Sjogren's Strong

Introduction

NewEnamel®: Preventative at Home Dental Care

Home Dental Care to the next level with NewEnamel® and the CAMBRA® protocol with DDS. Fernandez and Keith Harband of NewEnamel®.

NewEnamel®: Preventative at Home Dental Care

Take your Home Dental Care to the next level with NewEnamel®. DDS. Fernandez and Keith Harband discuss the NewEnamel® prescription products and services they provide online using the CAMBRA® protocol.

Lupe & Brian: [00:00:00] Welcome to another episode of Sjogren’s Strong.

[00:00:03] Brian: [00:00:03] This is Brian.

[00:00:04] Lupe: [00:00:04] And this is Lupe.

[00:00:04] Brian: [00:00:04] And this is your weekly podcast discussing how to live an active and healthy lifestyle despite a diagnosis of Sjogren’s.

[00:00:12] Lupe: [00:00:12] Hi everyone.

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[00:00:14] Brian: [00:00:14] What you got?

[00:00:14] Lupe: [00:00:14] What I got right now?

[00:00:17] Brian: [00:00:17] Today we actually have some guests with us. And we are joined by Dr. Fernandez and Keith Harband. Did I say that right, Keith?

[00:00:27] Keith: [00:00:27] You did.

[00:00:28] Brian: [00:00:28] Awesome. And they are with New Enamel. And we’d been talking for a little while and we actually had the opportunity to receive some of their product and Lupe has been utilizing it. And we’re going to talk about that, about the product, about their company, why they’re doing what they’re doing and how it can benefit all of us here, with not only Sjogren’s, but anything that’s causing dry mouth.

[00:00:52] So, welcome to the show, doctor.

[00:00:55] Dr. Fernandez: [00:00:55] Thank you. Thank you, Lupe, and thank you Brian.

[00:00:57] Keith: [00:00:57] Thank you guys, pleasure to be here.

[00:00:59] Brian: [00:00:59] All right. We are happy to have the both of you with us and first off, Lupe wants to comment in about your packaging.

[00:01:06] Lupe: [00:01:06] Oh, I received the box. Okay. I used to be in packaging, right. So, I noticed packaging. I received the box, and everything was beautiful. Nicely packaged, so right on!

[00:01:22] Brian: [00:01:22] Kudos. She’s like, this is a nice box. She, she’s the gal that saves like all her, I think she has every iPhone box she’s ever gotten. The phones are gone. She’s got the box.

[00:01:32] Lupe: [00:01:32] I’m a bit of a hoarder, but over the weekend, I threw everything away so. I was getting a lot. I’m sorry for Brian.

[00:01:38] Brian: [00:01:38] Let’s start off with the patient experience and we’re going to take this, uh, to a point and then turn it over to you.

[00:01:46] Um, and then Lupe, actually has some awesome questions lined up for you, uh, regarding, you know, just dentistry and dental care, which, uh, which we’d love to get into, as well.

[00:01:54] But the NewEnamel® website, first of all, is beautiful, it’s clean, it’s easy to navigate, it’s well laid out. So, kudos there. And there is a button right up top that says start your free assessment, which is cool. You don’t have to hunt around for that.

[00:02:12] And Lupe a went through this questionnaire. And how long did it take you?

[00:02:17] Lupe: [00:02:17] Oh man, I like a minute, less. It was, it was really quick.

[00:02:21] Brian: [00:02:21] Yeah.

[00:02:21] Lupe: [00:02:21] It was a nice experience.

[00:02:23] Brian: [00:02:23] And asked her questions about, you know, her dental care, do you have dry mouth? Do you have this? Do you have that? And at the end it recommended a product. And why don’t you guys take it from there?

[00:02:35] Dr. Fernandez: [00:02:35] Sure. We’d love to. So, what you’re experiencing is an at-home version of UCSFs research. I like to take, Keith and I called a New Enamel, CAMBRA in a box. And CAMBRA is a protocol for optimal dental care, and it’s an acronym.

[00:02:52] CAMBRA stands for Carries Management by Risk Assessment. And what’s unique for Sjogren’s patients is because of the salivary conditions with the dry mouth, etc. Um, there are special needs that are associated if you have Sjogren’s and you want the optimal and dental care.

[00:03:06] So what New Enamel is, when you get your box, it’s actually a service. We’re providing products that are made by name brand companies. Um, but what you’re actually getting is the CAMBRA protocol, which was designed several years ago by leading researchers from around the country, but predominantly here in the Bay area at UCSF, which was my Alma Mater. So that’s what you’re getting in the box. You’re actually getting an at home treatment protocol.

[00:03:28] Brian: [00:03:28] So, does your products, I don’t want to say delay the time between, somebody should see a dentist, but what’s the thought process from these prescription strength items to be used in home.

[00:03:44] Dr. Fernandez: [00:03:44] Okay? So, what we were doing was, uh, you know, as a clinician, I started doing the CAMBRA protocol several years ago for our patients. You know, I’m sitting right now in my dental office. And what we were doing was we were using this, this system of care of tooth decay control.

[00:04:00] Let me step back a moment, as a dentist, you predominantly responsible, there’s gum disease, that’s a big category of disease. And there’s tooth decay. And then there’s sort of a third category, everything else, like cracked teeth, you know, Orthodox, crooked teeth, um, oral cancer, uh, bruxism, things like that.

[00:04:15] But you’ve got your basic tooth decay problems, your gum disease problems and everything else. And so, the CAMBRA protocol, what New Enamel’s about, is focusing on carries management. Carries is tooth decay, which still strikes over 90% of the population.

