WHAT makes homecare efforts so vexing for the dentist or dental hygienist (we call them Dentex in Guyana), and so frustrating for their patients who find out their efforts aren’t working is that many people think that state-of-the-art homecare is basically just brushing well two or three times a day, and flossing at least once a day. Most people now know to brush and floss after every meal, three times a day, and to floss thoroughly at least once  a day, probably because this message had been drummed into their heads over the years in toothpaste or mouthwash advertisements that induce them to buy and use certain products.
Unfortunately, the public has been grievously misinformed about brushing, flossing, and using some advertised product; they all still fall short of what is required for genuinely effective oral (systemic) health maintenance, by far, even though, together, they make up the current standard for oral care.
Let us begin with the shortcomings of brushing.  One has to obey the Rule of Thoroughness. This Rule states that the total time spent cleaning the mouth during every 24 hours must be equal to the amount of natural teeth in minutes. For example, if a person has 20 teeth, they should spend at least 20 minutes every day, brushing and flossing, etc.
Compounding the frequently ineffectual homecare regimen is the notion that flossing somehow cleans under the gums. It does; but only so far as the soft tissue on the tongue side and cheek of the tooth will let it. The depth below this level is where most of the disease occurs (gingivitis excepted).
While flossing has definite benefits for many who perform this important task, it has been said that only two (2) per cent of the population flosses every day. Even doubling that to four (4) per cent still leaves 96 per cent of the public not flossing even once a day. And those who do floss cannot clean the bacterial stew out from under the gums.
In fact, although flossing does move the plaque and food debris that builds up between the teeth, and does dislodge some of it so it can be cleansed out of the mouth, the balance of the debris is forced into the sulcus (crevice between tooth and gum).
The pitfalls of homecare can be made even worse if you use a toothpaste or mouthwash containing ingredients that carry such warnings as: “Seek professional help, or contact a poison control centre immediately,” and are known to cause harm.
And these products that are supposed to help us get healthy! My professional advice is to stay away from them. Products containing ingredients that can kill people, induce oral cancer, cause allergic reactions, burning, itching, redness, and soft-tissue sloughing, and degrade tooth-coloured fillings and cosmetic dental bonding agents not improving the health of the user.
But having said that, let me tell you a personal secret without the intention of being biased. I personally have the greatest confidence in any dental product that has the label, ‘ADA approved’. And that is not because I am a member of the American Dental Association.
People with gum disease already have enough problems, without adding toxic products to their oral health programme when they use products with ‘hazardous warnings’. I am concerned. Oral health can best be accomplished by exclusively using healthy products and techniques.
I would like to make it clear, just for the record, that I am all for brushing and flossing. Both of these activities are fundamental oral health procedures, and both offer benefits, if they are done frequently (brushing and flossing have to be done often enough to keep plaque, and other debris removed by these activities, at sufficiently minimal levels to ensure that the gum tissue remains healthy).
I especially want a patient’s brushing and flossing efforts to be effective and non-injurious, but unfortunately, I often see just the opposite. It is extremely common for dentists to see toothbrush abrasion from improper brushing, or the effects of the wrong kind of brush.
As I’ve said in previous articles, hard and medium brushes should  be used for cleaning small motor parts and boots; not teeth. I have no problem if these types of brushes are used on dentures.
As far as flossing is concerned, gingival clefts (cuts) can occur if not performed with care. Otherwise, there could be inflammatory injury to the gums also allowing germs into the body. Also, it can cause gum and bone recession, with even occasional tooth loss. (For some reason, I have seen moderate to severe flossing damage almost exclusively in women, some of it requiring surgery to repair the damage!) These are very poor rewards for such vigorous efforts intended only to improve health. Brushing and flossing can both be performed effectively, and without injury.
The public’s perception of periodontal (gum) disease and its consequences is, unfortunately, still not yet in tune with the health consequences associated with what is in fact a systemic infection. Until those perceptions change on a widespread basis, the medical and dental professions, as well as in the public domain, we will continue to lose the battle.
However, perceptions and concepts can occasionally change almost overnight, and I am encouraged that the public and the health professions may soon start viewing periodontal disease and its potentially lethal toll in a total new light. Only then will any meaningful improvement occur.
I don’t know if a person’s cause of death will ever be listed as gum disease, since it was perhaps a heart attack or stroke that will ultimately be the cause of death, but I do know that it would certainly help elevate the public’s awareness of how serious this health problem is.