Why do we need to brush or floss at all?

The goal that we are trying to achieve by brushing and flossing is to disturb and move around the bacteria in our mouth often enough that they can't form large colonies and cause problems with the teeth and gums.

Bacteria live in all of our mouths. These single-celled members of the plant family do us very little harm, as long as there aren't great numbers of them.

Our tongue, lips, and cheeks clean the broad surfaces of our teeth most of the time. Rarely do we ever get cavities starting on these surfaces.

The uncleanable areas, those between the teeth and below the gum line are dark, warm, and moist, and close to a regular supply of nutrients. These are ideal conditions for bacteria to thrive.

Unless we clean out the bacterial population that grown in these places, a sticky substance forms, and this allows the bacteria to stick to our teeth. The bacterial colonies in the plaque generate toxins and acids. These toxins cause the gum tissue to become inflamed and diseased, and the acids slowly dissolve our teeth, causing cavities.

Because the acid is most concentrated where the bacterial colonies in the plaque are, the teeth develop cavities more in these areas:

• along the gum line

• where the teeth touch each other

• and in the deep grooves of the biting surface where our toothbrush can't reach.

• in any cavities (holes) in our teeth that aren't naturally cleaned.

Gum disease always starts between the teeth, where no one has flossed, usually affecting the molar areas first, because the space between the molars is wider than that between the other teeth. If you want to avoid gum disease, you need to floss!

This teenager drinks carbonated beverages throughout the day, and doesn't brush effectively or often enough. This is what happens when bacteria are allowed to make a home under the gumline and in between the teeth. The white areas on the teeth are cavities that haven't broken through yet. There are also way too many bacteria growing in this mouth. It is obvious from this picture where we need to clean the most!
This is the result of poor diet habits and poor oral hygiene over several years.

How to be effective at brushing and flossing

I see patients every day that brush their teeth 2-3 times a day, but when I examine their mouth, I can't tell if they brush twice a day or twice a month. You see, most people don't get much instruction about oral hygiene, or don't listen to it. If they are concerned enough about their oral health to come to the dentist for an examination and cleaning, and are brushing twice a day, they want to be effective at it.

To be effective at oral hygiene, we need to disturb the bacteria. And the way a lot of people are brushing doesn't bother the bacteria in the least. Not only are they ineffective at removing bacteria, many are doing actual damage to their teeth and gums by using a hard or medium bristle toothbrush, or brushing in long back-and-forth strokes. See Toothbrush Abrasion.

With a soft-bristled toothbrush, try to get the bristles as far under the gumline as you can around every tooth, and using small, gentle, short strokes, move the brush back and forth in place , cleaning under the gumline.

With dental floss, do the same thing between your teeth, getting the floss under the gumline as far as it will go, and move it in gentle up-and-down motions once or twice in place.

If it bleeds, that is normal if you haven't been doing a thorough job in the past. You're just getting your toothbrush into areas where the tissue has been inflamed by the bacterial colonies. You should begin to see results (less bleeding and discomfort) within 5-7 days.

If you want your teeth to last a lifetime, you'll also need to see a dentist regularly for examinations and cleanings, and the dentist or hygienist will demonstrate proper brushing and flossing techniques.

These are before and after photos of the same patient who is now brushing and flossing correctly. Notice the redness and swelling in the left photo to the right of "a", and around "b" and "c". The right photo was taken 3 weeks after the left one. The dark lower tooth was also bleached. You can see how that turned out on our tooth whitening page.

Maintaining good oral hygiene can be a challenge, especially if you have developed a health condition that makes brushing and flossing more difficult, or have been in an accident that created new limitations. Dental professionals want to help all dental patients keep their mouths healthy and offer these suggestions.

Brushing tips

Problems in hands, wrists, arms and shoulders can hinder a person's ability to brush and floss. While each situation is different, there are some suggestions that have been effective in making dental care easier:

• Use a wide elastic band to attach the toothbrush to your hand for extra gripping power.

• Attach a small rubber ball, a sponge or a rubber grip to the toothbrush handle with strong tape. This enhances gripping power and is often useful when hand or arm movement is weakened or limited.

• Use a longer wooden dowel, a ruler or plastic rod to lengthen the toothbrush handle, wrapping it securely with strong tape. This longer length may help in more easily reaching your mouth.

• Use an electric or sonic toothbrush.

Flossing tips

If limitations make brushing harder, flossing may be an even bigger challenge. Depending on your limitations, try these techniques:

• Use a piece of floss, about 18" long, and wind one end of floss around each finger instead of holding it. This will increase your grip and prevent the floss from dropping out of your fingers with each tooth you floss.

• Hold the floss tightly and seesaw it back and forth between the teeth, instead of pushing the floss right through.

• Tie the floss into a long circle instead of using one long piece, which may make it easier to hold and less likely to drop from your hands.

• Try using a floss holder available wherever oral care products are sold.

These (81-yr-old and 65yr-old ) patients have been brushing and flossing successfully. Notice the healthy gum tissue.