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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1. American Dental Association. (2021, September 21). Floss/interdental cleaners. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/floss
2. 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/
3. 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
4. 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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Over the years there has been a rise in the usage of electronic cigarettes also known as “e-cigs,” “vapes,’ “e-hookahs, “vape pens,” and “electronic nicotine delivery systems (ENDS.)”^[2] The devices can look like traditional cigarettes, cigars, or pipes or they can be more unconventional in their design and resemble USB flash drives, pens, or something that is less detectable.^[2] This can be concerning as many youths could be potentially damaging their health while their caregivers are completely unaware.

The rise of underage use

It has been reported by various news outlets that there has been widespread usage of vapes by youths in schools in classrooms and bathrooms.^[8] The popularity amongst youth is attributed by researchers to the sweet flavoring that many companies incorporate into the vapor that is inhaled. Many youths believe that vaping is less harmful than smoking cigarettes. Vapes can also be less expensive than traditional cigarettes overtime which is more economical for the younger population.^[3][8] The U.S. Food and Drug Administration (FDA) prohibited the sale of prefilled cartridge e-cigarettes in any flavor other than tobacco or menthol, on January 2, 2020 unless authorized by FDA. Restricting harmful marketing tactics that were directed at young ones was instituted as well so as to help decrease the usage of these products by youths which was on the rise.^[8]

Oral health implications

Most popular reports tend to focus on the potential dangers using electronic cigarettes can have on one’s heart and lungs.^[1] The rise of vaping has lead to an outbreak of lung injuries and deaths that have been attributed to the individuals vaping habits.^[3] Research also shows that there is a negative correlation with the use of e-cigarettes and poor oral health.^[1] Nicotine in any form whether it is smoked or vaped restricts the blood flow to the gums.This restriction increases one’s risk to periodontal (gum) disease, inflammation, tooth cavities, and oral cancer.^[1]

Why vaping is not actually a safer alternative

Some e-cigarette users may have turned to vaping because they considered it a safer alternative to using traditional cigarettes. Research however, shows that the nicotine delivery and emission of some e-cigarettes is comparable to those from traditional cigarettes.^[6] E-cigarettes use a battery that heats up the liquid called “e-juice” into an aerosol that is inhaled by users. Some users think the steam from the vape pens are harmless water vapor when in actuality they can contain the following chemicals: nicotine, propylene glycol, formaldehyde, acetaldehyde, acrolein, dactyl, dtiethylene glycol, cadmium, benzene, heavy metals, and ultra fine particles that can be inhaled deep into the lungs.^[5][6] Many of these chemicals are considered to be cancer causing carcinogens that are also linked to causing lung disease, are weed killers, are used in explosives, or are used in antifreeze.The chemicals found in e-cigarettes increases an individual’s risk to gum disease, cavities, and oral cancer.^[1]

Gum disease & your health

The gums are the foundation of your mouth and aid in supporting your teeth and protecting the roots of your teeth. They provide a protective barrier between harmful oral bacteria that can affect our overall health and wellness. When someone has gum disease their gums are compromised. The gums aren’t able to protect the mouth from harmful bacteria due to being infected and inflamed. From the moment that the vapor from the e-cigarettes enter your body from the mouth, the toxic cocktail of chemicals begin to inflict damage.^[1] Nicotine in any form, whether it is vaped, smoked, or chewed restricts the blood flow to the gums and contribute to gum (periodontal) disease. Vaping can cause mouth and throat irritation, and cause the gums to become tender, swollen, and red.^[4] If the fluid in the vape contains nicotine, then there is an increased risk of teeth stains and discoloration, teeth grinding, and receding gums. Individuals with gum disease have an increased risk of having cardiovascular disease, diabetes, chronic respiratory disease, pregnancy complications, dementia, and cancer.^[6]

The time to quit is now

Quitting the use of tobacco can be difficult if you try to do it without the help of a healthcare professional. Often users relapse as tobacco dependence is a difficult habit to break. Talking with a healthcare provider can increase your chances of being successful. Your provider might counsel you and recommend cessation medications that are approved by the US Food and Drug Administration that are evidenced based treatments. Your health is worth all the effort that you make to maintain a healthy lifestyle and move towards having overall health and wellness.

