BRUSHING & FLOSSING Archives - Smile Brilliant

Why do we ACTUALLY brush our teeth twice per day?

Kari Carter-Cherelus — Sat, 06 Apr 2024 09:38:34 +0000

In the battle against dental issues like cavities and gum disease, maintaining proper oral hygiene is paramount. By adopting simple yet effective practices and being mindful of dietary choices, individuals can safeguard their oral and overall health.

Plaque Attack

So you have probably been told that you should brush your teeth twice a day by your dental professional. For many, this has been drilled into their subconscious. We grew up hearing that we should brush twice a day for two minutes and floss at least once a day. Many, however, don’t know why this is so important. I have had some patients relay to me that they only brush once a day, and others state they brush only maybe once a week!
When you brush and floss your teeth you are removing bacteria on your teeth that form a sticky white film called plaque.^[1] Plaque is a sticky complex biofilm matrix that is able to stick to your teeth, coat your tongue, and cause inflammation to your gums.^[7]

How Often Does Oral Bacteria Multiply?

According to research, if we don’t properly remove plaque biofilm for 24 to 72 hours it can lead to a drop in good bacteria and increase the number of harmful bacteria.^[5] We can have on average 20 billion microbes in our mouth at any given time.^[6] However, those 20 billion microbes can double their numbers every 5 hours.^[6] It only takes 24-72 hours for plaque to harden and calcify into the hard substance calculus (tartar). To keep the bad bacteria to a minimum it is important to exercise good home-care habits daily.^[7] Brushing and cleaning between your teeth help to keep the bacteria levels under control and remove the buildup of plaque.^[7]

How Does Bacteria Growth Affect Our Teeth?

Several variables can help contribute to the growth of the bacteria. Consuming a diet full of carbohydrates or sugary foods and drinks can feed the bacteria. This helps them to increase in numbers spreading throughout your mouth.^[7] Plaque can produce acids that attack your tooth’s enamel and cause tooth decay (cavities).^[1]
If that soft plaque isn’t removed in a timely fashion it begins to harden into what is called calculus (tartar). That hard calculus makes it more difficult to keep your mouth clean and free from attracting more harmful bacteria to its surfaces.^[1] Plaque and calculus buildup can irritate your gums causing gum inflammation which can then contribute to gum disease and compromise your overall health and wellness.^[1] Individuals with gum disease will need to have specialized therapeutic treatment to help control and manage the condition. This can be more intensive and costly.

How to Keep Bacteria To Keep Minimum

Brush your teeth twice a day with toothpaste.
Clean between your teeth with floss, a water flosser, or an interdental device to remove plaque from between your teeth.(7)
Clean your tongue by brushing it or using a tongue scraper.(7)
Eat a healthy diet and limit your consumption of sugary food and drinks as they feed plaque.(1)(7)
Avoid frequent snacking.(1)
Replace your toothbrush every three months or sooner.(1)
Use plaque detecting tablets or rinses that show you areas in your mouth that have plaque on them
See your dental professionals regularly for professional treatment.(7)

We all live very busy lives, however taking a few minutes out of our day can help us to avoid spending needless hours in the dental chair due to unwanted cavities and gum disease. Prevention is always cheaper than the cure. Preventing the growth of bacteria can contribute to a healthy mouth and a healthy body.

Kari Carter-Cherelus

Kari Carter-Cherelus RDH, DA is a registered Dental Hygienist, writer, consultant, coach, international keynote speaker, with 23 years of experience in dentistry. She is passionate about helping others recover from burnout, improving organization’s work culture, and helping her clients to improve their mindset. She authored the book The Ultimate Guide For Dental Hygienist Burnout, and has written for RDH Graduate, RDH Magazine, and Inside Dental Hygiene.

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References

Mayo Clinic. When and how often should you brush your teeth. Salinas, Thomas. https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/brushing-your-teeth/faq-20058193
Mayo Clinic.Oral health: A window to your overall health. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475
Genetic Engineering & Biotechnology News. Study Shows How Harmful Mouth Bacteria Multiply. (2021, January 7). https://www.genengnews.com/news/microbiome-study-shows-how-harmful-mouth-bacteria-multiply/
Microbiome: Does disease start in the mouth, the gut or both? Prodan, Andrei. (2019, March 19) https://elifesciences.org/articles/45931
Bissett, Gaby. (2021, March 10) https://dentistry.co.uk/2021/03/10/hours-interrupted-oral-health-complications/
Oral bacteria: How many? How fast? Landers, Bill. (2009, July https://www.rdhmag.com/infection-control/water-safety/article/16404976/oral-bacteria-how-many-how-fast
Mouth Microbes. (2019, May) https://newsinhealth.nih.gov/2019/05/mouth-microbes

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Help! I hate flossing!

Rachel Stroble — Thu, 07 Mar 2024 06:45:55 +0000

Flossing may not be the most enjoyable task, but its importance in maintaining oral health cannot be overstated. Neglecting to floss can lead to serious dental issues like cavities and gum disease. While it may seem inconvenient or uncomfortable, finding the right flossing method tailored to individual needs can make the process easier and more effective. Consistent flossing, even just a few times a week to start, can significantly contribute to a healthier mouth and a brighter smile in the long run.

If you hate flossing, you are not alone. In fact, many people say they would rather wash dishes or sit in traffic than to floss!^[4] Despite the dread most people feel for flossing, cleaning in between the teeth is one of the most important things you can do to keep your teeth for your entire life.

