MOUTHDENTALCAREFLOSSSULCUSORALHYGIENEHEALTHORTHODONTAL HOW A MOUTH WORKS
How a Mouth Works
In order to generate a healthy mouth, you need to understand the anatomy of the mouth and the way in which teeth are supported in the jaw. When you put force in the surface of a tooth, the weight is distributed through the periodontal ligament that surrounds each tooth into the lower jawbone. This 1mm thick ligament is suspended (from the bone like a hammock of fibres). Into these fibres each tooth is tightly nestled It's an extremely efficient system.
(Just for fun. here are a few facts to inspire you to work at keeping your own teeth. Inuit people, who often use their teeth as a third hand, can exert more than 360 pounds of pressure using their first molars. That's enough pressure to crush a brass pipe. In comparison, the average North American can exert 125- 150 pounds of pressure. The average denture wearer on the other hand, can exert a mere 15-17 pounds. What does all this mean to you? Any more than a small amount of pressure and their teeth will pop out!
But we digress…
Now, probably nobody has ever told you that it's your responsibility to keep that ligament clean. Once there's a weakness in those self-cleansing areas below the level of the gum where the hard and soft tissues join (it's called the sulcus) tooth and gum disease can begin. If you are like most other tooth brushers, chances are you are just brushing with the ends of the bristles, sliding the brush straight across the tops and sides of your teeth before you race madly off to work or school. This means that you're missing not only the cracks between the teeth, but also you're not even getting near the sulcus. If you're wondering how well you're doing, ask your dentist about "disclosing." He'll give you something to chew that will highlight the areas that you're missing.
Simple Steps to Home Dental Care
Sulcus brushing (need funny head brush has only two rows of bristles.) Ask you dentist to give you a sulcus brush or a multi-tufted brush. This small, two-row brush is used without toothpaste. Why? Toothpaste is only necessary to taste good and give you a flouride treatment. Hold the brush against the tooth at a 45 angle and gently jiggle it so that the bristles go into the sulcus. When your gum turns white, you'll know you're here. Once the bristles are in the sulcus, then brush up. The action is easy: gently jiggle, moving down on the uppers and up on the lowers.
Sulcus brush is important for three reasons: it disorganizes plaque that settles in and causes the gums to bleed and the teeth to decay. Brushing also stimulates saliva to flow and capillary action causes your saliva to follow the bristles down into the sulcus thereby neutralizing any toxin that may have been produced by the plaque and, finally, because the bristles tend to push away from the teeth, plaque is dislodged. The periodontal fibres that are responsible for maintaining the tooth it's socket will tend to tighten up. (A person who has been sulcus brushing will have gums that are so tight, it will be difficult to get even the smallest brush into the sulcus. The average person, on the other hand, usually has spongy, puffy gums with gaping spaces wide enough to run the INDY 500 in … well, almost.)
Sulcus brushing is a very gentle, accurate process that requires practice. Just as you can't play Beethoven concerto's after your first piano lesson, so it takes some time to learn where the sulci are and how to clean them. Practice sulcus brushing without a mirror, while you're watching T.V., reading or listening to the stereo.
Some tips: It's harder to reach the lower inside molars because the tongue is in the way. One trick is to keep the heal and toe of the brush level, so that both are resting in the sulci. Once the brush is in place, then use a systematic railroad brushing pattern: start in the front of the tooth, go all around one side, then all around the other. Don't forget, it's a gentle, probing action. Try different angles and experiment while you're doing it. Sulcus brushing, once you know how to do it, can be used as a stress breaker. The action is such that it can actually cause you to relax.
The world's greatest argh: Flossing
Chances are you hate to floss. Every time you do it (which is usually just before or just after a dentist appointment… on average about once or twice a year.) your gums bleed, your teeth hurt, you become all thumbs trying to get the floss out from between your teeth and then your mouth hurts all day. Not only that, sometimes you end up with an infection that you didn't have before flossing. Sound familiar?
Well, we hate to say it but all those problems belong to the infrequent flosser. If you learn how to floss properly, and you do it every day…your gums won't bleed, your teeth won't hurt, you'll have no problem maneuvering that wily floss, your mouth won't hurt, and most importantly, not only will you have fewer infections, you'll actually end up spending less time at the dentist's. Now, if that's not incentive enough to keep reading…
The most important thing to understand about flossing is that it is really the only way to halt the havoc that is surreptitiously carrying on in your mouth. Here is a truly ghastly analogy. Think of a fork after a spaghetti dinner. Imagine not washing the fork and instead just letting it sit somewhere warm–in an area about the same temperature as your mouth. The next night that fork is used to eat stew. Again it is left, unwashed, somewhere warm. The third night, a casserole is served by that same fork. And again, it is left to sit. No one would use that fork again, not only because it reeks but also because it might spawn an attack of food poisoning.
The human mouth is not much different from that fork. Between the teeth lie food, bacteria and a pussy discharge called pyria. As these build up, the little pockets between your teeth grow into stagnating swamps. As a matter of fact, if you added up all the infected areas between the teeth, you would have the equivalent of two six-inch infected wounds. If they were anywhere else other than in your mouth, you would be in the hospital with a fever. Flossing is one way to clean up those swamps and to prevent them from reoccurring.