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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There has been a renewed interest in home remedies over the years to improve one’s health without using traditional pharmaceutical means or medical interventions. This rise of interest in home remedies to fix oral issues is often attributed to social media trends that often go viral.^[5] However, according to the report Dental Dangers: Home remedies To Avoid While Waiting For Care, many are turning to at-home options due to their lack of access to professional oral healthcare services.^[6] Some individuals either are not willingly seeking professional oral care or have barriers that create access to care issues. These individuals often seek DIY options to help alleviate or cure bleeding gums, chronic dry mouth, broken teeth, toothaches, and cracked teeth.^[5] One method that some have considered is using oil pulling to cure their cavities. Some individuals have even become convinced from various internet sites that oil pulling can help cure cavities by reversing them, resulting in not needing fillings or other dental work. Can you cure your cavities by oil pulling? Is that really possible?

What is a cavity?

First, let’s discuss what a cavity actually is. Cavities or tooth decay is when the hard surface of your teeth (enamel) becomes damaged with tiny openings or holes.^[4] These openings are filled with harmful bacteria acids that will continue to burrow through the tooth breaking down the different layers of tooth structure and causing more damage.

You might not initially know you have a cavity when it first starts, however as it progresses you might experience a toothache, see holes or pits in your tooth, or see some brown, black, or white staining on your tooth.^[4] Delaying the proper treatment–having a dentist provide restorative treatment–can lead to a severe toothache, infection, nerve damage, or even tooth loss.^[4] Think of an apple that has a rotten piece on the fruit, if you cut the rotten piece out the apple is still salvageable. However if you don’t remove the rotten piece then it continues to infect the whole fruit and eventually becomes inedible.

To get rid of a cavity a dentist has to mechanically remove the decay from your tooth with special instruments and place a restoration on the tooth to strengthen it. Once the cavity has penetrated the hard enamel, restorative treatment is necessary because the decay cannot be reversed by any type of medicament.

What is oil pulling?

I know you’ve probably seen popular influencers or celebrities touting the healing benefits of oil pulling…but what is it? Oil pulling involves swishing with a teaspoon of oil in your mouth for twenty minutes every day and then to spitting the oil out.^[2] Many users prefer to use coconut oil for its antibacterial properties, however the original Ayurvedic method calls for the user to use sesame oil.^[2] Oil pulling has been done for centuries by enthusiastic users who claim it helps prevent tooth decay, bad breath, bleeding gums, throat dryness, and cracked lips.^[2]

Although oil pulling might not be the cure all that some claim it to be, according to research it can prove beneficial when used in conjunction with brushing and cleaning interdentally.^[3] Studies suggest that there are benefits to oil pulling such as reducing inflammation by decreasing the bacteria and it can prevent plaque formation.^[3] Certain oils such as coconut are known to have antibacterial properties and is a favorite amongst many who oil pull for its health benefits. You can not, despite the false claims online, cure your cavities by oil pulling.

How to oil pull:

• Swish with one teaspoon of coconut or sesame oil in your mouth for twenty minutes.^[3]
• After swishing for twenty minutes, spit the oil in the trash can. Spitting the oil down your drains could damage your plumbing.^[3]
• Rinse your mouth out with water.^[3]

The average individual can oil pull if they like as an adjunct to what they are already doing in their oral home care routine. If you are brushing at least twice a day for two minutes as well as cleaning in between your teeth with floss or another oral health aid ,then by all means have at it! (3) These are the basics and are the foundation of having a good oral routine that helps to reduce oral disease.^[3] If you are, however, not doing the basics will you realistically be able to incorporate oil pulling for twenty minutes a day daily into your routine?

It is important to make sure you have a realistic oral homecare routine that you can be consistent with. Make sure you visit a dental office regularly. Going to your dental office regularly to see dental professionals is important so as to alert you to any changes that are occurring in your mouth. Incorporating any adjunctive home remedy should be discussed with your dental professionals so they can give you the best tips and base suggestions on your specific needs. Seek out local resources that can help you with any access to care issues as there may be help available that you are unaware of.

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.