[00:04:30] And especially for Sjogren’s patients, because of the salivary complications. Your saliva, it turns out, is super critical to your oral health. And if that’s compromised, you’re going to suffer increased dental problems, specifically a tooth decay.

[00:04:44] So we wanted to, what New Enamel is, is at home delivery? We were doing this here in our office and it was really successful, and Keith and I are old friends from back in middle school. And I was telling him, hey, I’m doing this new system of dental care my for my patients and it’s really successful. And when the patients are following these instructions and using these products correctly. They basically stop having cavities.

[00:05:05] And Keith was like, wow, that’s pretty, pretty mind blowing. This is, you know, how come this isn’t a thing? I said, well, it’s got a new still. So, we talked back and forth, and we thought about how we can leverage technology to bring it to more than the people who come to see my office in Santa Rosa.

[00:05:18] So, we’re in the age of tele-dentistry and tele-health, and we thought with monitor technology, let’s see if we can get more people to follow the CAMBRA protocol via New Enamel at home.

[00:05:28] Lupe: [00:05:28] And that’s how you guys got started.

[00:05:31] Dr. Fernandez: [00:05:31] That’s how we got started.

[00:05:32] Lupe: [00:05:32] That’s awesome.

[00:05:33] Brian: [00:05:33] So the kit has several items in it and the instructions were well laid out. We kind of went through, read them a couple of times, put labels on each item to make sure, you know, at a glance we were utilizing the products as directed. And each item was kind of cool.

[00:05:52] Now, Lupe’s used that exact toothpaste before, but the other three items, in the box were new to her. Um, can you talk a little bit about what each product is doing inside the mouth to, to help with, you know, overall hygiene?

[00:06:12] Dr. Fernandez: [00:06:12] Sure we’d love to. That’s the cool thing about the New Enamel system is that when you’re answering those questions and Lupe, we appreciate the feedback that both you and Brian said the questions were pretty easy to do and there are free. We wanted to make that assessment process available to the public with no obligation.

[00:06:27] You can just sit there and go online. And it’s anonymous. We don’t collect the data. It disappears as soon as you, you check off. So, when you take those assessment questions, it’s asking, is this person at low risk for cavities, moderate risk or elevated risk?

[00:06:39] You know, higher extreme risk for having tooth decay? And depending on how you answer them, but what you get in your kit is dependent upon how you answer that.

[00:06:46] So, if you’re pretty healthy and you don’t need a lot of assistance, then you’re going to get an easier, less expensive kit with simple instructions. But if you have Sjogren’s Syndrome and you’ve got compromised salivary function, you’re going to probably need more protection.

[00:06:59] And the trick is, the products in the box, and we’ll talk about what’s in it, we’ll do moderate and high risk. You know, if you’re low risk, you just basically need to follow the, the standard dental directions, what most people do, which is brush twice a day with a fluoride toothpaste for two minutes, twice a day for two minutes.

[00:07:15] And, um, what we do is at New Enamel, we include a, a product that’s, this is pretty much the first time we’ve ever seen anybody offer this. It’s a prescription item called 5% sodium fluoride varnish, that’s even in a low risk kit. And what we’re saying is if you apply this little substance, we’ll see it’s a little tiny package with a brush and some material inside, and so you stir it up, it looks like nail Polish and you paint it on your teeth.

[00:07:36] And if you do that periodically, you’re going to create a coding about a hundred-micron thick coating of fluorapatite on your teeth, which is really acid resistant. So, we want to protect you from tooth decay. And as you know, if your saliva is not working properly, you’re just going to have higher risk of tooth decay.

[00:07:52] Moderate risk patients, the kits start to get more complicated as you go up in the risk continuum. A moderate risk kit will have, you’ll see you’re going from over the counter toothpaste to a prescription level, which is at 5,000 PPM.

[00:08:04] Um, I was looking at the, the Johns Hopkins, recommendations for Sjogren’s patients, and down at the bottom, they recommend, if a patient has Sjogren’s, they might benefit from the use of 5,000 PPM toothpaste. And if Lupe got a moderate or a high-risk kit, she’ll have a 5,000 PPM product, which is also a prescription item.

[00:08:24] That’s the thing, what we were trying to do is lower the barriers of access to people, so you don’t have to physically go see the dentist to do this. If your dentist is doing it, great, just continue on. But a lot of dentists, currently, aren’t really following CAMBRA protocol yet. It’s kind of new and it’s not how people were really taught back in school, when I was in school. Newer dentists are really familiar with it.

[00:08:44] So, the varnish, you apply once, you know, depending on your risk level. If you’re moderate risk, you’re going to get two varnishes. So, you’re going to do them every, every three months apart. And if you’re higher risk, you’re applying the varnish every two months apart.

[00:08:57] And that is really, um, pretty revolutionary for somebody to get a prescription varnish sent to them for home use. We’re not aware of anybody else that’s doing that, but you’re also getting the prescription toothpaste to go with it.

[00:09:08] It’s  important, you know, I think about how patients, you know, if you have Sjogren’s or you don’t have Sjogren’s, you want to do a care regimen that’s effective, but you try to use the least number of products possible. I talk to patients sometimes and they get these complicated home care routines.

[00:09:23] They’re doing Listerine and they’ve got this going and Biotene. And you want to try to narrow it down to keep your costs low and still get effective care. And the aim of new enamel, what we’re trying to do is, during the day your teeth lose minerals and if you have adequate saliva function, your teeth are able to re mineralize. Normally our saliva is really critical in that role.

[00:09:44] So, if you have Sjogren’s with a dry mouth and the moisture issues, you’re losing some of that re mineralization. So, it’s really incumbent that you’re able to read mineralized, effectively. And that’s what the products and New Enamel and the instructions, we’re really proud of the instructions, which were developed over time.

