WORDS Hannah May-Lee Wong

World Oral Health Day falls on March 20^th every year. The global awareness day highlights the importance of keeping good oral hygiene and reminds us that oral health comprises a big part of every individual’s wellbeing. Yearly, the World Dental Federation (FDI) focuses on a specific theme and this year, it’s “Say Ahh: Act on Mouth Health”. The campaign aims to encourage everyone to walk the talk, and actively take measures to improve their oral health.

Anyone remember the Academy Award winning movie Cast Away (2000) starring Tom Hanks? It talks about a FedEx employee who was on-board a plane that crashed into the sea. Although he survived, he was “cast away” to an uninhabited island. Before he got on the ill-fated plane, he was suffering a bad toothache and kept putting off going to the dentist to get it checked. As a result, he was left on an island with no dentist and was forced to extract his tooth himself (ouch!). Let’s not be that character. We don’t have to wait for a toothache to pay our dentists a visit. Beyond that, we should also diligently care for our teeth and encourage our children to do the same.

This World Oral Health Day, HealthToday chats with friendly local dentist, Dr Lau Lake Koon, as he graciously answers a series of frequently asked questions:

We’re curious to know, how would you as a dentist define good oral health?

The human mouth, just like the gut and other parts of the body, contains good and bad bacteria. A balance of these good and bad bacteria maintains healthy functioning of the body. Good oral health to me is defined by maintaining an optimum number of good bacteria against bad bacteria in the mouth. This can only be attained through practicing good oral hygiene, having a healthy diet and having a healthy body.

Your dentist, through your regular check-ups, should be able to identify any dental issues that may exist, treat them and educate you on how to care for your teeth. That said, it is important that you as a patient consistently practice good oral hygiene and carry out whatever that was prescribed to you by your dentist. Frequent visits to the dentist will catch existing problems in the early stages. This is a good thing because as the saying goes, prevention is better than cure.

We often hear dental experts telling us we don’t brush our teeth long enough for us to get a good clean. How long should we brush our teeth for, and how often?

Brushing your teeth, the proper way for approximately two minutes each time should be enough to keep the teeth clean. There are many ways of brushing your teeth and your dentist will show you what’s best for you. Generally, I recommend brushing with the Bass technique, which includes brushing under the gumline with the toothbrush at a 45-degree tilt.¹ That said, I rarely advise my patients to brush for longer. In fact, the more common problems I see daily arise from:

1. Not flossing
2. Not brushing at night before sleeping
3. Not brushing correctly

It is during our sleep that our mouths have a warm, stable environment that goes uninterrupted for hours. This kind of environment is most suitable for bacterial growth. If there are food debris and bacteria in the mouth, bacteria will grow exponentially. This can increase the risk of developing cavities and the formation of tartar (plaque that stays and hardens on your teeth) which leads to gum disease.²

The most important advice I give to patients is to brush their teeth at night, right before sleeping. It’s a simple procedure that will go a long way in keeping teeth healthy. It is recommended to brush twice a day: in the morning and at night before sleeping.

Are electric toothbrushes better than normal toothbrushes?

With the advent of stronger formulated toothpaste brands, more awareness on oral care, better oral care techniques and better designed toothbrushes, it is not necessary to use an electric toothbrush.

In my practice, there are two extreme groups of patients:

The first group consists of those who do not take care of their teeth at all and require lots of education to change their habits. In these cases, I would need to resolve all their dental issues, restore dental functioning and aesthetic, and rehabilitate the patient, for them to take care of their teeth effectively in the future. This group would benefit from using an electric toothbrush.

The second group consists of those who are experts in their oral care regime. They use the latest electric toothbrushes despite not really needing them. In some cases, the over-brushing can cause the tooth enamel (the hard, outer layer of the teeth) to be worn out and cause sensitive teeth. These people should stop using electric toothbrushes.

