Do you have Bad Breath?
If so, this is the most important page on this site, because it is where you begin to learn how to control it properly. However, there are other sources of bad breath.
In order to understand WHY you need to clean your teeth carefully once a day, it is important that you eventually refer to the following links on the diseases you are preventing. You can reach age 45 with a mouth full of loose, decayed teeth, or you can keep your teeth the rest of your life. The difference is 5 minutes a day in the bathroom and a small shift in your daily sugar intake.
It is difficult to be a successful person in today's world if you fear opening your mouth wide enough to let people see your teeth. Please click on the icons below to learn about the dangers of NOT spending that five minutes a day!
|Periodontal disease||Tooth decay|
Gum disease and tooth decay are invisible and largely painless when they first start, but the final outcome is always the loss of your teeth. By the time that any given area of the mouth becomes affected, the problem becomes so painful that you will be driven into a dentist's office even if you have vowed never to enter one in your life. At that point, you will either lose the offending tooth or teeth, or require expensive procedures to save them. It is infinitely easier to prevent the problems in the first place than it is to treat the problems caused by ignorance and neglect.
Yes! It has been well established that if a person cleans his or her teeth thoroughly (including between the teeth) once every twenty four hours, he can prevent periodontal disease. (Once a day will reduce the incidence of decay, but in the presence of the chronic sugar habits, even brushing four or five times a day will not prevent all decay. The best way to prevent decay is to reduce the number of times per day that sugar crosses your teeth.) I encourage patients to brush twice a day, in the morning upon getting up and in the evening before going to bed. I suggest that they use floss or Stimudents once a day. I like to do it at bedtime because doing the most thorough cleaning at that time reduces my "morning breath". It makes no difference what time of day you choose to clean between your teeth.
(Speaking of morning breath, Arm & Hammer has developed a new toothpaste called "PM" which I have been using for a while, and it really does seem to reduce morning breath if used before bed. Unfortunately, it tastes rather like baking soda, and for that reason failed as a marketable product. You can, however, create your own version of the same thing by dipping your toothpaste coated toothbrush into a teaspoon of baking soda and then brushing as described below. just ignore the taste, and if you brush thoroughly, you'll wake up in the morning without morning breath.)
By the way, plaque, the stuff you are brushing away is made of nearly 100% living germs. For some interesting pictures and a good description of plaque, click on the icon to the right. When you see it up close, you will know why you need to brush and floss!
This is the Key to keeping your teeth the rest of your life. It's an incredibly easy thing to do! The key to brushing the teeth is:
1. Always use a soft brush...A soft brush will clean much better than a hard or medium one because some of the bristles will bend at heights of contour and others will remain straight reaching down into the sulcus that surrounds the teeth. It is in this sulcus that Periodontal disease begins when plaque (made of germs) is allowed to accumulate here. The point is to always aim to remove the plaque from the sulcus around each tooth.
2. Hold the brush so the bristles point at an angle (45 degrees) into the sulcus as pictured here. Use short, vibrating, back and forth strokes. The tips of the bristles don't even have to move. The point is that each change of direction (each "vibration") forces the bristles further into the sulcus and as much as possible between the teeth.
Vibrate the bristles in one brush position for a few seconds, then move one tooth foreword and do it again, advancing around the "arch" of first the outside of your upper teeth, then around the inside as pictured here. Once you finish the bottom proceed to the top teeth beginning on the top left working around the outside of the teeth to the top right outside, then do the insides of the top teeth from the right inside to the left inside. The entire procedure should take about two or three minutes spending 30 or 40 seconds on each surface of each arch. after thoroughly brushing the insides and the outsides of the teeth, the job is one half finished. Now you must clean between your teeth.
A Bit of attention needs to be paid to the canine teeth (the eye teeth), especially in the upper arch. Because this tooth lies at the junction of the back teeth and the front teeth, it tends to be fairly prominent. Bearing down too hard directly on this tooth with the toothbrush sometimes can injure the gums, or even wear a notch in the tooth at the level of the gum line. It is generally best to brush the back half of the canine teeth while brushing the back teeth, then "turn the corner" and brush the front half once you change the angle of the toothbrush to brush the front teeth. By brushing each half of the tooth separately, you avoid injury to the gums and wear of the tooth.
Prior to the discovery of the benefits of Fluoride, toothpaste was just a form of perfume that induced people to brush their teeth. It had no real benefit over and above its esthetic value. But with the discovery that low concentrations of fluoride could actually reduce the incidence of decay, toothpaste gained importance as a vehicle for delivering the benefits of a true medication.
Since that time, new additives have been discovered which allow the toothpaste to deliver new benefits to the teeth. Among these additives are disinfectants which actually kill the germs in plaque, and can deliver a germicidal effect for hours after brushing. Another one (pyrophosphates) helps prevent the buildup of calculus, which is the hardened material the hygienist has to scrape off when you have your teeth cleaned. Both Proctor and Gamble, and Palmolive have toothpastes that contain all three additives. They are Colgate Total® and Crest Complete®. Other brands contain whiteners to help bleach the teeth. No matter which toothpaste you use, the largest single benefit of brushing the teeth is still the value of mechanically removing plaque. A toothbrush with NO toothpaste does this as well as one with toothpaste!
