Oral Care, Zebra Style

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In our first post on Dental Issues Prevalent in EDS and HSD, we talked about the most common dental problems found in these populations. We now turn to tools we can use to help prevent and manage these common issues. The best place to start is with the basics. While brushing and flossing are a must for everyone, not everyone learns how to do it right. For people with hypermobility, getting into a good routine of oral care can make a big difference.

This detailed post on basic oral care is designed to ensure you're getting the best results from your daily oral care routine, because with hypermobility, teeth can be a real pain!

Brushing Beyond the ADA Guidelines

  • Brush at least twice a day for a minimum of 2 minutes each. This is only a minimum guideline. If you’re hypermobile, you should probably be brushing after each meal.
  • If you brush more often than 2-3 times a day, be sure you’re using a gentle touch with a soft-bristle toothbrush and not causing too much irritation to your gums.
  • Use a soft-bristle brush that fits your teeth well. An electric toothbrush can do the work for you, taking the strain off of joints and saving precious energy. Use a small toothbrush head, so you can easily reach all surfaces.
  • Brush all exposed sides of your teeth, paying special attention to the gum line and chewing surfaces.
  • Brush your gums, tongue and the roof of your mouth to help stimulate blood flow and remove bacteria.

Going Beyond the Basics

In addition to proper oral care, there are a number of habits you can form to help prevent the onset of caries and gum disease.

  • Bacteria loves few things more than a damp, dark sugar-laden mouth. Try to limit sugary drinks and foods or brush soon after consuming them.
  • Limit or avoid smoking, chewing or consuming tobacco products.
  • When you feel something stuck in your teeth, remove it with an approved floss or pick. Using unapproved gadgets to reach between teeth can cause pain, chipping and even loosen teeth.
  • Avoid repetitive chewing, from pen caps to chewing gum. Even chewing ice can damage enamel and weakened enamel and receding gum lines mean increased sensitivity, pain and gaps where infection can take hold. Just as important is preserving the function of the periodontal ligament, which is only connected at the root of the tooth. Just like any soft tissue in our body, these ligaments can become overstretched and hypermobile. Besides, we also want to avoid overworking the jaw to try to avoid tempormandibular joint dysfunction, another common comorbidity to EDS and HSD.
  • If you’re fighting with sensitivity, cracks, chips and/or receding gum lines, try a remineralization toothpaste which helps to rebuild enamel, and balances the mouth’s pH. I was really surprised by how effectively they fill in existing chips and cracks and strengthen our enamel over time and prevent cavities. There are several options to choose from. This is especially important if you can’t tolerate fluoride.
  • If you grind your teeth, talk to your dentist about a proper mouth guard. Not only are those made and molded to you much more comfortable and effective, they can literally save your teeth. Dental grinding is very common for people with autonomic and anxiety issues, and neither are in short supply for zebras.
  • Gently massage your gums using a harder bristled toothbrush and/or myofascial tools, a topic which we’ll expand on in our next dental care post.
  • Get regular dental exams and cleanings. No matter how hard we work to keep our mouths clean, there’s no comparison to a good dental cleaning and regular check-ups, so you can prevent problems and know early on when they begin.
  • Treat existing dry mouth, a condition which promotes gum disease. There are many dry mouth products out there. Unfortunately, they all seem to be made with sugar alcohols like xylitol or sorbitol, neither of which I can tolerate. I do find that washes don’t bother me much, whereas mints and such do. If you absolutely can’t tolerate a dry mouth product, be sure you’re drinking water frequently and be sure to brush or rinse after every meal.

Tools that Help


Like many things, you get what you pay for when it comes to Electric Toothbrushes. I’ve been using them for about 20 years now and have tried many. I always come back to the latest Oral B rechargeable available on the market. You can’t best the clean their tiny round brush heads provide.

While I’ve used battery operated versions, you can’t beat the lasting power of a rechargeable. One charge lasts the two of us 2-3 weeks, whereas battery operated versions tend to slow a bit after the 2nd or 3rd brush and feels to me like I’m brushing at half power. Putting the batteries in the airtight compartment is also a pain, and often they break after so many change outs.

