Many patients come into our practice and are surprised after our thorough exam to find that their mouth is not in as good a shape as they thought, when they’ve been brushing and flossing somewhat regularly. “What am I doing wrong Doc?”
To answer that question it is helpful to understand a little bit behind the story of why we need to brush and floss those teeth that we want to keep. The reason is to remove the biofilm layer known as plaque that matures on our teeth in about 24 hours. This sticky layer is created from bacteria, which are normal inhabitants of the mouth. After 24 hours the bacteria will start replicating in the plaque. The goal of excellent plaque control is the removal of all soft biofilm from every surface of every tooth including the first 2 to 3 mm under the gum. It is not necessary to perform oral hygiene more than once every 24 hours, but more frequent brushing is beneficial in keeping your mouth clean and smelling fresh.
Most of us routinely miss the same areas of the mouth when we brush: the back molars and the tongue side of the teeth, particularly the lower back teeth. Disclosing tablets from your dentist or the drug store are the best way to see how good a job you are doing with your hygiene. Chew them up, swish all around, rinse and spit out. Use a small mirror and a flashlight. Any remaining red on the teeth is plaque. Go back in and remove it with your brush or floss.
As far as toothbrushes go you have choices, electric or manual. There is never a reason for a medium or hard brush because the bristles can cause irreversible damage by wearing away the softer root of the tooth. Hard bristles can also injure the gum. There are extra sensitive toothbrushes for people who have just had surgery that are very soft. Any bleeding from brushing is a sign of inflammation and active gum disease.
The general technique is to angle the tips of the bristles at a 45-degree angle to the gum and work the brush back and forth in brief strokes. You want to see the bristles waving back and forth, forcing some of the bristles under the gum. Ten to fifteen strokes with moderate pressure before moving to the next area is adequate. Toothbrushes should be changed every six months or when the bristles are splayed. If the bristles are splayed in one month there is a user error problem that should be assessed.
There are many sizes and styles of ‘electric’ toothbrushes on the market. As long as the bristles are soft, most any powered toothbrush will do. Sonic toothbrushes work in a unique way that vibrate the soft plaque off the tooth without vigorous scrubbing. Research has consistently found that patients do a better job with the sonic toothbrushes. Sonicare brand is the leader in the field. Sonicare brush heads should be changed regularly. An advantage to Sonicare toothbrushes is that they have a timer, which beeps every 30 seconds, so you can divide your mouth into quarters and brush accordingly.
Flossing is actually more important than brushing, as the floss gets in places that your toothbrush can’t. Floss slides between your teeth and under the gums where gum disease and decay begin. It is important to wrap the floss as much around the tooth as possible and scrape the plaque off the side of the tooth as far under the gum as you can without hurting the gum.
There are many kinds of floss. Waxed does a good job. The Glide or easy slide ‘slippery flosses’ are not as good as they can slip over the plaque. Dentotape is helpful with teeth that are tight together as it doesn’t break as easy. Your dental health professional can aide you in your technique in any areas that give you trouble. Floss is important once per day. Floss by fingers is better than the prepackaged floss devices on the market. But prepackaged floss devices are better than not flossing. You only have to floss those teeth that you want to keep.
Toothpicks, proxibrushes, stimudents, and soft pics need to be handled gingerly so as not to create more damage. They are helpful to clean between the teeth if there is room. They do not work well at getting under the gum. These devices can be an adjunct to, but not a replacement for flossing.
Toothpaste comes in many styles and flavors. Fluoride in toothpaste can be helpful in patients with an active decay problem. Sodium Laurel Sulfate, the agent in most toothpastes that cause foaming has been implicated in recurrent apthous ulcers or canker sores. Abrasive toothpastes such as ‘smokers toothpaste’ can actually wear down your teeth and gums. There are toothpastes for sensitivity that can be effective if you have sensitivity.
Xylitol is a natural sweetener that is very helpful in reducing the streptococcus bacteria, which creates plaque, secretes acid, and causes decay. It comes in numerous forms including toothpastes that have the building blocks of tooth to aide in remineralization of beginning decay. Xylitol toothpastes and products are available at health food stores and some dental offices.
A lifetime with a healthy mouth is achievable with excellent daily homecare and regular dental visits.