Oral Care Hints, Tips and Articles

The 80/20 rule relevant to teeth: Get the Gap!

Background information 

Most people find it very difficult and tedious to clean the gap between their teeth. It is much easier just to give a good old scrub, get it over and done with in 30 seconds and get out of there. The ‘good old scrub’ typically employs random movements primarily on the outside of the teeth – and occasionally on the inside if you’re lucky.

In truth this kind of tooth brushing – obviously two minutes would be better – does clean the outside surfaces of the teeth and often does a reasonable job of preventing decay and gum disease that starts in the areas that are fairly easy to get at.

However, and it is a big however , it is the gap in between the teeth that accounts for a huge percentage of the problems people get, such as decay and gum disease. You can think of it like the 80/20 rule – 80% of the problems start in 20% of the places.

Mathematically, the tooth has five surfaces – four sides and a top. Two of those sides touch adjacent teeth and form the gap – that’s 2 surfaces out of 5 or 40%. It is on those minority of surfaces that nearly all the decay starts and most periodontal disease. The other 60% of the tooth surfaces seem to get by fairly well with standard brushing especially if you have had fluoride in your drinking water when you are aged from 2 to 8 years old.  Later on I will give you a hint about how to make the top of your tooth virtually decay proof… This is the other area that does need addressing. But without a doubt it is the gap between the teeth that is the source of the greatest number of woes for dental patients, and the area that used to be the hardest to clean. The times are changing and cleaning these gaps is now nowhere near as difficult or tedious as it used to be. Traditionally most Dentists and Hygienists have recommended floss but a surprising large percentage of the population  (approximate 80 to 90%) never do it, or try it and give up because it is too tedious or manually difficult for them. So here are some tips on some time-saving and easy to use devices that clean the gap and can hopefully save you thousands if not tens of thousands of dollars fixing up the lifetime of problems caused by the initial weakening of the tooth cause by the decay in the gap and the drilling necessary to get it out and stop it, plus the issues of periodontal disease.

Oral Care Hint, Tip or Article

To make gap cleaning easier  try three easy alternatives:

Option one, use a Flosspick. (if you have seen these before and know what rubbish they are, hold on, that was then) These Flosspicks have small threads of floss mounted on a plastic bow so you don’t have to wrap it around your fingers, you don’t need two hands, and you don’t have to get your fingers in your mouth …making it a lot easier. In the past, the problem with many of these devices was that the thread was too weak, it broke too easily, it frayed and often little bits of the floss would get jammed between your teeth, making the problem worse and much more uncomfortable than it was before you started,  resulting in many people giving up in disgust. Those miserable little cheap Flosspicks you get on airlines were good examples of how not to do it. However, better Flosspicks are now available from a number of manufacturers that have more durable shred resistant floss so these problems hardly ever occur. Some of the floss is multi-filament and slightly twisted so it is less likely to fray, and some floss is monofilament and made of Teflon like material .Not only doesn’t it fray (because it is only one strand), but it goes down into the gap really easily without you fearing it is going to break or injure your gum when it finally snaps through.

Floss of any kind is the optimal way to clean the front teeth as it can slip down the fine crevice between the gum and the tooth without causing a bluntening of the little pink spike of gum in between the teeth, like toothpicks and interdental brushes can. This bluntening doesnt cause any health problems – it is just a minor cosmetic concern. Interdental brushes probably have a slight health advantage when cleaning back teeth.

Option two, use a plastic toothpick. The problem with wooden toothpicks is that the wood contains fairly abrasive particles and usage over long periods of time can actually wear a groove into the tooth, if used frequently. So by using plastic toothpicks correctly, it will not wear your teeth away.  Also small bits of broken porous wooden toothpicks , if swallowed , maybe problematic if you’re unlucky. I actually had a patient who nearly died from it… The wood didn’t show on the x-ray and the doctors couldn’t figure out what was causing the worsening infection. They opened him up and finally found a small section of a wooden toothpick. If you use a plastic toothpick make sure the plastic doesn’t break when you bend it backwards and forwards. If you get a bit break off in between your teeth make sure you get it out just in case you forget and swallow it, because, unlike broken interdental brushes made from wire, plastic won’t show up on x-rays.

Option three: interdental brushes. There are many manufacturers of these and they come in a large range of shapes and sizes so there is going to be one that fits the gap between your teeth. They are simple to use and only require one hand , unlike conventional floss you have to wrap around your fingers . Some would say interdental brushes have an advantage over floss on the back teeth where there are little indents between the roots. These indents , or furcations as dentists call them, are not really cleaned by the floss because it travels over the tops of the two bumps on either side, and skips over the valley in between, whereas interdental brushes have bristles that spring out to flick away any plaque and food debris in those valleys or grooves between the roots. Spectacular improvements in the condition of the gum and the reduced propensity for it to bleed are often observed by dentists and hygienists when patients start using interdental brushes. As a result of this, they have become very popular alternatives to flossing.

