Oral-Care 101.9: Helpful Tid-Bits--TOOTHSOME TALK-Blog-Carol Lee Skerpan DMD

' This blog appears long--but it's got lots of pictures! '

MUSCLES:
' 'Oral-Care 101.5: Tooth-brushing' 5-17-2018 lays out
five simple basic concepts for tooth-brushing.
  The two previous Oral-Care blogs (4-27-2018 and
  5-17-2018) have emphasized using a soft small-head
toothbrush with gentle pressure and correct
placement, brushing one small-section at a time
while keeping to a sequential order.
  Is today's blog going to cover more details about
  tooth-brushing technique & other helpful tid-bits? '

Dr Skerpan: You bet! For tooth-brushing
there are several techniques available,
but probably the most common are the
  Bass and the Modified-Bass techniques.
  Both of these require the bristles to be
pointed at the gumline--and to be at a
45 degree angle to the tooth-surface or
line-of-the-tooth (see picture at right).
  Notice that the brush stays ON-the-
  TOOTH-SIDE of the gum-edge!!  SEE
Blog 5-17-2018!  Both require short back-
  and-forth (or small circular) motions for
10-20 times before moving on. However,
only the Modified-Bass technique ends
with a full sweep of the tooth-surface
  before moving on to the next section.

Both Bass Tooth-brushing Techniques require the bristles to be pointed at the gumline--and to be at a 45 degree angle to the tooth-surface. NOTE that the brush stays ON-the-TOOTH-SIDE of the GUM-EDGE!!

 Bottom-line---
When in doubt, always be clear which of
the tooth-brushing techniques should be
used or avoided! And always remember
the simple basics:
--Use a soft-small-headed toothbrush!
--Keep GENTLE pressure!
--Keep direct-pressure OFF the gum-edge!
--Keep to one small-section at a time!
--Keep to a routine sequential order!

The Modified-Bass Technique finishes with a full sweep of the tooth-surface BEFORE MOVING ON to the next SMALL-SECTION!

MUSCLES:
' Well, can you please give me an example of a "sequential order"? '

Dr Skerpan:
First, a person should know their mouth & the tooth-positions in their mouth.
It even should be clear to the person which of the tooth-brushing techniques
should be used or avoided! Also, the person should be shown how to care for
any teeth or areas requiring careful or unique attention. A repeated order of an
oral-care routine will establish a comfortable habit. And if the routine is practiced
and kept up with, it will become easier & easier---and areas of the mouth will be
less likely missed or overly focused upon. Below is an example of a tooth-brushing
order for a full-set of teeth.

AN EXAMPLE OF A TOOTH-BRUSHING ORDER

1. UPPER OUTSIDE--right to left:
Start on the outside closing-down-half-way so the cheek loosens to stretch out!
Think of the teeth in small-sections as you move along (see pictures below)---
e.g., large (molars)-medium (premolars)-corner-front-corner-medium-large.
2. UPPER INSIDE--left to right:
On the inside open-wide to get the brush far enough back & angled correctly.
Think of the teeth in small-sections as you move along (see pictures below)---
e.g., large (molars)-medium (premolars)-corner-front-corner-medium-large.
(To negotiate the front-narrow-curves, hold the toothbrush vertically to use
only the narrow width-of-the-brushhead.)

3. LOWER OUTSIDE--right to left:
Start on the outside closing-down-half-way so the cheek loosens to stretch out! Think of the teeth in small-sections as you move along (see pictures below)---
e.g., large (molars)-medium (premolars)-corner-front-corner-medium-large.
4. LOWER INSIDE--left to right:
On the inside open-wide to get the brush far enough back & angled correctly.
Think of the the teeth in small-sections as you move along (see pictures below)---
e.g., large (molars)-medium (premolars)-corner-front-corner-medium-large.
(To negotiate the front-narrow-curves, hold the toothbrush vertically to use
only the narrow width-of-the-brushhead.)

5. TOPS-of-TEETH:
Brush upper right & left TOPS-of-TEETH for 7-10 strokes per side---
repeat the same for the lowers. Get all the way to the backs!
6. TONGUE:
Use the toothbrush or a tongue-cleaner to brush the tongue gently!
Get all the way to the back!
When finished, make sure to clean & rinse used items well for storage!

MUSCLES:
' I know the routine for my mouth stops without doing the tops, because my
teeth are pointy and have big "in-between" spaces. But people teeth are generally
close together, so how can people get these "in-betweens"? '

7. "IN-BETWEEN" the TEETH:
Dr Skerpan:
The "in-between" is actually called an "interproximal". There are many ways to
clean the interproximals depending on patient dexterity, tooth-positions, specific
finished dental-work &/or treatments, missing teeth, personal anatomical struc-
tures, medical status and patient Dental IQ. However in general, an individual
should not choose or use any over-the-counter dental object without recommen-
dation and instruction! Damage often happens very quickly if a dental object is
used without correct knowledge and instruction--or a choice among the myriad
of "dental-gadgets" out there may be an inappropriate one to begin with.

Basic Interproximal-aids may include a specific type of floss, floss-holders or
threaders, gauze, interproxy-brushes or "water-flossers". To repeat, recommen-
dation AND instruction is best for each patient individually. In my humble opinion,
toothpicks or "wood/plastic toothpick-shape objects" generally should not be
used--a slight wrong angle can cause great damage to the roots or to the perio-
dontal architecture in a short period of time! Below are images of some common
interproximal-aids to be used with recommendation, instruction and monitoring!

8. FINALLY......
...At exams, the dental professional should review the patient's routine, the develop-
ment of any harmful habits and change techniques for a better result if need be. If a
patient gets defensive when it is reviewed, usually that is a good indication of non-
compliance or a lower Dental IQ. A patient with a good Dental IQ cares that some-
one cares to review the oral status and make changes as needed. Also the patient's
honesty in communicating about their understanding & compliance is crucial for
healthy results. The dental professional may recommend a specific toothpaste for a
specific dental condition---but if not, generally one with fluoride is a good bet. A
specific mouth rinse may be used if the condition warrants (e.g., for a decay risk or a
periodontal situation). Any additional adjuncts should be tailored by the dental
professional for each patient's needs. Remember the D.O.G.G.Y. in DENTAL IQ!
Oral-care is for oral-health, and oral-health is for body-health! Also remember,
the mouth is an important working member of the whole body. And like the rest
of the body, it is ever-changing with treatments, use, habits & aging!