  • Oral B Pro 5000: A rechargeable unit with bluetooth capabilities so you can track your brushes and get feedback about your brushing habits. It has a built in sensor that alerts you if you’re brushing too hard, an automatic 2 minute timer that tells you when you’ve brushed long enough and it comes with everything you need to get started. They also claim that these brushes remove 100% more plaque from the gum line than manual toothbrushes and the proof is in the dental bill. On average, this level of toothbrush has lasted me as little as 3 years and as much as 6, making the cost well worth the price.
  • Oral-B Pro 1500: If you can’t afford the Pro 5000 and don’t care about connectivity, but still want a brush that’s going to last you years, you can’t go wrong with the Oral-B Pro 1500. It doesn’t have bluetooth connectivity, but it has just about everything else the 5000 offers.
  • Oral-B Pro 500: This is an Oral B classic and quite affordable. It doesn’t come with all the bells and whistles of the other two and it’s been so long since I owned one I really can’t speak to how well it’s withstands the test of time, but it still works quite well, has a 2 minute timer. A charge lasts approximately 5 days.
  • Cross Action Replacement Heads: To help keep me honest and a new brush head on my brush every 3-4 months, I like to buy them in bulk, which also saves a nice chunk of change in the long run. This 10 pack will last 1 person 2 and a half years!
  • Precision Clean Replacement Heads: If the Cross Action Replacements Aren’t Available, these are my second choice.


Flossing may be one of the most important things you can do to prevent gingivitis and periodontal disease. Early onset gingivitis and periodontal diseases is likely due to our faulty collagen, Unfortunately, many people forget the most important part of flossing, getting under the gum line to clear debris.

  • Floss daily. 1 is a minimum guideline, but if you’re gentle, you can do it every time you brush your teeth.
  • Using about 18″ of floss, wrap about 2/3 around the middle finger of your dominant hand. On the opposite hand, wind a couple of loops of the remaining end around your middle finger, leaving 4-5″ between your hands to work with.
  • Begin at the end of the row, behind the first tooth, gently working the floss into the gum line to help dislodge any food that’s collected. The floss should form a C shape around the tooth. Holding the floss firmly, drag it down the tooth to remove any plague that’s built up on the side that’s hard to reach with brushing.
  • Unwind your floss from your first middle finger and add the slack to your other hand. This keeps the floss clean, so you aren’t spreading bacteria around.
  • Move onto the next space, repeating step 2 on both sides of the gap where your teeth meet.
  • Repeat the process until you’ve flossed both sides of each tooth.
  • If any of the teeth are missing along the way, be sure to do the open sides, just like you do on the back of the molars or wisdom tooth we began with.
  • Rinse with mouthwash, aloe juice, watered down peroxide or even water to remove any debris that’s been loosened.

There’s no standard for when to floss. You can do it prior to brushing or after. You can do it morning, evening or both. You can do it after meals. Whatever you decide, be sure to stay consistent, building the habit. I enjoy a nice clean mouth just after breakfast and every night before bed. If you struggle at the end of the day to find the energy, try brushing and flossing right after dinner.


There are a wide variety of toothpastes on the market today, from popular grocery and drugstore brands to natural alternatives to prescription toothpastes targeting certain dental problems. It’s always a good idea to ask your dentist for recommendations. You can get completely natural toothpastes, fluoride-free toothpastes, remineralization toothpastes, toothpastes which target the gum line to help fight gingivitis and periodontitis and toothpastes for sensitive teeth, just to name a few.

I tend to use 2 or 3 different types at a time, on rotation. It may sound like a lot, but I have very weak enamel with painful sensitivity, and periodontal disease with receding gum lines, so I use what is necessary on rotation to try to keep all of these conditions under control.

Once upon a time, that meant using a toothpaste like Crest’s Gum Detoxify and a sensitivity toothpaste like Sensodyne Pronamel, but then I was introduced to remineralization toothpastes when I complained that the Sensodyne didn’t seem to be having the same effect it once did to my new dentist. I’ve also been concerned about how much Fluoride I’m getting and whether or not it might be contributing to some of my health problems, as it’s a known neurotoxin. At minimum, it should be avoided during pregnancy, as it is known to effect intelligence in utero.