In summary, electric toothbrushes should be reserved for those who are unable to care for their teeth (for example, those with Parkinson’s disease or are handicapped), those with very bad dental conditions or those who have severe stains from smoking or drinking tea, coffee or wine. In most cases, a normal toothbrush is more than enough to keep your teeth clean. It is important to check with your dentist what’s most suitable for you.

How often should we pay our dentists a visit?

It is recommended that a person with no outstanding dental issues visits the dentist every 6 months.

Cavities and gum disease are quite common among us. What causes them and how do we prevent them?

Cavities are mostly caused by taking sweet food or drinks. But one must understand, it is the frequency or exposure time to the sweet items, and not the amount consumed, that causes cavities.

For example, a person who drinks two cups of coffee in 15 minutes every morning will have much less incidences of dental caries (tooth decay) compared to a person who drinks one cup of coffee over a four-hour period every morning.

Gum disease is caused by a gradual build-up of plaque and tartar on the tooth surfaces. If these are left long enough, it causes gum infection. Gum bleeding is a sign of gum infection. This is also the main cause of gum recession and shaky teeth in one’s old age.

Why do some people have sensitive teeth and what are the best ways of dealing with it?

Besides over-brushing with an electric toothbrush or using overly strong formulated toothpaste, gum recession (from gum disease) and cavities can also cause sensitivity. The best thing to do is to make an appointment for a dental check-up as soon as possible.

Let’s talk about teeth whitening. Do whitening toothpastes work? What is the most effective way of whitening our teeth to look good?

Whitening toothpaste is an example of stronger formulated toothpaste brands. They contain higher levels of abrasive particles. They are more effective in removing stains and debris on the teeth. However, on a clean tooth surface, whitening toothpastes will not make teeth get whiter. On a stained and dirty tooth, whitening toothpastes will be more effective in removing the stains, thus the teeth look cleaner — NOT whiter.

Professional whitening done by dentists use approved chemicals with or without laser and they do not cause long-term side effects. These whiten the teeth beyond their original colour.

What can we do to avoid bad breath?

Most bad breath is caused by ineffective brushing techniques, not flossing, not brushing the tongue and indigestion issues. If the mouth still harbours large numbers of bacteria or rotting foodstuff, it will smell.

How about food? Is staying away from sugary food really the key to having good teeth?

Everything is about moderation. As I tell my patients, you must enjoy your life! But how you enjoy your cup of coffee or wine is important. Finish your coffee within 20 mins to reduce exposure time. Try to limit yourselves to a max of 2 sweet drinks a day, preferably during meal times so that your teeth can recover in-between meals. After a night of having wine, remember to brush your teeth before sleeping — don’t let the strong wine stains linger and bind onto the teeth surfaces. Overall, if you take care of your teeth, you can enjoy them for a much longer time.

How about caring for children’s teeth? Is it different from an adult’s oral hygiene routine?

It is important to instil good oral hygiene habits from young. I often start coaching parents about oral care for children, even before the baby is born. My advice:

After birth: It is important to gently wipe your baby’s gums with a clean wet cloth after every milk feeding.

6 months: The first front teeth will appear when the baby is approximately 6 months old. You should continue wiping with a clean wet cloth until the age of 1 to 1.5 years old. Make sure your children understand that they must have their teeth cleaned by their parents before sleeping every night and upon waking up every morning.

1.5 to 2 years old: Parents can start using small baby toothbrushes to brush their children’s teeth. Parents should brush for their children first, then let their children practice brushing after. This should go on until the child is 7 years of age. After that, continuous supervision should be sufficient. Non-fluoride toothpaste brands should be used until the child does not swallow toothpaste anymore (usually by 7 years of age). Parents should bring their children for dental check-ups every six months, as there are many changes happening in a growing child’s teeth.

References:

1. https://www.colgate.com/en-us/oral-health/basics/brushing-and-flossing/3-tooth-brushing-techniques-that-get-the-job-done
2. https://www.webmd.com/oral-health/guide/tartar-dental-calculus-overview#1

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