Flossing is the next crucial step in maintaining good oral health. You can remove plaque from between your teeth with dental floss. Your toothbrush can't reach these spaces, which is why this is so important.

Brushing and flossing both serve the same purpose - both mechanically remove bacteria build-up from the teeth and gums. Removing bacteria is the primary goal of good oral health. If the bacteria is not removed plaque forms. Over time, this plaque turns into a hard substance called tartar. The levels of more dangerous type of bacteria build up within tartar.

These bacteria produce toxins which irritate and cause inflammation of the gums. This is known as gingivitis. Untreated gingivitis leads to periodontal disease - a condition where bacterial toxins invade not only the gums but also the bones and the structures supporting the teeth. This can lead to bone loss, loose teeth, and teeth that fall out. Periodontal disease often requires more extensive and expensive treatment.

Another reason to rid the mouth of bacteria is the fact that bacteria in the mouth are responsible for bad breath. Bacteria break down food particles left after we eat creating volatile sulfur compounds. These sulfur compounds are responsible for malodorous breath.

By brushing we rid the mouth of bacteria reducing the risk of gingivitis and periodontal disease. We also help ensure that our breath remains fresh smelling.

If we only brush however, we miss the bacteria that reside on tooth surfaces that the toothbrush can not reach. These include the spaces in between teeth. Here bacteria will be allowed to grow uninhibited leading to tartar formation, gingivitis, periodontal disease, and tooth decay. It is also a great place for bacteria to rest while they create foul smelling sulfur compounds.

Flossing is a key component to any good oral hygiene program. The American Dental Association recommends that you floss at least once a day. Brushing without flossing is like washing only 70% of your body. The other 30% remains dirty.

If you haven't flossed in a while, you may see a little red tinge of blood on the floss after you use it. This indicates that your gums are slightly inflamed and vastly in need of flossing to remove bacteria. With a regular regimen of flossing this red tinge should go away. Also, white buildups on the dental floss are indications that plaque has accumulated between your teeth.

I recommend Glide dental floss because it slides easily between teeth. However, any floss that you can get between your teeth and which does not fray or break easily is good. Breakage and fraying of floss is an indication of rough fillings and these fillings should be replaced.

2. How do I floss properly?

To floss properly, follow these simple steps:

Break off about 18 inches of floss and wind most of it around one of your middle fingers. Wind the rest of the floss around a finger on the opposite hand.

Hold the floss tightly between your thumbs and forefingers. Using about one-half inch at a time, gently guide the floss between your teeth. Be careful not to force the floss into the gums.

When the floss reaches the gumline, curve it into a C-shape against one tooth. Slide the floss gently into the space between the gum and the tooth, making sure it goes all the way down under the gum. Hold the floss tightly against the tooth. Rub the side of the tooth gently with up and down motions to move the floss away from the gum.

Floss between all your teeth.

Since plaque is an invisible film, use a disclosing agent (available from your dentist) once a week. This will show whether you are thoroughly cleaning all the plaque away and indicate the areas you're missing.

If you haven't been flossing regularly, your gums may bleed the first few times you do this. But after a few days, they should stop bleeding during flossing. If they don't, make an appointment for a thorough teeth cleaning and consultation.

3. How often should I replace my toothbrush?

You should get a new toothbrush every three or four months, or sooner if the bristles get worn out. Children's brushes may wear out even more quickly. When looking for a toothbrush, or any type of dental product, you may be overwhelmed by the choices available. To choose a good product, start by looking for the American Dental Association (ADA) Seal of Acceptance on the label. Products that may have this seal include toothpaste, tooth-brushes, dental floss, interdental cleaners, mouth-rinses and oral irrigators (a device that uses a stream of water to remove food from your teeth).

4. What role can fluoride play in preventing tooth disease?

Fluoride Tablets and Drugs

The use of dietary supplements of fluoride tablets or drops is also an effective and inexpensive measure against tooth decay. These supplements can be prescribed by your physician or dentist. Generally, fluoride drops are recommended for infants from birth until they are able to consume fluoride tablets. Fluoride tablets are prescribed for children up through the teen years. For maximum effectiveness, the drops and tablets must be consumed daily. Because some parents find it difficult to follow a protracted daily routine, public health programs in which fluoride tablets are provided to children in school have been established in some areas. The tablets are first chewed and the resultant solution is swished in the mouth before it is swallowed. This procedure benefits the teeth that have erupted as well as those being formed in the jaws.

