Regular teeth brushing and cleaning between teeth helps to keep your teeth and gums healthy, and helps to prevent tooth decay and gum disease. Other things that may help include: mouthwashes, tongue cleaning, and eating a healthy diet, which includes limiting sugary drinks and foods. If you smoke, stopping smoking will improve oral hygiene. Have a dental check-up at least once a year.
Why is oral hygiene important?
Good oral hygiene helps to prevent dental problems - mainly plaque and calculus which are the main causes of gum disease and caries (tooth decay). Good oral hygiene may also help to prevent or delay dental erosion.
- Dental plaque is a soft whitish deposit that forms on the surface of teeth. It forms when bacteria (germs) combine with food and saliva. Plaque contains many types of bacteria. You can remove plaque by good oral hygiene.
- Calculus, sometimes called tartar, is hardened calcified plaque. It sticks firmly to teeth. Generally, it can only be removed with special instruments by a dentist or dental hygienist.
Some common dental problems related to poor oral hygiene
Caries (tooth decay)
Caries is when holes form in parts of the enamel of a tooth. A main cause of caries is due to a build-up of plaque. The bacteria in the plaque react with sugars and starches in food to form acids. The acids are kept next to the teeth by the sticky plaque and dissolve the tooth enamel. If you have tooth decay you may need fillings, crowns or inlays.
Gum disease (periodontal disease)
Gum disease means infection or inflammation of the tissues that surround the teeth. Most cases of gum disease are plaque-related. Plaque contains many different types of bacteria and a build-up of some types of bacteria is associated with developing gum disease.
Depending on the severity, gum disease is generally divided into two types - gingivitis and periodontitis:
- Gingivitis means inflammation of the gums. There are various types. However, most cases of gingivitis are caused by plaque.
- Periodontitis occurs if gingivitis becomes worse and progresses to involve the tissue that joins the teeth to the gums (the periodontal membrane).
Gum disease is the most common cause of tooth loss in adults. It is also a main cause of bad breath (halitosis). However, gum disease is often treatable. (See separate leaflet called 'Dental Plaque and Gum Disease' for details.)
Tooth (dental) erosion
Tooth erosion is a common problem. It is the gradual erosion of tooth enamel by the action of acid on the teeth. This is different to damage caused by bacteria resulting in tooth decay and caries. Tooth erosion affects the entire surface of the tooth. In time, tooth erosion can cause thinned enamel, and eventually can expose the softer dentine underneath the enamel. Dentine is sensitive so erosion can lead to your teeth being more sensitive to hot, cold or sweet foods and drinks.
Routine oral hygiene
It is important to get into a regular habit of good oral hygiene. In particular, regular teeth brushing and cleaning between teeth.
Brush your teeth at least twice a day. Use a soft-tufted brush and a toothpaste that contains fluoride. The head of the brush should be small enough to get into all the areas of the mouth. Spend at least two minutes brushing, covering all areas (the inside, outside, and biting areas of each tooth). Pay particular attention to where the teeth meet the gum. Get a new toothbrush every 3-4 months. Studies suggest that powered toothbrushes with a rotation-oscillation action (where the brush rapidly changes direction of rotation) remove plaque and debris better than manual brushes.
Ideally, brush your teeth either just before eating, or at least an hour after eating. The reason for this is to help prevent tooth erosion. Many foods contain acids. In particular, fizzy drinks (including fizzy water) and fruit juices. After your teeth are exposed to acid, the enamel is a little softened. But, the action of calcium and other mineral salts in the saliva can help to counteract and reverse this softening. Therefore, do not brush teeth immediately after eating when the enamel tends to be at its softest. In particular, after eating or drinking acid foods and drinks. It is best to wait at least an hour after eating or drinking anything before brushing.
Cleaning between teeth
Clean between your teeth after brushing once a day, but ideally twice a day. This is to remove plaque from between teeth. Dental floss is commonly used to do this. However, some studies suggest that small interdental brushes may do a better job than floss. The aim is to clean the sides of the teeth where a toothbrush cannot get to, and clear the spaces between teeth (the interdental spaces) of debris. Some people who have not cleaned between their teeth before are surprised as to how much extra debris and food particles can be removed by doing this in addition to brushing.
If you are not sure how to clean between your teeth, then ask your dentist or dental hygienist. Briefly: normal floss looks a bit like cotton thread. Cut off about 40 cm. Wind the ends round your middle fingers of each hand. Then grab the floss between the thumbs and first finger to obtain a tight 3-4 cm section which you can pull between teeth. Gently scrape the floss against the sides of each tooth from the gum outwards. Use a fresh piece of floss each time.
