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Curbs, Gutters, & Gums

Question:
Dr. Crapo: Over my adult life I have had a lot of dentistry. I’ve been well looked after and everything looks and feels good. I can eat anything I need or want without discomfort or sensitivity to my teeth. I have bridgework in the front of my mouth, lots of crowns and two implants with crowns on my lower left side replacing teeth I lost ten years ago. The problem I have is maintenance. My hygienist always has lots to say about the build up I get and bleeding in some spots that seem to elude me. I need help with caring for what I’ve got, oh and sometimes I get a taste or smell from my mouth that I seem to detect but my wife can’t. What is that?


Answer:
Oral hygiene is a broad subject. From the sixties until today, though the science of prevention has made great inroads, dental decay is still an out of control disease, even in first world nations.


Let me help you organize an approach that will help you. The first and most important issue to address is bacteria. It must be removed mechanically and chemically. Plaque is a tenacious biofilm that must be removed daily. For some individuals calculus forms a crystal like structure that finds a foot hold with plaque. These folks must remove the plaque effectively several times a day. Knowing how and where to brush is the key.


The favourite place for bacteria to congregate is in the sulcus….right, what is the sulcus you say? I get blank stares every time I trot that word out. If I say cuticle, you all know where to find that little part of the fingernail with its associated groove. Each tooth has a “cuticle”. If the fingernail represents the tooth and the adjoining skin on your finger represents the gum of the tooth, the groove between the “tooth and the gum” is called the sulcus. You must clean that out thoroughly. It’s your curb and gutter clean up job daily – or as I said with some folks, several times a day. The very best cleaner is called a sulca brush a brush designed to get into that groove on the cheek and tongue side of each tooth. Yes, it’s better than an electric tooth brush because it’s specifically designed to find and clean out that groove. Don’t throw away that shiny new electric brush that Santa dropped in your Christmas stocking, though. Two minutes with it (thirty seconds per quadrant) after flossing, with a bactericidal toothpaste, will make great inroads in killing that taste and smell only known to you. But I don’t like to floss (you say) — you will after next week!


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