Oral Hygiene

How to Brush:

Brushing should be accomplished twice a day over at least a 2 minute period with a soft bristle toothbrush. Only use a soft bristle toothbrush with a non-scrubbing brushing technique. Hard or medium bristle tooth brushes may promote gum recession (link). If you brush too hard, you could also develop gum recession (link). Commonly, we find using an electric toothbrush beneficial. We recommend the Sonicare Electric Toothbrush (link)(picture sonicare toothbrush). When used correctly this toothbrush cleans effectively without harming your gum tissue, bone tissue, and tooth surface. Please see our suggestions on oral hygiene products (link).

You need to brush for at least 2 minutes each time you brush. Some people build calculus (tartar) more quickly and may need to brush for 4 minutes. Don't forget to floss! (link)

Manual Toothbrushing: We suggest using a soft bristle toothbrush with a non-scrubbing technique. Please see our section on how to choose oral hygiene products (link choosing oral hygiene products).

While brushing the outside surfaces of your teeth, position the brush at a 45-degree angle where your gums and teeth meet. This angle is up for the upper teeth and down for the lower teeth. Gently move the brush in a circular motion several times using small, gentle strokes. Do not scrub back and forth! Use light pressure while putting the bristles between the teeth, but not so much pressure that you feel any discomfort. Basically you need just enough pressure to "tickle" the gums.

When you have completed cleaning the outside surfaces of all your teeth, follow the same directions while cleaning the inside of the back teeth.

To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle circular motions several times over each tooth. Don't forget to gently brush the surrounding gum tissue.

Next you will clean the biting surfaces of your teeth. To do this, use short, gentle strokes. Change the position of the brush as often as necessary to reach and clean all surfaces. Try to watch yourself in the mirror to make sure you clean each surface. After you are done, rinse vigorously to remove any plaque you might have loosened while brushing. A special mouth rinse may be prescribed for you (link to mouth rinses).

As you brush and floss correctly, it is not unusual to have bleeding, sore gums for 7 to 10 days. If this does not stop, you may need periodontal treatment. Don't be fooled bleeding, sore gums do not have to be present to have periodontal disease. If you have any pain while brushing or have any questions about how to brush properly, please be sure to contact the office ( ).

*Do not forget to replace your brush or the bristles on your electric toothbrush every three months!

How to Floss:

Periodontal disease usually appears between the teeth where your toothbrush cannot reach. Flossing is the most effective way to remove plaque between the teeth. However, it is important to develop the proper technique. The following instructions will help you. Remember proper technique takes time and practice. Please see our suggestions on oral hygiene products (link).

Start with a piece of floss (waxed or unwaxed, which ever you prefer) about 18" long, and lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the other hand. Place your thumbs together to make a "football goal." This provides the ideal amount of floss to floss between your teeth.

How do I floss under a bridge or between splinted teeth?

Answer: Use a Floss Threader.

To floss effectively, hold the floss tightly between the thumb and forefinger of each hand. Keep the finger and thumb of both hands close together, so that a short length of floss will give good control. Some areas may be reached more easily with the floss extended over the index fingers. Gently insert the floss between the teeth using a back-and-forth motion. Do not force the floss or try to snap it in to place. Bring the floss to the gum line then curve it into a "C-shape" against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth. Do not saw back and forth, this will damage the gum tissue. Remember there are two tooth surfaces that need to be cleaned in each space. Be careful not to cut the gum tissue between the teeth. As the floss becomes soiled, turn the floss from one finger to the other to get a fresh section of floss. Do not forget the back side of the last tooth on both sides, upper and lower.

When you are done, rinse vigorously with water to remove plaque and food particles. A special mouth rinse may be prescribed for you (link to mouth rinses). Do not be alarmed if during the first week of flossing your gums bleed or are a little sore. As you brush (link) and floss daily to remove plaque (link) your gums will heal and the bleeding should stop by 7 to 10 days. If this does not stop, you may need periodontal treatment. Don't be fooled bleeding, sore gums do not have to be present to have periodontal disease (link indicators of perio).

Note: If your gums hurt while flossing you could be flossing too hard or pinching the gum. You could also need periodontal treatment.

If you need additional help with flossing, please contact our team.

How to Care For Sensitive Teeth:

Sometimes after dental treatment, teeth are sensitive to hot and cold. If the mouth is kept clean, this should not last long. If the mouth is not kept clean the sensitivity will remain and could become more severe. Luckily with advances in periodontal treatment, tooth sensitivity after treatment has been markedly reduced.

If your teeth are especially sensitive, this may be a sign of a dental problem. Please consult your dentist or our treatment team to determine if dental treatment is needed. We may recommend a medicated toothpaste (link to Oral hygiene products)(picture of sensodyne??) or mouth rinse made especially for sensitive teeth.