View My Profile Contact Kari

1. How to get rid of cavities: Do Home Remedies Work? (2022, December 29).https://health.clevelandclinic.org/how-to-get-rid-of-cavities/
2. Cleveland Clinic. The benefits of oil pulling for Dental Health. (2022, September 14). https://health.clevelandclinic.org/is-oil-pulling-your-best-choice-for-dental-health/
3. Oil Pulling for maintains oral hygiene. (2017, January 7). Shanghai, Vanish Kumar L. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198813/
4. Mayo Clinic. Cavities/tooth decay https://www.mayoclinic.org/diseases-conditions/cavities/symptoms-causes/syc-2035289
5. Dangerous at-home care: Who’s most at risk? Leaver, Elizabeth S. (2023, June 2). https://www.dentistryiq.com/dentistry/article/14294701/dangerous-athome-oral-care-whos-most-at-risk
6. CareQuest. Institute for Oral Health. Dental Danger: Home Remedies to avoid while waiting for dental care. Boston, MA (2023, April) https://www.carequest.org/system/files/CareQuest_Institute_Dental-Danger_5.19.23.pdf

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What is gingivitis?

Gingivitis is inflammation of the gums that can be caused by several factors, including poor dental hygiene, diet, hormones, and certain medications. If gingivitis is untreated, it can progress to more severe gum disease, periodontal disease, and bone loss. The condition is isolated to the soft-tissue area of the gingival epithelium and connective tissue. ^[1]

Gingivitis is a less serious form of periodontal disease and is a common condition affecting the gums. Gingivitis can be caused by a build-up of plaque leading to inflammation, redness, and bleeding gums, which is the most typical cause of gingivitis. Plaque is a biofilm that accumulates on the tooth surface and contains many bacteria. Leaving gingivitis untreated can progress to periodontitis, a more serious form of gum disease.

Periodontitis is when the periodontal condition has progressed beyond gingivitis into a chronic, destructive, and irreversible inflammatory disease state. If left untreated, bone loss and further destruction of the supporting tissue surrounding the tooth can become damaged, resulting in tooth loss and bad breath, and may complicate other systemic conditions.

Genetics, environmental, and behavioral factors are involved in the development of the disease, the exposure of susceptible individuals to its initiation, and the speed of progression. ^[2] Strong contributing factors to periodontal disease include smoking, diabetes mellitus, metabolic syndrome, and obesity.^[2]

The oral microbiome

The oral microbiome is defined as a collection of microorganisms that reside in the oral cavity. Oral bacteria can populate the human mouth as early as the day you are born. If these bacteria are imbalanced, the harmful bacteria can grow and cause destruction to your teeth and gums, leading to cavities and gum disease.

Common causes typically associated with gingivitis

Diet

An individual’s diet plays a significant role in their oral health, and what you eat directly impacts your oral health. Gingivitis may occur due to a vitamin C deficiency.^[1] A balanced diet rich in nutrients helps to keep teeth and gums healthy. On the other hand, sugary and acidic foods can influence a person’s oral environment making it more susceptible to tooth decay and gum disease. Be mindful of your dietary habits to maintain good oral and systemic health.

Hormones

Hormones play an essential role in oral health. Fluctuations in hormone levels can cause changes in the mouth, such as increased sensitivity or dryness. During adolescence, gingivitis appears earlier in girls (eleven to thirteen years) than in boys (thirteen to fourteen years).^[1]

During pregnancy, it has been suggested that estrogen levels determine the severity of gingival inflammation created against the biofilm at the gingival margin.^[1] Maintaining good oral health will reduce the risk of adverse pregnancy outcomes.

Oral pH

Saliva plays an essential role in oral health by washing away food particles and bacteria, influencing tartar formation and gum disease, and keeping the mouth hydrated. Saliva has a normal pH range of 6.2-7.6, with 6.7 being the average pH.^[3]. Healthy saliva contains basic compounds that neutralize acids produced by plaque bacteria.

