Dental health and oral hygiene
The following are some details about brushing and flossing that will help you in
your fight against plaque.
What’s the best toothbrush? The brand is not as important as the size and texture
of the brush. You should always choose a soft or ultra soft toothbrush with rounded
bristle ends. The brush head shouldn’t be too big for your mouth. It is difficult
to reach all the places where plaque hides with a large brush. Look for compact
sizes, they have smaller brush heads but the handles are for adults.
Replace your toothbrush on a regular basis, every two to three months or when you
notice the bristles fraying. Toothbrushes with fraying bristles won’t clean as well
and they can irritate the gums. Children are likely to wear out toothbrushes more
quickly because their brushing strokes are not yet perfected and they have a tendency
to chew on the bristles. Parents should keep a close eye on their children’s brushes.
Toothbrushes should be allowed to air-dry between uses. If you brush frequently,
alternating between toothbrushes is recommend.
How often should you brush?
If you are healthy and free of periodontal disease, two to three times a day should
be adequate. In the morning after breakfast and before bed are the most important
times to brush. Try to schedule additional brushings around meals.
If you have a form of periodontal disease, increased brushing is necessary. I usually
recommend a minimum of three times and up to five times per day. Controlling plaque
is a tough business. Many of my patients keep a toothbrush at work to make mid-day
brushing convenient. The key is to make your routine as uncomplicated as possible.
The optimum amount of time to brush is two minutes. Two of your daily tooth-brushings
should be for two minutes and supplement with shorter brushing times if necessary.
If you time yourself the next time you brush, you might be surprised how quickly
What is the best brushing technique?
Since everyone’s mouth is different, individual instruction given by your dentist
or dental hygienist is essential. Unless you use a proper technique, you can brush
five times a day and still not get your teeth clean. There are some basic techniques
to follow in proper tooth-brushing:
- Focus your soft bristled toothbrush at the gumline. This is where plaque hides.
- Begin by placing the bristles of your toothbrush at a 45-degree angle on the outside
of your teeth (cheek side) where the gums and teeth meet.
- Move the brush in a circular motion brushing two to three teeth at a time.
- Use light pressure so the bristles glide gently between the teeth.
- The same method is used on the inside (tongue side) surfaces of the back teeth.
- To brush the inside of the front teeth, hold the brush vertically using a back-and-forth
- Then move to the biting surfaces using the same back-and-forth motion.
- Finish by brushing your tongue.
- Bacteria that forms on your tongue, especially on the base (back), can cause mouth
odor. Start at the tip and work your way back down the middle, then each side. Special
tongue cleaning devices are sold, but your brush is adequate.
Parents will need to assist their children until they are about five years old.
Their small motor skills are still developing and it is impossible for them to be
effective alone. I recommend that children be allowed to brush alone first, then
parents should brush them again.
Is flossing really necessary? In a word—yes. Periodontal disease in adults starts
primarily between the teeth. Plaque forms mainly at the gumline (where the teeth
and gums meet) and in between the teeth. Brushing takes care of the gumline and
flossing reaches between the teeth.
Think of it this way: There are five sides to each tooth. When you brush, only three
are cleaned (top, outside, and inside). That means the surfaces on the sides (between)
of the teeth are untouched. The plaque has a protected environment, free to damage
the teeth, gums and bone. There is no real substitute for flossing. Floss reaches
below the gumline into the pocket area where plaque bacteria multiplies and toxins
are produced. Daily flossing is required to hinder calculus formation, which leads
to future breakdown. There are other dental tools that can be used to clean between
teeth but floss is the only one that can remove plaque below the gumline.
Children can be expected to start flossing for themselves, around age eight. Until
then, parents need to floss for them. Guidance from your hygienist on how to floss
your child’s teeth is advisable. The trick is to start early.
Which floss is the best?
There are dozens of flosses on the market, waxed, unwaxed, flat, round string, ribbon,
textured, spongy, flavored, fluoridated, etc. According to a recent study from Ohio
State University-Columbus, there aren’t significant differences between flosses.
The primary issue is comfort and ease of use for the flosser.
In my opinion, a flat, waxed floss is preferred because it is less likely that the
gum tissue will be cut. For my patients who have wider spaces between their teeth,
I recommend the textured or woven flosses. You can get a floss recommendation from
your own hygienist, and once you’ve tried a few different types, I’m sure you’ll
find a favorite.