Why is flossing important?

Brushing your teeth is critical to removing the harmful plaque that accumulates on the surfaces of the oral cavity. However, a toothbrush can only remove plaque if it can reach it. The areas in between the teeth are generally not large enough to allow access to toothbrush bristles^[1]. If you’re not doing something to clean in between the teeth, the plaque that collects in these areas can cause dental diseases such as cavities, gingivitis, or periodontal (gum) disease^[1]. Even though flossing is important, only about one third of people floss daily, while one third floss at least once per week, and one third never floss^[3]! In comparison, 77% of people brush twice every day^[2]. People may not floss because it is inconvenient or uncomfortable, while others do not see the value in doing it.

Is flossing for everyone?

Brush, floss, rinse, repeat. This routine has been engrained through messages from our dental care providers and dental product marketing. However, no two mouths are exactly alike, which means each individual’s oral care regimen should be individualized. People who have braces greatly benefit from the use of a water flosser. There are even special water flosser tips designed just for people with braces. Water flossers are also a great addition for people who have deep pockets around their teeth, and for those with dental implants. Interdental brushes can be helpful with people with wider spaces in between their teeth.

String floss comes in many varieties: waxed, unwaxed, taped, tufted… Most of the floss selection comes down to personal preference. Some types of floss are sturdier to avoid shredding between crowded teeth or on rough restorations. If you are able to effectively manipulate floss, string floss gives you the most control and effective adaptation to the teeth. However, if you have a hard time reaching your back teeth when flossing or if you struggle with dexterity challenges, floss holders or floss picks make flossing easier. While it is more difficult to get the floss to “hug” the tooth with these types of aids, they are still useful.

But what if my gums bleed when I floss?

Bleeding when flossing is a sign of disease. Bleeding is present in gingivitis as well as in most cases of active periodontal disease. Both types of disease are caused by an infection of the gums caused by bad bacteria. Your dentist or dental hygienist can tell you if you have one of these conditions. You may need special dental care in which the buildup is removed from the teeth above and below the gumline.

If your gums bleed when you floss, it is a sign that you should floss more frequently, not less frequently! Removing the bad bacteria from in between the teeth will help your body to heal, and will actually lead to a decrease in bleeding over the span of a couple of weeks. Just make sure you are hugging the floss in a soft “C” shape around the tooth and using an up-and-down motion. Do not saw the floss back and forth, as this will cut the gums.

Whichever method of flossing you choose to use, start by setting realistic goals. If you have never flossed before, consider starting by flossing two or three times weekly, and gradually increasing to daily flossing. Making flossing part of your hygiene routine will help to keep your mouth looking and smelling great!

Learn more about Rachel Stroble, and check out her other article A Few Minutes Can Save a Life.

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Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

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References

American Dental Association. (2021, September 21). Floss/interdental cleaners. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/floss
Busch, M. (2020, October 21). How did patients’ dental habits change during COVID-19? Delta Dental Institute. https://www.deltadentalinstitute.com/news/delta-dental-news/how-did-patients-dental-habits-change-during-covid-19/
Fleming, E. B., Nguyen, D., Afful, J., Carroll, M. D., & Woods, P. D. (2018). Prevalence of daily flossing among adults by selected risk factors for periodontal disease-United States, 2011-2014. Journal of Periodontology, 89(8), 933–939. https://doi.org/10.1002/JPER.17-0572
Rack, J., (2015, June 24). Are you flossing or just lying about it? The dentist knows. NPR. https://www.npr.org/sections/health-shots/2015/06/24/417184367/are-you-flossing-or-just-lying-about-flossing-the-dentist-knows

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What is biofilm?

Rachel Stroble — Tue, 12 Dec 2023 06:59:30 +0000

Biofilm is a sticky substance that grows in moist environments like the human mouth, where it’s known as dental biofilm or plaque. It contains bacteria, viruses, and fungi. It forms quickly, contributes to bad breath, damages teeth by causing cavities, and harms gums and bone. Find out from a dental hygienist how to stop it.

We all encounter biofilm in daily life. If you have been wondering what biofilm is, or what dental plaque is made of, this article will provide clarification.

Biofilm contains bacteria and other microbes

Biofilm is a sticky substance that forms in moist environments, such as ponds, pet water bowls, and the human mouth. Dental biofilm, commonly known as plaque, adheres to the teeth and other oral tissues such as the tongue. Plaque is sticky and contains food particles. Dental biofilm also contains bacteria and other germs, such as viruses and fungi ^[2]^[4]. In fact, the COVID-19 virus is present in the biofilm of people with active, symptomatic cases of COVID ^[2]. Both good bacteria and bad bacteria comprise the oral environment. Bad bacteria in the oral microbiome are usually anaerobic (meaning they do not need air to survive) ^[1]^[5]. Good bacteria have a protective role in your oral health.

It forms quickly

Dental biofilm begins to form within minutes of brushing and flossing your teeth. Most people develop biofilm above the gumline at about the same rate ^[7]. However, people who have gum disease develop bad bacteria below the gum line at a faster rate than those with healthy gums ^[7].

It causes bad breath

Bacteria produce acid and other byproducts as it digests the foods and beverages you eat and drink. The bacteria and its waste products emit an unpleasant odor, which is a key factor in bad breath. Your oral pH can contribute to the formation of biofilm (bad bacteria love acidic environments), so your diet and other oral factors influencing pH may be making your bad breath worse ^[6].