Pathogens

Salivary diagnostics are a non-invasive way to determine if harmful pathogens are present. Many studies have observed that periodontal pathogens grow at particular pH environments.^[4]

Medications

Certain medications can also affect oral health. Several drugs prescribed for systemic conditions can cause drug-induced gingivitis as a side effect, such as phenytoin (used for epileptic seizures), calcium channel blockers (used for angina and high blood pressure), anticoagulants, and fibrinolytic agents, oral contraceptive agents, protease inhibitors, vitamin A and analogs.^[1]

Gingival Hyperplasia (Enlargement)

Drug-induced gingival overgrowth (DIGO), also referred to as drug-induced gingival enlargement, is noted as a side-effect of certain medications given for non-dental uses where the gums are not the intended target.^[1][5]

Gingivitis Prevention

The best way to prevent gingival inflammation is to perform beneficial oral hygiene practices including brushing and cleaning in between the teeth, eating a healthy diet, and avoiding tobacco and vaping products. Continuous collaboration and communication with your primary care physician and dental healthcare professionals will help prevent gingivitis.

If you’re concerned about how hormones, your daily oral hygiene practices, pathogens, diet, or medications may be impacting your oral health, speak to your dentist and healthcare provider for a more holistic approach to your oral-systemic health.

Lacy Walker

LACY WALKER, RDH, BS, CDA, FAAOSH - dental hygienist, speaker, owner of Shared Hygiene, LLC, & writer w/ 25 years of experience in the dental field working in a psychiatric hospital, cosmetic, restorative, DSO, and periodontal practices. Lacy is the CE Director for A Tale of Two Hygienists podcast & Public Relations Chair for the AADH. She has a passion for the oral-systemic connection & is published in DACE, RDH Magazine, & DrBicuspid. Lacy is an approved provider of CE credits through AADH.

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1. Rathee M, Jain P. Gingivitis. [Updated 2022 Jun 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557422/
   
2. Könönen, Eija, Mervi Gursoy, and Ulvi Kahraman Gursoy. 2019. “Periodontitis: A Multifaceted Disease of Tooth-Supporting Tissues” Journal of Clinical Medicine 8, no. 8: 1135. https://doi.org/10.3390/jcm8081135
3. Baliga, S., Muglikar, S., & Kale, R. (2013). Salivary pH: A diagnostic biomarker. Journal of Indian Society of Periodontology, 17(4), 461–465. https://doi.org/10.4103/0972-124X.118317
4. Koppolu P, Sirisha S, Penala S, et al. Correlation of Blood and Salivary pH Levels in Healthy, Gingivitis, and Periodontitis Patients before and after Non-Surgical Periodontal Therapy. Diagnostics (Basel). 2022;12(1):97. Published 2022 Jan 3. doi:10.3390/diagnostics12010097
5. Tungare S, Paranjpe AG. Drug Induced Gingival Overgrowth. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538518/

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Did you know that prolonged high fever damages teeth? This is particularly true for children. Read on to learn more about the link between childhood illness and lifelong dental issues.

How does fever affect the body overall?

The human body generally maintains a stable temperature of 98.6 degrees Fahrenheit. A high fever is generally considered to be 102 degrees Fahrenheit or greater for children, or 103 degrees Fahrenheit or higher for adults ^[2]. When someone gets sick, their body works to fight illness by increasing their internal temperature. Fever often causes aching muscles and joints, and chills. During a febrile state (fever), the body’s metabolism speeds up and uses its own proteins as an energy source ^[6]. This is a shift from the body’s typical use of glucose, the sugar normally found in the blood. There is also an increased need for oxygen and a higher heart rate ^[6]. Prolonged fever can damage critical organs including the brain, heart, and kidneys ^[6]. What’s more, fever can damage teeth!

Who is most at risk for dental problems due to fever?

Children are at the highest risk of damage to teeth due to fever. Before teeth erupt, they slowly form inside the jaw bone in specialized capsules of tissue also known as tooth buds. Children under 12 have teeth that have not come in yet, so they have tooth buds inside the jaw bone where there is a possibility that the formation of the teeth can be disrupted.

How does fever damage teeth?

Teeth are formed through an amazing process that happens inside the bone. There are various different types of special cells that build the teeth layer by layer before they erupt. When the intricate tooth development process is disturbed, the enamel may suffer. When this happens, teeth erupt as rough, pitted, and discolored ^[1].

How does childhood fever cause dental problems in adulthood?

Even though fever damages teeth before they erupt, weak enamel comes with lifelong consequences. These teeth are at a higher risk of dental disease. Poorly formed enamel is not as strong as healthy enamel. Roughness and pitting in teeth cause them to retain more plaque because bacteria have more places to hide and attach. This makes it more difficult to effectively keep the oral cavity clean. Increased plaque retention results in more acid attack on the enamel, which causes an increased risk of dental decay ^[5]. Plaque also contains bacteria that are responsible for gum disease ^[5].

