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Teeth

Taking good care of your teeth can be easier if you remember that each visit to the dentist is both super expensive and painful. So those 10 minutes each day are really worth it.

How to take care of your teeth⚑

TL;DR: Daily actions to keep your teeth healty

Oral hygiene is the practice of keeping one's mouth clean and free of disease and other problems (e.g. bad breath) by regular brushing of the teeth (dental hygiene) and cleaning between the teeth. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease and bad breath. The most common types of dental disease are tooth decay (cavities, dental caries) and gum diseases, including gingivitis, and periodontitis.

General guidelines suggest brushing twice a day: after breakfast and before going to bed, but ideally the mouth would be cleaned after every meal. Cleaning between the teeth is called interdental cleaning and is as important as tooth brushing. This is because a toothbrush cannot reach between the teeth and therefore only removes about 50% of plaque from the surface of the teeth. There are many tools to clean between the teeth, including floss and interdental brushes; it is up to each individual to choose which tool they prefer to use.

Over 80% of cavities occur inside fissures in teeth where brushing cannot reach food left trapped after eating and saliva and fluoride have no access to neutralize acid and remineralize demineralized teeth, unlike easy-to-clean parts of the tooth, where fewer cavities occur.

Teeth brushing⚑

Routine tooth brushing is the principal method of preventing many oral diseases, and perhaps the most important activity an individual can practice to reduce dental plaque and tartar.

The dental plaque contains a mixture of bacteria, their acids and sticky byproducts and food remnants. It forms naturally on teeth immediately after you've eaten but doesn't get nasty and start to cause damage to the teeth until it reaches a certain stage of maturity. The exact amount of time this takes isn't known but is at least more than 12 hours.

Bacteria consume sugar and, as a byproduct, produce acids which dissolve mineral out of the teeth, leaving microscopic holes we can't see. If the process isn't stopped and they aren't repaired, these can become big, visible cavities.

So controlling plaque reduces the risk of the individual suffering from plaque-associated diseases such as gingivitis, periodontitis, and caries.

Many oral health care professionals agree that tooth brushing should be done for a minimum of two minutes, and be practiced at least twice a day, but ideally after each meal.

Toothbrushing can only clean to a depth of about 1.5 mm inside the gingival pockets, but a sustained regime of plaque removal above the gum line can affect the ecology of the microbes below the gums and may reduce the number of pathogens in pockets up to 5 mm in depth.

Toothpaste (dentifrice) with fluoride, or alternatives such as nano-hydroxyapatite, is an important tool to readily use when tooth brushing. The fluoride (or alternatives) in the dentifrice is an important protective factor against caries, and an important supplement needed to remineralize already affected enamel. However, in terms of preventing gum disease, the use of toothpaste does not increase the effectiveness of the activity with respect to the amount of plaque removed. People use toothpaste with nano-hydroxyapatite instead of fluoride as it performs the same function, and some people believe fluoride in toothpaste is a neurotoxin.

For maximum benefit, use toothpaste with 1350-1500 ppmF (that's concentration of fluoride in parts per million) to prevent tooth decay.

At night, you produce less saliva than during the day. Because of this, your teeth have less protection from saliva and are more vulnerable to acid attacks. That's why it's important to remove food from your teeth before bed so plaque bacteria can't feast overnight. Don't eat or drink anything except water after brushing at night. This also gives fluoride the longest opportunity to work.

How to brush your teeth⚑

The procedure I'm using right now is:

  • Wet the brush but don't add any toothpaste.
  • Slowly and systematically guide the bristle of the electric brush from tooth to tooth, following the contour of the gums and their crowns, remembering to massage the gums. For example, start with the upper left part on the outside, reach the other side of your mouth, clean the bottom of your right side teeth, then go back on the inside of each teeth until you arrive to your left side. Try to avoid brushing with too much force as this can damage the surface of your teeth.
  • Rinse with water.
  • Place a pea sized amount of toothpaste on the brush and repeat the cycle.
  • Brush your tongue.
  • Spit the extra toothpaste but don't rinse or drink anything in the next 30 minutes.

The whole process should take at least two minutes.

Manual versus electric tooth brush⚑

If you want to use a manual one, Oral health professionals recommend the use of a tooth brush with a small head and soft bristles as they are most effective in removing plaque without damaging the gums.

The technique is crucial to the effectiveness of tooth brushing and disease prevention. Back and forth brushing is not effective in removing plaque at the gum line. Tooth brushing should employ a systematic approach, angle the bristles at a 45-degree angle towards the gums, and make small circular motions at that angle.

