Most of us were taught to remove food debris to keep our mouths clean and fresh and to remove nutrients used by cavity causing bacteria to damage our teeth. Both of those objectives are quite appropriate and valuable, but usually will not prevent inflammation leading to bone damage in susceptible individuals. The film in which periodontal disease causing bacteria thrive is very adherent to our teeth, particularly below the gum line on the surface of the tooth where we clean with dental floss. Removing the biofilm from the sides of the teeth with the floss and then brushing it away as we brush the surfaces accessible to toothbrushes is the primary form of therapy to treat periodontitis. Our entire team is dedicated to the coaching usually needed to help patients become very effective and confident in the frequent removal of the pathologic biofilm on their teeth. Any sports coach will ask their athletes to demonstrate their abilities and then offer encouragement and guidance to improve their performances. In a similar way we will provide non-critical suggestions to help each patient develop their own therapeutic regimen, while demonstrating both kindness and patience with their progress. Since the bacteria are constantly repopulating our teeth and since the sticky film reforms within a few hours of its disruption, both skill and frequency are necessary for a patient's efforts to be therapeutic.
Periodontal disease usually appears between the teeth where your toothbrush cannot reach. Flossing is the most effective way to remove bacterial biofilm or plaque from those surfaces and the only way to reach most of the surface below the gum line on the sides of the teeth. Unwaxed floss is much more effective than waxed or slick floss. The biofilm has a consistency similar to cooking oil (maybe with a little honey mixed in) and we would never consider using waxed paper to clean cooking oil from a kitchen counter. Use of unwaxed floss requires the proper techniques to be optimally effective and minimally frustrating. Rough tooth surfaces and repeated use of the same site on the unwaxed floss often lead to its fraying, which is why coaching can be very helpful. Rendering each surface flossed "squeaky clean" is an achievable and very desirable goal. Disrupting the biofilm and getting it to the surface with unwaxed floss and then brushing it away adds value to both the flossing and tooth brushing performed. The following instructions will help you, but be patient and kind to yourself as it takes time and practice.
Start with a piece of unwaxed floss at least 18" long so that you use a new section between each pair of teeth. Wrap the floss around the middle finger of each hand. Hold the floss tightly between the thumb and forefinger of each hand. Gently insert the tightly held floss between the teeth using a back-and-forth motion with the fingers holding the floss as close together so that the span of floss is as short as possible. Do not force the floss or try to snap it in to place. Bring the floss toward the gum line then curve it into a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth. Remember there are two tooth surfaces that need to be cleaned in each space. Continue to floss until the surface squeaks or resistance is felt on the surfaces of the teeth. Be careful to keep the floss curved in a tight "C" with all the tension directed to the tooth to avoid cutting the gum tissue. Most people find it more difficult to maintain the tight curve on the inside or tongue-side surfaces of their teeth, especially on side of their dominant hand, so pay extra attention to those surfaces.
When you are done, brush your teeth carefully as described below and rinse vigorously with water. Do not be alarmed if during the first week of
flossing your gums bleed or are a little sore. If your gums hurt while
flossing you could be doing it too hard or pinching the gum. As you
floss several times daily, your gums will heal and the visible bleeding will often stop. Flossing before brushing is not only more effective, but that sequence will help you build a positive habit more easily.
While brushing the surfaces of your teeth, position the brush at a 45-degree angle where your gums and teeth meet. Gently move the brush in a circular motion at least 5 times using small, gentle strokes, then sweep the brush away from the gum line 5 times. Brush and clean each tooth individually, carefully and slowly to disrupt the biofilm on the tooth just beyond the gum line. If you are using a powered tooth brush direct it toward the gum line in a similar way. We often partner an electric brush with the narrow, two-row toothbrush that reaches the gum line most effectively with the least potential for trauma to the gums. Then brush biting surfaces before rinsing thoroughly.
Sometimes teeth are sensitive to hot and cold. This experience may occur or increase if swollen gums heal and shrink. As the teeth are repeatedly kept clean and flouride is used, often before bedtime, sensitivity usually diminishes.
The disruption of the bacterial biofilm is the primary means of treating and preventing periodontal disease. The bacteria repopulate our teeth constantly and the film reforms within hours of its removal. The physical scrubbing of the tooth surfaces is currently the only effective way to remove the biofilm. Though mouth rinses and tooth pastes claim various health benefits, they are not capable of disrupting the biofilm. If there is limited benefit, that impact would only follow effective flossing and brushing. Attempting to disrupt the biofilm with a water irrigating device is not recommended as trauma can occur though they can serve to rinse after flossing in brushing. There are so many products on the market that choosing the right one can be difficult. We will be happy to help you with your choices.
Drs. McDevitt, Jacquot, and Izarra and our team are the best source to help you select the right products and we always welcome your questions and your observations.
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