Arianna Marsden, RDH

Has your hygienist ever recommended that you brush twice daily?  I made this recommendation to a patient recently, and he informed me that because he brushed his teeth at night, he did not need to brush his teeth in the morning.  This patient asked me, “why would I need to brush my teeth in the morning?  I didn’t eat anything while I was sleeping, so my teeth are still clean.”

It became apparent to me that this patient had a misunderstanding of how plaque develops on his teeth, and I think that other people may have the same misconception about how plaque forms.  This patient and I were able to have an educational conversation about how plaque develops, and my patient was surprised to learn something new at the dentist.

So, first of all, what is plaque?  Plaque is the white, fuzzy stuff you feel on your teeth after not cleaning your teeth for a while.  This plaque is filled with bacteria that cause gum disease and cavities.  Seconds after a cleaning, whether from your hygienist or from brushing your own teeth, the plaque starts to come back.  It begins as a protein layer of slime that our mouths produce naturally, called the acquired pellicle.  Bacteria that are always present in our mouths bind to this pellicle and begin to colonize.  When bacteria colonize, they bind together into a film that you can see and feel on our teeth; the white fuzzy stuff we call plaque.  This plaque will form whether or not food is eaten.   It’s important to remove plaque about once every 12 hours, or twice per day, to help reduce the amount of bacteria present in our mouths, and to prevent cavities and gum disease.

During my conversation with my patient about how plaque is formed, we speculated about why he might have had a misunderstanding about plaque.  He asked me, “I thought you were supposed to brush after eating, because the food makes the plaque and the plaque gives you cavities.”  Part of this is true; brushing after meals does help to prevent cavities, but not for the reasons he initially thought.  The plaque that is already present uses the sugars in the foods we eat, and produces an acid, which is what causes the cavities.  By brushing after we eat, we remove the plaque so it doesn’t have the opportunity to produce acid; we also neutralize any acid that may have already been produced, thus preventing cavities.  We also discussed that removing, or disrupting plaque about once every twelve hours prevents the colonized plaque from mineralizing into calculus.  Calculus is the hard stuff that gets stuck on your teeth that you can’t brush off; it most commonly develops on the tongue side of lower front teeth.  This calculus, and the embedded bacteria, are one of the main causes of gum disease.  Calculus can’t be removed with a toothbrush, so it’s important to see your hygienist regularly for professional cleanings to remove the calculus deposits which have formed.

When my patient understood why brushing more than once per day would benefit his oral health, he expressed that he would consider brushing twice daily, and we would observe the results of his efforts at his next cleaning appointment.  Often times understanding why we do something is half the battle.