Dental Hygiene

Maintaining good oral hygiene and limiting sugar intake are the most important things you can do for your gums and teeth. Undisturbed bacterial plaque is the main cause of periodontal (gum) disease, and sugar consumption is the main predictor of tooth decay (caries). Daily preventive care, including proper brushing and excellent cleaning between the teeth, will help stop problems before they develop and is key to the success of any periodontal or dental implant treatment. Good oral health is important to your overall well-being.

This page contains important tools and tips for maintaining good oral hygiene.

Brushing Your Teeth

woman brushing teeth

Bacterial plaque starts developing in the area where your tooth meets the gum and in between your teeth. As the plaque matures it starts migrating below the gum line where it triggers an immune response that can ultimately lead to gum disease. It takes 24 hours for plaque to develop. When brushing your teeth you should:

  • Always use a toothbrush with soft bristles, and replace it often (about once a month).
  • Try to gently slide the bristles of the toothbrush in the narrow crevice between the tooth and the gum. To do this, position the brush at a 45-degree angle against the surface of the tooth with the bristles pointing at the sulcus between the gum and the tooth. Try to feel the bristles between the gum and the tooth.
  • Use short, vibrating or circular strokes.
  • Brush at least twice a day for a minimum of two minutes each time.
  • Spend as much time on the tongue-side as on the front side of the teeth.
  • If your dentist of hygienist has identified problem areas, pay special attention to those areas.
  • A pea-sized amount of fluoridated toothpaste is all you need.
  • Brush your tongue. The tongue can be a reservoir for sugars and bacteria. The bacteria growing towards the back of the tongue is the main cause of bad breath.

Gently move the brush in short strokes covering 2-3 teeth at a time. Be gentle. Use some pressure while sliding the bristles between the teeth, but not so much pressure that you feel any discomfort. After cleaning the outside surfaces of all your teeth, follow the same directions to clean the tongue-side of the back teeth. To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically, brushing each tooth up and down.

Next you will clean the chewing surfaces through short, gentle strokes. You may use a manual or an electric toothbrush.

Nimbus Microfine Brush

The Nimbus Microfine toothbrush is a great manual toothbrush. These brushes have extra soft, tapered bristles that slide easily in hard-to-reach areas.  The soft bristles decrease the likelihood of trauma to the gums and provide effective plaque removal. This toothbrush can only be purchased online; you may order it from

Electric toothbrushes can be more effective than manual brushes for some patients. Oral-B and Philips Sonicare are the two toothbrushes with the most solid clinical research. Most studies show 20-25% improvement in plaque control compared to manual brushes. The difference does not appear to be significant among patients with good hand dexterity. The use of electric toothbrushes is especially important in people with limited hand dexterity and those who need assistance from caregivers to clean their teeth.

Electric toothbrushes generally offer a variety of brush heads. The standard brush heads work very well for people who tend to develop deep pockets without gum recession. People with thin gums, who are prone to recession, and who prefer an electric brush should consider using the Philips-Sonicare Toothbrush with a Sensitive brush head, or an Oral-B electric toothbrush with a Sensitive Gum Care brush head. The standard brush heads for these toothbrushes are too stiff for patients at risk of gum recession.

Soft Bristle Head for Philips Sonicare Brush

Soft Bristle Head for Philips Sonicare Brush

Soft Bristle Head for Oral-B Brush

Soft Bristle Head for Oral-B Brush


Brushing technique 1

Place the brush at a 45 degree angle from the tooth surface, sliding the bristles between the gum and the tooth.

Brushing technique 2

Hold the brush vertically when brushing the inside surfaces of the upper and lower front teeth. Brush up and down one tooth at a time.

Cleaning Between Your Teeth

Periodontal disease usually starts between the teeth where your toothbrush cannot reach. These areas are also more likely to develop cavities in adult patients. There are many interdental cleaning devices including floss, interdental brushes, and WaterPik.


Flossing is a very effective way to remove plaque between teeth. However, it is important to use proper technique. You can use conventional string-floss or flossers. You should pick the method that is easier for you and the one you are more likely to use frequently.

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 fingers on both hands.

To clean the upper teeth, hold the floss tightly between the thumb and forefinger of each hand. Gently insert the floss between the teeth using a back-and-forth motion. Bring the floss to the gum line, curve it into a C-shape against one tooth, and slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth several times scraping the plaque off the tooth. Apply pressure towards the tooth and not towards the gum. Be careful not to cut the gum tissue between the teeth by flossing too aggressively. Remember there are two tooth surfaces that need to be cleaned in each space. Continue to floss each side of all the upper teeth. To clean between the bottom teeth, guide the floss using the forefinger of both hands. Do not forget to clean the back side of the last upper and the last lower teeth.

Your gums may bleed and will be a little sore for the first week after starting to floss. 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 toughen up and the bleeding should stop.


Gum Flossers

woman flossing

Flossers, or floss-picks, are small plastic devices that hold a piece of dental floss. For most people they are much easier to use than dental floss. Carefully insert the floss section between teeth, gently slide the floss section beneath the gumline, and slide the pick up and down cleaning the side of each tooth. To insert the flosser past the contact between teeth, you may use your opposing teeth to bite on the top of the plastic bow driving the floss towards the gum line past the contact.

Interproximal Brushes (proxabrushes)

Proxabrushes (interproximal toothbrushes) are very effective tools to clean in between teeth; especially when large spaces are present due to gum recession and past bone loss. Interproximal brushes are more effective than flossing when these gaps are present. These brushes come in different sizes. It is important to use smaller brushes in smaller spaces and larger brushes in larger spaces. The brushes should fit comfortably with the tips of the bristles touching the sides of the teeth. TePe and Gum have good quality and well-designed interproximal brushes.


TePe interproximal brushes
Gum proxabrush



The Waterpik uses water pressure to clean plaque and debris from the teeth and the areas between teeth. This device can be very effective when used properly and for long enough time. We recommend the counter-top models instead of the cordless models. There are many tips available for the Waterpik units: the Classic Jet Tip seems to be the most effective. When using these units you should:

  • Rest the tip against the junction between the gum and the tooth and follow the gum-line directing the waterjet towards the area under the gum.
  • Stop in the area between teeth and move the tip around trying to reach under the gum and to remove the plaque in between both teeth in each space.
  • Start with a comfortable power setting and gradually increase the power on the unit every 3-5 days. If increasing the power feels uncomfortable on your gums, stay at lower power for a few more days spending more time in the sensitive areas. Areas where plaque tend to accumulate can be more sensitive. Thoroughly removing the plaque on a daily basis is important for the gum to heal and the sensitivity to reduce. If an area is still sensitive, ask your dentist or dental hygienist. It may take some days to get used to it.
  • Use lukewarm water (especially if your teeth are sensitive).
  • Use the entire tank each time you use it.

Caring For Sensitive Teeth

Sometimes after dental cleanings, root planing or gum surgery your teeth may become sensitive to hot and cold (mostly cold). If the mouth is kept clean, this sensation should not last long. However, if the mouth is not kept clean, the sensitivity will remain and could become more severe. If your teeth are sensitive, you may consider using a desensitizing tooth paste like Sensodyne. If the sensitivity continues, consult with Dr. Ronderos. A medicated toothpaste or mouth rinse made especially for sensitive teeth may be recommended.

We are here to help you. Please do not hesitate to contact our office if you have any questions.