Russell D. Nishimura, DDS; Professor Emeritus, UCLA School of Dentistry; Fellow Academy of Osseointegration

Oral Hygiene

Why is oral hygiene so important?

Adults over 35 lose more teeth to gum diseases (periodontal disease) than from cavities. 3 out of 4 adults are affected at some time in their lives. The best way to prevent cavities and periodontal disease is by good tooth brushing and flossing techniques, performed daily.

Periodontal disease and decay are both caused by bacterial plaque. Plaque is a colorless film, which sticks to your teeth at the gumline. Plaque constantly forms on your teeth. By thorough daily brushing and flossing, you can remove these germs and help prevent periodontal disease.

How to Brush

Dr. Nishimura recommends using a soft to medium tooth brush. Position the brush at a 45 degree angle where your gums and teeth meet. Gently move the brush in a circular motion several times using small, gentle strokes brushing the outside surfaces of your teeth. Use light pressure while putting the bristles between the teeth, but not so much pressure that you feel any discomfort.

When you are done cleaning the outside surfaces of all your teeth, follow the same directions while cleaning the inside of the back teeth.

To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle back-and-forth strokes over each tooth. Don’t forget to gently brush the surrounding gum tissue.

Next, you will clean the biting surfaces of your teeth by using short, gentle strokes. Change the position of the brush as often as necessary to reach and clean all surfaces. Try to watch yourself in the mirror to make sure you clean each surface. After you are done, rinse vigorously to remove any plaque you might have loosened while brushing.

If you have any pain while brushing or have any questions about how to brush properly, please be sure to call the office at (805) 496-0026.

How to Floss

Periodontal disease usually appears between the teeth where your toothbrush cannot reach. Flossing is a very effective way to remove plaque from those surfaces. However, it is important to develop the proper technique. The following instructions will help you, but remember it takes time and practice.

Start with a piece of floss (waxed is easier) about 18” long. Lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the other hand.

To clean the upper teeth, hold the floss tightly between the thumb and forefinger of each hand. Gently insert the floss tightly between the teeth using a back-and-forth motion. Do not force the floss or try to snap it in to place. Bring the floss to the gumline then curve it into a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth. Remember there are two tooth surfaces that need to be cleaned in each space. Continue to floss each side of all the upper teeth. Be careful not to cut the gum tissue between the teeth. As the floss becomes soiled, turn from one finger to the other to get a fresh section.

To clean between the bottom teeth, guide the floss using the forefingers of both hands. Do not forget the back side of the last tooth on both sides, upper and lower.

When you are done, rinse vigorously with water to remove plaque and food particles. Do not be alarmed if during the first week of flossing your gums bleed or are a little sore. If your gums hurt while flossing you could be doing it too hard or pinching the gum. As you floss daily and remove the plaque your gums will heal and the bleeding should stop.

Caring for Sensitive Teeth

Sometimes after dental treatment, teeth are sensitive to hot and cold. This should not last long, but only if the mouth is kept clean. If the mouth is not kept clean, the sensitivity will remain and could become more severe. If your teeth are especially sensitive, consult with your doctor. They may recommend a medicated toothpaste or mouth rinse made especially for sensitive teeth.

Choosing Oral Hygiene Products

There are so many products on the market it can become confusing and choosing between all the products can be difficult. Here are some suggestions for choosing dental care products that will work for most patients.

Automatic and “high-tech” electronic toothbrushes are safe and effective for the majority of the patients. Oral irrigators (water spraying devices) will rinse your mouth thoroughly, but will not remove plaque. You need to brush and floss in conjunction with the irrigator. We see excellent results with electric toothbrushes called Rotadent and Interplak.

Some toothbrushes have a rubber tip on the handle, this is used to massage the gums after brushing. There are also tiny brushes (interproximal toothbrushes) that clean between your teeth. If these are used improperly you could injure the gums, so discuss proper use with your doctor.

Fluoride toothpastes and mouth rinses, if used in conjunction with brushing and flossing, can reduce tooth decay as much as 40%. Remember, these rinses are not recommended for children under 6 years of age. Tartar control toothpastes will reduce tartar above the gum line, but gum disease starts below the gumline so these products have not been proven to reduce the early stage of gum disease.

Anti-plaque rinses, approved by the American Dental Association, contain agents that may help bring early gum disease under control. Use these in conjunction with brushing and flossing.

Professional Cleaning

Daily brushing and flossing will keep dental calculus to a minimum, but a professional cleaning will remove calculus in places your toothbrush and floss have missed. Your visit to our office is an important part of your program to prevent gum disease. Keep your teeth for your lifetime.

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Child Dentistry

Your Child's First Visit

The first "regular" dental visit should be just after your child's 3rd birthday. The first dental visit is usually short and involves very little treatment. We may ask you to sit in the dental chair and hold your child during the examination. You may also be asked to wait in the reception area during part of the visit so that a relationship can be built between your child and your dentist.

We will gently examine your child's teeth and gums. X-rays may be taken (to reveal decay and check on the progress of your child's permanent teeth under the gums). We may clean your child's teeth and apply topical fluoride to help protect the teeth against decay. We will make sure your child is receiving adequate fluoride at home. Most important of all, we will review with you how to clean and care for your child's teeth.

What Should I Tell My Child About the First Dental Visit?

We are asked this question many times. We suggest you prepare your child the same way you would before their first haircut or trip to the shoe store. Your child's reaction to his first visit to the dentist may surprise you.

Dental Practice During Your First Visit:

• Examine your mouth, teeth and gums.
• Evaluate adverse habits like thumb sucking.
• Check to see if you need fluoride.
• Teach you about cleaning your teeth and gums.
• Suggest a schedule for regular dental visits.

What About Preventative Care?

