Questions :

17. Preserve Your Smile - be gentle to your teeth and gums Associate

Contributed by:

Professor Dr. Nasruddin Jaafar

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

Your smile is very precious. Every day you brush your teeth to preserve it. But do you know that you must be gentle to your gums and teeth? Some studies indicate that two out of three people apply too much pressure when brushing. If your new toothbrush starts to become frayed after only two weeks of use, chances are you are hurting yourself. Coupled with the use of strongly abrasive toothpaste, a hard toothbrush and an aggressive brushing technique, the signs of self-inflicted destruction starts to appear by middle age (around 35 years) even though there are no sign of gum disease. In some people this occurs even earlier. Over a lifetime the accumulated damage includes:

Receding Gums

Stand in front of a mirror. Smile while retracting your lips with your fingers. Does your teeth look longer that it should? Perhaps your hard brushing habit has destroyed the gum tissue causing your gum line to recede. This damage is permanent. You only have two choices: stop further damage or have an expensive and painful gum surgery where the long term results are not very good.

Notched Teeth

This usually occurs on the necks of the canine, premolar and first molar teeth. Try this simple experiment. Run your fingernail on these teeth starting from the crown towards the gum line. Do you feel an abrupt 'notch' as you reach into the gum line area. If you can feel it, this is an early sign of toothbrush abrasion. Although the dentist can repair this with modern adhesive fillings, the long term results can he disappointing, especially if there is no change in brushing habits. The filling itself may stay on but the softer parts of the tooth (the cementum and dentine) slowly become abraded by normal brushing causing a notch to form around the filling. Staining by foods and drinks makes it even more unsightly than before. Thus prevention is always better than cure.

Sensitive Teeth

This occurs because the area at the neck of the tooth has nerves, which become exposed, through tiny holes (pores) is the dentine. Normally this area is protected by the cementum and your gums but this layer has been stripped away by your vigorous brushing. Tooth sensitivity prevents you from enjoying the foods you love.

Increasing The Risk Of Root Caries

This is slowly becoming more common as more elderly Malaysians keep more of their teeth for life. The dentine and cementum at the necks of your teeth are very soft. So they are very vulnerable to dental caries especially with poor oral hygiene and diets. This is made worse by a condition called "erosion" which is caused by highly acidic foods we eat - like oranges, limes, apples, mangoes, 'jeruk' and fizzy drinks. The natural acids dissolve the calcium near the exposed necks of the teeth making them softer. If the teeth are brushed vigorously immediately after these acid-food attacks it may cause more damage. Repaired (filled) erosion cavities have very poor long-term prognosis. Again the old adage 'prevention is better than cure' applies.

So What Can You Do To Prevent This Self-Inflicted Damage?

Surprisingly not many people realize that they are brushing too hard. In fact the brushing habits of most "normal" people results in too much pressure. There are expensive solutions to this. For example, in the USA a patented toothbrush emits micro-sensor lights a warning whenever the user brushes too hard. Some new electric toothbrushes are designed to stall (stop), if too much pressure is applied on the teeth. But they are other simpler things you can do at minimal cost.

Step 1: Start with your toothbrush and toothpaste.

If you like using "hard" toothbrush - stop it right now. Get a medium or better still, a soft brush. Some new toothbrushes in the market have soft flexible necks to prevent you from applying too much pressure. Remember you are brushing to achieve basically three things.

First, to remove plaque.

Plaque is so soft that even the softest toothbrush with gentle pressure can remove it. You do not need great force.

Second, to apply fluoride in adequate quantities to re-mineralize (harden) tooth parts that have been softened by acid exposure in your diet (erosion) or plaque-sugar interaction (caries).

Third, to remove extrinsic stains.

This is where toothpaste manufacturers draw a fine line with abrasive ingredients: too gentle and the toothpaste don't clean well; too harsh and it can harm your teeth and gums. As a general rule, if you are not a smoker - never use smokers toothpaste - as they are among the most abrasive. Anyway isn't it better for you to stop smoking as well?

Different toothpastes have different abrasive qualities. Some consumer groups publish the abrasivity of different toothpastes so you can choose the less abrasive ones if you like. But most abrasive systems used nowadays are much gender than those used a generation ago and the risk of damage is less. But first, look at your teeth in a mirror. Do you have stains on your teeth that need such a hard brushing pressure? Most people don't but they brush hard anyway to make their teeth look "whiter". This is a mistakes belief. It is like trying to clean your dirty new car with steel wool and abrasive paste. Yes - you get a very clean car, not a speck of dirt but the paint work is permanently damaged.

What is important for you to have is clean teeth - free from plaque. Your teeth are as white (or as yellow) as your dentine colour are. Brushing will only remove the extrinsic (external) stain but will not change the intrinsic (natural) colour of your teeth. Stubborn extrinsic stains can be removed by your dentist. Then the regular maintenance can be carried out by you. So save yourself the effort and be proud of your natural smile.

Step 2: Change your brushing technique.

Some researchers suggest that if you are used to a medium-hard toothbrush, you can minimize pressure damage by changing to a pen-grip (as though you are holding a pen) when brushing, instead of the popular full-fisted grip. The pen-grip uses only three fingers to hold the toothbrush so that the pressure on the teeth is minimal. It is very easy to get used to. Although there are at least seven techniques of toothbrushing in the literature, scientific studies have shown none to be superior to the other. For most healthy people it does not make any difference which technique they prefer as long as it is effective in removing plaque. Besides, life-long habits are difficult to change. With gentle pressure you will not cause self-inflicted damage whichever method you choose.

Step 3: Avoid brushing immediately after taking an acidic (sour) food.

Some researchers suggest that if you plan to eat or drink something acidic (orange juice, lemonade, soda. fizzy drinks) you should brush before consuming it. But for most people this is not very practical because what you eat and when, is usually impulsive. Alternatively, they suggest that you wait for an hour or two after an acidic meal before you brush your teeth. This may seem to be contradictory to what most dentists have been telling you i.e. to brush immediately after every meal. But new research shows that the acid weakens the tooth structure causing abrasions when brushing immediately after eating an acidic meal. The two-hour delay allows the teeth to remineralize. This is why it is important to brush with a fluoride-containing toothpaste to help the process of micro-repair that your teeth need everyday. But the most practical thing for you to do is to always rinse your mouth thoroughly and immediately after all meals. We are fortunate that most of our piped water supply also contain traces of fluoride. This helps a lot to repair the daily damage.

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