Dental Hygiene (Proper Brushing and Flossing Techniques)

Developing good dental hygiene is extremely important in fighting against dental problems such as dental caries, gum disease and halitosis, which are mostly the result of an accumulation of dental plaque and dental calculus.

Dental plaque and dental calculus

Dental plaque is a white-ish substance that develops every day, and adheres to teeth.? It is mostly found on the gum line, or in between teeth. It is composed mainly of microscopic bacteria, food, and saliva, and it matures and becomes a problem if one eats a carbohydrate and sugar rich diet (source of nutrition for bacteria) or does not adequately clean their teeth.

Dental calculus is a form of hardened?dental plaque and is caused by the continual accumulation of minerals from saliva. It causes a roughened and hard covering over the tooth, which allows more plaque to adhere to teeth, and potentially cause or exacerbate problems.

The problems of dental plaque and dental calculus

Dental caries(tooth decay)

Tooth decay occurs when small holes (cavities) form in the tooth due to the accumulation of dental plaque. When the sugar and carbohydrates that are a part of our diet comes into contact with plaque, the result is acid formation. Over time, if the combination of plaque and an acidic environment is left to occur, tooth decay will result.

Gum disease

Gum disease refers to any infection or inflammation of the gums surrounding the teeth, although it is mostly a result of an accumulation of dental plaque. Healthy gums are pink and do not hurt or bleed when brushed. Unhealthy gums are open to the bacteria in plaque causing an inflammation called gingivitis. Gingivitis is a reversible condition, in that if the plaque is removed completely, the problem will solve itself. If the tissues that connect the teeth to the gums (bone, ligaments etc.) become involved, then it is called periodontitis - this step is irreversible.

Bad breath (halitosis)

Halitosis, the technical term for bad breath, is also often the result of unhealthy plaque build up. Halitosis can be a result of many medical conditions. Dental plaque-related halitosis results when the gums become infected or inflamed due to the bacteria in plaque. Keeping the teeth and gums clean, and even brushing the tongue may prevent this condition.

Good dental hygiene means getting into the routine of thoroughly cleaning the mouth at least once or twice a day, though preferably after every meal. The following discussion considers some important aspects of keeping teeth clean such as brushing, flossing, mouthwashes, and other adjuncts to maintaining good dental health.

Brushing

Brushing teeth for two full minutes with fluoride toothpaste and a brush that is small enough to manoeuvre around the inside, outside and top of every tooth in the mouth is considered necessary. Consider listening to an entire song whilst brushing teeth - this will be the appropriate time needed to clean teeth. Replacing a brush every three months has also been shown to be more effective in maintaining good dental health.

When buying a manual toothbrush, use one with soft bristles as this will protect gums from damage to a greater extent. Studies have shown that brushing harder will not remove more dental plaque. Consider investing in an electric toothbrush if more help is needed and it is difficult to use a manual toothbrush. The novelty of a fancy new toothbrush is motivation alone to brush more.

How to brush

Press gently at a 45-degree angle. Scrub the side closest to the cheek (of the tooth and gum) for a few seconds using a small circular/vibratory motion. In the same manner, move slowly around your mouth until you get to the other side. Pay particular attention to the gum line.Once on the other side of the mouth, rotate the brush so that it rests against the tooth and gum (on the side closest to your tongue), and use the same angle and same circular scrubbing motion to return to the first tooth. Next, briskly brush along the top surface of the teeth.Then repeat the entire process on the upper or lower set of teeth (depending on start position). Do not neglect the roof of the mouth and tongue, as these places also harbor bacteria.Try to only spit out the toothpaste, rather than rinsing it all out after brushing, as this will reduce the effect of the fluoride in toothpaste.

Figure 1: The toothbrush is angled at 45-degrees to the gum and teeth. The brush points upwards when brushing the top teeth and points towards the floor when brushing the lower teeth. Note the bristles of the brush cover the gums and the tooth at the same time when brushing.

