GENERAL ARTICLES

Are You a TOOTH SCRUBBER?

Dr. Charles H. M. Williams November 15 1944
GENERAL ARTICLES

Are You a TOOTH SCRUBBER?

Dr. Charles H. M. Williams November 15 1944

Are You a TOOTH SCRUBBER?

Dr. Charles H. M. Williams

As reported by Bruce McLeod

SHE WAS an attractive young woman about 27. Her teeth looked white, straight, strong. When told by her dentist that she might lose them as a result of already established pyorrhea it brought surprise and shock to her eyes.

“But,” she protested, “how could that possibly happen? I’ve always taken good care of my teeth— brushed them faithfully three times a day.”

Like millions of other people who brush their teeth after every meal, she thought she was protecting the health of her mouth. She couldn’t understand why her gums had become flabby and diseased. And, like the majority of people who scrub their teeth vigorously and conscientiously in the belief it will give them a brighter smile, add sparkle to their personality or do away with bad breath, she was startled to be told that about 90% of the effort spent on brushing teeth is wasted.

Yet this is true, for many people use a toothbrush in such a way that it is not only inefficient but, in some instances, actually productive of damage. Properly used, the brush can be an important aid in maintaining the health of the mouth. Yet every day many people do their teeth more harm than good through faulty brushing methods.

Most people brush only the high spots or the more accessible surfaces of the teeth. They might just as

well never brush their teeth at all. Tooth decay never starts on the high spots; nor does inflammation of the gums usually start on the prominent surfaces of the gum tissues. Disease in the gums or teeth starts either in the crevices between the teeth or in the crevice between the edge of the gum and the tootK. It may spread to involve other parts but it starts in the crevices.

Tooth surfaces exposed to the rubbing action of the tongue, lips and cheeks, and to the swirling, washing effect of the saliva in the mouth remain healthy even if not brushed. The only condition under which disease might start on the high spots would be if something interferes with the normal cleansing function—an acute soreness of the mouth which might cause the individual to avoid the normal chewing function, paralysis of facial muscles or the destruction of a saliva gland.

Ordinarily, using a toothbrush is of little value unless your brushing technique is such that your brush gets into the crevices and depressions where tooth decay and gum disease have their beginnings. The material that collects in these crevices is always, to begin with, a milky fluid composed of food debris, saliva and dead cells off the gums. It undergoes fermentation and decomposition, producing chemical byproducts which are damaging to the teeth and irritating to the gums. The dead cells are in great number and are a powerful factor in contributing to the formation of tartar on the teeth.

The saliva in the mouth is like hard water, there’s a great deal of lime in it, and as it comes into contact

with the debris lying in the crevices, the lime tends to deposit out on it. As the lime collects around the debris it hardens and tartar is formed. If the mouth is kept free of this soft, white debris, tartar can be kept off all parts of the teeth accessible to the toothbrush. The deposit hardens gradually and usuajly takes between seven and ten days before it’s too hard for the brush to remove.

Tartar Is Dangerous

TARTAR on the teeth is damaging, because if allowed to remain it causes injury to the gums and the underlying bone with the gradual destruction of these tissues and the establishment of the most common type of pyorrhea. This is the type easiest to control and it is in the control of it that the toothbrush, properly used, performs its greatest service.

Continued on page 59

Chances are ten to one you’re not doing right by your teeth. You should learn to brush properly — and use a toothpick

Are You a Tooth Scrubber?

Continued from page 11

But while the toothbrush can aid in the prevention of tartar, by removing food debris from the mouth, it cannot do its job if you use a scrubbing technique. The milky white fluid on the glazed surface of the tooth enamel is like steam on a window. It is not stuck there—but like steam on glass it cannot be removed efficiently by sweeping, whisking or scrubbing with a brush.

If you try to whisk steam off a pane of glass with a broom you’ll see what I mean. You simply can’t do it for the results are streaky, smeared. Neither can you scrub it off, for no matter how conscientiously you tackle the job vigorous action alone won’t give you a bright polish on that kind of a surface. It is the same with your toothbrush. You can’t merely scrub teeth and expect to cleanse them well. But proper brushing technique will not only give thorough cleansing but also the desired sparkle.

