As you eat, your teeth, braces and appliances collect food. If food is left on teeth overnight, a thick plaque forms on the teeth and gums. Plaque causes bad-breath, tooth decay and gum disease (swollen, puffy, red, overgrown, or bleeding gums). Drinks and foods containing sugar can damage the tooth surfaces and gum tissue. Bleeding and swollen gums are a sure sign that plaque is not being properly removed. If your gums are swollen and inflamed your teeth will not move as easily, you will experience more discomfort during your treatment and white spots or decay will form on the teeth under and around the braces and appliances. It is discouraging to work hard to straighten teeth, only to finish and find decay or white spots on the teeth. The following is essential for the proper care of your teeth and gums: BRUSHING Dr. Johnson recommends that you use a soft-bristled toothbrush with moderate force and a toothpaste that contains fluoride. Place the toothbrush at an angle so that you feel the bristles under your gum line and use small circular motions. Completely clean each surface of every tooth in your mouth, including the areas above, below and between each brace. Each surface of every tooth should be scrubbed with 10-20 strokes of the toothbrush. This should take 3-4 minutes. Dr. Johnson recommends that you brush at least 4 times per day: after breakfast, after lunch (or as soon as you get home from school or work), after dinner and at bedtime. Your toothbrush will wear out faster because of your appliances, so be sure to replace it whenever the bristles start to fray.   1. Use a soft toothbrush with a small amount of toothpaste. Completely clean each surface of every tooth in your mouth, including the areas above, below and between each brace. 2. Use circular, vibrating motions around the gum line. Scrub each surface of every tooth with 10-20 strokes of the toothbrush. This should take 3-4 minutes.   3. Brush every tooth slowly. Brush the upper teeth down. 4. Brush the lower teeth up. Also brush your tongue and the roof of your mouth   Remember that a toothbrush might not reach the areas under the archwire properly. Proper oral hygiene also involves flossing and the use of an interdental toothbrush (Proxabrush), an antiseptic mouth rinse (Peroxyl) and a topical fluoride (Phos-Flur) or ACT fluoride rinse! FLOSSING Dental floss is a nylon thread that is used to remove food particles and plaque from between the teeth. Flossing is more difficult when you have braces on your teeth. A floss threader may be needed to get the floss under the archwire (note: floss threaders are reusable). Use a piece of floss about 12 inches long. Use the floss threader to get the floss under the wire. Slide the floss up and down along the tooth surface. When the tooth is clean, the floss will "squeak" as you slide it up and down along the tooth surface. Be very careful to not pull with too much force on your archwire. Flossing is important and should be done every day. The best time to floss is before bedtime after brushing to remove the plaque missed by brushing. This process will take more time than flossing without braces. If your gums are not healthy, they may bleed the first few days you floss. Remember that consistent brushing and flossing will result in a great orthodontic smile!   1. Carefully pull waxed floss between wire and braces.   2. Floss carefully around the gum area. INTERDENTAL TOOTHBRUSH An interdental toothbrush (Proxabrush) is another aid you may find useful to keep your teeth, braces and gums clean and healthy. It can be used to clean under orthodontic wires and around braces. Use this device slowly so you do not damage your braces.       ELECTRIC TOOTHBRUSH Although it is not absolutely necessary for good hygiene, an electric toothbrush may make brushing easier. WATERPIK We highly recommend the use of a Waterpik to loosen food and plaque before flossing and brushing. The Waterpik should be used on the lower water pressure settings so the gum tissue is not excessively irritated. The use of a Waterpik does not take the place of good toothbrushing. ANTISEPTIC MOUTH RINSE (PEROXYL) Peroxyl is an antiseptic dental rinse (active ingredient: hydrogen peroxide 1.5%) used in orthodontics to control minor gum inflammation and irritations from orthodontic appliances. It is also used to cleanse canker sores and minor wounds or other irritations of the mouth and gums such as mouth burns, cheek bites and toothbrush abrasions. Its oxygenating action removes debris allowing natural healing to occur. Dr. Johnson recommends that you rinse with half a capful (two (2) teaspoons) around in the mouth for at least one (1) minute, then spit out. TOPICAL FLUORIDE (PHOS-FLUR) Phos-Flur is a topical fluoride gel (active ingredient: 1.1% sodium fluoride) used in orthodontics as a dental caries preventive. It is not a substitute for tooth paste. Its action is twofold: to re-mineralize tooth enamel which has been exposed to bacterial acids and to act as an antibacterial agent. Dr. Johnson recommends that you apply a thin ribbon of Phos-Flur Gel to the teeth with a toothbrush for at least one (1) minute at bedtime, then spit out. Drinking and eating are not recommended for thirty (30) minutes after using Phos-Flur, since doing so will dilute or rinse away the active ingredient. A FEW TRICKS Since most patients watch some TV, we have found it to be effective to sit down in front of the TV daily with a toothbrush without toothpaste, and massage the teeth and gums with the toothbrush bristles for about 30 minutes. Thirty minutes gives you plenty of time to do a good job, and makes TV time more productive. Brushing while listening to music or studying is also acceptable. You may want to use toothpaste to freshen your breath, but don't use toothpaste during this 30 minutes. We want you to avoid the "once over lightly" technique. To concentrate better, you may use your left hand if you are right handed, and vice versa. The most important time to brush is just before going to bed. Take your time and do it right. REGULAR DENTAL CHECK-UPS Although you are having your braces checked regularly, it is very important to continue to see your family dentist every three to six months for a thorough examination and cleaning of your teeth. If you experience difficulty with good oral hygiene you my need to see your dentist more frequently. CLEANING A REMOVABLE APPLIANCE All orthodontic appliances tend to accumulate food particles and plaque just like teeth do. Every time you brush your teeth, brush your removable appliance. Once a day you should soak your appliance in a glass of room temperature tap water with a denture-cleaning tablet, such as Efferdent. This will help prevent plaque buildup and will keep your appliance tasting better.