Talking to Edith Maurer Bussink, dental hygienist

Kriens, December 2013 – Edith Maurer Bussink, 56, has her own dental hygiene practice in Biel-Benken/canton Basle Land.

Talking to Edith Maurer Bussink, dental hygienist

Opening discussion: the topics

Edith Maurer, what is it like being a dental hygienist? Tartar, tartar, tartar?
Actually, there is a lot to clean and check. The positive side is that caries is becoming increasingly less common. Nevertheless, there’s still a lot of damage: people frequently brush too much and with excessive pressure.

Is it possible to brush too often?
Not really, but if too much pressure is always used, particularly with a medium hard or even hard toothbrush, it has an abrasive effect on the teeth over time. The gums also recede and the necks of the teeth are exposed.

That hurts.
Yes, it does and there’s another problem with gums that hardly ever hurts: inflammation of the gums, or gingivitis and this is extremely prevalent.

Why is this a problem?
Only a dentist or dental hygienist can diagnose it with any certainty. If you never have check-ups, you don’t notice it and, as the years go by, it leads to another disease, periodontitis. Tooth loss is only a question of time.

What can be done about it?
Several things, but it’s all very time-consuming. The ideal solution is to cure the inflamed gums immediately and not let it happen again.

Is it difficult?
No, anything but. It’s really easy. You only have to show people how.

The gumline

How do I deal with inflamed gums?
The secret is to remove the plaque. The problem lies in the fact that many people only brush their teeth.

What else needs brushing?
The gumline. This is vital.

What is the gumline?
It’s the very small groove between the teeth and the gum. Bacteria accumulate here and form deposits. This is the cause of inflamed gums.

In other words, clean the gumline instead of the teeth?
That’s a bit exaggerated, but basically yes. Cleaning the gumline also cleans the teeth.

How does that work?
By positioning the brush correctly: half of the bristles on the teeth, the other half on the gum. The brush is held at a slight angle so that the bristles point towards the gumline.

And then?
You now brush in small circles, using as little pressure as possible. You need a particularly soft brush with very fine bristles for this.

Why?
Fine bristles penetrate the gumline easily. And particularly soft to avoid damaging the gumline.

Are injuries common?
Yes, to get into the gumline with medium hard or even hard bristles needs a lot of pressure and this results in injuries. The gum recedes and the necks of the teeth are exposed.

Dental floss

So, are soft toothbrushes very important?
Definitely. I often see parts of the teeth that look like they’ve been ground away.

Just because of using the wrong sort of toothbrush?
People often brush their teeth right after eating – when there’s a lot of acid in the mouth, which intensifies the effect.

It’s better to not brush at all, in that case?
No – brushing is good but it’s better to wait for half an hour to an hour to let the acid-alkaline balance return to normal. And then a soft, dense brush should really be used.

And use dental floss, too?
Once a day is enough, in the evening before brushing your teeth. But you should again take care not to hurt yourself.

How?
People usually use quite a bit of pressure to force the floss between the teeth. When it suddenly goes in with a rush, it’s such a surprise and the dental floss cuts straight into the gum.

Is that so bad?
Well, if you keep on doing it, the gum will recede.

What should we be doing?
Only use dental floss where it’s really needed. This usually means only for the incisors and canines.

Only for those? Why?
The sides of the incisors and canines are nice and smooth so dental floss will remove deposits very well.

What about the other teeth?
The other teeth have niches and dental floss will simply pass over them. It will hardly clean anything there.

Anatomy of the molars

What’s the reason for this?
The front and canine teeth only have one root, but the side teeth and molars have two. In the upper jaw, the molars even have three roots. This is why the side teeth and molars are not straight like the front teeth and have these indentations, particularly between the teeth.

And what do these indentations look like?
They’re best described as niches bent inwards, as superb hiding places for bacteria between the teeth.

I can’t reach into them with a toothbrush?
No - and dental floss stretches right over these niches. A tiny little brush is what’s needed. With long bristles that reach into the niches and clean properly.

And if I don’t do that?
Then the gum between the teeth will start to defend itself against bacteria.

How?
It changes its climate, it becomes inflamed so that the bacteria suffer...

... and does that help?
No. The bacteria that start to multiply rapidly are precisely the ones that you don’t want. And the good bacteria are outnumbered, upsetting the balance.

Oh dear.
Yes. The inflammation goes from bad to worse, and you don’t even see it happening. Periodontitis is the result. The situation only improves when the tooth is out. But what will I do without teeth?

You could have an implant.
True, but you have to look after implants even more than natural teeth.

Implant

Implants aren’t vulnerable to decay, are they?
Well, it’s more a question of inflammation once again. The gum around an implant is more vulnerable to inflammation – and thus to periodontitis – than a natural tooth.

I’m not really following you!
It helps if you understand what happens with natural teeth: they have a gumline and, because bacteria like to accumulate along the gumline, our bodies have developed two strategies to fight off such bacteria.

What are these strategies?
Strong blood circulation and flushing out.