Important considerations when brushing

Keep a routine and do not rush! It is important to keep routines with oral hygiene; otherwise it is easy to miss areas of the mouth. Unfortunately, the same areas are missed EVERY time and these areas get gum disease. If you start on the top, don't rush the bottom teeth as these will tend to be worse than the top if this is the case. Make sure every tooth surface is cleaned! With the brush, it is possible to clean the top of your teeth, and the sides that are closest to your cheek and tongue! Make sure for every tooth, these surfaces are cleaned.

Flossing

Floss before every brushing. Remember that using just a small bit of dental floss to gently slide debris from between the teeth goes a long way towards eradicating plaque and keeping the mouth free from bacteria.

Floss should be wrapped around the fingers then stretched tightly between the thumbs, or thumb and first finger, of each hand so that it can be eased carefully between teeth. The floss should be moved carefully up and down the side of each tooth, pushing the floss down just under the gum line.

Other interdental cleaning devices (those devices that clean in between teeth) such as interproximal brushes or wooden or rubber tips are also valuable for certain people including those with missing teeth, large gaps, areas where the gum line has dropped, crowded teeth etc. A dentist is trained to determine the individual needs of a patient, and determine which tool will be the most effective.

Figure 6: Interdental pikster or interproximal brush used to clean in between teeth. This is especially useful for people who cannot use conventional dental floss, such as?those who have bridges that join teeth together, and/or orthodontic treatment (this person has a metal retainer behind the lower front teeth).

Mouthwashes

It is important to remember that if one cleans the teeth properly with brushing and flossing, there is no need for a mouthwash. To date, the best mouthwashes include an ingredient known as chlorhexidine gluconate. Any mouthwash with this ingredient should ONLY be used for short periods of time as it has problems such as altering taste, staining teeth and margins of fillings etc. Those mouthwashes containing thymol and cetylpyridinium chloride are effective, but to a lesser degree than chlorhexidine gluconate.

Recently, there has been the heated debate over alcohol containing mouthwash related to oral cancer. Some people have dismissed the link, however, one study in 2008 from an Australian journal proposed a link between oral cancer and mouthwash in non-smokers and non-drinkers, and fuelled the debate over whether dentists should be recommending alcohol containing mouthwashes. More and more companies are releasing alcohol free mouthwashes in light of recent evidence. At the moment, alcohol containing mouthwash does not cause oral cancer; it simply has been linked with a higher incidence in some research.

Gum, lollies, high fluoride toothpaste, and CPP-ACP

If you are unable to clean your mouth directly after eating, consider chewing sugar free gum. This will stimulate saliva in your mouth that will naturally help flush out any lingering remnants of food.? Also sugar free lollies will promote a similar mechanism.

High fluoride toothpastes should be used only in consultation with dental advice. They usually have five times the fluoride content of normal toothpaste and are advised in patients who are high-risk to dental decay. Other agents such as CPP-ACP (casein phosphopeptide - amorphous calcium phosphate), which are effective in helping remineralise the tooth, are being promoted in patients prone to erosion, dental decay, and dry mouth.

Maintaining good oral hygiene involves going to the dentist every 6-12 months. The dentist is able to:

Recommend cleaning techniques and products; Clean plaque and calculus from the teeth;Fill cavities that could lead to further tooth decay; Administer fluoride treatments; Treat mild gingivitis before it turns into periodontitis; Take radiographs; and Reinforce oral hygiene instruction over long term.Everyone requires the regular use of a toothbrush and fluoride containing toothpaste, either manual or electric, at least once or twice a day.Fluoride is safe in water and toothpaste!! There is less chance of problems if one spits only, rather than rinsing after brushing.Soft bristled toothbrushes should be used, and replaced every three months. Electric toothbrushes are as effective, if not slightly better than manual toothbrushes.Using floss every day, or another device to clean in between your teeth before brushing is essential to maintain good dental hygiene.Mouthwashes are not necessary if flossing and brushing are adequate, however those containing chlorhexidine gluconate are most effective if used, but should not be used for long periods of time.The dentist is able to determine the best way for every individual to maintain good oral hygiene, and is able to provide feedback and tips.It is essential to have 3-12 month visits to the dentist to have dental calculus and dental plaque removed professionally.

