Every day, I have the opportunity to help people who suffer from chronic Dental disease with signs and symptoms in their mouth, take control of their health. Better yet, I get to teach new moms how to prevent dental disease all together with by knowing what to look for and creating fun daily habits that will last a lifetime.

There are not many people who would dispute the fact that brushing your teeth is an essential part of your daily routine.

We are going to talk about toothbrushing 101. Back to the basics, what are teeth, the anatomy of teeth, history of toothbrushing, proper technique, and more.

Like anything in life, mindset and habits are the foundation of accomplishing your goals; the health of your mouth and teeth are no different.

For years we have treated the mouth as an isolated part of the body instead of seeing the complex interaction between the health of our mouth and our overall body health.

For decades we have looked at tooth decay, gingivitis, and gum disease as types of problems that happen in the mouth. We have not recognized cavities or gingivitis as a disease. Now, it is not only proven, but there is also more and more research being conducted that links systemic diseases like cardiovascular disease, infertility, diabetes, Alzheimer’s, autoimmune diseases, and intestinal diseases. More diseases in the body are made worse due to a diseased mouth and inflamed gums.

We know that most chronic diseases are not a coincidence, bad genes, or just bad luck. Instead, it is a result of stress and chronic inflammation in our bodies.

Chronic inflammation in our mouth can be an early warning sign and contributes to revealing what may be happening in the body. We generally treat our mouth and our body separately. If we pay more attention to our mouths, it is possible to feel better, prevent disease, and live healthier lives.

As a dental professional, I learned about the mouth, how to care for it, and how to make it healthy. What I was not taught was how the mouth was connected and inseparable from the body and to look for the root cause of the disease. Now, I know beyond a shadow of a doubt there most defiantly a connection. I have had to educate myself on this subject.

When I ask patients about their medical history, I get asked why you need to know that you are just cleaning my teeth. As an educated dental professional, I am not only maintaining the health of your mouth; I may see signs and warnings that will lead you to be your own health care advocate and follow up with your Dr. to get to the root cause of the disease in your mouth.

I saw my Uncle every three months to maintain his gum health; no matter what we did, I could not get his gums to respond; he even saw a periodontist. I begged him to see a doctor. They ran the normal blood work and said everything was within normal limits. HUMM…what I saw in his mouth was anything but normal. But what could I do? A few years later, he was diagnosed with diabetes. His gums got better for a year, then back to the same old bleeding gum he even lost a few teeth in over the years. Back to you need to see a Dr. he was not compliant! Fast forward a few more years, and he was diagnosed with cancer. Type 2 Papillary renal cell carcinoma. I feel if I was more adamant about what I saw we might have found it sooner. So now I am speaking gout. If I can help someone else’s family get an early diagnose and save them from the pain and suffering, and what-ifs, then this is all worth it

I like to start with educating patients on what I see in their mouth. You need to be your own advocate. Know your #’s the measurements we take around your teeth to see if they are healthy or diseases do you have radiographic bone loss? Is your disease active? Do you have bleeding on probing? Do you have a dry mouth? Is your mouth acidic?  If you have not been to the dentist in a while or have a lot of buildup and bleeding your teeth, we may recommend a deeper cleaning because it is too much to remove in the time we have allotted for your appointment, and your mouth may require a different setup and procedure then I had planned for that visit.

I will start by teaching you how to brush to get below the gum line with your toothbrushing so you can reduce the inflammation, and there will be less bleeding for the next appointment.

Just because you are moving the toothbrush bristles around your mouth doesn’t mean you are brushing your teeth properly.

Proper brushing technique isn’t exactly something that anyone really teaches you. Yet it is an important part of your daily self-care routine.

Brushing your teeth is a lot like a golf swing. You swing and let the club do the work. This is why I recommend an electric toothbrush; you can do the job with a manual brush. With a manual brush, you only get 300 strokes per minute, and compared with an electric, you get 33,000 strokes per minute. No matter what brush you choose, you will need to hold it in the correct potion and let the brush do the job it was specifically invented to do.

To help you make sure you are getting the most out of the time you have the toothbrush in your mouth, we are going to talk about what teeth are, the history of tools we use to keep them clean, why do we brush them, and how to brush them to keep them and you healthy.

Two minutes twice a day are guidelines. These are the general guidelines. You are a unique individual. You need to figure out what works for you in any medical or dental situation. Guidelines and norms and are made by taking what works for most and creating a system.

I have been in the dental field for over thirty years. I started when I was 16, to be exact; dental assisting was my first job.

Over the years, I have held many positions in the dental field over the years and loved them all.  I worked for a general dentist, a periodontist, a pedodontist, a mobile dental company, with my husband in our practice, as a temp at other practices.

