Brushing reduces the risk of various chronic diseases and keeps your teeth and gums healthy, But Most Of Us Do It Wrong.
Brushing our teeth is something most of us did before we were old enough to look at ourselves in the bathroom mirror, But we are notoriously bad at brushing our teeth. In Sweden, a study found that only one in ten people follow the best way to brush their teeth. According to a survey of 2,000 people in the UK, almost half of the respondents did not know how to brush their teeth properly.
Josephine Hirschfeld, a lecturer in restorative dentistry at the University of Birmingham in the UK, says: “Most likely, anyone who hasn’t received brushing instructions from a professional is brushing the wrong way. “In my experience, most people in any country have this situation.”
Considering the variety of information on how to brush teeth, this may not be surprising. A study showed at least 66 different and sometimes contradictory expert recommendations.
Nigel Carter, chief executive of the British Oral Health Foundation, said: “I think it’s very confusing for consumers to have such a variety of advice.
This confusion is exacerbated by the vast and varied array of dental care products available for purchase. So, what do most of us get wrong, and how can we change our routine to ensure we’re brushing our teeth to the best of our ability?
What is the best way to brush your teeth?
“Many people know they need to remove leftover food,” says Hirschfeld. It is somewhat true, But the more important thing is to remove bacteria from the teeth.” Bacteria and other microorganisms grow inside the mouth and form a sticky biofilm known as dental plaque. This layer consists of about 700 different species of bacteria, with the highest bacterial diversity in the body after the intestine. A large number of viruses and fungi are also present in this collection.
“They live in the sticky layer that’s attached to the teeth and also to the soft tissues,” Hirschfeld says. This sticky layer cannot be easily washed off with water and must be removed with the help of hands. The most important place to remove the microbial layer of the tooth is not the gum line.
The gum line is where microbes can penetrate the gum tissue and cause inflammation and diseases such as periodontitis. Therefore, it can say that brushing teeth is not a proper term.
“Think about brushing the gum line instead of the teeth themselves,” says Hirschfeld. In that case, the teeth will also be brushed automatically. One of the most effective ways to remove biofilm is the “Modified Bess Technique,” which requires more skill than our standard brushing method.
In the modified Bess method, the toothbrush is placed on the teeth at a 45-degree angle (tilted down for the lower jaw and up for the upper jaw, as if you were trying to get the bristles under the gums).
Then, delicate and vibrating movements are made forward and backward in the gum line.
“The modified Bess method is one of the best,” says Hirschfeld. This method cleans the teeth in the best possible way and does not harm the teeth or gums.”
Other techniques besides the modified bass remove the biofilm very well. One of these methods is the modified Stillman method, similar to the modified Bess method. In the modified Stillman method, the toothbrush’s bristles are placed in the gum line and move in a circular motion towards the tooth’s crown along with back and forth movements.
For this method, it is recommended that the brush has soft bristles. This method removes the accumulated plaques in the gum line and massages the gums. Will not damage The gums if this method is done with proper pressure.
Of course, you should remember not to put too much pressure on the teeth while brushing. While experts still debate the optimal pressure, most believe that no more than 150 grams of force should be applied, which is about the weight of an orange.
Brushing too hard, especially with stiff brushes, can damage the gums. Small tears in the soft tissue caused by vigorous brushing allow bacteria to enter the bloodstream.
In addition, the abrasion of toothbrush bristles on tooth enamel can create minor grooves in the tooth that cause significant wear and tear over time. People who use manual toothbrushes apply more pressure than electric toothbrushes.
Many electric toothbrushes have sensors that warn when the pressure is too high.
One of the other brushing methods is the Fones method, which is provided for children and people with less manual skills. This method includes holding the toothbrush at a 90-degree angle, making circular movements on the teeth, and cleaning the gum line. Nigel Carter of the Dental and Oral Health Foundation says there’s no need to follow an exact prescription: “Experts generally recommend looking at what the person is doing and making changes to their technique to help them do it better. ”
The brushing method focuses on removing dental plaque from around the gum line.
How long should brushing take?
Most experts recommend brushing your teeth twice daily for at least two minutes each time. The problem is that most of us are bad at estimating two minutes. In different studies, the average brushing duration varied from 33 seconds, 45 seconds, 46 seconds, to 97 seconds.
