Preventive care

Tooth brushingedit

Routine tooth brushing is the principal method of preventing many oral diseases, and perhaps the most important activity an individual can practice to reduce plaque buildup. Controlling plaque reduces the risk of the individual suffering from plaque-associated diseases such as gingivitis, periodontitis, and caries – the three most common oral diseases. The average brushing time for individuals is between 30 seconds and just over 60 seconds. Many oral health care professionals agree that tooth brushing should be done for a minimum of two minutes, and be practiced at least twice a day. Brushing for at least two minutes per session is optimal for preventing the most common oral diseases, and removes considerably more plaque than brushing for only 45 seconds

Toothbrushing can only clean to a depth of about 1.5 mm inside the gingival pockets, but a sustained regime of plaque removal above the gum line can affect the ecology of the microbes below the gums and may reduce the number of pathogens in pockets up to 5 mm in depth.

Toothpaste (dentifrice) with fluoride, or alternatives such as nano-hydroxyapatite, is an important tool to readily use when tooth brushing. The fluoride (or alternative)in the dentifrice is an important protective factor against caries, and an important supplement needed to remineralize already affected enamel. However, in terms of preventing gum disease, the use of toothpaste does not increase the effectiveness of the activity with respect to the amount of plaque removed. People use toothpaste with nano-hydroxyapatite instead of fluoride as it performs the same function, and some people believe fluoride in toothpaste is a neurotoxin.

Manual tooth brushedit

The modern manual tooth brush is a dental tool which consists of a head of nylon bristles attached to a long handle to help facilitate the manual action of tooth brushing. Furthermore, the handle aids in reaching as far back as teeth erupt in the oral cavity. The tooth brush is arguably a person's best tool for removing dental plaque from teeth, thus capable of preventing all plaque-related diseases if used routinely, correctly and effectively. Oral health professionals recommend the use of a tooth brush with a small head and soft bristles as they are most effective in removing plaque without damaging the gums.

The technique is crucial to the effectiveness of tooth brushing and disease prevention. Back and forth brushing is not effective in removing plaque at the gum line. Tooth brushing should employ a systematic approach, angle the bristles at a 45-degree angle towards the gums, and make small circular motions at that angle. This action increases the effectiveness of the technique in removing plaque at the gum line.

Electric tooth brushedit

Electric toothbrushes are toothbrushes with moving or vibrating bristle heads. The two main types of electric toothbrushes are the sonic type which has a vibrating head, and the oscillating-rotating type in which the bristle head makes constant clockwise and anti-clockwise movements.

Sonic or ultrasonic toothbrushes vibrate at a high frequency with a small amplitude, and a fluid turbulent activity that aids in plaque removal. The rotating type might reduce plaque and gingivitis compared to manual brushing, though it is currently uncertain whether this is of clinical significance. The movements of the bristles and their vibrations help break up chains of bacteria up to 5mm below the gum line. The oscillating-rotating electric toothbrush on the other hand uses the same mechanical action as produced by manual tooth brushing – removing plaque via mechanical disturbance of the biofilm – however at a higher frequency.

Using electric tooth brushes is less complex in regards to brushing technique, making it a viable option for children, and adults with limited dexterity. The bristle head should be guided from tooth to tooth slowly, following the contour of the gums and crowns of the tooth. The motion of the toothbrush head removes the need to manually oscillate the brush or make circles.

Flossingedit

Tooth brushing alone will not remove plaque from all surfaces of the tooth as 40% of the surfaces are interdental. One technique that can be used to access these areas is dental floss. When the proper technique is used, flossing can remove plaque and food particles from between the teeth and below the gums. The American Dental Association (ADA) reports that up to 80% of plaque may be removed by this method. The ADA recommends cleaning between the teeth as part of one's daily oral hygiene regime.

Types of floss include:

• Unwaxed floss: Unbound nylon filaments that spread across the tooth. Plaque and debris get trapped for easy removal.
• Waxed floss: less susceptible to tearing or shredding when used between tight contacts or areas with overhanging restorations.
• Polytetrafluoroethylene (Teflon): Slides easily through tight contacts and does not fray.

The type of floss used is a personal preference; however, without proper technique it may not be effective. The correct technique to ensure maximum plaque removal is as follows:

1. Floss length: 15–25 cm wrapped around middle fingers.
2. For upper teeth grasp the floss with thumb and index finger, for lower teeth with both index fingers. Ensure that a length of roughly an inch is left between the fingers.
3. Ease the floss gently between the teeth using a back and forth motion.
4. Position the floss in such a way that it becomes securely wrapped around the interdental surface of the tooth in a C shape.
5. Ensure that the floss is taken below the gum margins using a back and forth up and down motion.

There are a few different options on the market that can make flossing easier if dexterity or coordination is a barrier, or as a preference over normal floss. Floss threaders are ideal for cleaning between orthodontic appliances, and flossettes are ideal for children and those with poor dexterity. Special flossettes are made for those with orthodontics.

Interdental brushesedit

Interdental brushes come in a range of color-coded sizes. They consist of a handle with a piece of wire covered in tapered bristles, designed to be placed into the interdental space for plaque removal. Studies indicate that interdental brushes are equally or more effective then floss when removing plaque and reducing gum inflammation. They are especially recommended to people with orthodontics, often to use as well as floss.

The steps in using an interdental brush are as follows:

1. Identify the size required, the largest size that will fit without force is ideal, if necessary more than one size can be used.
2. Insert the bristles into the interdental space at a 90-degree angle.
3. Move the brush back and forth between the teeth.
4. Rinse under water to remove debris when necessary.
5. Rinse with warm soapy water once complete and store in a clean dry area.
6. Replace once bristles are worn.

Tongue scrapersedit

The tongue contains numerous bacteria which causes bad breath. Tongue cleaners are designed to remove the debris built up on the tongue. Using a toothbrush to clean the tongue is another possibility, however it might be hard to reach the back of the tongue and the bristles of the toothbrush may be too soft to remove the debris. Steps of using a tongue scraper:

1. Rinse the tongue scraper in order to clean it and remove any present debris
2. Start at the back of the tongue and gently scrape forwards. Be sure to clean the sides of the tongue, as well as the middle portion
3. After the cleaning is completed, rinse the tongue scraper and any debris that is left behind
4. Rinse the mouth

Oral irrigationedit

Some dental professionals recommend subgingival irrigation as a way to clean teeth and gums, instead of or in addition to flossing.

Single-tufted brushesedit

Single-tufted brushes are a tool in conjunction with tooth brushing. The tooth brush is designed to reach the 'hard to reach places' within the mouth. This tool is best used behind the lower front teeth, behind the back molars, crooked teeth and between spaces where teeth have been removed. The single- tufted brush design has an angled handle, a 4mm diameter and rounded bristle tips.

Gum stimulatorsedit

Toothbrushes with pointed rubber tips at the ends of the handles have been available for many years, and have more recently been replaced by a standalone tool called a gum stimulator designed to massage the gum line and the bases of the areas between the teeth. Such stimulators help to increase circulation to the gum line and to clear away bacteria which might not be removed by brushing and flossing alone.