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#Thread on #flossing and #mouthwash:

A few days ago, I posted a thread about the importance and proper technique of brushing your teeth. Here it is:

It was very well received and I thank all of you for that.

Here is part II:
Before we discuss how to use floss and mouthwash, let's understand why.

Food left behind on teeth=> Bacteria=> Acid production=> Destruction of tooth structure=> Cavities=> More food stuck there.

This cycles continues continuously unless it's broken.
Brushing properly helps removed food from the outside, inside and top of the teeth. Unfortunately, the most common area of food getting stuck is in BETWEEN teeth, where they touch each other. And the ONLY way to remove that is by proper and regular flossing.
These cavities are NOT seen by the naked eye, even for the dentist and can only be detected by xrays. Here is an example:
But take a look at the xrays:
Here they are after drilling:
SO two main takeaways:

Floss regularly.

Get xrays done once a year to detect these cavities while they are still small. Once they start hurting, they have invaded the nerve and can only be resolved with a root canal and crown or worse need extraction and be replaced.
Here are the basics of flossing:

How often: At least once a day. Ideally twice-post lunch and dinner

When: BEFORE brushing!!!!! PLEASE NOTE!

The ideal sequence is rinse with water=>floss=>brush=>use mouthwash.

The mouthwash can be done only at night.
Which floss:

Ideally waxed floss. The brands I recommend are Oral B and Glide. Waxed floss slides in and out much easier.

How to floss:

Here is a really good video to discuss how to floss. The only thing I advise differently is to slide it OUT
and NOT down for better results.

The water flosser does not really get in between the teeth and is better for people whose gums have receded and have triangular space between their teeth. Best discussed with your dentist than here.
Another way flossing helps is prevent periodontal disease aka gum disease.

Food also gets stuck in your gums and can cause long term damage. Here is how it progresses:
Flossing really helps prevent this. If untreated, it usually cause severe loosening of teeth needing complete extractions.The stages of the progression are as follows:
Typically in the previous generations, the incidence of dentures was very high because of this more than cavities. I often get asked "My grandfather never went to the dentist all his life and he never had any issues"
The simple answer to that is that gum disease does not cause pain like cavities do and hence people carry on. As late as the 90's it was very common for people in their 50's to have all teeth taken out and dentures made.

I did a root canal/ca on a 85 year old patient last week!
Another important step is to get a yearly check up and cleaning done. Specially with advanced age.

The last but probably the most ignored benefit of flossing is to prevent cavities under previous dental work like fillings and crowns.

Yes that can and will happen! Pls floss!

Without getting into the chemistry, a proper mouthwash is the final mode of attack on preventing cavities and periodontal disease.

For patients with no cavities, I recommend the regular listerine.
For those with high number of cavities/history of dental work/during braces and those at high risk of dental caries, I recommend the Listerine with Fluoride in it. But this needs to be discussed with your dentist first.

It has fluoride in it.
Fluoride makes your teeth more resistant to the breakdown by bacterial acids and hence reduce the number of cavities. Again best discussed with your dentist first.

There is a mouthwash specific for people suffering from Periodontal aka gum disease called Chlorhexidene.
It is an antibiotic and should only be used with written prescription, as should all antibiotics.

I have tried to make this thread as easy as possible for the layman to process. Hope this helps.

Main takeaway:
1) Floss
2) Brush
3) Rinse
See a dentist once a year for check-up, xrays and a cleaning. Get cavities filled before they hurt and ensure good diet and home care to prevent re cavities.

As always, wash your hands!
CC: @NachikethShetty here’s part 2!
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