So, what does this have to do with toothbrushing 101, you ask?

Every day no matter where I worked or how many people, there has been a common theme. The majority brush once a day for less than a minute. I see a day at least four patients a day have thanked me and said no one ever taught me how to brush my teeth or no has taught me to brush like that.

It was not until one person I saw thanked me, I looked back, and I had seen him before. It was not that no one ever told him before, because I had, and I documented it on his chart that I reviewed it.

I had shown him how to brush on a model, but I just had not with a brush in his mouth with a manual brush and an Oral B demo model. So, he could feel the difference, the difference in pressure in angulation in manual vs. electric in his mouth before I cleaned his teeth.

As dental professionals, we assume people know how to brush properly. Patients say yeah, yeah, I know what you are talking about. But do they? Do you? Who taught you how to brush your teeth? Are you doing it the same way you have since you were a kid?

I am a show, tell, do kind of person. I admit if I am running behind, I don’t always open up a toothbrush and show someone how to hold the brush and brush properly, and just because we are told once does not mean we remember or do it like we are supposed to.

When I open the toothbrush and put it on the gums, and they can feel what the bristles feel, the amount of pressure I am using is a game-changer and if they have bleeding gums at that visit, it usually improves if they follow up and brush as I showed them.

When you see me for a dental visit, I talk teeth, exactly what I see in your mouth. I am not good with small talk, especially because asking you questions about your life means I have to stop working to hear your answers, and I only have an hour to review your medical history, take x rays,  do your cleaning, review your oral hygiene show you what I see before the dentist comes in to do the exam clean the room for the next hour patient. So, when we are running behind, guess what gets skipped because we feel you know how to brush your teeth. Most of you feel you know how to brush your teeth and tune me out while I am talking, even though we see you are clearly missing areas. We clean them, give you some pointers and send you on your way till the next visit.

The American Dental Association says taking care of your mouth is like cleaning your house: You can’t do a proper job in your mouth with a single tool, such as your toothbrush, any more than you can maintain your house with just a broom. You need other instruments. In the case of dental care, that includes electric toothbrush, specialty toothbrush, floss, waterpik mouth rinses.

But before we get into how to care for your teeth, let’s talk about the anatomy of a tooth or teeth.

We need to look at the bigger picture. Our teeth do a lot of work that up until now, our mouths role as the central part of our body the connects our gut, and our brain has been taken for granted.

Our teeth and the saliva in our mouth start to break down our food and aid in digestion even before we swallow; we eat, speak, chew, and sometimes even breathe through our mouth—all things we need to survive and thrive.

Teeth are living organs, and their health is closely connected with the health of the whole body. Unhealthy teeth, gums, cavities, root canals, and other dental problems can be connected to severe degenerative conditions including cardiovascular any autoimmune disease, fibromyalgia, chronic fatigue, multiple sclerosis, allergies, and digestive problems.

Like every organ in our body, teeth are connected to the rest of our body; when we are run down, our teeth suffer; when there is a problem with our teeth, the rest of our body suffers.

What are teeth?

  1. Teeth are the hardest substance of your entire body. They are located in our mouths. We have two sets of teeth, Baby teeth or Primary and Adult teeth or permanent.  I have always been fascinated by why we call them permanent; if we don’t take care of them, they are not permanent like our bones. There is no guarantee they will be there for life. Our genetics and our choices of what we put in our mouth and how we take care of our mouth play a role in what happens to our teeth throughout our life. Many people believe teeth are not meant to last. That could not be further from the truth.
  2.  Enamel is a hard mineral! Once damaged or broken, enamel cannot regrow. There is a process you can do to repair it if only the surface is damaged.  Strengthen your enamel with toothpaste and mouthwash, and foods can stop the decay process from progressing. We are not going to talk about that here.
  3. Teeth aren’t bones; even though they are part of our skeleton, are both hard, white, and contain calcium. Unlike bones, they are the only part of our skeleton we clean, and teeth, if they are broken, teeth can’t heal themselves as bones can.
  4. Only two-thirds of your teeth are visible. The rest is hidden under our gums. Gums need just as much attention as teeth in your oral health care routine. When plaque and bacteria are not removed daily dental disease occurs, known as cavities, gingivitis, and gum disease.


Enamel is the outside layer of the tooth that protects the inside layer of the tooth called Dentine; just beneath the enamel is a soft yellow layer of the tooth, which is made from living cells and calcified tissue. The dentin’s main function is to provide support to the enamel. It is responsible for transmitting impulses from the enamel and root to the dental pulp.