To clean a steamed-up glass surface you don’t just pick up a lumpy piece of cloth and start rubbing. The most important thing is to make sure that the cloth fits the surface precisely. Then, as you move the cloth down the glass, you must keep it tightly adapted to the surface. Precise adaptation is what counts. Any haphazard motion ruins the adaptation and hence the cleansing. It is the same when you use a brush on your teeth. For best cleansing results you should always try to imitate with the toothbrush the effect of wiping glass with a cloth.

The toothbrush owes what efficiency it has to the resiliency of its bristles—a very essential quality in any instrument used to cleanse highly irregular surfaces such as teeth. If someone could invent an instrument combining the resiliency of the brush bristle with the fine adaptability of cloth, he’d come pretty close to the ideal tooth-cleaning instrument.

But because no toothbrush combines these qualities and is therefore only partly efficient, a special brushing technique is necessary if your brush is to do its job effectively. A correct technique—and it’s surprising how few

people brush their teoth this way until instructed by their dentist—is this: Start with the outer surfaces of the lower front teeth. Place the brush back of the handle up and with the sides of the bristles in contact with the teeth at a slight angle. The ends of the bristles should be just down over the edge of the gum.

Press it firmly against the gum and tooth surfaces, keeping in mind that you’re trying to make the brush bristles adapt themselves to the surfaces of the teeth.

Keep the brush at all times on its side and do not turn the ends of the bristles against the teeth, because if you do the bristles will separate and fail to cover the surface. Remember the broom on the steamy window.

Now, using a slight vibratory motion from side to side, keep the brush tightly against the teeth and drag it gradually from the gums toward the biting surfaces of the teeth. Be certain that you’re vibrating the brush in such fashion as to work the bristles into the crevices.—The amount of vibration or horizontal motion should always be less than a quarter of an inch, so as to allow the bristles to bend from side to side but not to flip out of the crevices. If they do the latter you’re wasting your time, for the crevices are not getting the cleansing which they should get.

When you try this technique you will see for yourself that if your brush moves upward from the gum over about one half the exposed length of the tooth the whole of the latter surface will be brushed. For when the brush is first applied it already covers half the tooth before the actual brushing starts.

Exactly the same brushing technique can be used in all parts of the mouth. Y ou should brush the inside surfaces of the teeth in the same way as the outside. And remember, brushing the backs of your teeth is important, for you can lose your teeth just as quickly from disease on the inside surfaces as you can from trouble on the outside surfaces.

Many people neglect to brush the inside surfaces of their teeth, or they brush them differently to the outside surfaces because they find their brush too large to fit the inner surfaces in the manner suggested above. Rather than change your brushing technique to suit your toothbrush, change your brush to suit your technique. Manufacturers make small brushes—ask for them. For most people a brush four rows of tufts in length is the most adaptable. If you cannot get one take your brush and cut it down to four rows of tufts. Also, for maximum satisfaction your brush should be flat along the ends of its bristles and the tufts should not be crowded too close together.

It is a common mistake for people to brush their teeth with the ends of the bristles, This is wrong, because it spreads the bristles and makes it impossible for you to fit them evenly against the surface they are supposed to clean. Brushing teeth with the ends of bristles is as senseless as trying to paint with only the ends of the bristles of a paint brush.

Many parents have trouble brushing the teeth of their threeor four-yearolds. This needn’t cause much worry, for, actually, a child’s teeth need little artificial cleansing. Later, however, as the teeth become more irregular, either from losses or crowding, artificial cleansing becomes more advisable and the child should be taught how to use a toothbrush properly.

Faulty Brushing

Not long ago a middle-aged man, who looked as though he could lift a

piano with either hand, asked why his teeth were wearing away near the gum line. Anybody with half an eye could see how the necks of his teeth had been severely damaged—but these cavities had been cut into his teeth not by any dentifrice, as he suspected, but by the manner in which he had used his toothbrush. He was one of those twofisted people who use a brush on their teeth the same way they use a brush on their shoes. They are called vigorous scrubbers. There are thousands of such people—people who use their toothbrush to damage their teeth instead of to protect them. In this particular instance the patient would have been better off had he not brushed his teeth at all.

And, like this chap, there are thousands of people who, when they start to have trouble with their teeth and gums, blame it on their dentifrice. They worry about whether or not they are using the right kind of tooth paste. They seldom wonder if their brushing technique is at fault.

One of the questions invariably asked of a dentist is: “Doctor, what do you have to say about such and such a kind of tooth paste?”

