Home-care instructions and products

The information below is general information.  The use of various products should be part of a regimen prescribed by the dentist or hygienist that is specific to your individual needs.  In our office, we microscopically monitor the bacterial activity of our clients’ mouths and perform other diagnostic procedures which then allow us to provide an effective home care regimen suitable to the particular need.

The office of Dr. McBride shall not be held liable if the recommendations made here are not helpful to you or cause adverse reactions.  Everyone should be careful to get recommendations in person following an examination by Dr. McBride or the hygienist.

What is the best technique for brushing? 
There are a number of effective brushing techniques.  Patients are advised to talk with Dr. McBride's hygienist to determine which is the best one for them since tooth position and gum condition vary.  One effective, easy-to-remember brushing technique involves using a circular or elliptical, vibrating motion to brush a couple of teeth at a time, gradually covering the entire mouth.  Place a toothbrush beside your teeth at a 45 degree angle, aiming into the gum space and gently brush teeth by vibrating the toothbrush bristles. It is important not to scrub, let this motion be a focused vibration.  Following the vibrations, swipe in the direction away from the gum, on the teeth, to wipe away the loosened plaque.  Move around  the cheek-side of the teeth, the tongue-side of the teeth, scrub the chewing surfaces and scrub your tongue.  Using a back and forth scrub motion on or aroung the gum causes the gum surface no recede, or can expose the root surface or make the root surface tender.  You also risk wearing down the gum line. Read on for how long to brush.

How long should I brush?
It might he a good idea to brush with the radio on, since dentists generally recommend brushing 3-4 minutes, the length of an average song.  Using an egg timer is another way to measure your brushing time.  Patients generally think they're brushing longer, but most spend less than a minute brushing.  To make sure you're doing a thorough job and not missing any spots, patients are advised to brush the full 3-4 minutes twice a day instead of brushing quickly five or more times through the day.

Should I brush at work?
Sure, but most Americans don't brush during the workday.  Dentists say it's a good idea to keep a toothbrush in your desk, which increases the chances that you'll brush during the day by 65 percent, according to a recent survey released by Oral-B Laboratories and the Academy of General Dentistry.  Getting the debris off teeth right away stops sugary snacks from turning to damaging acids, and catches starchy foods like potato chips before they turn to cavity causing sugar.  If you brush with fluoride toothpaste in the morning and before going to bed, you don't even need to use toothpaste at work.  You can just brush and rinse before heading back to the desk.  If you don't have a toothbrush, rinsing your mouth with water for 30 seconds after lunch also helps.

The bottom line:  there's no real rules about what tool to use to disrupt and destroy bacteria, just how often to do it.  Research has shown that however you can reach every little spot of plaque (every square millimeter) hiding under the gum, between the teeth, on the teeth, on the tongue, all around, you will be successful, if done 2 times per day.  The goal is to kill bacteria and not leave any untouched.  They reproduce so quickly that you'll develop or harbor an infection where untouched plaque sits.  Of course, a tooth brush will cover a lot more surface area than floss, but a toothbrush can't go where floss can go, and vice versa.  So choose a multi-tooled approach and don't rely on your toothbrush alone.

Toothbrushes
Angled heads, raised bristles, oscillating tufts and handles that change colors with use: you name it, toothbrushes come in all shapes, colors and sizes, promising to perform better than the rest. Although the latest generation of powered toothbrushes are showing good results in studies, the only thing that matters is that whatever you brush your teeth with is effective for you.

Which toothbrush is best? Soft or hard bristles?
In general, a toothbrush head should be small (1" by 1/2") for easy access. It should have a long, wide handle for a firm grasp.  It should have soft, nylon bristles with round ends. Some brushes are too abrasive and wear down teeth or gums.  A soft, rounded, multi-tufted brush can clean teeth effectively.  Press just firmly enough to reach the spaces between the teeth and between the teeth and gum sulcus.  Medium and hard bristles are not recommended.  Remember you are removing and disrupted bacteria from soft, sticky plaque.  The hard deposits that can form called calculus (tartar) are not removable by any toothbrush or brushing technique.

