Reprinted from Recovery, May 2004

What every patient needs to know about oral hygiene

By Elena Ortega, RDH
Assistant Clinical Professor
School of Dentistry
University of California
at San Francisco

Preventing bacterial build-up on your teeth will be an important part of managing the oral effects of pemphigus and pemphigoid. In everyones mouth bacteria attaches to the teeth. This is known as plaque and is seen as a soft, yellow or white film. If plaque is not removed on a daily basis, it can cause healthy gums to be inflamed. If you are experiencing oral complications such as blisters and bleeding gums due to pemphigus and/or pemphigoid, brushing and flossing the teeth can be a daunting task. However, there are tech-niques that will be helpful in removing plaque even when your mouth is sore.

For maximum comfort and effectiveness use a small, soft toothbrush. A childs size toothbrush, usually labeled for the age of the child, will be able to move around your mouth more easily in hard to reach or sore areas. Look on the package for ages 3-7 years old and the word soft.

Changing your toothbrush once a month will keep the soft bristles effective in removing the plaque and will help to keep the bacterial count low that accumulates on the brush. If you are experiencing mouth ulcers or bleeding gums, soak the brush in warm water for five minutes before using in your mouth. This will make the soft bristles even softer.

In terms of toothpaste, it is not essential that you use it. It is designed to make brushing more pleasant, and it is a great way to put fluoride on your teeth. Fluoride is a safe and effective ingredient that prevents cavities even in adults. When your mouth is sore the flavoring and the foaming may cause more irritation. Brushing with warm water or water mixed with a teaspoon of baking soda will be helpful. Toothpastes with the ingredient sodium lauryl sulfate have been associated with mouth ulcers. Rembrandt makes a toothpaste without this ingredient. If the mint flavoring stings your gums, try using a childrens toothpaste in a nonmint flavor. Whatever toothpaste you use, remember that a pea-size amount on your toothbrush is all you need.

The area in between your teeth is where plaque can cause the most damage, and unfortunately the bristles of the toothbrush cant reach there. This is where floss comes in. If your teeth are not too close together and floss slides in easily, most any type of floss will be effective. You may want to use a woven floss, which looks like three small yarns woven together. It is soft and round. If your teeth are very close together and floss has a hard time moving into the interproximal space, you can use a floss called Super Floss. It comes in long pieces with one end that is stiff so that you can thread it between your teeth. It is made of a soft fuzzy thread that picks up a lot of plaque and is soft to the touch. However, this type of flossing requires more time. Flossing requires a lot of patience and skill, so you may want to review your technique with your hygienist or dentist. It is a skill worth developing as the latest research shows a definite benefit to your oral and general health.

Before you purchase a mouth rinse be sure to look at the ingredients

Avoid using mouth rinses that contain alcohol. It can be very irritating to oral tissues. Biotene is probably the most popular mouth rinse used for soothing the mouth. A product called ACT fluoride rinse does not contain alcohol either, but does contain fluoride. As we mentioned before, fluoride is very helpful in preventing cavities. It is especially effective in preventing cavities at the gumline where adults tend to develop decay.

A person with pemphigus and or pemphigoid may have more root expos-ure due to gum recession caused by oral lesions. If you have lesions in your mouth, you will probably be most comfortable using the mild flavored ACT rinse such as bubblegum or grape. These two flavors tend to have a more sweet flavor rather than an intense bubblegum or grape taste.

For help with bad breath Rembrandt makes a non-alcoholic peppermint rinse, and when diluted with water, the mint flavor becomes less harsh. If you choose to use a mouth rinse the key is swishing it around your mouth for at least a minute. On our teeth is an invisible film, and it takes at least one minute for the mouth rinse to penetrate this film. So for maximum effectiveness, rinse for a minute, even if you are rinsing with just plain water.

Brushing strategies are important to get the most plaque out of your mouth

First youll want to keep your eyes on a mirror and have good lighting for best results. When your mouth is relatively free of sores, brushing slowly and thoroughly after finishing your last meal of the day can be very beneficial. Waiting until right before bedtime to brush your teeth can sabotage your good intentions. Most of us are exhausted and hurry through our routines. The research shows us that brushing for two to three minutes is necessary to effectively remove plaque. Brush the areas that are the most challenging first and save the easy spots for last. Practically everyone has the most difficult time with the lower inside area next to the tongue. Brush all these surfaces and then move to the top teeth inside surfaces. After that, brush the areas on the outside nearest the cheeks and lips. The tops of the teeth or the chewing surfaces are also important to brush. And last but not least if your tongue is free of lesions, brush the top of the tongue. The bacteria that sits here is the primary bacteria associated with bad breath.

When you are having a major outbreak and your mouth is too sore to brush and floss there are some things you can do to keep the bacterial or plaque level lower. Rinsing with warm water or Biotene can be soothing. Soften your toothbrush in warm water, then dip it in a mouth rinse and watching carefully in the mirror so as not to touch lesions, brush just the chewing surfaces of the teeth. Getting some plaque out is better than none at all. If your mouth is sore in just one or two locations, brush them first and then brush the areas that are not affected.

Plaque can buildup quickly, and it becomes stickier and harder to remove each hour it is allowed to remain on the tooth. It doubles in mass every 24 hours. Taking seven to ten minutes once a day to brush and floss is important in maintaining oral health, or if your oral health is compromised, just being able to decrease the amount of plaque on your teeth is beneficial. Seeing your dental hygienist and or dentist every three months to have the plaque removed is ideal for your oral health.

Having sore bleeding gums is challenging. Be patient with yourself and know that even if you can only rinse your mouth with water, you are doing something positive to decrease the amount of bacteria on your teeth. As your pemphigus and or pemphigoid becomes more controlled, you will be able to do more with your oral hygiene routine.

Contrary to what advertisers would have us believe, brushing and flossing effectively requires practice and skill. Each time we brush and floss we have the opportunity to improve our skills and our health.

One thing I have observed with our patients is the powerful effect of attitude. Those who focus on the positive and have an activity or passion that helps them to divert their thoughts to other areas of their life seem to do better.

I realize that these diseases and medications make keeping a positive attitude challenging. Take a moment to look for the area in your mouth that is lesion free and focus your toothbrush on it. This will direct your thoughts towards the positive. You are taking control to maintain health even if its only in one area of your mouth or even on just one tooth.

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