Earn Your Dentistry Merit Badge
by Peter Zelchenko November 13, 2009

Thursday's Worldview Global Activism series on WBEZ featured a local dentist named Brian Evans who has gone to Haiti, Peru, Sierra Leone, and many other developing countries to train health-care workers in basic dentistry, including extraction and filling.

In Sierra Leone, Evans was shocked to learn, there are only 11 dentists for a population of almost 6 million people. He also learned that in the city of Bo, with a population of over 700,000, there is only one dentist. A colleague of his had gone to Morocco, where people were "dying because of infection and...postoperative hemorrhage" from complications after trying to do their own extractions without the proper training. "They're using pliers, nails they may try to sharpen and dig the teeth out, obviously not very successfully... ."

Many of us are consciously grateful of the level of dental services here in America, not to mention the fluoridated water, and yet most of us do not take proper advantage of these things. More importantly, dental care in affluent countries -- with the help of the highly processed grains and sugars available -- tends to focus its efforts not toward prevention but toward the more profitable treatment.

My eight-year-old Cub Scout has never had a cavity, and I attribute that to the controversial fact that his daddy still frequently flosses and brushes his teeth for him. I get looks from hoity concerned parents, but I stand my ground. These parents are the same ones whose poor kids' mouths are filled with Bondo because they haven't ever been really taught how to floss and brush. Several pediatric dentists applaud this method and have told me they do the same with their kids.

I have a (very minor but interesting) claim to authority in this field. You see, I was the very first Boy Scout ever to earn the Dentistry Merit Badge when it came out. (Actually, I had to share the honor with two older kids from Alsip, but I was cuter than them and got better press.)

That distinction in itself didn't help me much, because years ago I was beginning to need fillings. I decided to study my technique and actually interrogate the various dentists I came in contact with. Gradually, and only after years of work, I think I am doing things more or less right. I don't get cavities, and I only visit a dentist once every five years or so for a minor cleaning and fluoride update.

First of all, I believe that one very careful flossing and brushing, every night, is adequate. I also believe that if you only have time to do one thing, you should floss rather than brush. But you should endeavor to do both, and allocate up to 10 minutes to do it, every single day of the rest of your life. It's so much more mission critical than making your bed or washing your dishes, if you're having a busy week.

Flossing is very tricky to do effectively. To prepare the floss, I use an innovation developed many years ago by then-Northwestern Dental School student Hassan Zandieh, now a dentist in Phoenix: take a length of floss about 7 to 10 inches long. Holding the two ends together, tie two or three knots near the end to make a loop big enough to hold comfortably (you can make each subsequent knot below the previous ones and "slide" it up to them by pulling the sides of the loop apart). This "floss loop" is easier to hold and uses far less floss than the conventional method of wrapping lengths around your fingers. It's also easier for children to use, and more to the point than floss-picks, which make no sense to me and are probably counterproductive to teaching what is going on in there.

The problem of good preventive hygiene is that every day people mechanically follow a vague representation of the inadequate rules they were taught long ago, without ever having understood the reasons behind them.

Most people think that as long as you get the floss between the teeth, you're done. But the crucial thing is to get way under the gumline, and not so much between the teeth but rather along each side of each tooth. This means getting the floss all the way up the tooth until it stops. Then you fold the floss against as much of that side of the tooth as you can, and gently drag it across and out of the gap to pull off the plaque. Then you go in and do the neighboring tooth in that same gap. The object should be to get all of the plaque out, each and every time you floss.

Trust me, this is going to hurt and bleed a lot the first few days. That is an indication that you are doing it correctly. What you are seeing is gingivitis developing in the area of the teeth that is under the gums. You are treating that. The pain and blood will go away completely within a couple of weeks. When you go for your next cleaning, you will get complimented and the cleaning will take a fraction of the time and will not hurt much.

The right way to brush is just as difficult to convey. Dentists tend to do a very poor job of it. What's important to know is that the object, again, is not simply to get the toothpaste across some of the teeth, but to use the toothbrush as an instrument to contact and scrub every accessible surface of every tooth, including as far under the gums as you can. This is called sulcular brushing and does not require a fancy power toothbrush.

(The video above is pretty good for a start, but dentists are simply wrong about brushes wearing out in 2-3 months, assuming you don't use too much pressure. A good brush, properly used and cleaned, can last for years. This is the great myth of the manufacturers, who want to sell us boxes of new brushes.)

The keys to sulcular brushing are: using a brush with good bristles, working slowly and methodically, learning to rotate the brush, and angling the face of the brush toward all gaps, so that it has the best opportunity of getting into the cracks between the teeth and under the gums. This takes time to learn -- and to unlearn what we've been doing wrong all these years.

Do not apply much pressure: The tips of the bristles should not be bent far back but only enough to be accessing the gaps between the teeth and going into the gumline. When done right, the bristle tips will actually be getting under the gums slightly, which is where plaque likes to hide. Flossing achieves the same purpose along the sides of the teeth. (Always floss and brush the ends of the back molars as well.)

You do not need high-tech electric gadgets to brush well, just intelligent technique. In fact, I feel it is dangerous to rely on these devices, because they make us forget even more about what we're doing. When you are doing it right, your gums will never be red and sore, they will always be healthy pink.

If you have kids, doing their teeth for as long as possible gives them the only opportunity to feel how they should be doing it. If you think this is weird, I couldn't care less: I want my boy's teeth to last him the rest of his life, and so should you. If not, maybe you should be reading the bland pronouncements of someone like Eric Zorn, who once lumped it in with dozens of other things, confusing it in value with painting your porch and reading good books. But most of our Gapers Block denizens should agree it's far more important.

Come on, we're so great at pushing those little buttons for text-messaging. This is the same level of fine-motor skill, so why do we spend so little time on it? Any questions or insults, hurl them at me.

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