[00:10:00] And they were passed through some of the leading dental researchers. I would write these things up and show it to my colleagues at meetings and they were nodding like, yep, this is how you do CAMBRA, this is a very effective. So, we’re really proud, not just the products, but it’s the instructions when a patient is actually following those detailed instructions, they should see a significant decrease in demineralization.

[00:10:21] It’s amazing our teeth have the ability to heal themselves, but too often what we’re doing is insufficient to replace the minerals that are lost, during the day, when we’re eating and drinking things.

[00:10:31] Lupe: [00:10:31] And this product helps we mineralized and heal.

[00:10:35] Dr. Fernandez: [00:10:35] Yeah, absolutely. In fact, that was one of the nice things we thought about it. Before New Enamel was born, when I was doing CAMBRA with my patients, here at Santa Rosa. One of the things we noticed, my hygienist and I, we’ll be talking to our patients and they were saying, hey, you know, I’ve been brushing with that toothpaste, twice a day. And, you know, following the other instructions and I’ve had my varnish. And they were saying, my teeth aren’t as sensitive. They were noticing that within about a month or so.

[00:10:57] We often, Keith and I talk about, when a patient is using products like Sensodyne, which is an over the counter toothpaste, with fluoride, which is good. Uh, there’s a masking agent, there’s a potassium nitrate that hides the sensitivity.

[00:11:09] So to me, it’s always a red flag. If a patient’s using Sensodyne, to me it indicates they’re usually demineralizing, which is not uncommon for a Sjogren’s patient.

[00:11:17] And so what we want to do, is we don’t want to just mask the problem. We want to address it at a biologic level. And make sure that the enamel surface and the dentin, the root surfaces are adequately remineralizer. And that’s what those products in your kits are designed to deliver.

[00:11:31] Lupe, I’ve listened to you guys before, you’re really good about hygiene. Hygiene is still very important. You want to brush your teeth twice a day. You want to do a good job. You’ve got a Water pick or floss, or you’d like to use interdental brushes, all that’s really good and that’s important to do.

[00:11:43] But if you just simply clean your teeth. If the focus is just simple, good oral hygiene, which is good. You can still be very demineralized and continue to stop tooth decay. So, you want your patients to understand, look, go ahead, and do your home routine, whatever you like to do. But do it first and then you apply the New Enamel products or do the CAMBRA protocols second.

[00:12:02] The last step is always the remineralization step. And that’s how our instructions are set up. And the best way to help patients understand that is, is if somebody using a skincare product, like a sunblock, you would never put on your sunblock and then go wash your face. You understand inherently like, oh, okay, this is going to protect my skin. So, I’ll put that on as the last step.

[00:12:22] And we want our New Enamel patients to understand that that’s the same thing that they’re trying to accomplish with our kit. Is that you’re re-mineralizing, let that be the last step. Let teeth and root surfaces absorb all that mineral and let the rebuilding process happen for a good 30 minutes after you applied it.

[00:12:38] Keith: [00:12:38] Anthony, you might want to touch on, um, the best time to brush.

[00:12:43] Dr. Fernandez: [00:12:43] Right. And I’ve heard before, Lupe I know you’re a real dental, uh.

[00:12:47] Lupe: [00:12:47] Freak.

[00:12:48] Dr. Fernandez: [00:12:48] Fanatic. I wasn’t going to say that. You’re conscious. You know what it is? And I appreciate that. As a dentist, I love when people actually take the time to care about their teeth. Because when the patients aren’t really caring about their dental care, then they suffer. And it’s expensive and you know, it’s not fun to have in your teeth surgically repaired.

[00:13:04] So that, like Keith said, the timing is important. You know, you hear that thing that term your brush after every meal. Well, we don’t advise that, to be honest with you. You really only have to brush twice a day. And you want these two events, they’re only two minutes long of brushing and you want them to be an effective remineralization event. So, we spread them out.

[00:13:22] Brushing right after a meal is not very effective. Because after a traditional meal, let’s say you have lunch or dinner or you know something where there’s some carbohydrates involved, the mouth, the pH in your mouth will drop down into the acidic range and your  is sort of priests off and dose.

[00:13:36] So, if you go in and grab your toothbrush and put on some normal toothpaste. The polishing compounds and the toothpaste act like sandpaper and you’re going to remove about a hundred times more tooth structure by brushing right after a meal. So, we never recommend brushing directly after a meal.

[00:13:51] After a meal, if you want to chew some sugar free gum or some sugar-free laws, lozenges, um, those are advisable. You know, drink some water, swishing around. Just try not to brush directly after a meal because you’re not getting very good re mineralization. And you’re actually can cause some damage to the tooth surface by brushing too soon.

[00:14:08] So if you wait about an hour afterwards, sure, you’re fine to do that. So, we recommend brushing, right, you know, in the morning when you wake up or at bedtime, right before you go to sleep. And then when you go to bed, you’ve got that nice remineralization event going on.

[00:14:19] Lupe: [00:14:19] I think for people that have saliva, I mean, for me that I don’t have any saliva at all. I feel like I have food, if I don’t press right away, because I usually do. Um, I feel like food is stuck to my gum and my teeth. So, I shouldn’t be brushing after every meal? Cause I have been.

[00:14:36] Dr. Fernandez: [00:14:36] No, what you can do Lupe, because I understand that’s an uncommon uncomfortable feeling, having food particles. And you know, normally without the Sjogren’s, you have a natural salivary flow. When we’re healthy, we produce almost a liter a day of saliva, you don’t really notice it. That natural flow pushes away food particles.

[00:14:52] However, with Sjogren’s patients, with dry eyes, dry skin, et cetera, the dry mouth, is you don’t have that flushing action. And you’re also missing some, some really critical salivary function.