A word of caution!! Very vigorous brushing with toothpaste on the brush will, over time cause extensive wear on the teeth. This type of damage can be avoided by using the Bass technique described above with a "wiggle-jiggle" motion (very short strokes). Real damage to the teeth is caused by vigorous "sawing" over the teeth using commercial toothpaste. Surprisingly, the brush without the toothpaste does NOT cause tooth wear. Since it is the toothbrush, and not the toothpaste that actually cleans the teeth, you can do as good a job brushing with less long term damage to the teeth if you dip the brush in mouthwash instead of using toothpaste. Click on the image to see more images of "toothpaste abuse".
Toothpaste abuse is probably the most frequent cause of tooth hypersensitivity. By overbrushing with abrasive toothpastes in order to try to make your teeth brighter, you are removing much of the tooth structure around the necks of your teeth that used to protect the nerves from cold sensitivity. Only a dentist can repair the damage already done, but you can prevent further damage to the teeth by brushing your teeth with fluoride containing mouthwash (Act) instead of using abrasive toothpastes.
If you do not clean between your teeth once a day, I guarantee that you will still get periodontal disease by the time you are in your forties. You will be especially prone to the bone loss that is the final symptom of gum disease if you neglect to clean between your teeth and you grind or clench your teeth (bruxism).
There are two commonly used ways to clean between the teeth. The first way is Flossing the teeth. While flossing is considered the gold standard of interproximal cleaning methods, I have discovered through very hard experience that people really do not like to do it, and even if they begin flossing regularly, they tend to do it less and less over time. The second way to clean between your teeth is with thin toothpicks similar to the Stimudents demonstrated below . I have found that these toothpicks have two great advantages over floss. First, they are very easy to use (you can use them one-handed and can use them anywhere including on the way to work in your car). Second, if used properly, they clean as well as, or even better than floss. I have seen people with severely inflamed gums (moderate to severe periodontitis) literally stop their disease cold within two weeks using Stimudents regularly! I will cover both methods below. No matter which one you use, you will be assured that you will be the only little old man or woman in the rest home who isn't trading her dentures with the other little old ladies (they really do this) because you will have the real thing!
I have found that it is easier to use waxed floss than unwaxed. It does not slip between the fingers as easily as unwaxed floss, but it does slip between the teeth more easily and doesn't fray as much. You can use one of the new Teflon varieties like Glide. These slip between the teeth easily and don't fray as easily as unwaxed floss either, but I have found that that is too slippery for me to hold. It makes no difference which kind you use. They all clean the teeth equally well. Actually, baby yarn works great!
Tear off a piece of floss about two feet long (it's cheap), and wind it around your middle fingers as pictured in the top left image above. That way you have your two index fingers and two thumbs free to manipulate the floss between the teeth. Using two index fingers, two thumbs, or one index finger and one thumb, practice by beginning on the front teeth where the access is easy. Using any combination of fingers and thumbs, whichever combination is the easiest, slip the floss between two front teeth as pictured in the image on the top right above. Wrap the floss into a "C" around one of the teeth as pictured in the lower left image, and pull the floss up and down against the tooth. Notice that the floss actually appears to go under the gums. It is simply going into the sulcus that surrounds the tooth, and that's where you want to clean the most. Cleaning in an up and down motion reaches the bottom of the sulcus and actually removes plaque. Sawing the floss back and fourth does not, and it may actually wear grooves in the teeth. After drawing the floss up and down on the back tooth, bend it into the reverse "C" and do the same to the surface of the next tooth facing the one you just cleaned. Thus, for each space you enter between teeth, you have two separate teeth to clean.
It may take a while to complete the process all the way around your mouth the first time you do it, because the manual dexterity is a learning process, and for the first week or so, it will seem clumsy if you are not used to it. On the other hand, if you persist, you get good at it and it takes less and less time to complete the process, until you are down to less than a minute for the whole mouth. As time goes on, the constant pressure of the floss against the teeth actually causes the contact between the teeth to lighten, and getting the floss into each contact gets easier too.
If the floss frays or breaks between two teeth, it probably means that you have a cavity in one or both of the teeth, or that a filling has an overhanging margin and should be replaced. Persist, and the bleeding stops after a week or so, and your bad breath will begin to disappear.
Stimudents are simply a very thin wooden toothpick made of orangewood. You can buy them in many drug stores (especially CVS and Walgreens) or super markets. They work just as well as floss to clean between your teeth. (They can be hard to find, but you can call Johnson & Johnson at 800-526-3967. Wait until the automatic answering system gives you a choice to go to the oral health section. Once there you can speak to a representative who can tell you all the stores in your area where they are sold.) Simply break one off (see the middle image above), wet the end by sucking on it, and begin cleaning between each of your teeth just as you would use a toothpick at a restaurant. Notice that the Stimudents have a wedge shaped cross section (see the image at the right). The flat edge is placed closest to the gums while the point is pointing toward the edges of the teeth .The Stimudents are pushed as far between the teeth as they will go (see the rightmost image in the grouping of three above). You can reach the furthest spaces back in your mouth as I am doing here. At first, you will experience some bleeding and some discomfort because the plaque bacteria have caused a chronic infection in the gums, and like any infected tissue, it hurts when it is touched. However the pain and bleeding subsides within a week or two after you start using them.
