Sunday, July 26, 2009

Oral hygiene

Oral hygiene is the practice of keeping the mouth and teeth clean to prevent dental problems and bad breath.

A dental hygienist demonstrates dental flossing.

Teeth cleaning

Teeth cleaning is the removal of dental plaque and tartar from teeth to prevent cavities, gingivitis, and gum disease. Severe gum disease causes at least one-third of adult tooth loss.

Generally, dentists recommend that teeth be cleaned professionally at least twice per year. Professional cleaning includes tooth scaling, tooth polishing, and, if too much tartar has built up, debridement. This is usually followed by a fluoride treatment for children and adults.

Between cleanings by a dental hygienist, good oral hygiene is essential for preventing tartar build-up which causes the problems mentioned above. This is done by carefully and frequently brushing with a toothbrush and the use of dental floss to prevent accumulation of plaque on the teeth.

Interdental brushing

Periodontologists nowadays prefer the use of interdental brushes to dental floss. Apart from being more gentle to the gums, it also carries less risk for hard dental tissue damage. There are different sizes of brushes that are recommended according to the size of the interdental space. It is desirable to clean between teeth before brushing to enable easy access for the saliva fluoride mix to remineralise any demineralised tooth often resulting from food left on teeth after every meal or snack.


The use of dental floss is an important element of the oral hygiene, since it removes the plaque and the decaying food remaining stuck between the teeth. This food decay and plaque cause irritation to the gums, allowing the gum tissue to bleed more easily. Acid forming foods left on teeth also demineralise tooth eventually causing cavities. Flossing for a proper inter-dental cleaning is recommended at least once per day, preferably before bedtime, to help prevent receding gums, gum disease, and cavities between the teeth. Interdental cleaning is important before brushing to provide easy access of the saliva fluoride mix to remineralise any demineralised tooth to help prevent tooth decay.

Tongue cleaning

Cleaning the tongue as part of the daily oral hygiene is essential, since it removes the white/yellow bad breath generating coating of bacteria, decaying food particles, fungi (such as Candida), and dead cells from the dorsal area of tongue. Tongue cleaning also removes some of the bacteria species which generate tooth decay and gum problems.

Gum care

Massaging gums with toothbrush bristles is generally recommended for good oral health. Flossing is recommended at least once per day, preferably before bed, to help prevent receding gums, gum disease, and cavities between the teeth.

Oral irrigation

Dental professionals usually recommend oral irrigation as a great way to clean teeth and gums.

Oral irrigators can reach 3-4 mm under the gum line, farther than toothbrushes and floss. And, the jet stream is strong enough to remove all plaque and tartar. The procedure does leave a feeling of cleanliness and freshness, and does disrupt more plaque or bacteria as floss since it cleans deeper.

Food and drink

Foods that help muscles and bones also help teeth and gums. Breads and cereals are rich in vitamin B while fruits and vegetables contain vitamin C, both of which contribute to healthy gum tissue.(8) Lean meat, fish, and poultry provide magnesium and zinc for teeth. Some people recommend that teeth be brushed after every meal and at bedtime, and flossed at least once per day, preferably at night before sleep. For some people, flossing might be recommended after every meal. Some foods like fruit and sugar confection are acid forming. Chewing obviously forces food between teeth generally displacing previously trapped food so it is a good idea to chew tooth friendly foods before and after meals or snacks to reduce acid demineralisation and even remineralise demineralised tooth as when chewing celery that forces saliva into trapped food to dilute sugar, neutralise acid and remineralise demineralised tooth. However over 80% of cavities occur inside pits and fissures on chewing surfaces of back teeth. So it is clear that acid forming foods cause these cavities and if fissure sealants are places over these surfaces to block food being trapped inside pits and fissures, acid demineralisation and tooth decay cannot progress.

Beneficial foods

Some foods may protect against cavities. Fluoride is a primary protector against dental cavities. Fluoride makes the surface of teeth more resistant to acids during the process of remineralisation. Drinking fluoridated water is recommended by some dental professionals while others say that using toothpaste alone is enough. Milk and cheese are also rich in calcium and phosphate, and may also encourage remineralisation. All foods increase saliva production, and since saliva contains buffer chemicals this helps to stabilize the pH to near 7 (neutral) in the mouth. Foods high in fiber may also help to increase the flow of saliva. Sugar-free chewing gum stimulates saliva production, and helps to clean the surface of the teeth.(8)

Detrimental foods

Sugars are commonly associated with dental cavities. Other carbohydrates, especially cooked starches, e.g. crisps/potato chips, may also damage teeth, although to a lesser degree since starch has to be converted by enzymes in saliva first.

Sucrose (table sugar) is most commonly associated with cavities. The amount of sugar consumed at any one time is less important than how often food and drinks that contain sugar are consumed. The more frequently sugars are consumed, the greater the time during which the tooth is exposed to low pH levels, at which point demineralisation occurs (below 5.5 for most people). It is important therefore to try to encourage infrequent consumption of food and drinks containing sugar so that teeth have a chance to be repaired by remineralisation and fluoride. Limiting sugar-containing foods and drinks to meal times is one way to reduce the incidence of cavities. Sugars from fruit and fruit juices, e.g., glucose, fructose, and maltose seem equally likely to cause cavities.

Acids contained in fruit juice, vinegar and soft drinks lower the pH level of the oral cavity which causes the enamel to demineralize. Drinking drinks such as orange juice or cola throughout the day raises the risk of dental cavities tremendously.

Another factor which affects the risk of developing cavities is the stickiness of foods. Some foods or sweets may stick to the teeth and so reduce the pH in the mouth for an extended time, particularly if they are sugary. It is important that teeth be cleaned at least twice a day, preferably with a toothbrush and fluoride toothpaste, to remove any food sticking to the teeth. Regular brushing and the use of dental floss also removes the dental plaque coating the tooth surface.

Chewing gum assists oral irrigation between and around the teeth, cleaning and removing particles, but for teeth in poor condition it may damage or remove loose fillings as well. However gum cannot absorb and expell saliva so cannot force saliva inside pts and fissures or between teeth like chewing celery, so cannot easily dilute sugar, neutralise acid and remineralise demineralised tooth. It seems there is more in depth analysis is needed into the relationship between food, teeth and plaque bacteria.


Smoking and chewing tobacco are both strongly linked with multiple dental diseases. Regular vomiting, as seen in bulimics, also causes significant damage.

Mouthwash or mouth rinse improve oral hygiene. Dental chewing gums claim to improve dental health.

Retainers can be cleaned in mouthwash or denture cleaning fluid. Dental braces may be recommended by a dentist for best oral hygiene and health. Dentures, retainers, and other appliances must be kept extremely clean. This includes regular brushing and may include soaking them in a cleansing solution.

Oral hygiene and systemic diseases

Several recent clinical studies show a direct link between poor oral hygiene (oral bacteria & oral infections) and serious systemic diseases, such as:

  • Cardiovascular Disease (Heart attack and Stroke),
  • Bacterial Pneumonia,
  • Low Birth Weight,
  • Diabetes complications,
  • Osteoporosis.

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