Board Certified Periodontist

102 – Brushing and Flossing

Hi and welcome, or welcome back. You are listening to the Perio Patient Podcast, a podcast for my patients and anyone else who cares to listen. My name is Dr. Ben – or Benjamin — Young and I am a periodontist in private practice in San Antonio, Texas. This is Episode 102, and the title is Brushing and Flossing Review.
When I was a kid, the only person who called me Benjamin was my mom – and it usually meant I was in trouble.
Later in life, however, I discovered that Ben, being a less common name than Dan or Bob, was never picked up correctly through intercoms – like at drive-throughs, or by receptionists taking names, or on the phone. They will say, “What name should I put this reservation under?”
And I will say, “Ben.”
And they will say, “Bob?”
And I will say, “No, Ben.”
And they will probably then say, “What?”
And then I will say, “Bob. It’s Bob.” Or I will make up another name like Mephiboshef or something.
Anyway, I have learned that Benjamin is clear. Not that they will necessarily spell it correctly, but that’s fair.
Perhaps I should start saying my name is Benjamin, but you can call me Ben.
It’s the same with my email address.
There I have included my middle initial – which is W. It stands for William which was my father’s first name. My two brothers and I all have the same middle name – which is now way off topic.
Anyway, back to my email address. The way I tell people what it is is to begin by saying, “It’s my full name with a middle initial dot com.
This also works for a website that provides people with all my professional and less professional information.
Today I feel it’s time to review a few topics that I continually find myself reviewing with patients.
Let me begin with this. If you have questions in my area of dentistry – say for example, having to do with gum recession or dental implants or use of lasers – things I do routinely, then take a look at my podcast listing. This is episode 102. You might find I explain something you have been wondering about in one of these episodes.
About flossing. This is one of my favorites. And it is also something I find most people do not understand. Because I found myself repeating flossing information over and over day after day I finally broke down and wrote the book – with pictures in the middle of it that show people how best to floss their teeth.
When no one has explained how to floss, the default method people try first is to wrap the floss around their first fingers. The problem with this is they can’t get the floss to the back of their mouths because their two fists don’t fit.
By wrapping around the middle finger between the two knuckles, it frees up the first fingers and thumbs to manipulate the floss as needed throughout the mouth.
The problem with floss holders is that the tension of the floss is set. Sometimes it is too firm and sometimes it is too loose. By holding the floss with your hands it enables you to have the tension needed to move the floss under the contact of the teeth and then to be able to loosen the tension to effectively wrap the floss.
The big mistake when flossing is to snap the floss through the contacts between the teeth – which hurts, and then to saw the floss – or towel dry. This cuts the gums which results in an injury the body then must heal from while at the same time fighting the bacterial colonies trying to decay the teeth or injure the gums and underlying bone support.
My last point about flossing today – and this is true about everything you are trying to do with your oral hygiene routine – is that it doesn’t cure disease. In other words, if your gums are swollen or bleeding, floss will not fix this problem without causing permanent injury. Yes, you can get many infections to recover, but they are often at a loss to healthy tissues. Brushing harder to solve problems is the same thing. It will certainly remove the plaque that is causing the infection, but it will also injure healthy tissue in the process.
Should you have bleeding, tenderness, swelling, or any other odd symptom, seek an examination and diagnosis. You first want to know what is going on. The treatment then must be designed to effectively resolve the problem without further injury to the healthy structures. Once someone is back to health then flossing and brushing gently as preventive procedures work very well.
Let’s talk now about toothbrushing and toothpaste.
Use the softest bristles you can find and also use the gentlest stroke you can do. Use the least amount of toothpaste as well.
If you overdo toothpaste, you will wear down the enamel and the dentin. Of the two, you will wear the dentin, which compared to tooth enamel is softer, at a much faster rate. This causes notches to form at the point where enamel meets dentin. Gum recession is often the result of heavy brushing methods.
About electric toothbrushes. They are fine, just hold them in place and then move them from place to place. No broad brushing strokes with an electric toothbrush.
Waterpiks. High powered water pressure can injure the gums. Also, if the angle of the waterpik is into pockets it can injure these area and blast bacteria down into them.
Waterpiks are helpful for flushing food particles out from under bridge work or where someone is wearing braces. Also they should not be thought of a substitutes for brushing and flossing.
So now, I have talked about the intensity of brushing and flossing. Be gentle. Low intensity.
What, instead is important, is frequency. Low intensity. High frequency.
Your purpose when brushing and flossing with just a little toothpaste for flavor is to disrupt the plaque – not eliminate it – which is impossible to do. If you are disrupting the colonies of bacteria, it means you are removing them from the surfaces of the teeth. They then float off in the saliva.
Flowing this, almost immediately, new organisms will attach and begin the process all over again, resulting in larger colonies after another twenty-four hours or so. Frequently disrupting plaque – twice a day with the toothbrush and once a day with the floss, is generally adequate to prevent further disease – for a long period of time. This then means periodically you need examinations and professional cleanings.
If children are trained to accomplish these procedures young enough then they are very likely to never experience significant tooth loss in their lifetimes.
If people are learning these preventive procedures later in life after there has been tooth damage, even tooth loss, then their need for more frequent examinations and cleanings become necessary – and sometimes problems are not eliminated requiring continued treatment for the rest of their lives.
This is why I wrote my flossing book – which also talks about brushing as well – for families – in order for mothers, fathers, grandparents, and other adults to read and teach this information to their children.
The title of the book is The Joy of Flossing. It is in English and Spanish and can be purchased as a soft cover book or Kindle download from
Well that’s enough for today I think.
You have been listening to the Perio Patient Podcast and I am still Dr. Ben Young. Thank you, as always for listening. Bye for now.
Did you know deer can jump higher than the average house? It’s because of their strong hind legs and the fact that the average house can’t jump.