Kindly written by Dr Akhil Chandra BDSc. (Hons UWA)

Dentist, Whitfords Dental Centre and Editorial Advisory Board Member of the Virtual Dental Centre

Newman M, Takei H, Klokkevold P. Carranza's Clinical Periodontology. 10 ed. Carranza F, editor. St Louis: Saunders, Elsevier; 2006.Mitchell DA, Mitchell, L. Oxford handbook of Clinical Dentistry. 4th ed. New York: Oxford University Press; 2005.Bowen WH. Nature of plaque. Oral Sci Rev, 1976; 9:3-21.Oral and Dental Expert Group. Therapeutic Guidelines: Oral and Dental. 1st ed. Dowden J, editor. North Melbourne: Therapeutic Guidelines Limited; 2007.Gibbons RJ, Hay DI. Human salivary acidic proline-rich proteins and statherin promote the attachment of Actinomyces viscosus LY7 to apatitic surfaces. Infect Immun, 1988 Feb; 56(2):439-45.Master Dentistry. Heasman P, editor. Philadelphia: Elsevier; 2004.Loe H, Theilade E, Jensen SB. Experimental Gingivitis in Man. J Periodontol, 1965 May-Jun; 36:177-87.Gurenlian JR. Inflammation: the relationship between oral health and systemic disease. Access, 2006; 20(4) suppl: 1-9.Wefel JS. Root caries histopathology and chemistry. Am J Dent1994 Oct; 7(5):261-5.Featherstone JD. Fluoride, remineralization and root caries. Am J Dent, 1994 Oct; 7(5):271-4.Roberson TM, Heymann HO, Swift EJ, Jr., editors. Studervant's Art and Science of Operative Dentistry. 4th ed. St Louis: McGraw-Hill; 2002.Bass CC. An effective method of personal oral hygiene. J La State Med Soc, 1954 Feb; 106(2):57-73.Gilson CM, Charbeneau GT, Hill HC. A comparison of physical properties of several soft toothbrushes. J Mich State Dent Assoc, 1969 Nov; 51(11):347-61.Khocht A, Simon G, Person P, Denepitiya JL. Gingival recession in relation to history of hard toothbrush use. J Periodontol, 1993 Sep; 64(9):900-5.Daly CG, Chapple CC, Cameron AC. Effect of toothbrush wear on plaque control. J Clin Periodontol, 1996 Jan; 23(1):45-9.Robinson P, Deacon SA, Deery C, Heanue M, Walmsley AD, Worthington HV, Glenny AM, Shaw BC.Manual versus powered toothbrushing for oral health. Cochrane Database of Systematic Reviews 2005, Issue 2. Art.No: CD002281. DOI: 10.1002/14651858.CD002281.pub2Poyato-Ferrera M, Segura-Egea JJ, Bullon-Fernandez P. Comparison of modified Bass technique with normal toothbrushing practices for efficacy in supragingival plaque removal. Int J Dent Hyg, 2003 May; 1(2):110-4.Davies RM, Ellwood RP, Davies GM. The rational use of fluoride toothpaste. Int J Dent Hyg, 2003 Feb; 1(1):3-8.Gjermo P, Flotra L. The plaque removing effect of dental floss and toothpicks a group-comparison study. J Periodontal Res, 1969; 4(2):170.Finkelstein P, Grossman E. The effectiveness of dental floss in reducing gingival inflammation. J Dent Res, 1979 Mar; 58(3):1034-9.Lang NP, Cumming BR, Loe H. Toothbrushing frequency as it relates to plaque development and gingival health. J Periodontol, 1973 Jul; 44(7):396-405.Drisko CH. Non-surgical pocket therapy: pharmacotherapeutics. Ann Periodontol, 1996 Nov; 1(1):491-566.Van Strydonck DA, Timmerman MF, van der Velden U, van der Weijden GA. Plaque inhibition of two commercially available chlorhexidine mouthrinses. J Clin Periodontol, 2005 Mar; 32(3):305-9.Lang NP, Hotz P, Graf H, Geering AH, Saxer UP, Sturzenberger OP, et al. Effects of supervised chlorhexidine mouthrinses in children. A longitudinal clinical trial. J Periodontal Res, 1982 Jan; 17(1):101-11.Elmore JG, Horwitz RI. Oral cancer and mouthwash use: evaluation of the epidemiologic evidence. Otolaryngol Head Neck Surg, 1995 Sep; 113(3):253-61.McCullough MJ, Farah CS. The role of alcohol in oral carcinogenesis with particular reference to alcohol-containing mouthwashes. Aust Dent J, 2008 Dec; 53(4):302-5.O'Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol, 1972 Jan; 43(1):38.Lenox JA, Kopczyk RA. A clinical system for scoring a patient's oral hygiene performance. J Am Dent Assoc, 1973 Apr; 86(4):849-52.Tedesco LA, Keffer MA, Davis EL, Christersson LA. Effect of a social cognitive intervention on oral health status, behaviour reports, and cognitions. J Periodontol, 1992 Jul; 63(7):567-75.

