To Rinse or Not to Rinse?
With so many rumours about how to care for your teeth, it can be pretty confusing trying to differentiate between fact and fiction. To rinse or not to rinse? Fluoride or no fluoride? Which mouth rinse should I use, if any? In this article I have outlined some of the key pieces of advice I give my patients regarding oral hygiene.
Frequency and duration of brushing
Provided you are having a food intake of less than 5 times per day, it is advised that you brush your teeth twice, for 2 minutes each time. This is only 0.3% of your day, which is hardly any time at all to maintain your smile. Plaque (the white soft layer that builds up on your teeth containing decay-causing bacteria) forms on the teeth in 4-12 hours after brushing. Therefore brushing once per day is not sufficient. I recommend getting a timer or using an electric toothbrush which lets you know when you have brushed for 2 minutes as it can feel like a long time.
Brush before eating
It is advisable to brush your teeth before eating or drinking, or more than 60 minutes after. Following a sugar or acid attack on your teeth the enamel (outer surface) is softened, making it more likely to be worn away by brushing. For the next 30 to 60 minutes after eating, the acidity level (or 'pH') in your mouth gradually goes back to normal, and the enamel is less soft.
Avoid acidic or sugary snacks
Acids and sugars can both cause damage to your teeth (see the dental decay and fillings procedures pages for more information). Therefore, if you really can't resist a sweet treat, it is better to have this with a meal, to reduce the damage caused. Safe snacks are savoury crackers, crisps, cheese, vegetables and even fresh fruit.
I recommend the 'Modified Bass Technique' to my patients. This technique has X steps to follow.
1) Brush in circular motions rather than side to side
2) Tip the brush at a 45 degree angle towards the gum line
3) Follow a system to ensure all areas of the mouth are covered (cheek side, tongue side, biting surface)
4) Stroke the back of your bottom teeth from the gum line up to the tip to ensure this surface is cleaned
5) Have the toothbrush part overlapping the gums when brushing to ensure the gum line is cleaned - this is essential
It is essential that you do not rinse your mouth after brushing. This removes the toothpaste which is beneficial in strengthening your teeth and preventing decay. Therefore I recommend using a mouthwash that contains fluoride (but no alcohol), to rinse and spit for 60 seconds at a different point in the day, for example after lunch. Following brushing you should spit out excess toothpaste, but do not rinse with water or mouthwash at this time. Provided you are over 8 years old and do not already take other fluoride supplements, most people are safe to use a 225ppm fluoride mouthwash (0.05% NaF) such as Colgate fluoriguard, however it is always sensible to double check with your dentist to make sure your routine is right for you! More specific detailed advice can be found on the Department of Health website in their Toolkit for Prevention document.
I recommend using a toothpaste containing 1,450ppm fluoride. It should say this on the back. This is safe for children over 3 years old to use, as long as they only use a small smear, advancing to a pea size once they are over 7 years old. Below age 3 your child should be using a toothpaste with 1,000ppm fluoride, unless your dentist advises a different concentration. It is essential the toothpaste is not swallowed and is spat out after brushing. Children who are at high risk of developing decay may be given a stronger toothpaste or be prescribed fluoride mouthrinses or drops, for example.
I recommend all my patients use floss or TePe interdental brushes between their teeth every time they brush. I recommend using these before brushing so that any bits you pull on to your teeth can be brushed away. Water flossers and air flossers can remove debris, but I personally find the mechanical action of the first two suggestions works best for my patients. Floss can be bought on sticks or devices to help you reach the more fiddly areas. Insert the floss between the teeth and slide it back out whilst pulling the floss tight to the contour of the tooth. This physically scrapes away plaque that is stuck to the side of the tooth. Rinse the floss between each tooth to avoid transferring debris. TePe brushes should be inserted against the gum line between the teeth, twisted round in a circle then pulled out and rinsed. I recommend using the biggest size that comfortably fits (see youtube for demonstrations of this).
Sugar free chewing gum is great for stimulating saliva flow which helps to neutralise acids in the mouth following an acid attack. Whilst it isn't an alternative to brushing, it helps to freshen your breath throughout the day.
Regular dental check-ups
I recommend check ups at 3 months, 6 months and 1 year depending on the level of dental disease in my patients' mouths and their risk of disease. There are some exceptions to this however the majority of patients have dental examinations at these intervals. It is essential to keep on top of dental reviews to ensure your oral hygiene is optimum and doesn't need any alterations, to screen for gum disease and to check for decay, oral cancer and other conditions of the mouth.
Night time routine
At night the levels of saliva in your mouth reduce, meaning the re is less protection for your teeth against sugar and acid attacks. Therefore after brushing your teeth at night, I advise you do not eat anything else and only drink water, especially throughout the night. This is very important for children - to prevent caries only water should be drank throughout the night, not fruit juice, cordial (even low sugar) or milk. Talk to your dentist about caring for your children and babies teeth.
I hope this article was useful to you!
Take a look at the procedures for more information about common dental treatments.