Some people prefer floss tape which slides between teeth more easily than normal floss. Also, some people use disposable plastic forks with a small length of floss between the two prongs. These may be easier to hold and manipulate. However, they are expensive. Some people use sticks, or small interdental brushes to clean the space between the teeth.
The gums may bleed a little when you first begin to clean between your teeth. This should settle in a few days. If it persists then see a dentist, as regular bleeding may indicate gum disease.
Food and drink
Sugars and sugary foods in the mouth are the main foods that bacteria thrive on to make acid which can contribute to tooth decay. Acid foods and drinks are also a main factor in tooth erosion. So, some tips:
- Limit the amount of sugary foods and drinks that you have. In particular, don't snack on sugary foods.
- Try to reduce the amount of acid in contact with your teeth. So, limit fizzy drinks (including fizzy water) and fruit juices as these tend to be acidic. Perhaps just limit yourself to one fizzy or fruit juice drink a day. Otherwise, choose drinks that are much less acidic, such as still water, and milk, tea, or coffee (without sugar).
- Drink any acid drinks, such as fizzy drinks and fruit juices, quickly - don't swish them around your mouth or hold them in your mouth for any period of time.
- Brush your teeth at least an hour after eating or drinking anything - especially acidic foods and drinks. (See above for reasons.)
- Likewise, do not brush your teeth within an hour of vomiting (as stomach acid will be part of the vomit).
Other things you can do
The measures above are usually sufficient. However:
- Many people also use an antiseptic mouthwash each day to help prevent gum disease. In particular, for those who are unable to use a toothbrush, regular rinsing with an antiseptic mouthwash will help to clean the teeth.
- Many people also clean their tongue after cleaning their teeth. You can do this with a toothbrush. You can also buy a special plastic tongue scraper from pharmacies.
- If you smoke, you should aim to stop smoking. Smoking is a major risk factor for developing gum disease.
- If children need medicines, wherever possible use sugar-free medicines.
- Some people chew sugar-free gum after each meal. Chewing gum increases the flow of saliva. Saliva helps to flush the mouth to help clear any debris and acid remaining from the meal.
Some other general points
- Children should be taught good oral hygiene as young as possible.
- Have regular dental checks at intervals recommended by your dentist (this is normally at least once a year). A dentist can detect a build-up of plaque and remove calculus. Early or mild gingivitis can be detected and treated to prevent the more severe periodontitis. A dentist can also advise about special coating of children's teeth to help prevent tooth decay.
Oral hygiene, gum disease and heart disease
In addition to the benefits to your teeth, good mouth hygiene may have even further benefits. There is some evidence to suggest that poor oral hygiene is associated with an increased risk of developing heart diseases such as heart attack and angina, and other blood vessel-related problems (cardiovascular disease).
One research trial followed over 11,000 Scottish people. The trial found that those who reported poor oral hygiene (never or rarely brushed their teeth) had an increased risk of developing a cardiovascular disease. It is not clear if this is a direct cause and effect or simply an association or chance finding. That is, it is not proved that poor oral hygiene can actually increase your risk of cardiovascular disease. However, there is a plausible theory in that mild inflammation and infection in the mouth from gum disease can get into the bloodstream to trigger mild inflammation in the blood vessels which, over time, can lead to cardiovascular diseases.
Further research is needed to clarify this possible link. But, in the meantime, it may be an additional reason to look after your teeth and gums.
Further help and advice
See a dentist if you have a concern about your teeth or gums. The following may also be helpful:
British Dental Health Foundation
Helpline: 0845 063 1188 Web: www.dentalhealth.org.uk
Runs a helpline providing independent and impartial advice on all aspects of oral health.
Further reading & references
- Dental recall - Recall interval between routine dental examinations, NICE (2004)
- Gingivitis and periodontitis - plaque-associated, Clinical Knowledge Summaries (2007)
- Robinson PG, Deacon SA, Deery C, et al; Manual versus powered toothbrushing for oral health. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD002281.
- de Oliveira C, Watt R, Hamer M; Toothbrushing, inflammation, and risk of cardiovascular disease: results from BMJ. 2010 May 27;340:c2451. doi: 10.1136/bmj.c2451.
- Slot DE, Dorfer CE, Van der Weijden GA; The efficacy of interdental brushes on plaque and parameters of periodontal Int J Dent Hyg. 2008 Nov;6(4):253-64.
- Halitosis, Clinical Knowledge Summaries (January 2010)
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Tim Kenny