A Better Way to Brush: Effective but Gentle – Even if Gums are Swollen
The two most important gum care practices to use on your newly cleaned teeth and gums are proper brushing and flossing. Let’s start with proper brushing.
The primary objective of brushing is to use mechanical action to break up the formation of soft plaque on the front and back surfaces of the teeth and gums before it crystallizes into calculus. Brushing can’t effectively reach the side (interproximal) surfaces of the teeth, so flossing and interdental cleaning break up the plaque there.
Brushing both breaks loose the adhesive bonds between the plaque and teeth and also breaks up the soft mats of plaque into smaller disorganized bits. This disorganization requires the bacteria to reorganize themselves before putting their energy into a population explosion. Effective brushing twice a day keeps the bacteria from achieving the organization needed for efficient proliferation. Keeping these populations low and disorganized is your first line of defense against bacterial infection that makes a gum swollen or produces gingivitis.
It’s the mechanical action of brushing itself that disrupts the plaque, not the characteristics of toothpaste. Proper brushing technique has been shown to be equally effective with no toothpaste at all (called “dry brushing”) as with toothpaste. And conventional toothpaste does not provide any nutritional supplementation to support the health of gums.
Exercise care when brushing so as not to injure the soft gum tissue. It’s very easy to use too much pressure. Try to find and use a brush with extra soft bristles with rounded ends, which are perfectly adequate while reducing the chances of irritating your gums. Plaque removal doesn’t require hard brushing, like a scrub brush on a mildewed brick wall. All that’s needed is a little vibration of the bristle tips to dislodge the microscopic soft plaque. Hard brushing can microscopically scratch and irritate gum tissue, leading to gum recession.
Brushing with a manual toothbrush
Use one technique to brush the margins on the gums and teeth, another for polishing the biting surfaces and enamel. For gum margins the four most important aspects of brushing are (1) positioning the bristles, (2) the lightness of the pressure, (3) the shape of the brush strokes, and (4) the repetition of strokes. If using a manual toothbrush, angle the brush about 45 degrees with the bristle tips facing the margin between the gums and teeth and gently allow some bristles to nestle under the gum margin. Avoid using too much pressure; try holding a manual toothbrush by the end of its handle with just three fingers, as on a pencil or pen. Move the back of the brush head gently in tiny circles whose diameter is about one-tooth wide so that the bristle tips themselves wiggle in place just under the gums without sliding back and forth. Make about fifteen to twenty small brush strokes on each tooth before sweeping the debris away from the gum line and moving on to the next tooth. Follow a regular pattern, such as brushing along the gum line on the outside first, and then again along the inside. Apply only enough light pressure to allow the tips to wiggle just under the gum margin, since brush tips are more effective when stationary and wiggling than when sliding across the gums, and sliding bristles could make miniscule scratches on the gums, where bacteria can enter.
To brush the inside of the front teeth, turn the handle so that it’s mostly vertical (rather than horizontal) and tilted forward so that the bristles can nestle under the gum margin. As above, wiggle the bristle tips with 15 to 20 small circular strokes per tooth.
When brushing along the gum line is complete, use a different technique to brush and polish the biting surfaces and enamel. Point the bristles straight at (90-degrees to) the teeth and brush thoroughly, especially where there are crevices, on the back surfaces of the teeth, and the lower teeth, where plaque bacteria are likely to harbor. After brushing, clean the brush of accumulated bacteria by rubbing the bristles briskly under running water for a few seconds. Then store the brush where it can air dry completely without coming into contact with other tooth brushes. (You may have a slightly different strain of bacteria than others in your household.)
Obviously this way of brushing is more than a cursory two-minute procedure. But the commonly practiced two-minute method mostly just polishes enamel and leaves intact much of the plaque nestled at the edge of the gums, and it fails to keep the majority of people from developing chronic gingivitis and periodontal disease.
When the bristles start to become splayed, replace the brush. The tips will no longer be as effective. The American Dental Association recommends replacement every three to four months. If the bristles start to splay out after only a few weeks, you’re probably putting too much pressure on your toothbrush; ease off to avoid irritating the sensitive gum tissues.
Brushing with an electric toothbrush
If using an electric toothbrush, please still read the section above on using a manual toothbrush, so that you’ll know what the electric toothbrush is trying to emulate. Then angle the brush about 45-degrees toward the margin between the gums and teeth so that the bristles are contacting both surfaces. Gently guide the vibrating brush along the gum line until the teeth and gums have been brushed inside and out. Statistically a good electric toothbrush is more effective than a manual toothbrush, most likely because most people don’t use manual toothbrushes as effectively as described above.
The electric brush itself determines the shape of the brush stroke, so just pay attention to making sure the bristles nestle into the margin between the gum and each tooth with only a light pressure. As with the manual toothbrush, address the biting surfaces and enamel after the (more important) gum line has been brushed.
And as above, clean the brush of accumulated bacteria by rubbing the bristles briskly under running water for a few seconds. Then store the brush where it can air dry completely without coming into contact with other tooth brushes.
What to use when brushing
The mechanical break up of plaque can be complemented by substances that are cleansing (baking soda and salt), acid-neutralizing (baking soda), antiseptic (cranberry, and peppermint), soothing (peppermint and myrrh), or a nutrient for cell growth (Vitamin-C/a>). You may find that your preferred dentifrice may consist of substances such as these that come in the form of powder, rather than paste, for maximum effect. To properly use a powder as your dentifrice, tap into the palm of a clean hand a small mound of powder that would just cover a dime. Use your brush’s moistened (but not dripping wet) bristles to transfer the powder to the gum line and brush as described above.
Powder may seem funny because we have been trained since childhood to brush with toothpaste, without realizing that its two main purposes typically are to give a sweet taste to encourage its use and to serve as a drug delivery vehicle to the teeth. (For example, most toothpastes deliver fluoride, a chemical so potent that by law the toothpaste label must state: “If more than used for brushing is accidentally swallowed, get medical help or contact a Poison Control Center right away.”)
Some toothpaste ingredients can even be counterproductive. Glycerin, which is found in most toothpastes, is a syrup made from fats and oils that has 60% of the sweetness of sugar but has the virtue of not feeding the bacteria that cause plaque. However, glycerin does coat the teeth and gums, thereby reducing both the natural remineralization of the teeth and the absorption of nutrients by the gums. If you’re going to brush with natural substances as described above, avoid using toothpaste beforehand, or better yet to replace the toothpaste altogether with a dentifrice composed entirely of beneficial natural herbs and minerals.