Any dentifrice should be considered essentially as a mechanical aid to the polishing of teeth. Dentifrices, generally speaking, get their cleaning action from the inclusion of an insoluble material that is mildly abrasive and a soap that has a detergent action. To these is added a flavoring. Though the detergent and abrasive used in one dentifrice may differ from those used in another, the cleansing effect is about the same.

The Council on Dental Therapeutics maintains that dentifrices, regardless of kind, can only assist the toothbrush in the mechanical cleansing of the teeth. The Council holds that it has not been proved as yet that dentifrices have a therapeutic value.

The Council on Dental Therapeutics bases its opinion on impartial research and investigative work. It is a standing committee of the American Dental Association, formed in 1930 for the purpose of informing the dental profession and the public with regard to drugs, cosmetics, chemical and pharmaceutical mixtures used in dentistry.

As for the different types of dentifrice, the Council says: “There is no

essential difference in the cleansing properties of tooth powder over paste.” It claims further that liquid dentifrices contain no insoluble material to act as mechanical cleansers and argues that with most liquid dentifrices it may be necessary to use a polishing agent once a week for removal of stains. This has been suggested by at least one of the makers of liquid dentifrice in its advertisements. Household table salt or sodium bicarbonate are safe and useful teeth cleansers, although not necessarily the most efficient for all people.

Film Not Always Bad

Some patients wonder what dentifrices will remove film from their teeth. They are surprised to learn that the whole question of the effect of film on teeth is still wide open to debate. We know only that some film is thought to be destructive, while other film is thought to be protective. The question is so far from settled that, in my opinion, it is doubtful that any dentifrice should credit itself with protecting teeth by removing the film on them.

Nor is it logical, in my opinion, for a dentifrice to promise biological bliss to unkissed maidens by giving them whiter teeth if they use the product three times a day. The term “whiten” should never be confused with the term

“cleanse.” To dentists “whiten” means actual bleaching and only dead teeth can be bleached. The shade of a person’s teeth varies from cream to steel grey. No one has yet shown that the shade of your teeth can be changed even by faithful use of a dentifrice, except in so far as cleaning reveals the natural color.

Many people believe that bleeding gums can be aided or cured by the use of this or that dentifrice. It is foolish to expect that any dentifrice—paste, powder or liquid—can overcome the hidden dangers bleeding gums may be trying to warn you about. You may be able to help bleeding gums by brushing them but it is the stimulating and cleansing effect of the brush on the gums that does the trick.

One substance that should not be used as a dentifrice in its concentrated form is sodium perborate. It can produce a large degree of burn in the mouth, even if the patient is not conscious of it. It is too caustic for general use and lowers the resistance of the tissues of the mouth.

There are special means of cleansing available to people who have gum disorders. As a result of disease people usually lose some of the gum tissue points between the teeth, and food debris will collect in these resultant spaces. The brush cannot penetrate and clean out these deeper crevices nearly as well as modern modifications of the toothpick, in whose use the dental profession has become much interested in the past ten years.

Regardless of what our rules of etiquette have to say about the use of toothpicks these have a very definite place in the treatment and prevention of gum disease and tooth decay. Practically every man and woman over 30 could use these toothpicks to good advantage, for after that age there is usually enough gum tissue lost to warrant special cleansing of the spaces between the teeth. There are several excellent, specially designed toothpick types on the market and people with badly bleeding gums usually reduce this symptom of trouble in a week or two through the use of these toothpicks. After the dentist has completed the treatment of the gum disease the continued use of the special toothpicks is important in maintaining the health of the mouth.

Recommended toothpicks are triangular in cross section and made of some flexible material. For cleansing interdental spaces of ordinary size special wooden, medicated toothpicks are satisfactory, but once a man has big spaces between his teeth the larger, rubber-type toothpicks are probably to be preferred.

If people would stop looking down their noses at the toothpick they could save themselves a lot of mouth trouble and discomfort and probably keep their teeth longer. It’s nonsense to frown on the use of the toothpick for, after all, people don’t have to use them in public any more than they’d use toothbrushes at the dinner table or on the street.

Fluorine Research

Effective measures for preventing tooth decay have long been sought by the dental profession and research is being conducted in many parts of the country. The public, however, must wait patiently for the results, for though some promising things are being developed, study of them requires time and care. General interest in the subject has been vastly stimulated by the various experiments currently being conducted with fluorine—an element of the chlorine family found in certain minerals, mineral water, bones, etc.

