Dental health and oral hygiene
The following are some details about brushing and flossing
that will help you in your fight against plaque.
Whatâ€™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 shouldnâ€™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 wonâ€™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 childrenâ€™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
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 everyoneâ€™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 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 motion.
- Then move to the biting surfaces using the same back-and-forth
- 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 wordâ€”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 childâ€™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 arenâ€™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 youâ€™ve tried a few different types,
Iâ€™m sure youâ€™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.
Whatâ€™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 donâ€™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, donâ€™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 recommend.
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, donâ€™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
Choosing Oral Hygiene
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 wonâ€™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
Using an automatic toothbrush can give you an advantage in
your war on bacterial plaque. They are easy to use and are sold
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 canâ€™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
Like mouth rinses, there isnâ€™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 contain
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 anyoneâ€™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 doesnâ€™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
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
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
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
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