It damages your teeth

Acid is a key factor in cavity formation, and the production of acid in the mouth is a vicious cycle. The more bad bacteria you have in your mouth, the more acidic your oral pH. The more acidic your oral pH, the more the bad bacteria grow and reproduce ^[6]. Teeth are made of minerals, and all this acid eats away at the calcium and phosphate in your enamel and tooth root surfaces ^[6]. With weakened tooth structure, cavities form.

It damages your gums and bone

The bad bacteria in your oral microbiome also damages your gums and the bone underneath. It hides underneath the gums in areas that your toothbrush may not be able to reach and actually makes its way through the gum tissue. The bacteria can even end up on the bone that surrounds the teeth. All of this bacterial invasion causes the immune system to respond, which ultimately causes permanent damage to the bone. The bone slowly begins to recede, leaving less and less supporting structure for the teeth ^[3].

It needs to be removed

As you now know, dental biofilm needs to be removed to prevent dental disease like cavities and gum disease. Twice daily removal of dental biofilm is recommended with brushing and flossing along with plaque disclosing tablets or other techniques your dental care professional recommends for you. Look for our other articles on how to protect your teeth and gums with effective oral home care!

Rachel Stroble

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References

AGGREGATIBACTER ACTINOMYCETEMCOMITANS – AAP Connect. (n.d.). Higher Logic, LLC. Retrieved September 17, 2022, from https://members.perio.org/libraries/glossary/entry?GlossaryKey=7601a9b2-e9ce-42dc-b36d-83059e33ac32&ssopc=1
Gomes, S. C., Fachin, S., Fonseca, J. G., Angst, P. D. M., Lamers, M. L., Silva, I. S. B., & Nunes, L. N. (2021). Dental biofilm of symptomatic COVID‐19 patients harbours SARS‐CoV‐2. Journal of Clinical Periodontology, 48(7), https://doi.org/10.1111/jcpe.13471
Lasserre, J. F., Brecx, M. C., & Toma, S. (2018). Oral Microbes, Biofilms and Their Role in Periodontal and Peri-Implant Diseases. Materials, 11(10), https://doi.org/10.3390/ma11101802
Matsumoto-Nakano, M., (2018). Role of Streptococcus mutans surface proteins for biofilm formation. Japanese Dental Science Review 54(1), http://dx.doi.org/10.1016/j.jdsr.2017.08.002
PORPHYROMONAS GINGIVALIS – AAP Connect. (n.d.). Higher Logic, LLC. Retrieved September 17, 2022, from https://members.perio.org/libraries/glossary/entry?GlossaryKey=965ec455-2938-4d54-9947-196ea454164b&tab=groupdetails&ssopc=1
Tarcísio Jorge Leitão, Jaime, A. C., & Livia Maria Andaló Tenuta. (2018). Kinetics of calcium binding to dental biofilm bacteria. PLoS One, 13(1) https://doi-org.argo.library.okstate.edu/10.1371/journal.pone.0191284
Uzel, N. G., Teles, F. R., Teles, R. P., Song, X. Q., Torresyap, G., Socransky, S. S., & Haffajee, A. D. (2011). Microbial shifts during dental biofilm re-development in the absence of oral hygiene in periodontal health and disease. Journal of Clinical Periodontology, 38(7), https://doi.org/10.1111/j.1600-051X.2011.01730.x

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Easy tips to care for teeth even if you’re struggling

Esmy Ornelas — Fri, 18 Aug 2023 09:01:45 +0000

Amidst mental health struggles, oral care can feel overwhelming. Here are some simple alternatives to maintain health from a dental hygienist that understands.

“Brush your teeth twice a day and floss”, this is the advice given to every patient to keep their teeth clean and healthy. Sounds simple right? On a good day it is, but on other days, days that are filled with anxiety, depression, and other mental health struggles, the idea of brushing and flossing can seem impossible. During these times, there are other, more gentle ways to keep your teeth clean. The most important thing to remember? You’re not alone.

How common is anxiety and depression?

Anxiety and depression affect about 40 million Americans a year ^[1]. Even though it’s treatable, only about 36% receive treatment^[1], meaning many are battling it alone. These rates significantly spiked during COVID ^[2]and have had a lasting impact on the mental health of a large portion of the population. Clinical depression has effects other than feeling sad or a loss of energy. It directly impacts one’s decision-making skills and their executive functioning (the ability to take all the steps to get something done) ^[3]. This can make a seemingly simple task like brushing teeth or flossing seem like too much work. “What kind of toothpaste? Electric or manual toothbrush? Floss or floss pik… never mind. I don’t care anymore.” Many can feel terrible or lazy about not having the motivation to brush their teeth but it is not laziness, it’s the chemical imbalance in their brain^[1] working against them, depleting everything they have.

What can I do to keep my teeth clean when I’m struggling?

