Tips on tooth brushing techniques

What is the correct technique for tooth brushing ?

Researches have done various studies on effective tooth brushing and they have suggested different techniques for effective brushing.
It is advisable for a person who doesn't have a extensive periodontal condition to use Bass method for daily brushing.
Parents can introduce brushing to their kids with horizontal scrubbing method which have simple movement where the child find it easy to coordinate. When the child become mature enough to follow complex movements Bass method can be introduced.

The main indications of Bass method  are

1. For all patients for dental bio film removal adjacent to and directly beneath the gingival margin.
2. For open interproximal areas, cervical areas beneath the height of contour of the enamel, and exposed root surfaces.
3. For the patient who has had periodontal surgery.
4. For adaptation to abutment teeth, under the gingival border of a fixed partial denture and orthodontic appliances.

The stillman's method is the other commonly used method which have the following indications.

1. Dental bio-film removal from cervical areas belowthe height of contour of the crown and from exposed proximal surfaces.
2. General application for cleaning tooth surfaces.
3. Recommended for cleaning in areas with progressing gingival recession and root exposure.

Why is it important to follow a proper brushing technique?

• As we all know damage to a tooth is irreversible and last for the rest of the life time. The main causes of teeth damage are caries and periodontal diseases which are preventable with proper oral hygiene practice.
• Nowadays the cost of dental treatments are quite high as well as the time you have to spent in clinics are longer. These difficulties would not appear if you have a perfect oral hygiene practice.

Brushing techniques in detail ...........

Tips on use of Chlorhexidine mouthwash

Chlorhexidine Mouthwash

Chlorhexdine is one of most commonly used mouthwashes in worldwide. 0.2% or 0.12%  is the normal concentration of regular Chlorhexdine mouthwash and also available in higher concentrations.
Why Chlorhexidine is useful as a mouthwash?

• Having high antiplaque activity.
• Used as antiseptic.
• More active against gram positive bacteria.
• Absorbed by teeth and oral tissues and slowly released to the oral environment
• Bactericidal (kills bacteria) in high concentrations and bacteriostatic (limit bacterial growth) in low concentrations.
• Primary root of excretion is via faeces and not absorbed from bowel, and therefor safe to use.

What are the side effects of Chlorhexidine mouthwash?

Staining due to Chlorhexidine Mouthwash It may cause staining of teeth, restorations and your tongue usually if used more than 10 days. Not everyone will experience this. This stain can be removed by having your teeth professional cleaned. Lingering after taste that may change taste perception. You will adjust to time to this effect with no permanent change to your taste perception. May cause Irritation in salivary ductal areas rarely parotid salivary gland swelling may present. Increase in calculus formation above the gumline may develop.  Can Chlorhexidine mouthwash  be used if I am pregnant or a nursing mother? Pregnancy Teratogenic Effects Pregnancy category B. Reproduction studies have been performed in rats and rabbits at Chlorhexidine gluconate doses up to 300 mg/kg/day and 40 mg/kg/day, respectively, and have not revealed evidence of harm to the fetus. However, adequate and well-controlled studies in pregnant women have not been done. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Nursing Mothers It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Chlorhexidine gluconate oral rinse is administered to nursing women. In parturition and lactation studies with rats, no evidence of impaired parturition or of toxic effects to suckling pups was observed when Chlorhexidine gluconate was administered to dams at doses that were over 100 times greater than that which would result from a person's ingesting 30 ml (2 capfuls) of Chlorhexidine gluconate oral rinse per day. Pediatric Use Clinical effectiveness and safety of Chlorhexidine gluconate oral rinse have not been established in children under the age of 18. How to use Chlorhexidine Mouthwashes? Have to use as an adjunct. chlorhexidine alone cannot eliminate dental plaque proper brushig have to be done. Do not use before or immediately after tooth brushing. Use after at least 1hour  from brushing. Why ? Anionic surfactants in toothpastes cause low effective delivery of Chlorhexidine 0.2% mouthwash 10 ml twice daily. maximum period of use 2-3 weeks. keep in the mouth for 1 minute. do not swallow.

Why Teeth Erupt Late?

Delayed tooth eruption

• Eruption is the axial movement of a tooth from its nonfunctional position in the bone to functional occlusion. 
• Eruption is often used to indicate the moment of emergence of the tooth into the oral cavity. 
• The normal eruption of deciduous and permanent teeth into the oral cavity occurs over a broad chronological age range. Racial, ethnic, sexual, and individual factors can influence eruption and are usually considered in determining the standards of normal eruption.
• True and significant deviations from accepted norms of eruption time are often observed in clinical practice. Premature eruption has been noted,but delayed tooth eruption (DTE) is the most commonly encountered deviation from normal eruption time.

