The mouth contains millions of bacteria that live in organised communities known as dental plaque. The plaque bacteria are highly complex and powerful. Plaque if not removed daily by brushing, accumulates to form complex layers that causes tooth decay and gums infection.
We all are advised to brush well and brush twice daily. But, have we been ever taught the correct scientific method of brushing? Today I am a dentist but as a child, I was never taught a proper way/method of brushing teeth. Neither most of the parents know nor schools teach the correct brushing method to be followed. This article describes the proper brushing method to be followed from childhood to adulthood along with frequently asked questions and myth busters.
BRUSHING FOR INFANTS (6-18 months)
Newborns are very delicate but they have strong gum pads and cheek muscles to suck mother's milk. Newborns may have teeth at birth called Neonatal teeth and it is not abnormal to have them. By 6 months, teeth start to appear. You can start cleaning your baby’s teeth by wiping with a soft cloth or brushing with a small soft toothbrush and water twice a day. Small silicon finger toothbrushes are available that the parents has to wear on a finger and gently clean the teeth.
BRUSHING FOR CHILDREN (18 months- 6 years)
At 18 months, majority of the milky teeth erupt. A silicone finger brush can be used with pea-sized quantity of a kids toothpaste. Kids toothpaste have 50% less fluoride compared to adult toothpaste to reduce the risk of fluoride poisoning if the child ingests it. Children can start brushing by themselves under a parent's supervision by the age of 2.5-3 years. A pea-sized toothpaste is applied on to a baby toothbrush and children are taught to made small circles on teeth. Spitting of the toothpaste should be encouraged rather than rinsing as spitting removed the excess toothpaste and a small quantity of toothpaste remains in contact that causes fluoride remineralization and strengthens tooth enamel.
Brushing must be supervised in children up to 7-8 years of age.
BRUSHING FOR SCHOOL GOERS TO TEENAGERS (7-17 years)
This is the age when a lot of changes happen in the mouth. One by one the milky teeth fall off and permanent teeth erupt. This stage may be associated with teeth getting crowded and teeth erupting in abnormal positions. Hence, brushing well during this period is of prime importance. As the jaws grow, the baby brush may changed to a child brush and the toothpaste may be changed to an adult one at 8-9 years of age. With age, proficiency in brushing is achieved and manual dexterity increases, so the brushing method may be changed slowly from the roll method during childhood to modified bass method in adults.
BRUSHING METHOD FOR ADULTS (18 + years)
Most adults follow a horizontal scrubbing method of brushing due to lack of brushing knowledge. Horizontal scrubbing with a hard toothbrush or with excessive pressure causes the gums to recede and abrades the tooth enamel. Only medium or soft toothbrushes must be used with Modified bass technique for brushing. Shifting from horizontal scrubbing to modified bass needs some conscious effort and practice initially. This brushing method aims to remove the plaque that accumulates at the gum line and in between teeth .
BRUSHING FOR THOSE WITH SPECIAL NEEDS AND AGED PERSONS
Physically & mentally challenged children and adults as well as aged persons lose the manual dexterity required for a manual toothbrush. An electric toothbrush is the best solution for them. A caregiver can make them brush with an electric toothbrush which is moved over the teeth after applying toothpaste.
FLOSSING
A floss is a nylon thread that is inserted gently between the teeth used to clean the plaque in between teeth, which is not removed completely by a toothbrush. Flossing must be done gently as it may abrade the teeth as well as cause gum bleeding.
IS USING MOUTHWASH REGULARLY BAD FOR YOUR MOUTH?
Lots of people believe that rinsing with that colorful liquid will drastically improve their dental health. Unfortunately, for the simple reason that most mouthwashes contain lower levels of fluoride than most toothpastes. This means that by rinsing with mouthwash immediately after brushing people are actually increasing the chances that they will suffer from tooth decay.
Also, the mouth contains good and bad bacteria. The good bacteria remain in contact with the teeth, thus keeping the bad bacteria away from the tooth surface. Mouthwashes contain chemicals that indiscriminately kill all bacteria and also wipe out the “good” bacteria that is one of our natural defences against harmful bacteria, viruses and fungi. Thus, the bad bacteria get a chance to colonize the teeth. Mouthwashes may be used for short duration such as after dental surgery or when brushing is affected.
IS TONGUE CLEANING NECESSARY?
The tongue surface is rough as it contains millions of papillae and pits which contain taste buds at the base. Food gets decomposed and fills up those pits at regular intervals. If the tongue coating is not removed at regular intervals, it leads to bad breath and change is taste perception. Hence, daily cleaning/brushing of the tongue is necessary.
WHICH TOOTHPASTE AND TOOTHBRUSH TO CHOOSE?
With the market flooded with toothpastes and new ones advertised daily, it is very confusing to choose. I am always as which toothpaste is the best or which toothpaste to use. The answer is - composition of all the toothpastes is nearly the same, the main/active ingredients are same, the difference lies in the additional components that add flavor, color and desensitizing agent. Choose a toothpaste that contains fluoride and a flavor that you like/suited by you. Indiscriminate regular use of sensitivity toothpastes marketed on television masks the initial symptoms of tooth decay and causes more harm than benefit.
Pertaining to toothbrush, choose a medium/soft toothbrush which has a head size appropriate for you. The head of the brush must be able to clean the last tooth in the arch. It has been found through clinical research that brushes with zig-zag or criss-cross bristles are better by 10-15% in removing plaque as compared to flat-trim bristles. Toothbrush must be changed every 3 months and after systemic infections.
IS BRUSHING AT NIGHT NECESSARY?
The most important time to clean your teeth is just before you go to sleep. While you’re asleep, you have lower levels of protective saliva in your mouth and if sticky plaque is left on your teeth for extended periods then more of your teeth will suffer the effects of tooth decay.
The worst time to brush your teeth is immediately after drinking or eating anything acidic, e.g. fruit juices, smoothies, vinegars, fizzy sodas or wine. Acidic drinks make the outer layer of your teeth enamel softer and brushing your teeth at this moment will actually damage the surface of your teeth, making them more sensitive and liable to staining.
IDEAL BRUSHING DURATION is 2-3 minutes.
TAKE AWAY MESSAGE-
1) Brushing method is the most important factor for effective brushing, more than the type of brush and toothpaste.
2) Toddlers must be taught the correct brushing method, supervised till 7-8 years of age.
3) Brushing twice daily. Daily use of mouthwash can cause more harm.
4) Daily use of sensitivity toothpaste without dentist's advice could be causing harm.
5) Flossing is important
6) Dental check-up every year is a must. Dentist may see plaque build up in specific areas and may improvise the brushing method or provide additional oral hygiene aids.
7) Tongue cleaning is important.
8) Toothbrush and toothpaste selection is a subjective choice.