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Oral Hygiene – Tooth and Gum Care

“Achieving and maintaining oral health requires individual action, complemented by professional care… daily oral hygiene practices such as brushing and flossing can prevent both caries and gingivitis.” – U.S. Surgeon General’s Report

  1. What is Oral Hygiene and Plaque?
  2. What is dental plaque, calculus or tartar?
  3. Can diet influence plaque formation?
  4. Why is oral hygiene important?
  5. What is the best way to control dental plaque?
  6. What are the different methods for brushing teeth?
  7. How will disclosing tablets indicate that I have dental plaque on my teeth?
  8. Why is it important to use dental floss?
  9. What other helpful aids are there to improve oral hygiene?
  10. What kind of toothbrush should I use?
  11. What kind of toothpaste and mouthwash should I be using?

1. What is Oral Hygiene and Plaque?

  • Oral hygiene refers to keeping the mouth, and particularly the teeth, clean and free of dental plaque.
  • “Daily oral hygiene practices such as brushing and flossing can prevent both caries and gingivitis.”
  • The above should be combined with a daily flouride mouthwash.
  • You are also advised to see your dentist twice a year for professional cleaning.
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Healthy teeth,
gum and bone

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2. What is dental plaque, calculus or tartar?

  • Dental plaque is a thin coating of bacteria and food particles that stick to teeth.
    • Plaque cannot be rinsed off, but can be removed by brushing and flossing.
    • Dental plaque is formed when the bacteria that normally live in our mouths are allowed to accumulate on, and stick to the teeth.
    • Plaque converts dietary sugars to acid.
    • The acid dissolves the tooth material and causes tooth decay.
  • Plaque calcifies and hardens to become calculus or tartar.
    • These hardened deposits can only be removed by the dentist or hygienist, as brushing cannot do so.
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Gum disease

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3. Can diet influence plaque formation?

  • Soft, mushy foods that are rich in refined carbohydrates (sugars) assist the formation of plaque and tartar.
  • Avoid foods and drinks that have added sugar, such as soft drinks, sweets, biscuits and cakes.
  • Reducing carbohydrate intake helps to control plaque formation.
  • This will also lessen the probability of peridontal disease and dental decay.

See Diet and Decay

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4. Why is oral hygiene important?

  • The practise of oral hygiene is important because it prevents the build up of dental plaque. Plaque causes the two most common diseases found in the mouth, dental decay and gum disease.
  • The longer dental plaque is permitted to stick to he teeth, the greater is the risk of dental disease.
  • To prevent and treat these diseases, dental plaque must be removed every day, by thorough brushing and flossing.

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5. What is the best way to control dental plaque?

  • Brushing and flossing will control plaque formation.
  • Brush and floss twice a day, after breakfast and before bedtime.
  • Rinse daily with a fluoride mouthwash.
  • Eating less refined sugar will reduce plaque formation.

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6. What are the different methods for brushing teeth?

  • We recommend two methods for brushing teeth. They both use the same angled position of the brush:
    Place the brush at a 45-degree angle towards the junction of the tooth and the gum. This is the position for brushing the sides of the teeth.
  • One suggested method is to brush gently in a circular movement.
  • Another technique is known as the gentle scrub method.
    • The brush is moved backwards and forwards horizontally in very short strokes.
    • Each stroke is no more than the width of one tooth.
    • Brush all the tooth surfaces of all the teeth.
    • Brush behind the front teeth with an up and down movement using the end of the brush.
    • Brushing should be unhurried and thorough.
  • Partial dentures should be removed for the efficient brushing of the remaining teeth.
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Toothbrush position

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7. How will disclosing tablets indicate that I have dental plaque on my teeth?

  • Run your tongue over the surfaces of your teeth.
  • Dental plaque feels rough. Clean tooth surfaces feel smooth.
  • The use of disclosing tablets will let you see the plaque on your teeth.
    • Special disclosing tablets can be bought at a pharmacy or drug store.
    • These stain the plaque a bright pink colour, and show where more brushing is needed.
    • If your brushing has been thorough, little or no stained dental plaque will be seen.
    • If your teeth are not clean, the pink stain will show where more brushing is needed.
    • Disclosing tablets or solutions should be an integral part of tooth cleaning.
    • They can confirm how efficiently the teeth are being cleaned.
    • The example below shows how plaque is stained by the tablets.
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After disclosing tablets
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After further brushing

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8. Why is it important to use dental floss?

  • Dental floss is the best way to clean the tooth surfaces between the teeth.
  • Different types of floss are available, such as regular floss, dental tape and superfloss.
  • Floss is also available on a plastic holder, in the shape of a bow. It forms “the string of the bow” and it makes flossing very manageable.
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    Dental tape
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    Regular floss
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    Floss holders
  • Here are a few tips for flossing as demonstrated below:
    • Use a 12-15inch (30-40cm.) length of floss.
    • Wrap the floss around your middle fingers.
    • Hold the floss between the thumb and forefinger of each hand.
    • Leave about 2 inches (5cm) of floss between the hands.
    • The floss must be taut when it is used.
    • Gently guide the floss across the contact point between the teeth.
    • When the floss is in position between the teeth, curve it tightly against one tooth surface and rub it up and down a few times.
    • Each stroke should be from just under the gum to the contact point between the teeth.
    • Repeat this for each tooth surface between all the teeth.
    • The floss holders shown above are easy to use, if you have difficulty using the conventional floss.
    • Be careful not to cut your gums with the floss. <!–
    • Care must be taken prevent bleeding caused by the floss cutting into the gum. –>
    • A sharp downward thrust of the floss will damage the gum and make it bleed.
    • Your dentist will be happy to show you how to floss, and choose which floss is best for you.
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Floss on hands
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Floss up
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Floss down

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9. What other helpful aids are there to improve oral hygiene?

