How to Brush

Mouth bacteria that collect under the edge of the gum are the cause of periodontal disease. It is VITAL that the patient remove this plaque once daily, to prevent reoccurrence of the disease. Oral hygiene and regular maintenance appointments are the critical steps of long tern success. No matter how successful the initial treatment, without adequate follow-up the disease will reoccur. The patient must truly take responsibility for his or her own health.  

There are many other aids that are available to help with oral hygiene. These include small brushes that can clean spaces between the teeth (proxibrushes) and threaders to guide floss under bridges (floss threaders). Toothpicks may be recommended to help clean furcations. Each patient is individually assessed to see what may help optimize their cleaning efforts.

Because periodontal disease is an infection, it may cause bad breath. Elimination of the infection and good daily brushing and flossing is needed to stop this problem.

However, it is interesting to note that some people with chronic bad breath have healthy gums. We now know that most halitosis (bad breath) is caused by bacteria on the back of the tongue breaking down mouth proteins into odor causing compounds.

Vigorous tongue scraping will help with bad breath, but for some people this is still not enough. Specialized testing and treatment is available for those patients and complete elimination of the problem can be expected, in most cases.

Please Click Here for our Brushing and Flossing Guide

It’s All About Perio Maintenance

Periodontal Therapy involved many types of treatment including probing, scaling, irrigating, surgery, laser treatment and perio maintenance. Some or all of these activities are necessary to arrive at a successful clinical outcome; however only one of them determines the longevity of our successful treatment results. It’s all about perio maintenance!

Periodontal disease is a chronic bacterial infection that requires ongoing therapy. When we achieve disease resolution, the patient is in remission – not cured. Because the bacteria almost always come back, the disease is just stabilized. The treatment we undertake is designed to achieve disease control. It is not a one and done treatment.

Ongoing therapy is required. Effective homecare is requires daily to control the bacteria. Plaque bacteria live in a sticky film that prevents the irrigation access to them. The plaque colonies must be broken up first by cleaning between the teeth and brushing to allow antiseptics in the irrigator access to the individual bacteria.

Periodontal maintenance by a hygienist is required every three months for most patients. Periodontists, dentists and hygienists have the primary role in diagnosis and treatment but the patient has the primary role in maximizing the longevity of successful treatment results. It is critically important that patients understand their role. Without patient compliance, we will never be able to achieve long lasting, favorable results. Without effective maintenance and home care, the disease will recur every time. With proper maintenance and home care your smile can definitely last a lifetime.

Call “The FBI”

Controlling or eliminating the bacterial infection in your mouth is the key to keeping your smile for the rest of your life. We recommend The FBI method, a simple, easy to remember and effective homecare regimen.

Tongue Cleaning

First, we suggest cleaning the tongue (T) once a day. The tongue is like a shag rug and harbors lots of infectious and smelly bacteria. We suggest using a tongue scraper first and then brushing the tongue, concentrating on the very back. This will help prevent the infection from spreading to your gums or to other people and will also prevent bad breath.


Flossing is the only way to remove plaque from under the gum, between the teeth. Because most periodontal disease starts between the teeth, flossing is even more important than brushing. Mouthwashes do not replace the need for flossing. Good flossing is a skill that takes practice, but nothing can replace it in preventing periodontal disease. When learned, it should only take about 2-3 minutes a day. When flossing it, is important to slide the floss completely under the gum, wrapping around the tooth as far as possible.

After you have brushed your tongue, then remove or disrupt the bacteria between your teeth. The best device is floss (F). There are many types of floss and all are acceptable, although we prefer the traditional unwaxed. Many people have trouble flossing. Other alternatives are interproximal brushes, rubber tips, stimudents, or toothpicks. Floss holders will help some people. Regardless of the method, it is very important that the bacteria between the teeth be disrupted at least two times per week because this is where most gum infection occurs.

