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 Home Care Instruction
Brushing Flossing Irrigation

Charlotte Dentist NC North Carolina

 brushing flossing home care dentist charlotte north carolina nc


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Treating dental disease is costly and more importantly dental disease damages your body. I continuously preach to all my Charlotte North Carolina area patients about disease prevention. Preventing dental disease is not a mystery. There are two things that will prevent future dental disease:

    1) Impeccable home care

    2) A balanced bite or occlusion. 

All Charlotte NC area dentists should be continuously educating patients about both these aspects of disease prevention.




The following is our basic home
care instructions for Adults:

(Each procedure is described in
more detail further down the page.) 

1) Brush after every meal and snack with an Oral-B Professional Care (model 1000 or higher) toothbrush with a Sensitive head. Brush for a minimum of 30 seconds in each quadrant of your mouth (2 minutes total). This tooth brush has a 30 second timer built into it. Use a low abrasion tooth paste.

2) Floss 1 time per day. 

3) Irrigate ("waterpik") 1 time per day.

4) Once per day, after brushing your teeth, rub mouthwash (any mouthwash will do) into the teeth and gums with your toothbrush. Do not turn the tooth brush on. Continuously dip the bristles in the mouthwash while you do this to make sure you are getting an adequate amount of the mouthwash on the teeth and gums. Use any mouthwash you want. Twice per week the mouthwash should be chlorhexidine gluconate.



The following information expands on
our basic home care instructions:
 




Brushing:

The very first thing to understand about brushing is this. If your tooth brush looks remotely like the picture below, throw it out.

The working part of a tooth brush bristle is the tip.


When the bristles are bent, the tips are no longer contacting the teeth. This result in very poor removal of plaque from the teeth. 




When you eat food, bacteria in your mouth metabolize the sugar in your food and secrete acidic waste products. This acid is what causes tooth decay. Acid production from the bacteria peaks 30 minutes after eating a meal. This is why you should brush within 30 minutes of eating a meal. Powered toothbrushes are more efficient at removing bacterial from teeth than manual toothbrushes. Research shows that the Oral-B Professional Care (model 1000 or higher) are the best toothbrushes for removing plaque from the teeth. Brush each quadrant of your mouth for 30 seconds for a total of two minutes (more if you want). There is a 30 second timer built-in to the Oral-B toothbrush. Before turning the toothbrush on, rub the toothpaste or mouthwash on the teeth in each quadrant of your mouth to better distribute it on the teeth. When using the Oral-B toothbrush, you do not have to move the toothbrush any special way. As long as the bristles are touching your teeth, the built-in movement of the brush head will do the work. Your job is to just move the brush along the teeth so that all tooth surfaces are contacted.



Toothbrush recession:


Gum recession occurs when the gum tissue on the neck of the tooth "shrinks" away from the crown of the tooth and exposes the root.

gum recession 

Gum recession is caused by tooth brushing. More specifically, it is caused by the type of toothbrush bristle used (not the technique of brushing). A toothbrush that does not cause recession requires the following: 

    1) Thin (soft) bristles

    2) Rounded and polished bristle tips 

Microscopic view of a rounded and polished bristle tip. 


Microscopic view of non-rounded unpolished bristle tip.



Unfortunately, most toothbrushes with soft bristles do not have rounded and polished tips. The Sensitive toothbrush head of the Oral-B Professional powered toothbrush has rounded and polished bristle tips. Non-rounded and polished tips cut the gum tissue on a microscopic level. The microscopic blood vessels in the gum tissue are worn away which compromises the circulation which eventually causes the tissue to "die-off" and shrink away from the tooth. In addition,the blood vessels in the gum tissue supplies the blood circulation to the bone it is covering. So as the gum shrinks away, the bone also looses circulation and "dies-off" and recedes as well. 



Toothpaste abrasion:

Abrasion is caused by the abrasive particles in toothpaste. The particles will literally "sand away" the root surface. Regular toothpaste is too abrasive. Use mouthwash or a low-abrasion toothpaste with an RDA value of 80 or less. RDA stands for Radioactive or Relative Dentin Abrasivity. Contact the manufacturer of your toothpaste to get the RDA value of their product. Here is another way to determine if your toothpaste is too abrasive. Put a little toothpaste between your upper and lower front teeth and lightly grind the teeth together. If you can feel any grit between your teeth then the toothpaste is too abrasive.

The following video discusses tooth paste abrasion.


(Note: the dentist in the video discusses how more abrasive toothpastes remove the acquired pellicle (a microscopic layer of mucus on the teeth). When the acquired pellicle is removed, then the tooth is vulnerable to abrasion. Low abrasion toothpastes do not remove the acquired pellicle. They only remove the plaque which forms on the acquired pellicle and leave the acquired pellicle on the tooth surface (which is what you want).  




The following pictures show excessive wear (abrasion) of teeth caused by abrasive tooth paste.

The enamel is worn away from much of the biting surface of the teeth and the edges of the teeth are rounded from the abrasive particles of the tooth paste.


The enamel is worn away from much of the tooth surface which exposed the softer dentin below it. Because the exposed dentin is much softer than the enamel, the dentin wore away quicker causing craters to develop on the biting surface of the tooth.


Recession and Abrasion:

Toothbrush recession also makes a tooth more vulnerable to toothpaste abrasion. Recession exposes the root of the tooth which is much softer than enamel which covers the crown of the tooth. Abrasion appears as an indentation or "cupping" on the root surface. 

