#20 Brush Up for a Brighter Smile: Top Oral Hygiene Techniques

Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for healthier bodies. Hi, everyone. Welcome to the Holistic Dentistry Show. Today we're going to brush up for a brighter smile. We're talking about brushing techniques, how to brush, when to brush, how long to brush is two minutes, twice a day, a good way to brush. So with me today is Ms. Sheila. And I'm so excited to talk to you, Sheila, because we've known each other now for, gosh, how long? Long time? I think so. Yeah. So it's really nice to be working together and treating patients. You do an amazing job with oral hygiene instructions and really motivating patients to have a healthier smile at home.

Thank you.

Yes, absolutely. And, you know, you really are dedicated to providing exceptional conservative care and personalized attention. You believe in educating your patients about proper oral hygiene practices and regular dental visit. You have over 18 years of biomimetic, restorative, cosmetic, and biological dentistry experience. So excellent. Do you have your brush with you?

Yeah.

All right, perfect. So let's talk about brushing. You know, the first thing I want to bring up is I was looking into the research articles for the show is, you know, this notion that the ADA has about brushing two minutes twice a day. So do you recommend to patients to brush nowadays?

I recommend at least to brush for two minutes at least twice a day.

Yeah. And is there a reason using that recommendation for two minutes, or should we tell them you say at least two minutes? Which I'm glad you said that, because a lot of people just say brush two minutes twice a day. And if you actually go to the ADA website, that's what it says. But in fact, I actually found a research article here that basically states that brushing two minutes removes about 40% of plaque. What do you think about that? Is that sufficient enough? That's crazy. Yeah. So this study was actually, in 2000, a systematic study. People who brushed for one minute removed about 27% of plaque. People who brushed for two minutes removed 41% of plaque.

So where does the other 60% go?

Exactly. What do we do with the other 60%?

Yes. That's where the water jet and longer technique comes in handy. That's why I need a good hygienist to show you good oral hygiene instructions.

Absolutely. I think it's in the technique. It's not necessarily just the length, because I found this other study that says that brushing for 180 seconds, which is basically three minutes, removed 55% more plaque than brushing for 30 seconds. Which, let's be honest, how long do you think people brush on an average out there?

About 30 seconds?

Yeah, for about 30 seconds. So they're only really removing maybe, what, like, you know, 10% of plaque altogether. So I like what you say. At least two minutes, but definitely longer. And once a day, Twice a day. What's your recommendation?

My recommendation is always at least twice a day, ideally in the morning and for sure at nighttime. Because during the day we grow a lot of plaque, which is bacteria that sits in our mouth and gets in between our teeth. And we really want to brush our teeth at nighttime before we go to sleep, because when we lay down and go to sleep, we inhale that bacteria and it can get into our lungs and into the rest of our bodies.

That is so true. I'm glad you're mentioning that to people to realize how much the mouth is connected to the rest of us. And of course, we know with better oral hygiene also, we have less risk of heart attacks and strokes. Exactly.

Yes.

So brush at night. How soon after you eat should people brush?

Most of us are eating a lot of acidic food or having a glass of wine at night or having carbonated water, which all of this is all acidic. I always tell patients to wait at least 30 minutes after you're done eating to brush your teeth, because you can brush and spread the acid all over your teeth, and it can damage the enamel, which will cause you to have sensitivity and gum recession.

Absolutely. I'm glad you're bringing up this point about, you know, a glass of red wine, because then lemon water, you know, also in the morning, there's so many people, you know, want to be healthy, and they're going to drink a glass of water with lemon, which creates a lot of acidity from the mouth. So what happens is, if you're going to rush and brush your teeth, a lot of the enamel and micro particles, of course, is going to come off with a toothbrush. So definitely, that 30 minutes that you're mentioning is the necessary time for the saliva to bathe the teeth, to mineralize the teeth before we brush.

Yeah, I see it all the time with my patients when I'm doing an oral cancer exam, and I see lots of erosion, especially on the back teeth and on the bottom sides. And when I asked them, do you chew on ice or do you drink lemon water? And they said, yes. How did you know? I'm like, I see it all over your teeth. And I said, when do you brush your teeth? They say, oh, right after, because I Want to get the lemon off. And that's incorrect. You want to wait at least 30 minutes because you're just going to spread the acid all over.

Yes. And you know, if somebody wants to drink lemon water, I always say, you know, just take a drink of natural spring water, alkaline water, and just swish vigorously right after you're done with the lemon water to kind of neutralize the mouth.

Great advice.

And you know, this brings us to another point, is like what we really brushing, Are we brushing food? Are you brushing bacteria? What are we really brushing our teeth for?