How to Choose Oral Hygiene Products:

There are so many oral hygiene products on the market it can become confusing and choosing between all the products can be difficult. Here are some suggestions for choosing dental care products that will work for most patients.

Electric Toothbrush:

Some automatic, "high-tech" electronic toothbrushes are safe and effective and some are not. We see excellent results with electric toothbrushes such as the Sonicare (link) (we recommend any of the Sonicares with rechargeable batteries). Please ask us about which products to avoid. It is important to use the electric toothbrush with a non-scrubbing technique to clean the teeth and gum line for at least two minutes. Some patients who build up plaque quickly may benefit from brushing for four minutes. See our section on how to brush (link how to brush).

Manual Toothbrush:

If you use a manual toothbrush, we suggest using a soft bristle toothbrush with a non-scrubbing technique (link how to brush). Do not use a hard or medium bristle toothbrush because they may cause toothbrush abrasion (gum recession). Using the wrong type of bristle can result in the need for a soft tissue graft.

Oral Irrigator

Oral irrigators (water spraying devices) are a great way to help clean the gums but will not remove plaque. Note oral irrigation is not a substitute for flossing. You need to brush and floss first, and then use the oral irrigator. Using a special mouth rinse (link suggestions on rinses) in the oral irrigator is important. We recommend using the the Conair InterPlak Oral Irrigators on the lowest setting.

Tongue Cleaner:

The tongue has nooks and crannies on its surface. Bacteria and food debris can hide in these areas and cause bad breathe (halitosis). Using a tongue cleaner also called a tongue scrapper to remove bacteria and food as well as brushing and flossing are important ways to decrease bad breathe. Note certain types of food like garlic and onions cause bad breathe. Medical problems like diabetes (link to our section) and gastric esophageal reflux disease (GRD)(link) can also cause bad breathe.

Rubber Tip Stimulator:

Some toothbrushes have a rubber tip on the handle; this is called a rubber tip stimulator and is used to massage the gums between the teeth after brushing. They also aid in plaque removal.

Interproximal Brush

These are tiny brushes that clean between your teeth. If these are used improperly you could injure the gums, so discuss proper use with our treatment team. A travel size interproximal brush is also available to carry in your purse or pocket.

Cleaning Removable Appliances (Bite Guards, Orthodonitc Retainers, Partials or Complete Dentures):

A removable appliance needs to be cleaned like teeth. A toothbrush will wear out quickly if used to clean a removable appliance. Your appliance should be cleaned with a special "denture brush" twice per day with a dish detergent.

Toothpaste is abrasive and can scratch the partial or denture surface. Do not brush partials or dentures with toothpaste. These scratches are like "canyons" where bacteria and yeast can grow and cause gum diseases and teeth cavities. Additionally this can stain as well as create an odor to the appliance and result in bad breathe.

As denture adhseive allow bacteria and yeast to grow, it is important to remove all denture adhesive  everyday. After removing debris with the denture brush, a removable appliance can be soaked in a denture cleaner (like Efferdent). Denture cleaners cannot effectively clean a denture if they are not cleaned with a brush first. Note some devices should not be cleaned with a denture cleaner.

For the missing tooth/ teeth area(s), the gums where teeth used to be as well as the roof of the mouth should be cleaned with a soft bristle toothbrush without toothpaste. Toothpaste will abrade the gums.

Floss:

Please see our section on How to Floss. We recommend waxed or unwaxed floss which ever you prefer. To floss under a bridge you can use a floss threader or super floss.

Toothpastes:

If used in conjunction with brushing and flossing, fluoride toothpastes (link) and fluoride mouth rinses (link) can reduce tooth decay as much as 40 percent. Remember, these rinses are not recommended for children under six years of age. Tartar control toothpastes (like Colgate Total) will reduce tartar above the gum line and the beginning stages of gum disease.

We recommend the following toothpastes:

*A common question is "How much toothpaste should be applied to a toothbrush? " The answer is the "size of a pea."

*Note Baking soda and whitening toothpastes are highly abrasive and may damage your gum, bone, and teeth. This can result in gum recession (link) and may need treatment.

• Sensodyne for sensitive teeth.

• Prevident for tooth decay problems and/ or sensitive teeth.





• Colgate Total (Non-whitening) for periodontal disease.

We recommend the following Mouth Rinses:

1. Peridex (Chlorohexidine) for patients with active periodontal disease and immediately after periodontal disease treatment.
2. Listerine - for patients after healing from treatment of periodontal disease as a rinse or in an oral irrigator. Note Listerine has a high alcholol content and can dry the mouth (xerostomia).
3. Diluted Bleach Solution (download bleach instructions) - for patients after healing from treatment of periodontal disease as a rinse or in an oral irrigator.

If you have mouth sores (link Oral Pathology Mouth Sore Section), you might benefit from a special mouth rinse called Magic Mouth Rinse (link magic mouth rinse).

Our treatment team is well equipped to help you select the right products that are best for keeping your mouth healthy.