Questions :

15. Brushing Your Way To A Healthy Smile

Contributed by:

Professor Dr. Ishak Abdul Razak

Dept. of Community Dentistry, University of Malaya, Kuala Lumpur Malaysia

Ever wondered why a smiling child still looks cute even without teeth whereas an adult will not look quite the same. This is because when teeth are loss, the muscles of facial expressions are no longer supported and coupled by the decrease in facial height, will make the person appear old and wrinkled especially around the oral cavity. Many people regard tooth loss as part of growing old. However if teeth are well cared for, they will remain with you for life. Remember the quotation: " ignore your tooth and it will go away!"

The easiest way for you to care for your teeth is regular and effective toothbrushing. This habit is usually inculcated from young. Yet as parents we all know too well how difficult it is to initiate this habit among our children let alone ensuring regular brushing. There are many reasons why people brush their teeth. Some are health-directed whilst others are health-related. Some brush because they want to maintain oral health, others brush because it is part ot the grooming process or to obtain fresh breath. Yet others brush because it has become a force of habit. But more often than not we brush for a combination of reasons.

What is the problem?

There is an accumulation of masses of bacteria and salivary by-products on the tooth surface which is called plaque. They are invisible and continuously forming and their accumulation is the chief cause of tooth decay and gum disease. They do so by acting on the sugars which we consume and converting them into acid. If plaque is allowed to remain undisturbed, it may also become calcified into a hard deposit (tartar) and may further assist in plaque accumulation. So the main purpose of tooth cleaning is to prevent the build-up of plaque and because plaque is formed continuously, only effective daily removal will result in a healthy tissue. Experimental clinical studies have shown that withdrawal of oral hygiene measures in healthy individuals leads to the formation of gingivitis (a mild form of gum disease) within 10-21 days. However once the oral hygiene measures are reintroduced, the condition of the gums revert back to normal.

Is toothbrushing equally effective in preventing gum disease and tooth decay?

Toothbrushing by itself has been proven to be effective in removing plaque and hence prevents gum disease. Similarly, it would be expected that regular toothbrushing, by removing plaque, would reduce dental caries. However, toothbrushing by itself has only a small effect on dental decay. This is because the bristles of the brush cannot reach the depth of the fissures on the tooth surface or the contact areas between adjacent teeth. The value of toothbrushing in the fight against dental decay is, therefore, largely as an agent for applying fluoridated toothpaste to the tooth surfaces and fluoride makes them more resistant to acid attack. This is where you lose a significant benefit if you do not use fluoridated toothpaste.

When to start cleaning the teeth?

Tooth cleaning should start as soon as your baby's first tooth appears in the mouth. It is advisable to start by using a wet cloth to clean the baby's teeth by gently wiping away the dirt on the tooth surface. They may then graduate to gentle brushing using a small, soft children's toothbrush. Try and make it fun for the children to Iearn how to brush. Remember, children learn in small doses so start one step at a time. The child should first be allowed to play with a dry toothbrush in the mouth, then taught proper toothbrushing skills and finally with the use of a tiny amount of toothpaste when the child is able so spit out the excess effectively.

How often should we brush?

Ideally, brushing should be carried out after every meal. This is because acid formation occurs within 30 minutes of consumption of food. However, this may not be practical most of the time because hardly any of us carry our toothbrush around. Theoretically, brushing once a day would suffice to prevent dental disease if it is very thorough but the recommended frequency is twice daily. Always ensure that you brush before retiring to bed. A study on oral hygiene practices amongst Malaysian adults has shown that over 90% of them claimed to have brushed their tooth at least twice a day. Yet a national study on the health of their gums indicate that over 90% of them have gum disease though the majority of them are in the mild form. The answer lies in the effectiveness of brushing. Therefore, the effectiveness of brushing is more important than the frequency of brushing.

How can my brushing be effective?

As the objective of toothbrushing is to remove plaque from the accessible surfaces of the teeth and to maintain the health of the gingival, any technique that does this without traumatising the tissue may be employed. Very small children, because they lack manual dexterity may find the scrub technique (to and fro movements) the most easily mastered. Only light pressure should be employed using a suitable toothbrush.

lt is quite unrealistic to expect young children to clean their teeth effectively. In fact children up to the age of six, often have insufficient manual dexterity to perform such task adequately and parents should assume this responsibility for their children.

Cleaning the entire exposed surfaces of the teeth requires different movements for each accessible surface - the chewing surface, the tongue side and the cheek side. Take your time in brushing. Many people may regard toothbrushing a daily chore which they want to get it over with as fast as possible. A good thorough brushing will take you about two to three minutes. Make your brushing interesting by changing your usual brushing pattern. Most people brush their teeth the same way all the time. This means they miss the same spots all the time and thereby allowing the plaque in these areas to harden or calcify. Try reversing your usual pattern.

What toothbrush should I use?

There are many different types of toothbrushes but the right toothbrush cleans more effectively. Generally choose a soft to medium toothbrush with rounded nylon bristles. Pick a size and shape that you are comfortable with and that allows you to reach all the way to your back teeth. Unlike your teeth which should last you a lifetime, your toothbrush needs regular replacement. A toothbrush should be changed when the bristles start to splay or are worn out because they are no longer effective in removing plaque and food debris from the tooth surface. In fact it may even damage your dental tissues.

Can I rely only on my toothbrush for effective cleaning?

There are areas in the mouth (between adjacent teeth or the back surface of your last tooth) which are not easily accessible to the brush. A dental floss or tread is effective in breaking up the plaque in these areas, allowing it to be readily removed by vigorous rinsing. Take about 40 cm of floss and wrap it around your middle finger. Using the thumb and forefinger at each hand, the floss is guided gently between the teeth with a back-and-forth motion. The floss is placed slightly below the gumline and gently scrapes the side of the tooth away from the gum and towards the biting surface. Use a sew section of floss for each tooth.

PDPA

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