When should I change my toothbrush?
Be sure to change your toothbrush, or toothbrush head (if you are using an electric toothbrush) before the bristles become splayed and frayed.  Not only are old toothbrushes ineffective, but they may harbor harmful bacteria that can cause infection such as gingivitis and periodontitis.  Toothbrushes should be changed every three to four months.  Sick people should change their toothbrush at the beginning of an illness and after they feel better.

Electric vs. manual toothbrushes
Some electric toothbrushes work better than manual toothbrushes for some people, and they can motivate some reluctant brushers to clean their teeth more often.  The whizzing sounds of an electric toothbrush and the tingle of the rotary tufts swirling across teeth and gums often captivates people who own electric toothbrushes.  They are advantageous because they can cover more area faster.  Electric toothbrushes are recommended for people who have limited manual dexterity, such as a disabled or elderly person and those who wear braces.

Sometimes, it takes more time and effort to use an electric toothbrush because batteries must be recharged, and it must be cleaned after every use.  Most electric toothbrushes have rechargeable batteries that take 10 to 45 minutes to recharge.  The gearing in an electric toothbrush occasionally must be lubricated with water.  Prices range from $30 to slightly over $100.

How do electric toothbrushes work?
Electric toothbrushes generally work by using tufts of nylon bristles to stimulate gums and clean teeth in an oscillating or rotary motion.  Some tufts are arranged in a circular pattern, while others have the traditional shape of several bristles lined up on a row.

When first using an electric toothbrush, expect some bleeding from your gums.  The bleeding will stop when you learn to control the brush and your gums become healthier.  Children under 10 should be supervised when using an electric toothbrush. Avoid mashing the tufts against your teeth in an effort to clean them.  Use light force and slow movements, and allow the electric bristle action to do its job.

Sonic technology is the latest in electric toothbrushes.  A sound wave is transmitted which causes the bristle to vibrate at 30 to 31 thousand vibration per minute!  So you definitely want to just hold the brush still aiming at an angle toward the gumline and let the brush do the work for you.

How long have toothbrushes been used?
The first toothbrush was invented in China in 1000 A.D.  It was an ivory-handled toothbrush with bristles made from a horse's mane.  Toothbrushes became popular in the 19th century among the Victorian affluent.  Mass marketing and the advent of nylon bristles in the 20th century made toothbrushes inexpensive and available to everyone.

Don't forget . . .
Visit your dentist regularly because toothbrushing and flossing is most effective with periodic checkups and cleanings.  Ultimately, the best toothbrush is the one which best fits your personalized gum health program established between your hygienist and yourself.

 Sources: "The Plaque Fighters: Choosing a Weapon," Journal of the American Dental Association; April 1993; "Basic brushing," American Dental Association, 1991; "Oral Hygiene Homecare," Clinical Research Associates Newsletter, August 1986; "Update of Oral Hygiene Aids: Toothbrushes," Dental Health, 1992/3; "Oral Inflammatory Disease and the Toothbrush," Journal of the Alabama Dental Association, Fall 1993; "Toothbrush Age and Wear as it Relates to Plaque Control," Journal of Clinical Periodontology; Jan. 1986; "A Guide to Good Dental Care, " Consumer Reports, September 1992; "The End-tuft Brush for the Partially Edentulous Patient," Journal of Prosthetic Dentistry, August 1984; Howard S. Glazer DDS, FAGD; general practitioner The Bronx, New York

Toothpaste: Putting the Squeeze on Dentifrice
Why is brushing with a dentifrice so important?
Brushing with tooth paste or powder (also called a "dentifrice") is important for several reasons.  First and foremost, a dentifrice and a correct brushing action work to remove plaque, a sticky, harmful film of bacteria that grows on your teeth that causes caries (cavities), gum disease, and eventual tooth loss if not controlled.   Second, the dentifrice contains fluoride, which makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage can even be seen. Third, special ingredients in the dentifrice help to clean and polish the teeth and remove stains over time. Fourth, toothpastes help freshen breath and leave your mouth with a clean feeling.