[00:15:02] I tell my patients that your saliva is your real dentist, and I’m just the pothole repair guy. Because the saliva, it neutralizes the acids and then it actually delivers calcium and phosphate in a very special form with these, uh, there’s proteins that deliver the calcium and phosphate ions, statherin and proteins.

[00:15:20] But you asked what to do after a meal? If you want to clean after a meal, just go get some water and swish it around. I know you’re a fan of ACT or ACT, dry mouth. Uh, you can use any kind of fluoride mouthwash, is okay after a meal because you’re not doing anything abrasive by just swishing it around in your mouth.

[00:15:37] So that’s a good tactic. Or like we say, just go ahead and use sugar free gum to try to stimulate some salivary flow. Your saliva glands have two speeds, there’s the resting rate, and then there’s stimulated flow rate. And if you do a piece of sugar free gum or lozenge after where you’ll kind of get that stimulated flow rate. But in Sjogren’s it’s compromised, as you’re aware of.

[00:15:58] Lupe: [00:15:58] I didn’t know that. I learned something new today.

[00:16:00] Brian: [00:16:00] Yeah! She eats and I mean within two minutes she’s like, I got to go brush my teeth.

[00:16:06] Lupe: [00:16:06] Or I start flossing, you know.

[00:16:08] Dr. Fernandez: [00:16:08] Yeah! No flossing okay. You know, after a meal, like I said, you could just have access to clean water. Just get some water and swish it around in your mouth. Or you know, you can spend a lot of money on mouthwashes and things. But the trick is to have a routine that’s effective and inexpensive at the same time.

[00:16:21] So, even just getting some water. If you like your fluoride rinses, you can do those after a meal. We do include some of those in the high-risk kits for patients. Especially the rinses that don’t have sodium lauryl sulfate, which can dry out, you know, create dry mouth situation.

[00:16:36] You want to avoid alcohol in dry mouth situations with sodium lauryl sulfate. But just plain old water works in itself. And if you’d like to, just get your brush and wet your toothbrush and just brush your teeth without the toothpaste. Cause then you’re avoiding that sanding action of the polishing compound.

[00:16:50] Lupe: [00:16:50] That was actually going to be my next question cause uh, sometimes that work, that’s what I do. No, that’s good.

[00:16:57] Dr. Fernandez: [00:16:57] There you go.

[00:16:58] Brian: [00:16:58] Is there any risk from utilizing what’s in the New Enamel kit and Biotene products or some of the over the counter products, intermittently, in between?

[00:17:11] Dr. Fernandez: [00:17:11] Yeah. Well that’s how we designed it. We wanted a standalone protocol that didn’t need any extra bells and whistles. When Keith and I designed the New Enamel kit, it was really important what we put in it and what we left out. We didn’t want to make it too cumbersome or too expensive or too complicated.

[00:17:26] We looked at the research and what the instructions that were coming from the world’s leading dental researchers and said, look, what do we need to put in that kit that gets you to the goal line with the least number of products?

[00:17:36] So, what we recommend is, if you’re doing other things, put those aside and just try doing what we’re saying in those instructions. Just try to keep it lightweight and simple. If you start doing too much, then you know you don’t, you run the risk of adjusting too much fluoride and things like that.

[00:17:50] And fluoride, you know, fluoride is a medicine and you don’t want to overdose. You want to get the adequate level for what you need and not overdose. So, what we try to say, stick to what’s in the kit and that should get you there.

[00:18:00] Keith: [00:18:00] And you know what? Another point is that, you know, I’ve gotten to know a lot of Sjogren’s patients over the last couple of years and I go to a lot of support group meeting, where I have the ability to listen and learn and also share, you know what the optimal way to care for your teeth are when you’re a Sjogren’s patient. And one of the things that I learned early on is that Sjogren’s patients, unfortunately, buy a number of different products. And it runs into a lot of money. Keep things simple and inexpensive.

[00:18:32] Brian: [00:18:32] Yeah, definitely. There’s a lot of money that’s can be spent. I mean, we’ve tried, just the dry mouth sprays, you know, the little spritz to get you through the day. And you know, not all of them are inexpensive. And I mean, we’ve had five or six different brands through the house, you know, in the last 10 years.

[00:18:55] Lupe: [00:18:55] He’s giving me this look.

[00:18:56] Brian: [00:18:56] No, no, no, no. It’s all good. I want you to be comfortable. But it seems like she always fell back to Biotene and she’s playing with a new one right now. And they’re all over the counter. So, what about a dry mouth spray? Any issues there?

[00:19:13] Dr. Fernandez: [00:19:13] Yeah, no, especially for comfort, for patient comfort, if they have a lubricant. A lot of times the dry mouth will include, some surfactants and, and some lubricating agents that give you the comfort that you’re lacking due to the loss of saliva. So those are fine. Carefree is a good company that makes some products. I know Biotene that’s at GlaxoSmithKline company.

[00:19:35] And recently, um, the Biotene products did include some fluoride in them, so that’s okay. And they’re usually at a lower level, so you’re not going to overdose. And just make sure, it’s really important to stress, don’t swallow any of the products that are in the New Enamel kit or any of these other supplemental products.

[00:19:50] You just want to swish with them, use them topically, and expectorate them, as they’re directed to use. So, make sure you’re not swallowing any of that stuff. But as far as, you know, you want to use whatever’s getting the patient comfortable. And you know, the New Enamel kit is, is good for Sjogren’s patients. It’s actually designed for everybody.