Fluoride-Containing Mouthrinses

Another effective method of increasing the resistance of teeth to decay is rinsing with dilute solutions of neutral sodium fluoride. Rinsing for one minute with fluoride is done either daily or weekly depending upon the amount of fluoride in the solution. A 0.05 percent solution of neutral sodium fluoride is used for daily rinsing and a 0.2 percent solution is recommended for weekly rinsing. Studies show that school-age children who rinse weekly with a fluoride solution will have about 35 percent fewer cavities than usually expected. Other studies suggest that fluoride mouthrinses may provide added protection for youngsters receiving community fluoridated water as well. Fluoride mouthrinsing programs are easily conducted in schools and, in fact, thousands of children are participating across the county in weekly fluoride mouthrinsing programs. The procedure requires only about five minutes of school time each week. It is inexpensive and well accepted by teachers and students. Generally, fluoride mouthrinses are not recommended for children younger than 6 years of age. Fluoride mouthrinses are not intended for swallowing. Because many children younger than school age are not able to control their swallowing reflex, they often ingest mouthrinse. If too much fluoride is consumed while teeth are developing, a condition called dental fluorosis (white spots on the teeth) may result. Fluoride mouthrinses are also available commercially without a doctor's prescription for daily home use.

Fluoride Dentifrices

The use of a fluoride-containing dentifrice (toothpaste) is recommended for children and adults. Regular and thorough toothbrushing with a fluoride dentifrice will provide protection against tooth decay and added protection when used together with most other forms of fluoride therapy. The use of a fluoride-containing dentifrice by children below the age of 6 should be closely supervised by an adult. Because preschool-age children are susceptible to developing dental fluorosis, only a small, pea-size portion of toothpaste should be put on their toothbrush for brushing.

Professional Application of Topical Fluorides

Dentists and dental hygienists often apply fluorides directly to the teeth. These topical fluorides are either in the form of gels, applied in mouth trays, or solutions painted directly on the teeth. Semiannual applications of these fluorides also substantially reduce dental decay. The National Institute of Dental Research, one of the National Institutes of Health in Bethesda, Maryland, is studying other approaches and methods of fluoride use. One such possibility is the use of fluoride compounds that could provide a protective cover on the teeth for many hours, as well as ways to release fluoride gradually in the mouth. These efforts are part of a broad program to find better ways of preventing dental decay.

5. How often should I have my teeth professionally cleaned?

Regardless of how well you brush and floss at home, your teeth need to be professionally cleaned about every six months. The purpose is to remove the plaque and tartar that build up on and between teeth despite good cleaning habits.

In addition your teeth, gums, mouth and throat and neck should be examined to check for oral cancer, facial structure and the condition of your temporomandibular joint. X-rays should be taken to get a better look at the structure of your teeth and mouth. These X-rays are not dangerous. A clinical exam will include looking for signs of gum disease, tooth decay, broken fillings, erosion, and also checking the mobility of your teeth. The entire visit should take about 30 to 60 minutes. Regular dental visits are essential in maintaining healthy teeth and gums, and shouldn't be ignored even if your mouth and teeth are healthy.

6. What is the best toothpaste to use?

Here again, the ADA has some guidelines, so make sure you look for the seal. Of the various ingredients in toothpaste, for example, baking soda has not been shown to be beneficial. In fact, baking soda used for baking should never be used to brush: It is much too coarse and can damage your teeth. However, ingredients that promote tartar control, hydrogen peroxide and desensitizing ingredients have been shown to be effective. The toothpaste that makes you brush your teeth more often is the one you should use. Experiment and find which one makes your mouth feel the freshest and you will look forward to brushing.

7. How do you brush your teeth?

The best way to keep plaque off your teeth is to brush and clean between your teeth. You should brush twice a day with a toothbrush that has soft bristles. Be sure that your toothbrush is the right size and shape to fit into all corners of your mouth. Brush in a circular motion and not in a sawing motion, making sure a portion of the gum is covered as well. Improper toothbrushing can wear out your teeth or leave behind harmful plaque, especially near the gumline."

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