When you are done cleaning the outside surfaces of all your teeth, follow the same directions while cleaning the inside of the back teeth.

To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle back-and-forth strokes over each tooth. Don't forget to gently brush the surrounding gum tissue.

Next you will clean the biting surfaces of your teeth. To do this use short, gentle strokes. Change the position of the brush as often as necessary to reach and clean all surfaces.

Try to watch yourself in the mirror to make sure you clean each surface. After you are done, rinse vigorously to remove any plaque you might have loosened while brushing. If you have any pain while brushing or have any questions about how to brush properly, please be sure to call the office.

Periodontal disease usually appears between the teeth where your toothbrush cannot reach. Flossing is a very effective way to remove plaque from those surfaces. However, it is important to develop the proper technique. The following instructions will help you, but remember it takes time and practice.

Start with a piece of floss (waxed is easier) about 18" long. Lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the other hand.

To clean the upper teeth, hold the floss tightly between the thumb and forefinger of each hand. Gently insert
the floss tightly between the teeth using a back-and-
forth motion. Do not force the floss or try to snap it in to
place. Bring the floss to the gumline then curve it into
a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth. Remember there are two tooth surfaces that need to be cleaned in each space. Continue to floss each side of all the upper teeth. Be careful not to cut
the gum tissue between the teeth. As the floss
becomes soiled, turn from one finger to the other to get a fresh section.

To clean between the bottom teeth, guide the floss using the forefinger of both hands. Do not forget the back side of the last tooth on both sides, upper and lower.

When you are done, rinse vigorously with water to remove plaque and food particles. Do not be alarmed if during the first week of flossing your gums bleed or are a little sore. If your gums hurt while flossing you could be doing it too hard or pinching the gum. As you floss daily and remove the plaque your gums will heal and the bleeding should stop.

Sometimes after dental treatment, teeth are sensitive to hot and cold. This should not last long, but only if the mouth is kept clean. If the mouth is not kept clean the sensitivity will remain and could become more severe.

If your teeth are especially sensitive consult with Dr. Perry. He may recommend a medicated toothpaste or mouth rinse made especially for sensitive teeth.

There are so many products on the market it can become confusing and choosing between all the products can be difficult. Here are some suggestions for choosing dental care products that will work for most patients.

Automatic and "high-tech" electronic toothbrushes are safe and effective for the majority of the patients. Oral irrigators (water spraying devices) will rinse your mouth thoroughly, but will not remove plaque. You need to brush and floss in conjunction with the irrigator. We see excellent results with electric toothbrushes called Rotadent and Interplak.

Some toothbrushes have a rubber tip on the handle, this is used to massage the gums after brushing. There are also tiny brushes (interproximal toothbrushes) that clean between your teeth. If these are used improperly you could injure the gums, so discuss proper use with Dr. Perry.

Fluoride toothpastes and mouth rinses if used in conjunction with brushing and flossing can reduce tooth decay as much as 40%. Remember, these rinses are not recommended for children under six years of age. Tartar control toothpastes will reduce tartar above the gum line, but gum disease starts below the gumline so these products have not been proven to reduce the early stage of gum disease.

Anti-plaque rinses, approved by the American Dental Association, contain agents that may help bring early gum disease under control. Use these in conjunction with brushing and flossing.

Your dentist is the best person to help you select the right products that are best for you.

Education is an ongoing process and essential to the management of the patient over the course of treatment, follow-up care, and periodontal maintenance.  Patients need to know the benefits of both professional and self-applied fluoride therapies.  Patients stop using fluoride once the sensitivity has subsided, not understanding the long-term benefits of strengthening root surfaces to reduce the likelihood of future caries .

Root caries is a significant issue for the aging and adult periodontal patient.   By the age or 30, 50% of adults have experienced root caries.  An aggressive program of home-care fluoride application in combination with professional treatments can maintain the periodontal patient in a caries free state.  Since root surfaces are more porous than enamel they allow for a higher uptake of topical fluoride.  It has been proven, however, that 91% of root caries can be arrested by proper use of topical fluoride.  For high risk cases, a combination of chlorhexidine rinse therapy in addition to fluoride therapy can help reduce the bacterial challenge of the high risk patient susceptible to root caries.