Three quarters of the battle with flossing is learning how to hold it properly. And although there are as many different methods of holding floss as there are people to hold it, some methods are more effective than others. One of the best is to wrap the floss around the third finger. Using this finger as a kind of spool, you can unravel the floss as you use it.
Where to floss
We recommend a floss that is waxed and shred-resistant. This kind is great for beginners, especially, because it is less likely to shred. Granted, both good quality floss and poor quality floss will shred. Here is why: there may be a cavity at the contact point; a filling may have a slight ledge; the filling may have a slight overhang; and/or there is a hard tartar deposit on which the floss is catching. If you know the points at which your floss always snaps, you can identify the spots that need tour dentist's attention. In the case of tartar; it may be remover if it is subjected to the however, it may be removed if it is subjected to constant rubbing of floss.
Place the floss on the contact point between two teeth and gently seesaw it back and forth to ease the floss between the teeth and down to the gums. Do not force the floss in to the gums because they are usually very tender when you first start flossing.
Each tooth is surrounded by a sulcus. Lay the floss gently down on the bottom of the sulcus and arc it around the tooth in a "c". Then move the floss away from the gum on both sides of the tooth. Because the gum crests between two adjoining teeth, when you have finished one tooth come up a bit with the floss, then move over and come down again to do the other tooth.
Learn to floss without using a mirror. That way you are forced to keep your fingers close to the teeth, which makes flossing more accurate. If the fingers are not kept close enough to the teeth, the floss does not arc around the tooth properly, and this can lead to damage (of what?).
The magic of flossing
Systematic flossing can actually halt cavities, even if they have already begun so that sometimes it is possible to keep a cavity on hold and not have it filled immediately.
Make sure you know where your fillings are and why they are there Dental work generally will not break down if you floss regularly. More importantly, a tooth that has been flossed regularly and properly actually squeaks from having been polished. Cavities do not start on smooth, squeaky clean teeth.
Patient Oriented Oral Hygiene
Starting patient-centred oral hygiene in your practice actually begins with you. Since it's easier to communicate values you believe in and practice yourself, you need to get y our own mouth in order before you start teaching your patients about oral health. Wait until you can honestly say "Look, I don't have any oral diseases at all. If you're interested, I'll show you how easy (and inexpensive) it is to put your mouth in the same kind of order" At that point your understanding of and empathy for some of the pitfalls your patients will experience when learning to brush and floss, will enable you to convince them that it's worth their while to learn to take care of their own teeth.
Explaining how a mouth works
The very first step in generating a healthy mouth is to explain the anatomy of the mouth and the way in which teeth are supported in the jaw. Patients must first understand that any force put in the surface of the tooth is born initially by the periodontal ligament around the tooth down into the lower jawbone, the stronger that ligament (and that jawbone) are, the more pressure the teeth can bear without popping. (Telling people that the average denture wearer can only apply a fraction of the force that the average North American can is often incentive enough for people to keep as many of their teeth as possible.)
You know that keeping a healthy mouth starts with cleaning the areas around the base of the tooth where this ligament lies. Chances are, however, your patients do not know this fact. You need to explain that tooth decay starts in the sulcus, where the hard and soft tissues join Since that junction is below the level of the gum, people have to be told where it is and how to clean it. Probably most of your patients use only the ends of the bristles as they slide their brush straight across the tops and sides of their teeth in a mad frenzy befor they race off to work or school. Some patients may be a bit more systematic, brushing both back and forth and up and down, but few will be getting under the sulcus. It's a simple matter to check. Disclosing takes the guess work away from everybody.
Teaching about dental care
First, give the person a sulcus or a multi-tufted brush. Ask the patient to the brush on a 45 degree angle and gently jiggle it so the bristles go into the sulcus. Once the brush is in the sulcus, ask them to brush up. The action is easy: gently jiggle then up but it requires practice.(reasons it's effective in patient manual.) Once the patient has got the idea, get him/her to practice it without a mirror. They can do it while watching TV, reading or listening to music. Once they know how to brush the sulcus, they don't really have to think about the entire procedure.
note: Make sure they practice getting the brush into the areas around the molars. That area is trickier to reach since the tongue is in the way.
Most patients are sick and tired of being reminded to floss. That's usually because they only do it just before coming in for a dentist appointment or just after the appointment in a fit of resolve. And because they don't understand that flossing is really the only way to halt the havoc that's surreptitiously carrying on in the mouth, they have no incentive to keep flossing when it's an awkward, bloody, messy and painful thing to do. If you can effectively explain just what flossing does, and, most importantly that if a patient continues to floss his/her gums will tighten up and the bleeding will stop, you'll have done them an enormous favour.
Learning about the warning signs
A patient has to be taught the warning signs of poor teeth or gum disease. Few patients come into the office when they notice little red halos on their gums or because of occasional blood on the tooth brush or because someone has told them they have bad breath. Usually they wait until the damage has been done: a tooth has fallen out, decayed or broken off. That's why it's important to make patients aware of the early signs of disease and show how they are linked not only to the teeth, but also to the gum supporting structures. A person with a healthy mouth has a strong front-line resistance to infection and disease not only in the teeth and gums, but also in the glands, in the digestive tract and even in the colon. Good oral hygiene affects teeth, gums, alveolar (jaw) bone the circulatory system, the digestive system and the colon. A healthy mouth gives a person a chance at overall health.