How can I Improve my Oral health and Oral Hygiene?


The interest and overall standard of oral hygiene in our developed or industrial societies has improved dramatically over the last 20-30 years and is still improving. Approved oral hygiene advice says that to improve oral health we need to brush very thoroughly once a day and a shorter clean for a second time using fluoride toothpaste. It is recommended to use a little paste, spit the paste without rinsing the mouth so that the fluoride stays in the mouth to cling to the tooth surfaces and harden them. The most important tooth cleaning advice is to clean the more difficult, tongue side, back teeth and work around each half circle at a time finishing on the outside not starting there and don’t use more that a small pea size of toothpaste.



Should I use a mouthwash?

People are asking about and buying mouthwash and it is seen by some as almost as much an essential as fluoride toothpaste, probably in response to TV and other advertising. If you wish, use a mouthwash with fluoride but not after brushing as it is the frequency of fluoride on the teeth that is most beneficial so don’t wash the paste away. It has not been shown to ‘freshen the breath’ for more than a very short time. A non-sugar chewing gum or mint probably works just as well. Indeed, some mouthwashes of the ‘antibacterial’ kind can combine with foods, staining the teeth.



What else should I do?

Whilst tooth brushing is an almost universal habit, usually learnt from family during childhood or adolescence the same level of improvement in gum health and oral health is not seen between the teeth, these are termed the interdental areas so cleaning needs to be directed into these areas between the teeth as they tend to be neglected.


Even though mouthwash and pastes are promoted as being effective in these areas there is little unbiased evidence that they make much impact on the plaque or biofilm-the living bacteria colonies between the teeth. In these areas cleaning with interdental brushes or floss can physically remove this biofilm. Although a good habit for adults this is not recommended for children as it is difficult and premature for a child to adopt as they are changing from baby to adult teeth from 6 years old. However in the adult cleaning between teeth is likely to be beneficial after the large Molars (back teeth) come through. The most diligent teeth cleaning with a toothbrush will not remove plaque from interdental areas and allow access to the fluoride toothpaste. In between the teeth there tends to be more gum disease or new decay than on the flat surfaces yet each daily teeth cleaning session for most adults is apparently directed to the front teeth, particularly in the uppers. Perhaps this should be re-thought?


Interdental cleaning should be done first without toothpaste and followed by tooth brushing with a fluoride paste (so as not to wear the roots) just once a day is sufficient to help control the growth of the biofilm of the two dental diseases in the adult, caries (decay) and periodontal (gum) diseases. As a tooth cleaning routine is leaned in childhood, in adult life it is a accepted as complex problem to change behaviour adding a somewhat difficult technique to the daily routine. Some time with the dedicated dental professional should be spent learning from them how and when to include this daily habit.



Why is this so difficult?

It is not surprising due to early habits that in many dental practices we see patients with a combination of toothbrush wear and sensitivity in some areas due to over enthusiastic tooth cleaning and heavy plaque on other teeth all in the same mouth!


Just as we clean between our toes we need to clean accumulations from between our teeth. It appears that the use of dental floss, tiny bottle brushes and sticks advised as interdental cleaning aids and as a preventive habit are probably effective but without professional help few people use them effectively and consistently but properly adopted have been shown to be of benefit. On first or infrequent use floss or brushes can stimulate short-lived bleeding every time they are used. If you persist for a few consecutive days then you should expect bleeding to cease, if not or if there is soreness or short-lived bleeding each time on use then professional advice and treatment should be sought.


There is less improvement to be expected in bleeding or reduction of pocket depths in the interdental areas of patients with established periodontal disease and bone loss and once again treatment is a necessity to control periodontal breakdown. Initial bleeding is not an indication that you are doing damage and should stop cleaning these areas, try for a few consecutive days and if there is still short-lived bleeding do not ignore it rather you seek more individual tuition and possible treatment. Oral hygiene is often taught by dental hygienists who have been especially trained in this field.


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