Caring For Your Teeth & Gums

Both dental decay and gum disease are caused by bacteria in the mouth. This bacteria forms a sticky white “biofilm” on the teeth known as plaque.

Without prompt removal, this biofilm will calcify (harden) and is then known as calculus or tartar, which is impossible to remove effectively at home. High plaque levels significantly increase your risk of dental diseases, and controlling plaque bacteria is the key to a healthy mouth.

Dr. Joseph Hollywood BDS recommends brushing every surface of every tooth with a good-quality electric toothbrush, twice a day for a minimum of 2 minutes.

Ideally the brush should have a pressure sensor to ensure that you are applying appropriate force. Brush heads should be small and round, with dense bristles, medium or soft. Avoid brush heads with lots of space between bristles and plastic components (see picture). Make sure that the heads are replaced regularly as they wear-out, and that the brush is always fully charged before you use it.

Apply a pea-sized amount of fluoridated toothpaste and place it in your mouth. There is no need to wet the brush with water or rinse it during brushing as this will only dilute the active ingredients in the toothpaste. Make sure to keep your mouth closed during cleaning, and do not switch the brush on before it is in your mouth.

The Bass technique is commonly accepted as a good brushing method:

1. Hold the electric toothbrush at a 45 degree angle towards the gums (see picture).  This ensures that the gum margins are thoroughly cleaned and is very important to prevent gum disease.

2. Start with the upper jaw, beginning on the outside of the right molars at the far back. Position the toothbrush on the outer surfaces. 

3. Delicately glide the rounded brush head over each tooth, ensuring slow and steady movement. Avoid any scrubbing motions - the brush head will do the work.Your only movements should be moving slowly from one surface to the next, rotating the wrist to ensure that the bristles are nudged gently in-between the teeth and towards the gum-margins.

4. Dedicate several seconds to each tooth and pay close attention to the gum line to ensure all plaque is removed from this area. Avoid “zipping” erratically around the mouth - if you work methodically from one surface of one tooth before moving on to the next, you are likely to perform a more effective clean.

5. After brushing the outer surfaces of the upper row of teeth, switch to the inner surfaces. Then repeat the process on your lower jaw. Note that inner surfaces are often harder to access, especially in the lower jaw due to the position of the tongue, and will take more time and effort to do a good job.

6. Finally, clean the chewing surfaces. Ensure that the vibrating bristles are “nudged” into all of the detailed grooves on the chewing surfaces of the back teeth. This is a common area where plaque is missed and cavities form!

7. After brushing, spit excess toothpaste but do not rinse for 30 minutes. This allows the fluoride to work best. Rinse the brush head thoroughly and return the brush to its charger.

Even the best electric toothbrush in the world, used with perfect technique, will fail to remove plaque hiding between the teeth. Since many people do not remove this hidden plaque every day, cavities very frequently form in these areas. I would recommend using dental floss at least 1x daily to remove plaque from these areas. I would suggest using a good quality floss such as Oral B Glide that won’t break regularly, as this can be very frustrating. See picture for good technique.

Remember to floss between every tooth, and behind the back of the last tooth. If your gums bleed, this is a sign of gum disease caused by plaque bacteria, and is not usually because you have been too rough. With daily flossing, this bleeding will usually stop, once the health of the gums improves in the absence of bacteria.

Alongside floss, interdental brushes are a fantastic way to clean in-between teeth. They come in multiple sizes, and you should use the largest size that will fit between your teeth without being forced. This will ensure effective cleaning, and most people will need a couple of sizes as the size of the gaps will vary between the front and back teeth.

Insert the brush between the teeth and move it gently forwards and backwards. If you inspect the brush after use you will usually see the white plaque biofilm that you have removed. Rinse this off before moving onto the next space. Remember that you can bend the wire 45-90° to assist in accessing the back of the mouth. Just like with flossing, remember: if your gums are bleeding, it is a sign of disease, not because you are being too rough.

I do not feel that mouthwashes form an essential part of good oral hygiene, and their importance pales in comparison to effective brushing, flossing and interdental brush use. If you do choose to use a mouthwash, ensure that it is alcohol-free, and has an effective antibacterial ingredient such as hydrogen peroxide (eg Colgate Peroxyl).