If you’re someone who struggles with depression or anxiety (the hygienist writing this article does), there are other simple ways to stay on top of your oral care that don’t require too much effort. These things may seem small, but they go a long way in keeping you healthy. Don’t underestimate the power of small efforts! The first is to drink lots of water. This cleanses the teeth and flushes out any bacteria that may be trapped between the teeth. It also helps increase salivary flow which will keep the pH of the oral cavity balanced, preventing cavities. Another is to eat crunchy foods like apples or carrots. The mechanical action of crunching on these foods cleans the chewing surfaces of the teeth (areas especially susceptible to decay) and removes plaque. Lastly, take a multivitamin and an oral probiotic . If you’re only craving sugar, or salty comfort foods when you’re experiencing a bout of depression, taking a multivitamin will ensure your body is still nourished with the vitamins and minerals it needs. An oral probiotic will keep your oral microbiome balanced, which in turn will strengthen your immune system and lessen your susceptibility to cavities and inflammation. Depression and anxiety can make everything seem exhausting, even brushing your teeth. When experiencing a low period, drink some water, take some vitamins, be extra gentle with yourself, and know that you’re doing more than enough. You got this!

Esmy Ornelas

Esmy Ornelas is a registered Dental Hygienist, writer, educator, and consultant with 10 years of experience in dentistry. She is passionate about education, empowering hygienists to advance their careers in and out of the operatory, and about community. She has written for RDH Magazine, the RDH Graduate, and is a full-time professor of Dental Hygiene and Assisting at Rose State College in Oklahoma.

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How to brush your teeth to avoid damage

Kari Carter-Cherelus — Wed, 16 Aug 2023 07:05:22 +0000

Proper brushing, soft bristles, and regular care prevent dental issues. Optimal oral health shields against systemic diseases; invest in your oral health each day for a healthier future.

Dental hygienists teach their patients daily how to improve their oral hygiene techniques. Good oral hygiene is important for your overall well being, the prevention of cavities and gum disease. Your oral health can impact serious health conditions such as heart disease and diabetes.^[2] An important part of oral hygiene instruction is teaching patients how to brush effectively. Brushing incorrectly or with the wrong toothbrush can prove harmful to your teeth and your gums.

The proper brushing technique is to place your toothbrush at a 45 degree angle towards your gum line. Gently move your toothbrush in a circular motion. Brush upwards when you are brushing your teeth at the top of your mouth and brush downwards when you are brushing the bottom teeth. It’s important to brush all the surfaces of your teeth. These surfaces include the outer surfaces which our closest to your cheeks, inner surfaces closest to your tongue, and the surfaces that you use to chew with^[2] To brush the inside surfaces of your front teeth tilt the toothbrush vertically and brush using up-and down strokes.^[2]

You should brush your teeth at least twice a day with a soft-bristled toothbrush so as to remove the plaque acids that contribute to dental cavities. It is important to replace your toothbrush every three months or sooner. Most toothbrushes have indicator bristles that start fading to indicate that replacement is needed. If your bristles start to flare out that is and indication that it is time to replace your toothbrush as a worn out toothbrush won’t be effective in helping you to keep your teeth clean.^[1]

Although you can purchase a medium or a hard toothbrush, these are not recommended as they are known to contribute to damaging the gums, root surfaces, and tooth enamel.^[2] The risk of damaging these structure increases if you brush too hard or aggressively causing toothbrush abrasion.^[2]^[3] If we damage our tooth enamel we may become more susceptible to tooth decay as bacteria can penetrate damaged areas in our teeth more easily. Toothbrush abrasion can also contribute to tooth discoloration as well as painful sensitivity to temperatures and sweets.^[3] If you experience this your dentist will be able to go over various restorative options such as a filling, crown, or a veneer.^[3] The dentist will help alleviate pain or discomfort and recommend future prevention techniques.

Toothbrushes: disposable manual or electric?

Either a manual or a disposable toothbrush will be effective in removing plaque buildup if the user is using the proper brushing technique and brushing regularly.^[2] There are however some advantages to using an electric toothbrush. Some individuals find that using an electric toothbrush helps them to properly clean all their teeth surfaces properly.^[2] Use of an electric toothbrush can help individuals or their caregivers when there is an issue with limited hand mobility due to arthritis, Parkinson’s, or other ailments.^[2] Some electric toothbrushes have built-in timers, pressure indicators, and other features that help the user.^[2] Brushing and flossing can help to keep harmful oral bacteria under control that would otherwise overgrow and contribute to tooth decay, gum disease, oral infections, and harm our overall health and wellness.^[4] You can help protect your health by maintaining your oral health and making sure you see your dentist regularly.^[4] Caring for your oral health in an investment that worthwhile and benefits your overall health.^[4]

Kari Carter-Cherelus

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Answers to the 4 most commonly asked questions about cavities

Rachel Stroble — Mon, 22 May 2023 06:51:58 +0000

Most of us have had a cavity at some point. Maybe it required a filling, maybe it didn’t. But why? Find out how cavities develop, when they really need treatment, and how to prevent them in the future!

What are cavities?

Cavities are also called dental decay or dental caries. They are caused by bad bacteria and an acidic oral environment ^[3]. Additionally, frequent exposure to sugary foods and drinks increases the risk of cavities. In the early stages of a cavity, it may appear white and chalky if it is in an easily visible area. Next, cavities may appear brown, and then black. Over time, cavities appear as a hole in the tooth. However, even if you do not see a hole in your tooth, you could have a substantial cavity! Sometimes, they start small and burrow under the enamel, causing large amounts of damage.

Do cavities always hurt?