Flossing aids are very popular. They simplify hold the floss. They are especially
useful for people who have trouble flossing with their fingers. I prefer the disposable
floss holders that have the floss already attached. They are available in bright
colors and smaller sizes for children.
What’s the best time to floss?
The ideal time to floss is before bed. As stated before, it is imperative that your
mouth is clean before sleep because the levels of bacteria in the mouth rise during
sleep. I encourage my patients with periodontal disease to floss at night to gain
the greatest benefit. But if your teeth are relatively healthy, you can be flexible
about when you floss. You don’t even have to floss at the same time as you brush.
The important thing to remember is that you should floss once within a 24-hour period.
Remember, plaque will start to calcify and form calculus within that time frame.
How do you floss?
Proper flossing is a skill that takes time and practice to master. You will need
perseverance and patience if you are just beginning, but the end result is worth
the effort. If you have never flossed before, it will probably take about two weeks
of daily practice to get the hang of it. Make the commitment to yourself to try
flossing at least once a day for two weeks. If you are having trouble with a particular
area, don’t give up on the rest of your teeth. At your next dental appointment,
tell your hygienist where you are having trouble. She may have a flossing tool to
I encourage patients to call me during office hours if they have any questions or
concerns regarding their oral hygiene. The dental staff at your office is there
to assist you, don’t be afraid to ask questions.
While flossing, keep in mind that you are not cleaning the space between the teeth
or the gum. You are cleaning the tooth itself. The floss should hug the tooth when
being inserted. Use a back and forth motion to guide the floss down the tooth. When
you feel a slight resistance, stop, and slide the floss in an up-and-down motion
to clean the tooth. The floss should always be in contact with the tooth surface.
Notice how the gum tissue fills in the space between the teeth. If you pop the floss
straight down, you will hit the gum, causing injury and pain.
Choosing Oral Hygiene Products
We have already discussed how to select a manual toothbrush and dental floss, but
there are numerous other products that might be useful. Walking down the dental
supply aisle at your favorite store shouldn't leave you feeling overwhelmed.
A good starting point is to look for the ADA Seal of Approval. This is not a guarantee
that the product will work, but at least you are assured it won’t harm you. I have
listed the products most asked about by my patients.
Most mouth rinses will change the bacterial level in your mouth. Even rinsing with
water will have a benefit to some degree. The majority of rinses contain a percentage
of alcohol. Sometimes, these rinses can cause a burning feeling, but for the most
part the burning is harmless. There are times when rinses that contain alcohol should
be limited. If you are pregnant, or if you suffer from limited saliva flow (dry
mouth), then it would be beneficial to use a non-alcohol-based rinse.
In my opinion, it is better to use rinses after flossing and brushing, not before.
A good antimicrobial rinse (Listerine) used daily can help control early gum disease.
Your dentist may recommend a prescription mouth rinse in cases of acute or advanced
periodontal disease. They are only used as an adjunct to periodontal treatment and
good brushing and flossing. Keep in mind, rinsing will not remove bacterial plaque.
Using an automatic toothbrush can give you an advantage in your war on bacterial
plaque. They are easy to use and are sold everywhere.
Most of them have a two-minute timer (the optimum amount of time). The handles are
easy to hold, especially for those affected by arthritis or diseases that limit
motor skills. The cleansing action is greater overall and anyone can benefit, especially
the lazy brusher. Sonic brushes are the latest to appear on the market. I have seen
the greatest improvement in the oral hygiene of patients who use a sonic brush.
They are generally more expensive, but the results are worth it.
Take care with medications
If you are medicated (taking antibiotics) before dental treatment, then these brushes
might not be for you. It is imperative that you check with your physician, cardiologist
or orthopedist before using any automatic toothbrush.
For kids with braces
Parents, if your children have braces, do them a favor and buy them an automatic
toothbrush. You can’t imagine how difficult it is to adequately clean teeth with
braces using a manual toothbrush.
Water piks have come into favor again after years of sitting under the sink. The
new models are compact and easy to use. Some units come with attachments (Pik Pocket)
that make flushing the periodontal pockets feasible. You can get rid of food debris
in hard-to-reach areas (around and under bridges, orthodontic braces), but water
piks will not remove plaque. They should only be used in conjunction with brushing
and flossing. I have seen a decrease in bleeding gums in patients who use an oral
irrigator regularly. Again, if you need to be premedicated before dental visits,
consult with your physician before using these products.
