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Fight against plaque

One tooth at a time

Karen Miller
Fight against plaque
Nailah R. Tillman, D.D.S., M.S. is a general dentist at Mattapan Community Health Center. Tillman is currently training in Dental Public Health at Harvard University College of Dental Medicine due to her passion for improving access to oral health care. Photo: John Kelley

Brushing one’s teeth and flossing are not high on the list of favorite things to do. Some people avoid it altogether. That is not a wise thing to do.

The consequences can cause you pain, suffering and cost. Yet, with minimal effort, tooth decay and gum disease are largely preventable. To that end the American Dental Association has established guidelines on not only when to brush, but also the proper technique.


It’s all about the plaque  ─ that slick film of bacteria that perpetually invades the teeth and anything else in its path in the mouth. It’s everywhere ─ on the tongue, the roof of the mouth, even the inside of the cheeks. The ADA recommends brushing your teeth twice a day in an attempt to keep the plaque at bay. Brushing after every meal is better, according to Dr. Nailah R. Tillman, a general dentist with Mattapan Community Health Center. That’s because when you feast on sugars and starchy foods, like cakes and crackers, the bacteria feast as well. But the combination of sugar and bacteria in the mouth is not a good thing. It produces acid, the first step in tooth decay.

Tillman actually recommends a broader approach to cleaning. “Brush your mouth,” she said. Do a gentle sweep of all surfaces in the mouth, and pay particular attention to the tongue. She likened it to a sponge that attracts its fair share of the bacteria. The tongue can be cleaned with the toothbrush or a tongue scraper. Big Cheese Photo
Big Cheese Photo

Tillman also advises people with bridges and other dental prostheses to brush more frequently than twice a day. Bacteria tend to form more quickly on those surfaces, she explained.

The preferred times to brush are in the evening and upon waking. “When we sleep, whatever food is left in the mouth becomes a breeding ground for bacteria,” she said. “The closed mouth is dark, warm and wet.” In addition, the production of saliva decreases during sleep, thereby robbing the mouth of its natural protection. It’s not only the frequency of brushing but also the length of time. Two minutes is the suggestion – generally one minute for each row of teeth.

The technique for brushing has changed over the years. No more side to side or up and down. Hold the brush at a 45 degree angle against the teeth and move in a circular motion. Make sure the bristles are going in between the teeth and underneath the gums. Pay special attention to the back molars where decay typically forms.

Spit after brushing to remove the dislodged debris. Some dentists recommend against rinsing out the mouth, however, as it will wash away the fluoride in the remaining toothpaste.


The number and different types of toothbrushes are mind-boggling. Some bristles rotate, others spin, while still others vibrate. Some have floss tip bristles that are slightly longer for a deeper reach. Some come with cheek and tongue cleaners. Regardless of what you choose, the good old-fashioned manual will do the trick as well . It’s not the brush. It’s the brusher that makes the difference.

There is one thing that dentists tend to agree on. Use only soft bristles. Brushing too hard can destroy the enamel of the teeth, and enamel will not grow back, Tillman warned.

Toothbrushes should be changed every three to four months, but sooner if you’ve had a cold or sore throat to prevent re-contamination. Some brushes come with color-wear bristles to remind you to change. Once the color disappears, its time is up.

There is a difference of opinion on how to store toothbrushes. The ADA recommends standing the brush upright, and drying it in the open air taking precaution to avoid contact with other brushes. Tillman disagrees. “The bathroom is a hub for bacteria,” she explained. The Environmental Protection Agency is on her side. The EPA affirms that the quality of indoor air can be up to five times more polluted than outdoor air. The quality of the air next to the toilet is questionable. A possible solution is storing toothbrushes in plastic covers that have air vents to allow proper drying. When the toothbrush is tossed, the cover should be tossed along with it.


It used to be easy to buy toothpaste. There wasn’t much variation. Now the choice is overwhelming. Toothpaste promises to whiten, kill plaque and freshen the breath all at the same time. It comes in mint, peppermint, spearmint and even apricot or peach flavors. There’s only one ingredient that you need to look for, however, and that’s fluoride. The paste can make any promise that attracts you and come in any flavor that suits your fancy, but if it lacks fluoride, it will not provide the protection the teeth need.

Another tip is to look for ones that carry the approval by the ADA.


The tools for flossing have gone the way of toothbrushes and toothpaste ─ there are a lot of choices. There are floss picks, interdental brushes, water picks or the old stand-by dental tape. The ADA recommends flossing at least once a day, but Tillman advises to try to do it after every meal to improve oral hygiene. The type of floss does not matter, but the technique does. If you use string floss, make a “C” around each tooth, and slide it through, making sure you go below the gum line. Be careful not to use that same section of tape on another tooth. That’s just spreading the bacteria from one area to another.

Tillman recognizes that she has her work cut out for her. “Caries is the most preventable and most common disease in the world,” she said. She takes it one step at a time. “If I can get someone to floss once a day, perhaps they can soon floss twice a day.”

At a glance

  • Brush at least twice a day
  • Brush at night and first thing in the morning
  • Floss at least once a day
  • Use a toothbrush with soft bristles
  • Replace your toothbrush every three to four months
  • Use toothpaste that contains fluoride and is approved by the ADA
  • Get dental checkups every six months
  • If unsure of a dental product, visit
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