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Chapter 33: Building Your Personal Protocol

Not everyone has the same risk factors, the same resources, or the same lifestyle. A 25-year-old vegetarian with excellent salivary flow needs a different approach than a 60-year-old diabetic on multiple medications that cause dry mouth. One-size-fits-all protocols are convenient but suboptimal.

Let me help you assess your situation and build a protocol tailored to your actual needs.

Assessing Your Risk Factors

Caries Risk Assessment

Higher risk if you have:

Factor Why It Matters
History of cavities Past behavior predicts future risk
Visible white spots Early demineralization present
Deep grooves/fissures Traps bacteria, hard to clean
Frequent sugar consumption Feeds cariogenic bacteria
Dry mouth Reduced salivary protection
Reduced saliva flow (medications, conditions) Loss of primary defense system
Orthodontic appliances Plaque accumulation areas
Low socioeconomic status Access and resource constraints
Recent radiation therapy to head/neck Severe dry mouth risk
Sjögren's syndrome or other dry mouth conditions Chronic saliva deficiency

Lower risk if you have:

  • No cavities in past 3 years
  • Adequate saliva flow
  • Low sugar diet
  • Fluoridated water + fluoride toothpaste use
  • Regular professional care
  • Good oral hygiene habits

Periodontal Risk Assessment

Higher risk if you have:

Factor Why It Matters
Bleeding gums Sign of current inflammation
Family history of periodontitis Genetic susceptibility
Smoking Major risk factor, impairs healing
Diabetes Bidirectional relationship
Stress Impairs immune response
Certain medications Gingival overgrowth, dry mouth
Pregnancy Hormonal effects on gingiva
Poor oral hygiene Plaque accumulation
Crowded teeth Cleaning difficulty

Lower risk if you have:

  • No bleeding on brushing/flossing
  • Non-smoker
  • Well-controlled health conditions
  • Good oral hygiene
  • Regular professional cleanings

Self-Assessment Questions

Answer honestly:

  1. When did you last have a cavity filled? ___
  2. Do your gums bleed when you brush or floss? (Y/N)
  3. Do you have a dry mouth sensation? (Y/N)
  4. How many medications do you take? ___
  5. Do you have diabetes? (Y/N)
  6. Do you smoke? (Y/N)
  7. How many times per day do you consume sugar (including beverages)? ___
  8. Do you sip acidic drinks (soda, juice, coffee) throughout the day? (Y/N)
  9. Do you grind your teeth? (Y/N)
  10. When did you last see a dentist? ___

Scoring guidance:

  • Recent cavities, bleeding gums, dry mouth, diabetes, smoking, or frequent sugar = Higher risk, needs more intensive protocol
  • None of the above = Standard protocol probably sufficient

Protocol Templates by Risk Category

Low Risk Protocol

For: No recent cavities, healthy gums, good saliva, low sugar diet, regular dental visits

Morning:

  • Brush with fluoride toothpaste (2 min), spit don't rinse
  • Basic tongue cleaning

Evening:

  • Brush with fluoride toothpaste (2 min), spit don't rinse
  • Floss or interdental brushes

Weekly:

  • Nothing additional required

Professional care:

  • Every 6 months

Optional enhancements:

  • Salt/baking soda rinse if desired
  • Green tea consumption
  • Xylitol gum after meals

This is the minimum effective protocol for maintaining already-good oral health.

Moderate Risk Protocol

For: Occasional cavities, mild gingivitis, moderate sugar consumption, or some risk factors

Morning:

  • Tongue scraping
  • Brush with fluoride toothpaste (2 min), spit don't rinse
  • Salt/baking soda rinse

After meals:

  • Xylitol gum or mints
  • Water rinse

Evening:

  • Water flosser with dilute salt/baking soda solution
  • Floss or interdental brushes
  • Brush with n-HAp or fluoride toothpaste, spit don't rinse
  • Tongue scraping

Weekly:

  • Consider oil pulling 2-3x weekly
  • Botanical rinse (sage, green tea) occasionally

Professional care:

  • Every 6 months, possibly more frequently if gingivitis persists

Key additions:

  • Interdental cleaning becomes non-negotiable
  • pH management with rinses
  • Xylitol exposure throughout day
  • Consider n-HAp for additional remineralization

High Risk Protocol

For: Frequent cavities, periodontal disease, dry mouth, diabetes, or multiple risk factors

Morning:

  • Thorough tongue scraping
  • Brush with fluoride toothpaste (2 min), spit don't rinse
  • Wait 30 min, then use fluoride rinse (0.05% NaF)
  • Salt/baking soda rinse between meals as needed

After meals:

  • Water rinse immediately
  • Xylitol gum (5+ exposures daily)
  • Salt/baking soda rinse 30 min after acidic foods

Afternoon:

  • Additional xylitol exposure
  • Stay hydrated (crucial if dry mouth)
  • Consider CPP-ACP application (MI Paste) if dentist recommends