Like mouth rinses, there isn’t much difference between pastes in their effectiveness.
Paste or gel is a personal preference. Gels are preferred when using an automatic
toothbrush, to reduce splattering and foam. The main question should be: Does it
Tartar-control toothpastes are very popular and are billed as pastes that will reduce
calculus (tartar) formation. The fact is, they will reduce calculus, but only above
the gumline. Calculus that forms above the gumline is strictly cosmetic. Tartar-control
pastes do not affect calculus formation below the gumline where gum disease starts.
Therefore, they have not been proven to reduce gingivitis.
Tooth-whitening pastes in general have little lasting effect on the teeth. I have
never seen anyone’s teeth get whiter using an over-the-counter tooth-whitening product.
Stain reduction is possible, but any paste can achieve this with good brushing.
Due to the added chemicals in tartar-control and whitening pastes, some of my patients
have experienced increased sensitivity in their teeth and/or gums. For this reason,
I do not recommend these products to my patients.
Desensitizing toothpastes can be helpful in decreasing root sensitivity, but the
relief is usually temporary. The active ingredient varies in the different pastes.
So if one paste doesn’t work, it might be worth trying another brand. It could take
up to several weeks before you will know if the paste is working. Read the label
and follow the instructions to gain the maximum benefit.
Fluoride toothpastes and mouth rinses, used in conjunction with brushing and flossing,
can reduce tooth decay as much as 40 percent. Regular fluoride use can also help
desensitize and prevent decay on root surfaces in adults. In cases of excessive
decay and extreme sensitivity, your dentist may write a prescription for a toothpaste
that contains a higher dosage of fluoride.
Children who receive fluoride from many sources (vitamins, water, foods, rinses,
and toothpastes) should be monitored to avoid fluoride overdosing. Only a pea-sized
dab of fluoride toothpaste is necessary for any child.
Interproximal toothbrushes are tiny brushes that clean between your teeth. The brushes
come in various shapes and sizes that can be attached to a handle. As the brushes
wear out they can be replaced. Some disposable pocket versions come with the brushes
attached. These are great tools, and valuable in removing plaque and food from wide
spaces between the teeth. Still, they do not replace flossing. These brushes should
only be used in areas where they easily fit between the teeth. Applying force could
lead to trauma to the gum and tooth.
Toothpicks should be avoided. Since they are made of wood, they can break and become
lodged under the gum causing pain and trauma. Sometimes it takes a trip to the dentist
to remove them.
Rubber tips are used to massage and stimulate the gums. They can be useful in decreasing
red swollen gums. Rubber tips can sometimes be found on the end of your toothbrush
or they are sold separately. Place the tip gently against the gums between the teeth
and massage. Only use a light pressure, just enough to see the gum tissue blanch.
See Your Dentist Regularly
Even with good daily brushing and flossing, it is difficult to remove all the bacterial
plaque that leads to calculus. Hardened calculus must be removed by your dentist
or hygienist on a regular basis to help prevent gum disease. How often you need
to have your teeth professionally cleaned depends on how long you can stay healthy
between visits. If you have a normal level of health, six months is the suggested
length of time between visits. Your dentist/hygienist may vary the interval from
time to time to suit your needs. People with periodontal disease will need shorter
intervals, three to four months, indefinitely. Others may temporarily need closer
visits (like pregnant women, patients with braces, and lazy brushers/flossers).
Controlling periodontal disease is not only important to your teeth, it is important
for your overall health. New research indicates there is a link between gum disease
and certain heart disease. Additionally, doctors are currently researching a potential
link between gum disease in pregnant women and low-birth-weight babies.
It is necessary to take an active role in your dental health, and your dentist/hygienist
can assist you in keeping a healthy mouth. Fighting bacterial plaque with good oral
hygiene is an integral part in keeping your teeth for a lifetime.
An appealing and healthy smile is a great asset. A smile can communicate ideas and
feelings. It can build your confidence in business and social situations. Good digestion
depends on strong healthy teeth to chew food effectively.
If you have loose or missing teeth, your health could be compromised by a limited
diet and insufficient digestion. A clean mouth will have fewer dental problems,
and your dental work will last longer and look better. The need for new treatment
and painful emergency situations will decrease. All this will save you time and
money at the dentist's office.
So stay healthy and keep smiling!
For Further Reading