By CHARLES C. BASS, MD.*1 ROBERT C. COKER, DDS. **2
*Dean, emeritus, and Professor of Experimental Medicine, emeritus, Tulane University School of Medicine **Instructor in Oral Hygiene, Tulane University School of Medicine
The Bass method of personal oral hygiene was designed to provide practical application of accurate information secured through several years of intensive research relative to the microscopic etiological and pathological conditions at the particular locations where the lesions of caries and those of periodontoclasia originate and advance. It differs greatly from other methods heretofore advocated, none of which, in the light of this basic information, could be expected to be entirely effective in preventing and controlling these diseases. This exact method must be taught individually to each person by a dentist who knows (and follows) it himself and understands why it is necessary. Incidental to teaching this method to members of the faculty, students and other university personnel, and for our own purposes and guidance, we prepared a detailed description of just how we do it. We have had this printed, believing that it would be of interest and helpful to those dentists who have been instructed relative to the method and who are trying to teach it to their patients. The Authors
The patient is seated in the dental chair and made comfortable. The protective napkin is placed and the light is adjusted. The tray set-up necessary for teaching the Bass Method of personal oral hygiene is as follows:
1. One hand mirror. 2. One Bass 55 explorer (made by O. Suter Dental Mfg. Co., Chico, Calif.) 3. Several 2x2 inch gauze pads. 4. One "Right Kind" toothbrush. 5. One container "Right Kind" dental floss. 6. Optional-basic set-up.
HISTORY AND INFORMATION
Get acquainted with the patient and inquire about his oral hygiene habits and dental health. The following questions should be asked: 1. - "What is the condition of your teeth? 2. - "Do your gums bleed?" 3. - "How often and at what time do you brush your teeth?" 4. - "Do you use dental floss?"
OBSERVATION OF CARIES DAMAGE
Request the patient to open his mouth. Observe the conditions present such as caries or restorations which indicate previous caries damage. The locations at which caries occurs are pointed out while the patient observes in the hand mirror, saying: "You have fillings and/or cavities in some of your teeth which indicate previous damage from caries or decay. Dental caries begins (originates) in the pit and fissure depressions on the chewing (occlusal) surfaces of the back (posterior) teeth and on the surfaces (proximal) between the teeth about (apical to) the contact point. These are usually unclean locations. Caries does not occur on areas of the teeth continuously cleaned by functional friction from chewing of food and movement of the tongue, lips, and cheeks."
DEMONSTRATION OF THE GINGIVAL CREVICE
The patient continues to watch in the hand mirror throughout the entire instruction. After observing the general appearance of the tissue tone, take the Bass 55 explorer and insert the point of it into the gingival crevice, saying: "You see that the point of this instrument goes into the space between your gum (gingival margin) and the tooth. This space is called the gingival crevice. It completely encircles every tooth and is deeper between the teeth. Remnants of food material and bacteria tend to accumulate at the entrance to this crevice. Bacteria grow down into it and accumulate on the surface of the tooth within the crevice."
"This foreign material on the surface of the tooth, within the crevice, causes irritation and inflammation of the gum (gingival) tissues. Bleeding occurs from slight physical disturbance such as brushing, etc. This is gingivitis and is the early stage of periodontoclasia or pyorrhoea. Normally the gum should rest against a smooth, non-irritating surface and not against such irritating foreign material upon the tooth."
DEMONSTRATION OF FOREIGN MATERIAL WITHIN THE CREVICE
Some inflamed and swollen interdental papilla will be seen. The blade of the explorer is inserted into the interdental crevice, all the way to the bottom, then scraped along the surface of the tooth as it is brought outward. This removes foreign material and pus which remains on the instrument and the patient can see it. Start the demonstration on the lower anterior teeth and progress posteriorly to the last tooth; then start with the last upper tooth and progress anteriorly. Demonstrate the depth of the crevice or pocket and the foreign material, especially between the posterior teeth, saying: "This material consists of bacteria and pus. We see it as it is taken from the surface of the tooth within the gingival crevice. Foreign material is found in variable amounts on the surfaces of all teeth within the gingival crevices and is the cause of the disease periodontoclasia (pyorrhoea). The soft gum tissues resting against this material are irritated, inflamed and ulcerated. This disease is continuously advancing and unless further advancement is prevented, it ultimately results in loss of the teeth."