How can I protect my child’s teeth?

If your child has a fever, call a physician to see if a visit to the doctor’s office is needed, or if over the counter fever-reducing medications should be administered. Common fever-reducing medications are acetaminophen and ibuprofen. It is critical that you follow correct dosing instructions since children do not need adult-sized dosages. Too much of certain medications can cause serious damage to the liver ^[3]. Some children may not be able to take these medications, so be sure to follow your doctor’s guidance. Never give aspirin to a child or adolescent, as it increases the risk of Reye syndrome, a serious condition that can cause brain damage or even death ^[4]

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.

View My Profile Contact Rachel

1. Fatturi, A. L., Wambier, L. M., Chibinski, A. C., Assunção, L. R. da S., Brancher, J. A., Reis, A., & Souza, J. F. (2019). A systematic review and meta‐analysis of systemic exposure associated with molar incisor hypomineralization. Community Dentistry and Oral Epidemiology, 47(5), 407–415. https://doi.org/10.1111/cdoe.12467
2. Mayo Clinic. (n.d.) Fever. https://www.mayoclinic.org/diseases-conditions/fever/symptoms-causes/syc-20352759#:~:text=a%20preexisting%20illness.-,Adults,Severe%20headache
3. Normandin, P. A., Benotti, S. A., & Mullins, M. A. (2020). Hidden Danger: Pediatric Acetaminophen Overdose Unintentional and Intentional Emergencies. Journal of Emergency Nursing, 46(6), 914–922. https://doi.org/10.1016/j.jen.2020.06.015
4. Schror, K. (2007). Aspirin and Reye Syndrome: A Review of the Evidence. Paediatric Drugs, 9(3), 195–204. https://doi.org/10.2165/00148581-200709030-00008
5. Scharnow, A. M., Solinski, A. E., & Wuest, W. M. (2019). Targeting S. mutans biofilms: A perspective on preventing dental caries. MedChemComm, 10(7), 1057–1067. https://doi.org/10.1039/c9md00015a
6. Swetha Balli; K. R. Shumway; S. S. (2022). Physiology, Fever. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK562334/

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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

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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1. 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.
2. 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
3. Rathee, M., & Jain, P. (2022). Gingivitis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557422/
4. 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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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

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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1. Oral Hygiene – History of Dental Hygiene. http://www.historyofdentistry.net/dentistry-history/history-of-oral-hygiene/
2. Smithsonian. Oral Care. https://www.si.edu/spotlight/health-hygiene-and-beauty/oral-care
3. 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
4. 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
5. 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
6. ADA. Toothbrushes. (2022, October, 7). https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/toothbrushes

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Morning breath is a frustrating & embarrassing condition for people that are regularly brushing & flossing but nothing seems to stop it. Learn the causes and how to get rid of it.

What causes morning breath?

Morning breath, an unpleasant odor, is caused by the build-up of bacteria in the mouth during the night and can cause anxiety and social embarrassment. When you sleep, your mouth becomes dry, and this allows bacteria to multiply. Bad breath, also known as halitosis, is a common problem that can be caused by a variety of factors, including poor dental hygiene, cavities, certain foods and drinks, smoking, and medical conditions.

Oral malodor (halitosis) is common, and 8-50% of people perceive that they have persistent, recurrent episodes of oral malodor.^[1] Oral malodor typically originates directly from the oral cavity secondary to periodontitis (gum disease), tongue debris, poor oral hygiene, deep caries (cavities), inadequately fitted restorations, or endodontic lesions. ^[2][7] In a study that investigated salivary flow, dryness of the oral cavity is considered as one of the causes of oral malodor.^[3]

Saliva influences morning breath: Why is saliva production lower at night? How mouth breathing can affect morning breath

Saliva is more than just spit! It plays an essential role in your oral health and influences your morning breath. Saliva is the mouth’s natural cleanser and helps to remove food and bacteria from the teeth and gums to keep your mouth healthy. Saliva contains enzymes that help to break down food, assists in washing away food debris and bacteria, and contains minerals that help to remineralize your teeth to prevent cavities.

