Scope it Out. Floss, Brush and Wash — Forget the Booze

I had a small canker sore the other day. So I went for the mouthwash. It’s funny how certain events can trigger some old memories. This is what went through my mind.

First, I remind myself that I am a physician and NOT a dentist. My formal training in oral hygiene is based only upon good sound medical principals. So here I go.

Before I went to medical school, I dated a young lady who was a dental hygienist. She used to tell me repeatedly to quit wasting my money on mouthwash and to just take good care of my teeth and to stick with old fashioned water to keep the month from smelling bad. She would tell me that the best ways to get rid of bacteria are flossing, brushing and cleaning the tongue twice a day. It’s like showering to get rid of body odor. You’re not really killing bacteria when you’re taking a shower. You’re physically removing them. After they bathe, people put on deodorant—just as they use mouthwash after they brush their teeth. The mouthwash is not as important as physically removing the bacteria. You don’t need a mouthwash, she said. Yea, right, I thought. But I figured she knew more about it than I did. So I went mouthwash free! Water it was…

I suppose bad breath (halitosis) is like death and taxes. And it’s one of those personal hygiene embarrassments. We’ve all been there. The source of the odor is often particles of food stuck in between the teeth and an accumulation of bacteria in the back of the throat. When you get a high level of bacterial-producing malodorous chemicals coming from the lack of oral hygiene. It has the equivalent odor of feces – that much I did learn in med school.

Mouthwash does not eliminate bad breath. The mouthwash works at first—killing lots of germs. But the bad breath gets even worse. The alcohol content present in many mouthwashes can dry your mouth out. When the saliva glands are dry, they are unable to help wash away bacteria so the stinky stuff flourishes. Did you ever notice that babies have sweet breath because they manufacture lots of saliva; they are drooling all the time. This constant draining of saliva, among other things, helps to keep baby’s breath clean.

After all these years, I’ve resorted to just the basics: Floss all of your teeth well. Use non-alcoholic mouthwashes Keep your mouth moist by drinking lots of water And just like Mom always told me—brush for at least two minutes, including brushing your tongue.

Do I ever use mouthwash now? Yep, I sure do. But I AVOID any mouthwash or rinse that contains alcohol since I don’t want it drying out my mouth and causing gum damage. Sometimes I still just use plain water too.

If one of the rinses has the following ingredients, then I don’t worry. I just use them.

• Cetylpyridinium chloride
• Zinc chloride
• Chlorhexidine
• Chlorine dioxide
• Zinc gluconate
• Eucalyptus oil
• Mint
• Thymol
• No alcohol

However, if I had to take just one mouthwash with me to a desert island, I would want it to at least contain eucalyptus oil, mint and thymol!

Have you guessed yet which mouthwash I use?

David

Taking Namenda? Should I take Robitussin or Robitussin DM?

Well, today is the day I raise my dose of Namenda from 15-mg up to 20-mg. I’m supposed to take 10-mg twice daily. Since I’ve had a robust response to this drug overall, I’ll be very curious to see how the increased dose will work.

 

Are you taking Namenda? The prescribing information and package insert for Namenda contains this statement: The combined use of Namenda with other NMDA antagonists (amantadine, ketamine, and dextromethorphan) has not been systematically evaluated and such use should be approached with caution.

DM stands for dextromethorphan. DXM is another abbreviation for it. It is a cough suppressant which is chemically related to codeine. It isn’t addictive and it doesn’t work for pain though. It’s an active ingredient in over 120 nonprescription cough and cold medications. When used in normal doses it is usually OK. It’s a good over the counter agent for coughing, etc. Most people don’t have any problems so I’m not intending for the average person to stop using it or to scare anyone. It is usually safe in the 15- to 30-milligram dosages recommended for treating cough or colds. It is a very good agent when used safely!

This is the drug that teenagers are now abusing and getting “high” from. In high doses (100-milligrams or more), it can cause a mildly euphoric and stimulating effect similar to that of ecstasy. At even higher doses, the drug’s “stoning” effect increases and hallucinations may occur. The highest plateaus are characterized by ELABORATE HALLUCINATIONS AND OUT-OF-BODY EXPERIENCES. During such out-of-body experiences, users perceive a complete disconnection from their body and surroundings, WITH NO AWARENESS OF WHAT THEY ARE DOING (OR HAVING DONE TO THEM).

Even in normal individuals, especially the elderly and those with dementia, it can also cause confusion, impaired judgment, loss of coordination, paranoia, excessive sweating, psychosis, brain damage, rigid muscle tone or involuntary muscle movement and decreased ability to regulate body temperature, which can lead to heat stroke. Other side effects can be severe dizziness, anxiety, restless feeling, or nervousness, slow, shallow breathing, dizziness, nausea, seizures, panic attacks, and addiction, coma and death, blurred vision and/or slurred speech, numb fingers or toes, dry mouth, itchy skin, irregular heartbeat and high blood pressure.

The take home message is this. Individuals with dementia already have a lot of the above symptoms. And they are more sensitive and susceptible to them when taking the DM form of Robitussin. If you are not sure whether to take this or not, please check with your physician.

DXM products are known in the street as Skittles, Red Devils, Robo (from Robitussin) or Triple C’s. The high that dextromethorphan produces is called “robotripping” or “skittling.”

Robitussin is one of the brand names for guaiphenesin. It is usually the main ingredient in many of the “tussin” drugs. It is a common over the counter  drug which dissolves thick mucus sold over the counter and usually taken by mouth to assist the bringing up (“expectoration”) of phlegm from the airways in acute respiratory tract infections. The active ingredient in Mucinex and Robitussin is guaiphenesin. So, Robitussin becomes Robitussin DM when dextromethorphan is added to it.

Guaiphenesin also comes in tablets which are easier to take. I try to avoid the thick liquid cough syrups. Bitter tasting medicine!

By the way, when it comes to these old fashioned medications, I personally prefer the generics. They are much cheaper and just as effective as the brand names. Only my opinion.

Now, that I am on Namenda, I’ll have to be cautious this winter. I’ve always relied on the long-acting form of dextromethorphan for my coughs such as Delsym. Never had much luck with the regular dose of dextromethorphan which is in the Robitussin DM form. Guess I just try a small dose of it when I need it in order to make sure all is well.

(I have no financial interest in any of the above mentioned medical products).

David