Oral Hygiene

Oral hygiene is keeping the mouth clean. Oral hygiene is considered to be the best means of prevention of cavities(dental caries), gingivitis, periodontitis, and other dental disorders. It also helps to prevent bad breath (halitosis). Oral hygiene is necessary for all persons to maintain the health of their teeth and mouth. Healthy teeth have fewer cavities. They are clean and have minimal or no plaque deposits. Healthy gums are pink and firm.

Oral hygiene consists of both personal and professional care. Dental X-rays may be performed as part of routine professional examinations.

Personal care

Careful and frequent tooth brushing and flossing help to prevent build-up of plaque and calculus (tartar), which can lead to cavities. Cavities can be costly, in terms of the monetary cost to drill out the cavities and insert dental fillings, and in terms of the tissue already damaged.

The teeth should be brushed at least twice daily, preferably after every meal and at bedtime, and flossed at least once per day, preferably at night before you brush and go to sleep. For some people, flossing might be recommended after every meal. A dentist or dental hygienist can instruct and demonstrate proper brushing and flossing techniques.

Special appliances or tools may be recommended to supplement (but not to replace) tooth brushing and flossing. These include special toothpicks, water irrigation, or other devices. Initially electric toothbrushes were only recommended for persons who have problems with strength or dexterity of their hands, but many dentists are now recommending them too many other patients in order to improve their home dental care. In many parts of the world natural toothbrushes are used. In the Muslim world the Miswak or siwak is made from twigs or roots that are alleged to have an antiseptic effect when applied as a toothbrush.

Fluoride-containing, or anti-plaque (tartar control) toothpastes or mouthwashes may be recommended by the dentist or dental hygienist.

Dentures, retainers, and other appliances must be kept extremely clean. This includes regular brushing and may include soaking them in a cleansing solution.

Professional care

Regular tooth cleaning by the dentist or dental hygienist is important to remove plaque that may develop even with careful brushing and flossing, especially in areas that are difficult for a patient to reach on his own at home. Professional cleaning includes tooth scaling and tooth polishing and Debridement if too much tartar has accumulated. This involves the use of various instruments or devices to loosen and remove deposits from the teeth.

Many dentists recommend having the teeth professionally cleaned every six months. More frequent cleaning and examination may be necessary during the treatment of many of the dental/oral disorders. Routine examination of the teeth is recommended at least every year. This may include yearly, select dental X-rays. See also dental plaque identification procedure and removal.


Good oral hygiene prevents, and is vital to the treatment of, many of the dental and oral disorders. Good oral hygiene results in healthy teeth and mouth.


Usually there are no complications; however, overly vigorous or improperly performed brushing and flossing may result in injury to the gingiva (gums).

Call the dentist or dental hygienist if instructions or demonstration of proper brushing or flossing techniques is needed, or to schedule routine dental cleaning and examination.


The importance of brushing: 
The single best way to remove harmful plaque -- a thin, sticky film of bacteria -- from teeth and gums is to brush teeth regularly and properly.

What is the proper technique for teeth brushing?
Because every mouth is different, there is more than one technique of brushing that has proven to be effective. Deciding which technique is most appropriate for you depend largely on your teeth position and gum condition. Consult your physician and/or dentist to determine which brushing technique is most appropriate for your mouth.

Generally, most dentists recommend a circular technique for brushing. This includes brushing only a small group of teeth at a time -- gradually covering the entire mouth. The importance of maintaining a circular or elliptical motion is emphasized as using a back and forth motion may cause the following:

  • a receded gum surface
  • an exposed and tender root surface
  • a wearing down of the gum line

Instead, dentists recommend the following method:

Step 1: Place the toothbrush beside your teeth at a 45-degree angle.

Step 2: Gently brush teeth only a small group of teeth at a time (in a circular or elliptical motion) until the entire mouth is covered.

Step 3: Brush the outside of the teeth, inside of the teeth, the chewing surfaces, and in between each tooth.

Step 4: Gently brush the tongue to remove bacteria and freshen breath.

Step 5: Repeat steps 1 through 4 at least twice daily, especially after meals and snacks.

What type of toothbrush should be used?
A toothbrush head should be small -- about 1 inch by 1/2 inch -- and should have a handle suitable for firm grasping. The bristles of the brush should be soft, nylon, and rounded at the ends. This helps ensure that the brush bristles are reaching the spaces between the teeth as well as the surface. Some brushes are too abrasive and can wear down the enamel on teeth. Thus, in most cases, medium and hard bristles are not recommended.

How often is brushing necessary?
Generally, brushing is recommended twice a day for at least three to four minutes each time. Patients generally think they are brushing long enough, when, in fact, most people spend less than one minute brushing. In addition, it is generally better to brush 3 to 4 minutes twice a day instead of brushing quickly five or more times throughout the day.

Dentists advise brushing your teeth during the day while at work, school, or play. Keeping a toothbrush handy -- in your desk or backpack -- increases the chances that you will brush during the day.