What type of dentifrice should I use? 
It is our personal opinion, here at Dr. McBride's office that tooth powder is best.  We have observed reports that indicate that the ingredients in toothpaste either contain no antibacterial agent at all (and we know bacteria to be the main source of all dental diseases) or dilute the active antibacterial agent with ingredients like foaming agents, binding agents, gums and preservatives that you can do without.  The ingredients in tooth powder are 94% sodium bicarbonate (baking soda--a very effective antibacterial agent if undiluted) and 6% mint and fluoride.  We see it prove itself over and over with our clients and believe in it so much, we give our client's a grocery store sized box upon every hygiene appointment.

If you prefer not to use powder, or demonstrate healthy gums without the use of powder you can choose just about any toothpaste that contains fluoride, the brand you buy really does not matter, whether or not it is in paste or gel, or containing a certain flavor.  All fluoride toothpastes work effectively to fight cavities and clean and polish tooth enamel.  Your dentifrice brand should also bear the ADA (American Dental Association) seal of approval on the container, which means that adequate evidence of safety and efficacy have been demonstrated in controlled, clinical trials.

If your teeth are hypersensitive to hot or cold, consider trying a toothpaste designed for sensitive teeth.

If you get canker sores frequently avoid a toothpaste containing sodium lauryl sulfate (the foaming agent) which has been known to trigger these types of sores.

Even though toothpastes containing baking soda and/or hydrogen peroxide (which are both good cleansing agents alone) give the teeth and mouth a clean, fresh, pleasant feeling that can offer an incentive to brush more, the fluoride is the true active ingredient at work protecting your teeth.  And these agents are too diluted to be as effective as mixing hydrogen peroxide with tooth powder.

Some prefer a tartar control toothpaste containing pyrophosphates to prevent the buildup of calculus deposits on their teeth.  Unless you really build chunks of tartar on your teeth despite the adherence to regular check-ups and cleanings with the hygienist, we recommend avoiding tartar control agents.  It has been found that when harmful bacterial acids have penetrated into a tooth surface forming the start of a cavity, there is a component in saliva that can counteract this acid and bring about remineralization of the tooth structure.  But tartar control chemicals inhibit this chemical reaction to occur.  This is because it is designed to prevent the acid from combining with this salivary component because these are also the chemicals that form tartar.  Personally, we would rather see the hygienist a little more often to remove tartar build-up than risk the formation of a cavity.

New pastes offer advanced whitening formulas aimed at safely removing stains to make teeth brighter and shinier, although they can't nearly match the effectiveness of a professional whitening formulas administered or prescribed by a dentist.  This is because whitening toothpastes are designed to scour off surface stains, and can incidentally be very abrasive.  Whitening systems at home are designed to draw out stain from within teeth's enamel microtubules.  We recommend professional whitening systems over whitening toothpastes for your safety.

How much should I use? 
If you are using the tooth powder, dispense a teaspoonful amount into the palm of your hand (not the one you'll use to brush with).  Get your toothbrush bristles wet (with water or hydrogen peroxide), shake off the excess, wiggle your brush into the powder so that it clumps on the end of your brush.  Then begin to brush as usual.  As you make your way around the teeth, keep picking up fresh amounts of powder until you have used up the spoonful. (If you are able to save a little for when you scrub your tongue, it will help freshen your breath.)

Contrary to what toothpaste commercials show, the amount of paste or gel needed on your brush for effective cleaning does not have to be a heaping amount.  Simply squeeze on a pea-sized dab of paste on the top half of your brush.  If you brush correctly holding the toothbrush at a 45-degree angle and brush inside, outside and between your teeth, the paste should foam enough to cover all of your teeth.

Children under six, however, should be given a very small, baby pea-sized dab of dentifrice on their brush.

Is brushing with toothpaste enough to fight cavities and gum disease? 
No.  Although brushing thoroughly after each meal helps, flossing your teeth every day to remove plaque and food particles between teeth and at the gumline is just as important. Studies show that plaque will regrow on teeth that are completely clean within 3 to 4 hours of brushing.

 Sources: Consumers smile on Unilever s Mentadent, Laura Bird, Wall Street Journal, May 31, 1994; Comprehensive Dental Hygiene Care, edited by Irene Woodall, Mosby-Year Book Inc., 1993; Fluoride helps prevent tooth decay, American Dental Association, 1993: Dentifrice use among preschool children, by Steven M. Levy, DDS, et. Al., JADA, Sept. 1993; Clinical and Biological Aspects of Dentifrices, edited by G. Embery and G. Rolla, Oxford University Press, 1992.

