Cleanings and Prevention

Brushing and flossing are of paramount importance to oral hygiene.  Though bi-annual professional dental cleanings remove plaque, tartar and debris, excellent homecare methods are equally valuable.  Proper brushing and flossing can enhance the health of the mouth, make the smile sparkle and prevent serious diseases.

Reasons why proper brushing and flossing are essential:

  • Prevention of tooth decay – Tooth decay is one of the leading causes of tooth loss, and its treatment often requires complex dental procedures.  Tooth decay occurs when the acids found in plaque erode the natural enamel found on the teeth.  This phenomenon can easily be prevented by using proper home hygiene methods.
  • Prevention of periodontal disease – Periodontal disease is a serious, progressive condition which can cause tooth loss, gum recession and jawbone recession.  Periodontal disease is caused by the toxins found in plaque, and can lead to serious health problems in other parts of the body.  Removing plaque and calculus (tartar) from the surface of the tooth using a toothbrush, and from the interdental areas using dental floss, is an excellent way to stave off periodontal problems.
  • Prevention of halitosis – Bad breath or halitosis is usually caused by old food particles on or between the teeth.  These food particles can be removed with regular brushing and flossing; leaving the mouth healthier, and breath smelling fresher.
  • Prevention of staining – Staining or the yellowing of teeth can be caused by a wide variety of factors such as smoking, coffee and tea.  The more regularly these staining agents are removed from the teeth using brushing and flossing techniques, the less likely it is that the stains will become permanent.

The Proper Way to Brush

The teeth should be brushed at least twice a day; ideally in the morning and before bed.  The perfect toothbrush is small in size with soft, rounded-end bristles and no more than three months old.  The head of the brush needs to be small enough to access all areas of the mouth, and the bristles should be soft enough so as not to cause undue damage to the gum tissue.  The American Dental Association (ADA) has given electric toothbrushes their seal of approval; stating that those with rotating or oscillating heads are more effective than other toothbrushes.

Here is a basic guide to proper brushing:

  1. Place the toothbrush at a 45-degree angle where the gums and teeth meet.
  2. Use small circular motions to gently brush the gumline and teeth.
  3. Do not scrub or apply too much pressure to the teeth, as this can damage the gums and tooth enamel.
  4. Brush every surface of every tooth, cheek-side, tongue-side, and chewing surfaces. Place special emphasis on the surfaces of the back teeth.
  5. Use back and forth strokes to brush the chewing surfaces.
  6. Brush the tongue to remove fungi, food and debris.

The Proper Way to Floss

Flossing is a great way to remove plaque from the interdental regions (between the teeth).  Flossing is an especially important tool for preventing periodontal disease and limiting the depth of the gum pockets.  The interdental regions are difficult to reach with a toothbrush and should be cleansed with dental floss on a daily basis.  The flavor and type of floss are unimportant; choose floss that will be easy and pleasant to use.

Here is a basic guide to proper flossing:

  1. Cut a piece of floss to around 18 inches long.
  2. Wrap one end of the floss around the middle finger of the left hand and the other end around the middle finger of the right hand until the hands are 2-3 inches apart.
  3. Work the floss gently between the teeth toward the gum line.
  4. Curve the floss in a U-shape around each individual tooth and carefully slide it beneath the gum line.
  5. Carefully move the floss up and down several times to remove interdental plaque and debris.
  6. Do not pop the floss in and out between the teeth as this will inflame and cut the gums.

If you have any questions about the correct way to brush or floss, please ask your dentist or dental hygienist.

Brushing, Flossing with Braces

The objective of orthodontic treatment is straightening of the teeth and correcting the bite. If the health of the teeth is ignored along the way, the treatment result can be significantly compromised. Therefore, effective brushing and flossing is one of the most critical actions needed from patients during braces. Regular visits to the general dentist for examination and cleaning are also essential.
The results of inadequate oral hygiene include decalcification (white spots/marks), gingivitis (inflammation of the gums), and periodontal disease (inflammation leading to bone loss).
A common misconception is that the braces themselves cause marks on the teeth. The reality is that the plaque left around the braces causes decalcification, otherwise decalcification would occur in everyone that had braces. Fortunately, decalcification is preventable by thorough brushing and flossing, along with regular visits to the general dentist/hygienist.
In order to counter the process leading to decalcification, consistent and effective brushing techniques are required. An illustration of a technique that can be used to effectively clean around the braces is shown below. Notice that only a couple of teeth at a time are brushed. This helps concentrate on specific areas around the braces and along the gum line. The angle of the brush is important in order to properly clean all sides of the teeth and under the wire.
Using floss between the teeth is also very important during braces. The space between the teeth is unreachable by a brush, so regular flossing will help to prevent plaque buildup in these areas. With braces, the wires will prevent the usual technique for flossing. Therefore, the floss can first be thread underneath the wire by hand or with a flossing aid (i.e. a floss threader). Then the floss can pass in between the teeth up to the gum line as usual.
Following are additional brushing instructions to keep in mind.
  • First, frequent visits with a general dentist for examination and cleaning are critical to prevention. Most people see their dentist every 6 months. Some patients may need more frequent visits. Talk to the orthodontist and dentist about their recommendations.
  • Second, it is important that the teeth are brushed after every meal. Food can collect very easily around the braces and therefore needs to be removed on a regular basis.
  • Third, avoid trying to brush all the teeth at once. It helps to limit brushing to a couple of teeth at a time. This way, areas on certain teeth will not be missed.
  • Fourth, effective brushing requires time. Avoid rushing and make sure any areas that may have been missed are checked and re-brushed. A good technique would be to use a timer (some electric toothbrushes have timers built in).
  • Lastly, brush from the top, bottom, and middle towards and between the braces and wire. Also remember to brush towards the gums gently, since overaggressive brushing can damage the gum tissue.

The effectiveness of topical fluoride during orthodontic treatment is widely accepted in the scientific literature for providing significant protection against cavities and white spots (decalcification). Therefore, in addition to proper brushing and flossing, daily use of a fluoride rinse will help to reduce the chance of developing cavities and white spots on the teeth. Available rinses include Phos-Flur® (Colgate), Act® (Johnson & Johnson), and many more. The best way to decide on a product is to look for the American Dental Association (ADA) seal of acceptance. Products that have the ADA Seal of Acceptance have undergone testing to prove their effectiveness. Further information of accepted products can be found on the  ADA web site.