Keeping your teeth and gums healthy takes just a few basic steps. Brush and floss every day to prevent tooth decay and remove plaque from your teeth and gums. Visit your dentist for a professional cleaning at least twice a year to remove tartar from places brushing and flossing may miss. Eat healthy foods, drink plenty of water, and limit sweets. And, if you're a smoker, quit.

Daily care

You can remove plaque by brushing twice a day and flossing once a day. According to one study, brushing your teeth first without toothpaste and then again with paste reduces plaque by 67% and gum bleeding by 50%. Flossing removes bacteria and food particles from in-between teeth. Rinsing with certain mouthwashes also helps. Even rinsing the mouth with water after eating can reduce bacteria by 30%.

Steps to effective brushing

• Brush twice a day.
• Use a soft-bristled brush that fits your mouth.
• Use toothpaste with fluoride to help protect your teeth from decay.
• Place the brush where the gum meets the tooth, with the bristles at a 45-degree angle to your teeth so they get under the gum line.
• Move the brush back and forth in short (tooth-wide) strokes. Be gentle; brushing vigorously can actually injure the gums and make them more susceptible to periodontal disease.
• Brush both the inner and outer surfaces of the teeth and brush the broad chewing surfaces with the entire brush.
• To clean the inner surfaces of the front teeth, use the tip of the brush in gentle up-and-down strokes.
• Brush for at least 2 minutes.
• Scrub your tongue for about 30 seconds to remove even more bacteria.
• If you dry brush first, follow the same brushing procedure for about a minute and a half without paste, then brush again for another 2 minutes.
• Rinse the toothbrush thoroughly.
• Change brushes every 3 months or so, or when the bristles are bent or frayed, or after a cold or illness.

Steps to effective flossing

• Break off about 18 inches of floss and wind most of it around the middle finger of one hand and the rest around the other middle finger.
• Holding the floss between your thumbs and forefingers, guide it between two teeth by gently rubbing it back and forth.
• When the floss reaches the gum line, curve it around one of the teeth and gently slide it back and forth in the crevice between the tooth and the gum.
• Holding the floss tightly against the side of the tooth, rub gently up and down.
• Repeat for each tooth, including the backside of your last teeth, changing to a different part of the floss as you go along.

Dental healthcare products

On all products you purchase for oral hygiene look for the American Dental Association (ADA) Seal of Acceptance. This guarantees that the ADA has reviewed the advertising claims for the product, finds them to be true, and ensures the product is safe and effective.

• Because toothbrushes come in all sorts of shapes and sizes, it's important for you to choose one that fits the contour and size of your mouth. For most people, a 4- or 5-rowed, soft, nylon-bristled toothbrush will do, but extra features can be helpful. For example, an extended tip helps reach back molars and the inside of your front teeth. Brushes with higher bristles in the center are better at reaching below the gum line. The rubber tip at the end of some brush handles is good for massaging the gums after brushing and flossing. Electric toothbrushes and new high-tech models that use sound waves have been found to remove significantly more plaque than ordinary brushes. However, most experts agree that if a regular toothbrush is working for you, stick with it.
• Toothpastes deliver fluoride to the teeth and slightly under the gum line to protect against decay, whiten and remove stains from teeth, and encourage brushing by tasting good and preventing bad breath. Some toothpastes also reduce the amount of bacteria around the teeth and help reduce bleeding due to gingivitis. Tartar control toothpastes do indeed reduce tartar, but only above the gum line. Avoid highly abrasive toothpastes, which can add to gum damage, and tooth whiteners made with carbamide peroxide. That chemical breaks down into hydrogen peroxide, which may injure gums and soften tooth surfaces. And don't bother to mix baking soda with your toothpaste. There's no evidence the combination is effective against gingivitis or periodontitis.
• Choose a dental floss that does not shred or fray and isn't so thin it cuts the gum or can't be guided gently down and around the sides of your teeth. If you have teeth that are very close together, try a floss made of Gore-Tex®. It costs a bit more, but it slips more easily between tight teeth and will not tear on sharp edges. If you have difficulty using floss or have bridgework, a floss threader may help. Special picks, small brushes, and other interdental cleaners are handy for wide spaces between teeth. Standard toothpicks should never be used for regular hygiene.
• The only mouthwashes shown to fight plaque are over-the-counter Listerine® and the prescription-only ones containing chlorhexidine (Peridex®, PerioGard®). It seems the ads for Listerine are correct; it does reduce bacteria, plaque, and gingivitis when used for 30 seconds twice a day. Chlorhexidine is even more effective, reducing plaque by 55% and gingivitis by 30% to 45%. Rinses containing chlorhexidine should not be used at the time of brushing to avoid interaction between, and possible inactivation of, certain chemicals found in both products. Rinses are not a substitute for regular brushing and flossing.
• Oral irrigators (water spraying devices) will not remove plaque from your teeth unless used in conjunction with brushing and flossing.