Other words Used in delayed teeth eruption

• Delayed eruption
• Impacted teeth
• Primary retention
• Embedded teeth
• Pseudoanodontia
• Late eruption
• Retarded eruption
• Arrested eruption
• Primary failure of eruption
• Misplaced teeth
• Displaced teeth
• Impaired eruption
• Depressed eruption
• Noneruption
• Submerged teeth
• Reinclusion/inclusion of teeth

What are the normal ages of teeth eruption?

What are the Causes of Delayed tooth eruption?

Treatment for Delayed Erupting teeth (DE)

Delayed eruption presents a challenge for orthodontic treatment planning. A number of techniques have been suggested for treating. The main considerations for teeth affected by DE are

• the decision to remove or retain the tooth or teeth affected by DE, 
• the use of surgery to remove obstructions, 
• surgical exposure of teeth affected by DE, 
• the application of orthodontic traction, 
• the need for space creation and maintenance, and 
• diagnosis and treatment of systemic disease that causes DE.

Teeth Sensitivity

What Is teeth sensitivity / dentin sensitivity?

Teeth sensitivity

Teeth sensitivity is characterized by short, sharp pain arising from exposed dentin in response to stimuli typically thermal, evaporative, tactile, osmotic, or chemical that cannot be attributed to any other dental defect or pathology.
Dentin get exposed due to wearing off of overlying enamel of the tooth by mechanical and chemical means. Common examples are vigorous tooth brushing, frequent consumption of acidic beverages.

dentin sensitivity mechanism

What are the special features of tooth sensitivity?

sensitive teeth

• A short duration pain 
• sharp pain
• pain arising from exposed dentin in response to 
• Thermal (while taking hot or cold drinks) 
• Evaporative
• Tactile (while brushing) 
• Osmotic stimuli (while eating sweets)
• There is no evidence of caries

• wearing off of the enamel may not always visible.

What causes tooth sensitivity?

• Abnormal thickness or structure of enamel- most of the time may be present from birth. Ex. Amelogenesis imperfecta, enamel hypoplasia.
• Vigorous tooth brushing and other brushing related causes leading to enamel wear-off.
• Frequent consumption of acidic and carbonated drinks.
• Gastric acid regurgitation (frequent vomiting)
• Dentin exposure by enamel cracks or fractures.
• Aging
• Root exposure due to periodontal diseases.
• After tooth bleaching.

What are the preventive methods of tooth sensitivity?

reasons for tooth sensitivity

1. Use of Proper tooth brushing technique
1. Use a tooth brush with soft bristles.
2. Do not brush soon after meals. wait for about at least one hour.
3. Do not apply excessive pressure on the brush while brushing
4. Pregnant mothers should not brush there teeth soon after vomiting 
2. Do not drink acidic or carbonated drinks, fruit juices frequently
3. Protect your gums from periodontal diseases which lead to root exposure

What are the Treatment available for sensitive teeth?

Treatment Strategies

• Plug the dentinal tubules preventing fluid flow
• Desensitize the nerve making it less responsive to stimulation

Plug the dentinal tubules preventing fluid flow

• Composite or GIC restoration 
• Crown placement 
• Periodontal surgery to cover the exposed roots

 plug the inside of the dentinal tubules

Ions or salts: stannous fluoride, sodium fluoride, potassium oxalate, etc
Precipitates: glutaraldehyde 

Resin: dentin sealers

• Potassium nitrate containing product/toothpaste  should be used 2×day for at least 2 week

Desensitize the nerve making it less responsive to stimulation

Potassium Nitrate is the only one approved by FDA and ADA. 

KNO3 penetrates through the dentinal tubules to the nerve; K+ may depolarize the nerve and prevent it from repolarizing; Thereby, Preventing it from sending pain signals to the brain.

What could be done to eliminate Post bleaching sensitivity?

Active methods

Use of either fluoride,potassium nitrate, or both in combination. Traditionally,fluoride has been used
as a method of reducing sensitivity. The primary mechanism for action is to occlude dentinal tubules or
increase the hardness of enamel, which impedes the flow of materials to the pulp.

Passive approach

The passive approach for treating sensitivity was first used. This involved a reduction in wear

time, or in frequency of application.Cessation of treatment results in no lingering sensitivity.

Tips for Teeth Whitening

Tips  for Teeth Whitening

What cause staining of teeth?

Whitishness of the teeth can be lost due to two main types of stains. They are

EXTRINSIC stains (stains on teeth due to external factors).