The absence of saliva causes an increase in Volatile Sulfur Compounds, VSCs, and the detection of VSCs can aid in the identification of their source.^[3][8] Furthermore, sleeping with your mouth open can cause more dryness in addition to what naturally occurs at night and can influence the severity of morning breath.

Other causes that affect morning breath

Poor oral hygiene

The plaque that occurs naturally can accumulate on your teeth, contributing to morning breath. Wearing dentures at night and inadequate tongue cleaning can also contribute to morning breath. Morning breath is caused by stagnation of saliva and putrefaction of entrapped food particles, an accumulation of bacteria on the tongue recognized clinically as coated tongue, and a decrease in liquid intake. ^[3] A coated tongue is a grayish-white deposit on the tongue and is one of the main causes of bad breath, which is a socially unacceptable condition. ^[4]. Tongue anatomy can also play a role in the accumulation of bacteria. For example, a fissured tongue (grooves on the top of the tongue) provides the ideal environment for bacteria to grow. According to the American Academy of Oral Medicine, a fissured tongue occurs in about 5% of the U.S. population, and men are affected slightly more commonly than women.^[5]

Periodontal disease is a chronic inflammatory disease of the tissue supporting the teeth. If the gum tissue is compromised with the accumulation of pathogenic bacteria (bacteria that cause disease), it could lead to the unwanted side effect of bad breath. Halitosis is a common complaint in the population of patients affected by periodontitis.^[6]

Cavities

Poor oral hygiene and consuming food and sipping drinks high in sugar throughout the day can contribute to the development of cavities.

Smoking

Smoking is a major cause of bad breath because it dries out the mouth and increases the build-up of bacteria. It also stains the teeth and leaves a lingering smell on the breath.

Food consumption

Certain foods, such as garlic, onions, and spicy foods, can cause bad breath due to their strong odors. Other foods, such as coffee and citrus fruits, can also contribute to bad breath. Prevalence of bad breath is very common in the general population, and nearly more than 50% of the general population has bad breath. ^[7]

ENT

Most halitosis patients seen in an ENT (Ear, Nose & Throat) practice can be localized to the tongue. ^[8] Volatile sulfur compounds originate mainly from the oral and nasal cavities.^[9] Acute or chronic throat infections, postnasal drip, and tonsilloliths (tonsil stones) can contribute to bad breath. Tonsil stones are stones that arise as a result of calcium being deposited in conjunction with bacteria in the crevices of the tonsils.

When your head is full of mucus, either due to allergies or sickness, the mucus provides a food source for the bacteria in your mouth and throat, and this creates an environment for these bacteria to produce odors.

GI disease processes: Diabetes and GERD

Certain medical conditions, such as diabetes and gastroesophageal reflux disease (GERD) can cause bad breath due to the build-up of bacteria in the mouth or due to other factors associated with these conditions. A fishy-smelling breath is reflective of kidney problems, while fruity-smelling breath can be a sign of diabetes. Regardless of the oral conditions, a study has reported that GERD-related symptoms were associated with halitosis.^[10] People with diabetes have high blood sugar levels that increase glucose levels in saliva. This provides food for bacteria in the mouth and leads to the build-up of dental plaque, contributing to bad breath and gum disease.

How to prevent morning breath?

While there’s no complete way to eliminate morning breath, there are a few things you can do to lessen the severity, such as brushing your teeth, utilizing a tongue cleaner, using mouthwash, chewing sugar-free gum, taking probiotics, and avoiding tobacco and sugary foods before bed. Antibacterial mouth rinsing agents act on halitosis-producing bacteria.^[3] However, mouthwashes may only provide temporary relief, and if they contain alcohol, it can influence the severity of morning breath.

Reducing plaque buildup on the teeth and tongue will help in reducing your risk of developing cavities and morning breath. Tongue scrapers are shaped according to the anatomy of the tongue and reduce 75% of the VSCs compared to only 45% using a toothbrush.^[3] Sugar-free chewing gum could be considered a therapeutic alternative to decrease or neutralize the amount of VSCs present in oral breath.^[8] Morning breath can be easily treated once you know the source and the continuity of seeing your dental healthcare professional on a regular basis based on your needs.

