Why are my teeth so important?

Your teeth vary in shape and size depending on where they are in your mouth. These differences allow the teeth to do many different jobs. Teeth help us to chew and digest food. They help us to talk, and to pronounce different sounds clearly. Finally, teeth help to give our face its shape. A healthy smile can be a great asset; and because this is so important, it makes sense to give your teeth the best care possible.

What can go wrong?

Tooth decay can be painful and lead to fillings, crowns or inlays. If tooth decay is not treated, the nerve of the tooth can become infected and die, causing an abscess. This may then need  root canal treatment or even for the tooth to be removed. It is very important that you keep up a good routine at home to keep your teeth and gums healthy. Gum disease is common and, if left untreated, may lead to bone loss around the teeth. In some cases, it may lead to loose teeth and teeth being lost. Gum disease is preventable. It can be treated and kept under control with regular cleaning sessions and check-ups, preventing further problems. If teeth are lost, it may be necessary to fill the gaps with bridges, dentures or implants.

How do I keep my teeth and gums healthy?

It is easy to get your mouth clean and healthy, and keep it that way. A simple routine can help prevent most dental problems:

• brushing your teeth last thing at night and at least one other time during the day, with a fluoride toothpaste
• spit out after brushing and do not rinse, so that the fluoride stays on your teeth longer
• cleaning between the teeth with ‘interdental’ brushes or floss at least once a day
• good eating habits – having sugary foods and drinks less often, and
• regular dental check-ups.

Although most people brush regularly, many don’t clean between their teeth and some people don’t have regular dental check-ups. A few small changes in your daily routine can make a big difference in the long term. Your dental team can remove any build-up on your teeth and treat any gum disease that has already appeared. But daily dental care is up to you, and the main weapons are the toothbrush, toothpaste and interdental cleaning (cleaning between your teeth).

What is plaque?

Plaque is a thin, sticky film of bacteria that constantly forms on your teeth.

How can plaque cause decay?

When you eat foods containing sugars and starches, the bacteria in plaque produce acids, which attack tooth enamel. The stickiness of the plaque keeps these acids in contact with your teeth. After constant acid attack, the tooth enamel breaks down forming a hole or cavity.

How can plaque cause gum disease?

If plaque is not removed by brushing, it can harden into something called ‘calculus’ – another name for it is ‘tartar’. As calculus forms near the gumline, the plaque underneath releases harmful poisons causing the gums to become irritated and inflamed.

The gums start to pull away from the teeth and the gaps become infected. If gum disease is not treated promptly, the bone supporting the teeth is destroyed, and healthy teeth can become loose and fall out. Severe gum disease can lead to teeth falling out and needing to be replaced.

How can I prevent gum disease?

It is important to remove plaque and bits of food from around your teeth as this will stop your gums from becoming inflamed and swollen, and becoming infected. If you leave plaque on your teeth it can harden into tartar, which can only be removed by the dental team. It is important to keep up your regular appointments so that your teeth can have a thorough cleaning if they need it.

How do I know if I have gum disease?

Gum disease is generally painless, even though it damages the bone supporting the teeth. Gum disease (gingivitis) will usually show itself as red, swollen gums that bleed when you brush or clean between your teeth. Many people are worried when they notice their gums are bleeding and then brush more gently, or stop altogether.

In fact, it is important that you continue to clean regularly and thoroughly if you are to fight the gum disease. If the bleeding does not go away within a few days see your dental team to ask for their advice.

Which type of toothbrush should I use?

Your dental team will be able to recommend a toothbrush suitable for you. However, adults should choose a small- to medium-sized brush head. This should have soft to medium, multi-tufted, round-ended nylon bristles or ‘filaments’. The head should be small enough to reach into all parts of the mouth: especially the back of the mouth where it can be difficult to reach. Children need to use smaller brushes but with the same type of filaments.

You can now buy more specialised toothbrushes. For instance, people with sensitive teeth can now use softer-bristled brushes. There are also smaller-headed toothbrushes for people with crooked or irregular teeth. Some people find it difficult to hold a toothbrush, for example because they have Parkinson’s disease or a physical disability. There are now toothbrushes which have large handles and angled heads to make them easier to use.

Why is brushing important?

Daily brushing and cleaning between your teeth is important because it removes plaque. If the plaque isn’t removed, it continues to build up, feeding on the bits of food left behind and causing tooth decay and gum disease.

How do electric or ‘power’ toothbrushes work?

