and how they would work together (or against each other) to keep a patient’s mouth healthy during orthodontic treatment when we have higher risk of decalcification, periodontal disease, and dental caries.

OP: Let’s talk about a good oral health care regimen during orthodontic treatment. What does that look like? 

Hoss: Here’s what I recommend:

Morning Routine (BEFORE breakfast—not after)1. Alkaline mouthwash: Most OTC mouthwashes are acidic to extend shelf life. You can and should test the pH using a strip or a meter. Use the mouthwash for 1 minute to get to the areas of the mouth not easily accessed by a toothbrush. Ideally a mouthwash with no artificial colors, flavors, or preservatives, and prebiotics such as xylitol, erythritol, and inulin to promote a healthy oral microbiome.

2. Tongue brush/scraper: The tongue is a common source of microbes that cause bad breath. Toothbrush bristles are not really designed to clean the tongue.

3. Floss: Use a safe and effective floss
—No petroleum-based wax such as microcrystalline wax.
—No Teflon or other potentially toxic chemicals (PTFE, PFAS)
—Polyester, silk, or nylon material
—Safe wax such as beeswax
—Ideally the floss should be infused with key ingredients from the toothpaste such as nano-hydroxyapatite, xylitol, and erythritol. You can also add fluoride for higher risk and older patients.

4. Brush: Use a safe and effective toothbrush with only soft or ultra-soft bristles (soft nylon or PBT). Use a toothpaste that contains no unsafe ingredients such as artificial colors, flavors or preservatives, SLS, or antibiotics. The toothpaste must contain either nano-hydroxyapatite (at least 10% concentration for maximum efficacy) and/or sodium fluoride. It also needs to contain prebiotics such as xylitol, erythritol, and inulin to promote a healthy oral microbiome.
Daily Routine (during the day/after meals and drinks)You can use a safe and effective mouth-spray to alkalize the saliva after meals since you should never brush your teeth for at least 30 to 60 minutes after meals or acidic drinks.
Evening Routine (before bedtime)—Tongue cleaner
—Floss (second flossing is optional)
—Brush with toothpaste
—Mouthwash for overnight protection (Mouthwash is the first and last oral care product to be used daily).

OP: Are there specific ingredients that should be a part of an oral health care routine? 

Hoss: Absolutely. I have a full list of healthy and harmful ingredients in my book but here’s a summary:

Ingredients to use include nano-hydroxyapatite (at least 10% concentration), vitamin K2, vitamin D3, xylitol (at least 10% concentration), erythritol, and inulin should be used for everyone. When patients are in ‘braces’ they generally have a higher risk of decalcification, periodontal disease, and dental caries so for most patients I’d also recommend adding sodium fluoride to most products during treatment.

Ingredients to avoid include stannous fluoride, alcohol, antibiotics, antiseptics or antimicrobial agents, essential oils, aspartame, saccharin, sorbitol, sodium lauryl sulfate (SLS), propylene glycol, diethanolamine (DEA), artificial flavors, dyes, or artificial preservatives, and titanium dioxide.

OP: What role should orthodontists play in recommending oral health care products to their patients during treatment?

Hoss: I think for most dentists and orthodontists we are concerned primarily with taking care of our patients while they’re in our offices. Because there is little to no education in dental schools or residency programs about oral care products and how they work together—or against each other—we leave our patients on their own to figure out what products to use. But I believe as doctors, we all want to do more. So, I think it’s important we all educate ourselves about various oral care products so we can provide specific recommendations to our patients about how they should be taking care of their oral health at home.

OP: In your opinion, what has been the biggest advancement in oral health care for children? 

Hoss: In the last couple of decades, we’ve learned a lot more about the impact of oral development in airway, sleep, and overall health. There has also been a flood of data connecting oral health to various diseases. Additionally, going to the dentist has become a lot more fun so kids can grow up building positive associations with their oral health and oral care.

OP: You founded a multi-specialty practice—specifically pediatric dentistry and orthodontics. What do you think this practice model brings to orthodontic care and overall oral health for the patient? 

Hoss: I honestly cannot think of running an orthodontic practice without a pediatric dentistry practice as a team. In a group practice, we learn from each other’s expertise and experience and ultimately our patients win from the collaboration and cooperation between the different disciplines.

OP: For orthodontists who are not in a multi-specialty practice, what’s your advice for how they should communicate with the patient’s general/pediatric dentist during orthodontic treatment to ensure the patient’s overall oral health? 

Hoss: Communication is key, so dental practices need to develop protocols for connecting and communicating with other dental practices through phone calls, texts, emails, video calls, and in-person meetings. Ultimately though, I do recommend most orthodontists think about joining a pediatric practice if possible. OP