Treating the infection:

Since we know the infectious agent and that the oral levels are high, treatment is to suppress ms. Both the short term antimicrobial, chlorhexidine(CHX), and fluoride will aid in the elimination of ms.

1. At the initial offie visit provide 1.2% APF treatment.
2. Have the patient rinse 1/2 oz CHX for 30 sec. at bedtime. Treatment should continue for 2-3 weeks.
   -Use of 10% povidone iodine applied topically every 2 months or sooner to the teeth can be effective in controlling ms population.  This was both in early childhood caries and older children.*
3. Monitor oral hygiene procedures.
4. Stress diet control.
5. Pit and fissure sealants may be used to eliminate sites where ms is harbored in large numbers.
6. 2 sticks of xylitol gum should be chewed for 5 minutes, 5 times/day.

Monitor with evaluation of active white-spot lesions and in cavitated individuals with commercial ms test  in 3 weeks.  Commercial ms test appears to be more reliable in determining the low levels of ms.   

Once the infection control is initiated proceed to the remineralization protocol.

If the infection is NOT under control:

1. Check diet compliance with the lactobacillus test.
2. Continue with 1.2% APF office treatment.
3. Apply fluoride varnish.
4. Continue with CHX rinses-combined use of fluoride and CHX .
   -The addition of antibacterial agents with fluoride  and certain metal ions (Sn2+, Cu2+, Zn2+, Sr2+) to mouth rinses has been beneficial. (Roll and Saxegmrd 1990)
   - Fluoride with CHX rinses are successful. (S Luoma et al. 1978)
5. Monitor with tests in 3 weeks.
6. Recall the patient every 3-4 months for one year to monitor.

*Lopez L, Berkowitz R, Spiekerman C, Weinstein P,  Topical antimicrobial therapy in the prevention of early childhood caries: a follow-up report Pediatr Dent.  24(3):204-6,.2002
*Lopez L et al,  Topical antimicrobial therapy in the prevention of early childhood caries, Pediatr Dent 21:9-11, 1999.