Facts on Flossing
Plaque is a sticky layer of material containing germs that accumulates on teeth, including places where toothbrushes can't reach. This can lead to gum disease.  The best way to get rid of plaque is to brush and floss your teeth carefully every day.  The toothbrush cleans the tops and sides of your teeth. Dental floss cleans in between them. Although people try to substitute floss with oral irrigators (Waterpik, for example), tooth picks, and powered flossing devices, regular floss is the best choice.   

Should I floss?
Yes.  Floss removes plaque and debris that adhere to teeth and gums in between teeth, polishes tooth surfaces, and controls bad breath.  Floss is the single most important weapon against plaque, perhaps more important than the toothbrush.  Flossing teeth that are unencumbered by bridgework or bonded wire retainers can be flossed in 90 seconds or less.  Don't be intimidated by floss, many people were never taught how to floss, we understand that, so ask us to show you how.

Which type of floss should I use?
Dental floss comes its many forms: waxed and unwaxed, flavored and unflavored, wide and regular. Wide floss, or dental tape, may be helpful for people with a lot of bridgework.  Tapes are usually recommended when the spaces between the teeth are wide.

They all clean and remove plaque about the same.  Waxed floss might he easier to slide between tight teeth or tight restorations.  However, the unwaxed floss makes a squeaking  sound to let you know the teeth are clean.  Bonded unwaxed floss does not fray as easily as regular unwaxed floss, but does tear more than waxed floss.  There is a product that uses teflon which can glide between the teeth easily for crowded teeth, it resists fraying but can snap apart.

Use whatever product is easiest for you, and if unwaxed is no problem, go for it!  The important thing is to hit those plaquey deposits once or twice in 24 hours to keep the bacteria from getting a chance to recover and repopulate.  Each time you squish a piece of plaque you will kill the up to 90% of the bacteria in that piece.  But they will get busy, so you have to get be ready to attack again.

How should I floss?
There are two flossing methods: the spool method and the loop method. The spool method is suited for those with manual dexterity.  Take an 18-inch piece of floss and wind the bulk of the floss lightly around the middle finger.  (Don't cut off your finger’s circulation!).  Wind the rest of the floss similarly around the same finger of the opposite hand.  This finger takes up the floss as it becomes soiled or frayed.  Maneuver the floss between teeth with your index fingers and thumbs.  Don't pull it down hard against your gums or you will hurt them.  Don't rub it side to side as if you're shining shoes.  Bring the floss up and down several times forming a “'C”" shape around the tooth being sure to go below the gum line.

The loop method is suited for children or adults with less nimble hands, poor muscular coordination or arthritis.  Take an 18-inch piece of floss and make it into a circle.  Tie it securely with three knots. Place all of the fingers, except the thumb, within the loop.  Use your index fingers to guide the floss through the lower teeth, and use your thumbs to guide the floss through the upper teeth, going below the gumline forming a "C" on the side of the tooth.

How often should I floss?
At least once a day.  The important thing is to hit those plaquey deposits once or twice in 24 hours to keep the bacteria from getting a chance to recover and repopulate.  Each time you squish a piece of plaque you will kill the up to 90% of the bacteria in that piece.  But they will get busy, so you have to get be ready to attack again.  Flossing teeth that are unencumbered by bridgework or bonded wire retainers can be flossed in 90 seconds or less; in some situations it could take a few minutes.

What are floss holders?
You may prefer a floss holder, which often looks like a little hacksaw.  Floss holders are handy for people with limited dexterity for those who are just beginning to floss or for caretakers who are flossing someone else's teeth.  It can be difficult to wrap around the teeth in a C-shape fashion, but try.

Is it safe to use toothpicks?
Toothpicks are effective at removing food between teeth and around the gumline, but not as a replacement to floss.  Toothpicks come round and flat, narrow and thick.  When you use a toothpick, don't press too hard as you can break off the end and lodge it in your gums.  There are holders designed to insert toothpicks into, tighten and break off the long end so you can have access to the tongue side of the teeth.  Some hygienists swear by the cleanliness and healthiness that results from routine toothpicking.  Just be careful not to wear away at the gum with your toothpicks.