The causes for extrinsic stains are

• plaque and tartar
• restorations (fillings).
• Beverages ( drinks such as coffee, tea, carbonated drinks etc. which leave behind ugly stains).
• Eating habits (tobacco, aricanut etc.)
• Drugs (iron tablets)

INTRINSIC stains (stains on teeth due to internal factors)

• Hereditary disorders.(amelogenesis imperfecta)
• Medications (Tetracycline).
• Flourosis (excessive exposure to fluoride can cause unaesthetic white patches on the surface of teeth).
• Trauma to the teeth causing bleeding in to the pulp

What are methods used to make the teeth white?

teeth whitening

There are several method available for teeth whitening depending on the type of discolouration. Every type of method do not suitable for any type of discolouration. That is the first thing that you should keep in mind. Common methods of treating discolouration can be divided into two main types.

teeth bleaching

• Professional methods (That you should need a dentists help)
• Home used methods

Collectively they can be simply listed as below

1. Removal of surface stains through Scaling and brushing
2. Bleaching (Teeth whitening)
3. Microabrasion,
4. Macroabrasion,
5. Veneers 
6. Crowns

What I want to know about teeth whitening bleaching?

• various substances used
• Best work for  extrinsic staining
• Commonly used agents are 

• Hydrogen peroxide (3-35%)
• Carbamide peroxide (10%)
• Usually low concentrations used in home bleaching systems.
• The outcome of the procedure is usually unpredictable.
• gross intrinsic staining may require other types of treatment modalities 
• Office bleaching is usually more effective than over the counter products.
• As darker the stain it takes longer period to eliminate that (tetracycline stain takes about 6 months to improve)

How do i know whether I am a suitable candidate to undergo dental bleaching?

• Most important thing is that you should not have high expectations about the outcome.
• You also should not have
• Sever periodontitis 
• Extremely large pulps 
• Exposed Root surfaces 
• Severe loss of Enamel (enamel ware off )  
• Extensive large non-ceramic restorations 
• Peroxide Allergy
• You should not be Pregnant and a Nursing mother

How do peroxides make white my teeth?

mechanism of dental bleaching

Free radicals liberated from carbamide peroxide breaks down large chromogenic particles to smaller colourless molecules.

What are the adverse effects of teeth bleaching?

• Teeth Sensitivity
• Gingival irritation
• Shade regression
• Cervical resorption mainly due to heat
• Decrease the hardness of the enamel

What are the products available in the market for teeth bleaching?

 

A few years ago if you wanted to achieve a beautiful bright and white set of teeth, you had to take out of your pocket quite a hefty fee at the dentist’s. The situation has changed by now, because there are plenty of different types of teeth whitening kits available, which are quite affordable, and you can apply the treatment at home.

Certainly there are high quality kits that give exceptional results, but there are also several teeth whitening devices that only advertise they are good, but they ultimately fail to offer any results at all. Therefore, you need to be careful when purchasing such teeth whitening kits, and make sure you invest into a device that is of high quality and which is recommended by health specialists.

Teeth Whitening Toothpastes

Firstly, there are the so called “brush-on” teeth whitening systems. In this category, you will find the different toothpastes that contain whitening agents, so you will basically get cleaner and whiter teeth with every brushing.

However, the whitening toothpastes are not to be used as a main whitening solution, especially if your teeth are extremely stained. This whitening method s relatively cheap and it will help you get teeth that are one shade whiter than your natural set of teeth.


Teeth Whitening Strips

Then, there are the teeth whitening strips available, which have a whitening gel coating and which must be worn for quite an extended time until you see the desired results. Most often, the gel that can be found on these strips is similar to that used in the whitening tray devices. One downside of using these strips is that if you are not careful, and the strips move, you will get an uneven whitening result.

Teeth Whitening Trays

The teeth whitening trays are extremely popular because they are quite affordable and they are also effective. The trays usually contain a special teeth whitening gel, and the trays must be worn for at least half an hour every day.

According to statistics, people who use this method can obtain teeth that are up to 10 or 11 shades whiter than their natural set of teeth. You must make sure that the trays that you use are a perfect fit for your mouth, so that you will get the best results.

laser whitening

What are the causes for bleeding gums ?

What are the causes for bleeding gums ?

bleeding gums

presence or absence of gum/ gingival bleeding as an indication of gingival health. before talking about the treatment first we should know the causes for gum bleeding.

Gum bleeding can occur acutely or could have been there for a long period of time (Chronic). Sites that bleed on brushing have a greater area of inflamed connective tissue. Poor oral hygiene is the most common cause of gingival bleeding.

What could be the reasons to have Acute gum Bleeding?