So we're, we're not really brushing our teeth to have a healthy mouth, but we're also brushing to fight against cavities and to get all the bacteria that grows in our mouth out.

So when you're brushing, we're brushing against the biofilm.

Yes.

Right. So the main point of the brush is not really to remove food particles so much, but really to remove the biofilm. But most, of course, some food particles, I think the food particles are much better removed with the water flosser. But really the point of the brush is to go for the biofilm that gathers around teeth. So how do you recommend somebody to brush their teeth?

It's a good question. So I always have my toothbrush around and I keep my little demonstration. And I always tell patients, first of all, I really like a soft bamboo toothbrush because it's gentle on the teeth and on the gums. I always like them to start with like a four glute, not holding it like this because we can really brush our teeth too hard with a manual toothbrush. And I always say start at a 45 degree angle and start from the outside, do a little circular circle and then go to the top of your chewing teeth. These are very important. And then go around on the inside and brush this area like this, very gentle circles towards the front. I always say to add a little bit of a wiggle and you know, scroll it up like this. You're not scrubbing like this. I don't want to see this because this can lose your gum and you get end up with gum recession and then you need to pay a visit to the periodontist. But I always say start from the bottom because when we're brushing our teeth, we're always spending good time at the start. Towards the end we just want to finish and run away. So most of us build a lot of the bacteria, which is the biofilm, on the bottom of our teeth. So I always say start from the bottom and then Move your way to the top. And again, you want to hold it at a 45 degree angle and spend a couple of seconds on each teeth go around and then you can do this so you're not over scrubbing.

Yeah, I like that. And what you're really demonstrating there actually is called a sulcular technique. And what we're actually doing is especially we're using here this Orasana toothbrush, which has very, very fine bristles. And these bristles can actually go under the gum. So the sulcular brushing technique is actually getting the biofilm that's gathering just under the gum. And a lot of the studies on brushing says we're actually can target up to maybe 3 millimeters under the gum. And if you don't have that 3 millimeters under the gum, it could be maybe just 1 millimeter. But the whole idea is by wiggling and making small circles is to get the little bristles under the gum so you can sweep the biofilm that is actually sitting at that level and help to improve gum health. It's actually called a bass technique. You're actually showing, you know, this little rolling motion, this modified bus technique. You gotta have a good wrist for that.

Because when I ask patients to like show me how to brush their teeth, you know, they're like. And I'm like, no, no, no, no, no. And then, you know, their lips are like covering the front of their teeth or they have the crowding and they have. It's hard for them to brush. So I literally, like, I get in front of them, I'm like, tilt your chin down. Bring this. And yeah, like you said, just. I, I don't know, it's been one of my favorite ones because we build a lot of plastic, which is the biofilm down here.

So.

And then absolutely. I like the inside like this. I don't know if you guys can tell to go upwards so they're not losing gum and pushing the gum going downwards. Yeah.

And the reason why we gather so much plaque in this lower front area is because the salivary glands that are right in the back of those teeth and they're putting out those minerals and it's calcifying the bacteria here. Excellent technique for those, those people that are just brushing, like you said, back and front, you know, back and forth, really, really aggressively holding the brush like this, they're not even getting at the gum line. They're really just avoiding. So, you know, they're surprised when you go to the dentist, like, oh my God, you've got. Your gums are inflamed what do I time? But it's very, very important to, to use the right technique for brushing. One article I found actually said that we should use about per area 15 to 20 times. Either small circles or, or back and forth. Definitely not up and down. Okay.

Yeah.

Not an up and down motion. 15 to 20 times in an area before moving to the next area. So should you brush first or should you floss first?

So it's a, that's a really, I mean we get asked that every day nowadays with everybody's lifestyle. I tell them, as long as you do it, that's all that matters for me. So some doctors say, no, you have to do it before you brush your teeth. Some people say, I mean before you floss your teeth. Sorry, let's say you have to brush after. I just say as long, pick a time of day when you can spend an extra couple of minutes on your teeth and that's all that matters to me.

Exactly. You know, and actually looking at our literature, there's no evidence at all that brushing first or flossing first makes a difference. So I totally agree with you. As long as you do it, that's the most important thing. Should you brush your gums?

No, definitely not. Like I said, if you brush your gums, say goodbye to them. You're going to end up needing to see, like I said, a periodontist. The key is 45 degree angle. You want these soft bristles because they do go underneath. You want to just hold it and just brush at the midline. That's the most important part. No gums, no scrubbing, no up and down.