There are three types of dentin, which are defined by the location of the dentin. The outermost part is called the primary dentin and is the dentin that is in contact with the enamel. The part of the dentin that is in contact with the root and cementum is called the secondary dentin. Tertiary dentin is the dentin that is formed in response to acid and tooth decay. If form to help stop a cavity for progressing.

The outer layer of enamel covers the crown of the tooth, and the cementum covers the root of the tooth. There are tubules in the dentin and cementum that contain cells and fluid. This gives the dentin a degree of permeability, which can increase painful sensations and accelerate the progression of tooth decay. If you feel sensitivity in a tooth, it is usually because the dentin becomes exposed.

 Cementum is a bone-like mineralized tissue lining the dentin of the root that protects the root and also serves as an attachment surface to anchor the PDL.

Yellow teeth…  Everyone wants white teeth! The enamel/crown of the tooth is translucent. The weaker the enamel, the thinker the dentin beneath becomes, making your teeth appear more yellow. Another way your teeth lose their whiteness is through constant contact with substances that cause surface stains, such as coffee, red wine, and tobacco. Whitening pastes can be effective for removing these surface stains.

History of Tools for Cleaning Teeth

The oldest versions of toothbrushes were chewed sticks.

People used to brush their teeth using twigs or their fingers before toothbrushes were invented. The first toothbrush tools date back to 3500 BC to Egyptian times.

The practice of teeth-whitening began around 4,000 years ago with the ancient Egyptians; the Pharaohs were fascinated about white teeth; they created a special toothpaste made of wine-vinegar, pumice stone, and ground oxen hooves.  In ancient Egypt, beautification of the teeth was of great importance. People with white teeth were considered to have status, virility, wealth, and sensuous appeal.

In Ancient Roman times, people would use sterile urine as a mouth rinse. (Yep…you read that correctly)

The first toothbrush, as we know it, was invented in 1498 in China. The bristles were actually coarse hairs taken from the back of a hog’s neck and attached to handles made of bone or bamboo.

In 1780 the first mass-produced toothbrush was invented by William Addis of England. While in prison, he drilled small holes in a cattle bone, tied wild pigs’ hairs in bunches, passed them through the holes, and then glued them. I am happy for Dupont inventing nylon bristles! How about you?

Dental care is often an overlooked area of health care, even though cavities are the #1 common preventable childhood disease.

We only spend 38 days during our lifetime brushing our teeth.  What a waste if you are doing it wrong!

Here are some simple tips to make you an expert at something that it is recommended we be doing at least two times a day for at least 2 minutes a day!

You may think you learned what you need to know about brushing your teeth when you were little.

But guess what? Your mouth and your abilities have changed since then, and because of that, you need a different technique and different tools.

Kids are taught to start at the gums and brush away or in a back and forth motion because a circular motion is too hard for them to do. It is difficult for kids to get all surfaces, but that doesn’t apply to adults.

The technique really should be the same for both; it is just easier for adults to maneuver the brush around the gum line at a 45% angle.

  1. How your teeth are arranged in your mouth is as unique as your fingerprint — nobody else has a smile like yours!
  2. Nobody else in the whole world has the same shapes of teeth as you — your smile is unique, one of a kind and special.



When it comes to tooth brushing, most people are not doing it properly to efficiently to remove the plaque bacteria and biofilm, and they don’t even know it.

The majority of patients believe that scrubbing back and forth across the surfaces of teeth or in large circles removes plaque and bacteria adequately. To thoroughly clean teeth, remove plaque, and keep your smile healthy, follow the simple instructions listed:

  1. Start with the right tools. Always use a soft or ultra-soft bristled toothbrush. Medium or hard-bristled brushes can irritate soft tissue and are too abrasive for tooth enamel.
  2. Using your soft toothbrush that fits your mouth, you can concentrate cleaning efforts on the place where the teeth and gums meet. You may need more than one brush, depending on your mouth.
  3. Angle the brush slightly upwards toward the gums at a 45-degree angle and place the brush against teeth at the gum line.
  4. GENTLY move the toothbrush in small circles or quick back and forth in short sweeping motions over just one or two teeth at a time (see video for a demonstration). Don’t make big circles or move the brush back and forth across numerous teeth. If you use an electric toothbrush, all you need to do it get the angle correct and hold it in one spot for 3-5 seconds.
  5. Brush all the surfaces inside and outside of every single tooth and brush the top biting surfaces of teeth as well.
  6. Spit and you are done. Your teeth should feel clean. If you get blood when you brush, you will need to investigate to see where it is coming from. You may need to brush longer in that spot for a few days until it clears up.
  7. If you cannot get bleeding to stop with toothbrushing… it is a sign something else, it wrong. See a Doctor or Dentist to follow up and find the cause.


