It's no secret that practicing good oral hygiene daily is important. We've been told since childhood to brush and floss daily. And the words
So why is it that three out of four adults will develop some form of
To keep your teeth healthy, it is important to have a basic working knowledge of gum disease and tooth decay. It is also important that you establish an effective daily oral hygiene routine and have regular visits to your dentist/dental hygienist.
What Causes Periodontal Disease?
Plaque is removed with careful brushing and flossing. Plaque that is not completely removed every 24 to 48 hours can combine with other materials and harden into a rough, porous deposit called
Other contributing factors
Although bacterial plaque is the main culprit in periodontal disease, there are other contributing factors. Your genetic makeup determines how your body will react to the bacteria, and heredity plays a major role in whether or not you are likely to develop the disease. If your parents lost teeth to gum disease, then you are susceptible.
Other contributing factors are:
clenching, grinding of teeth
Pregnant women's gums will overreact in the presence of bacterial plaque, due to their increased hormone levels. People who have systemic diseases such as AIDS and diabetes have a lower resistance to infection, making periodontal disease more severe. There are some medications that can affect the gums as well, such as steroids, cancer therapy drugs, some calcium channel blockers, antidepressants and some types of anti-epilepsy drugs. It is important to update your medical history at each dental appointment so that your dentist or hygienist is aware of any factors that may cause increased susceptibility to gum disease.
Common Types of Periodontal Disease
Diagnosis of Periodontal Disease
Warning Signs of Periodontal Disease
gums that bleed.
red, swollen, or tender gums (healthy gums are pink).
gums that have pulled away from the teeth.
Pus appears between the teeth and gums when the gums are pressed (pus can look white or yellowish in color).
Persistent bad breath or bad taste.
Permanent teeth that are loose or separating (gaps between the teeth that weren't there before).
Changes in the way your teeth fit together when you bite (difficulty chewing certain foods, like raw vegetables).
Changes in the fit of partial dentures.
How to Prevent Decay
Daily diet and general nutrition:
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 you go.
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 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 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 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, 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
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.
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