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How to reduce damage to your gums caused by tooth brushing.

Background information 

the gums in some patients shrink back quite dramatically over the years – sometimes over a few months -and yet in others they go for decades without any apparent wear and tear on the gums. Why the difference? What are some people doing that others don’t?  I have asked patients what sort of tooth brushing technique they used and reached some conclusions which I will share below . it should be said  though that Shrinkage of the gums is not necessarily all about tooth brushing technique … Some people are born unlucky with very thin fragile types of gum and they are probably going to get some shrinkage or wear back no matter what they do – which gives rise to the saying “ long in the tooth “…..but if you want to reduce it ,consider these tips:

Oral Care Hint, Tip or Article

The length of the stroke is in my opinion the key determinant of how much the gum will wear back. The people that I’ve seen the most dramatic or rapid wear of the gums appear to have a stroke that is approximately 2 to 4 cm. This translates into a fair amount of dragging and scratching of the bristle tips on the gum. I recommend a 1 cm length of stroke which produces a shorter and arguably less abrasive 2 to 3 mm of bristle tip movement on the gum – just enough to remove the plaque and no more.

The other factor that affects gum wear is using a ridiculously hard brush… Most dentists recommend a soft brush for this reason.  A hard brush is like a bed of nails as far of the gum is concerned . .. And when you use it with a long stroke and plenty of pressure you can kiss goodbye to several millimetres of gum .  There is not a lot of science to prove that a medium bristle with a short stroke causes any problem but most dentists err on the safe side and recommend soft only. Some people feel that that does not clean their teeth properly so if you insist on using a medium make sure you use a short vibrating type of stroke … Look in the mirror and confirm it is not much more than 1 cm …rather than a long steam train style four centimetre. How hard you should push on the brush will be the subject of another hint, but as a teaser I will mention a brief anecdote. When I commenced practice I saw a dental history form from the American dental Association . It had some good questions – two of them were….1 do you brush your teeth vigourously or lightly, and the following question right next door to it was.2 do your gums lead when you brush?  I made up my own patient record card with these questions… And I was shocked at the answers and the conclusions that I reached were the exact opposite to what I expected from my undergraduate training.   I expected the correct answer was likely and that would mean your gums didn’t  bleed because you were being nice and gentle. How wrong I was… There was an overwhelming preponderance of peoples gums not leading when they brushed vigourously. Bingo. From then on I figured vigourous brushing is a good thing as long as the length of the stroke is short and the bristle is not too hard. But how to tell what is vigourous and how hard to push – that will be in another hint.

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Why biting your toothbrush can help clean difficult areas

Statement of problem Nearly everybody gets a hard rocky material called calculus (or tartar) forming at the back of the lower front teeth as a result of leaving small amounts of plaque behind. The saliva that washes over this area comes from under the tongue and it is rich in calcium phosphate which converts soft plaque into hard rock like calculus over a period of a few months. Any plaque left in this area almost certainly means you are going to get hard rocky material forming there …material that you can’t remove with a toothbrush. Once it is converted into the rocky material you have to have it professionally scaled away by your dentist or hygienist. To some extent it is inevitable that we all will get some of this, but you can minimise it by more meticulous brushing in this area. However, it is not an easy area to get at, and it is an awkward hand/wrist movement , so try this tip for improved brushing effectiveness: Proposed solution for above problem Instead of trying to use your wrist to push the brush down into those difficult curved areas behind the front teeth, try using the jaw closing muscles. Hold the brush so that the bristles are aligned vertically in the long axis of the tooth and simply bite down onto and into the brush. This will cause the bristles to slide down the back of the front teeth and go into the crevices between the teeth and dig down in the sulcus (or crevice) next to the gum. It is surprisingly easy and effective. Bite up and down a few times. The same technique works for top teeth and bottom teeth, however the results on the bottom teeth tend to be more dramatic because it is far more prone to the formation of calculus. Always use a soft brush -not one marked medium or hard – these harder bristles may push the gum back a bit. It’s not really a big problem if the gum does shrink back a millimetre or two for any reason, so don’t be overly concerned, but ask your dentist or hygienist to keep an eye on your gum at the back and to confirm that you are cleaning it better and not causing any excessive pushing back of the gum. The instructions on most toothbrushes that tell children “do not bite the brush?. Those instructions refer more to chewing the brush on molars and destroying the bristles by bending them over and crushing them, which ruins the toothbrush. What we are advocating here is keeping the bristles straight and using the biting power to drive them down in a controlled way into the crevices that are very hard to get. The patients I have told this technique to sometimes commented on how useful it was, so it is presented here for the benefit of a wider audience.

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