Brighter Smiles: Back to the Basics

Tuesday May 02, 2023

Every once in a while someone will say, “There must be a lot less cavities today than there were years ago because of improved home care, fluoride, etc., right?” There are. However, there are still way too many people that present with decay and most of them could use some major improvement in home care and diet.
Once, I had entered one of my hygienist’s rooms to check her patient, a 13-year-old boy, and asked the hygienist as I always do how his home care was. She said to me, “Jack, why don’t you tell the doctor how often you told me you brush your teeth.” The boy answered, “About once a week.” ONCE A WEEK?!?! Not to mention the fact that he is in braces too, which makes it even more important to keep the teeth clean.
It’s important sometimes to step back and review the basics, so here they are. At a minimum brush with a fluoride toothpaste at least twice a day for two minutes. A good electric toothbrush is preferable to a manual toothbrush. When I say “good”, I mean one that sits on a charger and not one that takes AA batteries. The evidence is indisputable that a good power toothbrush does a better job at cleaning the teeth and disrupting the bacteria in the mouth.
It amazes me how many people don’t floss their teeth. I have heard every excuse in the book; “My fingers are too big”, “I don’t have the time”, “It’s too hard”, “A recent news report just said flossing is ineffective”. Just like anything else, it is always hard to start a new ritual. There are so many different kinds of floss and gadgets to help floss. There is something out there for everyone.
Bacteria, which accumulates on and between the teeth, forms that white film called plaque. Plaque contains billions of colonized bacteria. The right kind of bacteria, along with the wrong king of diet and the wrong genetics can produce cavities. Plaque that is not removed with thorough daily brushing and flossing can harden and turn into calculus (tartar). These colonized bacteria can then lead to tissue inflammation (gingivitis), the early stage of periodontal (gum) disease.
Brushing your teeth helps get rid of most of the plaque, except for the stuff that accumulates between the teeth. That is what floss is for. I know it sounds gross but if you want to know what your breath smells like, floss a few teeth and then smell the floss. That will turn you into an avid flosser.
The routine should be, floss, brush, rinse. The whole event should be around five minutes. Believe me, you have five minutes. Flossing first allows the fluoride from the toothpaste to contact a cleaner tooth surface between the teeth. I prefer a non-alcohol based rinse, but any rinse that is anti-microbial is okay.
Oh, one important thing about flossing. Proper flossing is not popping the floss between the teeth and shooting it right back up. The proper way to floss is to get the floss between the contact of the teeth, slide the floss gently under the gum tissue around one tooth, “shoe-shine” the side of the tooth, gently move the floss over the papilla (the little piece of gum between the teeth), “shoe-shine“ the side of the other tooth and then bring the floss up.
If you are really averse to flossing, have braces, or have bigger spaces between your teeth, a water pik is an acceptable alternative. Like flossing, this should be used daily.
Remember, there are brushable and non-brushable surfaces of the teeth. Whatever you have to do to thoroughly clean both surfaces is essential to good dental health
Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at

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