PREVENTION AND CONTROL
"We can say in one sentence exactly what you, and everyone else, must know and do to prevent and control the two diseases, caries and periodontoclasia (pyorrhoea): "You must clean your teeth right with the right kind of both toothbrush and dental floss every night before retiring. You have not known how to clean them right and have not had the necessary toothbrush and dental floss. Neither did you realize that you had the slow, frequently symptomless, painless, progressive disease periodontoclasia or pyorrhoea. I will show you how to clean them right and give you the right kind of toothbrush and dental floss with which to do it."
DEMONSTRATION OF THE PROPER USE OF THE TOOTHBRUSH (BASS METHOD)
Take the "Right Kind" toothbrush and wet it. Demonstrate to the patient what is said in the following conversation: "This will be your toothbrush. It differs from other brushes in that the bristles are smaller, and therefore bend more easily. The tufts are properly spaced and if we looked at it under the microscope, we would see that the ends of the bristles are round or smooth, making them suitable for application directly into the gingival crevices."
"The objective of this method of personal oral hygiene is cleaning or dislodging soft, foreign material from the surfaces of the teeth within the crevices and also from the pit and fissure depressions on the teeth. This is where these diseases start (originate) and advance, and where they must be prevented and controlled."
The patient should see and feel the bristles properly applied into the crevices and to all surfaces. Demonstrate first on the buccal side of the lower posterior teeth, saying:
"The bristles are firmly applied to the outer side of the lower teeth, at an angle of about 45 degrees (to the long axis), directly into the crevices and the spaces between the teeth. Short back and forth stroke movements of the brush dislodge and remove soft foreign material. For the upper teeth the bristles are applied in the same way. This is done first on the outer side (buccal and labial) of all the teeth."
"Next the pit and fissure depressions on the chewing (occlusal) surfaces are cleaned. This is done by applying the bristles firmly to these surfaces and stroking back and forth to dig Out and dislodge material that has accumulated and is retained there."
"Next the back (posterior) teeth are cleaned on the inner side (lingual) by applying the bristles into the crevices and spaces between the teeth in the same way as was done on the outer side (buccal) of these teeth."
“This brush is especially suitable for cleaning the back surface (distal) of the last tooth in each of the four quadrants. These are usually the most unclean places in the mouth. The toe or tip of the brush is placed over and back of the last tooth and the back surface of that tooth is cleaned by proper manipulation of the brush."
"To clean the front (anterior) teeth on the inner side (lingual), the heel or the side of the brush is used. The bristles are applied directly into the gingival crevices and between the teeth in the same manner as was done in the other areas."
"You must systematically apply the bristles of the brush to all locations to which they can be applied. This is the system I follow: With the mouth almost closed and the teeth almost together, I place the brush between the cheek and the teeth and apply the bristles into the gingival crevices and spaces between the teeth, cleaning the outer side (buccal) of both the upper and lower back (posterior) teeth on one side. I progress around cleaning the front (anterior) teeth and then the teeth on the other side. Then I clean the chewing surfaces (occlusal), the inner side (lingual) of the back (posterior) teeth and back (distal) of the last tooth in each of the four quadrants. I then clean the inner side (lingual) of the upper and lower front (anterior) teeth."
"I can brush my teeth well in less than a minute. Brushing in the right way is important, not how long you brush or what dentifrice you use. Precipitated chalk used as a polishing agent, is the only dentifrice anyone needs."
"You understand that the teeth are clean only where the bristles have been applied. There is still an unclean area along the middle between the teeth where the bristles did not reach. The only way that anyone knows, so far as I know or believe they will ever know, to clean the teeth at this location, all the way to the bottom of the crevice, is by proper use of the right kind of dental floss."
DEMONSTRATION OF THE PROPER USE OF DENTAL FLOSS (BASS METHOD)
Take a container of "Right Kind" dental floss and cut off a piece of floss two or three feet long. Tap the end of it with the finger to spread out the filaments and show this to the patient, saying: "This will be your dental floss. It was designed by Dr. Bass after having exact information as to the nature of the harmful (microscopic) material on the surfaces between the teeth and within the gingival crevices. This floss consists of a large "Right Kind" Dental Floss number of microscopic nylon filaments, not waxed, and twisted only enough to keep them from falling apart when in use. You can understand that if one draws this thread composed of 170 filaments over the surface of a tooth, as I am doing on my finger, each filament tends to dislodge and remove microscopic material."
