Told You So

 

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You think the floss is effective? In most cases it is not.

I couldn’t hide my satisfaction when I read the news in the US about effectiveness of the floss. Finally something I have been preaching about is out and in the open for everyone to read.

You see I have met many dental professionals who have doubted my way of giving oral hygiene instructions especially regarding the floss. I have met so many of them that I have stopped explaining the reasons behind my recommendations.

My hope has been that some day they would get enough experience to notice that the floss isn’t doing a proper job. Or that they would start using the disclosing solution (I use Rondell Disclosing Pellets) which would definitely prove it.

We’ll see what happens. My fear is that many will stubbornly stick to their old ways. Change will always bring along resistance.

If you haven’t read my blog before, please take a look at this page about my recommendations.

And click this link if you haven’t read the news about the effectiveness of floss yet.


You might also like:

Told You So, Part II

Told You So, Part III

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Do You Recommend Toothpick?

Dental Revelations Blog-24529

Toothpick or no toothpick, that is the question!

I will once again return to the times when I was a student in dental school and knew only little of the dentistry.

We were learning about cariology and were advised to bring in dental radiographs (x-rays) if we had any. I had had a panoramic radiograph taken recently and the teacher – a specialist in cariology – took a look at it. He said to me:

“You should use a toothpick”

I was very surprised and said to him that there is no way I can fit the toothpick in between the teeth. He showed me from my x-ray that there is enough space between the teeth for the toothpick. But I was not convinced (thought that he was wrong) and carried on using a floss for many years to come.

The reason why this occasion came to my mind was that I was reading through health and dental blogs to get ideas for my next topic and I ran into several blogs that wrongly advice people against using a toothpick. I got this certain annoyed feeling inside of me and I knew I had to write about it.

Toothpick Widens the Gaps Between the Teeth and So It Is Supposed To

I have worked with many periodontists and learned that floss is not – by far – the right tool when we try to tackle the gum disease. It does no massaging for the gums which is needed when we try to make the gums firmer around the teeth (plus it won’t remove all the bacteria). When the gum gets firmer it shrinks and leaves less space for the bacteria to hide and cause the disease.

When I moved abroad I very quickly understood that a toothpick was not considered to be a good tool for cleaning between the teeth. I received wondering commentary from my colleagues when they realised I am recommending it. It was considered to be old-fashioned, ineffective and even harmful to the gum. I had to explain the reasons for recommending it again and again:

“The toothpick – the triangle-shaped wooden one –  works well initially when the patient has inflamed and swollen gums. It is cost-effective, easy to use and effective in massaging the loose gum. Once the gums have healed and firmed up we can determine better which sizes of interdental brushes are the best ones to use.”

The patients often fear that whatever they are using to clean between the teeth will widen the gaps. I tell them that it might actually happen but in that case it is only a good sign. I explain to them – with their x-rays – that the bone levels will determine how much the gaps between the teeth will widen.

If the bone around the tooth has receded as a result of the bacteria presence and inflammation and there is swollen and loose gum on top of it, it is an unhealthy situation and will result in more bone loss eventually. The gum needs to be firm on top of the bone so that it can better resist the bacteria.

And the only way to get firm gum is by massaging it. This can be done with the triangle-shaped wooden toothpick by pushing it gently but firmly between the teeth as far as it goes and repeat it couple of times. If there is bleeding at first it is also a good sign – the toothpick is doing its job. The bleeding will stop if the toothpick is used for a week in every between the teeth every night.

Suspicion

People often leave the practice unconvinced of the advice they were given. But the ones that do as they were told despite being sceptical are gobsmacked by the way the bleeding (and hurting) stopped.

I recall having a phone conversation with a patient who had an advanced gum disease and who had recently seen me for the first visit of the course of treatments. I had advised him to use purple interdental brush (1,1mm) but he wasn’t convinced about it and this was the reason for to phone call. He thought the brush was too big as it hurt. I told him that the only thing he can do is to try to prove me wrong. To follow my advice and see if I’m wrong.

He carried on using the interdental brush and about week later I received another phone call from the patient. He wanted to share his amazement and joy about his gums that had stopped bleeding. He was thankful for the correct advise and said that he had suffered from bleeding gums for all his life and only now – at his fifties – he managed to stop the gums bleeding.