At Brantford, Ont., and Grand Rapids, Mich., fluorine is being added to the community drinking water. Since fluorine is very toxic it can be added to the water only in minute quantities — one part fluorine to 1,000,000 parts water. It will probably be five years or more before investigators are able to determine conclusively whether or not this experiment has produced a lower incidence of tooth decay in the communities where it was undertaken.

At Ripley, Ont., fluorine is thought responsible for the remarkable dental health of that community, but no one is quite sure of the part it plays. Fluorine alone may not be the answer. Some believe that the fluorine must be in a suitable combination with other trace elements before it aids in the prevention of tooth decay. At Ripley some of the wçll water of the district contains fluorine. But fluorine benefits may cöme from the soil through animal and vegetable products of the district. At any rate it is not correct to say that there is no tooth decay in Ripley.

In some cities dentists are studying the effect of painting a 1% solution of fluorine on the teeth of patients to see if the film formed by the fluorine is influential in the prevention of tooth decay. Since the fluorine is poisonous if swallowed in such a concentrated form, dentists must do this work with extreme caution, walling off the section of the mouth under treatment with cotton pads and then washing the fluorine off the teeth once it has had a chance to do its job.

From experiences such as these investigators hope to learn in what way fluorine works to prevent tooth decay. Actually swallowing water which contains fluorine may not be necessary. Some think the fluorine would do its work just as well if the mouth was merely rinsed out with the water. Then there is also the question of whether or not fluorine, taken after a certain stage in life, helps to prevent decay in teeth. Some investigators think fluorine is helpful only if absorbed into the body during those childhood years when the adult teeth are forming.

Eskimos Can Laugh

But for all our research and all our talk about toothbrushing and mouth hygiene, the primitive peoples of the world have the laugh on us when it comes to teeth. Many who have never seen a toothbrush have healthier teeth than we have. The primitive Eskimo in the eastern Arctic has the lowest incidence of tooth decay of all the peoples in the world—and he never brushes his teeth.

Diet plays an important part in the Eskimo’s remarkable freedom from tooth decay, but the beautiful straight, even arrangement of the Eskimo’s teeth can be attributed not only to the food he eats but to the manner in which he eats it. Like other primitive people the Eskimo eats food from his hands, and the gnawing function needed to bite and tear the food has fully developed his jaws so that his front teeth strike end to end when his back teeth are closed. This is known as the end-toend bite—the ideal condition rarely found in the mouths of civilized people.

The white man with his knives and forks and soft cooked foods, and the Chinese with his chopsticks, have eliminated much of this normal, biting function. This, to a large extent, accounts for our actually deformed, underdeveloped jaws, especially across the front parts of the mouth. As a result our front teeth are usually crowded and crooked. Look at your own teeth now and see if this is not true.

I have seen the effect of our civilized eating habits on Eskimo children who have come into contact with the white man’s soft foods and his lazy eating habits. These children, whose parents have magnificent teeth, show underdeveloped jaws and teeth that are as crooked, crowded and subject to decay as the white man’s.

If mothers would stop pampering their children with mushy foods— mashed potatoes, ground or finely shredded meat, and the dozens of other forms of “goo” they feed them daily—they’d be assuring the kiddies of far healthier, better jaws and teeth. In many homes children are given food that requires practically no chewing— hence their jaws can’t possibly develop as they should. As soon as the child is old enough for solid foods he should be fed things that are tough—not merely crisp. Biscuits aren’t the answer because they get soggy as soon as they go into the mouth. Be sure your child gets things to chew that have the same general consistency as dry rye bread.

Mothers should encourage children to eat as much as possible from their hands. This is particularly important during that period when the jaws are doing most of their growing—between birth and 12 or 14 years of age. Chops, baked potatoes, orange segments, bacon, cold meats, etc., should be eaten from the fingers whenever possible, so that the child gets a chance to bring his normal biting or gnawing function into action.

The ideal of the dental profession is to develop normal jaws and evenly arranged teeth in civilized man. The h alth of jaws and teeth—like those of the Eskimos—will then be little dependent upon artificial cleaning.

Give your child the best chance to develop normal jaws. If he fails make sure, at any rate, that he uses a correct brushing technique. Otherwise the chances are that he’ll have lost some teeth—unnecessarily—before he’s fifty.