According to a study led by Karolina Gans, a professor at the Department of Conservative and Preventive Dentistry at the Justus Liebig University in Germany, only about 25% of people brush their teeth long enough and with the correct pressure and movement. Fortunately, there are easy solutions, such as using a mobile app, a small hourglass, or an electric toothbrush with a built-in timer.
Carter says that the more time spent brushing, the more biofilm is removed, But it is generally believed that about two minutes are needed to touch the entire surface of the teeth and the gum line. For people with gum disease or other oral problems, it may take longer to ensure that the biofilm is wholly removed. Hirschfeld says:
The optimal brushing time depends on the individual’s condition. It is not defined and cannot be defined; Because each person’s mouth and teeth are different. What is essential is that all teeth, and all surfaces of each tooth, including hard-to-reach areas, are cleaned, which can take more than two minutes.
Funes’s brushing method is basically for children learning to brush their teeth. The child gently presses the bristles of the toothbrush on his teeth and moves the toothbrush 4 to 5 times with circular movements on all the teeth.
How many times a day should we brush our teeth?
Brushing too much is not valid for most people with no significant problem in terms of mouth and teeth. The current recommendation in countries such as the United States, the United Kingdom, and Australia is to brush twice a day, thoroughly and thoroughly. However, the Indian Dental Association recommends that up to three times (including brushing after lunch) can be helpful.
Hirschfeld says, “You don’t need to brush more than twice a day to clean bacteria from your teeth, and brushing more than twice a day can even be harmful; Because excessive brushing is associated with the risk of tooth wear. However, there are still exceptions. “For example, consider people who wear dental braces that get food stuck in them,” he adds. These patients are usually advised to brush their teeth after every meal.
Brushing twice will also help compensate for a faulty technique. Carter says:
If you brush your teeth carefully and thoroughly once a day, it’s probably enough; Because these are the old plaques on the teeth that cause problems in the field of tooth decay and gum disease, But none of us brush our teeth thoroughly. So, the idea is to brush twice daily to remove any residue that hasn’t already been removed, so you’re cleaning everything every day.
When should we brush our teeth: before or after meals?
Is it better to brush before breakfast or after breakfast? From toothpaste manufacturers to dental hospitals, many believe that brushing before breakfast is better than brushing after breakfast; But this issue is still debatable.
“There’s no hard and fast advice,” Hirschfeld says. But many dentists recommend brushing after eating; Because it not only cleans the plaques but also cleans the remains of the breakfast food.
Whether you should brush your teeth before or after breakfast depends on when and what food you eat. Two factors are needed to create a biofilm: microbes and food that eat it. “Cavities don’t form without bacteria or food,” says Hirschfeld. If you clean out those bacteria thoroughly before breakfast, it theoretically doesn’t matter how much sugar you eat. “If no bacteria can ferment it, there is no problem.”
It is not safe to remove biofilm altogether during one brushing before breakfast, especially considering the questionable habits of most people in the brush field. Likewise, brushing after breakfast can be beneficial.
“It’s just as good if you have the sugar with the bacteria and then brush and brush it off,” says Hirschfeld. Although one of the main disadvantages of brushing after breakfast is that there should be a proper gap between eating and brushing. The American Dental Association recommends waiting 60 minutes. The reason is that the acids in the food and the byproducts of the digestion of carbohydrates by microbes make the teeth temporarily vulnerable.
“The acids attack the enamel and soften it for a while,” says Hirschfeld.
It removes some of the critical components of tooth enamel (calcium and phosphate), although minerals replace these compounds in saliva within hours. Hirschfeld explains, “So this process is a kind of self-healing; But if you don’t wait for this process to happen, the worn surface of the tooth becomes very vulnerable to brushing.”
Carter agrees that the before or after breakfast question is complicated and depends on what you’re eating. If breakfast includes acidic foods and drinks (such as citrus fruits, fruit juice, and coffee), brushing your teeth before breakfast is better to avoid disturbing the remineralization process.
More important than the question of brushing your teeth in the morning is brushing your teeth at night, which also has a simple answer: brushing your teeth should always be the last thing before going to bed. “Saliva is your natural defense mechanism, preventing bacterial growth and tooth decay,” says Carter. “Saliva flow decreases during the night, so removing all the plaques before bed is important.”
