Back to Basics
What could be more fundamental to good oral health than brushing your teeth? Brushing is something we have done so many times that we often go through the motions without even thinking. Brushing your teeth may not be rocket science, but there are some basic concepts that should be remembered. If you are going to take the time and effort to do it, why not do it right?!?
When I discuss brushing habits and techniques with patients, I get a variety of responses. My favorite response goes something like this, “I’ve been brushing my teeth for 50 years and I still have most of them.” I think we might be setting the bar a little low here, but what do I know. Most people’s brushing habits are a pretty good reflection of their personalities. People with type A personalities tend to use what I call the steel-wool approach. They go at brushing with a “take no prisoners” zeal. When they come to the office, there’s hardly a particle of plaque in sight, but they’ve also brushed away 2-3mm of gum tissue. This motion is your typical horizontal back-and-forth technique in which everything in sight is removed, including healthy tissue.
For your competitive types, especially amongst kids, we see a race to the finish technique. This is where the patient attempts to cover as much ground as humanly possible in the shortest amount of time. One patient even bragged to me that he could get his whole mouth done before the first beep of his electric toothbrush (less than 30 seconds for those who are still going manual). I have to admit I was a little impressed that he was willing to admit this to his mother who was in the room. He sensed his mistake and remained conspicuously quiet for the rest of the appointment.
So how long should I brush for?
When it comes to brushing, the number 2 is very important. We would like patients to brush at least twice a day for at least 2 minutes at each brushing. Inevitably, there will be people reading this thinking to themselves, “Two minutes? I’m sure I’m brushing at least that long.” The reality is that many people fail to reach two full minutes of brushing. In school, we would ask patients to brush their teeth in front of us in the manner they would at home. The vast majority of the patients brushed for 45-60 seconds and that’s not accounting for the fact they many were stepping up their game since they were being monitored. Set a timer if you use a manual brush and take the challenge for yourself.
I don’t think my kids are brushing for two minutes.
If you are not monitoring or helping your kids brush, I can pretty much assure you they are not. Children, especially young ones, have difficulty brushing properly by themselves and benefit greatly from an adult helping and even holding the brush. This is important both for getting the teeth thoroughly cleaned every day but also in teaching kids the proper technique. Make it fun for kids by playing music or videos that are at least two minutes long. Establishing these good habits at an early age can go a long way in maintaining a healthy smile throughout their lives. Visit www.2min2x.org for fun videos that will keep kids entertained.
What is the proper brushing technique?
Proper brushing technique is easier to demonstrate than to explain so feel free to ask your dentist or hygienist next time you are in the office. The basic technique includes using a soft toothbrush and fluoride-containing toothpaste. The amounts vary depending on age. For children and adults, a pea-sized amount is sufficient. For children under 3, only a smear (grain of rice sized) of toothpaste is needed. These recommendations have recently been updated by the American Academy of Pediatricians in concert with the American Dental Association. Further recommendations for kids under 3 can be found at https://www2.aap.org/oralhealth/pact/ch5_sect1b.cfm.
Once the right toothbrush and proper amount of toothpaste is administered, begin brushing the teeth at a 45 degree angle, bristles towards the gums. Move in gentle circular or elliptical motions around a couple of teeth at a time. This motion should be continued on all surfaces of all the teeth including the inside, the outside, the chewing surface, and in between the teeth. The tongue should also be brushed thoroughly (bacteria also means bad breath so brush that tongue, your friends and co-workers are begging you). If the bristles of your tooth brush are splaying, you are probably brushing too hard.
When should I brush?
The obvious answer is morning and at night. It’s best to remove food particles from the teeth as soon as possible to prevent sugars from causing cavities. However, it is sometimes difficult to sneak a brushing in every time a morsel of food passes the lips. Even rinsing with a little water can be helpful between morning and evening brushing.
There is nothing very complicated about brushing but it is one of the most basic components of good oral health. Take a few minutes to think about how you are brushing and be sure you are getting the most out of it!