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Necessary Procedure

We may now state the fundamental facts to which the necessary oral hygiene procedure must conform and specify the procedure required. One of these facts is the time honored saying "a clean tooth does not decay." The other, more recent, is "periodontoclasia does not occur about a clean tooth".(8) The author has formulated one sentence which comprehends what every person must know and do to save his teeth from these diseases and to maintain reasonable personal oral cleanliness. It is used as a slogan in teaching personal oral hygiene to others. Anyone who undertakes to teach others how to take care of their teeth (after learning how to take care of his own) will find this sentence of instruction useful and helpful. "You must clean your teeth right with the right kind of both toothbrush and dental floss every right before retiring." No part of this sentence may be changed or omitted without impairing its completeness. In the light of present information, no part of these instructions may be disregarded or neglected by anyone except at the jeopardy of his dental health.

All other supposed preventive measures which conflict with, or are intended to supplement, what is comprehended in the above sentence, tend to confuse or detract from the personal oral hygiene that is essential for maintaining oral health and cleanliness. If the teeth are also cleaned partially or well at other times, this contributes to greater oral cleanliness, but under no circumstances may such cleaning at other times of the day take the place of the essential cleaning at night before retiring.

Heretofore the individual has not known exactly how to clean his teeth right and the right kind of toothbrush and dental floss have not been available. Therefore he must be taught by someone who does know.

Right Kind of Toothbrush

The function of the toothbrush is to dislodge and remove from any and all areas on the teeth that are accessible to the application of the bristles of the brush as much as possible of the decomposing food and bacterial material that has accumulated and is retained there-since the previous cleaning. This material is soft, often microscopic in amount and composed of microscopic particles (bacteria and food elements). Its presence and character can be ascertained only by appropriate microscopic examination. The most important places to be cleaned with the brush are (a) the occlusal pits and fissures, (b) the proximal surfaces in the sulci between teeth as far as the bristles may go and (c) the surfaces of the teeth within the gingival crevices wherever they are accessible to the application of the bristles of the brush.

Material is dislodged and removed by the digging action of the ends of the bristles when the brush is applied firmly against the places to be cleaned and moved back and forth with short strokes ("vibratory motion"). The brush must be pressed down hard enough to force some of the bristles into the pits, fissures, sulci and gingival crevices as far as their diameter will allow them to go. The bristles must be flexible enough to allow those that do not enter the deeper spaces at the moment, to be deflected and not prevent others from entering. They also must be flexible enough so they bend and do not injure the gingival tissue when applied directly to the gingival crevices, and manipulated so as to secure the necessary digging action to dislodge the foreign material on the tooth within the crevice. For the same reason the ends of the bristles must be round and smooth instead of sharp, jagged, chisel shaped and rough, as the bristles of so many current toothbrushes are (Figure 14). The shape, size and form of the brush must be such as to adapt it to the most practical and effective application and manipulation for the purpose for which it is used (Figure 15).