Do I need a water-jet irrigator (Waterpick, Viajet or Hydrofloss)? 
They are not intended as a substitute for toothbrushing and flossing.  But they are effective around orthodontic braces, bridgework and periodontal pockets that retain food in areas a toothbrush cannot reach. However they do not remove plaque very well.

Persons with gum disease (periodontal pockets) benefit most from the ability to saturate the pocket with an anti-bacterial agent.   Solutions containing various antibacterial agents can be added to the reservoir of the irrigator .  For the purpose of a destroying bacteria that live in periodontal pockets, a mixture of 1 pint warm water with 1/4 teaspoon of non-scented Chlorine bleach is very effective and safe.  This mixture has been recommended for nearly 20 years by a very successful periodontist that Dr. McBride respects dearly.  We are happy to report that we have seen success with this formula too.  But please use caution, stick to the dilution recommended, and of course, discontinue use if an adverse reaction occurs and report it to Dr. McBride immediately.

Special tips may be required for the access of special areas.  Consult the hygienist for this recommendation.  Our office has these tips available to the Hydrofloss brand irrigators, if you own a Waterpik or Viajet we can provide you with a catalog to purchase the tips by mail.  

Our hygienist and her assistant are ready to show you how to use an irrigator properly.  They can also provide you with a easy to read chart of the areas that you want to aim for most.

What are the differences in Mouth rinses?
Rinses are generally classified by the U.S. Food and Drug Administration (FDA) as either cosmetic or therapeutic, or a combination of the two.  Cosmetic rinses are commercial over-the-counter (OTC) products that help remove oral debris before or after brushing, temporarily suppress bad breath, diminish bacteria in the mouth and refresh the mouth with a pleasant taste.  Therapeutic rinses have the benefits of their cosmetic counterparts, but also contain an added active ingredient that helps protect against some oral diseases.  Therapeutic rinses are regulated by the FDA and are voluntarily approved by the American Dental Association (ADA).

Therapeutic rinses also can be categorized into types according to use:  antiplaque/antigingivitis rinses and anticavity fluoride rinses.

Should I use a rinse?
That depends upon your needs.  Most rinses are, at the very least, effective oral antiseptics that feel fresh to the mouth and curb bad breath for a few minutes.  Their success in preventing tooth decay, gingivitis (inflammation of the gingival gum tissue) and periodontal disease is limited, however.  We do have a few products that we favor based upon research and our own experience with hundreds of satisfied clients.

Rinses are not considered substitutes for regular dental examinations and proper home care.  Preventive dentists that monitor the gum health of their clients, stress a regimen of flossing followed by brushing with a fluoridated toothpaste, along with prescribed office visits, which usually is sufficient in fighting tooth decay and periodontal disease.

Which type should I use?
Again, that depends upon your needs.  While further testing is needed, initial studies have shown that most over-the-counter antiplaque rinses and antiseptics aren’t much more effective against plaque and periodontal disease than rinsing with plain water.  Most dentists are skeptical about the value of these antiplaque products, and studies point to only a 20 to 25 percent effectiveness, at best, in reducing the plaque that causes gingivitis.  An unfortunate twist is that the products that contain alcohol can make your breath worse and encourage bacterial reproduction!  It is our recommendation that you read labels, and stay away from alcohol based products.

Anticavity rinses with fluoride, however, have been clinically proven to fight up to 50 percent more of the bacteria that cause cavities.  Nevertheless, many dentists consider the use of fluoride toothpaste alone to be more than adequate protection against cavities.

Dentists will prescribe certain rinses for patients with more severe oral problems such as caries (cavities), periodontal disease, gum inflammation, breath concerns and xerostomia (dry mouth).  Patients who’ve recently undergone periodontal surgery are often prescribed these types of rinses.  Likewise, many therapeutic rinses are strongly recommended for those who can’t brush due to physical impairments or medical reasons.