How to Floss

Brushing removes the bacterial plaque from the sides of the teeth, but no brush is able to go between the teeth and under the gums. Unfortunately this is where most periodontal disease started, so it is critical to remove plaque from these areas. Flossing is the most important contribution you can make to your own oral health. To learn to floss properly takes time and patience, and most patients feel awkward flossing at first. However, once learned it is an easy task that you will enjoy because your mouth will feel cleaner than ever before. It is not important when you floss, only that you do it at least once a day. Because it is not necessary to rinse when flossing, many patients find that after learning the technique they can floss while watching television. First break off an 18-inch length of floss (about the length of your forearm). Wrap the floss around your middle fingers, allowing enough room to control the floss with your index fingers and thumbs. Gently slide the floss between two teeth, allowing it to pass through the contact of the two teeth. Many people think this is the stopping point, but it is only the preliminary step. Once the floss “breaks the contact” slide it between the gum and one of the teeth as far as it will go, without causing discomfort. The floss is moved up and down several times, until the plaque is dislodged. When you hear the floss “squeak”, the tooth surface is clean. Don’t remove the floss, but rather slide the floss against the other tooth and repeat the procedure. Once the floss has cleaned between the two teeth, move to the next contact and repeat the procedure until all teeth have been flossed. At first, it may take 10-15 minutes to complete the mouth, but on you become proficient, flossing should take less than 5 minutes. This is the best investment of time you can make toward your oral health.


The next step involves brushing (B) the inside and outside surface of the teeth with special focus on where the teeth and gums meet. Almost all soft brushes are acceptable. Most electric powered brushes are excellent. It is most important to brush about two minutes and these brushes have timers. A problem with brushing is using too hard a brush and /or brushing too hard or too frequently. This causes recession, wear grooves and sensitivity in the teeth. Always brush more on the insides surfaces and gently in areas on the inside surfaces and gently in areas of recession.

We suggest “Total” toothpaste which contains the antiseptic triclosan as well as fluoride and has been shown to reduce gingivitis, caries and calculus. We do not recommend Mentadent since it is abrasive and has only 5% baking soda. Is cavities are a problem, we suggest Prevident or Clinpro toothpaste which will help remineralize the cavitities. If sensitive roots are a problem, we recommend identifying acids in the diet and reducing them, i.e. citrus, vinegar, peppers, tea, etc. Using Crest Sensitivity toothpaste or Sensodyne toothpaste can help with this. We also have other treatment that can help too. Professional whitening is available from your general dentist. This does the best job.

How to Brush

The object of brushing is to remove plaque from the tooth surface and from under the edge of the gum and placing the bristles in the sulcus is important when brushing. Also remember that brushing cannot access plaque that forms under the gum’s edge between the teeth and flossing is needed to complete that important step of oral hygiene. Use the toothbrush at a 45 degree angle on the tooth, allowing the bristles to slide between the tooth and gum, to clean plaque hidden in the sulcus. This allows the bristles to slide under the gum reaching the plaque. Think of sliding a broom under the edge of a refrigerator to remove dirt. The brush should not be scrubbed back forth but rather in a circular motion. This allows the bristles to remain under the gum’s edge and also prevents wearing the gum.When all the teeth have been brushes under the edge of the gum, the top surfaces can be brushes. Brush the cheeks and tongue as well, for plaque forms throughout the mouth.  Remember that brushing does not clean between the teeth and that flossing is needed to complete your daily oral hygiene.


The last step is using a Water Pik or a Hydro Floss to irrigate (I). We recommend holding the tip between the teeth (pointing up for the upper teeth and down for the lower teeth) for a length of time of 10 second to allow an antiseptic to get beneath the gum where the real focus of infection occurs. Almost all people with periodontal disease will benefit from irrigation. There are several potent antiseptics we can recommend. For mild problem, Listerine or baking soda can be put in the water. It is very important that the irrigation be done last after the bacterial plaque has been loosened by flossing and brushing.

Please Click Here for our Water Pik Instructions

The FBI sequence for homecare is a powerful attack on the bacteria and will help you save your smile and have pleasant breath for a lifetime.

Please Click Here for our FBI Guide