The most important reason you go to the dentist is to decrease inflammation
in the mouth and jaw structures. Inflammation is caused by: 1) infection and
2) physical stress. Chronic Inflammation is harmful to the entire body. It will
severely compromise your health in the long run. The following home care
instructions are very effective in reducing infection in the mouth and therefore
the inflammation associated with it (Speak to us about how we decrease
inflammation caused by stress (from an unbalanced bite)).
Our Home Care Instructions for Adults
Brush after every meal .
Floss 1 time per day.
Irrigate (“water pick”) 1 time per day.
Minimize snacking between Meals.
The following information expands on each of these steps:
When you eat food, bacteria in your mouth metabolize the sugar in your food
and secrete acidic waste products. This acid is what causes tooth decay. Acid
production from the bacteria peaks 30 minutes after eating a meal. This is why
you should brush witihin 30 minutes of eating a meal.
Powered toothbrushes are more efficient at removing bacterial from teeth than
manual toothbrushes. Research shows that the Braun Oral-B Professional Care
series are the best toothbrushes for removing plaque from the teeth.
The Braun Oral-B Professional Care 8850 toothbrush is available from us and is
also available online.
Brush each quadrant of your mouth for 30 seconds for a total of two minutes
(more if you want). There is a 30 second timer built-in to the Braun Oral-B
Before turning the toothbrush on, rub the toothpaste or mouthwash on the teeth in
each quadrant of your mouth to better distribute it on the teeth.
When using the Braun Oral-B toothbrush, you do not have to move the toothbrush any
special way. As long as the bristles are touching your teeth, the built-in movement of
the brush head will do the work. Your job is to just move the brush along the teeth so
that all tooth surfaces are contacted.
* Very Important!: See the information on toothbrush recession at the end of these notes *
Fluoride: Fluoride is not necessary if your homecare is impeccable every single day. This does
not include the vast majority of people in this world. So for most people we do
recommend limited use of fluoride (there is still no chemical (natural or synthetic) that
is more effective in preventing cavities). It will not harm you if you use it the way we
tell you. Get a bottle of prescription strength liquid fluoride (available from us).
Do the following procedure twice/week:
Wet the bristles of the tooth brush with the fluoride solution. Remove the excess
fluoride on brush by tapping the handle of the brush against the rim of the sink. Before
turning the tooth brush on, rub the fluoride on the teeth in each quadrant of your mouth
to evenly distribute the fluoride.Then turn the toothbrush on and brush your teeth.
Rinse your mouth out with water after brushing with the fluoride. Fluoride only works
in reducing cavities when it is in contact with the teeth (topical application). Ingesting
fluoride does not help reduce cavities. Using fluoride as per our directions will cause
minimal exposure of fluoride to your body but give maximum protection to your teeth.
Flossing: Putting string between your teeth and popping food out is not flossing. Flossing
requires rubbing firmly against the roots of the teeth below the gums. The following
sites have videos on proper flossing technique:
Irrigation ("Waterpik"): We recommend using either a counter top irrigator or a shower irrigator
(both are available from us). The shower irrigator attaches between your
shower head and the pipe in the wall. Shower irrigators are more
convenient to use but you can only irrigate with water (although irrigating
with just water is effective). Counter top irrigators allow you to use
solutions other than water. Solutions alternatives for counter top irrigators
- Use what you want. Just check with manufacturer to make sure
it won’t damage the irrigator.
- Baking soda: Fill the reservoir of the irrigator with water. Leave
some room on the top. Dissolve 2 teaspoons of
baking soda in a cup of water then pour the solution
into the water in the reservoir.
- For patients with more advanced periodontitis (gum and bone
infection), we will recommend more powerful disinfectants such
as Therasol until the infection is reduced. To use the proper
concentration of Therasol, fill the reservoir of the irrigator with
water and leave some room on top. Then deliver 4 pumps of
Therasol into the reservoir.
If you use a counter top irrigator we recommend the “Hydro-Floss” irrigator
(available from us or online).
Proper Irrigation Technique:
When using the counter- top irrigator you must bend down with your head
over the sink to irrigate. Obviously this is not necessary with the shower
irrigator. Otherwise, the rest of the technique is the same. Start on the
back surface of the upper left or upper right back tooth. Have the irrigator
tip lightly touching the gum tissue. With the tip touching the gum tissue,
follow the surface of the gum tissue at the neck of each tooth. Make sure
the tip is aimed into the gum pocket at the neck of the teeth. Do the outside
(cheek side) of all the teeth upper teeth, then move to the inside (tongue side)
and continue irrigating all the upper teeth. Repeat for the lower teeth. You
will not damage your teeth or gums with this technique. To avoid a tickling
sensation when irrigating keep the irrigator tip touching the gum tissue. If
you lift the tip off the gum tissue, it will tickle the tissue of the palate
(especially with the shower irrigator which has a continuous (non- pumping)
Snacking: Snacking between meals (and therefore ideally between brushing your teeth) is going to
cause more dental disease. Snacking on "junk food" is worse than snacking on healthy
food. However, healthy foods still contain sugars and carbohydrates that the bacteria in
your mouth can metabalize. Unless you are going to brush after every snack as well as
every meal (not realistic for most of us), you need to stop snacking.
(A BIG PROBLEM)
Basic tooth and gum anatomy: The following picture shows basic tooth anatomy.
The following picture shows healthy gum anatomy.
Gingiva is the hard and tight gum tissue that wraps around the teeth (see above picture).