One of our favorite products is called Tooth and Gum Tonic made by the Dental Herb Company.  Research has shown this product to be the best breath control agent of all the products tested by the CRA (Consumer Research Association).  Dr. McBride was also impressed when he used the product.  Once we introduced it to our clients we found that many various infections that we were monitoring with our phase contrast microscope showed significant reductions in bacterial counts following proper use of the product.  Though this product isn't for everyone, it has sure been an integral part of our hygiene program.  The Dental Herb Company also makes a product called Under the Gum Irrigant Solution that is mixed with water into an irrigating device, designed to target bacteria living under the gum.  We and our clients have also been very pleased with the results of this product as well.

First, remember that any chemical is only good if it can touch the surface it's intended to alter.  If it's antibacterial, it must touch the bacteria; if it's anti-cavity, it must touch the tooth.  So if you have food stuck between the teeth with plaque underneath, the antibacterial rinse won't get there.  Or if your problem is periodontal disease (an infection that is under the gum), you can't expect the rinse to get there either.  It's like having dirty fingernails and swishing your hands in soapy water.  Be realistic as to what you can accomplish with a rinse and follow the advise of the hygienist.  After all, she may find on the microscope a type of bacteria that your rinse can't kill, so be flexible to switch your approach if necessary.

When and how often should I rinse?
If it’s an anticavity rinse, dentists suggest the following steps, practiced after every meal:  floss, brush, then rinse.  Teeth should be as clean as possible before applying an anticavity rinse to reap full preventive benefits of the liquid fluoride.  The same steps can be followed for antibacterial rinses, just make sure the anti-bacterial rinse you use is suited to the bacteria that reside in your mouth.

What is the proper way to rinse?
First, take the proper amount of liquid as specified on the container or as instructed by your dentist into your mouth.  Next, with the lips closed and the teeth kept slightly apart, swish the liquid around with as much force as possible using the tongue, lips, and sucking action of the cheeks. Be sure to swish the front and sides of the mouth equally.  Many rinses suggest swishing for 30 seconds.  Finally, spit the liquid from your mouth thoroughly.  Usually a rinse would become deactivate by water, so read labels before rinsing with water right after.

Are there any side effects to rinsing?
Yes, and they vary depending on the type of rinse.  Habitual use of antiseptic mouthwashes containing high levels of alcohol (ranging from 18 to 26 percent) may produce a burning sensation in the cheeks, teeth and gums, may cause sloughing of the cheeks and floor of the mouth feeling dry and encouraging bacteria to reproduce more quickly than if you hadn't rinsed at all.

Many prescribed rinses with more concentrated formulas can lead to ulcers, sodium retention, root sensitivity, stains, soreness, numbness, changes in taste sensation and painful mucosal (gum) erosions.  Most anticavity rinses contain sodium fluoride, which if taken excessively or swallowed, can lead over time to fluoride toxicity.  Because children tend to accidentally swallow mouthwash, they should only use rinses under adult supervision.  If you experience any irritating or adverse reactions to a mouth rinse, discontinue its use immediately and consult Dr. McBride.

How are vitamins a helpful component to dental health?
Vitamins are essential to our health and research has been suggesting that our food products are not as high in vitamins as before.  Stress is rising to a norm in our busy lives taking it's toll upon our immune systems.  And the fast food generation just isn't helping us to get well rounded meals regularly.

Vitamins can be supplemented.  Although you should do some investigating of your own to determine what vitamins are best for you.  It is recommended to choose vitamins that have been properly chelated for optimal absorption.  A physician or nutritionist may help you choose.

Here is a list of vitamins and dosages (for the average adult with systemic medical conditions) which have been reported to aid in the healing of periodontal infections:  Vitamin C at 1000mg, Vitamins B1, B2, B6 at 100 mg each, and the Co-Enzyme Q-10 at 100 mg each.  Consult your physician or discuss your situation with Dr. McBride if you think vitamins would help.  See Nutrition for more information.

Sources:  Available upon request from the office of Robert P. McBride, D.D.S.

Other Products?
There are many other products available and helpful for different conditions and situations.  If you have a question about a product or technique not mentioned here, please email us.  Our hygienist will return any available information to you at her earliest convenience.