Importance of Brushing Teeth and Flossing: Brushing and flossing are not just important for good oral hygiene and health, but for your overall well-being. It’s not something to be taken lightly; half of Americans (a 1st world country even!) have periodontal (gum) disease, a chronic inflammatory disease that affects the gum tissue and bone supporting the teeth, according to the American Academy of Periodontology (AAP). If left untreated, periodontal disease can lead to tooth loss. However, more importantly, gum (periodontal) disease is a major risk factor for the development of other serious health conditions (chronic inflammatory diseases), including heart (cardiovascular) disease and diabetes. Gingivitis is the earliest stage of periodontal disease and periodontitis is the most destructive form of periodontal disease. In addition, people tend to prioritize brushing, when it’s been said flossing is more important if made to choose only one!
Technique and Tips: American Dental Association (ADA) Recommendations
– Floss daily
– Brush twice per day
– Eat a healthy diet and limit between-meal snacks
– Replace your toothbrush every three to four months, or sooner if the bristles are frayed
– Schedule regular dental checkups
– Minimum Rinsing After Brushing is Recommended: This supports previous findings (2, 3) that mouth rinsing with water after brushing should be kept to a minimum in order to reduce rapid intraoral fluoride clearance and hence achieve the maximum beneficial effect of fluoride exposure via a dentifrice (toothpaste). (Source)
– If you’ve eaten an acidic food or drink, avoid brushing your teeth for at least 30 minutes. These acids weaken tooth enamel, and brushing too soon can remove enamel. If you know you’re going to eat or drink something acidic, brush your teeth beforehand.
Sonicare vs Oral-B vs Manual Toothbrushes
Best Toothbrush Recommendation: Oral-B Vitality Pro White Rechargeable Electric Circular-Oscillating Toothbrush $26 [Amazon], no need to get the more expensive Professional SmartSeries one with unnecessary accessories
Research Summary: Studies show that circular oscillating rotating toothbrushes, such as the Oral-B, are found to be slightly better at removing plaque and gingivitis (gum inflammation) in the short term, than both regular (manual) toothbrushes and the more expensive automatic toothbrushes that move side-to-side, like the Sonicare.
Reasoning: The Oral-B fares better in hard-to-reach regions. The creators of the Sonicare claim their dynamic fluid effect helps plaque removal from approximal surfaces where it is difficult for toothbrush bristles to reach, as it is here that any dynamic fluid effect should be most apparent. However, it is possible that factors associated with the clinical situation such as damping resulting from bristle contact with the tooth surface and the high viscosity of saliva and dentifrice (toothpaste) may counteract dynamic fluid activity in vivo. This review indicates that dynamic fluid activity beyond the reach of bristles as demonstrated in the laboratory is yet unproven in the clinical situation. Automatic toothbrushes are recommended over manual as people tend to brush too hard on their teeth (removing enamel) and with automatic toothbrushes, people tend to not press down as hard on their teeth, as it feels like they do all the work. This is also why some dentists recommend brushing in a circular motion. However light you think you’re brushing, brush lighter.
Sources: NIH Source1, ADA Source2, Source3
Don’t Need: Tongue-Scraper – A dirt cheap tongue scraper can be bought. Don’t need to get high-tech ones. “There is weak and unreliable evidence to show that there is a small but statistically significant difference between tongue scrapers and toothbrush on the tongue to eliminate bad breath/reduce halitosis.” Source: NIH
Toothpaste
Brushing with a fluoride toothpaste prevents tooth decay. The brand does not matter, ingredients are mostly very similar. Choose sensitive toothpaste if your teeth are sensitive. The expensive toothpastes (Sensodyne) are just branding. Also, if it doesn’t have Novamin (calcium sodium phosphosilicate) it won’t repair teeth or as well as you’d expect (and whitening toothpaste without Novamin won’t produce whitening results).
Best Value Fluoride Toothpaste: Colgate Cavity Protection Fluoride Toothpaste, Regular Flavor, 8.2 oz (Pack of 6) [Amazon]
Novamin Toothpaste: Sensodyne Repair & Protect Whitening Toothpaste 75ml [Amazon] (This version Imported from UK as Novamin is not FDA approved for some reason!, don’t get the USA version)
Flossing
No toothbrush, no matter how fancy, can replicate what flossing does. Use a water flosser such as the Hydro Floss, if you have weak/recessing gums. The Hydro Floss has better build quality than a Waterpik (ie WP100).
Night guard
If you grind your teeth heavily, recommended is to get a fitted custom night guard, either through your dentist or through Amazon such as this Armor Guard Custom. However, for temporary use, inexpensive alternatives include Med Tech Products Nightguard or disposable mouth guards such as the Plackers Mouth Guard Grind No More Dental Night Protector.
Miscellaneous Research
Halitosis: Up to half of the population in the USA and between 50% and 60% of the population in France claim to suffer from bad breath. There is some evidence that mouthrinses containing antibacterial agents such as chlorhexidine and cetylpyridinium chloride or those containing chlorine dioxide and zinc can to some extent reduce the unpleasant odour but the use of mouthrinses containing chlorhexidine resulted in noticeable but temporary staining of the tongue and teeth. Source Although the use of tongue scrapers was generally well accepted, the effects of tongue cleaning using scrapers or brushes appeared to be very short lived and there was some limited evidence of tongue trauma which occurred with prolonged use of one tongue scraper. Source Another note: For over-the-counter whitenings, don’t let it touch your gums (it will burn)
Night-time-only Essix retainer wear (as opposed to full-time) may be an acceptable retention regimen following the use of fixed appliances. (Source)
We recommend that patients with fixed braces rinse daily with a 0.05% sodium fluoride mouthrinse. Source
Additional fluorides to toothpaste such as mouthwash have an additional but not substantial benefit in adolescents and children (Source). One in two children had less tooth decay using mouth rinses/gels. Source For adults, mouthwash seems to not have much beneficial effect, only serves to make one’s breath smell nice.
Insufficient evidence exists to show the effectiveness of fluoridated milk in preventing tooth decay. Source
Removing wisdom teeth: This review found no evidence to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults; no studies of adults met the criteria for inclusion. In addition, some reliable evidence suggests that the prophylactic removal of impacted third molars in adolescents to reduce or prevent late incisor crowding cannot be justified. Such removal neither reduces or prevents late incisor crowding. Source
Fluoride Toothpaste at an early age: There is some evidence that brushing a child’s teeth with a toothpaste containing fluoride, before the age of 12 months, may be associated with an increased risk of developing fluorosis. This dental fluorosis can range from, typically, mild white patches on the teeth to severe mottling of the teeth with brown staining. There is stronger evidence that higher levels of fluoride (1000 parts per million (ppm) or more) in toothpaste are associated with an increased risk of fluorosis when given to children under 5 to 6 years of age. However, for some children (those considered to be at high risk of tooth decay by their dentist), the benefit to health of preventing decay may outweigh the risk of fluorosis. In such circumstances, careful brushing by parents/adults with toothpastes containing higher levels of fluoride would be beneficial. Source
Tooth Whitening Products: People should be aware of common side effects such as tooth sensitivity and irritation to the gums and note that long-term data on the use of such products are not yet available. Source Crest whitening strips (ie 3D) are a brandname that works (~$40). Amazon (Crest 3D White Luxe Whitestrips Professional Effects – Teeth Whitening Kit 20 Treatments)
