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Time to save you some time and money, pHers - aka, how to take care of your teeth. submitted 2010.06.30 08:20 AM by Stixs viewed 2112 times

Let's talk about how important brushing and flossing are as a daily routine

Hey...HEY...pipe down down there and listen! This stuff is actually useful information!

"But Dr. Ben, we already brush once a week and floss once-a-never"

Exactly. Which is why a majority of you need some education on the subject.

Now, the reason I'm telling you all of this baffles me, since I'm literally just losing a large pool of potential clientele, but part of me wants to be nice this morning, at 6:30am, so dammit, here goes nothing.

Everyone's mouth is naturally full of bacteria. There are good bacteria that make chemicals that kill viruses/other bacteria, and help break down certain chemicals in your food...but there are also bad bacteria that break down sugars to release acid that destroys your teeth, or those that cause bad breath, or even worse, those that incite your immune system to start destroying your bone and gums to cause periodontal disease.

You're probably just being a smartass now and saying "Well, let's rinse with some antibiotics three times a day for a week and we'll be all good!"

False, and here's why

All of these bacteria live in a large culture ON your teeth and tongue called a biofilm. Biofilms are large collections of bacteria, often composed of 1000s of species, that attach to one another and the surface via glue-like molecules called adhesins (scientists aren't very clever). That doesn't seem like such a big deal, right?


Because these bacteria are in a biofilm, they all help one another out in varying ways. The bacteria all the way at the base of the film, attached to your tooth (not directly, but I'm not going to get into what a Pellicle is and how it works...suffice to say, you don't need to know) are almost turned off. This means that they don't even metabolize antibiotics so they will never die. They also have such a firm attachment to the tooth that they have to be physically removed. This is incredibly important, too, in helping keep the biofilm growing because they produce gazillions of adhesin molecules and glue together other, worse bacteria. (In case you're curious what bacteria these are, they're most commonly Streptococcus sanguinis and Streptococcus gordonii). This biofilm, btw, is called "Plaque," which can later absorb calcium from your saliva and diet and become Calculus (Tartar), which is pretty bad news bears...

Next up, you get an attachment of myriad other bacteria...and most of them tend to be the 'bad bacteria.' These bacteria are particularly adept at making antibiotic chemicals and dispersing them throughout the entire biofilm (one HUGE reason antibiotics do not work against biofilms other than the physical limitation of being absorbed). These bacteria also serve as a basis of secondary attachment of all the rest of the biofilm building up, particularly Fusobacterium nucleatum, which is literally just a slut bacteria that attaches to every and any bacteria...it's a little social butterfly with self-esteem issues. Some other notable bacteria here that are known to cause disease are those that are almost always linked to gingivitis, Actinomyces israelii and Actinomyces naeslundii.

At this point, the plaque biofilm has only been around for a few hours. Yes. A few hours. Plaque forms on your teeth within seconds to minutes after brushing, especially if you provide a nice food intake for the bacteria. This is why you cannot brush just once a day. Keep reading.

Assuming you give the biofilm enough time to grow, within a day or so, the 'bad bacteria' decide to come out and play. They're very specific about where they grow, and most prefer to live on the surface of a thick biofilm, some even prefer to live in the little pocket between your gums and teeth (the periodontal pocket). They are known to cause periodontitis, in which your gums and bone degrade because your immune system recognizes a threat and just carpet bombs the area, destroying anything in the way, your own tissue included. The culprits behind this are Treponema denticola, Tanerella forsythia, and Porphorymonas gingivalis. They are especially good at eliciting an immune response because they egg on the immune system by producing toxins and chemicals that attract the immune cells. The toxins kill the cells and the chemicals (known as chemo-attractants) attract them into their untimely death...this is how you get pus in your gingival pocket (pus is just dead bacteria and immune cells). You *will* develop periodontal disease with a few weeks of sparse/no brushing, so don't be surprised if you develop it eventually when you brush only once/day. There have been numerous studies where participants were asked to stop brushing for 21 days, after all being brought down to the same baseline of completely clean teeth (3x/day professional cleaning for a week). ALL of them developed some form of periodontal disease within 21 days, and in all cases, it was reversed by brushing/flossing correctly. No joke.

One thing you should know - Treponema denticola is a spirochete and is related to the spirochete that causes syphilis. Just FYI. No biggie...

Tooth Brushing Break, you know you want to

So, for any of you that paid attention in biology, you may have noticed that in the bacteria that I mentioned, there was a shift from being Gram Positive to Gram Negative. If you know what that meant, you know the significance. For those of you that don't, it is VERY BAD. Gram Negative bacteria are notorious for how much disease they cause and how much havoc your body wreaks trying to fix it. You do NOT want a Gram negative infection, and yet you have one happily proliferating on your teeth if you don't brush.

So you now understand how important brushing is - if it is done correctly, it will physically and mechanically remove the plaque - the ONLY proven way to remove it.

What about flossing?

Unless your teeth are an inch apart each, I'm betting you can't get your toothbrush between teeth - that's where floss comes in, to physically scrape the plaque between your teeth off. It is also somewhat useful at getting *some* plaque from your pocket, but only between teeth.

"What about my electric toothbrush? It removes up to 99.856% of interproximal plaque"

Marketing gimmick. Just floss your damn teeth, OK?

So, what's the best way to brush? I recommend to all my patients a 2-minute variation of the Bass-Technique. I'm including an image below that outlines/details it, but remember to do about 20 strokes for every 3-4 teeth, on all tooth surfaces (outside, chewing, inside) and try extra hard to get behind the last molar on your upper arch.

You also have to go to the dentist twice/year, at least, to get any of the plaque that's sitting in the pockets out, because that's also something that is nearly impossible to get with a toothbrush.

So, I hope everyone learned a valuable lesson about the importance of brushing/flossing!

Time to shower, brush my teeth, and go deal with crabby old people and squirmy little kids all day!

Dr. Ben, over and out.

rating: 8

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