Teeth are made of three main layers. The enamel, or the outer surface of the tooth, is the hardest substance in your body. The next layer is dentin, a slightly softer layer. The third layer is the pulp, or the nerve and blood supply of the tooth. When cavities are just beginning in the enamel, you probably won’t feel pain ^[1]. Once they progress into the dentin, you may start to have tooth sensitivity to cold or sweets. By the time most people have pain, the cavity has progressed all the way into the pulp of the tooth! If your cavity is this advanced, you will probably need more complex dental treatment. It’s also important to know that there are other dental conditions that can cause pain, so be sure to see a dentist if your mouth is hurting.

How do I know if I need a filling?

Regular preventive dental visits are important to protect your dental and whole-body health ^[4]^[5]! During the earliest stages of dental decay, your dental healthcare professional is your best asset in identifying cavities. X-rays and special magnification eyewear are two of the ways your dental team can detect cavities when they are still very small. During this stage, simpler treatment may be possible to repair the damage. If you have noticed that you have a hole in your tooth, you need dental care! A filling or other treatment may be recommended. The earlier you catch dental decay, the more conservative your dentist will be able to be. Depending on how advanced your cavity is, you may need something more in-depth, such as a crown or root canal.

What can I do to prevent cavities in the future?

In addition to seeing your dental team two to four times annually, depending on your oral condition, one of the best things you can do at home to prevent cavities is to brush your teeth twice per day for two minutes each time and to clean in between the teeth with floss or other methods at least once per day. Also, toothpaste and mouthwash with fluoride help prevent cavities by strengthening the teeth ^[2]. Be sure to read the instructions on your dental products to be sure you are getting the maximum benefit from them!

Rachel Stroble

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Boyd, L. D., Mallonee, L. F., Wyche, C. J., Halaris, J. F., (2021). Wilkins’ Clinical practice of the dental hygienist. Jones and Bartlett Learning
Horst, J. A., Tanzer, J. M., & Milgrom, P. M. (2018). Fluorides and Other Preventive Strategies for Tooth Decay. Dental clinics of North America, 62(2), 207–234. https://doi.org/10.1016/j.cden.2017.11.003
Institute for Quality and Efficiency in Health Care (2020, February 27). Tooth decay: Overview. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK279514/
Little, J. W., Miller, C. S., Rhodus, N. L., & Little, J. W. (2018). Little and Falace’s dental management of the medically compromised patient (Ninth edition.). Elsevier.
Maurer, K., Rahming, S., & Prvulovic, D. (2018). Dental health in advanced age and Alzheimer’s disease: A possible link with bacterial toxins entering the brain? Psychiatry Research.

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Should I brush my gums too?

Esmy Ornelas — Wed, 26 Apr 2023 07:23:10 +0000

Keeping the gums clean & free of bacteria is definitely important, but there are more gentle & effective ways to do it. Find out how below.

You brush your teeth, and your tongue… but should you brush your gums too? Let’s discuss the best methods for keeping your gums clean and healthy without being too abrasive.

Should I brush my gums when I brush my teeth?

The short answer is… no. Brushing your gums is not necessarily bad, it just isn’t the best or most gentle way to clean the gum tissues. Most often the tissues are kept clean with flossing, drinking lots of water, and the mechanical action of chewing (especially crispier, crunchier foods like apples and carrots). Gum health is achieved through flossing the gums rather than brushing them ^[1]. This is because the pathogens and bacteria that cause gingivitis are underneath the gums ^[2] and can only be accessed with floss or an oral irrigator, not with a toothbrush.

Can you brush your gums too hard and cause damage?

Part of the problem with brushing the gums to keep them clean is that it can be too abrasive to the tissues and can cause irritation or worse, recession ^[2]. Recession is when the gums start to recede exposing the root of the tooth. This leads to tooth sensitivity and down the line can cause even bigger issues like tooth mobility and root caries (cavities).

What’s the best way to keep the gums clean?

People who have a lot of plaque or food debris on their tissues can use a warm washcloth to gently wipe it away. This happens often with the elderly, people who are edentulous (missing teeth), people who wear dentures, and babies. People who wear dentures must remember to clean their dentures and their tissues before putting them back in. Babies, especially those who only drink milk, are also prone to having biofilm on their gums. In these cases, a warm washcloth and wiping are a much gentler yet effective way to clean these areas.

Another great option for those prone to an accumulation of plaque and food debris is an oral irrigator like a water flosser. These are an awesome option for flushing out any plaque or food that’s caught in the teeth and soothing the tissues.

How do I know If I’m keeping my gums healthy?

The biggest sign of gingival health is a lack of bleeding when flossing or brushing ^[4]. Another sign is the overall appearance of the tissues. If they are red, swollen, or tender to the touch, there is most likely an accumulation of biofilm and plaque irritating the gums. If they are stippled, a lighter pink color (as opposed to red), and tight to the tooth with no bleeding, they are healthy!

Healthy gums make for a healthy oral cavity and it’s very simple to do. Floss or use a water flosser, drink lots of water, and if you notice an accumulation of plaque on your tissues, gently wipe it away.

