A Prosthodontist Answers All Your Questions About the Right Way to Brush Your Teeth

WORDS DR ZETHY HANUM MOHAMED KASSIM

FEATURED EXPERT
DR ZETHY HANUM MOHAMED KASSIM
Senior Lecturer and Prosthodontist
Faculty of Dentistry
Universiti Teknologi MARA (UiTM)

The health of your teeth and their supporting structures can be compromised by decay.

Indeed, tooth decay affects an estimated 2 billion adults and 514 million children worldwide, while gum disease affects 19% of the world population.

The following are answers to some common questions commonly received by dentists, related to the maintenance of healthy teeth and gums.

WHAT ARE THE CAUSES OF DENTAL DISEASES?

The main culprit is plaque.

Plaque is a sticky white substance found on the surface of a tooth. It contains bacteria, proteins, bacterial by-products, and food debris.

Tooth decay

Bacteria in plaque ferment sugar into lactic acid, the latter can cause the tooth to lose important protective minerals via a process called demineralization. Over time, this process will lead to tooth decay.

Gum disease

The presence of bacterial products can also trigger an overt response from your immune system. This could result in gum disease that, if left untreated, will eventually cause the destruction of the ligaments and bony socket that keep the affected tooth in place.

Tooth loss

Over time, when left untreated, both gum disease and tooth decay can lead to the loss of teeth.

WHY IS TOOTHBRUSHING IMPORTANT?

The act of brushing your teeth can disrupt plaque that is present on the surfaces of your teeth.

This will thus help to prevent tooth decay and gum disease.

HOW OFTEN SHOULD I BRUSH MY TEETH?

Currently, evidence suggests that how often you brush your teeth does not greatly affect your chances of developing tooth decay.

However, it is commonly accepted that you should brush your teeth at least twice a day—after meals and before going to bed.

SHOULD I USE A MANUAL TOOTHBRUSH OR A POWERED TOOTHBRUSH?

Both can be used, but research found that powered toothbrush—also known as electric toothbrush—is more effective in removing plaque (65% compared to 41% using a manual toothbrush).

HOW LONG SHOULD I BRUSH MY TEETH?

2 minutes is the recommended duration for effective plaque removal.

HOW SHOULD I BRUSH MY TEETH?

Use the modified Bass technique. Click on the image below for a larger, clearer version.

  1. Angle your toothbrush at 45° to your gum margin.
  2. Brush gently using a short circular scrubbing motion.
  3. Sweep your toothbrush toward the occlusion surface of the teeth.
  4. Do steps 2 and 3 for the top, outer, and inner surfaces of all your teeth.
  5. Clean your tongue as well in the same short circular scrubbing motion.

Compared to the horizontal scrub method—you drag the toothbrush across your teeth in a horizontal right and left manner—this is a preferred method for effective plaque removal while reducing the incidence of gum recession.

HOW DO I CHOOSE MY TOOTHBRUSH?

Evidence points to toothbrushes with angled bristle tufts being more effective when compared to flat-trimmed or multi-level bristles.

The stiffness of the toothbrush bristles can affect the effectiveness of plaque removal. However, stiffer bristles may lead to more gum recession overtime. Therefore, most dentists would recommend the use of toothbrushes with soft bristles.

SHOULD I PRACTICE INTERDENTAL CLEANING?

Interdental cleaning refers to the cleaning of the areas between the teeth to remove food particles and plaque that are ‘caught’ in those areas.

Toothbrushing alone cannot reach those areas, hence interdental cleaning aids have been introduced for such a purpose.

Interdental cleaning aids

Evidence suggests that the use of interdental toothbrushes and flosses leads to more consistent plaque removal and a reduction in gum inflammation, compared to the use of oral irrigators and wooden or rubber sticks.

When it comes to gaps between teeth, the use of interdental toothbrushes, which are available in various sizes, would be more effective compared to floss.

HOW DO I CHOOSE MY TOOTHPASTE?

Toothpaste must contain fluoride with a minimum of 1,000 parts per million (PPM).

Fluoride helps to mineralize teeth, which is important to help prevent tooth decay.

This substance is usually present in toothpastes in the form of sodium fluoride and sodium monoflourophosphate, so if you are unsure, you can check the package of the toothpaste for the presence of these active ingredients.

OTHER BENEFICIAL ACTIVE INGREDIENTS TO LOOK OUT FOR IN A TOOTHPASTE
  • Stannous fluoride, effective for the reduction of gum disease.
  • Nano-hydroxyapatite and arginine to help reduce dentine hypersensitivity.
  • Hydrogen peroxide and blue covarin colorant produce the best tooth whitening with continued use.
  • Abrasives such as silica, alumina, and calcium carbonate to remove stains. Those with a value below a unit of 250 radioactive dentine abrasion (RDA) are considered safe to prevent progressive tooth surface abrasion.
HOW MUCH TOOTHPASTE SHOULD I USE?

When using regular strength fluoride toothpaste (1,350 to 1,500 PPM), a pea-sized amount is recommended for all individuals and children aged 2 years and above.