I agree with you. I'm going to use that line. If you brush your gums, say goodbye to them. That's exactly what it is. Because you know, there's actually a company called Radius. I don't know if you've seen their toothbrushes, but their toothbrush heads are literally about this big. So four times as big. And they're meant to be that big. So you can brush your gums and your teeth at the same time. And I actually approach the company and tell them, you know, this is not the right way and you know, you can find unfortunately this brushes and many different natural food stores Radius and I completely advise people against them because as you brush your gums, especially for those of you that have really thin gums now you're really running into the danger of basically chasing them away.

Yeah, thin gums are small teeth because everyone has a different anatomy. That's why I love the toothbrush because it's perfectly shaped and it gets to the back areas. A lot of us have our wisdom teeth, and that's all you really need. Just a little bit?

Yeah, yeah. I mean, you know, there's so many different, like, toothbrush sizes. You know, I have here a toothbrush. This one is definitely a lot denture and mouth toothbrush. So it's huge. It has a nice handle, though, for people that have poor dexterity. But. But those big toothbrushes, you know, it's hard to reach in the back, especially where the muscle here kind of wraps around the wisdom tooth. And, you know, if people have a hard time, do you have a special technique for them to actually get their brush in the back there?

Yeah. So it. Most of my patients nowadays are starting to extract their wisdom teeth, but again, there's a good population that have them there. They don't want to take them out, which I'm totally okay. But I tell them you have to spend extra time on it. And like you said, you know, we have some really strong muscles back here that when you open your mouth all the way, even me as a hygienist, when I'm looking at your mouth, I won't even see your wisdom teeth. They're hiding underneath your cheeks and underneath the muscle. So I always recommend them to close down. And sometimes you can even close all the way. Just depends on how big your mouth is. When you close down, you can actually get all the way back here to the back area, where we call the distal part of the tooth, which is right here. When you open your mouth all the way, your toothbrush will stop right here. Now, mind you, your wisdom tooth is right here. So if you're brushing only till here, you're missing one tooth here and one tooth here. So that's two teeth, which is your chewing teeth. So I always recommend, again, close down, get the toothbrush at the angle, try to feel that you've gone down, count how many teeth you have, and then do the circular motion. And same thing with the bottom. You know, tilt your chin down, relax these muscles. It really does tighten up. When you open all the way and, you know, bend down, look in the mirror and just brush. Just, you know, give yourself some nice quality massaging time.

Yeah, great. What about for people that have crowding? You know, how. You know, especially the lower front teeth, and for women, that's something that's very common to have this crowding in the lower front area. Do you have any tips for them and how to clean?

Yeah, so I always tell them you know, for the back area, obviously, you know. So when you're starting like this to brush, I'll show you on the mouth when you're going like this, I tell them from lip to lip. Because if you hold the toothbrush like this, I don't know if you can see you're missing that whole bottom area. So I tell the toothbrush vertically, up and again, go up and down, tilt your chin down, up and down, left and right, up and down, left and right, up and down. And then you don't want to even, you don't want to scrub it like this. You're just gently going up and down more, you know, ending it at up and then left and right.

Good idea. And you know, sometimes I see people on the front, a tooth is set all the way in and it turns more yellow. Yeah. Any special techniques on how to brush this particular tooth?

I mean, the easiest thing for people to do is again the tilting your head down, you know, loosening up the lips a little bit and then holding it and then rolling it up, holding it and then rolling it up. And then if you have to tilt it, rolling it up. Because what happens is a lot of us, we brush here, we miss these teeth here and we skip. So that's why I always want them to look in the mirror while they're brushing.

Yeah. I also like, you know, for people that have quite a bit of crowding to use a children's brush. This is actually a children version of this one. So you can see here it does have a smaller brush head. So with this one, sometimes it's easier when you have this crowding for the brush to kind of get around the spaces there.

Yeah, because they'll have better dexterity too.

So how often should people change their brush?

That's excellent question. So, as you can see, we want you guys to brush with a soft toothbrush. So and I always say between a month, maximum month and a half, but more on the month when you see the bristles kind of splitting away, that's when you know it's time to change a toothbrush because you can be scrubbing it for even five minutes, but the bristles, they've lost their touch and they're not as effective anymore. So you're just going to be over brushing, ruining the enamel and not removing the biofilm off your teeth.

Yeah, absolutely. You know, when it plays like that, you know, there was a study that basically states that it just doesn't work. So definitely change it when it reaches that. And there's basically no real Formula, you can't say, okay, two minutes twice a day, change every three to four months, which is, by the way, that's the norm. I'm glad you're telling people to change it more often. But the recommendation from the ADA is every three to four months, which, you know, we know people can splay a toothbrush a lot faster than three months. So it just all depends on, you know, the technique that you're using. Her brush, how much plaque you're forming. Because have you seen some of your patients are forming more plaque than others?