Fluoride is a subject I won’t be covering here in detail, but I’m providing some links for further investigation. It’s important for the health of our teeth, but most of us get more fluoride than we need these days between added fluoride in our drinking water, our toothpaste and other products. It’s up to you whether or not you want to include even more in your dental care products. Below I provide both fluoridated and fluoride free options in remineralization toothpastes:

  • MI Toothpaste: I bought a tube of MI from my dentist and it was one of the best purchases I ever made. It works far better than Sensodyne or any other sensitivity tooth paste I’ve found, and you can get it with or without fluoride. It’s a professional product that you can get through your dentist. It’s a bit pricey, but well worth the expense. One tube provided excellent benefits, including teeth so smooth and white, I hardly recognize them. I just wish I still had more of them!
  • Coral White: A tea tree oil and coral toothpaste packed with minerals can do much the same as MI. It also helps to prevent cavities by raising the pH (alkalinity) of your saliva, whitens teeth, and freshens breath. Fluoride free.
  • Uncle Harry’s Natural & Fluoride-free Remineralizing Toothpaste: Sensitivity friendly, strengthens enamel, whitens teeth, and freshens breath. Preservative and fluoride free.

Given the uphill battle bendy zebras tend to have with dental care, it’s never too early to instill good dental care in our children, whether we suspect they carry a mutation or not. Good habits instilled early stick. Children under 8 should be assisted with their dental care (especially flossing) until they are well trained on how to do it properly. It’s also important that we lead them by good example with our own dental care.

Mouthwash or Rinse

Mouthwashes are grouped into two categories, cosmetic and therapeutic. Therapeutic mouthwashes are designed to address problem areas and usually rely on disinfectants, be they natural or synthetic. Both chlorhexidine and essential oils can be used to help control plaque and gingivitis. While chlorhexidine is only available through a prescription, there are some great mouthwashes with essential oils that can help.

It’s important to avoid most whitening mouthwashes, which can contain 10% or more hydrogen peroxide. Too much hydrogen peroxide content, and even prolonged use at lower levels can weaken enamel, increase sensitivity and even cause inflammation of the gums and nerve. If tooth whitening is a must for you, use diluted peroxide, which is usually a lower concentration than what comes in whitening mouthwashes.

A 5% peroxide cut with water (1 part peroxide to 1 part water) is just as effective as higher amounts and will do less damage. If using peroxide as an oral rinse, swish with the solution for :30-:60 seconds before spitting it out. Be sure to rinse thoroughly, as the length of time peroxide is in contact with the tooth, the more likely it is to damage enamel.

There are a number of mouthwashes with helpful essential oils you can also use instead. Here is a list of some I’ve tried that are in the more “natural” category.

  • Uncle Harry’s Natural Alkalizing Miracle Mouthwash: This mouthwash is made with essential oils and is mineralizing, much like their paste. It balances pH & soothes the throat while freshening breath.
  • Listerine Naturals Antiseptic Mouthwash: Fluoride-free, prevents bad breath, plaque build-up and gingivitis (gum) disease.
  • Aloe Vera Juice: There are mouthwashes made with aloe vera juice, but I don’t quite see the point of using an expensive mouth wash with preservatives when you can keep a fresh jar in the fridge to use for your oral care. Aloe can reduce inflammation, fight gingivitis and gum disease and is a natural antibacterial. Drinking it is also of great benefit to us bendy types!

There are also a variety of prescription mouthwashes for gum disease. Ask your dentist.

Dry Mouth Solutions

In all honesty, I haven’t had a lot of these because I’ve been afraid of their sugar alcohol content messing with my stomach, but I’ve recently broken down and tried one. They do help and so long as I only use it a couple times a day, it doesn’t seem to bother me. If you have a problem with sugar alcohols, you probably want to avoid the mints and sprays, but I’m including a few of the more liked brands for those who can,

Other Dental Tools

These tools might come in handy for targeted concerns.

Our next post on hypermobility and dental care will explore the issues of numbing and what you can do to improve this problem. In the meantime, what are some of the things you do to keep your pearly whites in good shape despite EDS/HSD?

Teeth can be a real pain when you have EDS/HSD, but there are things you can do to prevent cavities, gum disease and other prevalent dental problems that go along with having a collagen disorder.

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