 Manual toothbrushes.

Manual toothbrushes need no introduction. These are simply the hand held, hand manipulated toothbrushes we are all familiar with. 

When a manufacturer designs a manual toothbrush one of their goals is to create a brush whose bristles have the ability to reach difficult areas, such as those areas in between teeth or on the side of teeth down by the gum line, more effectively than their competitor's brush. 

Despite what you see advertised no one company's toothbrush head design has proven to be universally the most effective. Most studies have concluded that there is no significant change in brushing effectiveness when differences in bristle design, texture, or brush shape are evaluated. However, for any one individual and related to their own specific situation and own individual brushing technique, one toothbrush design might be more effective or easier to use than another.

Manual tooth brushing can be very effective but it is extremely dependent on technique. The person brushing must:

  • brush in the right directions, ...
  • using the right motions, ...
  • without too much force, ...
  • for an appropriate amount of time (at least two minutes), ...

This is typically why so many persons fail at brushing their teeth effectively with a manual toothbrush.

Usually it's best to choose a manual toothbrush whose bristles have been categorized by its manufacturer as "soft." Toothbrushes having harsh bristles could possibly clean away dental plaque more readily than their counter parts designed with softer bristles, but a stiff brush would likely also damage or abrade soft oral tissues. You just need to remember that dental plaque is soft. It simply requires brushing long enough, in the right areas, using an appropriate technique to dislodge it. Harsh scrubbing is not needed.

Electric toothbrushes / sonic toothbrushes

Modern conventional electric toothbrushes (the "rotary" brushes).

While sonic toothbrushes do represent a very technologically advanced form of electric toothbrush design, the recent generations of conventional electric toothbrushes, the "rotary" brushes, have made great advances also.

Rotary electric toothbrushes.

While encompassing a number of different individual designs, rotary electric toothbrushes are all similar by way of the fact that they each have a set of rotating bristles. These bristles are either arranged in a circular format that rotates or oscillates, or else the individual tufts of bristles contained in the brush head each possess a spinning motion. In most cases these brushes generate between 3,000 and 7,500 brush strokes per minute but one manufacturer, Braun Oral B, has added a high frequency pulsating motion to enhance the cleaning action of their brush. You will find that rotary brushes comprise a large percentage of all electric toothbrushes sold today, both high-end and low-cost models.

The plaque removing capability of rotary electric toothbrushes, in similar nature as with all toothbrushes that came before them, relies on the scrubbing motion of the brush's bristles on a tooth's surface (there is no disruption of dental plaque beyond where the bristles actually touch as there is with sonic toothbrushes). However, different from previous generations of electric toothbrushes these brushes often possess some ability to reach into the interproximal (between the teeth) or sub gingival (below the gum line) regions in the mouth to some degree. 

Studies that have evaluated rotary electric toothbrushes (as opposed to the more primitive designs of electric toothbrushes that came before them) have produced a large amount of clinical evidence that shows that these brushes are superior to manual tooth brushing in regards to plaque removal and reduction in gingivitis (gum inflammation). These findings can probably be attributed to both the enhanced cleaning action of the bristle movements of these brushes, and the fact that the effective use of these brushes relies little on the dexterity of the individual using it.

The oscillating / pulsating rotary electric toothbrushes.

Electric toothbrushes that have both an oscillating and pulsating motion, such as the Braun Oral B "3D" model brushes, could certainly be considered to be examples of the pinnacle of conventional (non-sonic) electric toothbrush design.

Related to the relatively small brush head size of this design of brush, oscillating/pulsating toothbrushes are generally intended for use using a tooth-by-tooth technique, cleaning each side of one tooth before moving on to the next. This is somewhat in contrast to sonic toothbrushes whose more conventional style brush head is intended to be manipulated more like a manual toothbrush.

These brushes have a round brush head that is capable of oscillating back and forth at a rate of 7,600 brush strokes per minute. In addition to this motion the Braun Oral B company has incorporated a pulsating action which creates movements somewhere between 20,000 and 40,000 pulses per minute, depending on the specific brush model. 

Even with this intense high rate of movement the Braun Oral B "3D" brushes are not considered to be "sonic" type toothbrushes. We are unaware of any claims by the manufacture of afluid dynamic clean action such as the one generated by sonic toothbrushes. The conventional mode of cleaning that is produced by these Braun Oral B brushes however (that cleaning produced by the toothbrush's bristles scrubbing a tooth's surface) is exceptional (per our van der Weijden et al reference). 


