Gum Disease, A Disease Of Behavior
Have you ever wondered why so many people have gum disease? Have you ever had a patient who constantly presents with gingivitis regardless of how many times you badger them about the need for improvement? What is it about the seemingly benign task of brushing and flossing that’s so difficult for some people to grasp and place value in? Why is it that even with all the latest implements in-home care, gum disease is still the sixth most prevalent health condition in the United States? It’s been linked to heart disease, diabetes, and even cancer, yet it persists.
I have a theory!
As dental professionals in addition to treatment, we spend most of our time educating patients about the need for good home care and the consequences of its absence, We tirelessly opine about the functionality of oral bacteria while placing great emphasis on methods of control and identification, and yet what happens? Patients respond well in the short term but 70% inevitably cycle back into their old habits allowing gum disease to rear its ugly head once again. They tell you they floss, use the latest power brush, and swish with mouthwash twice a day; yet from your chair, they’re bleeding like crazy and packed full of plaque. So once again we stand on our soapbox and pontificate about the finer points of brushing and flossing.
Many of you may disagree with what I’m about to say and that’s ok, I’ll welcome your comments. My only objective in writing this post is to share a rationale that makes sense to me and drove me to action. Several years ago, I read a study that compared a Sonicare with a store-bought manual toothbrush. Care to guess the results? Zero, that’s right zero. The study found that there was clinically no significance between the two brushes and their ability to remove plaque. Oh, I can hear the jeers and boo’s now; but wait there’s a catch. The study was performed on 3rd-year dental students. Think about that for a moment and what it implies. What does the dental student know that allows them to implement a manual brush in a way that yields the same results as a Sonicare? What are they doing differently than Joe the plumber and soccer mom Suzy? I’ll tell you what it is. The dental students, as well as all dental professionals, can see the teeth with the mind’s eye when they brush. They are thinking about angles, position, stroke, the sulcus, and the bass method because it’s how they are taught. In dental school the bass method is established as the gold standard, so combine that with a 300K education in dental anatomy and the bad brushing habits present on orientation day are quickly eliminated. Ok, let’s hold that thought as we compare this to Joe the plumber and soccer mom Suzy.
The average joe
Ask yourself this question, “when do we learn to brush our teeth and how were we taught”? The most common answer is somewhere between 1st and 3rd grade using up/down, circles techniques or if our parents were exceptional lazy, random scrub. Having seen over 100,000 patients I’m of the professional opinion that the prevalence of gum disease can be attributed to these early brushing lessons. These early techniques are useful in keeping the surfaces of the teeth clean for cavity prevention and supragingival plaque removal, but lack in their ability to clean out the sulcus and therein lies the problem. For parents, cavity prevention holds a higher priority for their children than periodontal disease which is understood to be a disease of adults. As with all things performed over time, habits and behaviors are ingrained and for our purposes, a muscle memory is established in the brushing arm. This muscle memory is then carried forward in time and becomes extraordinarily difficult to change as an adult. I would argue that gum disease exists in such high numbers because 75% of the population is brushing their teeth on autopilot based on a technique and muscle memory that was formed in the 3rd grade. Our patients are doing what they were taught to do but it no longer fully addresses their needs as an adult which is cleaning out the sulcus. I would further argue that this is the reason patients do well for several weeks after a dental visit but then cycle back into gum disease. Life gets in the way; the brain disengages and the old 3rd-grade muscle memory kicks back in. Gum disease is a bacterial condition predicated by an ingrained behavioral pattern.
Additionally, think about every toothpaste or toothbrush commercial you’ve seen that shows someone brushing. How are they brushing? You guessed it, up/down or circles. I’ve often wondered why these techniques are taught to begin with and the only thing that comes to mind is that it’s easier. A 3rd grader will have a much easier time understanding circle brushing than the more precise bass method. So, the rational becomes, some brushing is better than not brushing at all, even if it’s incomplete. Now to be fair up/down, circle brushing does have a place for those showing recession and I will recommend it for those situations, but for many of my adults, it’s strictly the bass method.
Let’s face it, not everyone wants to shuck out the $100 needed for a Sonicare or similar product so I would like to introduce you to the MD Brush. It’s designed to force the user to consider angles and position as it relates to the Bass method to permanently break the muscle memory associated with poor brushing. In a nutshell, it helps them THINK and BRUSH like a dental student. Everything about the brush from the grip, bristle design, and visual indicators was purpose-built to target the sulcus. Users say it takes several days to get the hang of, which is understandable given its purpose, but consider it to be the best, most effective manual toothbrush made.
Give a man a fish and feed him for a day. Teach a man to fish and feed him for a lifetime.
Written by Mike Davidson, BSDH, CEO MD Brush