Having a healthy mouth and saving your teeth all begins with prevention.
1) Why Tooth Brushing is Misleading
An observation after many years of practicing dentistry, is that every patient I've ever treated for periodontal disease or having excessive 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.
First let's look at the science. After you have your teeth cleaned in which the hygienist removes any tartar, which is hardened bacteria, and any plaque or stain on your teeth, you leave the office with no bacterial plaque on your teeth, bacterial plaque being 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 a mucoprotein, 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.
This sticky film called a pellicle 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 is 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.
For the last nine months, I elected to do a little experiment on myself. Just to give you historical background, my father lost all his teeth at age 26 and my mom had only 12 teeth by the time she was 40 years of age. I had multiple cavities starting at the age of 10 and by the time I got to dental school, I needed all of my back teeth capped because of the amount of decay I had experienced as a child. Over the next number of years, the caps were changed twice. I've had a couple of root canals done and two of the teeth eventually fractured and were replaced by implants. My history has been to form plaque rapidly which was something that occurred thanks to the genetics I inherited. Over the years, I have been developing different techniques to keep my mouth free of plaque and have been able to retain all of my natural teeth with good oral hygiene except for the two that fractured.
However, that being said, I decided to do a little experiment to see whether the WaterPik used on high pressure twice a day would be efficacious in lieu of cleaning between the teeth with a toothbrush, floss or tooth pick
Well, the results are in. The hygienist cleaned my teeth this past Thursday and there was not a speck of plaque, no bleeding, and no inflammation. She was amazed because at my prior visit, I had more debris despite my efforts with a daily tooth pick.
I've now observed a number of my patients who I have been placing on a WaterPik twice a day and I've seen a marked improvement in their oral hygiene.
The reason a WaterPik works but only when used twice a day, is because the plaque, the sticky film that forms on your teeth from your saliva, for many patients begins to form within 8-12 hours of having a professional teeth cleaning or you cleaning them completely yourself. If you don't disturb that plaque film every 8-12 hours, the film gets thick enough to start irritating the gums. Multiply that by 365 days and you have plaque on your teeth for half of that time causing the decay and inflammation that we see on a regular basis. This happens independent of food. Eating does not cause plaque development any more or less. Food does provide a substrate in the form of sugar to help cause decay but it does not cause plaque and does not cause periodontal disease.
In addition, I have been using a Radius toothbrush which I have mentioned to many of my colleagues, hygienists and patients. I found this to be a wonderful device that enables me to brush my teeth more efficaciously and quickly. It takes me a little over three minutes in the morning to brush and WaterPik and the same in the evening.
The results have been more than outstanding and I would urge all of you to consider this as a daily regimen.
As I've discussed many times, preventing disease is a lot easier than treating it.
3) Radius Toothbrush
For those of you who have been in our practice for awhile, you know that over the years we have been stressing repeatedly the importance of appropriate oral hygiene; the foundation of which is the use and abuse of the toothbrush.
During my career, I have used many toothbrushes personally and shared my experiences with my patients. In addition, we have encouraged our patients to purchase and use electric brushes with the Sonicare being the one I favor the most.
However, I have recently come in contact with a brush I have been using for the last three months called the RADIUS Toothbrush. At first sight, it looks more like a hair brush since its head is about three times the size of a normal brush and the handle is very unusual but basically those are the only differences.
After using this brush for three months, I have found it to be the single, most effective toothbrush I have ever used personally. The size of the head makes it easy to brush both the upper and lower front teeth with your teeth together at the same time making your brushing more effective as well as shortening the time to effectively brush your teeth. Also, the length of this brush allows you to brush the inside of the upper teeth and on the tongue side where the inside of the lower teeth have to be reached. These areas are often difficult to reach with a regular toothbrush or even an electric toothbrush.
I encourage everyone to try the RADIUS Toothbrush since my experience has been so overwhelmingly positive. After three months, the brush is still working very effectively. The company claims that it lasts nine months. Although as you are well aware, I recommend that brushes be replaced probably every 3-4 months since the bristles begin to fray. But you can determine this for yourself.
Here is a photograph of the brush:
It can be ordered online at www.radiustoothbrush.com or many online retail sites. Just search on RADIUS toothbrush and many options will be available. It can also be found in a number of retail locations such as Bed, Bath & Beyond, Whole Foods, The Vitamin Shoppe, Duane Reade just to name a few
207 Railroad Street
Kutztown, PA 19530
toll free - 800 626-6223 x.105
business - 610 683-9400 x.105
fax - 610 683-9433
We will have some of these brushes available in the office if you would like to try one.