Got 3 minutes?

July 29, 2005
Author suggests a quick oral hygiene plan for the real world

by Beth Sciarratta, RDH

Good oral hygiene not only prevents dental disease, it eliminates bad breath, improves personal appearance, and promotes good general health. However, most patients don't have nearly as healthy a mouth as they could, due to not practicing consistent oral hygiene habits. We drive ourselves crazy trying to motivate them. This is a technique I have developed. I call it "3 Minutes to Good Oral Hygiene."

Many patients believe that good oral hygiene means spending hours in front of a bathroom mirror. For the typical general practice patient (perio is different) I tell them this is not true. I believe adequate cleaning can be accomplished in three minutes if done effectively.

Step One: Floss first! This is the most important thing. When they floss first they won't skip it. Everybody knows they should floss, but they pick up the brush first; load it up with toothpaste and brush. The mouth feels clean and they say, "I'll floss next time." Next time never comes, and the days and weeks go by with no flossing.

I have "Floss First" on my operatory computer as a screen saver. I swear to God I'm going to get it on my license plate. I can't say enough how important this is. We need to change our instructions completely from brush and floss to floss and brush

I tell all my patients flossing first cleans better than brushing alone. Flossing alone cleans better than brushing alone. If you're going to skip something, I say skip the brush. There are more bacteria between the teeth and on the corners than anywhere the toothbrush reaches. When patients complain about flossing I empathize with them. Exercise for me is like flossing for everybody else. I know I need to do it but there's always something better. If flossing were aerobic, I would look like Madonna!

I say flossing isn't difficult. It just takes practice. If you can use a remote control, a computer mouse, or a video game, you can floss, especially kids. There must be a brain area that has to be activated by a certain age or it never works to use those hand-held games. Mine obviously has never been used. But I can floss!

I instruct all my patients to hold the floss on the middle fingers and direct it with the thumb and index fingers. Use the pads of the fingers and the tip of the nail. For my ladies with super long nails I tell them to cut a notch in the index finger and they have a built in floss holder. I am trying to get this out there as a fashion statement but so far it hasn't caught on.

If I have time, I like to sit and floss with a patient. What seems simple to me can be difficult at first for them. Showing is better than telling. It is a few minutes well spent. When they get good at flossing, it should only take a minute to 90 seconds.

Step Two: Brushing for one and a half to two minutes. If flossing has been done adequately, the teeth are half clean already. Use the toothbrush in the patient's mouth to show them. Angle the brush into the gum and use a small, soft, circular stroke. This is very important.

Most people press too hard and use too broad a stroke, like they are scrubbing the kitchen floor. The brush should only cover two teeth at a time. Start with the furthest back molar. Do 10 strokes and move the brush forward. This can only be done with a soft bristle. Wet the bristles with hot water to make them very soft.

Most patients are shocked to think this cleans their teeth because it feels so different. I tell them to think of brushing as a massage. The tissues should tingle, not ache. More strokes are better than more pressure.

The same can be accomplished with an electric brush. Rinse it with hot water. Angle it into the gum and move it forward slowly. Let the bristles do the work. Polishing with the prophy angle is a great way to demonstrate this.

One minute to floss, two minutes to brush. That's three minutes. Using a rinse helps but it will add to the time. I would rather patients spent time flossing than rinsing. My method is all about efficiency. It's not the amount of time, it's how the time is used. Being lazy, I like to get the most out of any effort I make.

I try to keep my instructions positive and realistic. I have found the "3 Minute Plan" to be successful. Good luck!

Beth Sciarratta, RDH, lives in Rochester, N.Y., with her husband, daughter and dog. She has worked for three years for Dr. Dave Skeels. She graduated from hygiene school in 1988 and also has a bachelor's degree in English and Theater Arts. She has practiced in New York and Colorado in a variety of settings. She is also a fiction writer who gets much of her inspiration from her patients.