Why brush twice a day?
You’ve heard it over and over. Brush your teeth in the morning and before you
go to bed. Brush your teeth
three times every day. Did you
ever wonder why? Read on,
because there really is a good scientific reason.
Brushing flossing and rinsing with mouthwash keeps our breath fresh and makes our
mouth feel cleaner. It
accomplishes this by reducing the bacterial count in the mouth, which then reduces stains, removes food particles
and slows disease development. But why do it twice? What is the real reason for frequent cleaning?
In order to understand why twice a day cleaning is so important we have to look at
something called biofilm formation. What is biofilm? It is that nasty slimy stuff that forms on hard surfaces like teeth, crowns and dentures in
any warm dark wet bacteria laden environment such as the mouth. You can really feel it when you first get up in
the morning. Biofilm is made
up of bacteria and their byproducts. Biofilm formation follows a very precise sequence, with different bacteria forming layer
upon layer. The first layer is
made up of gram positive aerobes, Streptococcus and Actinomyces. These are oxygen loving (aerobes) and non
pathogenic. In fact, they are
considered beneficial, associated with healthy gums and aid in the first steps of
digestion. They do not
cause gum disease.
Remember, the mouth is full of bacteria and other bugs. Healthy gums are not sterile but colonized with
healthy bacteria, the early colonizers.
Once the biofilm is established by these early bacteria, the environment starts to
change. Over the course of several hours to days, the biofilm matures to the point where it can support other types
of bacteria. These are the
anaerobic (oxygen hating) bacteria that can cause gum disease. These bacteria that cause gum disease are
floating in the mouth. While
free floating they cannot damage the gum tissue. Once they can attach to the biofilm they can start to do
As the biofilm further matures, the bacteria that cause the gum disease grow
stronger, and soon becomes the dominant component of the biofilm. Signs of gum disease begin to
appear. At this point the
biofilm is very strong and is not easily disrupted by the body.
As we review the formation of the biofilm, it becomes obvious that the best way to
prevent the gum disease bacteria from growing in the biofilm is to continually disrupt and remove the
biofilm. This keeps the early
colonizers the predominant strain in the biofilm, and since these are not pathogenic, we prevent gum
Clinically the best way to disrupt the biofilm within the time frame to discourage
growth of pathogenic bacteria is to brush and floss twice each day. Remember that the biofilm coats the entire
tooth, and to break it up you must clean every single part of the tooth. Done twice each day the pathogenic gum disease
causing bacteria are kept floating in the mouth with no place to settle and grow. This is the single most effective (not to
mention cost effective) treatment to allow you to keep your teeth. Happy brushing!
by Dr. Greg Dilger - May 26, 2011
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