THE primary objective of treating periodontal (gum) disease is to remove plaque from teeth and to keep it from returning once removed. This is known in dentistry as prophylaxis, but is called “cleaning” by patients. However, because plaque re-forms within 24 hours, only personal hygiene can keep it from re-establishing itself; effective plaque control is the “secret” to oral health. Because some people are more susceptible than others, not everyone may be required to practise prevention with the same diligence.
Anyone with obvious gum disease should floss their teeth thoroughly at least once a day, preferably twice. By the same token, excessive brushing and flossing can be harmful. A woman with an immaculately clean mouth complained to me that her teeth were sensitive to cold water, brushing, and even breathing through her mouth. When she reported brushing five or six times a day, she was advised to brush no more than twice a day and to avoid scrubbing the necks of the teeth with a straight back-and-forth stroke. Within a few weeks, the sensitivity to cold and brushing disappeared. Her problem resulted from her needlessly wearing down her enamel and dentin with abrasive toothpaste.
Similarly, there was a young man who never had a cavity. His gums were healthy, but the tissue between the teeth was “punched out.” He had been advised to use dental floss. Figuring if a little floss was good, a lot was better, he tied knots in the string and pulled them through the teeth, destroying the interdental papilla, the triangular-shaped gum tissue that normally fills the space between the teeth. Upon cessation of this destructive flossing, the gum tissue gradually returned to its normal shape.
Professional treatment for diagnosed periodontal disease is generally divided into non-surgical and surgical phases. Antibiotics and antimicrobial chemicals are used for acute infections and for supportive therapy. Mechanical protective devices, such as plastic occlusal guards, relieve problems caused by compulsive grinding. Orthodontic realignment of teeth corrects severe and traumatic occlusion. Prosthetic appliances — fixed and removable bridges and splints — may be necessary to restore and stabilise teeth. And, of course, there is no substitute for personal effort.
There are two major motivations for practising good oral hygiene. They are to have sparkling clean teeth and wholesome breath, just like the chewing gum twins of the TV ads. Preventing periodontal disease, which requires an understanding and perhaps fear of its cause, is seldom foremost in the avid tooth brusher’s mind.
Primary prevention of periodontal disease requires good personal home care, with particular emphasis on diligent daily toothbrushing and flossing. Once the disease has occurred, the same methods, supplemented by professional treatment and special devices and rinses, prevent further extension of the disease. While gingivitis is a reversible form of gum disease, over the years various brushing and flossing methods have been advocated: this shape, that shape, soft bristles, hard bristles, waxed floss, unwaxed floss, and so on. Whenever we find such an inconsistency among authorities, we can reasonably conclude that there is no one best way, but rather several modalities that work well.
As long as one brushes without abrading, puncturing, or otherwise irritating the gums, one technique is probably as good as another, provided plaque is effectively removed.
Being a dentist for over 20 years has taught me that the best way to prevent and maintain oral health is to obey the Rule of Thoroughness. This Rule states that the total time spent cleaning the mouth over 24 hours must be equal to the number 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.
One should not scrub the teeth with a straight back-and-forth stroke because of the danger of wearing grooves along the necks of the teeth, the area at the gum line where the crown joins the root. Brushing from the gums to the tips of the teeth, or in a circular motion, removes most plaque without damaging the tooth surfaces. However, plaque also forms beneath the gingival cuff. If the bristles are placed at a 45-degree angle at the neck of the tooth, with the tips slipping under the cuff, and the brush is then jiggled back and forth, newly formed plaque can be removed from this covered area.
The average person takes less than a minute to brush their teeth and fails to remove two-thirds of plaque. While emphasising the importance of tooth and gum care in oral health, one should not ignore the tongue. A healthy tongue is smooth and pink. Excessive smoking and coffee consumption can cause stains and irritate the top surface. Mouth breathing, particularly during sleep, dries out the mouth, preventing adequate salivary lubrication. A dry mouth may leave the tongue with an unpleasant white coating of dead surface tissue cells that are normally washed away by saliva. As some people age, their tongues become fissured, and the taste buds and other papillae on the top of the tongue grow longer, giving the appearance of a hairy surface. To eliminate stains and mouth odours emanating from the tongue, it should be cleaned daily with a soft nylon toothbrush.
