We learn to take care of our teeth when we are youngsters. By adulthood, our main objective when brushing is to finish as quickly as possible, often neglecting proper form, flossing and fluoride. You may think cavities only occur in children. Think again! Plaque, the cause of tooth decay and periodontal (gum) disease, is present in everyone of every age.

Concentrate on cleaning
Chances are, you aren't brushing as well as you could. Cyn-Dee Sweetser, a clinical hygienist with more than 20 years of experience, says, "The correct way to brush is thoughtfully, thoroughly and in small increments. Avoid daydreaming, avoid putting your brain on automatic pilot, and concentrate on brushing." It's difficult to stop drafting grocery lists in your head, but for the sake of your health you need to focus on teeth and gums, not bread and milk.

We've all been taught to brush from the gum towards the tooth, but that's just the beginning. "Start somewhere on one tooth and keep track of where you need to go next. Your technique should include each tooth surface, giving priority to the gumline area. Avoid long strokes that target many teeth at once. Instead, aim for one tooth at a time with a soft brush that flexes into the nooks and crannies between the teeth," says Sweetser.

Most adults should brush for approximately two minutes, which isn't as interminable as it sounds when using good technique. Remember to use a gentle hand or you may end up with receding gums, resulting in tooth sensitivity and a higher susceptibility to decay.

Most adults do not brush as often as they should. It seems impossible to make time for brushing when you're rushing out the door in the morning, scrambling to get back to work after lunch, or dreaming of your comfy bed at night. Slow down and make the time. Sweetser says, "In general, frequency of brushing should match frequency of eating. You can prevent cavities within 20 minutes of eating." Take a pro-active stance, and you may never have to get a cavity filled.

No matter now tired you are, don't skip that last brush of the day. Dr Carl J DiGregorio, a dentist in a large group practice specializing in periodontics, prosthetics and restorations, says "Generally speaking, dental decay is a nighttime disease, and it's preventable. Some people have to work harder at it, but it's preventable."

The necessary extras
Brushing alone will not keep your teeth and gums healthy. Sweetser says, "The tissues between the teeth need extra attention. Somehow, this tissue needs stimulation or, like a muscle, it will atrophy." Enter, daily flossing. "Flossing is an efficient way to massage the gum, blanch the tissue, and introduce oxygen."

Healthy gums are pink and firm, and flossing should not hurt. If your gums are red, swollen, and bleed easily, you may have gingivitis, an early stage of periodontal disease, which you can usually eliminate with increased brushing and flossing.

Flossing also helps prevent tooth decay. Dr DiGregorio says, "The floss rids the interproximal areas (contact points between teeth) of the adhesive plaque that is present in everyone after every meal." The main point, says Dr DiGregorio, is to get the plaque away from the margin of restorations and away from where the teeth contact because decay between teeth usually starts just below that contact point, and the plaque is readily removable with floss.

Fluoride is an important, though generally ignored, aspect of good oral hygiene in adults. "Topical fluorides soak into the pores of the teeth microscopically and strengthen the teeth. They are especially helpful for desensitizing exposed root surfaces and around open margins of old fillings." Use oil-based mouthwashes or prescription-strength gels for the most effective fluorides, says Sweetser. "Fluoride is a finishing product that should follow brushing and flossing," says Sweetser. Pay attention to the package directions because fluoride needs to be applied to the teeth for a specific amount of time.

Many people use a pre-brush rinse, but Sweetser has little confidence in the product. "Pre-brush rinses can be motivational, as some of my patients like the feel and taste, but this psychological benefit is the only benefit I am aware of. Plaque is loosely attached to the teeth. It requires strategic friction to dislodge, but not pressure and chemicals."

The mistakes we make
Next time you have your teeth cleaned, which should be at least every six months, take note of where your hygienist lingers with her scaling implement. According to Sweetser, hygienists spend the most time removing calculus (tartar) from the back of the lower front teeth, due to the proximity of a source of calcium and other minerals, the lingual gland under the tongue.

Calculus alone does not cause gum disease or decay, but it does provide a rough attachment surface for plaque. Heavy brushing will not remove the calculus, so don't bother; you'll only harm your gums. Only a professional can safely remove calculus and return the tooth to its natural smooth surface, allowing for easier home maintenance. At home, Sweetser advises focusing on removing the soft outer layer of plaque to prevent decay and disease.

Sweetser notes the areas most often neglected while brushing are the hard-to-reach surfaces of the lower molars beside the tongue. While flossing, people usually avoid the tightest contacts between the upper molars. These are also the most common areas of periodontal disease.

Special precautions for women
As Dr DiGregorio said, some people need to work harder to prevent decay and disease. "Pregnant women have to be extra cautious about massaging their gums," says Sweetser. "During pregnancy, the body is focusing on sharing nutrients and energy with the developing baby. Fighting gum disease takes a back seat." Sweetser notes the presence of plaque in a pregnant woman's mouth can lead to swollen, tender gums and, occasionally, pregnancy tumors (red, raspberry-like lesions) between the lower front teeth. Keep the gum area clean and healthy with frequent brushing and flossing.

Sweetser advises pregnant women with morning sickness to be aware of cavities along the gumline. The regurgitated stomach acids cause decalcification of the enamel of the teeth, which manifests itself in a chalky white ring at the gumline. "Chalky white patches are the first sign of decay and should be monitored carefully by a professional," says Sweetser.

Pregnant women should have their teeth cleaned every four months. Sweetser also recommends increasing home care effort and using a daily fluoride rinse.

Women on oral contraceptives have issues similar to pregnant women. The hormones in birth control make the body think it's pregnant, causing oral hygiene repercussions like tender, bleeding gums. Sweetser recommends increased diligence at home and cleanings every three to four months.

Women suffering from bulimia experience the same decalcification as pregnant women with morning sickness. Sweetser suggests increasing the frequency of X-rays (not advised for pregnant women) to catch new decay in its early stages, making it easier to repair. "Gumline cavities can progress deep into the center of the tooth, rapidly requiring expensive root canal procedures. Women with bulimia often develop many areas of decay at once."

With a little bit of patience and effort, you can have the healthiest mouth possible. Frequent, thorough brushing and daily flossing and fluoride keep your mouth free of decay and disease.

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