Oral hygiene

Oral hygiene is the practice of keeping the mouth and teeth clean to prevent dental problems, especially the common dental caries and gingivitis, and bad breath. There are oral pathologic conditions in which a good oral hygiene is required for healing and regeneration of the oral tissues. These conditions included gingivitis, periodontitis, dental traumas^[1] such as subluxation,^[2] oral cysts,^[3] and after wisdom tooth extraction.

Teeth cleaning

See also: Tooth brushing

Teeth cleaning is the removal of dental plaque and tartar from teeth to prevent cavities, gingivitis, and gum disease. Severe gum disease causes at least one-third of adult tooth loss.

Tooth Decay is the most common global disease affecting every family. Over 80% of cavities occur inside pits and fissures on chewing surfaces where brushing cannot reach food left trapped after every meal or snack and saliva or fluoride have no access to neutralise acid and remineralise demineralised tooth like on easy to reach surfaces where few cavities occur.

Fissure sealants dentists apply over grooves in chewing surfaces of back teeth, block food being trapped and halt the decay process. An elastomer strip has been shown to force sealant deeper inside all opposing chewing surfaces at the same time and can also force fluoride toothpaste inside chewing surfaces before brushing to remineralise demineralised teeth.

Since before recorded history, a variety of oral hygiene measures have been used for teeth cleaning. This has been verified by various excavations done all over the world, in which chew sticks, tree twigs, bird feathers, animal bones and porcupine quills were recovered. Many people used different forms of teeth cleaning tools. Indian medicine (Ayurveda) has used the neem tree (a.k.a. daatun) and its products to create teeth cleaning twigs and similar products for millennia. A person chews one end of the neem twig until it somewhat resembles the bristles of a toothbrush, and then uses it to brush the teeth. In the Muslim world, the miswak, or siwak, made from a twig or root with antiseptic properties has been widely used since the Islamic Golden Age. Rubbing baking soda or chalk against the teeth was also common.

Generally, dentists recommend that teeth be cleaned professionally at least twice per year. Professional cleaning includes tooth scaling, tooth polishing, and, if too much tartar has built up, debridement. This is usually followed by a fluoride treatment. However, there is no good evidence that scaling and polishing is cost-effective.^[4]

Between cleanings by a dental hygienist, good oral hygiene is essential for preventing tartar build-up which causes the problems mentioned above. This is done by carefully and frequently brushing with a toothbrush and the use of dental floss to prevent accumulation of plaque on the teeth.^[5]

Plaque

Plaque is a yellow sticky film that forms on the teeth and gums and can be seen at gum margins of teeth with a food dye. The bacteria in plaque change carbohydrate like sugar in food to acid that demineralises tooth eventually causing cavities after repeated attacks over a number of years where demineralisation exceeds saliva and fluoride remineralisation. Thorough daily brushing and flossing can prevent tartar from forming on the teeth.

Plaque can also cause irritation to the gums, making them red, tender, or bleeding easily. In some cases, the gums pull away from the teeth, leaving cavities inhabited by bacteria and pus. If this is not treated, bones around the teeth can be destroyed. Teeth may become loose or have to be removed as with periodontal (gum) disease in mostly adults. Eating a balanced diet and limiting snacks can prevent tooth decay and periodontal disease. Nutritious foods such as raw vegetables, plain yogurt, cheese, or a piece of fruit are considered good snack foods to grab.^[6]

Flossing

The use of dental floss is an important element of oral hygiene, since it removes the plaque and the decaying food remaining stuck between the teeth. This food decay and plaque cause irritation to the gums, allowing the gum tissue to bleed more easily. Acid forming foods left on teeth also demineralise teeth eventually causing cavities. Flossing for a proper inter-dental cleaning is recommended at least once per day, preferably before brushing so fluoride toothpase has better access between teeth to help remineralise tooth,^[7] prevent receding gums, gum disease, and cavities between the teeth.

A dental hygienist demonstrates dental flossing.

It is recommended to use enough floss to enable easy use, usually ten or more inches with three to four inches of taut floss to put between teeth. Floss is then wrapped around the middle finger and/or index finger, and supported with the thumb on each hand. It is then held tightly to make taut, and then gently moved up and down between each tooth. It is important to floss under visible areas by curving the floss around each tooth instead of moving up and down on gums, which are much more sensitive than teeth. However, bleeding gums are normal upon first usage of floss, and will harden with use.^[8] One should use an unused section of the floss when moving around different teeth. Removing floss from between teeth requires using the same back-and-forth motion as flossing, but gently bringing the floss up and out of gaps between teeth.