The pain makes people think that something they use is not right for them. That’s why it is important to advise patients that when they have a gum disease (any stage from gingivitis to severe periodontitis) it will be painful at first when they begin using the interdental brush or toothpick – there’s no way around it. I always tell patients that for about week they need to suffer from tender and sometimes very painful gums. But if they persevere with the use of interdental brush/toothpick as advised they will notice it won’t hurt after a while.

 Conclusion

I have said this before and I am saying it again – do not believe everything you read from the internet. I have run into several sites that offer wrong advise on oral health. Even dental professional offer wrong advise. Here’s one example about advise against the use of toothpick

The sharp surface area might destroy the polish of the tooth, damage the gums or perhaps create the voids in between the teeth to broaden.

A correct technique of any product recommended needs to be established at the dental practice before patient leaves the practice. Toothpick can cause harm to the gum if used incorrectly but so can floss, interdental brush and toothbrushes. I have pointed out two times in this post that the toothpick needs to be the triangle-shaped one if it is used in between the teeth. Never use cocktail sticks!

Also a toothpick should be used only temporarily as it won’t remove all the bacteria from between the teeth for the same reasons as the floss doesn’t. Neither one of them cannot get into the grooves of the teeth (area where the roots start to separate) and the grooves of the fillings.

I will emphasise that a toothpick is perfect in the beginning of the periodontal treatment when the swelling of the gum needs to be reduced.

Finally back to my teacher who advised me to use toothpicks. He was right. Of course he was – he had decades of experience. I was just a cocky rookie in dentistry and thought I knew better.

It wasn’t until I had periodontists as colleagues when I realised that I need to use something else than a floss. My bone level around the teeth was naturally that low that I could fit in a toothpick and later I moved on to the interdental brushes (size 0,7mm). I have used them for over a decade now and haven’t used floss since – and no, I have not developed any decay in the contact point of the tooth.

Compilation of Excuses

After being so serious for a while it is time to lighten up for a moment.

People are funny creatures. You can tell all sorts of tales of them and their funny ways. This time I will tell you about people’s creativity when they put a blame on so many other things than their own indolence when it comes to oral hygiene routines.

I’ve collected a list of the answers we get to two of the very common questions we ask. Let’s see if you recognise yourself?

So Are You Using Your Electric Toothbrush?

  • lost in a house move
  • it’s still in an unpacked box after a house move (moved a year ago)
  • it’s still in an unopened box after buying it a year ago
  • out of battery and haven’t got around to charge it
  • it’s malfunctioning
  • can’t find brush heads from the shops
  • I don’t have a plug-in in the toilet
  • it makes me feel dizzy
  • it’s too vigorous.. I’m nervous about loosing a filling
  • dropped it and it broke
  • the manual toothbrush is quicker
  • the manual toothbrush is easier to use
  • it takes too long
  • it’s too noisy.. I’m afraid of waking up the kids/wife/neighbour/partner
  • I don’t like the feeling in my head
  • it tickles too much
  • it makes my gums bleed
  • it hurts
  • the bristles feel too hard
  • don’t have batteries in the house (battery operated electric toothbrush)

How About Are You Cleaning Between The Teeth?

  • too difficult
  • too tired
  • floss gets stuck/shreds
  • my gums bleed
  • I lost a filling once
  • it hurts
  • my teeth are so close together that the floss/interdental brush/toothpick is impossible to use
  • I use a mouthwash instead
  • I use the water pick
  • I rinse with water after every meal
  • I use chewing gum
  • my gaps between the teeth are so wide that nothing gets stuck there
  • I push the bristles of the toothbrush between the teeth
  • I use a toothpaste that says it cleans between the teeth
  • I run out of floss/interdental brushes/toothpick (last year) and never got round to buy new ones
  • can’t be bothered
  • it makes the gaps between my teeth wider
  • I don’t have time for it
  • don’t know which one to use
  • is it harmful?
  • is it needed? I never see anything coming out when I floss
  • are you?

Linnanmäki, Finland.

Feel free to add more excuses on the comment box!