Everyone’s feelings about their teeth are different; some people are better able or willing to follow a home care program than others. What we hope to do is give you a general description of how to remove plaque from your teeth at home. Without a doubt, the most effective way to learn the techniques is to have them demonstrated to you (ideally by your dentist or their assistant). All dentists prefer to have patients interested in prevention. It makes their job easier, and patients actively concerned with keeping their teeth healthy appreciate treatment more.
Plaque is the sticky, thin accumulation of bacterial products from food and saliva that grows in the mouth, adhering to teeth, gums and tongue. To prevent decay, it must be removed from the places (warm, wet and dark) where it grows best—in the crevice where the tooth and gum meet (the sulcus), between the teeth, and in the grooves of pre-molars and molars. Plaque left undisturbed for a period of time calcifies and hardens, becoming calculus or tartar, which has to be removed professionally—you cannot do it by yourself at home.
Plaque forms continuously. For example, two hours after your dentist or hygienist has cleaned your teeth, even before eating, plaque starts to form again. Within eight hours, it starts to deposit on the teeth, and in twenty-four hours, it is “organized,” adhering to the teeth and potentially dangerous to dental health. That, in short, is why teeth must be cleaned for two minutes twice per day, everyday.
Accumulation of plaque causes the gums to bleed, become tender, and swell—it’s like having an enemy in your mouth. The real danger of plaque is when it burrows under the gums, where it can tear the fibers that attach the tooth to the gum and finally the bone that supports it. Eventually, untreated plaque affects the bone itself, which literally melts away since it is no longer protected by fibers.
Plaque that forms on the surface of teeth can cause cavities. Once it adheres to the surface, nothing unites as rapidly with plaque except refined sugar. The combination of plaque and refined sugar forms an acid that bores into the enamel and provides nourishment for decay-causing bacteria. During the day, saliva acts as a detergent and helps neutralize the acids on the teeth (we swallow about two thousand times a day). However, when we sleep, we swallow only about twenty times, and any plaque that is left in the mouth when we go to bed has plenty of time to work undisturbed and propagate. This is why plaque must be thoroughly removed every night after your last meal or snack.
The program of home care most widely recommended (besides brushing after meals) is the critically important thorough cleaning before going to sleep at night. Investing ten minutes or so at the end of the day to clean your teeth correctly may prevent uncounted hours in the dentist’s chair.
Equipment. People always pack a toothbrush when they travel; and when they forget to do so, are unsettled. A toothbrush is part of our lives, and should be, since it is essential to good home care. Although we don’t often think about what kind to buy, there are differences, and important ones. Not long ago, the hard natural bristles had almost knife-like tips that could cut the gums and, when used to remove plaque under the gums, could break and create an irritation in the area. Consequently, more and more dentists are recommending the soft, multi-tufted nylon brushes with rounded bristles. These are ideal for plaque removal. These bristles won’t break under or irritate the gums. When properly used, the many bristles loosen the plaque and scrub it away. This does not mean that the multi-tufted brush is the only one to be used, it means that it is the best one for plaque removal. When choosing a toothbrush, look for brushes with bristles that form a 45 degree angle. This particular angle, allows you to remove the plaque from the area between the teeth and gums where it is hardest to remove, but quickest to propagate. If your dentist suggests a brush for you, use it, as he or she knows your condition and what is in your best interests.
Besides a toothbrush, you need dental floss. Many types are available, we prefer unwaxed (unbounded) nylon floss, made of thin nylon filaments that separate when used and can consequently better remove plaque. Waxed dental floss is also effective and there are tight contacts between teeth, it gets through them more easily. However, the waxed nylon may glide over minute plaque areas that the unwaxed filaments can pick up.
Disclosing solution or tablets (which, like toothbrushes and dental floss, can be bought at almost any drugstore) are coloring dyes used to uncover the difficult-to-see plaque. If the teeth are clean, it washes them off harmlessly, but when plaque is present, the coloring material sticks to it and exposes (discloses) the harmful bacterial deposits that must be removed.
Most dentists will recommend one of the ADA-approved fluoride brands of toothpaste, particularly for children. However, with children who actively dislike toothpaste of any sort, it’s more important to insist that they brush properly rather than insist their using a toothpaste that might discourage brushing. Dentists often recommend specific toothpastes for specific situations. A desensitizing toothpaste can be suggested for a patient with sensitive teeth (certainly if decay is the cause, this would be treated first.) A whitening toothpaste may be suggested for someone whose teeth stain easily, for a heavy smoker, or for someone whose bonded teeth darken. Your dentist will always tell you how frequently to use it.
The following program, when followed nightly, can aid in the prevention of plaque, tooth decay and gum disease.