There are many dental hygiene products available. We describe and show them below:

  • Interdental (interproximal) brushes
    • These are triangular shaped small brushes, like little bottlebrushes.
    • They are very useful for cleaning between the teeth.
    • They fit onto a plastic handle, and are available in varying sizes.
    • Select the size of brush that is best suited to you.
    • Gently push the brush back and forth into the spaces between the teeth.
    • This interdental brush is best suited to teeth that have spaces between them, caused by gum recession, or following gum treatment.
    • Some degree of gum recession is seen in most mouths by middle age, and in those with gum disease, at any age.
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    Interdental brushes
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    Interdental brushing
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    Interdental brushing
  • End or single tuft toothbrushes
    • These are toothbrushes with only one tuft of bristles.
    • They are used where the normal, multi-tufted toothbrushes cannot reach.
    • These brushes are designed for brushing around crowns, bridges, displaced and rotated teeth.
    • Gum recession creates spaces between the teeth that need to be kept free of food and plaque.
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    End tuft brush
  • Interdental picks or sticks
    • These are specially designed soft wooden wedges for cleaning between teeth. They can be used after meals or at any time.
    • The end of the stick should be moistened and softened in the mouth before use.
    • Gently insert the stick between the teeth, with the flat edge facing the gum.
    • Then move it in and out gently to clean the teeth and massage the gums.
    • Food trapped between the teeth can be removed with these sticks.
    • They are effective for mouths where receding gums have left spaces between teeth.
    • The sticks should only be used where there is sufficient space to allow the free movement of the stick between the teeth. Do not force them into position.
    • They should not be used if they cause any bleeding.
    • They are not suitable for children.
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    Interdental sticks
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    Stick in use
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    Stick in use
  • Interdental rubber tip stimulators
    • These are pointed rubber tips that are fitted to a handle.
    • They are used to stimulate and toughen up the triangular soft gum between teeth.
    • Your dentist or periodontist will tell you if you need them.
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    Rubber tip stimulator
  • Tongue cleaners
    • The tongue should also be cleaned to remove bacteria from the surface.
    • Special tongue cleaners are available.
    • Tongue cleaners are recommended for scraping the surface of the tongue, where bacteria can convert food remnants into bad smelling sulphur gases.
    • Tongue cleaning is a method of removing food particles, white or coloured coatings and bacteria, from the tongue’s surface.
    • A post-nasal drip and a cold can cause coating of the surface of the tongue. The coating may be quite thick and may cause halitosis.
    • They are easy to use and come in sizes for adults and children.
    • Tongue cleaners are available from pharmacies or drug stores.
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    Tongue cleaners
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    Tongue cleaning
  • Pulsating water or medicament spraying devices
    • Irrigating devices provide a steady or pulsating stream of water under pressure through a nozzle.
    • They are especially useful in mouths with fixed bridges, and for cleaning between teeth.
    • They should not be used as a substitute for toothbrushing.
    • Speak to your dentist before you buy one.

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10. What kind of toothbrush should I use?

  • Here are the characteristics of a good toothbrush:
    • The toothbrush should have a head that is small enough and correctly angled to reach all the teeth.
    • A toothbrush should be multi-tufted, and have a medium/soft texture.
    • Hard bristles can damage teeth and gums, and are not recommended.
    • The bristles should be made of nylon, and their ends need to be rounded.
    • Bristles made from synthetic rather than natural materials, are preferable for hygienic reasons. Natural bristles may be porous and likely to absorb bacteria.
  • Electric and ultrasonic toothbrushing methods are very effective for plaque control. Electric toothbrushes are becoming popular.
    Consult your dentist and follow the manufacturer’s instructions.
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Toothbrush bristles
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See Toothbrushes for detailed information

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11. What kind of toothpaste and mouthwash should I be using?

  • A large variety of toothpastes and mouthwashes are available to choose from. The inclusion of fluoride is most important:
  • Most modern toothpastes contain flouride to prevent decay, and are recommended.
    • Toothpastes and mouthwashes that contain fluoride claim to strengthen teeth and reduce decay by up to 40%.
    • Fluoride is also alleged to reduce the amount of acid produced by bacteria in the mouth.
    • Sensitivity to hot and cold can be relieved by toothpastes containing de-sensitising agents.
    • Whitening toothpastes are now becoming popular for teeth that have darkened in colour.
    • All toothpastes and mouthwashes have breath freshening properties.
    • There are many toothpastes to choose from. Some of the ingredients may differ, but most appear to work well.
  • Rinsing daily with a fluoride mouthwash will increase the beneficial effect of a fluoride toothpaste on teeth.
    • Other over the counter mouthwashes, containing different chemicals, are also available. They serve many purposes.
    • Ask your dentist which toothpaste and mouthwash is recommended.

See Toothpaste and Mouthwash sections for more details.

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12. Can dental plaque be controlled with a chemical mouthwash?

  • Mouthwashes that contain chemicals like chlorohexidene are used to control the formation of dental plaque.
    This type of mouthwash can also been used to treat gingivitis.
  • These mouthwashes should be discussed with your dentist, as there may be some drawbacks to their long-term use.
  • Flouride mouthwashes form part of the daily oral hygiene routine and do keep plaque at bay. They are safe for adults, but not for children before they know that that the mouthwash is for rinsing only, and not to be swallowed.

See Mouthwashes

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