  • Two minutes of brushing is not just a recommendation. It’s essential for proper dental care for many of us if we do not brush for at least two minutes at a time, we are not removing the sticky plaque buildup from the day. For kids or if you have fewer teeth, you may not need the full two minutes to get them all clean
  • Consider brushing with an electric toothbrush. These toothbrushes clean teeth in two ways, mechanical scrubbing of the teeth, gums, and tongue, and fluid strokes that can also dislodge bacteria, biofilm containing harmful microorganisms from tooth surfaces. We find that patients are more likely to brush systematically twice daily when using an electric toothbrush with a two-minute timer.
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  • Brush Systematically, NOT randomly. If you struggle to get results, it is your system that is usually the issue. A recent study revealed that one of the main mistakes people make when brushing their teeth is to brush to fast and randomly. Brushing for two minutes with no systematic way of ensuring every tooth was cleaned can result in a large amount of plaque remaining on teeth. Without changing any brushing technique or style, participants were asked to brush each “quadrant” of their mouth for 30 seconds. The result was less than ½ as much plaque remaining. Developing a habit of systematic cleaning also makes it easier to ensure you brush for two full minutes. Start in one spot slowly move to the next establishing a system to assure you will not miss any areas.
  • Check with a Disclosing Solution

There are tablets, liquids, toothpaste, and mouth rinses that will stain the plaque to show you where you missed. I find doing this once a week or at least once a month keeps you accountable and gives you feedback on your toothbrushing technique.

The technique is the Key

Believe it or not, the most important part of brushing your teeth is not which toothbrush or toothpaste you choose, but the technique you use.

Here are more tips:

  •   Hold the brush at a 45-degree angle to your teeth and gums.
  •   Gently brush all sides of your teeth (front, back, and chewing surfaces).
  •   Make sure to massage the gums to stimulate blood flow to the gums and prevent gingivitis.
  •   2×2 Regimen:  Brush twice a day minimum (morning and night) for at least two minutes.
  •   Bacteria can hang out on your tongue, causing bad breath and tooth decay, unless you brush or scape them away daily.  Some toothbrushes come with built-in tongue cleaners in the backside.
  •   After brushing, spit and rinse your toothbrush getting all the toothpaste out from between the bristles and store it upright to air dry. Do not keep it in a closed container, next to another family member’s brush or humid place. If possible, keep it away from the toilet plume, which can spray germs when flushed. Close the lid if possible when flushing.

In a previous post, we talked all about why we think an electric toothbrush is worth the investment for most of our patients. The one I love and recommend is listed above. It comes in three colors and is very affordable. It has a 90-day money-back grantee, and if you stay on the replacement brush head subscription, it has a lifetime warranty. There is no reason not to give it a try. You won’t regret it!

So let’s recap!

1. Make Sure Your Brush Fits

This is especially relevant when trying to get children to build healthy dental hygiene habits. If a brush is too big for your mouth will be uncomfortable and bulky when you are trying to maneuver through your mouth and will not be very efficient in cleaning their teeth. Find an appropriately sized brush for your mouth and teeth.

2. Pick a Soft-Bristled Brush

The point of brushing isn’t to scrub away plaque and tartar with a hard-bristled brush, which by the way, can cause permanent damage to the gums and root surfaces.

The goal is to gently loosen and disrupt the plaque and biofilm that have accumulated in all the nooks and crannies between the teeth and under the gums.

3. Brush Twice a Day

After a long day of eating and drinking, the food you have eaten starts decaying between your teeth. The longer it is allowed to stay put, the more damage it can cause, so removing that it before you fall asleep is essential.

Have you ever heard the saying brush in the morning to keep your friend’s brush at night to keep your teeth?

After sleeping for a full night, the bacteria in your mouth have had plenty of undisturbed time to grow, so disrupting as many of that bacteria you can is equally important in the morning, especially if you did not brush the night before or you have a dryer mouth. Saliva decreases at night while you sleep. It is your natural defenses against the process of destruction that goes on at a microscopic level.

Skipping brushing either of these times means that you are drastically increasing the likelihood of developing a cavity, gingivitis, or infection. 

4. Two Minutes Per Session

This is the recommended length of time to shoot for when brushing your teeth. Why two minutes? Because that is the length of time we see most people need to remove all of the nasties in their mouth. I know two minutes may seem like a long time to commit to cleaning your teeth, especially when you are in a hurry, but making sure you are getting every surface of the teeth per session is as important as making the most out of the time you are spending in there. You may also need more than one tool for your individual situation. That discussion is for another time.