Dry brushing. The first step is brushing every tooth with a dry toothbrush at the gum crevice, both on the inside and on the outside of teeth. Hold the brush at a 45-degree angle to the teeth and slide the bristles closest to the inside of the upper lip under the gum. Vibrate the brush, making sure the tips of the bristles rotate under the gums (rather like scrubbing the cuticle of a fingernail). Use about ten quick rotations of the brush per tooth, trying not to lift the brush at any point (it’s been found that a person invariably lifts the brush on the same teeth time after time, and those teeth never get the right amount of cleaning). On the inside of the front teeth, hold the brush like a lollipop, parallel to the teeth, and brush with the tip, making sure the bristles slip under the gum. If you want to make sure the bristles get under the gum, bite the brush gently and you’ll force the bristles up.
Brushing. After dry brushing, use your dentist-recommended toothpaste and brush all the teeth surfaces with a circular (scrubbing) motion, inside and out. Make sure to clean the inside of teeth, top and bottom. This can be done by putting the tip of the brush inside and moving it back and forth against the inside of the teeth like a windshield wiper.
Tongue. After rinsing, don’t neglect to clean the tongue. Certain types of bacteria that cause gum-line cavities find the tongue an ideal place to grow. Simply stick out the tongue and brush the surface with your toothbrush from back to front, then rinse well to wash away the residue. Bad breath is often caused by gases released from plaque, and this one step will make your mouth fresher, especially on awakening.
Flossing. Flossing helps clean areas that the brush can’t reach, between the teeth and in the sulcus (the area just under the gum). Use a piece of unwaxed nylon floss about eighteen inches long. Wrap it around the middle finger of each hand so there remains about six inches of floss between them. The index finger and the thumb of each hand are the working fingers, which hold the floss taut, keeping about three quarters of an inch of floss between them. ) If you hold your elbows close to your body, the floss gets between the teeth at the proper angle. )
Starting with the upper back teeth, wrap the three quarters of an inch of floss around each tooth in a C shape, so that you clean both between the teeth and onto the inside and outside of the tooth. Next, slide the floss gently past the contact points between the teeth (be careful not to snap it against the gum). Now wrap the floss tightly front to back around the tooth, slip it under the gum crevice, and scrape down. If you haven’t been flossing lately, you’ll notice a whitish substance on the floss—that’s bacterial plaque.
Remember- your gums may feel a little sensitive, but you should have no pain associated with any of these procedures. If you feel actual pain, you are doing it incorrectly and are either cutting or pinching your gums. If you find that your gums bleed when you brush, they will probably also bleed when you floss. Floss each tooth under the gums until the bleeding stops (all the accumulation has been cleaned out). This may not happen in one sitting, but you should have no blood on the floss after a few days. If you don’t have time to do the entire mouth thoroughly, do a quarter of the mouth thoroughly one night, another quarter the next, and so on, and within a week or so the bleeding should have stopped. But be sure to floss at least briefly between and around every tooth every night. Flossing yields immediate rewards. You’ll wake without an unpleasant taste in your mouth if the plaque that caused it has been removed.
Dentures. If you have a denture, you shouldn’t neglect home care. Plaque forms whether there are teeth or not, and it can affect the gums. Brush the gums! Bad gum conditions can result in expensive dentures becoming ill-fitting and unsatisfactory. And of course, brush and clean your dentures as well.
Bridges. You must clean carefully under and around bridges.. (Your dentist or their assistant can demonstrate the variety of dental aids that help you floss under and around bridges.) After the bridge is cemented, the replacement teeth have to be cleaned with extra care. Dental floss used with a soft plastic threader (available at any drugstore) is essential. This threader slips the floss under the bridge so that you can scrape clean the gum under the replacement tooth or teeth and around the teeth holding the bridge on either side.
Implants. Good home care is both possible and essential with implants. It is slightly more difficult to master and requires careful instruction. Because of its difficulty, many dentists recommend frequent professional cleanings to limit plaque buildup and potential inflammation around the implants.
There is no area of the mouth that you should not be able to clean at home. A lack of coordination or particular conditions in your mouth may make it more difficult, but your dentist or their assistant can offer advice on how to overcome individual problems. Even persons with handicaps will find that they can circumvent many difficulties by using special aids and devices that have been developed.
Disclosing Solution. It’s always a good idea to check yourself to see how well you’ve brushed and flossed. Use the disclosing solution or tablet. Check the directions: you generally rinse with the solution or chew the tablets. If you’ve cleaned your teeth perfectly, the dye will wash right off; if not, it shows up as a color (red, pink, or purple, depending on the product) wherever plaque was left. Brush and/or floss these spots again.