What effect does strong circulation have?
It transports the materials that defend against bacteria to precisely where they are needed. This is why the tissue around natural teeth has very strong circulation. The antibodies are brought as close as possible to the teeth and gumline in order to fight off bacteria.

And the flushing out?
The gumline produces a fluid – known as sulcus fluid.

You mean saliva?
No, saliva is something quite different. It comes from the salivary glands. In contrast, the sulcus fluid is produced around the teeth in the gumline. This sulcus fluid wells up at the gumline and tries to wash away the bacteria. Almost like a mountain stream.

And with an implant?
Circulation is affected. And sulcus fluid is no longer produced.

How does that happen?
The place where the natural tooth used to be, the periodontium as it is called, is badly scarred. All that’s left is bone and mucous membrane. The fine tracery of tiny veins has largely been destroyed and, as a result, the antibodies are hardly able to get to where they’re needed.

What can be done?
It is vital that the gum line around an implant is cleaned really well on a daily basis – even better than with a natural tooth. Interdental brushes are indispensable when cleaning implants and the finer the brush the better. In addition special toothbrushes and dental floss that have been specifically designed for implant care are also available. The advantage of using these tools is that the bristles are able to reach under the crown of an implant. I would recommend very careful cleaning twice a day around an implant using all of these tools for an effective, thorough clean.

How?
It’s best to have your dentist or dental hygienist show you how to do this properly. This will also ensure that you use the correct size of the interdental brush. If they are too small, they won’t clean well and if they are too big, they can cause damage. A sonic toothbrush can also be a useful tool.

What’s that?
An electric toothbrush that cleans with more than 30,000 oscillations a minute.

Benefits of a sonic toothbrush

Isn’t a manual toothbrush enough?
Yes. If you brush your teeth well, then a manual toothbrush is sufficient. However, sonic toothbrushes make brushing that bit easier.

What is the difference between the various electric toothbrushes?
Some have a round brush head that moves back and forth, in other words it oscillates. They clean very well; the only problem is that a lot of people use too much pressure. This can damage the gums and the necks of the teeth.

And with sonic toothbrushes?
This cannot happen since the bristles come to a standstill if excessive pressure is used. Injuries are therefore ruled out. Sonic toothbrushes also have an another benefit.

What’s that?
Sonic toothbrushes also clean where the bristles of a manual toothbrush simply cannot reach.

Is that a magic trick?
Yes - and it’s called the hydrodynamic effect.

How does that work?
The bristles move with more than 30,000 oscillations a minute. This is so fast that the mixture of saliva, water and toothpaste is literally swirled around in the mouth. This mixture gets to the plaque between the teeth - and at high speed. The plaque is simply cleaned away, even in those hard to reach areas.

Where’s that?
The gum line and between the teeth.

Your own – for a lifetime

So dental floss and interdental brushes are no longer needed?
They still are – it’s better to use dental floss and interdental brushes as well.

The time spent on cleaning teeth is fairly high.
It’s within bounds. Clean your teeth in the morning and teeth and interdental spaces in the evening. At midday, you can simply do a lap of honour, as a professor has said, to clean up the worst. That’s enough. 

Can you keep your teeth for a lifetime?
Yes, and if that is your goal, you will gladly accept this minimum effort. Anyone who has ever lost a tooth knows that it’s almost a traumatic experience. It’s far nicer to be able to laugh with your own teeth for all your life. There’s an even better way to keep your teeth for a lifetime.

There is?
This uses the solo technique. It involves cleaning each tooth individually, with a special single-tufted brush. There are courses for learning how to clean individually. This almost guarantees that you will keep your teeth for a lifetime.

Back to the sonic toothbrush: who is it suitable for?
Actually, for everyone. People who find it difficult to clean their teeth – the elderly and children – benefit especially. Also people who have implants or wear braces on their teeth.

Children and the elderly

You’ve just mentioned two keywords: the elderly and children.
With children, you should start cleaning as soon as the first tooth appears – something that many people forget. It’s best with a very soft toothbrush. For example, Curaprox’s CURAkid toothbrush is really gentle, which is why it received an award for best bristles from “wir eltern” magazine in 2013.

Is a gentle toothbrush particularly important with children.
Yes. Firstly, it prevents injuries. Secondly, babies get used to cleaning teeth in a playful way with a toothbrush that is so gentle. Babies thus like to brush teeth, because there is nothing that hurts - unlike with hard bristles. It’s just like playing.

What about elderly people'
The flow of saliva decreases with age. However, it’s important to have enough saliva because it contains minerals, enzymes and proteins that are important for oral health. I recommend a mild toothpaste, in particular Enzycal by Curaprox, which contains enzymes present in saliva and boost it. It is also SLS-free.

What’s the problem with sodium lauryl sulphate
SLS is present in almost all toothpastes. It foams and helps slightly with cleaning but attacks the oral mucosa. I also recommend an SLS-free toothpaste for people who suffer from mouth ulcers.

Thank you for talking to us

Edith Maurer Bussink, 56, has her own dental hygiene practice in Biel-Benken/canton Basle Land. This is Part 9 and the final one in this series.