Maximizing dental care at home

WHAT makes home-care efforts so vexing for the dentist, and so frustrating for their patients who find out their efforts aren’t working, is that many people think that state-of-the-art home care is basically just brushing well two or three times a day, and flossing at least once a day. Nowadays, most people are now encouraged to brush and floss after every meal, three times a day, and to floss thoroughly at least once a day. This is probably because this message has been drummed into their heads over the years in dental hygiene advertisements. Unfortunately, the public has been grievously misinformed about brushing, flossing, and using some advertised products; they all still fall short of what’s required for genuinely effective oral (systemic) health maintenance, by far, even though together they make up the current standard of oral care.
Let us begin with the shortcomings of brushing.  One should 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 number of natural teeth expressed in minutes. For example, if a person has 20 teeth they should spend at least 20 minutes everyday brushing, flossing, etc.
Compounding the frequently ineffectual home-care 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 percent of the population flosses every day. Even doubling that to four percent still leaves 96 percent of the public not flossing even once a day. And those who do floss can’t 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 (the crevice between tooth and gum).
The pitfalls of home care can be made even worse if you use a toothpaste or mouthwash containing ingredients that carry warnings such as “seek professional help or contact a poison control centre immediately”.   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 cannot be of benefit to the user. People with gum disease already have enough problems without adding toxic products to their oral health programme.
Oral health can best be accomplished by exclusively using healthy products and techniques. Obviously, I am all for brushing and flossing. Both these activities are fundamental oral health procedures, and both offer benefits if they are done frequently. Brushing and flossing must be done often enough to keep plaque and other debris away from the teeth. This should be done 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. Unfortunately, I often see just the opposite. It is extremely common for dentists to see toothbrush abrasion at the necks of teeth caused by improper brushing, or the effects of the wrong kind of brush. As I said in previous articles, hard and medium brushes should only be used for cleaning small motor parts and boots, not teeth.
As far as flossing is concerned, gingival clefts (cuts) due to carelessness can result in injury to the gums which not only allow germs into the body but also cause gum and bone recession, and 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 totally 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.