Esmy Ornelas

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Addy, M., & Hunter, M. L. (2003). Can tooth brushing damage your health? Effects on oral and dental tissues. International dental journal, 53 Suppl 3, 177–186. https://doi.org/10.1111/j.1875-595x.2003.tb00768.
How, K. Y., Song, K. P., & Chan, K. G. (2016). Porphyromonas gingivalis: An Overview of Periodontopathic Pathogen below the Gum Line. Frontiers in microbiology, 7, 53. https://doi.org/10.3389/fmicb.2016.00053
Rathee, M., & Jain, P. (2022). Gingivitis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557422/
Sambunjak, D., Nickerson, J. W., Poklepovic Pericic, T., Johnson, T. M., Imai, P., Tugwell, P., & Worthington, H. V. (2019). WITHDRAWN: Flossing for the management of periodontal diseases and dental caries in adults. The Cochrane database of systematic reviews, 4(4), CD008829. https://doi.org/10.1002/14651858.CD008829.pub3

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How to care for your dental cleaning tools & keep them safe

Kari Carter-Cherelus — Fri, 31 Mar 2023 09:38:42 +0000

Good oral hygiene is associated with a healthier mouth and body. Find out how to take care of dental appliances to minimize microbes & maximize health.

According to archeologists, centuries ago humans used bones, sticks, washcloths, and other items to clean their teeth and gums. The first toothbrush that resembles what we commonly use today was first designed in China in the 15th century.^[1] They used bamboo handles with bristles made from animal hair. In the early 1800’s it was recommended that floss silk be used to clean between our teeth to help prevent decay.^[1] During the 1930’s toothbrushes were often made from plastic materials with nylon bristles instead of animal hair. This was deemed to be more hygienic and less of a breeding ground for bacteria and fungus.^[2]

During the early twentieth century government agencies emphasized the importance of good oral habits to reduce oral disease within the population. Soldiers returning home from battle incorporated the oral hygiene habits they had been trained to do while they served, into their daily civilian lives. This helped establish the importance of oral health within the general population. It later became a part of everyday life as we now know it to be. When we browse the oral hygiene aisle at our local grocery store or pharmacy, there is typically an assortment of options for one to choose from to meet their specific needs.

You can choose from a manual toothbrush that is made from plastic or bamboo, with bristles that are made from nylon or polyester fibers. Toothbrush bristle options are available in either soft, medium, or hard. The American Dental Association and most dental professionals recommend that individuals only use soft bristles, as they are the gentlest on our teeth and gums.^[6] Soft bristles lead to less damage, sensitivity issues, and costly treatment.^[6]

Many find that a battery operated or an electric toothbrush helps them in their efforts to effectively remove plaque and stain from their teeth. This option especially assists individuals who have hand dexterity challenges.^[6] It can prove helpful to the elderly, individuals with disabilities, individuals with braces, or children who have not yet developed full use of their hand dexterity.^[6]

Using floss or a water irrigator helps to remove debris interdentally. Cleaning between our teeth is important to help prevent interdental cavities and gum inflammation. Many love to be masters of frugality, however it is important to throw away floss or floss picks after you have used them once. These are not items that are intended to be reused. Reusing floss causes the strands to accumulate with more bacteria from your mouth as well as from the surfaces of wherever you placed it.^[5] Introducing bacteria into your mouth is never a good idea.

If your teeth are crowded together it can seem impossible to initially find floss that works best for you. Trial and error might be needed to find a floss that doesn’t seem shred or get stuck in your teeth. It’s usually best to avoid waxed flosses as they tend to be too thick for tight areas. Using ribbon-style flosses that are thin and flat are easier for people with tight spaces to use as it is easier to wiggle the floss between the teeth and less prone to getting stuck and shredding within the spaces. Some individuals like to use interdental brushes and picks to fit between spaces to remove debris.

It is important that we properly care for our oral hygiene devices such as our toothbrushes as they can be breeding grounds for bacteria. Our mouths are host to millions of germs.^[4] Our toothbrushes become contaminated with bacteria and oral debris which makes it important that we clean our toothbrush after each usage. Many people keep their toothbrushes on the bathroom counters. Studies have shown that an uncovered toothbrush can harbor 100 million bacteria, including E.coli bacteria, and Staphylococci (Staph), a bacteria that can cause skin infections.^[4]

Recommended toothbrush care:

After brushing, rinse your toothbrush thoroughly with tap water to remove debris.^[3]
Store you toothbrush in an upright position where the bristles can properly dry.^[3] Don’t place your toothbrush in a drawer or a medicine cabinet.^[3] You should refrain from placing it near others toothbrushes in a cup as well as if they touch they will transfer germs to one another.^[3]
Use a cover that will allow air to circulate so as to prevent the growth of mold or more microorganisms as a lack of air can breed more bacteria.^[3]
Use of a toothbrush sanitizer that uses an ultraviolet light to kill microorganism is recommended by many dental professionals.^[3]
Your toothbrush should be replaced every three months or sooner. If the brush shows signs of wear such as frayed bristles or bristles that fan out, that is a sign that it is time to replace the brush. Continuing to use a toothbrush or toothbrush head from an electric toothbrush that is in this condition, will decrease its effectiveness of removing debris from your teeth and gums.^[3]
I know we were taught the importance of sharing however when it comes to personal items such as a toothbrush we should not share our toothbrush with others.^[3] Sharing our toothbrush can cause the transfer of saliva, bacteria, and infectious disease to be passed between users.^[3]

Many choose to use a water flosser to remove the debris between their teeth. I have seen my patient’s gums improve when they use this device as many wouldn’t floss regularly despite how much I encouraged them too. A water flosser must be properly maintained.