Evening:

  • Water flosser with salt/baking soda solution (thorough)
  • Floss AND interdental brushes
  • Brush with fluoride toothpaste (2 min), spit don't rinse
  • Fluoride rinse before bed
  • Consider n-HAp paste as additional treatment (not instead of fluoride)
  • Thorough tongue scraping

Daily additions:

  • Probiotic lozenge (S. salivarius K12 or M18)
  • Green tea consumption
  • Dry mouth products if needed (saliva substitutes, xylitol products)

Weekly:

  • Oil pulling 3-5x weekly
  • Botanical treatments (propolis, sage) as adjuncts

Professional care:

  • Every 3-4 months (periodontal maintenance)
  • Discuss prescription fluoride if very high risk
  • Consider in-office fluoride varnish applications

Key differences:

  • Multiple fluoride exposures daily
  • Aggressive pH management
  • Maximum xylitol exposure
  • Professional care more frequently
  • Supplemental remineralization technologies (CPP-ACP, n-HAp)
  • Probiotic support

Dry Mouth Protocol (Specific Addition)

Add to any protocol if you have xerostomia

Ongoing throughout day:

  • Sip water frequently (keep water bottle nearby)
  • Xylitol products multiple times daily (gum, mints, dissolving tablets)
  • Avoid alcohol-based mouthwashes
  • Avoid caffeine in excess (diuretic)
  • Humidifier at night if air is dry

Products to consider:

  • Biotene or similar dry mouth products
  • Saliva substitutes (carboxymethylcellulose-based)
  • Dry mouth toothpaste (often higher fluoride, gentle formulations)
  • Xylitol sprays

Key principles:

  • Your saliva is compromised, so you need to compensate with:
  • More frequent fluoride exposure
  • More frequent pH management
  • Artificial saliva supplementation
  • Extra diligence with plaque removal

Talk to your doctor about:

  • Whether any medications could be switched to less xerostomia-causing alternatives
  • Pilocarpine or cevimeline if severe (prescription saliva stimulants)

Life Stage Considerations

Your protocol may need adjustment based on your life stage. I've dedicated full chapters to the most significant transitions:

These aren't just variations on the standard protocols—each life stage has unique physiology, unique risks, and unique opportunities for intervention.

Customization by Preference

If You Prefer Minimal Products

Core essentials only:

  • Fluoride toothpaste (any basic brand)
  • Floss or interdental brushes
  • Salt and baking soda (you likely have these)
  • Water

This minimal approach can work well if you're consistent and don't have elevated risk factors.

If You Prefer Natural/Botanical Approach

Emphasize:

  • n-HAp toothpaste instead of fluoride (Apagard, etc.)
  • Salt/baking soda as primary rinse
  • Botanical rinses (sage tea, green tea, ginger)
  • Oil pulling
  • Miswak products (Peelu gum)
  • Propolis
  • Xylitol throughout day

Be aware:

  • You're trading the strongest evidence (fluoride) for alternatives with less robust data
  • Consider professional fluoride applications periodically even if avoiding it at home
  • Monitor cavity incidence; if it increases, reconsider fluoride

If You Love Technology and Optimization

Add:

  • Electric toothbrush with pressure sensor and timer
  • Water flosser with multiple tip options
  • Oral probiotic supplements
  • CPP-ACP (MI Paste)
  • n-HAp toothpaste (alternate with fluoride)
  • Smart toothbrush with app feedback
  • Professional fluoride varnish applications

Track:

  • Cavity incidence
  • Gingival bleeding episodes
  • Professional assessments

If You Travel Frequently

Travel kit essentials:

  • Travel toothbrush + mini fluoride toothpaste
  • Floss or disposable flossers
  • Xylitol gum (TSA-friendly, useful on planes where hydration is challenging)
  • Small container of salt/baking soda mix (if you use it regularly)

On-the-go strategies:

  • Xylitol gum after meals when brushing isn't possible
  • Water rinse in restrooms
  • Maintain evening routine even when exhausted from travel

Putting It Together

Step 1: Assess your risk (use the questions above)

Step 2: Select your template (low, moderate, high risk)

Step 3: Customize for preferences (natural vs. conventional, minimal vs. comprehensive)

Step 4: Customize for circumstances (dry mouth additions, travel adaptations)

Step 5: Implement for 3 months

Step 6: Evaluate (any new cavities? Gum bleeding? Professional assessment?)

Step 7: Adjust (intensify if problems; simplify if excellent results and you want less complexity)

The Sustainability Test

Whatever protocol you design, ask yourself:

"Can I do this consistently for years?"

If the answer is no, simplify. A simple protocol done consistently beats an elaborate protocol done sporadically.

I've watched countless humans start ambitious oral care routines and abandon them within weeks. Don't be that person. Build something you'll actually do.

The teeth you save are the ones you care for consistently, not the ones you care for perfectly for a short time.