Chapter 32: A Day in the Optimized Mouth

Let me walk you through what an ecologically-informed day of oral care might look like. This isn't prescriptive—you don't need to do everything here. It's illustrative, showing how the principles we've discussed translate into practical timing and choices.

The Morning

Upon Waking

The state of your mouth: You've just spent 6-8 hours with minimal saliva flow. Your mouth is drier than it will be at any other time of day. The pH has likely drifted somewhat acidic. Anaerobic bacteria have been more active than usual in the reduced-oxygen environment. Morning breath is normal and universal.

First move: Rinse with water. Before anything else, a simple swish with plain water dilutes and removes some of the overnight bacterial accumulation. You can use your salt/baking soda rinse here if you prefer, but plain water works fine for this initial clearing.

Tongue cleaning: This is the highest-impact moment for tongue scraping. The overnight tongue coating is at its peak. 3-5 gentle passes with a scraper, rinsing between each. You'll be amazed at what comes off.

Brushing: Whether you brush before or after breakfast is debated. Both approaches have merit:

Before breakfast: - Removes overnight plaque before you feed it - Applies fluoride coating before acid challenge of meal - Avoids brushing softened enamel if breakfast is acidic

After breakfast: - Removes breakfast debris - More intuitive sequence for most people - BUT: If breakfast includes acidic foods (citrus, fruit, coffee), wait 30 minutes before brushing to allow saliva to reharden enamel

My suggestion: If you eat a non-acidic breakfast, brush after. If you eat citrus or drink orange juice, brush before or wait 30 minutes after.

Brushing technique:

• Fluoride or n-HAp toothpaste (2 minutes)
• 45-degree angle at gumline
• Small circular or Bass technique movements
• Don't forget lingual surfaces
• Spit but don't rinse (leaves fluoride or n-HAp residue in contact with teeth)

Interdental cleaning: Floss or interdental brushes. The specific tool matters less than the consistency. If you hate flossing, find an alternative you'll actually use—water flosser, soft picks, interdental brushes.

Post-Breakfast Window

If you had acidic foods/drinks (coffee, OJ, fruit):

• Don't brush for 30 minutes
• Rinse with plain water or alkaline rinse to restore pH
• Xylitol gum can help stimulate saliva and accelerate pH recovery

If you had neutral/alkaline breakfast:

• Regular routine applies
• No special waiting needed

Midday and Afternoon

The Between-Meals Vulnerability

The challenge: Most people don't brush during the workday. Lunch happens. Snacks happen. Coffee happens. Each acid exposure starts the demineralization clock, and without intervention, you're relying entirely on saliva for recovery.

Smart strategies:

After lunch:

• Rinse with water (even just at a drinking fountain)
• Xylitol gum or mints (saliva stimulation + xylitol's antimicrobial effect)
• If you can manage it: a quick salt/baking soda rinse (keep some at your desk)

That afternoon coffee:

• Drink it within a reasonable time window (20-30 minutes) rather than sipping all afternoon
• Follow with water rinse
• Don't add sugar

Snacking patterns:

• If you're going to snack, do it in defined sessions rather than continuous grazing
• Choose low-cariogenic options when possible: cheese, nuts, vegetables
• Worst choice: sticky, sugary snacks spread throughout the day

The Carbonated Water Question

If you drink sparkling water during the day:

Check ingredients: No added citric acid? Much less concern.

Consumption pattern: Drink it, don't sip it for hours. One 10-minute drinking session is better than nursing a can all afternoon.

Follow with still water: Rinse and dilute.

Context matters: If you're also consuming other acidic things (coffee, citrus), the cumulative acid load matters. Sparkling water alone is low-risk; sparkling water plus coffee plus orange juice plus wine is more concerning.

Evening

The Pre-Dinner Period

Usually no special intervention needed. If you've been sipping acidic drinks all afternoon, a water rinse helps. Otherwise, just proceed to dinner.

Post-Dinner

Timing considerations:

• If you'll be going to bed within 2 hours of dinner, your evening routine should come soon
• If dinner will be followed by hours of evening activity, you might rinse after dinner and do full routine closer to bed

The cheese trick: Ending a meal with a small piece of cheese has genuine evidence behind it:¹

• Casein protein adheres to enamel and provides some protection
• High calcium and phosphate content supports remineralization
• Buffers pH
• Traditional in French culture; now we know why it makes sense

The Evening Routine

This is your most important oral care session. During sleep, saliva flow drops dramatically, reducing the natural defense system. Whatever state your mouth enters sleep in will persist for hours.

