Oral Hygiene Instructions

The purpose of this page is to convey the most effective, thorough technique in a general sense to prevent disease from affecting your teeth or gums. While more specialized techniques exist, it is our belief the information here is often left out from home care routines, and including these practices before trying less-conventional methods can offer enormous potential.

1. Starting at night, floss first. This removes food between your teeth so toothpaste can flow through, carrying minerals prevent cavities. Don’t only floss in-between your teeth. The very back surface of the back-most tooth must be flossed as well. Start there. Swipe the floss up and down 8-12x (each up-and-down motion counts as one). Then move to the in-between areas of your next teeth. Slide the floss through the contact point, push the floss back to engage the back tooth, swipe up and down 8-12x. You do not need to snap the floss through the contact each time. You just want to floss up to where floss touches the contact point, then bring the floss down again to where the gums give it resistance, and repeat flossing up-and-down in between the contact and the gums. After 8-12x, slide the floss forward to engage the other tooth surface, repeat. When done, bring the floss up until it presses the contact point, motion the floss side to side, “shoe-shining” this area a few times, then slide the floss up and through the contact of the teeth.

If you have bone loss around your teeth, or recession, the root surfaces will be exposed to the mouth. Roots may have indentations and plaque traps despite floss efforts. Use an “interproximal brush” - basically a pipe cleaner with a small handle sold in any department store, and brush this side to side in-between your teeth akin to a toothbrush. Interproximal brushes are invaluable in such cases and will stop cavities. They work excellent for cleaning under dental bridges and implants as well.
For more aggressive flossing, you can tie a knot in your dental floss and shoe-shine it between the teeth. Don’t do this frequently, as it can damage gums, however it is superior for dislodging stubborn food, such as popcorn kernels, as well as cleaning underdental bridges and implants. For these restorations, we actually do advise routinely putting a knot in your floss and shoe-shining under them 8-12x. This will ensure all plaque is physically removed.
Nightly flossing is mandatory so plaque doesn’t sit on your teeth and fester overnight. Cavities are exacerbated by dry mouth, and our mouth additionally gets dry while we sleep.
If you chew firm foods which get stuck between your teeth during the day, such as meat, floss once or twice between the back teeth after the meal.
We don’t advise electronic water flossers unless you lack the ability to use some form of manual, mechanical floss or interproximal brush. Plaque physically anchors to the surface of teeth. Water flossers will burst general plaque and food out of the area, however they will leave a “smear layer” of plaque anchors behind, which will quickly recolonize and cause your teeth to be chronically dirty and a high cavity risk.

Below is a picture of how to hold floss. Wrap it twice around your middle and ring fingers, press it against the pads of your index fingers. Point the pads toward you (below picture), move this floss arrangement into your mouth until you can place the floss against the back-most tooth surface in your upper right or left tooth. Once in position, begin flossing up and down. Proceed forward and floss all teeth. Don’t let the way you hold the floss change - the hand position shown below works for flossing upper and lower teeth.

2. After flossing, brush. An ideal amount for a full set of normal & gums teeth is 5 minutes at night and 2 minutes in the morning. If you have plaque traps, recession, etcetera, you may want to brush longer.

If you have recession, the brush may not be tall enough to brush the top and bottom of teeth. Check in the mirror. If this is the case, brush the top half of your teeth first, then go back and brush the bottom half.
Night-time brushing is the most important. This is because cavities need three things to flourish: warmth, carbohydrates (sugar), and dryness. When we sleep, saliva flow diminishes dramatically causing the mouth to be dry, and any carbohydrate (sugar) food left behind will feed bacteria for hours while you sleep. In fact, if you brush all the plaque off your teeth at night, there is none that can form to exist in the morning, and thus brushing time can be shorter to account for any missed areas and good breath.
The “brush for two minutes” rule is actually insufficient. This rule is not based off plaque removal, and has become a misquoted phrase. It is in fact based on fluoride. Plaque leaches minerals out of teeth, and when enough minerals are lost, the hard structure of a tooth is gone, and a soft opening, a “cavity” forms in the tooth. That is all a cavity is - a hole in a tooth due to plaque leaching enough minerals out. Fluoride is the only mineral which soaks into teeth fast enough to work in day-to-day life, and this is why we use it. It takes fluoride two minutes to start soaking into teeth. It saturates a tooth for the full effect at five minutes. So the two minute rule in fact exists to have people brush for a minimum amount of time for the anticavity mineral, fluoride, to start working. If you brush only for two minutes, you rinse the toothpaste out before fluoride works very much, and you leave plaque behind! It actually takes at about 5 minutes for all the plaque to be brushed off a normal, complete set of adult teeth. If you brush for at least 5 minutes, you accomplish this and get the full effect of fluoride as well. Then your cavity risk drops dramatically. Interestingly, the sole purpose of toothpaste is to apply fluoride to the teeth. You can brush with water and the bristles and get the same hygienic effect!
Other anticavity minerals are calcium, magnesium, and phosphate. These can take up to 30 minutes to soak into a tooth, and as a result, are not worthwhile on their own. Of benefit, fluoride has mineral properties which allow fluoride to fuse with these calcium and magnesium, and fluoride pulls them into the teeth in 2-5 minutes as well!

3. The last area to brush is the tongue, and this is very important. If you stick your tongue out, it should be pink. A white film you see on the top back of your tongue is plaque, which grows on the tongue as well! Nightly, stick your tongue out and brush the top back of it 12-24x with an old toothbrush using reasonable pressure. If your tongue is not brushed before bed, the plaque remaining on it will reinfect your teeth overnight. Brushing plaque off your tongue will likely solve “morning breath” as well.

Save an old toothbrush for this purpose - using your normal brush will cause the bristles to splay prematurely, and an old toothbrush will work better than “tongue scrapers” sold in stores.

Here’s to your success, we wish you health and happiness!