Tongue cleaning

Cleaning the tongue as part of daily oral hygiene is essential, since it removes the white/yellow bad-breath-generating coating of bacteria, decaying food particles, fungi (such as Candida), and dead cells from the dorsal area of the tongue. Tongue cleaning also removes some of the bacteria species which generate tooth decay and gum problems.

Gum care

Massaging gums with toothbrush bristles is generally recommended for good oral health. Flossing is recommended at least once per day, preferably before bed, to help prevent receding gums, gum disease, and cavities between the teeth.

Oral irrigation

Some dental professionals recommend oral irrigation as a way to clean teeth and gums.^[9]

Oral irrigators reach 3–4 mm under the gum line. Oral irrigators use a pressured, directed stream of water to disrupt plaque and bacteria.

Food and drink

Foods that help muscles and bones also help teeth and gums. Breads and cereals are rich in vitamin B while fruits and vegetables contain vitamin C, both of which contribute to healthy gum tissue.(8) Lean meat, fish, and poultry provide magnesium and zinc for teeth. Some people^[who?] recommend that teeth be brushed after every meal and at bedtime, and flossed at least once per day, preferably at night before sleep. For some people, flossing might be recommended after every meal.

Beneficial foods

Some foods may protect against cavities. Fluoride is a primary protector against dental cavities. Fluoride makes the surface of teeth more resistant to acids during the process of remineralisation. Drinking fluoridated water is recommended by some dental professionals while others say that using toothpaste alone is enough. Milk and cheese are also rich in calcium and phosphate, and may also encourage remineralisation. All foods increase saliva production, and since saliva contains buffer chemicals this helps to stabilize the pH to near 7 (neutral) in the mouth. Foods high in fiber may also help to increase the flow of saliva and a bolus of fibre like celery string can force saliva into trapped food inside pits and fissures on chewing surfaces where over 80% of cavities occur, to dilute carbohydrate like sugar, neutraluise acid and remineralise tooth like on easy to reach surfaces.^[7] Sugar-free chewing gum stimulates saliva production, and helps to clean the surface of the teeth.(8)

According to World Dental,^[10] these are the top ten beneficial foods for teeth.

1. Green tea contains polyphenol antioxidant plant compounds that reduce plaque and help reduce cavities and gum disease. Tea may help reduce bad breath. Tooth enamel is strengthened because green tea contains fluoride which promotes healthy teeth.
2. Milk and yogurt are good for teeth because they contain low acidity, which means that wearing of teeth is less. They are also low in decay-inducing sugar. Milk is a good source of calcium, the main component of teeth and bones.
3. Cheese contains calcium and phosphate, which helps balance pH in the mouth, preserves (and rebuilds) tooth enamel, produces saliva, and kills bacteria that cause cavities and disease.^[10]
4. Fruits such as apples, strawberries and kiwis contain Vitamin C. This vitamin is considered the element that holds cells together. If this vitamin is neglected, gum cells can break down, making gums tender and susceptible to disease.
5. Vegetables: Vitamin A, found in pumpkins, carrots, sweet potatoes and broccoli, is necessary for the formation of tooth enamel. Crunchy vegetables may also help clean gums.
6. Onions contain antibacterial sulfur compounds. Tests show that onions kill various types of bacteria, especially when eaten raw.^[10]
7. Celery protects teeth by producing saliva which neutralizes acid that causes demineralisation and cavities. It also massages the teeth and gums.
8. Sesame seeds reduce plaque and help build tooth enamel. They are also very high in calcium.^[10]
9. Animal food: beef, chicken, turkey, and eggs contain phosphorus which, with calcium, is one of the two most vital minerals of teeth and bone.
10. Water cleans the mouth and produces saliva that deposits essential minerals into the teeth. It keeps gums hydrated and washes away particles from the teeth.^[10]

Detrimental foods

Sugars are commonly associated with dental cavities. Other carbohydrates, especially cooked starches, e.g. crisps/potato chips, may also damage teeth, although to a lesser degree since starch has to be converted by enzymes in saliva first.

Sucrose (table sugar) is most commonly associated with cavities. The amount of sugar consumed at any one time is less important than how often food and drinks that contain sugar are consumed. The more frequently sugars are consumed, the greater the time during which the tooth is exposed to low pH levels, at which point demineralisation occurs (below 5.5 for most people). It is important therefore to try to encourage infrequent consumption of food and drinks containing sugar so that teeth have a chance to be repaired by remineralisation and fluoride. Limiting sugar-containing foods and drinks to meal times is one way to reduce the incidence of cavities. Sugars from fruit and fruit juices, e.g., glucose, fructose, and maltose seem equally likely to cause cavities.^{[citation needed]}

Acids contained in fruit juice, vinegar and soft drinks lower the pH level of the oral cavity which causes the enamel to demineralize. Drinking drinks such as orange juice or cola throughout the day raises the risk of dental cavities tremendously.

