Your Guide to a Healthy Smile, Part 1

Tooth Brushing "Easy, Isn’t It?"

A blog by Joanna Howell, Qualified Dental Nurse.

‘I know how to brush my teeth, I’ve been doing it for years’.

Have you ever thought about why and how you brush your teeth? In fact, most of us could make simple and easy improvements to our health by improving our oral hygiene technique and habits.

Why Do We Even Need to Brush?

Brushing and flossing physically removes plaque and food debris. Plaque is a soft film like coating of ‘bad’ bacteria, that builds up on your teeth and along the gumline (the edge where the gum and tooth meet). It is this plaque bacteria that produce toxic acids which are responsible for what we call caries, cavities, decay, or even more simply put, holes in the teeth. Decay starts small in the enamel (outer surface of the tooth), becoming bigger and deeper into the next layer of the tooth (the dentine). Decay can start without being noticed and without pain but can eventually lead to severe tooth ache, infections and broken teeth making them unsightly, useless for eating and requiring dental treatment.

Plaque bacteria also irritates the gums causing gingivitis (inflammation, redness and bleeding) which overtime can progress to gum disease (degenerative disease of the gum and bone around the tooth), which in turn can lead to infections and tooth loss. Gum disease can easily go unnoticed as it is not always accompanied by bleeding or pain and in fact nearly half of all adults have been affected by gum disease at some point in their lives. It has also been found that gum and heart health are related, as the plaque bacteria can enter the blood stream and cause inflammation of the heart. The effectiveness of your brushing has an impact on recovery from gum disease, and will help to maintain any fillings, crowns, bridges and implants you have for longer. Dental implants (surgical screws placed in the bone to support a false tooth) require as much care as natural teeth as they too can suffer from the effects of plaque bacteria causing a similar issue to gum disease.

We have all heard the saying

‘Prevention is Better than Cure'

This could not be truer than for your dentition

How to Effectively Clean Your Teeth

Brush a minimum of twice a day with a fluoride toothpaste. Seems obvious, however many people skip on occasion or routinely only brush once a day, and some may even brush a few times per week. You should brush consistently twice a day, last thing at night and once at another time of the day; this could be first thing in the morning or even at lunch. ‘So why is this important?’ It takes approximately 12 hours until plaque starts to calcify (harden) on the tooth surfaces turning into calculus (tartar), which cannot be removed by brushing. Tartar gets trapped under the gum creating more surface for more plaque to accumulate. The night time brush is the most important as our saliva which serves as a protective buffer against the bacteria’s toxic acids is reduced when we are sleeping. Fluoride is a naturally occurring mineral salt that binds into the tooth structure making it stronger and more resistant to decay and can even help reverse the process of decay in the early stages. The brand of toothpaste does not matter as long as adults use one containing no less than 1350ppmF (parts per million fluoride).

Brush Effectively for at Least 2 Minutes. Use a small headed soft or medium bristled manual brush or a round headed electric brush. Whichever you choose, it should be for at least 2 minutes. The technique is a key; effective brushing requires brushing all surfaces of each tooth, one at a time, in slow gentle small movements (manual brush) or holding the brush on each tooth, one at a time (electric). Angle the toothbrush towards the gumline, you do not need to brush vigorously back and forth; being gentle and systematic is more effective. Be sure to change your toothbrush or toothbrush head regularly about every 3 months as splayed bristles just will not wash!!

Spit Don’t Rinse!!!. After brushing do not rinse that tooth protecting paste away with water or mouthwash! Leave a residue of paste in your mouth and it will continue to work its protective magic for longer. Fluoride mouthwash generally contains less fluoride than toothpaste and can be used before brushing or at another time of the day for a boost of fluoride and freshness. Medicated mouthwashes that contain chlorhexidine usually recommended for gum disease interact with fluoride so should also be used at another time of the day or with 30 minutes gap. Do not rely on mouthwashes; the simplest, cheapest, and most effective prevention of decay and gum disease is the manual removal of plaque with brushing and flossing.

Flossing – (Interdental Cleaning). So, you have always brushed twice a day, spent time brushing, invested in an electric toothbrush but you skip on the flossing? Why?

‘I’ve never flossed, I don’t have the time or energy, I don’t know how’

For whatever reason, you are leaving plaque and food debris behind risking getting gingivitis, gum disease and decay forming between the teeth where it is not easily visible. You should clean between your teeth at least once a day before brushing. There are many products on the market, floss, tape, super floss, floss picks, and interdental brushes; there will be a product to suit your needs. A dental hygienist will be able to help you with this and give you a demonstration on how to use them. Dental tape is a good option if your teeth have tight spaces, ‘click and slide’ it into the gap, clean the side of the tooth and gently sink it below the gumline being careful not to damage the gum papilla (the triangle of gum between the teeth). A cross over technique with tape can be used around implants (have a dentist or hygienist show you this). If you find flossing tricky or you have larger gaps, try interdental brushes instead. They come in a range of sizes, the correct size should have a snug fit and not take force to fit through. They can be reused until bristles are splayed. Super floss and interdental brushes are good for cleaning around orthodontic braces, under bridges and around implants.

Single tufted brushes are good for brushing difficult to access areas such as partially erupted wisdom teeth, between larger gaps where interdental brushes are too small and the tooth brush is too big, or where teeth are not standing straight creating difficult gaps as well as for orthodontic braces and under bridges. Water flossers or jets are also available, a good extra but again not a replacement for manual removal of plaque with brushing and interdental cleaning.

To Refresh

To prevent decay and gum disease and maintain your teeth, brush twice a day, especially at night with a fluoride containing toothpaste for at least 2 minutes. Brush each tooth effectively and angle your toothbrush to the gumline. Spit out the toothpaste, do not rinse it away. Clean between your teeth with an interdental cleaning aid (floss or interdental brushes) consistently at least once per day. Clean under and around bridges, implants, and orthodontic braces and difficult to reach areas. Keep regular check-ups as recommended by your dentist so any dental problem can be detected and treated early to keep your mouth healthy.

Reference: Public Health England. Department of Health. Delivering Better Oral Health: An Evidence-Based Tool Kit for Prevention. 2017.