The following are some details about brushing and flossing that
will help you in your fight against plaque.
Whatï¿½s 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
shouldnï¿½t 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 wonï¿½t 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
Toothbrushes should be allowed to air-dry between uses. If you
brush frequently, alternating between toothbrushes is recommend.
How often should
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
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 you go.
What is the
best brushing technique?
Since everyoneï¿½s 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 motion.
- 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
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
Is flossing really necessary? In a wordï¿½yes. 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
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 childï¿½s teeth is advisable.
The trick is to start early.
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 arenï¿½t 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 youï¿½ve tried a few different types, Iï¿½m sure
youï¿½ll 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.
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 donï¿½t 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
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, donï¿½t 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, donï¿½t be afraid to
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 wonï¿½t
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
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
Take care with
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
Parents, if your children have braces, do them a favor and buy
them an automatic toothbrush. You canï¿½t 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 isnï¿½t 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 fluoride?
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
Tooth-whitening pastes in general have little lasting effect
on the teeth. I have never seen anyoneï¿½s 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 doesnï¿½t 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
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!