A smear is recommended for children under the age of 2, as these children are more likely to swallow their toothpaste—something that can increase their risk of developing mottled teeth or fluorosis.

Fluorosis is caused by ingestion of large amounts of fluoride by children before eruption of their permanent teeth. A common sign of fluorosis is tooth discolouration.
SHOULD I USE MOUTH RINSES?

Mouth rinses may be useful to increase the availability of fluoride for individuals 8 years and older who experience difficulties in brushing their teeth. For example, children that wear braces.

Mouth rinses with active ingredients such as chlorhexidine, acetyl pyridinium chloride, and essential oils may be useful to prevent gum disease.

To improve their effectiveness, mouth rinses should be used at different times from toothbrushing.

Oral Health Tips From a Dentist for People With Diabetes

WORDS DR LAU LAKE KOON

FEATURED EXPERT
DR LAU LAKE KOON
Dentist
Koks Dental Surgery

Most people with diabetes or those that have someone close to them that have this disease will know that the disease can harm many organs in the body—such as the eyes, nerves, kidneys, heart, and more.

DO YOU KNOW THAT DIABETES CAN AFFECT THE TEETH AND GUMS AS WELL?

People with diabetes are more likely to have:

  • Periodontal or gum disease
  • Persistent bad breath
  • Tooth decay or cavities
  • Oral fungal infections
  • Oral ulcers
  • Loss of teeth
Diabetes can cause increased levels of glucose in the blood as well as saliva
Progression of gum disease, from gingivitis to the more serious periodontitis. Click on the image to view a larger, clearer version.

The increase of glucose in the saliva encourages the growth of bacteria in the mouth and together with food particles can build soft sticky whitish layer called plaque.

Plaque is the yucky smelly stuff that you can scrape off from your teeth if you haven’t been cleaning them properly. It is the main cause of bad breath.

If left unchecked, the persistent plaque buildup can cause tooth decay and harden to form tartar.

Persistent plaque or tartar buildup causes irritation to the gums

The gums can become red and swollen, and bleeding may occur.

This is the first warning sign that it’s time to visit the dentist.

Comparison of normal tooth and a tooth with periodontitis. Click on the image for a larger, clearer version.

Otherwise, the infection will go deeper under the gums, causing infection of the bone structure supporting the teeth. This is periodontitis, the second stage of gum disease.

The gums will start to recede, trying to pull away from the tartar formed. Over time the teeth will become unstable, and one may experience pain as a result.

At the final stage of gum disease, the teeth will become so infected and painful that it may need to be removed

In poorly controlled diabetic cases, the gum disease may progress much faster. The severity of the condition may be worse, which is why it is important to visit the dentist early to resolve the issues.

Diabetes and certain drugs can reduce the production of saliva in our mouth

Our saliva contains minerals to protect our teeth from tooth decay, mucin to keep the teeth moist and slippery, antibacterial substances to eliminate potentially harmful bacteria, and it also has the ability to neutralize the acids produced by bacteria in our mouth.

Without the presence of saliva, there is a higher risk of tooth decay and gum disease.

Dry mouth can increase the risk of developing fungal infections called thrush, which are painful white patches in the mouth.

In denture wearers, the dryness can decrease the suction effect of the denture and increase abrasion against the gums, leading to ulcers and mouth sores.

Smoking will worsen the condition further.

In severe uncontrolled diabetic cases, some people can develop burning mouth syndrome—a continuous burning sensation in the mouth that will alter taste and sensation.

HOW THE DENTIST CAN HELP YOU
Gingivitis or periodontitis

The dentist will need to carry out deep cleaning of the teeth and gums, in order to decrease the bacterial load and to allow the gums to heal.

However, the dentist can only do so much—you have to also keep good oral hygiene and use of mouthwash daily.

Fungal infections

Your dentist may prescribe some medications to kill the fungus responsible for the infection.

If you use dentures, they will be checked to ensure that they are still fitting properly. You must keep them clean in a disinfection solution at night.

Dry mouth

For most non-severe cases, the simplest solution is to keep your body well hydrated at all times. Drinking water regularly also moistens the mouth.

Only in severe cases are saliva substitutes prescribed.

Burning mouth syndrome is usually more complicated and will require specialist attention.

HELPFUL TIPS
  • A well controlled blood glucose level as well as a healthy diet and lifestyle are key to reducing and preventing oral health problems. Keeping your mouth healthy will also prevent diabetes-related health problems such as heart disease and kidney disease.
  • Good oral hygiene will keep your gums and teeth healthy. Brushing twice a day every day, and use a floss or water floss daily.
  • Visit your dentist regularly for a routine checkup. Please make sure you tell your dentist if you have diabetes. Keep your dentist updated about any changes to your health and blood sugar levels.
  • For denture wearers, make sure your dentures fit properly, and clean them by soaking them in denture disinfectant at night.
  • Quit smoking. Smoking will worsen gum condition and overall health.