A power brush has an oscillating rotating or vibrating head, which provides a large amount of cleaning action with very little movement needed from the user, although you do need to position the brush correctly.

Do electric toothbrushes clean better?

Tests have shown that power toothbrushes are more effective at removing plaque. Those with heads that rotate in both directions (‘oscillating’ heads) are the most effective. Everyone can use a power brush. They are particularly useful for people with limited movement of the arm or hand, such as disabled or elderly people, who often find that using a normal toothbrush does not allow them to clean thoroughly.

Power brushes can also be better for children as they may be more likely to brush regularly because of the novelty of using a power brush. Discuss the idea with your dental team to find out if you would benefit from using a power brush.

How should I brush?

Brushing removes plaque and bits of food from the inner, outer and biting surfaces of your teeth.

Here is one way to remove plaque – discuss with your dental team which is the best for you:

• Place the head of your toothbrush against your teeth, then tilt the bristle tips to a 45-degree angle against your gumline. Move the brush in small circular movements, several times, on all the surfaces of every tooth.
• Brush the outer surface of each tooth, upper and lower, keeping the bristles angled against your gumline.
• Do this again, but on the inside surfaces of all your teeth.
• To clean the inside surfaces of your front teeth, tilt the brush vertically and make several small, circular strokes with the front part of the brush.
• Brush the biting surfaces of your teeth.
• Brush your tongue to help freshen your breath and clean your mouth by removing bacteria.
  How often should I brush my teeth?

Be sure to brush thoroughly with a fluoride toothpaste last thing at night and at least one other time during the day. If you regularly keep getting discomfort or bleeding after brushing you should see your dentist.

How do I know if I have removed all the plaque?

You can stain the plaque with special dye, which you can paint onto your teeth with a cotton bud, or you can use special disclosing tablets. You can get these from your dental practice or pharmacy.

The stain is harmless and will show any areas of your mouth which need better brushing. Look particularly at where your teeth and gums meet. Further brushing will remove the stained plaque.

How often should I change my toothbrush?

Worn-out toothbrushes cannot clean your teeth properly and may damage your gums. It is important to change your toothbrush every two to three months, or sooner if the filaments become worn. When bristles become splayed, they do not clean properly.

Should I use fluoride toothpaste?

Yes. Fluoride helps to strengthen and protect teeth, which can reduce tooth decay in adults and children.

All children up to three years old should use a smear of toothpaste with a fluoride level of no less than 1000ppm (parts per million). After three years old they should use a pea-sized amount of toothpaste that contains 1350ppm to 1500ppm.

Some children’s toothpastes only have about half the fluoride that adult toothpastes have. They only give limited protection for the teeth. If your children are under 7 you should keep an eye on them when they brush their teeth and encourage them not to swallow the toothpaste.

What sort of toothpaste should I use?

As well as regular family toothpastes, there are many specialised toothpastes. These include tartar control for people who get tartar build-up, and a choice of toothpastes for people with sensitive teeth. ‘Total care’ toothpastes include ingredients to help fight gum disease, freshen breath and reduce plaque build-up. ‘Whitening’ toothpastes are good at removing staining to help restore the natural colour of your teeth, but are not strong enough to change the natural shade of the teeth.

Some children’s toothpastes only have about half the fluoride that adult toothpastes have. They only give limited protection for the teeth. If your children are under 7 you should supervise them when they brush their teeth. Encourage them not to swallow the toothpaste and to just spit, not rinse, after brushing.

To have a clean and healthy mouth you need to use the correct dental-care products. Ask your dental team to tell you what choices there are and to give their recommendations.

How much toothpaste should I use?

You do not need to cover the head of your brush in toothpaste. Children under three should use a smear, and children over three, a pea-sized blob of toothpaste. Remember to spit out after brushing and do not rinse, so that the fluoride stays on your teeth longer.

Should my gums bleed when I clean in between my teeth?

Your gums may bleed or be sore for the first few days that you clean between your teeth. This should stop once the plaque is broken up and the health of your mouth has improved. If the bleeding does not stop, tell your dental team. It may be that you are not cleaning correctly, or that your teeth and gums need a more thorough clean by your dental team.

How should I clean between my teeth?

You can clean between your teeth with an ‘interdental’ brush or dental floss. Cleaning in between your teeth removes plaque and bits of food from between your teeth and under your gumline – areas a toothbrush can’t reach. When flossing or using interdental brushes, keep to a regular pattern and remember not to miss any teeth. It helps to look in the mirror.

