Dental care more than just brushing and flossing
By the faculty of Harvard Medical School for The Harvard Medical School Adviser

Q: I'm teaching my children about good dental health. Brushing and flossing seem so straightforward that I'm worried I'm forgetting some of the finer points. Can you give me a quick review?

A: The cornerstone of every good oral-hygiene program is regular brushing, which may be one of the most ingrained of all health habits. We do it almost without thinking once or twice a day. But just because we do something often doesn't mean we do it well.

Any dentist can tell you that there's lots of bad brushing going on. An inadequate job leaves behind the bacterialaden plaque -- the whitish stuff that collects in between teeth and near the gum line -- that causes cavities and gum disease. Overzealous brushing is a problem, too. It scrapes away tooth enamel and damages gums, causing them to lose their tight grip on teeth and opening the door to infection.

These 10 tips might help:

1. Brush twice a day. To prevent plaque buildup, try to brush at least twice a day -- once after you eat breakfast and again at night before you go to sleep.

2. Brush longer than you think you need to. Most people say they brush for two to three minutes, but studies have shown that they only spend about half that time. A good, thorough brushing takes at least two minutes whether you are using a manual or powered toothbrush.

3. Work systematically. Some dentists recommend dividing the mouth into quadrants and moving from the upper right to the upper left to the lower right and then to the lower left. The order doesn't matter as much as being thorough. Spend the same amount of time in each quadrant.

4. Use a brush with soft bristles of varying height. Soft bristles are easier on the teeth and gums and may do a better job of cleaning between teeth. Many brushes now have bristles that vary in a height, creating a multilevel brushing surface rather than a flat one. This design may improve cleaning between teeth and of the sulci, the tiny pockets between the teeth and the gums.

5. Change your brush at least every three months. When the bristles splay, they're less effective.

6. Don't feel compelled to buy an electric toothbrush. Some studies have shown that powered brushes may be more efficient and do a better job of cleaning between teeth. But many others have shown that you can achieve similar results with a manual brush, provided that you put in the time and effort.

An electric toothbrush can be particularly helpful for people who wear braces, parents brushing their children's teeth and people with limited dexterity or hand strength. The thicker handle is a plus for older people with arthritis who have difficulty grasping a thin manual brush. Some deluxe models sell for more than $100, but you can also buy a batteryoperated toothbrush for about $6.

7. Pick an effective technique. Numerous tooth-brushing techniques have been recommended over the years. All have similar goals -- removing food, stimulating gums and preventing plaque buildup.

One way: Hold the brush horizontally with the bristles along the gum line at a slight angle and then brush repeatedly toward the chewing surfaces of the teeth. To get behind top and bottom front teeth, hold the brush vertically with the bristles pressing against the interior surface of the teeth. Move the tip of the brush up and down over the teeth and gums. Use short, vibrating strokes on the chewing surfaces, pushing down slightly so that the bristles get into the grooves.

Your dentist can help you decide which method is best for you.

8. Brush your tongue. This will cut down on the bacteria that gather on its surface. It can also help banish bad breath.

9. Floss. No matter how thoroughly you brush, it's impossible to reach plaque and bits of food that lodge between teeth and under gums. Flossing every time you brush makes your teeth cleaner, stimulates gums and helps prevent gingivitis (red, swollen and bleeding gums) and controls plaque buildup.

Gently slide the floss between two teeth using a seesaw motion. Curve the floss around the side of one tooth, forming a C shape. Rub the floss up and down to clean the tooth. Curve the floss in the opposite direction and repeat the scraping action on the adjacent tooth. Repeat the procedure between the next two teeth.

10. See a dentist regularly. For most people, two checkups a year are sufficient. Your dentist can watch for early signs of decay, gum disease, oral cancer and other dental problems. Professional cleaning also rids your teeth of hardened plaque, or tartar, that can build up in hard-to-reach places.

In our busy world, tooth-brushing doesn't get much attention or respect. It deserves both.

Copyright 2008 the President and Fellows of Harvard Developed by Harvard Health Publications (www.health.harvard.ed u). Distributed by UFS. Submit questions to harvard_ adviser@hms.harv ard.edu.