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Tooth or Consequences: Thoughts on Oral Care from the Professionals

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Thoughts on Oral Care from the Professionals

Tooth or Consequences: Thoughts on Oral Care from the Professionals

November 13, 2006
By: Jean Johnson for Dental1

“There’s no tomfoolery when it comes to taking care of your mouth,” Kenneth Bueltmann, DDS, a member of the board of directors for the Chicago Dental Society and former president of the American Academy of Periodontology (AAP) told the AAP. “Dental cavities are the number one reason for tooth loss. Knowing how to identify potential problems and incorporating a daily hygiene regimen of brushing and flossing could prevent your chances of tooth decay, tooth loss, and other illnesses that may be linked to infections of the mouth.”
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Below we’ve summarized some of ‘The Top Worst Excuses for Not Brushing and Flossing’ collected by the American Academy of Periodontology. We’ve also provided the AAP’s answers to these excuses.
  • My hands are too big and I have no dexterity.
    A: Try a floss holder.
  • My gums bleed.
    A: Gingivitis, a mild form of gum disease, can make the gums bleed easily. It is often caused by inadequate home care.
  • I get my teeth cleaned professionally twice a year, so I don’t have to brush and floss.
    A: If plaque is not removed, it can turn into a hard decay-producing substance called calculus/tartar in less than two days.
  • Losing teeth is part of aging.
    A: “This is definitely not true.” Good home care has resulted in more people keeping their natural teeth longer.
  • My teeth are too tight for the floss.
    A: Try polymer floss that has the American Dental Association approval seal.
  • I’m afraid of damaging my gums.
    A: That’s why technique is so important. Have your hygienist demonstrate the next time you have your teeth cleaned. In the mean time, use gentle, firm strokes.
  • I went hiking and forgot to bring the floss.
    A: Not to worry, chewing on sticks may be just the ticket. “Dental researchers have studied the periodontal status of Sudanese populations who use Miswak chewing sticks and found that their periodontal health status was comparable to Sudanese toothbrush users.”


  • Bueltmann may sound stern, but he’s apparently seen it all. As a leader in his field at national and local levels, he would like to do his part in raising the awareness that can lead to better dental health throughout a person’s lifetime.

    “There are still many myths about oral health that people truly believe,” Bueltmann adds. “If we can dispel these myths and educate children and adults about the real facts of proper oral hygiene, we might be able to help save teeth and produce a lifetime of smiles.”

    The 26 Hour Rule

    The AAP maintains that some people think that the primary reason for brushing is to remove food debris. True as far as it goes, the professional organization says, but there is more to it than that. “Daily brushing and flossing will also keep the formation of plaque to a minimum. If not removed every 26 hours, plaque can turn into calculus that can lead to tooth decay and periodontal disease.”

    “I recently had a 65-year-old patient who said he had flossed once in his life,” an unnamed periodontist told the AAP. “I explained to him the importance of cleaning between his teeth. He came back for an evaluation two months after treatment and said he was now flossing five days a week. Needless to say, his periodontal health has improved significantly.”

    Think of Your Gums Like You Would the Skin on Your Hands

    The AAP goes on to refute the idea that it’s normal to have bleeding gums. “Bleeding gums are one of the eight signs of gum disease.

    “Think of gum tissue as the skin on your hand. If your hands bled every time you washed then, you would know something is wrong.”

    Gum Health is Critical: From Pre-Term Babies to Heart Disease to Diabetes and Beyond

    “When gums are infected, periodontal bacterial byproducts can enter the bloodstream and travel to major organs and set off other problems,” the AAP explains. “Research suggests this may: contribute to the development of heart disease, the nation’s leading cause of death; increase the risk of stroke; increase a woman’s risk of having a preterm, low birth-weight baby; and pose a serious threat to people whose health is compromised by diabetes, respiratory diseases or osteoporosis.”

    “It makes sense,” said Robert Schoor, DDS, associate professor and director of post graduate periodontics at New York University College of Dentistry. “Periodontal or gum disease is a bacterial infection of the gums, and that bacteria can travel into the bloodstream and other parts of the body, putting a person’s health at risk.”

    The Right Equipment

    Now that the pros have our attention, they want to offer some insights on how to best approach oral hygiene. Stocking the medicine cabinet with the right tools is a great place to start.

    Whether electric or manual, the idea is to have a soft-bristled brush that easily gets into the crevices between the teeth. It’s also good to mark tooth brush replacement time on the calendar. Frayed bristles are not good – most brushes need replacing every three to four months.

    Also get a supply of fluoride toothpaste in the house. Nothing else but fluoride pastes will do, according to the AAP: “fluoride products can reduce tooth decay by as much as 40 percent.”

    On the subject of floss, dentists are less picky. Get whatever kind of floss will motivate you. If you have any bridges, be sure to get some floss threaders so that you can keep the area under them clean.

    The Right Technique and Timing for Brushing

    Dentistry has refined its approach to home care since we first learned how to brush our teeth. Current prevailing thought suggests that short, gentle, circular motions with the brush held vertically at a 45-degree angle to the tooth and gum surfaces is best. Pay special attention to the junction between the teeth themselves and the gums, again using gentle circular motions.

    Generally people are encouraged to spend around 10 minutes brushing and flossing their teeth. That said, dentists vary in their recommendations. Most think two minutes per session for brushing is sufficient, while 43 percent of a group of 195 periodontists said three or more minutes was preferred.

    As far as Ravi Smith, DDS, a periodontist in San Francisco is concerned, though, time isn’t a factor. In this respect he’s like a personal trainer who tries to get people to slow down and concentrate on what they are doing so that they can notice changes and respond to their body’s needs.

    “Patients often ask how long they should spend brushing,” Smith told the AAP.”I do not recommend a timed regimen. Rather, I tell them however long it takes for them to properly brush all surfaces of their teeth.”

    We at Dental1 found Smith’s idea intriguing, so we tried it. Instead of being a bit bored with the routine, we found that remaining in the moment, being mindful, and really paying attention to what we were doing elevated brushing to a new, enjoyable level.

    Most dentists say that brushing two to three times per day and flossing once is adequate.

    Nadar Rassouli, DDS, M.D., a Portland, Oregon prosthodontist underscores, though, that the main thing is to keep the teeth clean. “That’s why we recommend brushing after each meal and avoiding snacks. Any time you eat something, if you don’t brush afterward the bacteria get started.”

    Rassouli realizes that many skip the lunch brushing because they don’t like to pack a toothbrush around at work. “It’s best if people can find a way to brush then too, but if they can’t the main thing is to get everything cleaned up before bedtime. That’s when it’s best to floss also. We see a lot of decay and gum problems developing when people don’t take the time to clean their teeth before they go to sleep.”

    On flossing, Rassouli also had some suggestions. “People floss best when they think about what they are doing. They have to remember that gum tissue is relatively delicate and won’t tolerate anything that’s too aggressive. At the same time, it’s important to get up under the gum surface to remove plaque.”

    He explained that gentle but firm pressure is best, and that floss needs to be run around the tooth in a curved fashion that catches both the front and back facets. While some recommend eight swipes per tooth, Rassouli is more in the Smith camp. He tells his patients to be mindful of what they are doing and to stop when they think they have done a good job.

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