What toothpaste and toothbrush should we use?
Hirschfeld says there are toothbrushes and kinds of toothpaste on the market that remove teeth. Highly abrasive types of toothpaste are often labeled as whitening, and toothbrushes with tough bristles are incredibly unpleasant when used together. “It’s a prolonged process that happens over years or decades,” he says. But over time, teeth wear down and can become very sensitive to temperature or cavities.”
The toothbrush tree ( Salvadora persica ) has played an essential role in dental hygiene for about seven thousand years. The gnarled trunk with pale bark in mature trees leads to a lush, dense canopy. This small tree grows in Africa, the Middle East, India, and Pakistan.
Since Babylonian times, the leaves were removed and made into pieces that could easily hold in hand. One end of the unit and its stringy tip was used as a toothbrush. In addition to helping to mechanically separate biofilms, this tree produces antimicrobial compounds that prevent the growth of pathogens that cause periodontitis and cavities and naturally contain high fluoride levels.
Toothbrushes with medium bristles are the best option for adults, and suitable kinds of toothpaste are those that do not contain fine abrasive particles. Hirschfeld says a toothbrush with a smaller head is better; Because you can use it more easily around the teeth.
Also, replace a worn-out toothbrush before the bristles become too distorted. Traditional toothbrushes or chewing sticks, such as those made from the milk tree, widely used in Africa, the Middle East, and South Asia, are also effective in removing plaque and preventing cavities. Still, if misused, they are associated with a higher risk of scratching the gums.
More effective than manual toothbrushes, although more expensive, They are electric toothbrushes.
After years of studies showing no significant difference between the two, a few meta-analyses have shown moderate evidence that electric toothbrushes are more effective at removing plaque. The authors of these meta-analyses noted that they had previously received funding from manufacturers of electric toothbrushes.
Part of the reason for this is that the vibratory motion is automatic and relies less on manual dexterity, But another factor is the size of the brush head. In addition, many of these toothbrushes have sensors that turn on when the user applies too much pressure, which is associated with the risk of damaging tooth enamel.
“If you use a manual toothbrush and use it correctly in terms of brushing technique, pressure, etc., you’ll get just as good results,” says Hirschfeld.
Should you use dental floss?
Despite the lack of research on the use of dental floss, many oral health organizations still stubbornly advocate this practice. Hirschfeld says: “If you think of each of your teeth as a cube with five surfaces exposed to the oral environment, biofilms form on all surfaces, and there is no reason not to remove half of them.”
Carter estimates that a tiny proportion (perhaps one in 20) in the UK floss regularly. A survey from 2019 found that a third of British adults have never flossed.
Toothbrushes, made from trees such as the toothbrush tree (Salvadora persica), have been used for thousands of years to help keep teeth clean.
For those with gum or tooth problems, interdental cleaning is an opportunity to get things done. Flossing is not the only way to obtain rid of biofilm between teeth. The characteristics of your teeth (for example, whether they are spaced apart) will determine whether a small toothbrush or floss will work better.
“Many of our patients use a wide range of interdental cleaning tools and may have five or six different sized toothbrushes, flossers, and other brushes,” says Hirschfeld. “The time spent flossing should be part of your two-minute brushing routine, and you don’t need to do it more than once a day.”
However, a 2011 review of randomized controlled trials claimed that there was weak and highly unreliable evidence that flossing with a toothbrush could be associated with a slight reduction in plaque over one to three months. Most of these studies had methodological flaws.
However, this review was retracted after raised objections that “a lack of evidence is not a lack of evidence.”
A later updated version showed that flossing was significantly better than brushing alone in reducing gingivitis (surface gum disease that can lead to severe gum disease or periodontitis). Although the evidence that this reduced plaque was still weak and highly unreliable. Hirschfeld says:
This type of study is tough to do. Obtaining a prominent enough cohort representative of the general population rather than the dental students who readily participate in such studies is complex. Factors such as the unreliability of individual self-reports are difficult to overcome. Another big challenge in conducting such studies is that they should last long enough, perhaps several decades, to see how the incidence of dental and gum problems changes. Doing these studies is, if not impossible, But it is difficult. It is why the available evidence is weak.
What kind of toothpaste is better?
