141 North State Road #2; Briarcliff Manor, NY (914) 762-1885
Dr. Victor Sternberg: Westchester Center for Periodontal and Implant Excellence
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We strive to keep our patients and friends up to date with 
the most recent news regarding dentistry, including special news and announcements. You are encouraged to review our journal below.  You never know what you will learn!

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ODE TO THE TOOTHBRUSH - ITS USE AND ABUSE

5/19/2017

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As a young periodontal graduate student four decades ago, I was introduced to Dr. Leonard Hirschfeld.  His father Isador was  the first periodontist;  before we had a formal specialty, he limited his practice to treating periodontal disease.  His practice began in 1919.  In 1935 he wrote a book called The Use and Abuse of the Toothbrush.  It's interesting how so little has changed.  
 
Every patient who comes to my practice, in fact every patient that I've ever met, brushes their teeth except for one.  A sergeant in the Army when I was a Captain in the Dental Corp stopped brushing his teeth in 1945.  His front tooth was chipped in the battle of Iwo Jima and I met him 30 years later.  He had not brushed his teeth for nearly 3 decades.  He was the only exception.
 
So what is this about tooth brushing and the fact that everybody who has had tooth decay and periodontal disease brushes their teeth.  It is that it is not just the act of brushing one's teeth or what kind of brush one uses but rather how effective one is in removing bacterial plaque.   
 
In my earlier correspondence, I indicated that bacterial plaque forms on the teeth within 12 hours.  That's why we suggest WaterPiking on a twice-a-day basis.  Similarly, plaque that forms at the gumline also forms within 12 hours and therefore effective toothbrushing is intended to do the same thing a WaterPik does; in this case remove the bacteria at the gumline.  However, as I mentioned earlier, it does not effectively remove the bacteria between your teeth.
 
That being said, it is learning how to use a brush effectively and how much time is spent which are critical to the outcome.    
 
I did a little study on myself to see how long it took me to effectively brush the gumline of all my teeth of which there are 28.  Using a stopwatch, I noted that it took me approximately 2 minutes to brush every surface of every tooth.  I observed how many strokes per minute I generated as I brushed 2-3 teeth at a time.  Just as an aside, I use a Radius manual toothbrush (a large toothbrush).  I gave up my electric brush and other brushes because I found the Radius reached the gumline more effectively than any other brush and because of its large size, it covers more teeth at one time.  By generating 170 strokes per minute which means rapidly brushing and doing it in a rigorous manner, I was able to accelerate the process so that it took under 2 minutes.  I was careful to hold the brush in one spot starting on the upper right, on the inside (palate) side and work my way around to the upper left side in the palate.  I then repeated the process on the lower left on the inside and working around to the lower right.  These surfaces on the inside of the mouth are often the ones that are missed by most of us for reasons I will address later.
 
Once I finished brushing the inside of all my teeth, I brushed the outside (cheek-side) in a similar fashion beginning on one side and worked my way around.   
 
I'm committed to using the WaterPik twice a day and along with this method of brushing has rendered me plaque-free for years and I must reiterate that I came from a family where there 12 teeth possessed between both of my parents and one parent had all 12.   
 
Points to Consider:
 
1) The key is to keep the brush at the gumline, not at the top of the tooth but at the junction of the tooth and the gum tissue.  That is where plaque first forms.
 
2) For some individuals, it's just a matter of mastering their technique and knowing exactly and explicitly where to place the bristles of the brush.   Time is important.  Brushing 2-3 teeth at a time and keeping the bristles there for 15 strokes and rigorously brushing is necessary.

 3) The brushing technique should be a scrub technique; something that was abandoned years ago because the bristles were much firmer and could cause recession.  The newer brushes have softer bristles that will not cause gum recession but can effectively remove plaque if used with a very rapid scrub technique.
 
4) Electric brushes are often necessary for individuals and preferred by many.  Again, the bristles must be kept at the gumline; and in my case for a count of 10 before you move on, covering 2 teeth at a time.  I want to reiterate that the biggest failure of the electric brush is that is that it is being moved as it's being used instead of staying in place.  It only works when it's standing still.  It is not a brush.
 
The key point is that the brush must be kept on the gumline on the inside of the upper and lower teeth; the areas that are often missed.
 
