We place an emphasis on your home care, as you are the person most responsible for the health of your mouth and smile.
Brushing your teeth
Primary focus for preventive dentistry is on removing plaque – the sticky layer of germs that constantly forms on your teeth – by brushing teeth regularly.
Not all brushing techniques are created equal. I recommend using the “Bass technique” (that’s right, we even have a title for it) with a soft, small headed (“child” size) toothbrush.
- Directing the tips of the bristles at approximately a 45 degree angle to the tooth surface, nestling at the gum level
- The brush is then jiggled with very small movements – either back and forth, up/down, or tiny circles which should have the effect of almost massaging the bristles into the gum crevice of the tooth, NOT using a large scrubbing action.
- This is used on just one or two teeth at a time, doing the upper or lower teeth separately, and especially ensuring that also the inside of the teeth is done, not just the outside.
- The inside (or tongue-side) of the lower molars is usually the most often missed or overlooked, so I recommend starting there and ensuring you get right down to the gum level.
Toothpaste is not essential for removing the majority of plaque but it does make the job more efficient, especially polishing off the sticky foundation layer (or pellicle), to delay (although not prevent) plaque regrowth. It is a most useful method of exposing the teeth to fluoride on a regular basis.
Cleaning in between the teeth where brushing doesn’t reach may include interdental sticks or brushes (eg Piksters, Proxabrush), but mostly the favoured method is: FLOSS. *Warning – as my patients will attest to: I am a “Floss Nazi”.
Flossing can be the most effective weapon against gum disease
Flossing needs to be done well, or it may achieve little.
Floss is classically used by guiding it between the teeth with the finger tips, but there are an increasing number of floss holders or handles for those who have difficulty manipulating the floss “manually”.
Guide to flossing
- First slip the floss between the teeth, using a back and forth see-sawing action where the teeth (ideally) touch snugly together. If there is no contact or a large space: simply place the floss into the “gap”
- See-sawing the floss is generally not useful in cleaning, simply to gain access past a “tight contact”
- The floss then needs to be kept level, curved around one tooth, ensuring it is hugging the inside “corner” as well as it does the outside, with firm pressure against the tooth.
- The floss is then scraped up and down the tooth repeatedly, extending as far under the gum as it will readily reach, without driving it into the gum attachment, but with vigour against the tooth, to disrupt and remove the sticky plaque.
- This is then repeated for each tooth surface where the teeth touch, on the sides of teeth where a one two or three tooth gap exists – brushing still doesn’t reach these spots generally – and also the back of the very last tooth.
The goal is the same as brushing: we are out to clean the teeth, not so much on cleaning the “gaps”. This will tend to happen anyway, but shouldn’t be the primary focus.
Most people will notice some bleeding – from a little to a lot – the first few times when they start or resume flossing or brushing. This is to be expected when the gums are inflamed and unhealthy (gingivitis) but, when continued once daily, the cleaning will quickly improve the health of the gums to a point where no bleeding should occur.
If it bleeds, it needs more cleaning! This goes for brushing, flossing or other forms of interdental cleaning that we recommend as part of your preventive dentistry treatment.
Mouthwashes may help in limiting plaque formation but won’t reduce plaque as effectively as mechanically removing it with brushing & flossing.
It is used as a supplement in certain circumstances where you physically can’t reach certain areas eg overlapped teeth, deep gum “pockets”.
Diet – consuming less sugary food and drinks helps prevent decay
The bacteria in plaque on the teeth use simple sugars such as sucrose or table sugar, maltose, glucose, fructose etc, as a source of energy.
When various bacteria have a supply of sugar for fuel, they produce acids as a by-product which can slowly dissolve the calcium and other mineral components out of the enamel in a process known as demineralisation which makes the enamel first chalky then ultimately can progress to a hole which we would refer to as a cavity.
After each time we consume some sugar-containing foods, where plaque is present in sufficient quantity, this acid attack can continue for a couple of hours after eating. It only takes a relatively small amount of sugar to trigger this occurring.
Therefore the less frequently we consume sugar-containing foods (even if we don’t regard them as being especially sugary or sticky) the less opportunities there are for cavities to form.
Timing of eating can also play a role – brushing and flossing soon after consuming sugary food is best.
Saliva is fortunately a powerful natural protection against decay
It can dilute the decay-causing acids. The chemistry of saliva can buffer (chemically limit/neutralise) the acids. It can also provide a way of reversing the earliest stages of decay by “remineralising” by means of the dissolved calcium and other minerals it contains.
Some people however may have low or reduced saliva flow, either naturally occurring or due to the side effects of many medications (especially certain anti-depressants) or damage to the salivary glands from deep Xray therapy or chemotherapy.
Stimulating the salivary glands to maximise their production of saliva can be achieved readily by the action of chewing, such as a (sugar-free) gum. It is unwise to chew sugary materials as this will more than likely fuel the decay process more than can be offset by the increased saliva flow.
Saliva flow will naturally drop dramatically when sleeping, therefore eating shortly before retiring to bed is especially inadvisable. Unless you thoroughly clean the teeth beforehand!
Fluoride – drinking water and using toothpastes containing fluoride is beneficial to oral health
Continuing and ongoing exposure to topically applied fluoride is important even as an adult. Common sources of fluoride to achieve this are fluoridated drinking water and fluoride containing toothpastes.
How fluoride helps
Fluoride can be incorporated into the enamel calcium hydroxyapatite mineral structure – substituting in place of some of the hydroxyl groups – to form fluorapatite which is somewhat less soluble than the original hydroxyapatite therefore less susceptible to acid attack or dissolution.
The decay preventive quality of fluoride was originally thought to occur primarily through the incorporation of fluoride during the formation of enamel. However the presence of free fluoride ions on the surface or outside the enamel mineral itself has also been shown to significantly supress demineralisation, and aid remineralisation.