How to Maintain Your Water Flosser:

Daily: To maintain the device, remove the water from the device prior to and after usage.
Weekly: Use a damp microfiber cloth with mild dish soap to wipe down the device on the outside. Clean the inside then flush the unit to remove all of the water that you placed within the unit while cleaning it.
Monthly: Every 1-3 months clean the reservoir. Use diluted distilled white vinegar to disinfect the reservoir, handle, flosser, and flosser tip. After using the distilled vinegar solution flush the unit with water.

Oral hygiene is important for our overall health and wellness. Taking proper care of the various devices we use to achieve good oral hygiene is critical to keep us healthy as well. Disposing of items within the recommended time frame is key to making sure they are effective and won’t cause you any health problems. Always read the instructions on your oral healthcare aides as some recommendations will vary depending on the manufacturer of the products.

Kari Carter-Cherelus

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Oral Hygiene – History of Dental Hygiene. http://www.historyofdentistry.net/dentistry-history/history-of-oral-hygiene/
Smithsonian. Oral Care. https://www.si.edu/spotlight/health-hygiene-and-beauty/oral-care
WebMD. The Ugly Truth About Your Toothbrush. Bernstein, Susan. (2015, March 22). https://www.webmd.com/oral-health/features/the-ugly-truth-about-your-toothbrush
CDC. Use & Handling of Toothbrushes. (2016, March 25) https://www.cdc.gov/oralhealth/infectioncontrol/faqs/toothbrush-handling.html#:~:text=Toothbrushes%20can%20have%20germs%20on,it%20in%20an%20upright%20position
Health Digest. Never Reuse Your Floss. Here’s Why. Marie, Erin. (2021, August 30). https://www.healthdigest.com/589744/never-reuse-your-floss-heres-why
ADA. Toothbrushes. (2022, October, 7). https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/toothbrushes

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Why you actually shouldn’t brush your teeth right after eating

Rachel Stroble — Mon, 27 Mar 2023 05:49:01 +0000

It’s counterintuitive to think that cleaning our teeth could ever be unhealthy, but due to invisible microbial processes, we could actually harm our teeth immediately after eating. Find out why.

You already know that brushing is important to your dental health, but were you aware that when you brush matters?

When should I brush?

To keep your mouth healthy, you should brush twice per day. The most important time to brush is before you go to bed, after your last meal or snack of the day. Pre-bedtime brushing is incredibly important because it removes plaque, which contains bad bacteria that multiplies overnight and can cause cavities and gum disease. Furthermore, any lingering sugars or carbohydrates feed the bacteria, compounding the issue.

What you eat matters

Even though brushing is critical, you should consider the timing of your brushing. If you have eaten or drank something acidic, such as soda, fruit, or coffee, brushing immediately afterward means you are scrubbing the acid into your tooth enamel. Acid is extremely detrimental to enamel and increases the likelihood of cavities. Also, even if you ate something that isn’t obviously acidic, such as crackers, the bacteria in your mouth metabolizes the carbohydrates to produce acid. Because if this, it is best to wait at least 30-60 minutes after eating to brush your teeth ^[1].

Consider these options instead

If you want a fresh mouth after eating, consider chewing sugar-free gum. Chewing gum helps to stimulate saliva flow, which in turn neutralizes pH and rinses away food debris^[3]. Additionally, gum helps to remove tiny food particles from the grooves in your teeth, helping to lower your risk of cavities^[3]. Selecting gum that contains xylitol offers a bonus! Xylitol is a naturally derived sugar alcohol that actually helps to kill the bad bacteria that causes cavities^[3]. Ingredients in food products are listed in order of concentration. In other words, the earlier in the ingredient list xylitol is listed, the more the product contains. Look for gum that has more xylitol in it for greater benefit. Keep all xylitol containing products away from dogs! It is poisonous to them ^[2]!

Another option is using mouthwash. Mouthwash can help to remove food debris and freshen your breath, without the risk of damaging the teeth. Look for a rinse that is alcohol-free and has a neutral or basic pH. Selecting a rinse that also contains fluoride will help to lower your risk of cavities as well.

If you must brush now

If you have a need to brush immediately after eating (maybe you will be giving a big presentation or walking down the aisle), ideally you should swish with baking soda water, as it neutralizes acid in the mouth. If you don’t have any baking soda on hand, plain water will rinse away some of the acidity. Try to keep brushing right after eating to a minimum, perhaps only for special events.

When you do brush…

No matter what time you are brushing, there are certain qualities to look for in a toothbrush. Always select a soft or extra soft brush, and replace it at least every 3 months, or sooner if you have been sick or the brush is worn out. If you use an electric toothbrush, you may consider using an at-home ultrasonic/UV cleaner to disinfect your toothbrush head after you’ve been sick. However, remember electric toothbrush heads need to be replaced just as often as manual brushes.

Rachel Stroble

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References

BDJ Team. (2015). The oral health benefits of sugarfree gum. BDJ Team 2, 15151. https://doi.org/10.1038/bdjteam.2015.151
Food and Drug Administration (n.d.) Paws Off Xylitol; It’s Dangerous for Dogs. https://www.fda.gov/consumers/consumer-updates/paws-xylitol-its-dangerous-dogs
Newton, J. T., Awojobi, O., Nasseripour, M., Warburton, F., Di Giorgio, S., Gallagher, J. E., & Banerjee, A. (2020). A systematic review and meta-analysis of the role of sugar-free chewing gum in dental caries. JDR Clinical & Translational Research, 5(3), 214-223. https://doi.org/10.1177/2380084419887178

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Don’t put germs in your mouth! Guide to keeping retainers, teeth aligners and oral appliances clean

Kari Carter-Cherelus — Mon, 30 Jan 2023 11:50:39 +0000

Cleaning the appliances that you use in your mouth is just as important as brushing your teeth. Appliances like clear retainers & night guards can grow unwanted bacteria and other types of germs that are harmful to your oral & overall health.

