An observation I've made after many years of practicing dentistry, is that every patient I've ever treated for periodontal disease or tooth decay has always brushed their teeth. They've been doing it since they were children and continue to do so right until the time I meet them. The idea of brushing your teeth as a way to keep your mouth healthy goes back eons. Primitive man used to use little straw sticks to clean between their teeth before toothbrushes were invented and this has morphed into every conceivable device both manual and electronic to "brush your teeth".
Yet despite this mantra to "brush your teeth", dental disease proceeds for many people unabated. More than 50% of adults have periodontal disease and they all brush their teeth.

After you have your teeth cleaned where the hygienist removes any tartar (hardened bacteria) and any plaque (a soft bacterial biofilm on your teeth), you leave the office with no bacterial plaque on your teeth. Bacterial plaque is the sticky film at the gum line between your teeth ladened with bacteria that causes gum disease and tooth decay. You leave with no plaque on your teeth and within hours, a sticky film produced by your saliva called an acquired pellicle, begins to adhere to the enamel and root surface of your teeth. Within 12 hours, bacteria are now embedding into that sticky film and beginning the disease process. If that bacterial film or plaque is not removed every 12 hours or thereabouts, it begins to thicken and become more difficult to remove and then at that point, has the possibility of beginning to irritate the gum tissue.

The acquired pellicle (sticky film) and the bacteria that adhere to it create something called plaque. That plaque forms independent of food. Thus if you're in a hospital getting fed intravenously, plaque is forming on your teeth, actually slightly more rapidly than if you were eating because the detergent action of food can be somewhat dislodging to certain plaque even more rapidly than if you ate. Yes, food does not contribute to the formation of plaque. Food, particularly sugar, is necessary to get decay because that sugar in the food will be digested by the plaque bacteria producing acids which cause the cavities. But importantly, the plaque is independent of the food you eat. Most of us brush our teeth to remove food particles and that's where the problem begins.

Since we know that plaque begins to form within 12 hours of it all being removed from our teeth at a dental visit, what should we be doing in between visits? What is your role in preventing the reforming of this plaque?
Given that, I've come up with a different paradigm .

What we're trying to do is deplaque our teeth (remove all bacteria) at the gumline and between our teeth every 12 hours. As long as we deplaque the teeth every 12 hours, it never gets thick enough to accumulate enough bacteria that can begin this cycle of inflammation of the gum and ultimately periodontal disease.

The reason we have continued inflammation, bleeding, and in some cases bone loss despite "brushing our teeth" regularly is that one is not completely removing the plaque from the areas where it begins to accumulate which is between the teeth, at the gumline and slightly under the gumline.

So if you don't completely deplaque your teeth every time you clean and you do leave residues of plaque, that plaque continues to thicken, you continue to miss those areas and the process goes on and on and on and on. At that point, you arrive at the dental office, the hygienist or I say "show me how you're brushing your teeth", your gums are bleeding and you say "but I do exactly what you tell me". And I say "Yes, you do but you are not effective in completely "deplaquing your teeth". Thus the concept of deplaquing is going to replace "brushing your teeth" as what you're trying to accomplish.

You know from previous correspondence that I favor using a Radius toothbrush and a WaterPik but irrespective of what you do to deplaque your mouth, it is the daily effectiveness that makes all the difference. Our staff is committed and has been committed for my entire career to teaching our patients how to deplaque effectively. This change of language is important so that we all understand what we're trying to accomplish. Knowing what you need to do and what we need to teach will make us more effective in eliminating plaque and preserving dental health.

If you have questions about any of this, please feel free to contact my office by email or phone or discuss with me or the hygienists when you come into the office.

Once again, as always, we always appreciate your viewpoint.

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

Us News and Report coincidentally had an article in their issue today, March 20, on the very topic called "Health Tip:Am I at Risk for Gum Disease?" and listed the common factors click here to read it. However, I don't think it went far enough to keep the public adequately informed.

Are you at Risk?

Aggressive peridontitis can affect young people who are otherwise healthy. Localized aggressive periodontitis is found in teenagers and young adults and mainly affects the first molars and incisors. It is characterized by the severe loss of alveolar bone, and ironically, patients generally form very little dental plaque or calculus. Certain systemic conditions such as Type 1 diabetes, Downs syndrome, Kindler syndrome and Papillon-Lefevre syndrome make young adults more susceptible. Chronic gingivitis is common in children. Evidence shows that periodontal disease may increase during adolescence due to lack of motivation to practice oral hygiene. Hormonal changes related to puberty can put teens at greater risk for getting periodontal disease. During puberty, an increased level of sex hormones, such as progesterone and possibly estrogen, cause increased blood circulation to the gums. This may cause an increase in the gum's sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. Every one of us is at risk for gum disease if we don't perform the following on a daily basis:

• Brushing your teeth, gums and tongue, rinsing and flossing
  

That may seem quite obvious and simple enough but many people need reinforcement to develop goods habits.

The Art of Flossing

Use a floss that does not shred or break. Avoid a very thin floss, which can cut the gum if brought down with too much force or not guided along the side of the tooth. Break off about 18 inches of floss and wind most of it around the middle finger of one hand and the rest around the middle finger. Hold the floss between the thumbs and forefingers and gently guide and rub it back and forth between the teeth. If this challenging, electronic products, such as water piks, are also helpful.

Early diagnosis is important for successful treatment of periodontal diseases. It is important that children receive a periodontal exam as part of their routine dental visits. Be aware that if a child has an advanced form of periodontal disease, this may be an early sign of systemic disease. A general medical evaluation should be considered for children who exhibit severe periodontitis, especially if it appears resistant to therapy.

Researchers suggest periodontal disease can pass through saliva. This means that the common contact of saliva in families may put children and couples at risk for contracting the periodontal disease of another family member. If one family member has periodontal disease, all family members should see a dental professional for a periodontal evaluation.

Please feel free to discuss with me.

Click here to contact me

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.