Oral Hygiene Techniques at Home
This resource guide is lovingly dedicated to Dr. Paul A. Levi, my beloved mentor, whose wisdom and guidance have shaped my approach to periodontal care and patient education.
The Foundation of Periodontal Health
Proper home care is essential for maintaining your periodontal health between professional visits. The techniques described below focus on removing bacterial plaque from both above and below the gumline.
Stationary Bristle Tip Technique (Modified Bass Technique)
The Stationary Bristle Tip Technique is a highly effective method for cleaning at and below the gumline, where harmful bacteria collect and cause inflammation.
Technique Steps:
1. Select the right tools:
Use a soft-bristled toothbrush
Replace your toothbrush every 3 months or sooner if the bristles are frayed
2. Proper bristle placement:
Hold the brush at a 45-degree angle to the gumline
Position the bristles so they slip under the gum margin
Focus on one tooth at a time
3. Gentle vibration (not scrubbing):
Apply gentle pressure so the bristles flex slightly
Use short, vibratory motions to displace plaque
Avoid aggressive scrubbing, which can damage gums and tooth surfaces
Count to 2-5 seconds while vibrating the bristles before moving to the next tooth
4. Pressure control tip:
Hold your toothbrush with just your fingertips rather than a full grasp. This naturally reduces pressure and allows for more delicate control
Your grip should be light enough that the brush would fall if someone bumped your arm
5. Complete coverage:
Systematically work around your mouth, one tooth at a time
Brush all tooth surfaces: outer, inner, and chewing surfaces
For inner front teeth, tilt the brush vertically and use the "toe" of the brush
Why it works:
The stationary bristle tip technique is specialized for disrupting and removing the bacterial biofilm that forms in the sulcus (the space between your tooth and gum). By focusing on one tooth at a time with gentle vibration rather than scrubbing, you can effectively clean these areas without causing tissue trauma.
Adapted Horizontal-Vertical Flossing Technique
Dental floss reaches areas between teeth that your toothbrush cannot access. This technique ensures thorough cleaning of these crucial spaces.
Technique Steps:
1. Preparation:
Break off approximately 15-18 inches of dental floss
Wrap each end around the middle or ring finger of each hand
Leave about 5-6 inches of working floss between your hands
Hold the floss tightly between your thumbs and index fingers, with only about 3/4 inch of floss between them
2. Insertion:
Guide the floss gently between your teeth using a sawing motion
Never snap or force the floss through the contact point, as this can injure your gums
3. Cleaning motion:
Once the floss is between teeth, curve it into a "C" shape against one tooth
Hold the floss tightly against the tooth surface
Use both horizontal (forward-backward) and vertical (up-down) motions, similar to how you would dry your back with a towel
Move the floss up and down against the side of the tooth, making sure to go beneath the gumline
4. Complete coverage:
After cleaning one tooth surface, curve the floss around the adjacent tooth and repeat
Use a clean section of floss as you move from tooth to tooth
Systematically work through all teeth, including the back side of your last molars
Why it works:
The adapted horizontal-vertical technique maximizes plaque removal by combining two directional movements. The horizontal motion helps disrupt plaque at the contact point between teeth, while the vertical motion cleans the sides of teeth and just below the gumline. Using the floss properly against each tooth surface ensures comprehensive cleaning of these hard-to-reach areas.
WaterPik / Water Flossing Technique
Water flossing is an excellent adjunctive method, particularly for cleaning around dental implants, which have different anatomical considerations than natural teeth.
Technique Steps:
1. Preparation:
Fill the reservoir with lukewarm water (add 1 tablespoon of non-alcoholic antimicrobial mouthwash if recommended)
Select the appropriate tip: Standard tip for general use and specialized implant tips for cleaning around dental implants
Begin with the lowest pressure setting, especially if you're new to water flossing
2. Positioning:
Lean over the sink to avoid splashing
Place the tip in your mouth before turning the unit on
Close lips enough to prevent splashing while allowing water to flow out into the sink
3. Proper technique:
Aim the tip parallel to the tooth root surface, focusing on the gumline
Pause briefly at the space between teeth, targeting the crevice where the gum meets the tooth
For implants, direct the water flow into the sulcus around the entire implant
Allow the water stream to flush out debris from below the gumline
4. Systematic approach:
Follow the gumline, pausing briefly between each tooth
Work systematically around your mouth to ensure you clean all areas
Pay special attention to hard-to-reach areas like back molars
Important notes for implant care:
Dental implants require special attention because they connect to bone differently than natural teeth. The junction between an implant and the gum tissue lacks the same natural defense mechanisms found around teeth, making thorough but gentle cleaning essential.
Recommended sequence:
For optimal results, use your WaterPik after brushing and flossing. This sequence allows the water stream to flush out any remaining debris that was loosened by brushing and flossing.
Daily Oral Hygiene Routine
For best results, we recommend:
Brush with the Stationary Bristle Tip Technique twice daily (morning and before bed)
Use the Adapted Horizontal-Vertical Flossing Technique once daily
Follow with WaterPik/water flossing, especially if you have dental implants
Complete your routine with any prescribed antimicrobial rinses
Remember that consistency is key!
References
Poyato-Ferrera M, Segura-Egea JJ, Bullón-Fernández P. Comparison of modified Bass technique with normal toothbrushing practices for efficacy in supragingival plaque removal. Int J Dent Hyg. 2003;1(2):110-114.
Slot DE, Dörfer CE, Van der Weijden GA. The efficacy of interdental brushes on plaque and parameters of periodontal inflammation: a systematic review. Int J Dent Hyg. 2008;6(4):253-264.
Berchier CE, Slot DE, Haps S, Van der Weijden GA. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. Int J Dent Hyg. 2008;6(4):265-279.
Goyal CR, Lyle DM, Qaqish JG, Schuller R. Evaluation of the plaque removal efficacy of a water flosser compared to string floss in adults after a single use. J Clin Dent. 2013;24(2):37-42.
Ng E, Lim LP. An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dent J (Basel). 2019;7(2):56.
Chongcharoen N, Lulic M, Lang NP. Effectiveness of different interdental brushes on cleaning the interproximal surfaces of teeth and implants: a randomized controlled, double-blind cross-over study. Clin Oral Implants Res. 2012;23(5):635-640.
Please contact our office if you have any questions about these techniques or need a personalized demonstration during your next visit.