[00:20:07] But the Sjogren’s patients do have special needs, so, you won’t want to tailor that, you know, the mint flavors. You know, sometimes mint is an issue with Sjogren’s patient. But the day to day things, like what Lupe is trying to accomplish with comfort, yeah, you want to have, you know, rinses and things that can assist you, in between meal times when you, when your mouth is really feeling dry.

[00:20:28] Lupe: [00:20:28] Well, my mouth feels really good since I’ve been using the product. Um, there’s no aftertaste. I mean, it just lubricates. It feels really good.

[00:20:39] Dr. Fernandez: [00:20:39] I appreciate that. That’s good. You, the other thing I wanted to mention is, you know, I know that, um, some Sjogren’s patients, uh, have a sensitivity to mint it’s just a little bit too strong. So, we do have the ability to substitute products in the New Enamel kits with the milder fruit flavors. So, that that’s an option. We’re happy to do that. It’s the same price. There’s no difference there. And for those folks who have a sensitivity to mint, we can switch it out to fruit.

[00:21:11] Lupe: [00:21:11] You know, that was going to be a question because since we’ve been doing the show, a lot of listeners have said that they’re very sensitive or they don’t prefer it. They want regular or another flavor. So, I’m glad you have options.

[00:21:26] Dr. Fernandez: [00:21:26] Yeah, that was one of the reasons why we went with Colgate. Colgate has a really broad spectrum of different products. And some of them are SLS free spin, lauryl sulfate, the foaming agent. Almost all the normal toothpastes have SLS in them.

[00:21:40] But we do have one, our dry mouth formula that we’ll put in a kit, if you do check that box and we can get a SLS free, prescription level toothpaste to you.

[00:21:49] Lupe you were talking about what to use in between? You know, any product that has some glycerin in it. The glycerin is usually the comforting agent that provides the lubrication and comfort for dry mouth patients.

[00:21:59] Lupe: [00:21:59] Glycerin.

[00:22:01] Dr. Fernandez: [00:22:01] Correct. Look for that on the ingredients. Usually, the Biotene should have some glycerin listed somewhere on the ingredient list.

[00:22:06] Lupe: [00:22:06] Okay.

[00:22:07] Brian: [00:22:07] And Lupe pointed out to me that there are options for dairy free, I believe it was.

[00:22:14] Dr. Fernandez: [00:22:14] Oh, yeah. there’s an extreme risk kit that we were using that, you know, New Enamels been around so long now that we were on the first version of the UCFS CAMBRA protocol, and they were recommending, at the time for patients, like you say, because you’re a Sjogren’s, patient that does have, you know, decreased salivary flow. And like I said, one of the things that saliva does that so amazing is it’s delivering calcium and phosphate, which are the two building blocks of your enamel.

[00:22:38] And when you have decreased saliva flow, it was thought that if we could supplement that somehow. And so, some of the, the kits, the extreme risk` kits had a product from GC America called MI Paste. And MI Paste had a really cool amorphous calcium phosphate substance, it feels kind of creamy. And when you apply it, it was supposed to deliver a supplemental calcium and phosphate.

[00:22:59] Now that may be comfortable, it might be good for Sjogren’s patient from a comfort standpoint, from a carries prevention standpoint, the more modern research that’s come out in the last few months said, you know, we can see the fluorides  working. And there’s other things that work pretty well. The varnishes that we talked about.

[00:23:14] But the calcium supplements in the MI Paste may not all, on their own, they might not be as effective, but they might provide a level of comfort. So, that’s where we stand on that.

[00:23:24] Keith: [00:23:24] It has milk products incorporated in the MI Paste.

[00:23:27] Dr. Fernandez: [00:23:27] When we’re doing the algorithm for the questions, if you’re showing up and the questions that you were taking as an extreme risk patient, which a lot of Sjogren’s patients might be, because of the decay background. The decay they’re experiencing, the kits, the extremist kits do have MI Paste. We have to ask them, if you have a milk allergy, then you’re probably, you’re not supposed to be using MI Paste. So that’s very important. That’s why that question’s in the algorithm for the patient safety.

[00:23:52] Brian: [00:23:52] Got you. That makes that make sense.

[00:23:53] Lupe: [00:23:53] Okay, so toothpaste, the mouthwash, the polish, and the varnish, what does the varnish do?

[00:24:00] Dr. Fernandez: [00:24:00] But that’s a good question. So, the whole aim of New Enamel is to aid in remineralization. Like we said, a lot of times when you go to your dentist, the hygienist, and the dentist themselves, they’ll focus on mechanical hygiene.

[00:24:12] Oh, you’re getting cavities cause you’re not flossing enough or et cetera. It’s important to understand that, yeah, good hygiene is important, whether use Water pick, et cetera, toothbrushing, get your mouth clean. But you also have to focus on remineralization.

[00:24:25] So what the varnish is doing, the varnish is a relatively, you know, it’s been around for a while, but it’s still kind of a new product. It’s a prescription item that when you’re applying it, you’re applying something that’s over 20,000 PPM fluoride. It’s super concentrated.

[00:24:40] So, when you paint that on your teeth and let it sit there for a while, it’s going to form this, this layer, a barrier on the teeth. Keith likes to call a Teflon for teeth. But in reality, it’s forming a very acidic resistant layer on your enamel and root surfaces, so that when your mouth does become acidic from things that we eat or drink,  then that acid is not able to do as much damage. Fluoride increases remineralization, so it helps speed up the repair of the surface of your tooth, and it decreases demineralization. And it also inhibits bacterial activity. So, there’s a lot of really cool things that fluoride is responsible for.

[00:25:14] And that’s what’s in that varnish. That varnish, it’s a loading dose of mineral for the surface of your teeth. And then you’re using that toothpaste to help maintain high level of protection.

