Though it is very important that everyone brushes at least 2 times a day, I tell my patients that if their life depended on brushing only once a day, then they should brush before bedtime. Night time brushing is critical in preventing dental caries (cavities), because the defense against caries is low. During the day we salivate profusely regularly providing a natural barrier and lubrication against plaque accumulation. Saliva has acid neutralizing effects. At night, on the other hand, we hardly salivate (main reason why we have bad breath in the morning), thus decreasing the defense against caries. Plaque, which is acidic, likes to stick on dry surfaces rather than slick wet surface (coated with saliva). So when a person falls asleep without brushing his/her teeth, the plaque will slowly and continuously erode through the enamel throughout the whole night. A good analogy is a bird dropping (plaque) on your car will have greater damage to the paint (teeth) on a sunny dry day, than on a rainy day.
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