Tips on How to Improve Your Oral Hygeine Routine

We need to brush slowly and carefully at the gum line, usually with small circular movements, as harsh sideways movements can result in the gums being pushed away from the teeth. (ShutterStock)

Ok, so how should I brush my teeth?

Well, you need to pay particular attention to all the red and swollen areas of the gums.

But when I brush them they start to bleed!

That’s why you need to brush them! I know it sounds counter intuitive, but there is plaque on and around your teeth and calculus or hard plaque, also called tartar, has formed under your gums. That is what’s causing the gums to bleed.

Plaque is an accumulation of food particles and microorganisms that create biofilms which are left on your teeth after eating. Sticky snacks are especially dangerous and adhere more readily to tooth surfaces. 

A biofilm forms within hours. Proteins from saliva deposit on teeth even after cleaning and fast growing bacteria in the saliva quickly re-colonize tooth surfaces. These colonies may initially be good bacteria but as the colonies grow there are more opportunities for bad bacteria to proliferate, creating an imbalance called dysbiosis. The bad bacteria release toxins and enzymes that trigger inflammation in the gum tissues and as the condition worsens, it leads to a condition called periodontitis which is one of the most prevalent medical conditions worldwide.  

How to Brush Your Teeth

We need to brush slowly and carefully at the gum line, usually with small circular movements, as harsh sideways movements can result in the gums being pushed away from the teeth. Any initial bleeding on brushing will usually diminish within days with careful cleaning.  If this tooth brushing method sounds like too much trouble, then an electric brush can efficiently do those movements for us. An electric brush may also be more easily maneuvered to reach the more difficult areas of the mouth to clean properly. Closing the mouth after inserting any brush will allow easier access to the outside surfaces of the teeth as the lips and cheeks won’t be stretched.

Certain toothpastes claim greater efficiency and effectiveness in removing plaque from the teeth.  Some are prescribed by a dentist.  Mouth washes also make claims to help with oral hygiene and in keeping bad breath in check.

The relative dentin abrasivity (RDA), or how abrasive a toothpaste is on the tooth enamel, had been measured for different toothpaste brands. A level of 70 is considered a lower index, suitable for those who have exposed root surfaces. Some toothpastes, especially the whitening ones, can have RDA levels of up to 200. The ADA (American Dental Association) recommends levels below 250 and offers a list of acceptable products. 

Removing Deposits from Between the Teeth

In-between the teeth, unhealthy deposits or biofilms are more protected  by the surrounding tooth walls from being displaced by bruising.

For younger people, or those with minimal spacing between the teeth, dental floss is very effective – if used properly. Deposits between the teeth must be removed, so just moving a piece of floss up and down between them may not be effective. Also, the floss may dig into the gum below with some force as it is squeezed through tight contact areas between teeth.  

Recall the image from long ago of two woodsmen sawing through a tree or log. Such a saw blade is relatively flexible and so the woodsmen had to maintain correct tension between the two of them, holding the blade taught to keep it from snagging.  

So the two ends of the floss should be wound around the index fingers of both hands with a small area of exposed floss to go in-between the teeth, guided by the thumb and index finger.  Gently push past the contact point, which is about a quarter of the way down the tooth. Keep this movement under control, otherwise the floss may become like a bow and arrow if it suddenly flips past the contact point.  Once past the contact point, one can then release the tension and rearrange the grip to draw almost the full length of the floss around one tooth and then do the same to its neighbor.  That way the errant deposits can be drawn through the space and wiped off the floss with a tissue.  Dental tape is more efficient than floss as it is wider. If a large amount of calculus is present, the floss won’t be able to go in-between the teeth.

The preloaded type of floss will be helpful for some people who have less manual dexterity. This will not be as comprehensive in drawing through deposits, but it is better than nothing as it will help to disturb the biofilms.

Removing Deposits When Spaces are Visible Between the Teeth

With visible spaces present between the teeth and for those with more periodontal or gum issues, Interdental brushes are really effective. These, somewhat surprisingly, have only been developed in recent years. They are like a mini toothbrush but used horizontally, directly between the teeth at the gum level. One should keep this straight angle and not poke the brush end into the gums, but go straight through between the teeth at an angle parallel to the floor. As a bonus, one can dip the interdental brush in toothpaste each time before moving it between the teeth. 

