Q&A with “The Queen of Dental Hygiene’s” Barbara Tritz

I’m very excited for today’s post! Last week I got to talk with Barbara Tritz, RDH, the author of the blog The Queen of Dental Hygiene. If you have not seen her blog yet, please go check it out! It has amazing and informative posts about keeping your mouth clean and healthy.

Without further ado, here are the questions I had for Barbara, along with her responses 🙂

Talk a little about yourself and your background.

I’m a registered dental hygienist with 37 years of hygiene under my belt. I love being a dental hygienist. Patient education and oral health coaching are what I do best for my patients. I look for the cause of the problem, and find the best products to help them fix it. It might be better home care and techniques, or it could be caused by mouth breathing, sleeping and airway issues and that’s a whole other blog post! Everything starts with the mouth. If the mouth’s not healthy, neither is the body.

I’m married and a mother of two lovely young ladies. About three years ago, my oldest daughter convinced me I needed to start writing a blog about dental hygiene/oral health. Who’d want to read that, I asked her!? With her help as editor, I started writing and now have 75 posts and over 100,000 page views. Someone must be reading it! I fell in love with writing. I enjoy reading, exercising, and travelling. In my spare time I also enjoy cooking. There just aren’t enough hours in a day!

What are the most common issues you see with regards to your patients’ brushing and flossing habits?

Unfortunately, I see adults brushing the same way they did when they were six years old – scrubbing back and forth. They completely miss brushing their gumline and leave lots of plaque biofilm behind. They are also still using the same old manual toothbrush. That means they brush until their toothpaste foams up, and then they spit and rinse and are done in about 45 seconds. Again, leaving all that plaque biofilm still on their teeth.

Flossing – most folks don’t floss. For those that do, most use Glide or other slippery floss. That kind of floss is great for getting food out, but not so great at removing plaque biofilm. It instead glides right over the plaque, leaving it all right there on the teeth.

What are your least favorite foods (in terms of negatively affecting oral health)? Any non-obvious ones that will surprise people?

Sticky, sugary, sour hard candies – everything bad all wrapped up in one. It’s sugar, sticks to teeth, slow to dissolve, and has a low pH.

Carbohydrates in general are not good for teeth. Breakfast cereals, bagels, jam, protein bars. All these items are really just sugar passed off as healthy foods. Soda pop–I call that liquid decay.

Lattes, and fancy coffee drinks–again, acidic and sugary and folks sip them over a long period.

There are studies showing that electric toothbrushes do better than manual toothbrushes at removing plaque. However, if we were to diligently brush our teeth with a manual toothbrush, could we achieve the same results or are we at a distinct disadvantage by using a manual toothbrush?

I always prefer my patients to use an electric toothbrush. It just does a better job. That said, yes, a manual toothbrush will eventually get the plaque off. It’ll take about 15 minutes. Research shows that people will manually brush for about 30 to 45 seconds. That’s the time it takes to make the toothpaste all foamy. Then they spit, rinse and are done brushing. Toothpaste numbs your tongue so your teeth “feel” clean but really aren’t. I don’t know too many folks who really want to brush for 15 minutes. I do suggest that patients who prefer a manual brush to dry brush- no toothpaste or water. Brush until their teeth feel and taste clean, then use tooth paste. I personally use a Sonicare brush and baking soda.

How do you (as a dental hygienist) find plaque on our teeth if it’s something that we can’t see unless we use plaque-disclosing tablets/solution?

I use loupes with magnification and a headlight. Plaque biofilm appears white, leaves the teeth fuzzy and the gums red and inflamed. I run my explorer around the gumline and if I end up with anything on the explorer, I show the patient. Then I pull out the disclosing solution and show the patient see what’s there. It’s always an eye opener for both of us.

What’s your favorite toothbrush (electric and manual) and why? Any particular ones we should be avoiding?

I have two favorite electric brushes- the Sonicare and then there’s one called The 30 Second Smile– It brushes six surfaces at one time and gets it done much faster.

I don’t like cheap electric brushes, they are noisy, and saw or chop at the tooth surface. Buy the very best electric brush you can afford and do change the head quarterly.

Manual brushes–I prefer good quality ones from name brand companies. For folks with recession, I recommend the Nimbus– it’s extra soft and gentle. I also love my GUM brush.
I do recommend brushes with multilevels- They are better than flat, all one size bristles.

Don’t waste time on generic or cheap brushes. Their bristles aren’t polished and those brushes just aren’t worth it in the long run. They cut the gums.

