EVIDENTLY, most people have been 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 for oral care. Consequently, dentists frequently encounter these grievously misled patients, much to our chagrin.
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. Most people now know how to brush and floss after every meal, three times a day, and floss thoroughly at least once a day, probably because this message has been drummed into their heads over the years by toothpaste and mouthwash advertisements that encourage them to buy and use certain products.
Let’s begin with the shortcomings of brushing. One must 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.
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 practise this important task, it has been reported that only 2 per cent of the population flosses every day. Even doubling that to 4 per cent still leaves 96 per cent of the public not flossing even once a day. And those who 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 (crevice between tooth and gum).
Appropriate oral health cannot be best achieved by exclusively using healthy products and techniques. I want to make it clear, just for the record, that I am all for brushing and flossing. Both activities are fundamental oral health procedures, and both offer benefits when done frequently (brushing and flossing must be done often enough to keep plaque and other debris removed by these activities at sufficiently low 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 caused by improper brushing or by using 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) are also inflammatory injuries to the gums. This not only allows microorganisms into the body but also causes gum and bone recession, and even occasional tooth loss. (For some reason, I’ve 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. Both brushing and flossing can be performed effectively and without injury.
