Dr. Michael L. Cohen Specialist Periodontist Implants
periodontics gum disease dental implants

Our office is located on Main Street in Lakemont Park at 166 Lakemont Park Boulevard in Altoona, Pa 16602     Directions/Map

  Patient Information

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  Office Address

  Michael L. Cohen, D.D.S.
  166 Lakemont Park Blvd.
  Altoona, PA 16602

Plaque Control Facts:

  1. Gum disease is due to plaque getting below the gum tissue.  Toothbrush bristles and floss must be placed below the gum line.

  2. About 90% of gum disease occurs between the teeth.  The toothbrush can only clean the fronts and the backs of the teeth.  Therefore without flossing gum disease cannot be prevented.  Flossing or some other sort of interdental plaque control needs to be done daily.

  3. Current information recommends brushing and flossing twice a day because plaque develops in 12 hours.  Plaque is soft and sticky.  If not removed, it will harden on the teeth.  This is called tartar and it can only be removed by a dental professional.  It is preferred to clean in the morning and before bed, but everyone needs to find time when they will be most effective.

  4. Each tooth needs to be cleaned individually and it takes 7-10 minutes to clean one's mouth effectively.

  5. Other instruments are available besides floss to clean in between teeth.

  6. Systematically clean all teeth by starting at one spot and slowly work your way around the mouth.  Each time you clean your mouth you should do it the same way so it becomes a habit.

  7. Plaque doesn't necessary need to be removed, just broken up or disturbed.  Plaque can only cause disease when left undisturbed.

  8. Soft toothbrushes are needed to brush in the gums.  A hard or medium brush may need cause gum recession.  These types were recommended in the past because brushing was used to clean teeth, not gums.

  9. When flossing one must concentrate on cleaning the sides of two teeth not a space between the teeth.

  10. Plaque is sticky and leaves a film on the teeth like grease on a plate.  It can not be simply washed off.  The floss must aggressively be applied.  A squeaking sound should be heard when the tooth is cleaned.  It sounds similar to when a finger is run across a clean plate.  Unwaxed floss is recommended because it produces the squeakiest tooth.  Special floss is available for teeth with tight contacts.

  11. Initially, there may be increased bleeding when brushing and flossing in the gums.  This is because gum disease has caused infection in the gums and the gums are not used to a more aggressive plaque control method.  In a few days the gums will toughen and be more resistant to disease.  Like a muscle that hasn't been used in a while there is some soreness initially but like a muscle that strengthens with exercise the gums strengthen with flossing.

  12. Our recommendations:
    a. Brush with a soft brush twice per day
    b. Floss with unwaxed floss twice a day
    c. Use a proxabrush between teeth twice a day

What other instruments are helpful in removing plaque?

Electric toothbrushes are not more effective then manual brushes in removing plaque.  Both are equally effective if used correctly.  Electric brushes are recommended for people who have problems with manual dexterity or those who find manual brushes difficult due to arthritis or another medical problem.

Dental floss and proxabrushes are the most effective instruments to remove plaque between the teeth.  Toothpicks and stimudents are only mildly effective.

Plaque must be mechanically and physically removed by brushes and floss.  Chemical irrigation via waterpicks or mouth rinses do not remove plaque below the gum tissue or where the periodontal disease is located.  They do help above the gum tissue but this doesn't help the periodontal condition.  Plaque located in the pockets is causing the disease not the plaque on the top of the teeth.

Which types of toothpastes and mouthwashes are best?

Mouthwash and toothpaste do not remove enough plaque to stop periodontal disease.  Only tooth brushing and flossing remove enough plaque.  Mouthwash and toothpaste make your breath fresher and put fluoride on the teeth; both of these are important functions.  At this point in time there is no "magic bullet" to fight plaque.  Floss and toothbrushes are the best.

Listerine has had some success in the treatment of the earliest form of periodontal disease, gingivitis, but it has not shown to be very helpful in early, moderate, or severe periodontitis.

The reason mouthwashes and toothpastes are ineffective in periodontal disease is because they cannot get deep enough in the periodontal pocket.  They also cannot be present in great enough concentration to detoxify plaque.

As a result we recommend any toothpaste that has fluoride and Listerine for home use.  They are an adjunct not the first line in defense of periodontal disease.

Detailed Treatment Information

Periodontal Maintenance Goals

Pre-Visit Periodontal Maintenance Preparation

Periodontal Maintenance Visit Protocol

Long Term Success

Plaque Control Instructions

Directions to the Office