Picture shows teeth with toothbrush recession and toothpaste abrasion.


Lateral view of tooth with toothpaste abrasion on the root. 



Baking Soda:

Some of you want to use baking soda as an alternative to toothpaste. The proper mix for making is 1 part baking soda to 3 parts water. This will make a minimally abrasive paste. 



Flossing:

Flossing requires a little "elbow grease" and effort. There is no way around it. Nothing replaces the benefits of flossing. So you have to "bite the bullet" and do it.

Putting string between your teeth and popping food out is not flossing. Flossing requires rubbing firmly against the roots of the teeth below the gums



The following link gives information on proper flossing technique:

                                                       flossing

The following videos give more information on proper flossing technique:






Note: The dentist in this video is flossing too fast. But he does show good flossing technique and shows how flossing does not have to take a long time if you use proper technique. So use his technique but slow down a little. Even in this video, the dentist is not just pushing the floss through the teeth. He is actually going under the gums and rubbing the root surfaces of the teeth. He is just going too fast for you to appreciate it.



 

Flossing around a bridge:

The following videos show how to floss around a bridge:







Flossing Aids:

There are many devices on the market to aid in flossing or replace flossing. Any instrument or device that makes it easier to floss is okay to use. But remember, no matter what device gets floss between your teeth, you still have to firmly and properly rub the floss on the side of the tooth to remove the plaque. Here are some flossing aids that are on the market:

The following flossing aid is what we believe is the easiest device to floss with and is what we recommend if you are not going to floss with your fingers:

The following is how we recommend you use it:

Lay the floss between each set of teeth (L). Then bite down on the head of the instrument (arrow) (L). This pushes the floss between the teeth (R). Then floss under the gums and against the root surfaces of each tooth. Pull the floss out and move to the next set of teeth. 




Other home care aids:

Here ares some other devices to use to clean between the teeth. In our strong opinion, there is nothing on the market that replaces flossing. However, using these devices along with flossing is okay.



Here's an old device (above) that's still around. Place a toothpick in the holder and break the end off (L). The place the toothpick between the teeth and rub the sides of the teeth. (R).


Irrigation:

We recommend using either a counter top irrigator (Hydro Floss) or a sink or shower irrigator (Oral Breeze). Sink and shower irrigators are more convenient to use but you can only irrigate with water (cannot use an antimicrobial solution). 


Oral Breeze sink and shower irrigators.




Counter top irrigators allow you to use solutions other than water. Solutions alternatives for counter top irrigators include:

- Use what you want. Just check with manufacturer to make sure it won’t damage the irrigator.

- Baking soda: Fill the reservoir of the irrigator with water. Leave some   room on the top. Dissolve 2 teaspoons of baking soda in a cup of water   then pour the solution into the water in the reservoir. 

- For patients with more advanced periodontitis (gum and bone infection),we will recommend more powerful disinfectants such as Therasol until the   infection is reduced. Therasol is available premixed or concentrated.To use   the concentrated Therasol, fill the reservoir of the irrigator with water and leave some room on top. Then deliver 4 pumps of Therasol into the reservoir. 


The Hydrofloss irrigator.



Proper Irrigation Technique:

When using the counter-top irrigator you must bend down with your head over the sink to irrigate. Obviously this is not necessary with the shower irrigator. Otherwise, the rest of the technique is the same. Start on the back surface of the upper left or upper right back tooth. Have the irrigator tip lightly touching the gum tissue. With the tip touching the gum tissue, follow the surface of the gum tissue at the neck of each tooth. Make sure the tip is aimed into the gum pocket at the neck of the teeth (see below). 

Irrigate into the gum tissue. 

Blue line shows the path to follow when irrigating. Irrigate the inside and outside of the upper teeth and repeat for the lower teeth. 





Brushing mouthwash into the 
teeth and gums after brushing the teeth:

Tooth paste is good at removing plaque from the teeth and re-mineralizing the teeth. Toothpaste is not very antibacterial. Mouthwash is antibacterial. So once you remove the plaque from the teeth, it is an excellent idea to rub mouthwash onto the teeth. Once each day after brushing is enough. You do not have to do it every time you brush.
Doing this after brushing will allow the mouthwash to penetrate deeper around the teeth. Use any antibacterial mouthwash you want. Do not turn the tooth brush on. As you rub it into the teeth, keep dipping the toothbrush bristles into a cap-full of mouthwash to ensure you are using enough of it. You can also use bleach in a 1 part bleach 20 part water mixture instead of mouthwash. We do recommend that twice each week you use chlorhexidine gluconate as the mouthwash. This solution is the "gold standard" of mouthwashes because it is effective for the longest period of time. However, using it too often will stain the teeth and you will need to come in for a cleaning to remove it. There will not be staining issue if you use it just twice each week.


Blue line shows the path to follow when irrigating. Irrigate the inside and outside of the upper teeth and repeat for the lower teeth. 


Snacking:

Snacking between meals (and therefore ideally between brushing your teeth) is going to cause more dental disease. Snacking on "junk food" is worse than snacking on healthy food. However, healthy foods still contain sugars and carbohydrates that the bacteria in your mouth can metabolize. Unless you are going to brush after every snack as well as every meal (not realistic for most of us), you need to stop snacking.