The end of a piece of floss about two or three feet long is anchored (wrapped) around the right index finger, then grasped by the left hand to manipulate it between the teeth. Demonstrate the following on the lower anterior teeth, saying:
"The floss is carried between the teeth all the way to the very bottom of one crevice, held firmly against the tooth and drawn outward (not endways). Then before removing it from the space, it is carried to the bottom of the other crevice, held firmly against that tooth and drawn outward (occlusalward). This cleans the surfaces of the teeth within these crevices."
"You will note that I have presented one idea and one idea only. The floss is carried to the very bottom of the crevice and the surface of the tooth is cleaned as the floss is drawn outward."
“You must develop your own system and manipulations for cleaning every one of your teeth. This is the system I follow: I cut off a piece of floss two or three feet long and wrap one end, with two or three turns, around the first phalanx of the right index finger, for the purpose of anchoring or holding it. Then I bring the floss over the end of the right thumb, which is also held against the finger around which the floss is anchored. Then I grasp the floss with the left hand and bring it over the end of the first finger. Thus, a section of floss, about an inch long, is held between the thumb of the right hand and the first finger of the left hand. With it held in this manner, I carry it into my mouth and back (distal) of the last upper right tooth. I carry it into the crevice all the way to the very bottom, hold it firmly against the tooth and draw it outward. This cleans the back surface of that tooth."
"Then I move forward to the space between the next two teeth, carry the floss between them into one crevice to the bottom, hold it firmly against the tooth, and draw it over the surface. Before removing it, I carry it into the other crevice, to the bottom, hold it firmly against the tooth and draw it over the surface. When cleaning between two teeth, remember there are two crevices. Soon the used part of the floss is soiled. Another turn around the right index finger quickly brings up a clean section."
"For the upper left side, it is usually more convenient and practical to hold the floss over the end of the thumb of the right hand as before and over the thumb (instead of the index finger) of the left hand. The floss may be held over the ends of the two longer middle fingers to reach some of the back (posterior) teeth more easily. It is immaterial which fingers you use or how you go about it, provided you clean all teeth from the very bottom of the crevice outward."
"If there is difficulty in passing the floss between two teeth don't force it. With slight end to end movement it can be passed between any of them. If difficulty is still encountered, the cause should be corrected."
"You should brush first, then clean all your teeth with dental floss. Then take water into your mouth and rinse vigorously (two or three times), forcing it through the spaces between the teeth, to wash out material that was dislodged but was not removed by the brush or floss."
"If I have done a good job, as anyone knowing what I know about the conditions would do, every tooth is clean from the bottom of the crevice outward. There is no food remaining in the mouth to decompose during the night and growth of bacteria is greatly reduced. One arises the next morning with about as clean a mouth as when he retired. I like to brush my teeth also in the morning when I wash my face."
"A clean tooth does not decay. Periodontoclasia does not occur about a clean tooth. These two diseases are the cause of almost all loss of teeth. Therefore this thorough cleaning with both toothbrush and dental floss every night before retiring is essential for oral cleanliness and good dental health throughout life."
"You have the right kind of toothbrush and dental floss and you know how and why to use them. They are not available commercially and now you should realize that if they were, you would not have known how to use them effectively. At return visits I will supply you more brushes and floss, as needed, and check for any areas you may have missed."
"The Bass method of personal oral hygiene was designed by Dr. C. C. Bass and is based upon extensive and intensive research work relative to the microscopic etiological and pathological conditions at the particular locations where the lesions of caries and those of periodontoclasia originate and advance. The exact specifications for the 'Right Kind' toothbrush and dental floss are based upon this correct information. Thousands of individuals have been taught and are now following this method. As a result they are enjoying superior oral cleanliness and dental health, as you also will now be able to do."
"A Clean Tooth Does Not Decay, nor does periodontoclasia occur about a clean tooth." C. C. Bass, M.D.