TROUBLESOME  TRIANGLE 

I often tell the story that if I had to go and live on an island and had to make
the choice between taking a toothbrush or taking dental floss, I would leave
the toothbrush behind.  That is how highly I regard dental floss. 
The reason for this is that, in adults, the main dental problem is gum 
disease. The prime site where gum disease begins is between the teeth where
a toothbrush cannot reach.

The space between teeth and the gum line is roughly triangular in shape
and, because of the problems originating there, has been called the 
troublesome triangle.

If plaque is left to build up in the troublesome triangle some of the bacteria
can produce acids which attack the teeth (decay) whilst others can produce
toxins that cause inflammation of the gums (gingivitis) and more serious
gum conditions.

With adults, decay is not usually a major problem in the troublesome triangle
as long as one avoids regular intake of foods rich in sugar and uses floss
daily.

The first sign of gingivitis is that the gums bleed easily on touch.  If
left untreated gingivitis can lead to a more advanced form of gum disease
called periodontitis, which was formerly known as pyorrhea.  Basically what
happens is that the toxins from accumulated plaque first cause the gums to
be inflamed (gingivitis) and then begin to attack the fibres and bone 
holding the tooth in place (periodontitis).  Eventually the teeth become
loose and will eventually begin to fall out.

Gingivitis in the troublesome triangle, unlike gingivitis on the inner
and outer sides of teeth cannot be treated by a toothbrush alone because
invariably a toothbrush cannot reach the right spots.  Therefore the 
accumulated plaque (bacteria) has to be removed by other means, that is by
using dental floss.

When one starts removing plaque from between the teeth the gums may bleed
and feel sore.  If this happens don't give up!  Keep on with the procedure
at least once each day from then on.  For the first few days the gums will be 
tender, however, as long as one perserveres the gums will feel healthier and
bleed a lot less by the fourth to fifth day.

You can help rid your mouth of many bacteria (plaque) by using an antiseptic
mouthwash 3 times daily after brushing and flossing.

The same advice applies to all bleeding areas on the inner and outer surfaces
of the teeth.  Keep brushing at least twice daily, right through the sore
period, Remember, bleeding gums are a sign to brush more - not less!
 

CHILDREN  HAVE  SPECIAL  PROBLEMS

Although gum disease can begin in childhood, it usually does not become
a major problem until later in life.  With patience young children can
be taught to brush properly and use dental floss.

Special flossing aids such as the floss wand are available to help parents
clean between their children's teeth.  Ask your dentist or pharmacist for a
suitable brand.

USING  DENTAL  FLOSS  OR  DENTAL  TAPE

Some people have real difficulty in using dental floss, especially if they
have tight crowded teeth or a lot of old fillings.  if you have this problem 
switch to dental tape, as it does not tear or shred readily. 
The waxed type of floss or tape is generally easier to use.
When using dental floss or dental tape take at least a 30cm length from
the container.  Wrap one end around the other index finger and draw it taut. 
Place your two thumbs about 2.5cm apart in the centre of the floss or tape.
Ease it between the upper teeth in a gently sawing motion.  Once it passes 
through the tight portion, ease it down one side of the triangle to the 
gum line and rub the floss up and down the tooth surface. Repeat the same
procedure down the other side of the triangle, rubbing up and down the tooth
surface. For lower teeth subsitute the middle fingers for the thumbs.
You may develop your own style of flossing, so long as you can clean between
all teeth effectively (and don't forget to clean behind the back teeth)

TOOTHBRUSHING  IN  PERSPECTIVE

People are invariably surprised when told that toothbrushing alone is 
not enough to prevent and control gum disease or they are surprised to
find that they have gum disease despite years of regular brushing.
However on reflection, it is clear why this is so. 
Gum disease starts in places where a toothbrush cannot reach.

However, a toothbrush in combination with dental floss and antiseptic
mouthwash are an indispensible team, in fact they are the only means available
to prevent gum disease. 

Every adult who wants healthy gums should after every meal, clean the 
troublesome triangle between the teeth with dental floss, then clean the
readily accessible surfaces of the teeth with a toothbrush and finally rinse
the mouth thoroughly with an antiseptic mouthwash.