Tooth decay and children no longer have to go hand in hand. At our office, we are most concerned with all aspects of preventive care. We use the latest in dental sealant technology to protect your child's teeth. Dental sealants are space-age plastics that are bonded to the chewing surfaces of decay-prone back teeth. This is just one of the ways we will set the foundation for your child's lifetime of good oral health.

Cavity Prevention

Most of the time cavities are due to a diet high in sugary foods and a lack of brushing. Limiting sugar intake and brushing regularly, of course, can help. The longer it takes your child to chew their food and the longer the residue stays on their teeth, the greater the chances of getting cavities.

Every time someone eats, an acid reaction occurs inside their mouth as the bacteria digests the sugars. This reaction lasts approximately 20 minutes. During this time, the acid environment can destroy the tooth structure, eventually leading to cavities.

Consistency of a person's saliva also makes a difference; thinner saliva breaks up and washes away food more quickly. When a person eats diets high in carbohydrates and sugars they tend to have thicker saliva, which in turn allows more of the acid-producing bacteria that can cause cavities.

The first baby teeth that come into the mouth are the two bottom front teeth. You will notice this when your baby is about 6-8 months old. Next to follow will be the 4 upper front teeth and the remainder of your baby's teeth will appear periodically. They will usually appear in pairs along the sides of the jaw until the child is about 2 1/2 years old.

At around 2 1/2 years old, your child should have all 20 teeth. Between the ages of 5 and 6 the first permanent teeth will begin to erupt. Some of the permanent teeth replace baby teeth and others don't. Don't worry if some teeth are a few months early or late as all children are different.

Baby teeth are important as they not only hold space for permanent teeth but they are important to chewing, biting, speech and appearance. For this reason it is important to maintain a healthy diet and daily hygiene.

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Periodontal Maintenance

Periodontal diseases are infections of the gums, which gradually destroy the support of your natural teeth. There are numerous disease entities requiring different treatment approaches. Dental plaque is the primary cause of gum disease in genetically susceptible individuals. Daily brushing and flossing will prevent most periodontal conditions.

Why Is Oral Hygiene So Important?

Adults over 35 lose more teeth to gum diseases, (periodontal disease) than from cavities. 3 out of 4 adults are affected at some time in their lives. The best way to prevent cavities and periodontal disease is by good tooth brushing and flossing techniques, performed daily.

Periodontal disease and decay are both caused by bacterial plaque. Plaque is a colorless film, which sticks to your teeth at the gum line. Plaque constantly forms on your teeth. By thorough daily brushing and flossing, you can remove these germs and help prevent periodontal disease.

Periodontal diseases can be accelerated by a number of different factors. However, it is mainly caused by the bacteria found in dental plaque, a sticky colorless film that constantly forms on your teeth. If not carefully removed by daily brushing and flossing, plaque hardens into a rough, porous substance known as calculus (or tartar).

Periodontal Disease

Bacteria found in plaque produces toxins or poisons that irritate the gums, which may cause them to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss.

Preventing Gum Disease

The best way to prevent gum disease is effective daily brushing and flossing as well as regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.

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Dental Specialties

What Is an Oral and Maxillofacial Surgeon (OMS)?

Oral and maxillofacial surgeons are dentists specializing in surgery of the mouth, face and jaws. After 4 years of dental school, surgeons receive 4-7 years of hospital-based surgical and medical training, preparing them to do a wide range of procedures including all types of surgery of both the bones and soft tissues of the face, mouth and neck.

What Is a Periodontist?

Periodontists are dentists who specialize in the diagnosis and treatment of periodontal (gum) disease. They have had extensive training with 2 additional years of study after dental school. As specialists, they devote their time, energy and skill to helping patients care for their gums. A periodontist is one of the 8 dental specialists recognized by the American Dental Association.

Why Is Your Dentist Referring to a Periodontist?

Your dentist has determined that your gums require special attention. The periodontist and dentist work together as a team to provide you with the highest level of care. They will combine their experiences to recommend the best treatment available to you while keeping each other informed on your progress. By referring you to the specialist, your dentist is showing a strong commitment to your dental health.

What Is an Endodontist?

The Endodontist examines, diagnoses and treats diseases and destructive processes, including injuries and abnormalities of dental pulps and periapical tissues of the teeth.

Endodontists examine patients and interpret radiographs and pulp tests to determine pulp vitality and periapical tissue condition. They evaluate their findings and prescribe a method of treatment to prevent loss of teeth.

What Is a Prosthodontist?

The prosthodontist examines and diagnoses disabilities caused by loss of teeth and supporting structures. They formulate and execute treatment plans for the construction of corrective prostheses to restore proper function and esthetics of the mouth, face, and jaw.

What Is a Prosthodontist?

A pediatric dentist has at least 2 additional years of training beyond dental school. The additional training focuses on management and treatment of a child’s developing teeth, child behavior, physical growth and development, and the special needs of children’s dentistry. Although either type of dentist is capable of addressing your child’s oral health care needs, a pediatric dentist, his or her staff, and even the office décor are all geared to care for children and to put them at ease. If your child has special needs, care from a pediatric dentist should be considered.

What Is an Orthodontist?

An orthodontist prevents and treats mouth, teeth, and jaw problems. Using braces, retainers, and other devices, an orthodontist helps straighten a person's teeth and correct the way the jaws line up.

Orthodontists treat kids for many problems, including having crowded or overlapping teeth or having problems with jaw growth and tooth development. These tooth and jaw problems may be caused by tooth decay, losing baby teeth too soon, accidents, or habits like thumb sucking. These problems can also be genetic or inherited.

So Why Would You Go to the Orthodontist?

Your dentist or one of your parents might recommend it because they see a problem with your teeth or jaws. Or a kid who doesn't like the way his or her teeth look might ask to see an orthodontist.