As a child, I would take my fingernail and scrape white “junk” off my teeth. That was plaque building up on my pearly whites. I wasn’t a great brusher then. But, in my defense, I really didn’t understand how to brush any better. I thought it normal to wake up with a fuzzy feeling on my teeth, and to again feel that coating midafternoon. I brushed with the standard commercial toothpaste like I was told, and trusted that was sufficient. Little did I know plaque, or as we now call it, “biofilm” was actually alive and regrowing on my teeth.
And, because I was not doing a great job removing it, the bacteria left behind after brushing was regrowing faster. I did not know until I became a dental hygienist that teeth can feel silky-smooth with that “just got my teeth cleaned” feeling– every single day, even first thing in the morning! Here are my top ten tips for clean, healthy, silky-smooth teeth (and maybe even beat morning breath too!) But first, some biofilm background information.
Biofilm
Plaque, that fuzzy, stinky stuff that grows on your teeth has been renamed. We now call it a “plaque biofilm”. Biofilms are everywhere. They form not only on your teeth, but also on your tongue, gums, roof of mouth, nose, and elsewhere throughout your body. Think about a fast-rushing stream with slippery rocks, that’s a biofilm covering those rocks. The waterline in your refrigerator also has a biofilm and my friend, Amanda Hill recommends you test that for microbial biofilm! She’s the Waterline Warrior. And those red dots mean the waterline is full of pathogens.
Dental plaque biofilms are alive with bacteria, viruses, parasites, and yeasts. There is also food debris, minerals, proteins, and blood cells. It is normal to have plaque growing on teeth. And, healthy plaque is supposed to be there. It has a job to do- it protects teeth, neutralizes acids, and remineralizes teeth. It regrows in a very orderly fashion. The microbes live together in a very organized community. I liken it to a very tiny busy city. They form communities of microbes that give birth to more microbes. They communicate and talk to each other. They have a system of removing toxins (taking the garbage out – even microbes are smart, they don’t want to live in their own bacterial poop). They have a defense system to protect their way of life. They form a shell that makes them impenetrable to brushing, antimicrobial rinses, or even antibiotics. The problems start when they get too comfortable. They start populating and building a bigger biofilm city. The plaque biofilm gets thicker. They get “fat and happy” eating what you eat, especially sugar. They grow faster and move in more more relatives. Their protective shell gets thicker and more impenetrable. That lipopolysaccharide coating makes it very hard for you to remove with brushing. It can even be hard for me to remove, and I have power tools.
That’s why a quickie 30-second brushing does little to penetrate their ecosystem, and they grow back by midafternoon. They like living undisturbed in the nooks and crannies of your nice warm mouth. They are crafty and have outwitted you, especially if you are ten years old and doing the best you can (see above). The bacterial slide video is of the plaque bacteria from the front tooth of the above patient. It is a crazy busy slide- full of high-risk gum disease pathogens. This patient was not able to remove this plaque with his manual toothbrush. He had no idea it was there because his teeth always felt the same before and after brushing.
The Problems of Brushing
Problem number one: Manual toothbrushing needs a little, well actually, a lot of help. Research shows most folks that “manual” brush do so for 30 to 45 seconds. That means you spent about 1.9 seconds on each tooth surface. The biofilm is not even penetrated in that amount of time. When I teach “proper brushing”, I use a disclosing solution that stains the plaque pink for new plaque, purple for old plaque (over 48 hours old- 2 days!,) and then blue for acidic – cavity-making plaque) I show my patients how long it really takes to even penetrate the coating of the biofilm, at least 10 to 15 seconds each TOOTH SURFACE! and that often is not enough to completely remove it. It actually takes about 10 to 15 minutes to clean every tooth surface properly. Surprise, most folks don’t brush that long. That stuff is really sticky and hard to remove… That’s why you feel it regrowing every single morning. You did not completely remove it the night before. I liken manual toothbrushes to a Yugo- it will get you there, just not in style or as quickly. It can work and I will share how to use manual brushes better in just a second.
Problem number two: Toothpaste. Gobbing on a full ribbon of toothpaste from one end of the brush to the other is a waste of paste. It just coats the biofilm and makes your tongue numb. If your tongue is numb, you can’t feel if your teeth are clean. You spit because of all that dang foam from the sodium lauryl sulfate in the paste, and then rub your tongue over your teeth. They feel just fine and dandy, because, your tongue is numb. But, by midafternoon, your teeth have that familiar fuzzy feeling all over again.
Problem number three: The biofilm in and on the rest of your mouth, especially your tongue. Tongues are like Grama’s 1970’s avocado green shag carpet, it is dirty. All those taste bud follicles are coated in a blanket of plaque biofilm. The tongue should be pink, or variations of pinkish, depending on ethnicity. It should NOT be white. It should NOT be coated. If you are not cleaning your tongue twice daily when you brush, you are leaving all that plaque biofilm behind. And by cleaning, I mean with a tongue scraper, until no more plaque squeezes off. (Tongue Sweeper for the win.) The bacteria are mobile and able to move around your mouth.
Plaque biofilm is also on your gum tissues, the roof of the mouth, and cheeks. Brush/wipe them as well. Tonsils are also a bacterial petrie dish. Gargle with iodine water, ozone water, or warm salt water to help dislodge tonsil stones and clean the crevices. Tonsil stones are also called Tonsililths and can harbor all the same gum disease and tooth decay pathogens as the teeth crevices do. As a bonus, they can get particularly smelly.