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How Facial Hygiene Can Affect the Eyes

Bacteria, dirt and other foreign particles on the face can sometimes pass through the eyelids and come into contact with the eye's surface. Everyday dirt from a garden, soiled clothing or a kitchen bench often contain chemicals and bacteria, and there are many ways in which these substances can enter the eye while an individual is working or relaxing. Exposure of the eyes' surface to these foreign substances can lead to irritation or infection. However, preventing exposure to these substances or preventing the eyes from becoming damaged as a result of such exposure is simple and can be achieved largely through keeping the face clean.

The eye disorders associated with facial cleanliness are mostly minor irritations and infections. However, more serious infections and irritations can also result, particularly if minor infections are not promptly treated. In addition poor facial hygiene is associated with the development of trachoma, an eye infection which is the world's leading cause of blindness.

Swelling or inflammation of the eye area

Foreign particles (e.g. from a dirty face) occasionally enter the eyelids and contact the eye's surface. Such particles may cause irritation, redness or inflammation of the eye.

Trachoma

Trachoma is an eye disorder characterised by infection of the conjunctiva by Chlamydia trachomatis. It is the world's leading cause of blindness and is associated with poor sanitation and hygiene, overcrowding and poverty. Poor facial hygiene also facilitates the spread of the infection.

Trachoma mainly affects children in the third world but is also common amongst Indigenous Australians. Australia is the only developed country still affected by trachoma and in some Indigenous communities, trachoma prevalence is as high as 50%. The infection is spread through direct or indirect (e.g. touching, contaminated bedding, flies) contact with infected eye, nose and throat secretions.

There are a range of measures which can be taken to protect the eyes from exposure to facial dirt and bacteria.

Face washing

Poor facial hygiene (having a dirty face) is associated with trachoma infection. Improving facial hygiene through face washing has been promoted as a strategy for preventing the disease. A number of surveys have found that children with cleaner faces are less likely to have trachoma. Studies which have assessed the effectiveness of face washing on preventing trachoma have found that combining face washing with the application of antibiotic creams or ointments are more effective than either face washing or antibiotic application alone.

Washing and removing objects from the eyes

Keeping the face clean promotes eye cleanliness, however in some situations the eyes themselves will require cleaning, or foreign objects will need to be removed from eyes. It is important that individuals ensure they wash their hands thoroughly before washing or removing a foreign object from their eye, or another person's eye (e.g. a child's eye).

