THERE ARE more theories and styles of toothbrushes to choose from than even a professional could deal with. I visited a WalMart supermarket in Manhattan, New York recently and counted 22 different types and brands of toothbrushes. People always ask me which toothbrush and method I advocate. Quite simply, I recommend whatever keeps your teeth clean.

There is really not a lot of mystery to this process. You know that your teeth are clean when they feel nice and glassy smooth as you run your tongue against them. But technically, you can confirm clean teeth with plaque disclosing tablets which are sold in my clinic for $25 each. Just be careful to use a soft enough brush so that you do not erode the teeth or mechanically abrade the gums.

For many years I have been recommending The Rule of Thoroughness. And again I will emphasize it. The principle and theory is that the important consideration is how thorough you brush and not how often. So, based on this tenet, it is necessary to brush your teeth only once a day. The Rule of Thoroughness states, “The total time spent cleaning the mouth (brushing the teeth, gums and tongue as well as flossing), during 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, flossing etc.”

As far as electric toothbrushes are concerned, I find they are more efficient than many make them out to be. In fact, I personally use one which also flosses. These brushes are not abrasive and I have never noticed patients who use them to have erosion of their tooth structure. The electric toothbrush I would not hesitate to recommend is the Jetpik. I find it to be the most effective plaque remover with the least amount of mechanical trauma. It has a built- in safety mechanism that limits the amount of pressure you can apply – if you press too hard, it stops.

Notwithstanding, be careful with using a non-ADA approved electric toothbrush if you have mercury amalgam fillings. By mechanically stimulating the surface of the amalgams you increase the amount of vapor released into the oral cavity.
I recently had a patient come in because after he began using an electric toothbrush he noticed that his personality began to change significantly. He was suddenly getting very angry and aggressive during his half-hour commute to work. The only reason he thought it might be vapor from the fillings was because his wife had just removed all her amalgams and experienced a phenomenal mood improvement.

He stopped using the electric toothbrush and a month later, when he came in to have his amalgams removed, he related that his mood changes had improved significantly. While this may sound ridiculous, current research points to this phenomenon as a distinct possibility.
Toothpaste manufacturers also routinely use excessive sweeteners and even chemicals that can cause mild burning of the delicate gum tissues. Colgate, my favorite toothpaste, has a variety of choices (total, luminous, etc).

However, an option is to make your own toothpaste at home. It is really quite easy. Simply mix enough hydrogen peroxide with baking soda to make a paste, and use it as you would any other toothpaste product – but with much greater peace of mind.
As far as floss is concern I do have a definite recommendation here: use unwaxed floss, or preferably tape. When floss is coated with wax, the fibers get smooth together resulting in less surface area to clean the teeth. Unwaxed floss is made up of many strands of fiber so there is more surface area to pick up plaque.

Some patients complain that unwaxed floss shreds. In that case, the problem is not with the floss, but with your teeth. Discuss it with your dentist. You may have a filling that is not flush with the tooth or a corroded amalgam. When flossing, do not just move the floss up and down once or twice. Rub gently to remove the plaque and do each side of the tooth individually.