Ten Tips On Busting This Biofilm
Time for my tips so your teeth can feel “dental hygienist clean” EVERY. SINGLE.DAY! Yes, you can make your teeth that clean. There is nothing magic that I can do that you cannot. The key to hygiene clean is that I spend 45 to 60 minutes getting them to this level. You cannot do it in one to two minutes, no matter how fast you brush. But, if you properly and thoroughly clean them every 12 hours, you can absolutely maintain them at a healthy level! The biofilm takes 24 hours to mature and return to the precleaning level of dysbiosis.
#1. Manual toothbrush users: Dry brushing. No toothpaste, no water. Brush until your teeth feel and taste clean. Use your tongue to feel if the teeth are smooth and silky. If they still feel fuzzy, brush more. Wiggle that brush into the nooks and crannies. Brush your gums. Wipe your cheeks and the roof of your mouth. Then, brush with a pea-sized smear of your favorite toothpaste. Kiddos only need a rice grain sized smear of toothpaste.
#2. Circle brushing: I use a small, circular motion with both manual and electric brushes. I realize the directions say to hold that electric toothbrush and let it do the work. I see better results when patients incorporate tiny circular motions with the brush. I want it to wiggle into those gum crevices, around crowns, implants, bridges, braces, fixed appliances, and anything else in the mouth. Creativity counts here. Holding the brush horizontally to the tooth only cleans the flat surfaces. We need to curl, bend, angle, and twist that brush into all the hidey-holes that biofilms favor.
#3. Brush your gums: Again, gentle, circular motions. You are not scrubbing grout. NO back-and-forth sawing motion – no scrubbing. You are GENLTY cleaning the gums. The crevices along the gum need your attention. You will not create recession by gently brushing your gums. Be aware of the gum line. Sometimes there is recession and one tooth has less attached tissue and more tooth exposed so the toothbrush needs to follow this gumline. Gently.
#4. Sensitive teeth: Sensitive Teeth need extra loving. Plaque bacteria left on these teeth are excreting acids which contributes to sensitivity. Extra soft brushes are key. There are great manual extra softs as well as several electric brushes with extra soft replacement heads. Sensitive teeth need an entire blog post of their own. There are numerous ways to handle them and to reduce and eliminate the sensitivity.For today’s blog post my goal is the get the plaque off gently.
#5. Toothbrush part 2: Brushing harder is not better. The part of the brush that does the plaque removal work is at the end of the bristles- those soft tips. When you press harder, the brush mashes the gum tissues and cuts the gums with the sides of the bristles. If your brush looks like you sat on it, time to throw it away and brush MORE GENTLY.
#6. Toothpaste: Toothpaste is medicine. It has many jobs to do. More is not better. Opt for a gentle toothpaste. Tartar control pastes and stain removal pastes are more abrasive. Xylitol is a perfect ingredient in toothpaste because it reduces the plaque. Six to 10 grams a day reduces plaque by 60%. That’s a tasty win in my book!
#7. Cleaning In between: If you only brush the flat surfaces, you only clean about 60% of the tooth surface. How to clean the other 40% is up to you. Floss, electric flossers, waterflossers or brush picks or interdental sticks are the options that come to mind. There is not one perfect tool, each has its pluses and shortcomings. Pick one, and try it. Ask your favorite dental hygienist for tricks and tips to use them more effectively. I like for the patient to be able to see the plaque with the disclosing solution to try out the tools in their hands. Since tooth decay and gum disease start in these hard-to-clean areas it is critical to remove and reduce the bacterial levels in these hard-to-reach areas.
#8. Penetrating the biofilm: How can we penetrate the biofilm if it is so tenacious and resistant? Oxygen-ozone is my secret weapon to conquer the lipopolysaccharide igloo-like shell. Oxygen-ozone oil can be purchased without a prescription and applied with a brush/floss/pick/interdental pick or even a finger. This magic oil is super oxygen. It penetrates the biofilm, adds oxygen to these anaerobes, and kills them or stops them from reproducing. Ozone water is another great option- especially in the waterflosser. (Use my discount code – Queenofozone)
#9. Nasal Hygiene: Use your nose for breathing- all the time. Nasal breathing is critical for proper breathing, clean air into your lungs, and correct facial development. This sets the stage for a healthy mouth. This allows you to have lots of nutrient-rich saliva cleansing your mouth, rehydrating the tissues and teeth, remineralizing the teeth, and neutralizing the acids. Mouth breathing does none of that. Nasal hygiene is probably more important than oral hygiene. Without nasal breathing tooth decay and gum disease take off like wildfire. Mouth breahting allows the plaque to be even stickier, fuzzier and smellier Check out my blog post on nasal hygiene.
#10. Bust that biofilm twice a day: Fuzzy teeth mean the bacteria are reproducing and the biofilm is growing. Electric brushes take two to four minutes. I vote for power tools every time. They just work better and faster.
Change the brush or brush heads with the seasons. That way, you have a soft, polished bristle brush working at 100% for you every time.
Brush twice a day, every day for a beautiful smile. You are worth it!
Warmly,
Barbara The Plaque Annihilator
Queen of Busting Biofilm, and Beautiful Smiles
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