What are your thoughts on these more unique toothbrush bristles like binchotan charcoal (Boka, Goodwell+Co, Charbrush) or “rubber” (Boie)?

I’ve not been impressed with rubber-type bristle brushes. I didn’t feel they did a good job. I have not used the binchotan bristle so will have to try it out before I comment on them.

Any tips for people who don’t feel like they get a good brush in unless they use harder bristles or brush harder?

Use less toothpaste, and gently use the end of the brush, jiggling into the gum line. When folks press harder, that makes the bristles splay out, causing them to brush with the sides of their bristles. This unfortunately cuts their gums, and leaves their teeth still feeling unclean. Hold the brush like a pencil and wiggle it into the gum line. Brushing longer is fine with me, just be gentle!
I recommend changing brushes every three months, with the seasons.

Why don’t the dental instruments used to scrape off plaque and tartar (during a dental checkup) damage our enamel but brushing too hard or using tough bristles do?

Enamel is the hardest substance in the body. Its surface is like glass. It takes a diamond to cut it. My instruments only take off the plaque and tartar, leaving the tooth smooth and undamaged. Now, if there’s beginning decay, I could certainly breakdown the surface and cause damage. That’s why I like to polish the teeth first, so I can remove the plaque and only have tartar left to remove. I gently glide my instrument around the surface until I feel roughness, then I engage my instrument and scrape the tartar off.

Dental scalers and ultrasonic scalers don’t dig into enamel because they are a softer metal than healthy enamel.   As I mentioned, I’m sweeping my scaler and only engaging it when I feel a roughness, or a chunk of tartar.  Then I activate my pulling stroke to loosen and remove the debris.  A tooth brush, especially a soft brush, used properly won’t harm healthy enamel.

What’s your favorite floss and why? Again, any particular ones we should be avoiding?

Avoid slippery or teflon coated flosses. They just slide right over plaque and leave it behind.
I use woven floss- my personal favorites are Listerine Gentle Gum Care – be sure the package says woven, and the Spry Sponge Floss. I have just discovered Coco floss. They have a great floss, and different flavors, I’m not the biggest mint fan so love their mandarin flavored floss.

What about mouthwash? Does everyone need to use it?

Too many OTC (over-the-counter) mouthwashes have a very low pH. Tooth decay needs an environment where the mouth has a pH of 5.5 or below. Root decay needs only for the mouth to stay at 6.5 or lower. When we swish and then go to bed, our salivary glands go to sleep too. So that means the mouth stays acidic all night long. No saliva, plus an acidic environment and plaque left at the gum line is a recipe for disaster.
My favorite mouth rinses have either a neutral pH like ACT or a basic pH like Carifree.
Carifree is designed to shock the decay bacteria dead, and raise the pH so that’ll change the plaque biofilm to a healthy one.

Does everyone need to use mouth wash? Short answer is no, if your mouth is healthy. If you have tooth decay or gum disease, it’s important to customize a program that fits your needs, changes the biofilm to healthy and then is simple enough to keep it up on a daily basis. I have patients use either the Carifree or even something as simple as baking soda and water. I also recommend a bleach water rinse. One part bleach ( from the laundry room) to 25 parts water. Rinse and gargle. This would also work in a water pik. Yes, it tastes like a swimming pool but it’s so effective and cheap. Just don’t wear your best clothes when you mix it up. You mouth will feel clean for days!

Is there an ideal order of brushing, flossing, and rinsing (with mouthwash)?

I’m always just happy if folks will do it, I’m not picky about the order. I do recommend tongue cleaning as a vital part of any oral health routine.

How about toothpaste? Do you have a favorite? What key ingredients should we be looking for in toothpaste and what ingredients should we be avoiding?

Toothpaste is really just a cosmetic- it makes the mouth taste minty. I want toothpaste to be more medicinal – put minerals back in the teeth, be antibacterial, raise the pH, put antioxidants in the mouth, or even keep plaque from attaching to teeth.

My Favorites:

I avoid triclosan, and anything with “whitening agents” because they are too abrasive.
Tooth paste has what’s called an RDA number which tells us how abrasive the paste is. I want pastes that have an RDA number at 80 or less. That will exclude a whole bunch of OTC pastes.

What’s a good plaque-disclosing product that we can use at home to improve our brushing habits?

Red Cote by Sunstar Butler GUM. I’d recommend a timer too. That’ll keep you brushing longer if you have a manual brush.