[00:25:23] Lupe: [00:25:23] Okay, so I opened that, and I tried cheating a little bit. Cause I was going to save half of it for later.

[00:25:29] Dr. Fernandez: [00:25:29] Oh, the little varnish packet?

[00:25:30] Lupe: [00:25:30] Yes.

[00:25:31] Dr. Fernandez: [00:25:31] It’ll dry out.

[00:25:33] Lupe: [00:25:33] I’m like, I’m going to get away with you know. And so, I’d save half for later but then, I felt it in my mouth, it dried to right away.

[00:25:41] Dr. Fernandez: [00:25:41] Yeah.

[00:25:41] Lupe: [00:25:41] So I just used it all.

[00:25:46] Dr. Fernandez: [00:25:46] You’re one of those patients.

[00:25:47] Lupe: [00:25:47] Yes. I want to get the max. I’m like, I want to use this more than once.

[00:25:52] Dr. Fernandez: [00:25:52] No people, who are aware of what we’re doing with the home application of varnish, were really like, holy cow, you’re having your patients varnish?

[00:25:59] Usually, you know, you can have your hygiene do it. You could actually take it into your dental office, if you want them to do it. But we’ve designed instructions that are pretty easy to follow. That’s why we say put the whole thing on, because once you open that packet, it’s going to dry out pretty quickly.

[00:26:11] Lupe: [00:26:11] I taped it back.

[00:26:13] Dr. Fernandez: [00:26:13] No, no, no! Glop it on there.

[00:26:17] Lupe: [00:26:17] I did. I did.

[00:26:18] Dr. Fernandez: [00:26:18] It’s like when your doctor gives you the medicine, you don’t just shave down a little and just take part of it and save it for later.

[00:26:25] Brian: [00:26:25] Oh, she has pill splitters.

[00:26:26] Lupe: [00:26:26] Oh, I cleaned the brush off, right? And then my fingers got sticky and I was like, oh man, it’s not going to work. I should just use it all, so anyways.

[00:26:34] Dr. Fernandez: [00:26:34] Yeah, no, use it all. What makes it sticky, is actually from a plant. It’s a natural plant resin that’s really sticky. But that’s how it works, is it’s holding it on the surface of your teeth for several hours while you’re going through the therapy.

[00:26:46] Lupe: [00:26:46] Yeah. So, it was the last thing I used. And then I just, you know, didn’t eat or drink or anything else after that?

[00:26:52] Dr. Fernandez: [00:26:52] Perfect.

[00:26:53] Lupe: [00:26:53] But you know what? I do grind my teeth at night, especially when I’m stressed or something, or even if I’m not, I grind my teeth. So, I did use my night guard, was that okay to do?

[00:27:03] Dr. Fernandez: [00:27:03] Oh yeah, no, absolutely. The night guard is just going to sit on the top and protect you from bruxism and clenching. And that’s, you know, when a patient has that bruxism clenching habit, they’re also at a higher risk for cracking roots, which I understand that’s an issue. So, if you want to know, you know, why you’re cracking roots, it’s the bruxism, can do that.

[00:27:20] But yeah, you’re fine. After you apply your varnish, you can put on your, uh, you know, that can be the last step. And then you put on your, if you have a retainer, if you’re doing orthodontic treatment or a bite guard, you put it on your teeth and go to bed and just lay there while your teeth are re-mineralizing.

[00:27:33] Lupe: [00:27:33] Yeah, I waited till it dried and it dried pretty quick.

[00:27:36] Dr. Fernandez: [00:27:36] Yeah. And then the next morning you got to go brush it off and get all that sticky stuff off.

[00:27:41] Lupe: [00:27:41] Yeah, it was still there, and my mouth was minty, so I was like, alright, I like this.

[00:27:46] Dr. Fernandez: [00:27:46] It’s a good thing.

[00:27:48] Keith: [00:27:48] It’s always fascinating to hear the perception and the experience of another patient. It always is helpful for us. So, you know, Lupe’s experience with the assessment and, uh, the products and the packaging, it’s great.

[00:28:04] We take notes on everything. It’s a constant state of improvement. We always want to make the process simpler, easier, cheaper, if we can possibly do it and as effective as possible. That’s what we’re passionate about it.

[00:28:21] Lupe: [00:28:21] So, after people take the assessment and they get a recommendation, can they order right away or do they, do they need to speak to somebody?

[00:28:31] Keith: [00:28:31] Yeah, they can occur immediately. So, the process for all your podcast listeners, is they go to NewEnamel®.com, they take the assessment, just like you did. And Anthony mentioned that. It’s really a no risk, a no obligation assessment. We really look at it as a public service. We want people to find out what their risk level for tooth decay is, so they can make an informed decision, in terms of how they take care of their teeth.

[00:28:57] So, as soon as you finish your assessment, our proprietary algorithm will determine what your risk level is. And it’ll show you on the site, and then you have the ability to order a kit, which is customized to your needs that we will fulfill and ship directly to your house. Every kit will have a written PDF, print out PDF of your specific prescription.

[00:29:26] So, if you have a flexible spending account at work, you can apply the cost of your kit, to your flexible spending account, because they are prescription products.

[00:29:38] Dr. Fernandez: [00:29:38] What’s Keith is saying, is we’re a form of tele dentistry. We’re telemedicine, where we’re providing a service with prescription products directly to the consumer.

[00:29:46] Keith: [00:29:46] Yeah, so it’s a really simple process. And once you order your kit, you can pay with credit card or PayPal. And when it gets shipped out, it will typically show up at your doorstep, in three to seven business days, and then you open the kit and start the treatment at home. So, we’ve really made it into a very simple process.

[00:30:09] Lupe: [00:30:09] It really was.