Fluoride therapy is recommended after periodontal debridement (scaling and root planning) to prevent root caries initiation.  Exposed root surfaces are softer than enamel, and are not meant to be exposed to the onslaught of acids produced by the tinerration of fermentable carbohydrates and the bacteria in plaque.  As our population ages, many adults now keep their natural dentition well into old age, often for the duration of their lifetimes.  It is important to be aware of the factors that will affect adult patients as the age.  Factors to consider include xerostomia, limited dexterity, failing eyesight, poor oral hygiene, illness or injury, in addition to the use of medications and the need for periodontal therapy.  The risk factors involved must continually be evaluated, and treatment recommendations must be made appropriately.  Preventive therapy is less invasive and less traumatic than continual dental repair and reconstruction and is less costly to the patient.

Fluoride works by inhibiting demineralization and by enhancing remineralization of the enamel and dentin.  Remineralization requires higher concentration and more frequent application of fluoride.

Your dentist or dental hygienist can prescribe fluoride topically to be used before bedtime for most adults.  Fluoride will also decrease sensitivity at the gumline of certain teeth.

Another way to receive fluoride is by using oral care products such as toothpastes, mouth rinses and gels   In fact, about 90 percent of toothpastes and many mouth rinses contain fluoride.  Systemic fluoride (fluoride that comes from eating foods and drinking liquids) and topical fluoride (fluoride that is applied to the surfaces of the teeth) both work together to keep teeth healthy.

Fluoride is beneficial to people of all ages.  When children are young and their teeth are still forming, fluoride works by making tooth enamel harder and more resistant to the acid that causes tooth decay.  In fact, studies indicate that people who drink optimally fluoridated water from birth will experience a significantly higher percentage of lower amounts of tooth decay over their lifetimes.  As far as adults are concerned the benefits are just as great.  Fluoride helps repair the early stages of tooth decay even before e they become visible in the mouth, a process known as remineralization.  Other benefits include a decreased amount of sensitivity to cold foods along the gumline due to periodontal recession (another topic) and/or tooth brush abrasion (another topic) and for older adults who experience problems with root caries (decay along the gumline), fluoride has been effective in decreasing this condition.

Parents must monitor their children’s tooth brushing habits.  This office as well as the ADA encourages all parents to take an active role in their children’s oral health and one way to do so is to supervise their brushing habits.  Children should be told to use only a small amount of toothpaste and not to swallow toothpastes and mouth rinses.  You should always supervise your children in the bathroom when they are brushing.  In fact it is a good idea to demonstrate a good oral hygiene regimen by brushing and flossing along with them.  Children are often impressed by what their parents’ habits are and will often due the same.  Give small children a chance to brush on their own.  Then you should brush for them; you have to help them in the beginning until they get it right.  Fluoride alone cannot prevent dental disease, to help, the ADA recommends brushing 2-3 times a day, flossing daily and eating a well-balanced meal.  Regular dental check-ups also are recommended at least twice a year for all.

Q: My teeth are very sensitive when the dentist uses the sonic cleaning method. Would the new sonic toothbrushes that one can purchase help with that condition if I used one regularly? Or would a toothpaste for sensitive teeth be more effective?

Ultrasonic scalers generate a high frequency vibration to remove tartar from your teeth during cleanings performed at your dentist's office. While sensitivity to such scaling is common, the sonic toothbrushes sold for at-home use are set at a much lower power and shouldn't irritate your teeth. However, if you have sensitive teeth, using a sonic toothbrush may not alleviate the problem.

There are two primary reasons for tooth sensitivity. Dentinal sensitivity occurs when the middle layer of a tooth is exposed. This layer, known as dentin, lies below the gumline. The dentinal layer consists of fine tubules, which contain nerves that branch from the tooth's pulp chamber. When the dentin is exposed, the nerves can be stimulated by pressure of temperature changes, resulting in sensitivity that can affect any number of your teeth. In contrast, pulpal sensitivity is a reaction of the pulp to infection, recent dental treatment, or excessive pressure from biting or grinding. Pulpal sensitivity is usually confined to an individual tooth.

There are several treatments available for dentinal sensitivity, all of which aim to block the tubules in the dentin, preventing the stimulus from reaching the nerves. In the dental office, your dentist or hygienist may use higher-strength fluoride varnishes and other products that are painted on the tooth to reduce sensitivity. At home, you can use any number of widely available toothpastes and fluoride rinses for sensitive teeth. Look for products that include potassium nitrate or stannous fluoride, which have been proven to reduce dentinal sensitivity in the roots. You should discuss treatment options with your dentist. Happily, tooth sensitivity is usually easily remedied.