Clear braces or aligners are a type of orthodontic treatment that is used to straighten your teeth and correct malocclusion or bite issues.^[2] They have gained in popularity as they are considered by many to be more aesthetically pleasing, comfortable, and easier to comply with than traditional braces. Many wearers of the teeth aligners love that they are removable and that they can take a short break from them when needed.^[3] The old aligners are disposed of every couple of weeks and are replaced as treatment progresses.The problem however is that some users reportedly go long stretches without cleaning their oral appliances.^[4]

Despite being disposable, clear aligners still need to be cleaned properly.^[1] Just as you are supposed to brush your teeth at least twice a day, you should also maintain all oral appliances such as your aligners. Failure to clean aligners properly will result in them harboring harmful bacteria that causes odors, stains, and the accumulation of harmful debris that leads to tooth and gum problems.^[1]

The benefit of clear aligners is that you can remove them when needed such as when you are going to eat. Clear braces can stain easily if proper precautions are not taken. The user should avoid wearing them while consuming dark-colored foods and drinks, such as coffee, tea, red wine, and tomato sauce..^[2] It is important that upon removal you place them in a clean container and not in unhygienic places such as unclean surfaces, napkins, or in your pockets. Doing this will subject the oral appliances to bacteria that you then will introduce into your mouth.

Before placing the aligners back in your mouth you should either rinse them or clean them. Rinsing the aligners makes them appear cleaner and can remove visible debris. It is similar to rinsing dirty dishes prior to placing them in a dishwasher, you still haven’t removed the unseen bacteria that may have built up with just rinsing. To remove the unseen bacteria you must thoroughly clean them upon waking and prior to going to sleep.

How to properly clean aligners:

Rinse your aligners with water in the morning and at night.^[2]
Brush your aligners with a soft toothbrush and a nonabrasive toothpaste, so as to remove debris, food particles, and bacteria.^[2] Some manufacturers of oral appliances recommend that you use a clear liquid soap to remove debris.^[1] Speak with your dentist regarding their recommendations.
Rinse the aligners thoroughly after brushing them.^[2]
Store them in a clean dry protective case when not in use.^[2]

Cleaning Accessories:

Some clear aligner companies recommend maintaining your aligners by using tablets or cleaning crystals that dissolve in water to aid in cleaning them.^[1] You should try to avoid using denture cleaner tablets as these can potentially discolor the aligners overtime. Instead use cleaning tablets that are made especially for cleaning oral appliances such as clear braces, mouth-guards, whitening trays, or retainers.

You should place your aligners in a container and place the tablets or crystals in the container so that the aligners could be disinfected. After soaking in the solution for a few minutes you would manually brush the aligners with warm water.^[1]

Many dental professionals such as dental hygienists recommend using a UV cleaner to regularly disinfect your oral appliances such as clear braces, mouth-guards, whitening trays, or retainers and oral cleaning aides, such as your electric toothbrush heads. A UV light can kill up to 99.9 % of bacteria and germs that might be on your oral appliances.^[5] Many choose to use this method as they don’t have to worry about possibly having an allergic reaction to using a tablet or solution, as these products that might become absorbed into the appliances.^[5] A UV cleaner is great for quickly, safely, and effectively cleaning oral appliances as all you do is place the appliance in the UV cleaner with some water and press a button.^[5] After the designated time you can remove the appliance. This helps to maintain the appliances in-between thoroughly brushing them.

It is imperative that while you are in orthodontic treatment you make sure your oral hygiene routine is impeccable so that you can keep your mouth healthy. Brush your teeth two to three times a day and floss.^[2] Drinking plenty of water will prevent your mouth from getting dry as the aligners can decrease the saliva that is in your mouth leading to dental issues.

Staying hydrated with water can prevent the retainer from drying out, becoming damaged, and help to prevent bacteria overgrowth.^[4] Avoid smoking as this will also dry our out oral tissues, and increase the likelihood of gum issues. Visit your dentist regularly so that they can monitor the progression of your orthodontic treatment and alert you to any treatment changes or concerns.^[2]

Kari Carter-Cherelus

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References

How to Clean Invisalign: Do’s, Don’ts, and Best Practices. Nall, Rachel. (2020, October 19). https://www.healthline.com/health/how-to-clean-invisalign
Cleveland Clinic. Clear Braces.(2022, July 25). https://my.clevelandclinic.org/health/treatments/23568-clear-braces
Dental Health Society. Keeping Invisalign Clean-How to Do it and Why It’s Important. (2021, November 1). https://dentalhealthsociety.com/invisalign/keeping-invisalign-clean-how-to-do-it-and-why-its-important/
Medical News Today. 8 tips for cleaning a retainer. (2021, March 7). https://www.medicalnewstoday.com/articles/317894#Retainer-cleaning-myths
Do UV sanitizers work on retainers? Pepito, Mary Grace. (2022, April 7). https://www.orgoneenergy.org/blogs/news/do-uv-sanitizers-work-on-retainers

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