Most gingiva is attached gingiva. Attached gingiva is attached to the bone under it.
There is a narrow band of un-attached gingiva closest to the crown of the tooth. This is
called marginal gingiva. Mucosa is the soft and loose gum tissue that is present further
from the crown of the teeth. Gingiva is strong tissue that can best resist mechanical wear
and trauma and bacterial infection. Mucosa is weaker tissue that cannot withstand
mechanical stress and bacterial infection. A healthy situation for a tooth is to have a
thick band of gingiva around the crown of the tooth and mucosa after that.
Toothbrush recession: Gum recession occurs when the gingiva on the neck of the tooth "shrinks"
away from the crown of the tooth and exposes the root.
Gum recession is not caused by bacterial infection. Gum recession is caused by toothbrushing.
More specifically, it is caused by the type of toothbrush bristle used (not thetechnique of
brushing). Brushing with toothbrush bristles that are too thick ("hard" or "medium" britsles)
and bristles with incorrect tips will cause recession. A toothbrush that does not cause recession
requires the following:
1) Thin (soft) bristles
2) Rounded and polished bristle tips
Microscopic view of a rounded and polished bristle tip (magnification = 200x)
Microscopic view of a non-rounded and unpolished bristle tip (magnification = 200x)
Unfortunately, most toothbrushes with soft bristles do not have rounded and polished tips. The
"Sensitive" toothbrush head of the BraunOral-B Professional series powered toothbrush has
rounded and polished bristle tips. Non-rounded and polished tips cut the gum tissue on a
microscopic level. The microscopic blood vessels in the gum tissue are worn away which
compromises the circulation which eventually causes the tissue to "die-off" and shrink
away from the tooth. In addition,the blood vessels in the gum tissue supplies the blood
circulation to the bone it is covering. So as the gum shrinks away, the bone also looses
circulation and "dies-off" and recedes as well.
Note: Powered toothbrushes are not more likely to cause gum recession.
(Remember, it is the bristles not the brush.)
Toothbrush recession makes the tooth more vulnerable to bone loss caused by bacterial infection
This pictures shows a tooth with gum recession. The arrow points to a very narrow band
of gingiva that remains. When the band gets narrow enough, only un-attached gingiva
remains. Unattached gingiva is also called marginal gingiva. Without attached gingiva,
bacteria can easily penetrate below the gum and cause periodontitis (a serious bacterial
This picture shows a narrow band of gingiva. The probe extends through the gingiva into
the mucosa. Only un-attached gingiva or marginal gingigva remains. Bacteria can now
easily penetrate below the gum line and cause periodontitis.
Other problems associated with toothbrush recession: The root surface is much softer and more
porous than the enamel surface covering the crown of a tooth. The root surface is therefore much
more vunerable to sensitivity. pain.and tooth decay.
Advance decay on root of tooth. The root of a tooth is more prone
to decay than the crown of the tooth.
Toothpaste abrasion: Toothbrush recession also makes a tooth more vulnerable to wear or
"abrasion". Abrasionoccurs on the root surface of the tooth. Abrasion appears as an indentation
or "cupping" on the root surface.
Toothpaste abrasion on the root.
Abrasion is caused by the abrasive particles in toothpaste. The particles will literally "sand away"
the root surface. Regular toothpaste is too abrasive. Use mouthwash or a low-abrasion toothpaste
with an RDA valueof 40 or less. RDA stands for Relative Dentin Abrasivity. Contact the manufacturer
of your toothpaste to getthe RDA value of their product. Here is another way to determine if your
toothpaste is too abrasive. Put a little toothpaste between your upper and lower front teeth and lightly
grind the teeth together. If you can feel any grit between your teeth then the toothpaste is too abrasive.
Note: Toothpaste abrasion can occur without gum recession. I
occasionally see patients with no gum recession but
when I examine under the gum tissue, I will find
abrasion. This type of patient is brushing their teeth with
the correct type of bristles but is using toothpaste that is
Here are some non-abrasive tooth paste alternatives:
- Tooth and Gum Tonic by the Dental Herb Company
(available from us).
- Any mouthwash you want.
- Any toothpaste with an RDA value of 40 or below.
- Any tooth paste that passes the “grit test” (above)
- Baking soda properly mixed with water (see below).
Baking soda: Depending on how baking soda is used it can be very abrasive
or minimally abrasive. Baking soda used dry is very abrasive.
If properly mixed with water first it is minimally abrasive. Water
dissolves the crystals and makes them smaller so they are less
abrasive. The proper mix is 3 parts water to 1 part baking soda.
This will make a minimally abrasive paste that you can brush with.
Note: Desensitizing toothpastes will just cover up the symptoms
(pain) from abrasion. Desensitizing toothpaste will continue
to wear away tooth structure.
Note: Whitening toothpastes are very abrasive and will accelerate
Fortunately, toothbrush recessiong (along with the toothpaste abrasion and decay often associated
with it) can usually be treated by doing minimaly invasive surgical procedures. These treatment will
recover the exposed root surfaces. As long as the patient uses the correct type of toothbrush bristles,
the results of the treatment should be permanent.
The before picture (top) showing toothbrush recession, toothpaste abrasion and decay.
The after picture (bottom) showing complete root coverage after surgery.
(a major health problem)
Periodontal disease is caused by bacterial infection (plaque) on the root surface of the teeth that can
cause inflammation of the gum tissue only (gingivitis) or inflammation of the ligament and bone
around the tooth (periodontitis). Periodontitis can severely compromise your health as you age.
Periodontitis causes systemic disease