Mouth bacteria that collects under the edge of the gum is the cause of periodontal disease. It is VITAL that the patient remove this plaque once daily, to prevent reoccurrence of the disease. Oral hygiene and regular maintenance appointments are the critical steps of long term success. No matter how successful the initial treatment, without adequate follow-up the disease will reoccur. The patient must truly take responsibility for his or her own health.
New patient with inflamed
gums caused by poor oral hygiene
Patient returns to health
after 6 weeks of excellent
Brushing and flossing are the two mainstays of oral hygiene. Most people brush, but few have been shown to remove the plaque from under the edge of the gum. The bristles of the brush must slide into the cuff of the gum, like a broom may slide under the edge of the refrigerator. The brush should be positioned at a 45 degree angle to the tooth, and move in a small circular motion, or shimmy. Scrubbing is not recommended, in that it may lead to gum recession. (See How to Brush )
Brush angles under the gum
Brushing lower molars
Brushing upper molars
Electric brushes have been shown to be more efficient than manual brushes. For most people they are easier to use. However, they also must be properly placed around the teeth to remove plaque. They do NOT replace the need for floss.
Sonicare electric brush head
Flossing is the only way to remove plaque from under the gum, between the teeth. Because most periodontal disease starts between the teeth, flossing is even more important than brushing. MOUTHWASHES DO NOT REPLACE THE NEED FOR FLOSSING. Good flossing is a skill that takes practice, but nothing can replace it in preventing periodontal disease. When learned, it should only take 2-3 minutes a day. When flossing it is important to slide the floss completely under the gum, wrapping around the tooth as far as possible. (See How to Floss )
Floss between teeth, but not yet under the gum
Floss wrapped under gum
There are many other aids that are available to help with oral hygiene. These include small brushes that can clean spaces between the teeth (proxibrush), and threaders to guide floss under bridges (floss threaders). Toothpicks may be recommended to help clean furcations . Each patient is individually assessed to see what may help optimize their cleaning efforts.
Proxibrush entering space between teeth
Proxibrush cleaning between teeth