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Five minutes once a day can keep your teeth intact
the rest of your life
| In order to understand WHY
you need to clean your teeth carefully once a day, it is important
that you eventually refer to the following links on the diseases you
are preventing. You can reach age 45 with a mouth full of loose,
decayed teeth, or you can keep your teeth the rest of your life.
The difference is 5 minutes a day in the bathroom and a small shift
in your daily sugar intake. |
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It is difficult to be a successful person in today's world if you fear opening
your mouth wide enough to let people see your teeth.
Please click on the icons below to learn about the dangers of NOT spending that
five minutes a day!
Gum disease and tooth decay are invisible and largely
painless when they first start, but the final outcome is always the loss
of your teeth. By the time that any given area of the mouth becomes
affected, the problem becomes so painful that you will be driven into a
dentist's office even if you have vowed never to enter one in your life. At that point, you will
either lose the offending tooth or teeth, or require expensive procedures to
save them. It is infinitely easier to prevent the problems in the first place
than it is to treat the problems caused by ignorance and neglect.
Once a day???
Yes! It has been well established that if a person cleans his
or her teeth thoroughly (including between the teeth) once every twenty four
hours, he can prevent periodontal disease. (Once a day will reduce the
incidence of decay, but in the presence of the
chronic
sugar habits, even brushing four or five times a day will not prevent all
decay. The best way to prevent decay is to reduce the number of times per
day that sugar crosses your teeth.) I encourage patients to brush
twice a day, in the morning upon getting up and in the evening before going to
bed. I suggest that they use floss or
Stimudents once a day. I like
to do it at bedtime because doing the most thorough cleaning at that time
reduces my "morning breath". It makes no difference what time of
day you choose to clean between your teeth.
(Speaking of morning breath, Arm & Hammer has developed a
new toothpaste called "PM" which I have been using for a while, and it
really does seem to reduce morning breath if used before bed. Unfortunately, it
tastes rather like baking soda, and for that reason failed as a marketable
product. You can, however, create your own version of the same thing by
dipping your toothpaste coated toothbrush into a teaspoon of baking soda and
then brushing as described below. just ignore the taste, and if you brush thoroughly,
you'll wake up in the morning without morning breath.)
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 By
the way, plaque, the stuff you are brushing away is made of nearly 100% living
germs. For some interesting pictures and a good description of plaque,
click on the icon to the right. When you see it up close, you will know
why you need to brush and floss!
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And it's incredibly easy!!!
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The Bass technique. The correct way to brush your
teeth The key to brushing the teeth is:
 1.
Always use a soft brush...A soft brush will clean
much better than a hard or medium one because some of the bristles will
bend at heights of contour and others will remain straight reaching down
into the
sulcus
that surrounds the teeth. It is in this sulcus that Periodontal disease
begins when plaque (made of
germs)
is allowed to accumulate here. The point is to always aim to remove the
plaque from the sulcus around each tooth.
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2. hold the brush so
the bristles point at an angle (45 degrees) into the sulcus as pictured
here. Use short,
 vibrating,
back and forth strokes. The tips of the bristles don't even have to move.
The point is that each change of direction (each "vibration")
forces the bristles further into the sulcus and as much as possible
between the teeth . Vibrate the bristles in one brush position for a few
seconds, then move one tooth foreword and do it again, advancing around
the "arch" of first the outside of your upper teeth, then around
the inside as pictured here. Once you finish the bottom proceed to the top teeth beginning on the top left working
around the outside of the teeth to the top right outside, then do the
insides of the top teeth from the right inside to the left inside. The
entire procedure should take about two or three minutes spending 30 or 40
seconds on each surface of each arch. after thoroughly
 brushing the
insides and the outsides of the teeth, the job is one half finished. Now
you must clean between your teeth.
A Bit of attention needs to be paid to the canine teeth
(the eye teeth), especially in the upper arch. Because this tooth
lies at the junction of the back teeth and the front teeth, it tends to be
fairly prominent. Bearing down too hard directly on this tooth with
the toothbrush sometimes can injure the gums, or even wear a notch in the
tooth at the level of the gum line. It is generally best to brush the
back half of the canine teeth while brushing the back teeth, then
"turn the corner" and brush the front half once you change the
angle of the toothbrush to brush the front teeth. By brushing
each half of the tooth separately, you avoid injury to the gums and wear
of the tooth.
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What type of toothpaste is best?
Prior to the discovery of the benefits of
Fluoride, toothpaste
was just a form of perfume that induced people to brush their teeth. It
had no real benefit over and above its esthetic value. But with the
discovery that low concentrations of fluoride could actually reduce the
incidence of decay, toothpaste gained importance as a vehicle for delivering the
benefits of a true medication. Since that time, new additives have been
discovered which allow the toothpaste to deliver new benefits to the
teeth. Among these additives are disinfectants which actually kill the
germs in plaque, and can deliver a germicidal
effect for hours after brushing. Another one (pyrophosphates) helps prevent the buildup of
calculus, which is the hardened material the hygienist has to scrape off when
you have your teeth cleaned. Both Proctor and Gamble, and Palmolive
have toothpastes that contain all three additives. They are Colgate Total
and Crest Complete. Other brands contain whiteners to help
bleach
the teeth. No matter which toothpaste you use, the largest single
benefit of brushing the teeth is still the value of mechanically removing
plaque. A toothbrush with NO toothpaste does this as well as one with
toothpaste!