Lacy Walker

LACY WALKER, RDH, BS, CDA, FAAOSH - dental hygienist, speaker, owner of Shared Hygiene, LLC, & writer w/ 25 years of experience in the dental field working in a psychiatric hospital, cosmetic, restorative, DSO, and periodontal practices. Lacy is the CE Director for A Tale of Two Hygienists podcast & Public Relations Chair for the AADH. She has a passion for the oral-systemic connection & is published in DACE, RDH Magazine, & DrBicuspid. Lacy is an approved provider of CE credits through AADH.

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References

1. Porter, S. R., & Scully, C. (2006). Oral malodour (halitosis). BMJ (Clinical research ed.), 333(7569), 632–635. https://doi.org/10.1136/bmj.38954.631968.AE
2. Suzuki, N., Fujimoto, A., Yoneda, M. et al. Resting salivary flow independently associated with oral malodor. BMC Oral Health 17, 23 (2017). https://doi.org/10.1186/s12903-016-0255-3
3. Kapoor, U., Sharma, G., Juneja, M., & Nagpal, A. (2016). Halitosis: Current concepts on etiology, diagnosis and management. European journal of dentistry, 10(2), 292–300. https://doi.org/10.4103/1305-7456.178294
4. Seerangaiyan, K., Jüch, F., & Winkel, E. G. (2018). Tongue coating: its characteristics and role in intra-oral halitosis and general health-a review. Journal of breath research, 12(3), 034001. https://doi.org/10.1088/1752-7163/aaa3a1
5. https://www.aaom.com/fissured-tongue
6. Musić, L., Par, M., Peručić, J., Badovinac, A., Plančak, D., & Puhar, I. (2021). Relationship Between Halitosis and Periodontitis: a Pilot Study. Acta stomatologica Croatica, 55(2), 198–206. https://doi.org/10.15644/asc55/2/9
7. Aylıkcı, B. U., & Colak, H. (2013). Halitosis: From diagnosis to management. Journal of natural science, biology, and medicine, 4(1), 14–23. https://doi.org/10.4103/0976-9668.107255
8. Krespi YP, Shrime MG, Kacker A. The relationship between oral malodor and volatile sulfur compound–producing bacteria. Otolaryngology–Head and Neck Surgery. 2006;135(5):671-676. doi:10.1016/j.otohns.2005.09.036
9. MK Nakhleh,M Quatredeniers,H Haick. Detection of halitosis in breath: Between the past, present, and future. First published: 16 June 2017 https://doi.org/10.1111/odi.12699
10. Struch, F., Schwahn, C., Wallaschofski, H., Grabe, H. J., Völzke, H., Lerch, M. M., Meisel, P., & Kocher, T. (2008). Self-reported halitosis and gastro-esophageal reflux disease in the general population. Journal of general internal medicine, 23(3), 260–266. https://doi.org/10.1007/s11606-007-0486-8

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If someone’s hands started bleeding when they washed them, they would panic instantly. Inside their head, alarms would be ringing, “do I have an infection?”, “Am I sick?”, “Should I see a doctor?” and they would be right to ask these questions since it is not normal for your hands to start bleeding when you wash them.
It also is not normal for your gums to bleed when you brush your teeth.
Do your gums bleed because you have an infection? Is it because you’re brushing too hard? Maybe both, maybe neither. Let’s explore a few reasons your gums could be bleeding when you brush your teeth.

Hormones

Women are likely to experience bleeding when brushing due to cyclical hormone fluctuations. One prime example is pregnancy. When a woman is pregnant, her progesterone levels rise^[1], which can cause pregnancy gingivitis. Progesterone also rises during a woman’s menstrual cycle, so she is likely to experience bleeding then as well. While men may not experience hormonal bursts of oral cavity bleeding as adults, they did as teenagers^[1]. Puberty causes hormonal fluctuations which result in increased systemic blood flow. This results in increased blood flow to the gums making them more prone to bleeding^[1].

Calculus/tartar buildup

If one is not brushing or flossing regularly, they will begin to get tartar (or calculus) build up on their teeth. This calculus can also build up underneath the gums and harbors plaque and bacteria further irritating the tissues. If one has light build-up and plaque on their teeth and is experiencing bleeding, they likely have gingivitis, inflammation of the gums. If the tartar is already underneath the tissues and has made its way to the supporting bone of the teeth, they have periodontal disease and will need a deep cleaning followed by regular cleanings to keep their teeth clean and to prevent further bleeding in the oral cavity.

