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Patient Education
Brushing Instructions
Proper brushing is essential for cleaning teeth and gums effectively. Use a toothbrush with soft, nylon, round-ended bristles that will not scratch/abrade teeth or irritate/damage the gums. Place bristles along the gumline at a 45-degree angle. Bristles should contact both the tooth surface and the gumline. Gently vibrate the bristles into the gum and then roll the toothbrush toward the chewing surface. This should be done three times and then moved up to the next set of teeth. This method cleans 2-3 teeth at once. You should start at the back, top or bottom and work your way from one end of the arch to the other. Do the outside, inside and then the chewing surface. For the front teeth it may be easier to tilt the brush vertically.
Remember to replace your toothbrush every three to four months. Researchers have established that thousands of microbes grow on toothbrush bristles and handles. Most are harmless, but others can be cold or flu viruses, the herpes virus that can cause cold sores and also bacteria that can cause periodontal infections.
Brushing should ideally be done two times a day, in the morning after breakfast and in the evening before bed. Use only a soft tooth brush!!! Toothpaste should be ADA approved and should contain Fluoride (unless it is being used on a child that can't spit out yet). The idea of brushing your teeth is not to scrub them but to gently remove the plaque (soft debris) and food particles.
Electric Toothbrushes
Electric toothbrushes are highly recommended by dental professionals. Overall, they have proven to remove plaque and massage the gum better than manual toothbrushes. There are many types of electric toothbrushes and your dental hygienist can discuss with you which they feel is the correct one for your situation. Not all electric toothbrushes are created equal.
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Flossing Instructions
It's a fact. Flossing daily (combined with brushing and a rinse) helps protect against gingivitis by removing plaque and food particles, keeping your teeth and gums healthy, while giving you a beautiful smile. Flossing removes plaque from between the teeth and at the gumline where periodontal disease usually begins.
Wind an 18 inch piece of floss around both index fingers leaving 1-2 inches in between. Start where you are most comfortable. Gently slide the floss between the teeth taking care not to snap it down on the gum. Once the floss is below the contact, curve the floss slightly around one side of the tooth. Slide the floss up and down below the gumline. Curve the floss around the other side of the tooth and repeat. Make sure you floss between all the teeth, especially the back teeth where periodontal disease usually develops first.
If you find flossing awkward there are many floss holders and interdental cleaners available as an alternative.
One in eight adults has some form of gum disease. Gum disease can start at a very early age; it is not limited to the elderly. It can be prevented. Starting early with a comprehensive home care routine that includes brushing, flossing and rinsing can help prevent problem from starting.
If you did not floss regularly before, you may experience bleeding and sore gums at first, but this will stop after a regular routine has been established. If bleeding continues after the first week of flossing consistently call your dentist.
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Mouthwash
Many patients ask about mouth rinse. Mouth rinse or mouth wash can be a great adjunct to your home care protocol. Mouth rinses are never a replacement for brushing and flossing. There are many types of mouth rinses available over the counter and they provide different benefits. The most desired effect is breath freshening. There are rinses that provide breath freshening alone, such as Scope, and there are rinses that provide additional benefits.
Antibacterial rinses come in alcoholic and non-alcoholic options. Listerine is an alcoholic option that provides antibacterial properties with essential oils. Listerine also has tartar control and fluoride rinse products.
There are also non-alcoholic options. Crest Pro-health and Breath Rx are examples of non-alcoholic antibacterial rinses. They contain chemicals that kill bacteria and freshen the breath.
Fluoride rinses provide extra protection from cavities. Fluoride also contains antibacterial properties. There are many over the counter mouthrinses that contain fluoride. Your dental hygienist can go over these with you. Fluoride rinses benefit children as well as adults. It is important to rinse with fluoride for at least 30 seconds and not eat, drink or rinse out for half an hour afterwards (before bedtime is ideal).
Occasionally the doctor will prescribe a specific rinse for a special problem. Chlorhexidine is a prescription antibacterial rinse that helps with inflamed gingiva. It is also used as a pre or post treatment rinse for oral surgery and other dental procedures. Prescription fluoride rinse is also antibacterial but can help to strengthen teeth to prevent cavities. Fluoride also helps with sensitivity. A fluoride rinse is often prescribed with other treatments as a cavity prevention protocol in cavity prone patients.
