New Orleans Dental Center Newsletter - March, 2011
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Everything You Should Know about Toothbrushing
but Didn’t Know to Ask
We’ve been brushing our teeth since we were little children, but did anyone ever actually teach you how to brush and floss? No one taught me; I learned in dental school. Nowadays, in the dental office, we give “oral hygiene instructions” to children and adults alike, regarding brushing and flossing techniques. Dentistry has changed its philosophy, over the years, on how to brush. In our office, we are often asked about which toothpaste our patients should use. Actually, the type of toothbrush is important, and the way in which you use your toothpaste is much more important than the type of toothpaste you use! Here are some recommendations of which you may not be aware.
Toothpaste is made up of several ingredients, each of which has a purpose. It has detergents (surfactants) for cleaning and foaming, thickeners to stay on the toothbrush, water softeners to make the detergents work better, flavorings and sweeteners to hide the taste of other ingredients, abrasives to help in removal of plaque and the very beginnings of tartar, and (usually) fluoride to strengthen teeth against decay-causing bacteria. Many toothpastes also have “tartar control,” “whitening,” and/or plaque bacteria-killing ingredients. I found an informative website page, if you’re interested, that gives a much more detailed explanation of toothpaste ingredients: www.sci-toys.com/ingredients/toothpaste.
Beware of advertising claims of various toothpastes:
- Tartar occurs when dissolved minerals in the saliva precipitate (come) out and become incorporated into the soft plaque that’s on the teeth. The minerals harden the plaque into tartar, which sticks to the teeth very tenaciously, like cement. That’s why you can brush or floss to remove plaque but not tartar; tartar has to be removed by instruments at the dentist’s office. “Tartar control” toothpaste has an ingredient like tetrasodium pyrophosphate, which removes calcium and magnesium from the saliva, so they can’t contribute to tartar formation. It won’t remove tartar that already exists!! It only helps to decrease the amount of tartar that forms.
- “Whitening” toothpastes tend to be especially misleading in their advertisements, in my opinion. Whitening toothpastes usually have something like sodium carbonate peroxide, which breaks down into hydrogen peroxide. Hydrogen peroxide does have some bleaching properties, but the concentration is very weak, and the amount of time the toothpaste stays on the teeth probably won’t cause any bleaching that you will notice. If you look at the “fine print” on the TV commercial or the toothpaste box, you will usually see it says something like “whitens by removing surface stains.” I worry that whitening toothpastes may contain harsher abrasives, and I’ll explain that worry later.
- Toothpaste seems to have become a lot more expensive to me, recently. You are wasting a lot of money each year if you (or your kids) use the amount of toothpaste they show in commercials. Of course they show that much—the more you use (waste), the more money the manufacturers make! If there is “unused” toothpaste that you’ve spit into your sink when you’re finished brushing, you’re wasting it!
Most people need to work on their brushing techniques. If you “scrub” when you brush, you will cause the gums to recede (move up the root of the tooth), which will tend to lead to sensitivity of the exposed root surfaces of the teeth (like when you drink something cold or get your teeth cleaned). In young people, very minor recession can sometimes be reversed, if it is very recent. In most people, recession is permanent. Think about it—if the gums have receded, that is an area where bone has been lost. The body won’t allow you to strip the gums off and leave the bone exposed, so it will cause the bone to be “dissolved” away as the scrubbing pressure causes the gums to recede. That bone loss is permanent damage.
Brushing should be a very gentle motion. Remember, teeth aren’t flat. The harder you scrub a flat surface, the cleaner it tends to be. But teeth are round in shape on the cheek and tongue sides, and they have delicate gum tissue next to them. The motion to use when brushing is SLOW, GENTLE CIRCLES, aiming toward the gums but NEVER SCRUBBING. We tend to brush too fast, usually because we’re thinking of the million other things we need to do. I suggest training yourself to think only about brushing while you’re brushing. You will do a better job and not take any more time, if you are mindful of your technique. I know it makes you feel as if you’re doing a better job when you’re scrubbing, but actually, you’re doing a worse job! When you scrub, you don’t give time for the bristles to “walk” around and follow the rounded surfaces of the teeth, so you’re missing some of the surface area. Not only that, but when you use pressure to brush, you are “laying” the bristles down onto the teeth, so the sides of the bristles rub against the teeth and gums. If gentle pressure is used, the TIPS of the bristles are being used, which are the part of the bristles that do the cleaning! That’s why toothbrushes are recommended to be changed every three months. The tips of the bristles become frayed and don’t do as good a job of cleaning after that amount of use. Buy toothbrushes of the “soft” variety—this actually means that the bristles bend easier and can therefore move well around the shape of the teeth. The “harder” the bristles, the stiffer they are. Again, it feels as if they clean better, but they’re actually doing a worse job. Medium and hard toothbrushes should be banned. People buy them because they don’t know any better. If you’re used to using a medium or hard toothbrush, using a soft brush will take a little getting used to, but I think it’s worth it. Or better yet, get a sonic brush.
Sonic toothbrushes are always better at cleaning than manual toothbrushes. This has been proven in studies comparing sonic brushes to manual brushes used by the same patient. They’ve been around for several years, and I highly recommend them for two reasons. First, they really do clean better than a manual toothbrush, because of the technology in the brush. (I was skeptical, until I tried one for myself!) Sonic (sound) waves come out of the brush head and travel through whatever liquid (water, toothpaste, saliva) is on your teeth and “blast away” whatever bacteria the waves touch. Your teeth really do feel cleaner after you use it than when using a manual toothbrush because the sonic vibrations go farther under the gums and actually in between the teeth, where regular toothbrush bristles can’t reach. Sonic brushes have been shown in studies to help reduce teeth staining (which is actually a thin layer of tartar that becomes stained with foods or cigarette smoke) and to help in decreasing the severity of periodontal (gum) disease. Second, I prefer the sonic toothbrush because it can’t damage the teeth or cause gum recession, like improper manual brushing can. If you already have areas of recession (or abfractions—“dug-out” areas of the root surfaces on the cheek sides of the teeth), it is very important to prevent any further damage. We will discuss abfractions in a separate newsletter. A friendly warning: sonic toothbrushes tickle (a lot!!) when you first use them--don’t give up; it only took me about three times of using it for the tickle to go away. DO NOT confuse sonic toothbrushes with electric toothbrushes. Most electric toothbrushes, in my opinion, have bristles that are too stiff and could therefore cause damage (see paragraph above).
For using a manual toothbrush, my recommendations for brushing your teeth are as follows:
1) Place a green pea-sized amount (not more!) of toothpaste on your soft toothbrush.
2) Brush the chewing sides and the tongue/palate sides of your upper and lower teeth. You don’t have to worry too much about the amount of pressure you use when brushing here, especially on the chewing sides.
3) Brush your tongue well.
4) Rinse your mouth, brush your tongue with water a few times, and rinse all the toothpaste off of your brush.
5) With your wet toothbrush, GENTLY AND SLOWLY brush the cheek sides of the teeth, using small circles aimed at the gums. When I do this, I “hang” over the sink and wet the brush after brushing each “quadrant,” (upper right, upper left, lower left, lower right), letting the water run out of my mouth into the sink.
6) Rinse your toothbrush well.
Following these steps will help you prevent any (or further) damage to the roots of your teeth.
I hope this helps you and your family in your oral care efforts. Please call us if you have any questions.
Please call New Orleans Dental Center today at 504.347.6000 to schedule an examination.
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