Do not use it straight after brushing as you will only rinse off all the fluoride in the toothpaste. Rinsing at different times of day (eg after lunch) is better. Mouthwashes containing Chlorhexidine (eg Colgate Savacol) are very antibacterial, and can be useful for short-term treatment of infections (for example 1-2 weeks of use to help alleviate a wisdom-tooth infection or a gum abscess). However, their long term use is not advised.

It is imperative that you use a fluoridated toothpaste. There is an abundance of evidence showing its safety and efficacy when appropriately dosed. Aim for the following doses, which can be found on the back of the box:

• Adult - Low risk: 1450 ppm.

• Child 6+: 1450ppm.

• Child 18 months to 6 years: 500ppm (consider 1000ppm if the child can spit out effectively).

For high risk adults, your dentist may recommend 5000ppm toothpaste (Colgate Neutrafluor 5000). This is obtainable from the pharmacy counter at the chemist and is used just like an ordinary toothpaste (pea sized amount, spitting not rinsing afterwards).

Plaque biofilm is white, and camouflages very well against teeth. For this reason, it is easy to miss when checking your teeth after cleaning. Disclosing tablets can help to address this. After brushing, flossing and using interdental brushes, chew the tablet so that the pink dye coats the teeth. Then take a cup of water and rinse the mouth thoroughly.

The dye will slide readily off all of the clean surfaces, but will stain any plaque you have left behind. New plaque appears bright pink, while older plaque deposits appear purple. Note where you have missed so you can modify your technique next time, then clean the teeth again until all the stained plaque is gone. Some chemists stock disclosing tablets, but they can be found easily online if you are having difficulty finding them (eg Curaprox). 

Sugar is the favourite food of oral bacteria. This includes both added sugars and natural sugars, such as those present in fruit and honey. Every time you consume sugar, the bacteria in your mouth go into overdrive. They rapidly multiply and will be very hard to control if they are well-fed, just like throwing petrol onto a fire that you are trying to extinguish. As they metabolise the sugar, they excrete acids which damage the teeth and start the formation of cavities.

If you minimise the number of occasions that your mouth is exposed to sugar, you will have a much easier time maintaining healthy teeth. It also causes type II diabetes and obesity. Soft drinks, energy drinks, fruit juice, smoothies, chocolates, lollies, biscuits and cakes are the obvious culprits, but if you check the packaging of processed foods you will be horrified how much sugar is added to things you might not expect.

You will need to be a savvy shopper to avoid sugar nowadays, but I strongly believe it is worth the time and effort. The cravings usually disappear with time, and your teeth and health will be vastly improved!

Acidic foods and drinks usually taste “sharp” or “sour”, and include vinegar, yoghurt, sauces, wine, beer, soft drinks and fruit juice. Acidic foods will cause the teeth to erode (wear) over time, and since tooth enamel has no ability to heal or regrow, this wear is permanent. For this reason, I would recommend minimising the consumption of acids in the diet.

Similarly, if you have any symptoms of acid reflux, such as a burning sensation in your chest (heartburn), usually after eating, which might be worse at night or while lying down; or backwash (regurgitation) of food or sour liquid, it is important you don’t ignore it as it can rapidly destroy the teeth and lead to other serious health problems. Speak to your GP if you think this may be the case.

Both smoking and vaping significantly increase the risk of gum disease. Smoking also increases the risk of oral cancer. We understand that quitting can be extremely challenging, but remember that you are much more likely to succeed with the help of your GP. 

Alcohol also increases the risk of oral cancer, especially so when combined with smoking. Most alcoholic drinks are acidic (including beer, especially sour and craft beers, wine, mixed drinks and cocktails). Many are also sugary (including sweet wine, most mixed drinks and cocktails). 

For most people, a dental check every 6 months is recommended. For high-risk individuals, 3 months may be more appropriate. This will help to ensure that any problems are detected and fixed early before they become major issues, and any missed plaque/calculus is removed before it becomes abundant. 

If you have any questions or need any further advice, please do not hesitate to contact the team on (07) 5441 3583.

Remember, prevention is better than cure!