Bleeding gums/ gingiva

• Acute episodes of gingival bleeding are caused by injury or occur spontaneously in acute gingival disease.
• Laceration of the gingiva by toothbrush bristles during aggressive tooth brushing or by sharp pieces of hard food can cause gingival bleeding even in the absence of gingival disease.

aggressive tooth brushing 

• Gingival burns from hot foods or chemicals increase the ease of gingival bleeding.

• Spontaneous bleeding or bleeding on slight provocation can occur in diseases like acute necrotizing ulcerative gingivitis. In this condition, engorged blood vessels in the inflamed connective tissue are exposed by ulceration of the necrotic surface epithelium.

Chronic( long term )Recurrent Bleeding?

• The most common cause of abnormal gingival bleeding on brushing is gum disease (chronic inflammation). You may experience bleeding which is chronic or recurrent and is provoked by mechanical trauma (e.g., from tooth brushing, toothpicks, or food impaction) or by biting into solid foods such as apples. Sites that bleed have a greater area of inflamed connective tissue

• The severity of gum bleeding is increased during pregnancy beginning in the second or third month. oestregon or progesterone hormones which are high in pregnancy  can substitute for menadione (vitamin K) as an essential growth factor for gum disease causing organisms.

Pregnancy gingivitis

Do Systemic disorders cause gum bleeding?

• In some systemic disorders, gingival haemorrhage occurs spontaneously or after irritation and is excessive and difficult to control. These haemorrhagic diseases represent a wide variety of conditions that vary in etiologic factors and clinical manifestations. Such conditions have the common feature of a haemostatic mechanism failure and result in abnormal bleeding in the skin, internal organs, and other tissues, including the oral mucosa.

• The tendency to excessive bleeding may be due to failure of one or more of the hemostatic mechanisms.

Drug induced gingivities

• Haemorrhagic disorders in which abnormal gingival bleeding is encountered include vascular abnormalities (vitamin C deficiency or allergy such as Schonlein-Henoch purpura), platelet disorders (thrombocytopenic purpura), hypoprothrombinemia (vitamin K deficiency), other coagulation defects (haemophilia, leukaemia, Christmas disease), deficient platelet thromboplastic factor (PF3) resulting from uremia,21 multiple myeloma, and postrubella purpura.

• Gum Bleeding may follow the administration of excessive amounts of drugs such as salicylates and the administration of anticoagulants such as dicumarol and heparin.

Why Milk Teeth (baby teeth, deciduous teeth) so important ?

Why  Milk Teeth (baby teeth, deciduous teeth) so important ?


Even-though baby teeth is going to replaced by the permanent teeth they have very important functions.The milk teeth  usually  starts to erupt when the child is around 6 months with the eruption of lower A or central incisor and end around 2 1/2 years.

The primary teeth starts to shed at the age of 6 starting with lower central incisor and second molars are the last to fall.

Why primary / milk teeth are so important


Primary teeth have essential function for the child physical and psychological development. The main functions are simply explained below.

1. They used to chew the food which facilitate the  better absorption of nutrition.
2. Essential in proper growth in face and jaws.
3. To gain proper pattern of speech where pronunciation of letters like "T, V, " need the help of teeth.
4. To maintain the space for the lately erupting permanent teeth. 
5. Providing the guidance for the eruption of the permanent teeth.
6. To have a pleasant smile.
7. To maintain child's psychological well being.

• The first stage of digestion of some foods takes place in the mouth, and chewing helps break up foods to more easily digested sizes. If your child swallows too rapidly and without chewing food properly, she may prolong the digestion process.

• When a child having bad set of primary / milk teeth it causes difficulty chewing and may not be able to eat a well-balanced diet. If your child's mouth is sore because of cavities, loose teeth, or sore gums, she may refuse to eat or may accept only those foods or liquids she can consume without more pain. But she needs a variety of foods for a balanced diet, and chewing foods of different textures stimulates and exercises the gums and provides a cleansing action for the teeth.

• Chewing also exercises these muscles of the face and jaws. This exercise is necessary to develop facial bones facial profile.

• One of the main functions of primary teeth is to guide the permanent teeth to the correct position of the jaw by maintaining the space for them.premature loss of the primaries will lead to malocclusion. is this type of cases teeth tend to erupt in aesthetically unacceptable positions.

Animation- how primary teeth guide their permanents

• Primary teeth must last five or ten years or longer. As a permanent tooth reaches the stage of development when it is ready to erupt (emerge through the gum), the roots of the primary tooth it will replace begin to resorb (break down and dissolve). Gradually, the permanent tooth pushes the primary tooth out and takes the place the primary tooth has been reserving for it. If a primary tooth is lost too soon, the permanent tooth has no guide to follow.
• If your child has a good set of primary teeth he will be having a pleasant smile which leads to a good self steam and avoid sleepless nights with toothache.