Yeah. So some of it has to do, you know, they say with genetic factors, but also autoimmune disorders, patients with, you know, health history issues, you end up with like dry mouth. You have appliances in your mouth. So we end up building more, you know, biofilm than others. Some people are light, some people are moderate. Some people, they say they brushed right before they came and there's like a bunch of soft biofilm on their teeth. So that's why I just like once a month change it. It's worth it.

Yeah. Can you brush too much?

Yeah.

Yeah.

You know, I know, I know some people like to walk around with their toothbrush and brush all the time, but I mean, you really will wear down your enamel and your gums. So I don't recommend it.

Yeah, I don't recommend it either. I think you can definitely create more damage. And in all the studies we have, in order to maintain good oral hygiene, let's say you brush for three to four minutes. One of the studies I actually found, which was very interesting to me, was looking at people brushing once a day and they actually were finding that brushing once a day is sufficient to maintain oral health as long as the brushing is about three to four minutes. So you're getting the plaque off. And of course it has to do also with our diet, you know, what kind of diet are you eating? If you're eating more sugary foods, you're going to get more plaque buildup as compared to somebody who's eating, let's say, more of a keto based diet. You're going to generate a lot less plaque. So, you know, for me, I don't know if I'm sure for you too. When I have something sweet, I can feel fuzzy teeth. You know what I'm talking about? Yeah, I can't fuzzy teeth. So I really have to like go and brush them. Yeah, because you know there's a party in your mouth when you have sweets. It's just what happens. So definitely, if you're Going to have, I say, something sweet, you know, birthday cake or whatever it is. Definitely after half an hour, go ahead and brush your teeth. So to, to kind of, you know, break up the party.

Yeah, excellent.

What about, you know, brushing the tongue? I know some people use their actually toothbrush to brush their to. Is that the best tool to use or do we have better things for the tongue?

I say to start first, you know, always end it with the toothbrush. Like after you're done brushing. I always say, okay, stick your tongue out, brush the roof of your mouth and your tongue. Because we do create biofilm on the tongue that can spread to your teeth and that also can like, you know, freshen your breath a little bit. If you can get your hands on a tongue scraper, the tongue scraper will, you know, remove it as well. But for sure, definitely. When you're brushing, you know, the last 10 seconds, 5 seconds on the roof of your mouth, 5 seconds on the tongue.

Yeah, makes sense. I mean, you know, when people, if you stick your tongue out and you see that white coated film, definitely it's time to brush it because what's really on the tongue is bacteria, dead cells that it's nice to remove them. You're going to taste the food better and just have fresher breath in general. So tongue hygiene is absolutely important, you know, and you can definitely use the toothbrush to brush. And for those of you that have gagging reflux, you're gonna stay tuned for our episode coming up about techniques on how to clean the tongue. Sheila, anything else you'd like to say about brushing techniques at all that you wanna leave people with that are listening to this show?

A lot of people, you know, even friends of mine, they think going to the hygienist is just about getting your teeth clean. But we spend a lot of time face to face teaching patients honestly how to brush their teeth. Forget the flossing, but the brushing is the key because everyone is always in a hurry and they're just running out and they don't see how much of an effect the bacteria that stays onto your teeth and your gums as on the rest of your mouth. I mean, your mouth is like you've heard, the gateway to your health and you really want to remove all the bacteria as much as you can so it doesn't go to the rest of your body. So I, I mean, I, I want you to leave with. It's really important to brush at least twice a day, at least two minutes a day and you know, take the time to really take care of yourself because everything starts with the biofilm that grows in your mouth. So if you want to stay away from, you know, all the different types of dentists, you gotta fresh, fresh brush.

Excellent advice. And you bring up a good point. I think, you know, as a hygienist, you're really a health educator. And unfortunately, that's not the norm in most dental offices. The hygienists don't have enough time typically to go over oral hygiene instructions. I talked to some hygienists that they have to see 10 to 15 patients a day. I mean, I think that's not humanly possible to do a proper cleaning, let alone talk to somebody about their oral health at home. But what you're doing is really giving somebody really such valuable tools for life. Great job on that.

Thank you.

Excellent. It was a pleasure having you. And for those of you listening, yes, anytime, there's going to be a link below. We're going to include a PDF on the proper brushing techniques. For those of you who are interested, see you next time. Please make sure you check out the show notes for any links mentioned in the show. Do you have a question you'd like me to answer? Message me on Instagram. DoctorsAnda. This is Dr. Sandha. And remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.