5. Replace Your Toothbrush Often

We recommend getting a new toothbrush every three months. If you are rough on your brush (which you shouldn’t be) or if the brush you have is showing wear, replace it as soon as it frays around the edges.

A frayed brush is not as effective, it will take more time to remove bacteria from the mouth.

6. Use Proper Toothpaste

A toothbrush’s best friend is the toothpaste that accompanies it. The American Dental Association (ADA) recommends using fluoride toothpaste. I do not agree necessarily agree this is right for everyone, however. My daughter has sensory issues. It took me some time to come to the realization we were not going to use toothpaste. Having this drilled in my head for years, I fought to find the right toothpaste. It was a struggle. Learn from my experience. It is not the toothpaste that is important. Sometimes skipping this step will make your life much easier with a little mouth you care for. You have my permission not to use toothpaste.

If you are at your wit’s end and not sure what to do to get your little one to brush. Below is a link for a free consultation with me.


7. Correct Angle

Keeping your toothbrush at a 45-degree angle toward your teeth and gums is the ideal position to maximize the removal of bacteria, plaque, and leftover food debris on your teeth and below your gumline.

8. Use the Right Motion

Try to avoid brushing or scrubbing your teeth in a back-and-forth motion. The most effective pattern to follow is a circle since it will move the particles both horizontally and vertically between the teeth and 3 mm under the gums

9. Get All the Surfaces

Make sure you are consciously brushing to get the front, back, and chewing surfaces of your teeth during your two-minutes with your brush. If you are in a hurry, at least get the back teeth this time, and the next time you brush, get the spots you know you missed.

10. Use Disclosing

On occasion or at least once a month, give yourself an accountability check to see if you are getting all of the surface clean for both you and a loved one. It is fun and easy to do. It may be a little messy but worth the time and mess if it saves you from a cavity or worse, a systemic condition that could have been pre3vented by you.

People just like you can stop and even reverse dental disease. My goal is not only to help my clients eliminate the disease in their mouths but find out what the root cause is so they can live healthy lives. Unfortunately, the one out of two Americans have gingivitis.

Ultimately, for many of us, we end up losing teeth and not getting diagnosed until a disease has progressed to a later stage, and there is pain. But there are many who are beginning to take control of their health and make changes that will allow them to live long, healthy, vibrant lives. We believe that health is not just the absence of the symptoms of a disease, but, rather, a process of being your own advocate and asking tough questions for your own wellbeing.

No matter where you are in your health journey, the principals in this book apply to you and can work for you.

  1. Your care is not designed for you. Our healthcare system has become a one-size-fits all system.
  2. We treat symptoms, not causes.

Symptoms, like pain, are like a warning light coming on in your car. The light is not the problem. If you turn the light off or remove the little bulb illuminating the warning sign, the problem is still there and will continue to worsen until the part, or your whole car ultimately breaks down. When it comes to your health, don’t you want to know what the symptom means, just like you would want to know why your check engine light came on? Knowing what is causing the warning light to come on requires the proper diagnostics and a peek under the hood. Determining the cause of the symptoms requires the right clinical investigation.

  1. Don’t just treat the symptoms

Our system treats symptoms with drugs

This cycle seems like a never-ending cycle – and it will never change as long as we keep blindly spending our hard-earned dollars in this broken system as opposed to investing in learning how to prevent illness or finding the root cause and solutions for our own individual needs

A Better Approach

Heal your mouth, Heal Your Gut, Heal Your Brain The connection between this trifecta is complex, to say the least. There are many connections between what you put in your mouth and how your care for it that affects, your airway, breathing, your gut, and brain health.

Eat healthily is another key component of this puzzle that we will save for another day another discussion.

I have a brushing basis box that has the tools you need for better toothbrushing, disclosing and videos with how to use what comes in the box and the next steps to a healthy mouth.


This is my option based on my professional experience, helping thousands of patients and families have better oral health, over the last 35 years, in the dental field.  If I can be of any help to you please reach out. Join The Healthy Mouth Moment together, we can change the way we care for your mouth, learn the warning sign and stop, reverse or find disease before you are in pain, and it is more invasive and costly to treat.

It all starts in the mouth at home with you and your toothbrush! A healthy mouth is a healthy body and a healthy life!

Disclaimer Copyright by Sheree Wertz RDH BS, OMT

All Rights Reserved. No part of this book may be reproduced in any form without permission in writing. This book provides education and general principles and, in no way, represents medical advice or specific recommendations. The treatment of the principals contained herein are general and not intended as a comprehensive discussion of all potential relevant issues. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this book. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. If you have any questions, please contact Sheree Wertz @ support@dentalhygien411.com