A. Tooth brushing: Brushing the teeth after every meal is not excessive, but before bedtime is the most important tooth brushing session. Brushing removes much of the food debris and provides a clean feeling. Unless you have some special allergy or sensitivity problem, fluoride-containing, tartar control toothpaste should be used (FIG. 19.1). You need only a very small amount of toothpaste for each brushing, just enough to flavor the procedure. Be consistent when brushing. Start in a specific place and move systematically around both the front and back sides of the teeth. Avoid back-and-forth horizontal strokes and emphasize up-and-down and circular movements on teeth (FIG. 19.2). Toothbrushes are made in every shape, size, and color you can imagine (FIG. 19.3). However, a soft nylon bristle brush of average size is usually the most satisfactory. Don’t use it until it is destroyed—a few weeks is enough. Make sure to replace it after a serious illness or an encounter with canker sores. If you do not discard it, you may reinfect yourself. Brushing is only the first step to totally cleaning your mouth.

B. Dental Flossing: Flossing is not practiced by enough people. If everybody flossed daily, a significant amount of need for dental therapy could be eliminated because the debris between the teeth, where it cannot be disturbed with a brush, would be eliminated. As with toothbrushes, several types of dental floss are available. Most people find that standard waxed floss is the most acceptable (FIG. 19.4); the unwaxed variety catches and frays be- tween the teeth of many people. If the floss catches between your teeth, see your dentist for smoothing. Also, new types of floss that do not shred are now available (FIG. 19.5). Floss should be used at least once daily, and the best time is just before bedtime. Debris accumulated on the teeth that stays undisturbed during sleeping can be hazardous to your teeth if allowed to continue. Many people do not use floss correctly. The floss should be placed gently between the tooth contact areas and then slipped between the gums and the tooth on both sides of the gum (papilla) between each tooth.

C. Mechanical Toothbrushes: Some people need mechanical toothbrushes. If you do not like to brush your teeth and find that you neglect the task often, or that you are not thorough in carrying it out, a mechanical toothbrush may be best for you. If you are physically disabled with your hands, or if you know someone who has a mental disability that does not allow them to understand the need for oral care, a mechanical toothbrush is necessary. If you have a friend or relative with natural teeth who is ill or debilitated and living in a nursing home, a mechanical toothbrush could be helpful. Almost any mechanical toothbrush can be better than a manual toothbrush for most people, but at least two brands have achieved significant acceptance. Braun and Rota-dent toothbrushes (FIG. 19.6) are examples of mechanical toothbrushes that can provide optimal cleaning capability when used properly.

D. Special Cleaners: Certain cleaners that allow access to difficult areas of the mouth and between teeth (FIGS. 19.7 and 19.8) are needed by some persons with special oral cleaning needs. Ask your dentist or dental hygienist about your particular needs.

E. Tongue Cleaning: (FIG. 19.9). In many people, the tongue is covered with food debris and microorganisms. About 50% of the population needs to clean their tongues daily. Research has shown that the taste buds on some tongues are long enough to collect debris and microorganisms and cause bad breath. It has been estimated that the majority of bad breath is caused by tongue debris. Tooth brushing does not remove this debris, and brushing the tongue does not remove the debris well either. Pull your tongue out. If it is gray and has obvious debris on it, you need a tongue scraper.

Tongue scrapers are readily available in the oral hygiene departments of stores. They are easy to use. You place the device as far back in your mouth as comfort allows, press firmly, and pull the scraper forward. After using the scraper, your mouth will feel clean, your breath will be fresher, and tooth decay and gum disease should be reduced.

F. Mouthwashes: (FIG. 19.10) Many mouthwashes currently are on the market. Most of these solutions taste good, and they make your mouth feel clean. Research has shown that their positive influence on breath odor varies />