Oral Hygiene
Looking after your teeth and gums

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).

• 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 by a dentist or dental hygienist with special instruments.
• Caries (tooth decay) 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) 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 are 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.)

Routine oral hygiene

It is important to get into a regular habit of good oral hygiene. The most important are to brush and floss your teeth every day.

Tooth brushing
Brush your teeth at least twice a day. Use a soft-tufted brush. 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 (inside, outside, and biting areas of each tooth). Pay particular attention to where the teeth meet the gums. Get a new toothbrush every 3-4 months. Many people find that an electric toothbrush does a better job and so they have become popular.

It is usually advised that you should use a toothpaste that contains fluoride. (The fluoride helps to prevent tooth decay.)

Flossing
Floss your teeth at least once a day after brushing, and preferably twice a day. (Some people who have not flossed before are surprised as to how much extra debris can be removed by flossing in addition to brushing.) If you are not sure how to floss, then ask your dentist or dental hygienist. Briefly: the 'usual' floss looks a bit like cotton thread. Cut off about 40cm. 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. This will clean the narrow spaces between the teeth which toothbrushes cannot get to. Use a fresh piece of floss each time.

Some people prefer floss 'tape' which may slide between the teeth more easily than normal floss. Also, some people use disposable plastic 'forks' with a small length of floss between the two prongs. The plastic fork may be easier to hold and manipulate. However, they are more expensive than a roll of floss.

The gums may bleed a little when you first begin to floss. This should settle within a few days. If it persists then see a dentist as regular bleeding after brushing or flossing teeth may indicate early gum disease.

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.
• Eat a well balanced healthy diet. In particular, you should limit the amount of sugary foods and drinks that you have. Sugars and sugary foods in the mouth are the main foods that bacteria thrive on to make acid which can contribute to tooth decay.
• 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 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.

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 free helpline providing independent and impartial advice on all aspects of oral health.

References

1. Gingivitis and periodontitis - plaque-associated Prodigy Guidance 2005

© EMIS and PIP 2007   Updated: February 2007   PRODIGY Validated