What is toothpaste?
Also called dentifrice, toothpaste is comprised of the following cleaning ingredients (stated in approximate percentages):

  • humectants and water - 75 percent
  • abrasive - 20 percent
  • foaming and flavoring agents - 2 percent
  • pH buffers - 2 percent
  • coloring agents, binders, and opacifiers - 1.5 percent
  • fluoride - .24 percent

Facts about toothpaste: 
Brushing with toothpaste (particularly toothpaste with fluoride) helps to accomplish the following:

  • remove plaque
  • resist decay
  • promote remineralization
  • clean and polish teeth
  • remove teeth stains
  • freshen breath

Which type of toothpaste is best?
Fluoride is the most crucial ingredient in toothpaste. As long as the toothpaste contains fluoride, the brand, nor type (paste, gel, or powder) generally does not matter. All fluoride toothpastes work effectively to fight plaque and cavities, and clean and polish tooth enamel. The brand you choose should bear the IDA (Indian Dental Association) seal of approval on the container, which means that adequate evidence of safety and efficacy have been demonstrated in controlled, clinical trials.

Some toothpastes offer tartar control pyrophosphates to prevent the build-up of soft calculus deposits on teeth, while others offer whitening formulas to safely remove stains making teeth brighter and shinier. But, contrary to clever advertising and popular belief, fluoride is the true active ingredient that works the hardest to protect your teeth.

Fluoride Therapy

Benefits of fluoride therapy

Fluoride therapy is commonly practiced and generally agreed upon as being useful in the modern dental field. Fluoride combats the formation of tooth decay primarily in three ways:

  • Fluoride promotes the remineralization of a tooth.

Fluoride has been found to enhance the tooth remineralization process. Fluoride found in saliva will adsorb onto the surface of a tooth where demineralization has occurred. The presence of this fluoride in turn attracts other minerals (such as calcium), thus resulting in the formation of new tooth mineral.

  • Fluoride can make a tooth more resistant to the formation of tooth decay.

The new tooth mineral that is created by the remineralization process in the presence of fluoride is actually a "harder" mineral compound than existed when the tooth initially formed. Teeth are generally composed of hydroxyapatite and carbonated hydroxyapatite. Fluorapatite is created during the remineralization process when fluoride is present and is more resistant to dissolution by acids (demineralization).

  • Fluoride can inhibit oral bacteria's ability to create acids.

Fluoride decreases the rate at which the bacteria that live in dental plaque can produce acid by disrupting the bacteria and its ability to metabolize sugars. The less sugar the bacteria can consume, the less acidic waste which will be produced and participate in the demineralization process.

There are many different types of fluoride therapies, which include at home therapies and professionally applied topical fluorides (PATF). At home therapies can be further divided into over-the-counter (OTC) and prescription strengths. The fluoride therapies whether OTC or PATF are categorized by application – dentifrices, mouthrinses, gels/ foams, varnishes, dietary fluoridate supplements, and water fluoridation.

Fluoride, while beneficial to adults, is more important in children whose teeth are developing. As teeth are developing within their jaw bones, enamel is being laid down. Systemic ingestion of fluoride results in a greater component of fluoroapatite in the mineral structure of the enamel.


FLOSSING: We often get asked questions such as how often should I floss, is flossing necessary, and what teeth should I floss? Our response is the cliché used by dentists the world over. You should only floss the teeth you want to keep! You see next to brushing, flossing is the most important thing that you can do to ensure good oral health.

The purpose of both brushing and flossing is to reduce the number of bacteria which inhabit our mouths. Normally, millions of these microscopic monsters call your mouth home feeding on food particles left on our teeth.

Ungrateful guests, these bacteria produce acid as a result of their feasting and it is this acid which eats into tooth enamel creating cavities. If this wasn't bad enough, the bacteria also pour out volatile sulfur compounds creating embarrassing bad breath.

Normally bacteria are found within a mesh of mucus and debris known as plaque. Regular brushing removes the plaque and the bacteria plaque contains. Unfortunately, many people only brush forgetting that flossing is a key component to any good oral hygiene program.

Flossing removes the bacteria that escape the toothbrush by hiding in the tiny spaces in between teeth. Brushing without flossing is like washing only 65% of your body. The other 35% remains dirty! The American Dental Association recommends that you floss at least once a day.

What happens if you don't floss? If you do not floss and allow plaque to remain in between teeth it eventually hardens into a substance known as tartar. Unlike plaque which can be easily removed by brushing, tartar can only be removed by your dentist.

Over time, levels of more dangerous types of bacteria build up within tartar. Mean and vengeful, these bacteria produce toxins which irritate and inflame the gums. This condition is known as gingivitis. If gingivitis is left untreated it can progress to periodontal disease - a condition where bacteria and their toxins invade not only the gums but also the bones and the structures supporting the teeth. This can lead to bone loss, loose teeth, and teeth which fall out.

We recommend Glide or any other coated dental floss because they slide easily between teeth. However, any floss that you can get between your teeth and which does not fray or break easily is good.

Alternatively, if you don't like using dental floss, consider an interdental cleaner (electric flosser) which makes flossing easy and convenient.

If you haven't flossed in a while, you may see a little red tinge of blood on the floss after you use it. This indicates that your gums are slightly inflamed and vastly in need of flossing to remove bacteria. With a regular regimen of flossing this red tinge should go away.

By brushing and flossing we help to eliminate the bacteria which can lead to bad breath, gingivitis, and periodontal disease thus creating smiles which last a lifetime.


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