Washing children's eyes

In order to prevent the introduction of bacteria, parents should wash their child's eyes if they appear dirty or sticky. Boiled water which has cooled to body temperature should be used. Normal bath water should not be used as it will contain bacteria from the child's body.

Parents should wash their hands before cleaning a child's eye and use a fresh cotton wool swab each time they wipe an eye. The cotton wool should be dipped in the cooled, boiled water and squeezed to remove excess water. It should then be used to wipe the child's eye gently, starting at the nose and working outwards. If the child's eye remains sticky, the parent should take a fresh piece of cotton wool and repeat the cleaning process.

Removing foreign objects from eyes

Small foreign objects which enter the eye are often removed by the eye's natural cleaning mechanisms of tears and blinking. However, in some cases blinking and tears will not remove a foreign object and human intervention may be needed. If children needs help removing a foreign object from the eye, parents should:

Wash their hands thoroughly before assisting the child;Examine the eye in a well lit area, by asking the child to look up, down, left and right. This will usually enable the parent to see the foreign object;Rinse the eye with a gentle flow of water to try and dislodge the foreign object;If rinsing fails, a clean cotton tip can be used to remove objects stuck on the eyelids, but the cotton tip should not come into contact with the eye's surface.

If a foreign object penetrates the eye's surface, parents should not remove the object and seek immediate medical attention.

If a chemical substance enters the eyes parents should flush the eye with tap water or saline solution immediately. Once the eye is flushed, emergency medical treatment should be sought.

Antibiotic treatment to prevent trachoma progression

Early treatment of trachoma with antibiotics is effective in preventing progression of the disease and alleviating symptoms such as vision loss and eye irritation. Antibiotics can be administered either orally or topically. However, it is important to note that antibiotic treatment can only cure existing infection and is not a strategy which can control transmission of new infections.

Improving sanitation and environmental conditions

The health of an individual's environment also affects their health, and many diseases are associated with poor environmental conditions such as lack of water and sanitation. These conditions are characteristic of remote Indigenous communities in Australia, where trachoma infection remains rife.

Trachoma is one disease which is associated with inadequate environmental health (such as overcrowding and poor sanitation). Numerous environmental improvement interventions have been implemented in developing countries in an attempt to prevent trachoma infection. These include the provision of water and sanitation facilities (in particular pit latrines to control fly populations) and insecticide spraying to eradicate infection carrying flies.

There is some evidence that insecticide spraying can reduce active trachoma, Studies also suggest that broad environmental health interventions (e.g. combined provision of pit latrines and clean water alongside insecticide spraying) can reduce trachoma prevalence.

United States Food and Drug Authority. Eye cosmetics and eyebrow/eyelash dyes. 2001. [cited 2010, October 15]. [URL Link] Solomon AW, Mabey DCW. Trachoma. BMJ Clin Ev. 2007; 11: 706-18. [Abstract | Full Text] National Institute of Health. Eye Emergencies. 2009 [cited 2010, October 15]. [URL Link]Victorian Government Health Department. Trachoma. 2009. [cited 2010, October 15]. [URL Link]Ejere H, Alhassan MB, Rabiu M, Face washing promotion for preventing active trachoma. Cochrane Database Syst Rev. 2004; 3: CD003659. [Full Text]Kuper H, Solomon AW, Buchan J, et al A critical review of the SAFE strategy for the prevention of blinding trachoma. Lancet Infect Dis. 2003; 3: 372-81. [Abstract]National Health Service. Eye cleaning for newborns. 2006. [cited 2010, October 15]. [URL Link]Emerson PM, Cairncross S, Bailey RL, Mabey DCW. Review of the evidence base for the F and E components of the SAFE strategy for trachoma control. Trop Med Int Health. 2000; 5(8): 515-27. [Abstract]Khandekar R, Thanin TTK, Thi PD, Impact of face washing and environmental improvement on reduction of active trachoma in Vietnam: a trachoma intervention study. Ophthalmic Epidemiol. 2006; ?13(1): 43-52. [Abstract]

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