Dental examinations

Regular exams to check the health of your teeth and gums and regular cleanings to remove plaque and tartar are essential for a healthy mouth. For most people, seeing the dentist and hygienist twice a year is all that is needed. However, a pregnant woman or a person with periodontal disease in the family might need to visit more frequently.

Periodontal screening

Today, in many dentists' offices, a periodontal screening is included along with the cleaning and checking for cavities. Find out if your dentist conducts this screening. If he or she doesn't, ask for one. Known as a Periodontal Screening and Recording (PSR), this exam can reveal the early stages of periodontal disease. Using a mirror and a special calibrated probe, the dentist checks for bleeding gums and pockets. If a pocket is found, the dentist measures its depth by placing the tip of the probe inside the pocket down to where the connective tissue attaches to the tooth. Pocket depths greater than 3 millimeters indicate disease; depths greater than 4 millimeters indicate periodontitis. A new automatic probing device may prove to be more sensitive and accurate than the manual probe most dentists use. After the screening, the dentist records where pockets were found, how deep they were, where the gum appeared inflamed or injured, and which teeth were loose. If the condition is severe, the dentist may refer the patient to a periodontist for treatment. Although PSR appears to be more reliable than x-rays in diagnosing gum disease, it is still recommended that you receive a full series of mouth x-rays every 2 to 3 years, not only to discover early bone loss, but also to find cavities or fractures in the teeth.

Confirming a diagnosis of gum disease

Your first visit to a periodontist to confirm a diagnosis of periodontal disease will be similar to the screening your regular dentist did. The periodontist will ask you questions about your medical history and the medications you take. This will reveal whether you've had prior periodontal problems and whether there is any condition that might contribute to your problem. The dentist might also ask you about how you care for your teeth and gums. Next, the gums are inspected thoroughly for signs of inflammation, redness, puffiness, bleeding upon probing, and recession of the gums. The periodontist will then conduct another PSR to measure pockets and check for tooth mobility. When the stage and extent of the disease has been determined, he or she will decide upon a treatment.

Dental care for children

Regular checkups and cleanings are as important for children as they are for adults, if not more so. Children should also receive regular fluoride treatment to prevent decay and reduce periodontal disease. Studies have shown that adults who received fluoride treatments as kids, have less periodontal disease.

Other preventive measures

• Quit smoking. Gum disease can be added to the long list of reasons why it's healthier not to smoke.
• Hormone replacement therapy might be something to consider if you're a woman past menopause. Not only does it lower the risk of developing heart disease and osteoporosis, which is linked to periodontal disease, but a study published in August 1999 by the Journal of Periodontology showed that taking estrogen supplements can reduce gum inflammation and bone loss around the teeth.
• Drinking water helps reduce inflammation in the mouth by producing more saliva. Saliva is important for diluting the toxins created by plaque. In addition, the more water you drink, the less soda you're likely to consume, which means less sugar in your diet.
• Eat healthier. A balanced diet enhances your overall health. Fewer sweets decrease the amount of sugar in your mouth that's available for bacteria to eat and turn into corrosive acids that can cause tooth decay.