[00:30:11] Brian: [00:30:11] She wasn’t happy about having to take a test though.  I’m like it’s not a test.

[00:30:16] Keith: [00:30:16] At least it was short.

[00:30:17] Lupe: [00:30:17] Yeah. It was easy. No problem.

[00:30:20] Brian: [00:30:20] We understand it’s only available in California, right now. Are you working on expanding that or do you work with dentists out of state, if a patient is out of state? Or how, is there a process there?

[00:30:33] Keith: [00:30:33] We’re limited to California at this point in time. But we are planning to expand into states outside of California, a little bit later in 2020. Things got a little bit delayed because of the whole Covid-19 pandemic. But our goal is to be active in as many states across the country as possible.

[00:30:55] Brian: [00:30:55] That’s great. And you know, I actually did see a tab for professionals on your website and unfortunately, I did not take the time to read that. I’m kind of perusing it now.

[00:31:07] Dr. Fernandez: [00:31:07] What that’s for is just to kind of invite other dentists to participate and become CAMBRA based dentists, like our office and our New Enabled patients are. There’s organizations such as The National CAMBRA Coalition, and the American Academy of Cariology that feature  this whole, you know, aspect of dentistry, of treating tooth decay with medicines and not just with drills and needles, that’s what we’re all about.

[00:31:31] Brian: [00:31:31] And I thank you.

[00:31:34] Lupe: [00:31:34] Oh, Brian, he’s a chicken. I have to go with him.

[00:31:38] Brian: [00:31:38] I call them and say, do you have gas? And they’re like, yeah, we have gas. I’m like, great, meet me in the parking lot because I need that before you even fill out paperwork.

[00:31:47] Dr. Fernandez: [00:31:47] Oh, see that sounds like another New Enamel patient.

[00:31:52] Keith: [00:31:52] Here’s, you know, an anecdotally, when I used to go to the dentist, you know, the cold air hose, used to really bother me. So, I had a, a degree of demineralization. And once I got on the New Enamel protocol, the cold air hose, the cold water, no issue anymore. So, it’s amazing. And we have patients anywhere from 13 years old to 95 years old. And the results are great.

[00:32:21] Dr. Fernandez: [00:32:21] We really, to get a better idea of what the science is behind what New Enamel is, we invite listeners to just, you know, do a Google search, type in, I have a cavity, and write the initials N I H. N I H standing for the National Institutes of Health. And if you write, I have a cavity, NIH, a little article will come up about tooth decay and how to prevent it. And a lot of that sort of a layman’s explanation of demineralization and remineralization and how to avoid it.

[00:32:49] You know, that’s, it’s very helpful. And so that’s the underpinnings, the science behind what we do. Keith and I recently had some really exciting news this summer, based on the studies of our patients in brick and mortar here at Santa Rosa.

[00:33:01] There was an independent survey was done on 450 of my patients who were on the, the CAMBRA protocol for over four years. And what they looked at were how are these people doing in the long haul with regards to getting fillings and cavities and root canals and that sort of thing. Things that are related to dental decay.

[00:33:20] And they looked at our patients over four years, and then they compared them to random other offices that they selected. So, you know, we we’re the treatment group, and they were the control. And there was a really vast difference between what our patients were experiencing, as far as the need for fillings and crowns, versus the people that were at the other dental offices doing the traditional, you know, dentistry, where it’s a surgical approach. And not the medication approach through that we we’re trying to use with New Enablement and CAMBRA.

[00:33:48] Brian: [00:33:48] Well, that’s awesome. I know she’s excited about this product because she’s that dental freak, as I referred to her lovingly. Is there anything you’d like to leave us with or leave the listeners with, with what you’re doing and how important this product is, or it can be for them?

[00:34:06] Dr. Fernandez: [00:34:06] Sure. The one thing I want to leave on as a message of hope. So, sure, it’s super important, like we said, to have good oral hygiene. But we want to always match that with the importance of remineralization. Learn how to avoid demineralization, you know, by appropriate diet. And you know, obviously you don’t want to be snacking on a lot of sugary treats and things. But if you can keep your sugar to three times a day and understand that the science of remineralization and get that done, then you really can improve your dental health. And we see that on a, you know, daily basis, where we see improvements to people’s health.

[00:34:37] Lupe: [00:34:37] Before I was diagnosed with show was, I didn’t know I had dry mouth. But I remember when I used to eat candy, my mouth felt sticky, you know? But I didn’t know why. So anyways.

[00:34:50] Dr. Fernandez: [00:34:50] Right. Yeah, because of the Sjogren’s, what you’re experiencing is you’re not getting that, that normal clearing event. When I have a patient, who’s getting tooth decay and it’s not obvious what the cause is. Clearly, they’re not drinking Mountain Dew all day or whatever, you can actually do a salivary check. There’s a kit, here I’m going to hold it up, called Saliva Check. There’s a test in these boxes that you can test the resting flow rate and the buffering capacity of the saliva.

[00:35:14] And so what happens is, if you were a patient of mine, Lupe, I could have done this test takes about 15 minutes, it’s pretty inexpensive to do. And we’d see, yeah, you’re hypo salivary. Um, you’re missing the key protective factors. So, we would have, you know, addressed your needs from the start.

[00:35:28] And another thing, and Keith and I, we haven’t even hit on that yet. Sjogren’s, if you’re a Sjogren’s patient, you’re very familiar with, the moisture, issues. The number one reason why the general population experiences dry mouth are medications.

[00:35:42] So if you’re a Sjogren’s patient and you’re taking in a histamine or you’re taking anti-inflammatories or blood pressure medications, which a lot of people do, the medications, they compound the problem. Because they could affect your saliva flow and your saliva function. So those are also compromising factors that need to be compensated for.