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Fluoride
Fluoride has many benefits for both children and adults. Most of these benefits have been known for over 3/4 of a century. These benefits are strengthening the enamel by surface application or better yet by incorporating the fluoride ion in the enamel structure by ingestion, decreasing sensitivity and antimicrobial action.
The most common source of fluoride for the general population is fluoride tooth paste. This is a topical application which will decrease the incidence of decay. All toothpastes do not contain fluoride.
Fluoride has been added to many local water supplies. It is important for parents to speak to their supplier to know whether they have fluoridated water. New York City has fluoridated water, Rockland and Orange Counties do not. Bottled water which is widely used does not have fluoride. Your dentist or pediatrician can prescribe fluoride drops or chewables with or without vitamins for children starting by age 6 months in non fluoridated locations.
Many adults have teeth that are sensitive to hot or cold temperature changes. Often this is due to gum recession that occurs from periodontal disease, overzealous tooth brushing or naturally with age. The root of the tooth that is softer and more sensitive is exposed as the gum recedes. Fluoride helps cover the root surface to decrease the problem. The added benefit of using fluoride for this situation is that it also decreases the probability of getting cavities.
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Children and Fluoride
Children often have poor brushing habits. They forget to brush after breakfast or before bed and when they do they often do a poor job. Braces also add an extra burden of keeping the teeth clean and often children will develop gingivitis or white spots under the brackets. The use of fluoride can counter these effects and help the child remain cavity free.
Dental Sealants
Dental sealants, a plastic that is bonded to the teeth, acts as a barrier, protecting the teeth against decay-causing bacteria. The sealants are usually applied to the chewing surfaces of the back teeth (premolars and molars) where decay most often occurs.
Gingivitis
Gingivitis is inflammation of the gums. It is the earliest and most common form of gum disease and it can lead to bigger problems if it is not addressed. Gingivitis is the only reversible form of gum disease.
Gingivitis is caused by plaque build up around the gums and between the teeth. Plaque is a naturally occurring bacteria in the mouth but it needs to be removed daily and adequately. Plaque leads to gingivitis, as well as bad breath and tooth decay. The symptoms of gingivitis are bleeding, tender swollen gums and bad breath.
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Periodontal Disease
Periodontal disease is an infection that causes the breakdown of the supporting structures of the teeth. Teeth are held in to a socket by bone and tissue. There is a small space between the gum and the tooth known as the sulcus. The sulcus is where plaque collects and begins to cause inflammation. When plaque is allowed to cultivate it begins to infect and destroy the structures that are holding the teeth in the sockets. As the infection worsens the sulcus deepens and is known as a pocket. If treated early enough tooth loss can usually be prevented, but if it is left alone teeth will eventually be lost.
Diagnosing periodontal disease is done with appropriate x-rays and periodontal probing. During this procedure the dentist or hygienist uses a measurement tool called a periodontal probe. This instrument is calibrated and it measures the sulcus in millimeters. Anything between 1-3 millimeters is considered a normal sulcus while 4 millimeters and up indicates periodontal disease that has started to breakdown the supporting structures of the teeth. The practitioner is also checking for bleeding, pus and tooth mobility. A pocket may be within normal limits but it can still bleed indicating the beginning of infection. A normal pocket with bleeding is the only reversible form of periodontal disease. Once pocketing becomes deeper the bone is already lost. In this case it is important to stabilize any further loss.
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Non Surgical Periodontal Therapy
It is important to understand, periodontal disease has no cure. If it can be stabilized at an early stage then tooth loss can be prevented, but follow-up is key to maintaining periodontal health. Generally a person with a history of periodontal disease is seen for periodontal maintenance cleanings every 3 months. Periodontal disease treatment varies depending on the severity. Mild to moderate periodontal disease can be treated in a general dental practice; while more advanced periodontal disease might require initial treatment in a general practice with follow-up treatment at a gum specialist or periodontist. Severe cases should be immediately evaluated by a periodontist.