5) Finally, for many patients, gagging can be an issue when they brush the inside of their lower teeth or the palatal surfaces of the upper teeth.  In the lower, if you relax your tongue so that it doesn't push against the bristles as you move the brush up to the top of the teeth, you will be more effective.  Just be aware that for many of us, we have to fight with the tongue so instead of fighting with it, relax and let it just be passive and you'll have an easier time reaching the gumline.   
 
The palate is also an area that triggers gagging.  If you breathe through your nose while you brush your teeth, it may eliminate some of this but be aware that you must consciously relax particularly your tongue as you do this.
 
Summary:
 
1) It's not the brush; it's the brusher and the technique!
 
2) Time matters.  It takes me just under 2 minutes doing this very rapid brushing.  It may take you more time but a minimum of 2 minutes is required by most of us.
 
3) Changing brushes regularly is necessary.  I prefer the Radius toothbrush, the large oval brush, because it reaches the gumline more readily.  In any event, brushes wear out if they are used twice a day within 3-4 months and for some of you, sooner.  They are disposable unlike teeth.
 
4. For some individuals, dexterity is an issue.  Electric brushes can be preferable.
 
5. Finally, this is a skill like any other.  It often requires a great deal of reinforcement and instruction.  Please let us help you master this; if you do, it can make a great difference in the survival of your teeth in a state of health.
 
As usual, I appreciate your comments.

Yours truly,
Victor M. Sternberg, D.M.D.


Dental Office of:
Victor M. Sternberg, D.M.D., PC
Westchester Center of Periodontal and Implant Excellence
141 North State Road
Briarcliff Manor, NY 10510
EMAIL: officesternberg@verizon.net
WEBSITE: www.DrSaveMyTeeth.com
Office: 914-762-1885
Fax: 914-762-1880

odetothetoothbrush.pdf
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Changing Toothbrushes!

12/17/2011

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Picture
Changing toothbrushes, whether it is the head of an electric Sonicare brush or a manual toothbrush, is vitally important. The effectiveness of the brush is directly dependent upon the firmness of the bristles. As the bristles become softer, frayed, and bent, they are unable to penetrate between the teeth or under the gumline.


As a rule, we change the heads of the sonicare brushes every three months and discard our manual brushes every month. If you rigorously brush with a manual brush twice a day, the bristles should begin to deteriorate in about one month. Irrespective of which brush you use, even though I have found that the sonicare is more effective than a manual brush, it is essential that the focus of tooth cleaning and plaque removal be directed at the gumline and between the teeth. These are the areas where the bacteria accumulate first.

Almost all periodontal disease and dental decay begins between the teeth and at the gumline. Brushing alone, no matter how effective, can only remove 80-90% of the bacteria that accumulate. Additional devices such as floss, toothpicks, where accessible, and a water irrigator are necessary. These devices, when used in conjunction with careful brushing, can remove up to 90-95% of the bacteria rendering the mouth healthy enough to be maintained for a long period of time.


If you are not comfortable or clear on how to use the different devices, please share the information with our staff. We will be more than happy to help you master this vital technique.

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Dental Care You Can Do At Home

11/5/2011

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Using a water pik 2 times per day with warm water and full force has made a difference in removing loose plaque. Using it twice a day AM and PM has resulted in patients with significantly healthier mouths.

A second tip is the use of a Sonicare electric toothbrush. It is important to brush as to understand it is a cleaning machine. One must hold the brush still, count to ten and then move it to the next two teeth. Utilizing it in this way and holding it on the gum tissue will make a big difference in removing plaque. When you are in for your visit ask us to demonstrate if need be.

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    Staff

    From the desk of...
    Dr. Victor Sternberg

    This is a series of regular postings focusing on preventing disease and maintaining good health.  I will share information available through professional journals as well as my own personal experiences and those of my patients.

    When you are in our office our time communicating to you is focused on your treatment and visit. We have much to share with our patients that we feel is valuable for continued health and wellness.


    I hope you find this page informative and helpful. We look forward to having additional dialogue with you electronically and in person!  All the best!

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Dr. Victor Sternberg:
Westchester Center for Periodontal & Implant Excellence
141 North State Road #2
Briarcliff Manor, NY 10510
TEL: (914) 762-1885
FAX: (914) 762-1880

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