Restorations

If one has crowns or large fillings, one may also be susceptible to bleeding when brushing or flossing. This is because the margins of crowns can be sneaky places for plaque to hide or food to get trapped. This is also true of large fillings which can make it difficult to floss or remove any plaque or debris that may get trapped or lodged in between the teeth. The plaque, food, and debris that are not removed irritate the tissues and cause them to swell and bleed.

Aggressive Brushing

People often think the harder they brush the cleaner their teeth will be, but nothing could be further from the truth. Aggressive brushing only leads to dental issues like gum recession, gum irritation, and the loss of tooth enamel. When brushing, it is important to brush in soft circles with a soft toothbrush and not side to side as the scrubbing motion is too aggressive to the gums.

Bleeding in the oral cavity is always a cause for concern and should always be taken seriously. The body is incredibly smart and when it tries to tell you something, you should listen!

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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References

1. Grover, C. M., More, V. P., Singh, N., & Grover, S. (2014). Crosstalk between hormones and oral health in the mid-life of women: A comprehensive review. Journal of International Society of Preventive & Community Dentistry, 4(Suppl 1), S5–S10. https://doi.org/10.4103/2231-0762.144559

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The cycle of demineralization and remineralization

The mouth needs to be balanced and rebalanced to maintain a healthy environment for our teeth. Each time we eat, the acid measurement in our mouth fluctuates significantly. The pH value depends upon the foods we consume and how frequently we are consuming them.^[2] Oral pH drops significantly when fermentable carbohydrates, sugars, and acids enter the mouth. When pH is low plaque bacteria joins with acid causing essential vitamins to dissipate from the enamel.

The balance

Saliva neutralizes the pH and clean acids produced by bacteria, creating a balanced pH and preventing further demineralization of enamel. If production of bacteria accelerates faster than saliva removal, colonization of bacteria begins, lessening the buffering effect, and within an acidic environment, demineralization continues to damage tooth structure.

Remineralization can only occur in an environment free of acid

Remineralization will occur naturally with healthy flow continuous production of saliva.^[3] Saliva washes away acids allowing essential minerals to return to the tooth surface. If frequency of food intake is high and saliva is unable to maintain a balance, permanent damage to a tooth can occur.

pH function at different values

The pH of saliva at rest, like when we are sleeping, is about 6.75 and considered safe. The pH of stimulated saliva is about 7.8 and is ideal for tooth remineralization. During the consumption of food and beverages the oral pH drops below 5.5, the teeth are at risk for mineral loss until the pH recovers.^[4] Prolonged periods of low pH cause more demineralization than mineralization and with time, result in permanent damage.

Reducing the risk

Limit the amount and frequency of sugary and acidic substances. Ideally, consumption of sugary or acidic foods and beverages should be limited to mealtime. It is advised to only drink water between meals. If it is necessary to snack, it is best not to sip on a beverage or pick at food continuously. Allowing saliva to return to healthy pH, as often as possible is key to reducing the risk of tooth decay.

Erin Stelbrink

Erin Stelbrink is a Registered Dental Hygienist with 11+ years of experience as a licensed hygienist and oral health care professional. She holds a passion for researching and acquiring awareness of the latest technologies and methods for providing valuable health care service and clinical treatment. Have more questions? Email Erin at erin@smilebrilliant.com

References

1. Super Health – Nature’s Sunshine Products – Introduction to …" Insert Name of Site in Italics. N.p., n.d. Web. 13 Oct. 2014 http://a-renewedhealth.com/health_information/super_health
2. Darby, Michele Leonardi. Mosby’s Comprehensive Review of Dental Hygiene. St. Louis, MO: Mosby Elsevier, 2006. Print.
3. The Demin/remin Cycle.- Registered Dental Hygienist. N.p., n.d. Web. 13 Oct. 2014.
4. Wilkins, Esther M.Clinical Practice of the Dental Hygienist. Philadelphia: Wolters Kluwer Health/Lippincott Williams Wilkins, 2009. Print.

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