Sequence:

1. Water flosser (if using) with salt/baking soda solution: Mechanical disruption + ecological rinse delivery. See Chapter 16 for detailed technique.

2. Interdental cleaning: Floss or interdental brushes for areas the water flosser may miss.

3. Brushing: Full 2-minute routine. If you're alternating between fluoride and n-HAp, consider using fluoride in the morning (for daytime acid protection) and n-HAp at night (for overnight remineralization).

4. Spit, don't rinse: Leave toothpaste residue on teeth.

5. Optional: Fluoride rinse: If you're at high caries risk, an additional 0.05% NaF rinse before bed provides extra overnight protection. Swish for 1 minute, spit, don't rinse or eat/drink after.

6. Tongue scraping: If you didn't do it thoroughly in the morning, now is good too.

After evening routine: Nothing except water until morning. No tea, no snacks, no midnight fridge raids. Your mouth is in its optimal pre-sleep state; don't disrupt it.

Weekly and Occasional Additions

Oil Pulling

If you're incorporating oil pulling (Chapter 23), morning is the traditional time. It can be done during your shower or while doing other morning tasks. 15-20 minutes, then spit, rinse, and proceed with your normal routine.

Intensive Botanical Treatments

If you're using herbal rinses (sage tea, ginger preparations, propolis):

• These can substitute for or supplement your salt/baking soda rinse
• Some people alternate: basic rinse most days, botanical rinse 2-3 times weekly
• Use them when you feel you need extra soothing (mild gum inflammation, after stress)

Professional Cleaning

Every 6 months for most people; more frequently (3-4 months) if you have periodontal disease or high caries risk. The professional cleaning removes subgingival deposits that home care can't reach.

The Timing Grid

Here's a condensed reference:

Time	Action	Purpose
Wake	Water rinse	Clear overnight accumulation
Wake	Tongue scrape	Remove tongue coating
Pre/post breakfast	Brush (fluoride or n-HAp), don't rinse	Plaque removal, remineralization substrate
Post-acidic foods	Water rinse, wait 30 min to brush	Protect softened enamel
After meals	Xylitol gum, water rinse	Saliva stimulation, pH recovery
Mid-afternoon	Water or alkaline rinse if needed	pH maintenance
Pre-bed	Full routine: water flosser → floss → brush → don't rinse	Overnight protection
Pre-bed (optional)	Fluoride rinse	Extra remineralization
During sleep	Nothing	Undisturbed recovery

What If You Can't Do Everything?

Real life interferes. Travel, illness, exhaustion, busy days. Here's a priority hierarchy:

If you can only do one thing:

• Brush before bed with fluoride or n-HAp toothpaste, don't rinse

If you can do two things:

• Above + morning brushing

If you can do three things:

• Above + interdental cleaning (evening)

If you can do four things:

• Above + tongue cleaning

If you can do five things:

• Above + pH-supportive rinse

Everything beyond that is optimization. The core is: brush thoroughly twice daily, clean between teeth once daily, prioritize the evening routine.

The Minimum Effective Dose

For someone who "does the bare minimum and wonders why they keep getting cavities"—my target audience, remember?—the minimum effective dose is:

1. Brush 2 minutes, twice daily, with fluoride toothpaste. Actually time yourself; most people think they're brushing longer than they are.

2. Don't rinse after brushing. This simple change dramatically increases fluoride exposure.

3. Clean between teeth once daily. Find any method you'll actually do consistently.

4. Reduce sugar frequency. Total intake matters less than how many discrete sugar exposures you have daily.

5. See a dentist. Early problems are fixable; late problems lose you teeth.

That's it. Do those five things consistently and you'll probably be fine. Everything else in this book is optimization and deeper understanding—valuable, but the basics come first.

The Tooth Fairy doesn't ask for perfection. I ask for consistency. Your teeth forgive occasional lapses; they don't forgive habitual neglect.

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A note on life stages: This chapter describes an adult protocol. Children, pregnant individuals, and older adults have different needs—see Chapter 34: Children and Resilient Teeth, Chapter 36: Pregnancy and Oral Health, and Chapter 37: Oral Health in Later Years for specific guidance.

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1. Telgi, R. L., et al. (2013). The effect of cheese on dental caries prevention: A systematic review. Journal of Clinical and Diagnostic Research, 7(7), 1498-1501. ↩