 A
word of caution!! Very vigorous brushing with toothpaste on the brush
will, over time cause extensive wear on the teeth. This type of damage can
be avoided by using the Bass technique described above with a "wiggle-jiggle"
motion (very short strokes). Real damage to the teeth is caused by
vigorous "sawing" over the teeth using commercial toothpaste.
Surprisingly, the brush without the toothpaste does NOT cause tooth wear.
Since it is the toothbrush, and not the toothpaste that actually cleans the
teeth, you can do as good a job brushing with less long term damage to the teeth
if you dip the brush in mouthwash instead of using toothpaste. Click on
the image to see more images of "toothpaste abuse".
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Sensitive teeth
Toothpaste abuse is probably the most frequent cause
of tooth hypersensitivity. By overbrushing with abrasive
toothpastes in order to try to make your teeth brighter, you are
removing much of the tooth structure around the necks of your teeth
that used to protect the nerves from cold sensitivity. Only a
dentist can repair the damage already done, but you can prevent
further damage to the teeth by brushing your teeth with fluoride
containing mouthwash (Act) instead of using abrasive toothpastes.
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Cleaning between the teeth (just another couple of minutes)
If you do not clean between your teeth once a day, I
guarantee that you will still get
periodontal disease by the time you are in
your forties.
You will be especially prone to the bone loss that is the final symptom of gum
disease if you neglect to clean between your teeth and you grind or clench your
teeth (bruxism).
There are two commonly used ways to clean between the teeth.
The first way is Flossing
the teeth. While flossing is considered the gold standard of interproximal
cleaning methods, I have discovered through very hard experience that people
really do not like to do it, and even if they begin flossing regularly, they
tend to do it less and less over time. The second way to clean between your
teeth is with thin toothpicks
similar to the
Stimudents
demonstrated below .
I have found that these toothpicks have two great advantages over floss. First,
they are very easy to use (you can use them one-handed and can use them anywhere
including on the way to work in your car). Second, if used properly, they clean
as well as, or even better than floss. I have seen people with severely inflamed
gums (moderate to severe periodontitis) literally stop their disease cold within
two weeks using Stimudents regularly! I will cover both methods below. No matter
which one you use, you will be assured that you will be the only little old man
or woman in the rest home who isn't trading her dentures with the other little
old ladies (they really do this) because you will have the real thing!
Flossing
I have found that it is easier to use waxed floss than
unwaxed. It does not slip between the fingers as easily as unwaxed floss, but it
does slip between the teeth more easily and doesn't fray as much. You can use
one of the new Teflon varieties like Glide. These slip between the teeth easily
and don't fray as easily as unwaxed floss either, but I have found that that is
too slippery for me to hold. It makes no difference which kind you use. They all
clean the teeth equally well. Actually, baby yarn works great!
Tear off a piece of floss about two feet long (it's cheap),
and wind it around your middle fingers as pictured in the top left image above.
That way you have your two index fingers and two thumbs free to manipulate the
floss between the teeth. Using two index fingers, two thumbs, or one index
finger and one thumb, practice by beginning on the front teeth where the access
is easy. Using any combination of fingers and thumbs, whichever combination is
the easiest, slip the floss between two front teeth as pictured in the image on
the top right above. Wrap the floss into a "C" around one of the teeth
as pictured in the lower left image, and pull the floss up
and down against the tooth. Notice that the floss
actually appears to go under the gums. It is simply going into the
sulcus
that surrounds the tooth, and that's where you want to clean the most. Cleaning
in an up and down motion reaches the bottom of the sulcus and actually removes
plaque. Sawing the floss back and fourth does not, and it may actually wear
grooves in the teeth. After drawing the floss up and down on the back tooth,
bend it into the reverse "C" and do the same to the surface of the
next tooth facing the one you just cleaned. Thus, for each space you enter
between teeth, you have two separate teeth to clean.
It may take a while to complete the process all the way
around your mouth the first time you do it, because the manual dexterity is a
learning process, and for the first week or so, it will seem clumsy if you are
not used to it. On the other hand, if you persist, you get good at it
and it takes less and less time to complete the process, until you are down to
less than a minute for the whole mouth. As time goes on, the constant pressure
of the floss against the teeth actually causes the contact between the teeth to
lighten, and getting the floss into each contact gets easier too.
If the floss frays or breaks between two teeth, it probably
means that you have a cavity in one or both of the teeth, or that a filling has
an overhanging margin and should be replaced. Persist, and the bleeding stops
after a week or so, and your bad breath will begin to disappear.