Treatment in a general practice involves a procedure called Non-Surgical Periodontal Therapy or scaling and root planing with or without medications. In this procedure there is no cutting of the gums and in most cases no needles are required. NSPT is done a portion of the mouth at a time. It can be done in quadrants, half or full mouth at one appointment depending on the severity and insurance limitations. In this procedure the gum is numbed with a gel or an injection. The pockets are then cleaned out using special instruments designed to remove debris down below the gumline on the root surfaces. Finally an antibiotic is placed in any pockets that are 5mm or deeper. This antibiotic dissolves over the next three weeks and destroys the bacteria that are causing the infection. The antibiotic allows the gum to heal without the bacteria interrupting the process.
About a month after the completion of periodontal treatment a follow-up is necessary to remeasure the pockets and evaluate healing. If any pockets remain they are treated again with an antibiotic. After periodontal therapy it is very important to have periodontal maintenance cleanings every three months. It takes 90 days for the bacteria to recolonize, to a damaging state, below the gum. Three month cleanings break up the bacteria before it can cause serious damage. If there are pockets still they can be treated with a locally placed antibiotic. Three month cleanings help avoid future break-down and additional full-mouth treatments.
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Oral Health and Nutrition
Complete total health includes complete oral health. That is why it imperative to eat healthy. Many foods that help build strong bones, muscles and immune systems help your teeth and gums.
Dairy products provide calcium and vitamin D for strengthening teeth and bones. Breads and cereals supply B vitamins for growth and iron for healthy blood, which in turn contributes to healthy gum tissue. Fruits and vegetables containing vitamin C (among other important vitamins) are essential to maintaining healthy gums.
Lean meat, fish, poultry and beans provide iron and protein for overall good health, and magnesium and zinc for teeth and bones.
If you are a smoker your dentist or hygienist can discuss with you the options to help you quit. There are many medications and support groups you can be informed of.
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Oral Health and Total Health
Poor oral health has been associated with many illnesses. It has been shown that the bacteria that are in your mouth can circulate throughout you body in your bloodstream. The bacterial chemicals created by periodontal disease infections have been linked to many illnesses and systemic complications. The 2000 Surgeon General's report, Oral Health in America, has called attention to this connection and states that, if left untreated, poor oral health is a "silent X-factor promoting the onset of life-threatening diseases which are responsible for the deaths of millions of Americans each year." Research has shown that periodontal disease is a risk factor in heart and lung disease, strokes, diabetes, premature, low birth-weight babies and other illnesses.
Signs and symptoms of systemic disease often manifest in the mouth first. Regular maintenance allows the practitioner to make observations in relation to these matters and then educate you on their findings. The practitioner can urge you to follow up with your general physician. When necessary the dental hygienist can provide therapy for complications associated with systemic illness.
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Heart Disease
Heart disease is one of the number one killers in the United States. Numerous research studies have shown a connection between heart disease and key bacteria in periodontal disease. Dental hygienists are instrumental in identifying the presence and extent of the periodontal infection and work with patients, both to treat existing periodontal problems and to prevent future complications.
Diabetes
Periodontal disease is considered a major complication of diabetes. 95 % of people with diabetes have periodontal disease. Research has shown that diabetes patients with uncontrolled periodontal disease have trouble stabilizing their blood sugar. People with periodontal disease are also at higher risk for developing diabetes in the future. It is imperative that patients with diabetes come regularly for dental visits and follow a customized home-care routine to keep their blood sugar in check.
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Oral Cancer
One of the most serious diseases found in the mouth is oral cancer. Often curable in its early stages, oral cancers are a major cause of death and disfigurement in the United States, according to the National Cancer Institute. Oral cancer is more common than leukemia, skin melanoma, Hodgkin's disease and cancers of the brain, liver, thyroid, gland, stomach, ovaries, and cervix. If caught early it can be treated successfully; however, if not detected early, it can spread into other parts of the body and become difficult, if not impossible, to treat. The oral cancer screening constitutes one of the most important components of a routine dental hygiene
ViziLite Plus®
ViziLite Plus is a new screening procedure that helps to identify pre-cancerous and cancerous tissue. ViziLite Plus is similar to other proven early cancer detection procedures such as mammography, Pap smear, and PSA. ViziLite Plus is a simple and painless examination that gives the best chance to find any abnormalities at the earliest possible stage. Early detection of pre-cancerous tissue can minimize or eliminate the potentially disfiguring effects of oral cancer and possibly save your life.
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