Oral Hygiene


The best way to prevent periodontal disease is by consistent tooth brushing and flossing.  Periodontal disease is caused by dental plaque/bacteria.  Plaque is a colorless film that sticks to your teeth and surrounding tissues in the oral cavity.  Plaque constantly forms on your teeth putting you at risk for periodontitis.  Daily brushing and flossing help to eliminate plaque and bacteria which cause periodontal disease.

Dr. Berwald recommends using a soft tooth brush.  Position the brush at a 45 degree angle where your gums and teeth meet.  Gently move the brush in 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 discomfort.  Repeat the same technique to properly brush the inside tooth surfaces of the back teeth.

To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Gently move the brush back and forth over each tooth.  Gently brush the surrounding gum tissue.


Periodontal disease usually appears between the teeth where your toothbrush cannot reach.  Flossing is an effective way to remove plaque fro those surfaces. However, it is important to develop the proper flossing 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 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 forefinger 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.

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 the Braun Oral B and Sonicare electric toothbrushes.

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 six years of age. Tartar control toothpastes will reduce tartar above the gum line, but gum disease starts below the gum line 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.

Your periodontist is the best person to help you select the right products that are best for you.

Professional Cleaning and Periodontal Maintenance

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.  It is important to see your periodontist on a regular recall schedule.  Dr. Berwald evaluates each patient individually, and places them on an appropriate maintenance schedule.  Your consistent office visits and compliance are an important part of your program to prevent gum disease.