Hirschfeld and Carter agree that while there are various kinds of toothpaste, from anti-cavity types of toothpaste to whitening and desensitization kinds of toothpaste, expensive brands aren’t necessarily needed to get the job done. “I’ve looked at the ingredients list of some cheap kinds of toothpaste and haven’t seen anything wrong with them,” says Hirschfeld.
Fluoride content is a crucial factor. Hirschfeld says that of the long list of ingredients listed on the toothpaste box, there’s one component to look out for fluoride content. Fluoride should be at least 1350 parts per million for adults To protect tooth enamel against acids and 1000 parts per million for children.
Tooth enamel is the most complex tissue in the human body and one of the hardest substances found in nature. “It’s almost as hard as a diamond,” says Hirschfeld. Tooth enamel is mainly composed of a type of mineral called hydroxyapatite (a type of calcium phosphate) which has a complex crystal structure to have the characteristics of hardness and durability.
Despite its resistance to mechanical force, tooth enamel easily dissolves in acid. Microbes in the biofilm produce lactic acid as a byproduct of digesting the sugars and carbohydrates that get stuck between our teeth. Lactic acid gradually washes calcium and phosphate from tooth enamel and eventually causes cavities.
Naturally occurring compounds in saliva can somehow replace lost minerals. Especially if fluoride is present (fluoride is naturally present in soil and water in many parts of the world), tooth enamel forms fluorapatite, which is more resistant to acids than hydroxyapatite.
Throwing out toothpaste after brushing, But avoiding rinsing with water helps the fluoride stay around the teeth longer for added protection. “Since fluoride has been added to toothpaste, the incidence of caries has decreased in all areas where fluoride toothpaste is used,” says Hirschfeld.
However, some modern materials should handle with caution.
For example, charcoal has been used to clean teeth for thousands of years and is common in commercial toothpaste; But there is little research to support it.
There is little evidence that charcoal whitens teeth and may increase the risk of tooth wear and other problems. According to a review, claims about the antibacterial, antifungal, and antiviral properties of charcoal-containing kinds of toothpaste have not been proven, and dentists should warn their patients against using charcoal-containing products.
Many charcoal kinds of toothpaste do not contain fluoride. Therefore, they offer little protection against pitting. However, if someone uses fluoride-free toothpaste, they will still benefit from brushing their teeth. “They can still mechanically remove plaque,” Carter says. But they don’t have the benefit of preventing decay, which is basically what fluoride in toothpaste does.”
Some other common leavening additives may be less controversial. According to the authors of one review, kinds of toothpaste containing sodium bicarbonate (baking soda) removed plaque better than those without, although they noted that more follow-up studies were needed (the authors of that study indicated that in the past, toothpaste manufacturers and the toothbrush had received funding). The same analysis showed that toothpaste containing baking soda might slightly reduce bleeding from gingivitis.
Should you use mouthwash?
Carter says mouthwash is less effective at removing plaque than brushing, But when combined, they can remove plaque a little better than brushing alone. “I think it’s a handy addition, not as a replacement for brushing, but as a supplement,” he says.
According to several experts, mouthwash can help treat gingivitis (inflammation of the gums). T, o be effective, mouthwash must contain at least 100 parts per million of fluoride and be clinically proven to reduce plaque. It is best to use mouthwash if your gums are bleeding and not as a preventative measure.
An old and worn-out toothbrush does not clean the teeth well
There may be a sweet spot for effective tooth brushing. If you don’t brush enough, plaque builds up, and tooth decay and periodontitis risk increase. On the other hand, if you brush too often or too hard, the enamel wears away over time.
Although maintaining an optimal routine (with flossing or interdental brushes and perhaps mouthwash if you have gingivitis) can be laborious, it’s worth it for the impact it will have on your overall health.
As mentioned in the previous articles, effective brushing is an effective way to reduce the risk of not only bad breath and yellow teeth, and tooth decay, but also a way to prevent diseases such as type 2 diabetes, cardiovascular disease, and cognitive decline. Bea Wu, a professor of global health at New York University’s Rory Myers College of Nursing, says:
According to evidence, inflammation is one of the pathways linking periodontal diseases and cognitive deficits. Good oral hygiene habits such as effective brushing can reduce plaque and the risk of gingivitis.