Put on a happy (and healthy) face

By Neale McDevitt

The next time your dentist gives you the bad news about a fresh cavity eating away one of your molars and you throw your hands up and protest “But I brush and floss twice a day,” remember the words of Leon Trotsky, who said “Technique is noticed most markedly in the case of those who have not mastered it.”

“There are a number of factors that can contribute to a person developing dental caries and gum disease, such as heredity and diet,” says Dr. Melvin Schwartz, Chief of the Jewish General Hospital’s Department of Dentistry. “But the fact of the matter is many people use improper technique when they clean their teeth.”

This could explain why although eight in ten Canadians report that they brush and floss regularly, as many as 96 per cent of them have had at least one cavity and one fifth have experienced moderate to severe gum disease.

Schwartz doesn’t like those numbers so, with April being Oral Health Month, he is going public with some of the same lessons he’s been teaching his patients for over 35 years. “It’s not how often you floss or how hard you brush,” he says. “It’s how effectively you do it.”

One of the most common mistakes people make when they brush their teeth is exactly that – they concentrate solely on their teeth. “People don’t recognize that it is also important to brush at the junction of where the teeth and the gums meet,” says Schwartz, who, in his practice, has dental hygienists armed with mirrors, talk patients through the ABCs of good brushing.

The Canadian Dental Association recommends the following steps to ensure you’re getting the most from your toothbrush:

• Brush after every meal, because the bacterial attack on teeth begins minutes after eating. At the very least, brush once a day and always before you go to bed.

• Brush at a 45-degree angle to your teeth. Direct the bristles to where your gums and teeth meet. Use a gentle, circular, massaging motion, up and down. Don’t scrub. Gums that recede visibly are often a result of years of brushing too hard.

• Clean every surface of every tooth. The chewing surface, the cheek side, and the tongue side.

• Don’t rush your brush. A thorough brushing should take at least two to three minutes. Try timing yourself.

• Change your usual brushing pattern. Most people brush their teeth the same way all the time. That means they miss the same spots all the time. Try reversing your usual pattern.

• Use a soft brush with rounded bristles. The right toothbrush cleans better. Choose a size and shape that allow you to reach all the way to your back teeth. There are many different types of brushes, so ask your dentist to suggest the best one for you. CDA recommends you replace your toothbrush every three months.

Flossing is another area in in which the road of good intentions is paved in silver fillings.

“A lot of times people go too quickly when they use dental floss, just snapping it up and down between their teeth,” says Schwartz. “But teeth have a convex surface. So if your floss is just going straight between your teeth, then you’re only cleaning a very narrow area of your tooth. You have to wrap your dental floss around each tooth in a C-shape. That way, your dental floss is engaging a lot more of the surface of the tooth.”

Flossing removes plaque and bacteria that toothbrushes can’t reach and people who don’t floss are missing more than one-third of their tooth surface, giving plaque – an invisible bacterial film that develops on your teeth every day and is the main cause of gum disease – a foothold in your mouth.

Within 24 to 36 hours, plaque hardens into tartar, which can only be removed by professional cleaning. Floss at least once a day, says Schwartz, and plaque never gets the chance to harden into tartar.

But Schwartz says, even the most careful and conscientious brushers and flossers still need to visit their dentist on a regular basis. “Believe it or not I go to a dentist every six months to have my teeth and gums checked,” he says. “I like to think I do a pretty good job of cleaning my teeth but I also know how important it is to see my dentist because the earlier you can detect a problem, the better your chances are of avoiding a major intervention.”

The cost and discomfort of surgery aside, dental problems can have an impact that reaches far beyond a person’s mouth. “Certainly the loss of teeth will diminish your efficiency in terms of being able to chew certain food, not to mention the obvious impact on aesthetics,” says Schwartz. “There is also been a lot of discussion these days about the association between oral health and systemic disease such as diabetes, heart disease and hypertension.

“I don’t believe there is any clear and definitive literature that indicates that there is a causative relationship between oral disease and systemic disease, but there may be a relationship.”

To reap the benefits of good oral health over the course of a lifetime, a person should be introduced to solid oral hygiene practices at an early age. Schwartz believes that children can start seeing a dentist as young as 18 months or two years old – more as an introduction than anything else. “As soon as a child has teeth, they should see a dentist,” he says. “We try to introduce them to the dentist, the dental office and the dental chair in an atmosphere that is welcoming and comfortable rather than waiting until there is a problem like a cavity. The earlier they learn good habits, the better off they will be down the road.”