Though it is not really good to have spaces between the teeth, an interdental brush can help you physically brush between the teeth. Interdental brushes come in various thicknesses to correspond to the amount of space between teeth.

Water Flossers

Water flossers are also a more recent development with some very efficient brands now in use. One can physically wash between the teeth with a stream of water – or with medicines. This will help to wash away toxins that have developed from the bacterial biofilms between the teeth and those that lurk in the deeper part of any periodontal pocket that has developed.

All of these aids require a certain amount of practice and skill to use to the maximum efficiency. A quick wash with a water flosser may not be as effective as an interdental brush. Imagine the difference between washing dishes by running them under the tap compared to washing dishes with a brush. However, I think the idea is to do both and there is certainly no harm in doing both, especially if the periodontal status is less than ideal.

Coloring the Deposits on the Teeth

Disclosing solution will color the deposits on the teeth—from microscopic to macroscopic—making them more visible to the eye.  If one applies disclosing agents to the teeth after one’s usual cleaning method, one can see what and where deposits have been left behind allowing them to be effectively remedied. 

Peroxide is an Ongoing Healing Agent for Periodontal Disease

Hydrogen peroxide gel can also be applied to teeth and gums, normally at a 3% concentration. Peroxide is an ongoing healing agent for chronic conditions such as periodontal disease. Special trays similar to bleaching trays are made, but usually extend just beyond the gum level to ensure that the gel reaches down below the gum line. One holds the trays with small amounts of the peroxide in the mouth for a certain amount of time a day, or a number of times per day, depending on the severity of the condition. If done for long enough, hydrogen peroxide gel may even have a whitening effect on the teeth as a bonus.

Antibiotics were used in the past, applied directly under the gums, for more aggressive forms of periodontal disease. A chip containing chlorhexidine has also been used in deep periodontal pockets.  These periodontal areas naturally must first be professionally cleaned to remove the hard and soft deposits as these are the cause of the problem in the first place.

What if the swelling or bleeding doesn’t get any better? Hormonal or systemic conditions can be the reason and so these need to be checked by the dentist. Certain drugs can also cause the gums to swell and bleed such as anticoagulants like warfarin and anticonvulsants such as phenytoin.

Dry Mouth and Swollen Gums

Xerostomia (dry mouth) is more prevalent in older age groups and drugs such as antidepressants and hypertensive drugs can exacerbate this condition. Without the natural protection and washing of the saliva, decay is also more prevalent and periodontal conditions can be exacerbated.

Swollen gums are relatively common in pregnancy due to hormonal changes. Dental advice should be sought if careful oral hygiene does not resolve the problem.

Swollen gums, especially in young people, may be from leukemia and this must be addressed without delay. 

A dentist or hygienist needs to remove the hard deposits from between and around the teeth as home care will not be effective because these deposits by now have been ‘cemented’ to the teeth by the calcium and phosphate in the saliva. 

Should You Brush Your Teeth Before or After Breakfast?

The mantra is to brush at least twice a day, and this makes sense. One also traditionally hears about brushing the teeth before breakfast. Bioflims do form overnight even without eating. However, if one is eating a more sugary type of breakfast, that is only going to add more deposits to the teeth and so it would make more sense to brush and floss after breakfast, to remove both accumulations together. Deposits form on the teeth after eating anything, so if one has a periodontal condition it makes sense to clean each time after eating.

We tend to forget about the deposits on the teeth and gums left by snacks and sugary drinks in-between meals when we are busy and stressed. This will inevitably lead to more decay and gum problems as we tend not to clean the teeth afterwards. The more snacks, the more attacks there are on the teeth and gums. Even just rinsing the mouth with water will be beneficial to wash away some of the remaining food particles. In an ideal world one would like to train oneself to eat raw carrots or celery sticks in-between meals or even an apple a day would be more conducive to a healthy mouth. 

Good oral hygiene will lead to both a fresh feeling and fresh smelling mouth as well as an environment that is systemically healthier for the entire body. Healthy habits for a healthy outcome really do not take too much time or effort when we make them part of our daily routine.