Healthy gums are firm, pink, and tight around the teeth. They do not bleed, are not swollen, and are not sore during eating or cleaning. The gums between the teeth are flat and triangular in shape (See Exhibit 1). These triangles are taller in the front teeth than in the back teeth. Exhibit 2 demonstrates healthy bone associated with these gums.

Exhibit 1 - Healthy Gums
Exhibit 2 - Healthy Bone

It is helpful to think of the tooth as rectangular in shape – having four sides - where it emerges from the gum tissue. The gums surround the entire tooth, and there is a shallow space between the tooth and the gum that can trap disease-producing bacteria, known as dental plaque.

In order to remain healthy, teeth require regular cleaning to remove the plaque that builds up each day. As there are four sides to the tooth, tooth brushing alone will clean only two of the four tooth surfaces. The other two must be cleaned using dental floss or some acceptable substitute that can be recommended by your dentist. Effective daily personal oral hygiene, and a healthy diet, when combined with regular professional check ups and cleaning by the dental team, will maintain a healthy smile and teeth that can last a lifetime.

Tooth brushing:
A toothbrush is effective in cleaning two of the four sides of the tooth. It is important to remember that the two other sides are not well cleaned by the brush, and some effective approach must be used to clean the two other sides. The following guidelines will be most appropriate for most individuals:

The toothbrush should be medium to medium soft. It is helpful to develop a sequence of brushing the teeth that can be used repeatedly, so as to minimize the chance of missing any given area.

Begin by brushing the upper right back teeth on the surfaces that touch the cheeks, moving from back right, around the front, to the back left. Then, follow the same pattern on the surfaces that touch the roof of the mouth. Once the upper teeth are brushed, use the same sequence to brush the lower teeth – cheek-surfaces, followed by tongue surfaces.

The brush should point slightly down towards the gumline at a 45 degree angle to the tooth, and gently rotated in a very small circle, keeping contact with the gumline at all times. Once this circular motion begins, the brush is slowly moved from the back teeth, around the front, to the back teeth on the other side.

Gums that are normally thick can better tolerate more vigorous brushing. If the gums are thin or receded, there may be a special approach to clean the teeth that can be recommended by your dentist.

Toothpaste: The use of tooth pastes is not necessary, though the polishing and flavoring agents in the pastes are desirable. Fluoride toothpastes can help with cavity-prevention and can help reduce sensitivity. There is no particular brand of toothpaste that is right for everyone, and the decision as to which one to use is a matter of personal preference, combined with input from your dentist.

Dental floss:
The most effective way to clean between the teeth to reach the other two tooth surfaces is with the use of dental floss. The most common way to use floss is to place it on the biting surfaces of two adjacent teeth where they touch each other, and move it back and forth until the floss passes between the contact point of these two teeth. Then, lightly press on one of the two surfaces, and rub that surface in an up-and-down manner, carrying the floss under the gums until it gently stops where the gum contacts the tooth. Teeth that are clean will often “squeak” when the plaque has been removed. Once one of the surfaces is clean, bring the floss back up and over the gum between the teeth, and repeat this procedure on the adjacent other tooth surface. Once clean, the floss is removed in the reverse manner, and the adjoining teeth are similarly cleaned. This process is repeated, using a similar sequence as with the toothbrush, until all teeth have been cleaned. Yes, this does take a bit of work and time, but it is worth it!

This approach to using dental floss, however, may be a challenge for some individuals, particularly when the teeth are very tight together, there are lots of filling edges, or there are dexterity problems. Your dentist can develop the best method for each individual to use dental floss.

Special aids:
Special types of floss holders, toothpicks or small brushes, can be effective additions or alternatives to the use of dental floss. Consult with your dental team to find what will work best for you.

American Dental Association Web site