Using toothpicks (Stimudents)
 Stimudents are simply a very
thin wooden toothpick made of orangewood. You can buy them in many drug
stores (especially CVS and Walgreens) or super markets. They work just as well as floss to clean between your teeth. (They
can be hard to find, but you can call Johnson & Johnson at
800-526-3967. Wait until the automatic answering system gives you a choice
to go to the oral health section. Once there you can speak to a
representative who can tell you all the stores in your area where they are
sold.) Simply break one off (see the middle image above), wet the end by sucking
on it, and begin cleaning between each of your teeth just as you would use
a toothpick at a restaurant. Notice that the Stimudents have a wedge
shaped cross section (see the image at the right). The flat edge is placed
closest to the gums while the point  is pointing toward the edges of the
teeth .The Stimudents are pushed as far between the teeth as they will go (see
the rightmost image in the grouping of three above). You can reach the furthest
spaces back in your mouth as I am doing here. At first, you will experience some
bleeding and some discomfort because the plaque bacteria have caused a chronic
infection in the gums, and like any infected tissue, it hurts when it is
touched. However the pain and bleeding subsides within a week or two after you
start using them.
These little sticks are worth their weight in gold, because they have worked
so well to cure so many of my more motivated patients' chronic periodontal
disease. Since they are disposable, the patient does not have to be near
running water to use them. They frequently use them while commuting to work or watching
television. It feels great to use them, especially after the disease clears up, and once
patients notice that the bleeding has stopped and their teeth are no longer mobile,
they feel good about themselves.
 Doctor's
BrushPicks are a cleaning aid similar to Stimudents, and are used in the
same way. They are double ended, one end being a toothpick and the other a
tiny plastic brush which also fits between the teeth (see image below).
BrushPicks have a number of advantages. They are made of plastic and are more
durable than Stimudents. They are much thinner and stiffer than Stimudents
which makes them fit between teeth that are very close together. They come in a dispenser
which makes them easier to dispense than Stimudents. There are three sizes
of dispenser; 60, 120 and 250. All of the dispensers are small enough to
fit in your pocket or purse. Finally, they can be found in most large drug stores
(specifically, Walgreens and CVS). They can also
be ordered by clicking
here.
Other tooth cleaning aids
Pointed rubber tips are used in much the same way
as the Stimudents above. They are especially easy to use since they come
on a handle which makes access to the spaces between the teeth even easier than Stimudents.
They are made out of a fairly soft rubber, and therefore are comfortable
to use. I prefer Stimudents because the grain in the wood adds a roughness
which is more likely to remove plaque than the smooth surface of the rubber tip.
Mouthwashes used to be almost
exclusively perfume for the mouth. They didn't do much more than cover up
the bad odors of the disease processes. But fairly recently, some
mouthwashes have been introduced which contain medicaments which do more
than cover up odor. Some are designed to deliver
fluoride
to the teeth.
Fluoride has proven to combine chemically with the teeth to create a thin
layer of fluoroapetite which is resistant to acid attack and helps to
reduce the decay caused by the
sugar
habits. The old eucalyptus formula
of Listerine mouthwash has proven actually to reduce the number of bacteria in
plaque and helps fight periodontal disease when used in combination with
toothbrush and floss  or toothpick.
The newer forms of electric toothbrush are quite
effective in removing plaque if the bristles are held at a 45 degree angle
to the teeth and gums as noted
above. They
force a two minute brushing time and supply a super fast vibratory motion,
a slower version of which is noted in the above description of the Bass
technique.
The little "Y" shaped implement on the lower
left is a floss holder for people who have trouble gaining the dexterity
needed to manipulate floss between the back teeth. The other alternative
for these people is, of course, Stimudents.
The handle to the right of the
floss holder is a "Proxabrush". The brush itself
is the tiny
extension at the top pointing to the left. It is a tiny brush made to be
used between the teeth in the same way the Stimudents are. They are
very effective aids and are a staple in the treatment of severe
periodontal disease. They are excellent for cleaning between the teeth if
the spaces are large enough to accommodate the brush. The only problem is that the
brushes wear out and must be replaced fairly often, and since they are reusable
(unlike Stimudents) the patient must be near running water to wash them
off during and after use.
The three long strap like objects to the right of the
Proxabrush are tongue scrapers. These have serrated edges and are very flexible.
They come in three stiffnesses. They are bent into a "C" shape, and
the middle of the "C" is placed as far back on the surface of the
tongue as possible and then scraped forward over the surface of the tongue.
Your
tongue has a feltlike surface. The feltlike material is actually composed of
tiny "hairs" which naturally break off (exfoliate) when they get too
long. Under some circumstances, this hair does not exfoliate properly and the
tongue gets a white (or sometimes black depending on your diet) "coat" on it. This coat may catch food
odor and cause bad breath. These tongue scrapers help to "shave" the
tongue to eliminate the hairy coat.
Halitosis
Bad breath plagues just about everyone at one time or another. People
snicker about it, but bad breath can be a devastating social disability.
More than a few people have been denied employment, failed in business and
relegated to low social status because of it. There are four areas from
which bad mouth odors originate. Before you can begin to treat your
specific problem, you must be able to diagnose it. For this purpose, I
have provided an entire page on
the diagnosis and treatment of bad breath.
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