UPPER TEETH: Brush down starting high on the gingiva (gums) - 1 to 1 1/2 inch. Do this until you have brushed all of the sides of the teeth next to the cheeks and lips and the sides of the teeth next to the tongue and the roof of the mouth. LOWER TEETH: Brush up on teeth and gums in direction of gum growth, cheek side and tongue side. This brushing is done to clean the teeth and the gums and is done to keep the gingiva (gums) "tough" (well keratinized). STEP TWO: DENTAL FLOSS OR TAPE - (OPTIONAL) - This is an optional home care practice and we leave the use or non-use of floss or tape entirely up to the patient. If you do choose to use the floss or tape, use about 8 strokes with a polishing action between each tooth. We do not emphasize the floss or tape because we do not want to overload the patient with so much to do that home therapy becomes too demanding and burdensome. Since flossing is a very time consuming procedure, more important home care efforts might be by-passed or given less emphasis than we feel is necessary. In essence, flossing demands a major investment in time and effort but yields only minor benefits. In our view, based on controlled clinical studies, the considerable time spent by patients on flossing could be put to better use and could yield greater benefits to the patient from the time necessary to carry out effective daily flossing. Flossing does help and is of some benefit, but not that much. STEP THREE: SOFT BRUSH, SULCUS BRUSH, CHILD'S BRUSH OR ELECTRIC BRUSH: 1 - 2 times daily. *DO NOT USE MEDIUM BRUSH* Oral B makes a 2 row sulcus brush that is good. Other companies make equally good brushes - no better, no worse. With table salt, baking soda and 3% hydrogen peroxide (or fluoride solution) mixed into a paste (see formula below), and using a soft bristled brush, with a modified Bass technique (wiggling the soft brush tips up under the gum), the tips of the soft bristles of the brush are used to carry the bacterial paste up under the gum (where periodontal disease - infection - and the bacteria that cause the infection are). It is critical that we use a a suitable carrier to deposit the paste the soft brush bristles carry UNDER THE GUM!! Don't use long sweeping strokes. Use wiggling vibrating strokes all the way under the gum. RINSE YOUR MOUTH WITH CLEAR WARM WATER AFTER BASS BRUSHING UNTIL THE SALT TASTE IS GONE. This is very important - so do this thoroughly (2 - 3 glasses of warm water). If, after brushing, rinsing is not done thoroughly, the mouth, gums and lips may become sore and irritated to a degree that future home therapy efforts may be done with less enthusiasm than is necessary. MODIFIED BASS TECHNIQUE: UPPER TEETH - use small, circular motion with tips of bristles directed under the gum line - margin of gum. LOWER TEETH - Use same circular motion to carry and push the bactericidal paste under the gingiva. FORMULA FOR SALT, BAKING SODA AND 3% HYDROGEN PEROXIDE OR FLOURIDE MOTHWASH PASTE - Acidulated Phosphate Fluoride (Phos-Flur) can be used instead of 3% hydrogen peroxide with slightly better results. Phos-Flur kills bacteria (is bactericidal), reduces dental caries and makes sensitive teeth less sensitive. Hydrogen peroxide kills bacteria (is bactericidal). But Phos-Flur is more expensive than hydrogen peroxide (and is generally a prescription item). Paste to be used 1 - 2 times daily - To prepare you will need: table salt baking soda 3% hydrogen peroxide OR Phos-Flur mouthwash In an empty container (margarine container or small jar works well), mix 1 part baking soda to 1 part table salt. Cover. Each time you are ready to use the past, put a small amount of the salt-baking soda mixture into a small container and mix with 3% hydrogen peroxide or Phos-flur mouthwash until it forms a useable paste. You don't want the paste too thin or too thick. You will find the right consistency by experimenting a few times. You can conserve the peroxide by putting a small quantity into an eye dropper depositing just a few drops at a time. NEVER USE HYDROGEN PEROXIDE STRONGER THAN 3%!!!!! You may dilute hydrogen peroxide to 1 1/2% if the 3% solution seems unduly irritating to your gums and inner cheeks, but never exceed 3%! To prepare a 1 1/2% solution, mix an equal amount of water to an equivalent amount of 3% peroxide. OBJECTIVE OF PASTE - This paste provides a useable vehicle, with the help of a soft bristled sulcus brush, to carry salt, baking soda and 3% hydrogen peroxide or fluoride gel paste up under the gum. If we fail to carry these anti-bacterial agents UNDER THE GUM, the paste will not achieve its objective -- which is to kill and destroy those under the gum bacteria that cause periodontal disease (infection). If we deliver these