When using an electric one, the bristle head should be guided from tooth to tooth slowly, following the contour of the gums and crowns of the tooth. The motion of the toothbrush head removes the need to manually oscillate the brush or make circles.

Another study suggest that the effectiveness of electric toothbrushes at reducing plaque formation and gingivitis is superior to conventional manual toothbrushes.

Regardless of the type, you are always best using a soft-bristled toothbrush with a small head and a flexible neck because this will most effectively remove plaque and debris from your teeth, without damaging your teeth and gums and drawing blood.

Toothbrush replacement⚑

Remember to replace your brush at the first sign of wear-and-tear or every three months, whichever comes first. Frayed or broken bristles won't clean your mouth properly. Change your toothbrush once the bristles lose their flexibility. 1

Also, after a couple of months of daily use, bacteria and food particles begin to accumulate on the toothbrush.

To rinse or not to rinse⚑

There is a lot of controversy on the topic on whether you should rinse or not your mouth after brushing your teeth. (1, 2)

People in favor of rinsing your mouth argue that:

  • You’ll get rid of the excess toothpaste along with any food or bacteria that could have been stuck in your teeth or released by the brushing itself.
  • You’ll also be removing the fluoride from your mouth, which if swallowed, might upset your stomach.

People against rinsing your mouth argue that:

  • When you rinse with water, you’re potentially washing away any remnants of toothpaste, including the fluoride that makes it work. That could mean that even though you are brushing your teeth, it might not be as effective as it should be.

Whilst there have been studies on the effectiveness of rinsing, the results only indicate that there COULD be an advantage of one over the other. So it's up to you to evaluate the advantages and disadvantages of each method.

Some people are prone to cavities, or might have poor dental health. If your teeth chip, crack or break easily, it’s strongly recommended that you don't rinse after you brush. Similarly, if you consume a lot of sugar, you should probably avoid rinsing. If you don't fit into these categories, then it’s really based on your own preference.

Keep your brush away from your feces⚑

As the Mythbusters showed, Fecal coliform were found on toothbrushes stored at the bathroom. And even though none were of a level high enough to be dangerous, and experts confirm that such bacteria are impossible to completely avoid, you can reduce the risk by:

  • Storing the brush in a cupboard or in other room.
  • Putting a lid on your toothbrush
  • Closing the lid on your toilet seat before flushing.

How to floss⚑

Tooth brushing alone will not remove plaque from all surfaces of the tooth as 40% of the surfaces are interdental. One technique that can be used to access these areas is dental floss. When the proper technique is used, flossing can remove plaque and food particles from between the teeth and below the gums. The American Dental Association (ADA) reports that up to 80% of plaque may be removed by this method. The ADA recommends cleaning between the teeth as part of one's daily oral hygiene regime, with a different piece of floss at each flossing session.

The correct technique to ensure maximum plaque removal is as follows: (1, 2)

  • Floss length: 15–25 cm wrapped around middle fingers.
  • For upper teeth grasp the floss with thumb and index finger, for lower teeth with both index fingers. Ensure that a length of roughly 2.5cm is left between the fingers.
  • Ease the floss gently between the teeth using a back and forth motion. Do not snap the floss into the gums.
  • When the floss reaches your gumline, curve it into a C-shape against a tooth until you feel resistance.
  • Hold the floss against the tooth. Gently scrape the side of the tooth, moving the floss away from the gum. Repeat on the other side of the gap, along the side of the next tooth.
  • Do not forget the back of your last tooth.
  • Ensure that the floss is taken below the gum margins using a back and forth up and down motion.

You should floss before brushing your teeth because any food, plaque, and bacteria released by flossing are removed by the afterwards brushing.

Another tips regarding flossing are:

  • Skip the toothpick: Use floss instead of a toothpick to remove food stuck in between your teeth. Using a toothpick can damage your gums and lead to an infection.
  • Be gentle: Don't be too aggressive when flossing to avoid bleeding gums.

When you first start flossing, your gums may be tender and bleed a little. Carry on flossing your teeth and the bleeding should stop as your gums become healthier. If you're still getting regular bleeding after a few days, see your dental team. They can check if you're flossing correctly.

Mouth washing⚑

Using a mouthwash that contains fluoride can help prevent tooth decay, but don't use mouthwash (even a fluoride one) straight after brushing your teeth or it'll wash away the concentrated fluoride in the toothpaste left on your teeth. [1]

Choose a different time to use mouthwash, such as after lunch. And remember not to eat or drink for 30 minutes after using a fluoride mouthwash.

Do yearly check ups⚑

First find a dentist that you trust, until you do, search for second and third options before diving into anything you may regret.

Once you have it, yearly go to their dreaded places so they can:

References⚑