Another factor which affects the risk of developing cavities is the stickiness of foods. Some foods or sweets may stick to the teeth and so reduce the pH in the mouth for an extended time, particularly if they are sugary. It is important that teeth be cleaned at least twice a day, preferably with a toothbrush and fluoride toothpaste, to remove any food sticking to the teeth. Regular brushing and the use of dental floss also removes the dental plaque coating the tooth surface.

Chewing gum assists oral irrigation between and around the teeth, cleaning and removing particles, but for teeth in poor condition it may damage or remove loose fillings as well.

Other

Smoking and chewing tobacco are both strongly linked with multiple dental diseases.^[11] Regular vomiting, as seen in bulimia nervosa, also causes significant damage.

Mouthwash or mouth rinse with saline (salty water), fluoridated solution or the antiseptic chlorhexidine gluconate solution improve oral hygiene. Dental chewing gums claim to improve dental health.

Retainers can be cleaned in mouthwash or denture cleaning fluid.^[12] Dental braces may be recommended by a dentist for best oral hygiene and health. Dentures, retainers, and other appliances must be kept extremely clean. This includes regular brushing and may include soaking them in a cleansing solution such as a denture cleaner.

Oral hygiene and systemic diseases

Several recent clinical studies show a direct link between poor oral hygiene (oral bacteria & oral infections) and serious systemic diseases, such as:^[13][14]

• Cardiovascular Disease (Heart attack and Stroke)
• Bacterial Pneumonia
• Low Birth Weight/Extreme High Birth Weight
• Diabetes complications
• Osteoporosis

See also

• Smiley's Good Teeth Puppet Theatre
• Dental hygienist
• Receding gums
• Periodontology
• List of oral health and dental topics
• List of basic dentistry topics
• Halitosis
• Toothbrush
• Tongue cleaner
• Dental floss
• American Dental Hygienists' Association

References

1. ^ Zadik Y (December 2008). "Algorithm of first-aid management of dental trauma for medics and corpsmen". Dent Traumatol 24 (6): 698–701. doi:10.1111/j.1600-9657.2008.00649.x. PMID 19021668. 
2. ^ Flores MT, Andersson L, Andreasen JO, et al. The International Association of Dental Traumatology (April 2007). "Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth". Dent Traumatol 23 (2): 66–71. doi:10.1111/j.1600-9657.2007.00592.x. PMID 17367451. 
3. ^ Zadik Y, Yitschaky O, Neuman T, Nitzan DW (May 2011). "On the Self-Resolution Nature of the Buccal Bifurcation Cyst". J Oral Maxillofac Surg 20 (5): e282–4. doi:10.1016/j.joms.2011.02.124. PMID 21571416. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WKF-52VP3D1-6&_user=10&_coverDate=05%2F14%2F2011&_rdoc=9&_fmt=high&_orig=browse&_origin=browse&_zone=rslt_list_item&_srch=doc-info(%23toc%236905%239999%23999999999%2399999%23FLA%23display%23Articles)&_cdi=6905&_sort=d&_docanchor=&_ct=207&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=47e40681e02990c1d46b7f818fe30630&searchtype=a. 
4. ^ NHS Evidence
5. ^ Curtis, Jeannette (13 November 2007). Effective Tooth Brushing and Flossing. WebMD. http://www.webmd.com/oral-health/effective-tooth-brushing-and-flossing. Retrieved 2007-12-24 
6. ^ http://www.ada.org/public/topics/cleaning_faq.asp
7. ^ ^{a b} www.supertoothndk.org
8. ^ http://www.webmd.com/oral-health/effective-tooth-brushing-and-flossing
9. ^ Template:Vol. 1,
10. ^ ^{a b c d e} 10 most healthy foods for teeth
11. ^ Tobacco use and incidence of tooth loss among US male health professionals. Journal of Dental Research, 86(4):373-7. April, 2007
12. ^ "Dental Appliances". Dentistry.com. 13 November 2007. http://www.dentistry.com/articles/Dental_Appliances.aspx. Retrieved 2007-12-24 
13. ^ Systemic Diseases Caused by Oral Infection Clinical Microbiology Reviews, October 2000, p. 547-558, Vol. 13, No. 4
14. ^ Osteoporosis and Periodontal Disease Division of Periodontology, Department of Dentistry, Taipei Veterans General Hospital, School of Dentistry, National Yang-Ming University, Taipei, Taiwan, R.O.C.

External links

• World Health Organization site on oral health
• Official website for the FDI World Dental Federation