anti-bacterial agents under the gum AT LEAST ONCE A DAY, they will destroy the disease associated bacteria primarily responsible for periodontal disease (infection). If we are able to destroy these bacteria at least once a day, with salt - through the paste an in the Water Pik - and with baking soda and peroxide in the paste, then we can usually establish and maintain a healthy, disease-free environment under the gums - and thereby not only maintain bone, but it has also been shown that when we are able to maintain a healthy environment under the gum "long term" (1 - 1 1/2 years), our bodies and the good Lord will heal and repair damaged peiodontal tissues and replace a significant part, NOT ALL, of the tissues that had been earlier destroyed by periodontal disease (infection) - INCLUDING BONE. STEP FOUR: SATURATED SALINE (SALT) IRRIGATION USING THE WATER PIK - 1 to 2 times daily. Use the Water Pik 1-2 times each day with a saturated saline solution (a saturated saline solution is a salt solution with as much salt in a given amount of water as that water can dissolve). The saturated saline must be directed UNDER THE GUM by the Water Pik tip, or the beneficial effects of the salt are lost. The tip should be held an inch to an inch and a half way from the margin (edge) of the gum - and again should be aimed under the gum. The saturated saline (salt) solutiion has been shown by extensive clinical research to be strongly destructive (bactericidal) to those bacteria thought to be primarily responsible for periodontal disease (infection). If we are able to, on a daily basis, introduce salt, baking soda, hydrogen peroxide or fluoride mouthwash under the gum, we can on a daily basis help to eliminate active periodontal disease, and alter on by continuing to destroy these bacteria daily, we can prevent "disease associated bacteria" from securing an under the gum foothold sufficient to cause periodontal disease (infection) to recur. Thus these agents, salt, baking soda, hydrogen peroxide and fluoride mouthwash are effective both as therapeutic (treatment) agents, and as preventive agents (preventing recurrence of periodontal disease). FORMULA FOR SATURATED SALINE SOLUTION - (BRINE) - To be used 1 - 2 times daily Need: Box of table salt or Epsom salt, water Use 32 oz. = 4 cups = 1 quart of water and 2/3 cups (10 - 12 tablespoons) of salt. Really!! Mix the water and salt together in a container other than the Water Pick container ( a 1 quart measuring cup works well). DO NOT MIX THE SALT AND WATER IN YOUR WATER PIK RESERVOIR!!! THIS WILL ADVERSELY AFFECT THE WATER PIK MOTOR. After mixing the solution, pour it into the Water Pik reservoir and use as earlier directed (direction the solution flow up under the gum). REMEMBER TO RINSE YOUR MOUTH WITH CLEAR, WARM WATER AFTER USING. ALSO, REMEMBER TO RUN 2 CONTAINERS OF CLEAR WATER THROUGH YOUR WATER PIK AFTER YOU USE THE SATURATED SALINE SOLUTION. STEP FIVE: FLUORIDE RINSE - OR BRUSH WITH OMNI GEL - 1 time daily *USE SOFT, EXTRA SOFT, OR CHILD'S BRUSH* We recommend the use of "Phos-Flur" mouthwash as a rinse NIGHTLY (the last thing before going to bed), and after completing steps 1 - 4 listed previously. Swish with one to two teaspoons of Phos-Flur mouthwash for ONE MINUTE and then expectorate. DO NOT RINSE WITH WATER OR ANY OTHER LIQUIDS AFTER USING THE PHOS-FLUR. YOU MUST NOT EAT NOR DRINK ANYTHING AFTER USE, OR IT WILL NOT REALLY WORK WITH ANYTHING LIKE FULL EFFECTIVENESS. FLUORIDE RINSE: There are several areas in which the fluorides and fluoride mouthwashes or rinses are helpful. This makes these agents particularly useful - not just for our patients, but for the entire family - especially the children in a family. The benefits of fluorides in solution are as follows: 1) They minimize and often ELIMINATE caries or tooth decay IF used as directed - before bedtime, NIGHTLY, and without eating or drinking anything after the fluoride rinse. 2) They are the most effective agen we know of for reducing or eliminating tooth sensitivity. 3) They slow down and sometimes arrest dental caries and tooth decay already active in the present. 4) Fluorides are bactericidal (both against the bacterua tgat cayse debtak carues above the gum, and against the disease associated bacteria that cause periodontal disease (infection) under the gum. With this much potential and this much benefit to be realized from one agent (fluoride in solution), I am simply astounded that every dentist and every dental office and hygienist does not strongly encourage every child AND ADULT to take advantage of this tremendously effective, preventive, anti-bacterial, anti-tooth decay, anti tooth sensitivity, anti-periodontal disease agent. It doesn't even taste bad!!