Don’t forget the backs of your last teeth. It is also very important to clean around the edges of any crowns, bridges or implants. You should clean between your teeth at least once a day. Your dental team can show you how to clean between your teeth properly.

Interdental

Interdental brushes come in various sizes. It may be helpful to ask your dentist or hygienist to show you the correct sizes for your mouth.

Hold the interdental brush between your thumb and forefinger. Gently place the brush through the gap between your teeth. Do not force the brush head through the gap. If the brush splays or bends then it is too big – you will need a smaller brush head for this space.

Flossing

• Break off about 45 centimeters (18 inches) of floss, and wind some around one finger of each hand.
• Hold the floss tightly between your thumbs and forefingers, with about an inch of floss between them, leaving no slack.
• Use a gentle ‘rocking’ motion to guide the floss between your teeth. Do not jerk the floss or snap the floss into the gums.
• When the floss reaches your gumline, curve it into a C-shape against one tooth until you feel resistance.
• Hold the floss against the tooth. Gently scrape the side of the tooth, moving the floss away from the gum. Repeat on the other side of the gap, along the side of the next tooth.
• Don’t forget the back of your last tooth.
• When flossing, keep to a regular pattern. Start at the top and work from left to right, then move to the bottom and again work from the left to right. This way you’re less likely to miss any teeth.

Are ‘oral irrigators’ useful? 

Oral irrigators use a stream or jet of water to remove plaque and bits of food from around your teeth. They can be particularly helpful if you wear an orthodontic appliance (‘brace’) or a fixed bridge that is difficult to clean, or if you find it difficult to use interdental brushes or floss.

Should I use a mouthwash?

A fluoride mouthwash can help prevent tooth decay. Your dental team may recommend an antibacterial mouthwash to help control plaque and reduce gum disease. If you find that you are regularly using a mouthwash just to freshen your breath see your dental team, because bad breath can be a sign of unhealthy teeth and gums or of poor general health.

Can my diet help?

Many people think that it is a high level of sugar in your diet that causes decay, but this is not true. It is how often you have sugar in your diet, not the amount, that causes problems. It takes up to an hour for your mouth to cancel out the acid caused by eating and drinking sugar. During this time your teeth are under attack from this acid. It is therefore important to limit the number of attacks by having sugary foods and drinks just at mealtimes. Chewing sugar-free gum and drinking water after meals or snacks can also help to cancel out the acid more quickly.

As well as causing decay, sugary fizzy drinks, fruit juices, sports drinks, and wine can be acidic – which can also cause dental erosion. This is when the acid in foods and drinks gradually wears away the hard enamel coating of the tooth. This may lead to the tooth being sensitive.

How should I clean my dentures?

It is just as important to clean dentures as it is to clean your natural teeth. Food can become caught around the edges of dentures and clasps, and the food can rot if you do not clean them thoroughly.

You should keep a separate toothbrush for cleaning your dentures. The general rule is: brush, soak and brush again. Clean your dentures over a bowl of water in case you drop them. Brush your dentures before soaking them, to help remove any bits of food. Soak the dentures in a specialist cleaner for a short time and then brush the dentures again. Brush them like you would your natural teeth.

Make sure you clean all the surfaces of the dentures, including the surface which fits against your gums. If you notice a build-up of stains or scale, have your dentures cleaned by your dental team. Most dentists still recommend a small- to medium-headed toothbrush.

I have implants, do I have to do anything special?

Your dental team or oral surgeon will tell you how to care for your implants after surgery. It is very important to make sure you clean them regularly and thoroughly to prevent gum disease and possible infection. Follow the instructions your dental team or oral surgeon gives you.

Why should I visit the dental team regularly?

It is always better to prevent problems rather than have to cure them when they happen. If you visit your dental team regularly you will need less treatment and they will spot any problems earlier, making any treatment easier.

Final words

Good dental health begins with you. By following these simple tips you can keep your mouth clean and healthy:

• Brush your teeth for two minutes, last thing at night and at least one other time during the day, using fluoride toothpaste.
• Spit toothpaste out after brushing and do not rinse.
• Use a toothbrush with a small- to medium-sized head.
• Use a toothbrush with soft to medium, multi-tufted, round-ended nylon bristles.
• Consider using a power toothbrush.
• Use small, circular movements to clean your teeth.
• Change your toothbrush regularly, and at least every 3 months.
• Clean between your teeth every day using interdental brushes or dental floss.
• Have sugary drinks and foods less often.
• Visit your dental team regularly, as often as they recommend.