[00:36:00] And that’s what we’re doing with the New Enamel system, is we’re trying to get patients to have an effective system of remineralization, despite the fact they have Sjogren’s or they’re taking prescription medications for their health conditions.

[00:36:11] Keith: [00:36:11] The other thing I would urge your podcast listeners to go to NewEnamel®.com and poke around, take the assessment, even if you don’t live in California and you can’t necessarily order a kit. We’ve really created a website that we hope to be the source for preventive dentistry, CAMBRA remineralization. So hopefully your, your listeners will go on and poke around it and learn something.

[00:36:41] Brian: [00:36:41] Yeah, there’s, there’s a lot of useful information, whether you, you know, use the product or not, or purchase from New Enamel. But that was really appreciated because it’s not just a sell, it’s evident that you guys truly care, and you want to help people. And that’s, kudos.

[00:36:58] Dr. Fernandez: [00:36:58] Well, thank you Brian, we appreciate that. And you know, we talk about the products, but we like to think of New Enamel, it’s actually a service, we’re trying to do this as a service to people. The products are there, they’re the vehicle to get there. But what you’re saying, we appreciate that Brian. And that’s what we’re trying to do. We have FAQ that talk a lot about the science behind it, cetera. But yeah, we really want to help people.

[00:37:17] Lupe: [00:37:17] So, for returning customers, do they have to take the assessment again or how does that work?

[00:37:24] Dr. Fernandez: [00:37:24] Correct. Right. Because the CAMBRA protocol, which is the science behind New Enamel is a dental care system, it’s carries management. And so, what we’re doing is, you go back again, and you know the algorithm’s pretty intelligent. So, you come back again, okay, hi Lupe, I see you’re returning.

[00:37:41] Then as you answer the questions, the questions will change based on your status. If you’ve already had varnish applications and 5,000 PPM, and what’s really important is we keep throughout the site is we don’t want to be a standalone. We want to work with conjunction with good home care. Even though new and happens at home, we want to work with your dental care, your actual brick and mortar dentists. So, if you see your dentist, we want them to say, hey, how am I doing? Do I have any active cavities? How are things looking, et cetera?

[00:38:09] So, you want that feedback. And if you didn’t have any active decay on that last appointment, your kits going to change. It’s going to get less expensive, simpler. And the products are adjusted to that.

[00:38:18] So if you continue to have a high risk, well yeah, you’re going to continue to get the stronger products. But if you’re improving, if you’re actually physically improving and having better results, you won’t need a complex kit, and you’ll move down the risk continuum, maybe from a high to a moderate or from a moderate to low risk kit. And that’s proof of concept.

[00:38:35] Lupe: [00:38:35] I like that. So, I have a dentist appointment tomorrow and I’m going to have him check me and then, yeah.

[00:38:40] Dr. Fernandez: [00:38:40] Yeah.

[00:38:41] Lupe: [00:38:41] I’d be interested to see that.

[00:38:43] Brian: [00:38:43] She’s the one that goes in for a cleaning and they’re like, when was your last cleaning? Yeah.

[00:38:51] Lupe: [00:38:51] He’s the one that never goes. You should have a talking with him.

[00:38:57] Dr. Fernandez: [00:38:57] We’re not going to get in the middle of that one.

[00:39:00] Brian: [00:39:00] You’re a wise man, Doc.

[00:39:02] Dr. Fernandez: [00:39:02] Yeah.

[00:39:03] Keith: [00:39:03] We typically stay in our lane.

[00:39:07] Dr. Fernandez: [00:39:07] But what’s funny though is usually when the phone rings at our office and usually online too, for New Enamel, it’s the healthcare decisions are usually made by the female of the household, the men tend to hide the bushes.

[00:39:20] Brian: [00:39:20] Amen. I’ll second that.

[00:39:22] Lupe: [00:39:22] Funny!

[00:39:23] Brian: [00:39:23] Well, awesome! Keith, any parting words?

[00:39:27] Keith: [00:39:27] No, we just really appreciate having the opportunity to speak to you and your podcast listeners about New Enamel and we’re here to help. Uh, any questions, feel free to email at me, keith@NewEnamel®.com and I will forward appropriate questions to Anthony, if need be. If I can answer them, I certainly will. We’re, we’re really here to provide a public service.

[00:39:50] Brian: [00:39:50] And as always, for the listeners, these links will be in the show notes below, and I’ll include your email address so people can get ahold of you, along with your social post. Yeah, you’ve got an Instagram, Facebook, and Twitter down here.

[00:40:05] Keith: [00:40:05] Yeah.

[00:40:05] Brian: [00:40:05] So I’ll include those as well.

[00:40:08] Keith: [00:40:08] Great.

[00:40:09] Dr. Fernandez: [00:40:09] Very good. Thanks Brian. Thanks Lupe. We had fun today. This was good. Hopefully help some people.

[00:40:14] Brian: [00:40:14] Good. Good.

[00:40:15] Lupe: [00:40:15] I wish you guys were in Southern California. I would change dentist.

[00:40:22] Dr. Fernandez: [00:40:22] Appreciate that. That’s a very kind word. Thank you.

[00:40:24] Keith: [00:40:24] Take a road trip up to the wine country, Anthony. will take care you.

[00:40:28] Brian: [00:40:28] Amen.

[00:40:28] Lupe: [00:40:28] Hey, you know what? That’s a good idea too.

[00:40:31] You know, a lot of, well, I haven’t had a lot of dentists, I’ve only met one recently that’s been familiar with Sjogren’s.

[00:40:40] Dr. Fernandez: [00:40:40] Wow,

[00:40:41] Lupe: [00:40:41] One.

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