Daryl E. Malena DDS
  Periodontics
10838 Old Mill Road
Omaha, Nebraska 68154
402 330 4100

Failure to brush and floss properly accounts for most of the gingivitis and periodontitis cases that we see, and effective oral hygiene is necessary to successfully treat the disease.  Fortunately it is not that difficult to keep your teeth clean. Because it takes three days for the first signs of gingivitis to develop (as measured by the first appearance of white blood cells concentrating under the gingiva next to the plaque) you don't even have to be perfect every day... but once you start doing it right it is easy to get good at perfect brushing and flossing.

First, use a soft tooth brush.  When the bristles are about .007 inch in diameter they will bend around the corner and about 3mm down into the gingival sulcus where the diseases start--without harming your gums.  Be reminded that if you have been using a harder brush, soft brushes don't feel like they clean as well unless you are using them correctly by squeezing them against the tooth and letting the bristles reach under the gums. Brush in circles about the size of the teeth and think about brushing one tooth at a time.  Don't neglect the inside surfaces.  In fact, start on the inside and finish on the outside surfaces. In that way you will get the hard parts clean before you start thinking about other things!

Second, find a way to clean between your teeth because that is where the disease tends to start. Floss does a good job, but it is hard to get into the habit.  Be sure to use a piece at least 18 inches long and reach to the bottom of the sulcus on both teeth after you slide through the tight spot where the teeth make contact.  Don't forget to floss behind the last tooth in each corner.

Note that most of our patients have spaces large enough for floss to be inefficient at cleaning.  For those patients we suggest interproximal brushes.  Most of these look like half-inch Christmas trees.  Butler Proxibrush is our favorite brand.

Plaque needs to be removed mechanically, so the toothpaste you use is far less important than the ads suggest.  All toothpaste contains a light abrasive of some sort to remove stains, a detergent to help clean, a flavor and some other ingredients.  Then there are additives that have some useful effects: fluoride reduces cavies, sodium pyrophosphate blocks calculus (tartar) formation, potassium nitrate plugs the tubules and stops sensitivity and peroxides are whiteners.  Take your pick, but don't use an antitartar toothpaste if you have sensitive teeth--it can make them more sensitive.

Here are some links that might help:
http://www.ada.org/prof/pubs/jada/p-page/p-page1.pdf
http://www.ada.org/public/faq/cleaning.html

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