Periodontal disease occurs primarily between the teeth where a toothbrush can't reach. Since flossing is a very effective way to clean plaque from those surfaces, it's important to develop the proper technique. The following instructions will guide you, but flossing is a skill that takes time and practice. Ask your dental care provider to show you how to floss comfortably and correctly. He or she may recommend one of a number of flossing tools to help you.

Begin with a piece of waxed or unwaxed floss about 18 inches long. Lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the opposite hand.

To clean the upper teeth, hold the floss tightly between the thumb and forefinger of each hand. The fingers controlling the floss should be no more than onehalf inch apart. (See figure 5)

Gently insert the floss between the teeth, using a back-and-forth motion. Do not force the floss or snap it into place. Guide the floss to the gumline. Curve the floss into a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. (See figure 6)

Using both hands, move the floss up and down on the side of one tooth. Remember, there are two tooth surfaces that need to be cleaned in each space. Repeat this technique on each side of all the upper teeth. (See figure 7) As the floss becomes frayed or soiled, a turn from one middle finger to the other will bring up a fresh section.

To clean between the bottom teeth, you will find it easier to guide the floss using the forefinger of both hands. (See figure 8) Don't forget the back side of the last tooth on both sides, upper and lower. (See figure 9)

Rinse vigorously with water after flossing to remove the plaque and food particles. For the first week of flossing your gums may bleed or be sore. As you daily remove the plaque, your gums will heal and the bleeding should stop.

If the bleeding does not stop within a few days, talk to your periodontist.

Are your teeth clean?
To find out if your teeth are clean, that is, free of plaque, you can use a disclosing tablet or solution available at your local drugstore. (Disclosing tablets and liquids are made from harmless vegetable dyes that temporarily stain plaque in your mouth.) Chew the disclosing tablet until it dissolves. Swish vigorously and empty your mouth. Rinse with water. Now look at your teeth in a mirror. The stains will indicate areas where plaque is still present. Those areas probably need attention when you brush and floss. Gently brush and floss the stained areas until the dye is gone.

Caring for sensitive teeth
After dental treatment, teeth are often sensitive to hot and cold. This usually is temporary, lasting a few weeks or months, but only if the mouth is kept free of bacterial palque. If the mouth is not kept clean, the sensitivity will remain and become more severe. If your teeth are especially sensitive, consult with your periodontist. He or she may recommend a medicated toothpaste or mouth rinse made specifically for sensitive teeth.

Choosing oral hygiene products
A wide variety of oral hygiene products is currently on the market. When you face a supermarket aisle stocked with toothbrushes, floss, mouth rinses and other dental products, you may find selection difficult. Here are some guidelines for choosing dental care products -- what works for most patients most of the time. To find out what's best for your particular needs, talk to your periodontist.

In addition to manual toothbrushes, your choices include automatic toothbrushes and "high tech" electronic toothbrushes. These are safe and effective for the majority of patients. Oral irrigators (water-spraying devices) will thoroughly rinse your mouth, but will not remove plaque from you teeth unless used in conjunction with brushing and flossing.

Another aid is the rubber tip, often found on the handle end of a toothbrush, used to massage the gums after brushing and flossing. Other options include interproximal toothbrushes (tiny brushes that clean between teeth) and interdental cleaners (small sticks or picks that remove plaque between teeth). If used improperly, these dental aids can injure the gums, so it is important to discuss proper use with your periodontist.

Fluoride toothpastes and mouth rinses, used in conjunction with brushing and flossing, can reduce tooth decay as much as 40 percent. So, fluoride products are a good buy. However, mouth rinses are not recommended for children under six. Children should use only a pea-size dab of fluoride toothpaste on the brush to avoid fluoride overdosing.

Tartar control toothpastes will reduce tartar (a buildup of hardened plaque, also called dental calculus) above the gumline. Because gum disease starts below the gumline, tartar control toothpastes have not been proven to reduce gingivitis, the early stage of gum disease. However, they may offer cosmetic benefit.

Anti-plaque rinses, approved by the American Dental Association, contain chemical agents that may help bring early gum disease under control. These rinses can be a helpful addition to brushing and flossing.

Again, your periodontist is the best person to help you select the dental products that are right for you.