Tactical Oral Hygiene
Orthodontists have always been blamed for the demise of proper oral hygiene efficiency once the braces have been placed.
And to some degree, the blame is well-earned, with the various paraphernalia that are attached to the individual tooth. Not to mention that all the teeth are strung together! Yes, this does produce a formidable barrier to brushing and flossing. However, as I have moved more and more toward Invisalign, my desire for a cleaner system is becoming a reality. In fact, this was one of the driving forces in my decision to use this type of a tooth-moving system for my patients. But some of my Invisalign patients have proven that the lack of desire or ability to work a toothbrush and floss is more the issue than the type of tooth-moving system.
This buildup of plaque on and between the teeth and the orthodontic appliance leads to gingivitis and tooth decay (along with various degrees of white pre-carious spotting) after the orthodontic appliances have been removed.
If you would be so kind as to let me give you a very brief biological description of how tooth decay, gum inflammation, and gingivitis are produced, the term tactical in the title will be poignantly understood!
Only one bacteria can break down a tooth’s enamel by consuming sucrose, sugar, and creating a calcium dissolving acid as a by-product. That bacteria is Streptococcus mutans and is commonly found in everyone’s healthy mouth. Gingivitis is formed by this and potentially several other bacteria, as is periodontal disease. Decay and gingivitis are formed when this acid stays in contact with both tissues for an extended period of time.
Enter plaque into the equation. Plaque is a sticky, micro-protein that adheres to teeth and gums and provides a condominium for Strep mutans, serving as a catch basin for the bacteria’s acid production.
Tooth decay and gingivitis can be prevented by removing the bacterial condominiums (plaque) as quickly and efficiently as possible. We, therefore, need a strategy… an attack plan… an expedient technique to attack the plaque and eradicate it. Check your Webster’s definition of tactical... hmmm... spot on! Let’s look at the latest armamentarium for this plaque attack.
I will not belabor the fact that the time-honored gold standard of oral hygiene is as follows:
Brush the front and back of each tooth in both arches for 2 ½ minutes (children, 3 times a day; adults, twice a day). I feel the tomatoes being thrown as to why adults should not brush 3 to 4 times a day?! Over the years, I have seen a lot of gum tissue permanently removed by over-brushing in individuals over 21 years of age. Suffice it to say, take it up with your dentist if you have specific needs that mandate more than two times a day.
Once done brushing, I’ve always recommended leaving the remaining toothpaste in the mouth (don’t spit) and floss between each tooth. My theory is that the floss will drag microscopic amounts of fluoride down between the number one decay spot on a tooth - its contact point with the adjacent tooth.
If we could leave oral hygiene at the brush-and-floss level, there would be no reason for my writing this week’s blog. But my concern is that, due to our busy lifestyles, alternative equipment has been introduced to streamline and reduce our time involved in oral hygiene… not always for the better. Let’s look at some products available today:
Teledyne introduced the first water pik nearly 40 years ago. You filled a reservoir with water or mouthwash and held the hand piece with a small hose from the reservoir and, like a mini firehose, you cleaned your teeth for 3-4 minutes. Eventually, it was deemed a great gum stimulator; but a lot of plaque was left behind due to its tenacious attachment to enamel.
I’ve always recommended brushing, flossing, and then water-pikking… but now we are up to 6 minutes, two times a day!
Over the last couple of years, water sprays and electric toothbrushes have been combined for a very effective, time-saving approach to plaque removal. In fact, this year we are looking at a portable machine called the Fusion, which combines a water spray and a rotating electric toothbrush. This device, I feel, will be ideal for orthodontic patients (as well as the rest of us) for aggressive plaque removal and gum stimulation.
In order to thoroughly clean between the teeth, remember the contact point - flossing is still necessary!
While we are on the subject of flossing, have you tried floss forks or G.U.M.’s pro flossers? These are amazing! I can floss when walking the dog, when stuck in traffic, or even when going over my e-mails on the computer (one-handed, of course).
If flossing is now so easy and convenient, why was the portable oral irrigator - hydro floss (also called Water Flosser) - introduced this year? A little more investigating and I found these hydro machines narrowed the jet spray and upped the pressure to nearly 110 psi in some models. That can darn near take tar off a bumper! But no matter how much pressure you generate, you still will not clean the contact point between the teeth. What you will do is remove gum tissue, especially the soft papillae between the teeth.
The concern of gum specialists with whom I have spoken is that, with this kind of pressure, you can actually deepen the periodontal pockets around the tooth and jam plaque deeper into the tooth’s sulcus. Once deep into the pocket (greater than 5mm), only a professional can remove it. Alternatively, it sits there and becomes dinner for a myriad of gum disease-producing bacteria.
So please, before you run out to buy the next Greatest Floss Invention and destroy your gums, seek the advice of your family dentist!
Sending you into your weekend with floss-for-thought.
Have a great weekend Medina County. Get out and enjoy our state. And support local!
- Dr. Pfister