These little sticks are worth their weight in gold, because they have worked so well to cure so many of my more motivated patients' chronic periodontal disease. Since they are disposable, the patient does not have to be near running water to use them. They frequently use them while commuting to work or watching television. It feels great to use them, especially after the disease clears up, and once patients notice that the bleeding has stopped and their teeth are no longer mobile, they feel good about themselves.
Doctor's BrushPicks are a cleaning aid similar to Stimudents, and are used in the same way. They are double ended, one end being a toothpick and the other a tiny plastic brush which also fits between the teeth (see image below). BrushPicks have a number of advantages. They are made of plastic and are more durable than Stimudents. They are much thinner and stiffer than Stimudents which makes them fit between teeth that are very close together. They come in a dispenser which makes them easier to dispense than Stimudents. There are three sizes of dispenser; 60, 120 and 250. All of the dispensers are small enough to fit in your pocket or purse. Finally, they can be found in most large drug stores (specifically, Walgreens and CVS). They can also be ordered by clicking here.
Other tooth cleaning aids
Pointed rubber tips are used in much the same way as the Stimudents above. They are especially easy to use since they come on a handle which makes access to the spaces between the teeth even easier than Stimudents. They are made out of a fairly soft rubber, and therefore are comfortable to use. I prefer Stimudents because the grain in the wood adds a roughness which is more likely to remove plaque than the smooth surface of the rubber tip.
Mouthwashes used to be almost exclusively perfume for the mouth. They didn't do much more than cover up the bad odors of the disease processes. But fairly recently, some mouthwashes have been introduced which contain medicaments which do more than cover up odor. Some are designed to deliver fluoride to the teeth. Fluoride has proven to combine chemically with the teeth to create a thin layer of fluoroapetite which is resistant to acid attack and helps to reduce the decay caused by the sugar habits. The old eucalyptus formula of Listerine mouthwash has proven actually to reduce the number of bacteria in plaque and helps fight periodontal disease when used in combination with toothbrush and floss or toothpick.
The newer forms of electric toothbrush are quite effective in removing plaque if the bristles are held at a 45 degree angle to the teeth and gums as noted above. They force a two minute brushing time and supply a super fast vibratory motion, a slower version of which is noted in the above description of the Bass technique.
The little "Y" shaped implement on the lower left is a floss holder for people who have trouble gaining the dexterity needed to manipulate floss between the back teeth. The other alternative for these people is, of course, Stimudents.
The handle to the right of the floss holder is a "Proxabrush". The brush itself is the tiny extension at the top pointing to the left. It is a tiny brush made to be used between the teeth in the same way the Stimudents are. They are very effective aids and are a staple in the treatment of severe periodontal disease. They are excellent for cleaning between the teeth if the spaces are large enough to accommodate the brush. The only problem is that the brushes wear out and must be replaced fairly often, and since they are reusable (unlike Stimudents) the patient must be near running water to wash them off during and after use.
The three long strap like objects to the right of the Proxabrush are tongue scrapers. These have serrated edges and are very flexible. They come in three stiffnesses. They are bent into a "C" shape, and the middle of the "C" is placed as far back on the surface of the tongue as possible and then scraped forward over the surface of the tongue. Your tongue has a feltlike surface. The feltlike material is actually composed of tiny "hairs" which naturally break off (exfoliate) when they get too long. Under some circumstances, this hair does not exfoliate properly and the tongue gets a white (or sometimes black depending on your diet) "coat" on it. This coat may catch food odor and cause bad breath. These tongue scrapers help to "shave" the tongue to eliminate the hairy coat.
Most people are familiar with carbamide peroxide since it is the agent most commonly used for bleaching (whitening) the teeth. The dental profession has recently begun to recommend carbamide peroxide as a means of preventing periodontal disease and tooth decay in patients who are unable to carry out normal oral hygiene measures such as regular brushing and flossing. For patients like these, rubber trays are fabricated to fit over both the teeth and the gingiva. The tooth indents in the trays are filled with 10% carbamide peroxide and the patient wears the trays for two hours once a day, or overnight. The carbamide peroxide breaks down into 3.5% hydrogen peroxide and 6.5% urea when it contacts plaque. The urea further breaks down into ammonia and carbon dioxide under the action of bacteria. The hydrogen peroxide kills the plaque bacteria, and the ammonia raises the PH of the plaque neutralizing the acid that causes tooth decay.
Bad breath plagues just about everyone at one time or another. People snicker about it, but bad breath can be a devastating social disability. More than a few people have been denied employment, failed in business and relegated to low social status because of it. There are four areas from which bad mouth odors originate. Before you can begin to treat your specific problem, you must be able to diagnose it. For this purpose, I have provided an entire page on the diagnosis and treatment of bad breath