It is no surprise then that we are bombarded in our culture with literally hundreds of ways to remove mouth plaque (bacteria) and have white teeth and fresh breath. How can you decide which is best to use when there are often several aisles of mouth care devices in our stores?

First, it is always best to get an exam from a dentist. Combine this with a plan from your dental hygienist for mouth care that fits your own needs and lifestyle. If you have advanced gum disease, a disability or you are medically restricted in some way, your dentist may refer you to a specialist dentist and dental hygienist team in a periodontal office or hospital.

Many of the tools for mouth care are designed to remove dental plaque from the teeth, the roots of the teeth and the tongue. Others are directed toward cleaning partial or complete dentures, fixed or removable bridges, and implants.

Dental plaque is composed of colonies of bacteria whose pollution products can cause dental disease. The results are tooth or root decay, pain, gum bleeding (gingivitis), tooth support loss (periodontal disease) or bad breath (halitosis). Bleeding gums may be an indication of where there is plaque. In some serious cases, mouth bacteria may enter the blood stream and cause infection in other parts of the body.

Removing bacteria from the teeth and gum line area may be easy for people who are healthy, have good eyesight and co-ordination, evenly placed teeth, few fillings and no missing teeth. For others, cleaning the mouth, teeth and gums is more difficult so special tools have been designed. Harmless red food dyes in tablets or solutions (disclosing agents) help you to see plaque.

Toothbrushes

Toothbrushes of all shapes, sizes, angles and stiffness are available to fit different mouths. Toothbrushes easily remove the soft, loose plaque that may cause gingivitis as it sits around the visible gum collar of the teeth. The brush may be neatly slipped under the gum line area a few millimetres to dislodge these bacteria.

Brushes are also designed to remove the stickier plaque that could cause tooth decay. These bacteria are glued onto the crown (the visible white part) of the tooth. Toothbrushes are great for taking coatings and bacteria that cause bad breath off the tongue. You can also buy tongue scrapers for this.

Most dental professionals and agencies agree that it is best to choose soft, nylon toothbrushes with rounded tips on the bristles (Fig. 1). Bristles that are too firm or uneven can cause the gum line to recede or the roots at the neck of the tooth to wear down or become sensitive.

You can choose any shape or handle or angle that you and your dental professional agree is doing the job even in the farthest back areas. It should be inexpensive so that you can replace it every few months or if you get a cold or mouth infection. Bristles can be in the shape of a dome, a two-level shape, or trimmed flat (Fig. 2). They can be big or small, long or short. The handle, head length, width and angles vary so you can choose one that has a good fit.

A well-fitting toothbrush needs to be able to get all the plaque off the inside, outside and chewing surfaces of all teeth, all the way to the back. It also needs to fit inside of the cheek muscles along the back of the upper teeth.

Put a clean index finger in this area to see how tight your cheek muscles are and then pick a brush with a head slim enough to fit in this area. Some people with tight muscles here or tiny mouth openings or crowded teeth may need child-size, narrow size or angled brush heads.

There are power (mechanical, electric, automatic, ultrasonic) toothbrushes for those who may prefer this to a regular toothbrush. The same reasons to pick a power toothbrush apply as to a manual brush. No one type has been proven to be better than another. Ultrasonic power brushes that move very rapidly (over 30,000 cycles per minute) are a new approach to removing more of the below gumline plaque. Time and further study will tell if they are better or not.

Plaque can harden into tartar in about 48 hours. Tartar provides a perfect rough spot for plaque to cling to. To prevent this happening, it is best to remove dental plaque really well at least once daily. Only a dental professional can remove tartar from teeth.

Harmful mouth bacteria must also be removed from between teeth, under the gum line and along the roots of teeth. This task is more difficult than removing plaque from the more visible tooth surfaces. Bacteria between teeth are very bad because they can cause decay where it can progress more quickly (such as on the roots) or other hard-to-reach areas. Often this is also where gum disease will begin. Conditions here are just perfect for them to thrive and start to smell bad. Plaque from between teeth and on the tongue is the main cause of halitosis (bad breath).

Bacteria that are allowed to stay between teeth might just as well be in an incubator in a science lab. These bacteria can destroy the attachment of the gums.

These warm, moist, dark, well-fed areas are to the plaque like a trip to Hawaii would be for us. The bacteria even build colonies that resemble beach condominiums. This makes their pollution even worse.

There are many ways to remove or mess up these nasty colonies of plaque in between teeth and either gets rid of them completely or disrupt them enough to reduce the pollution that causes decay and gum disease.

In-between

If you are able to use dental floss correctly, you probably have minimal bad effects from plaque (Fig. 3). The styles of floss all work equally well. You can buy waxed, Teflon-coated or unwaxed, thin or fat, flavoured or fuzzy floss, yarn, tape or gauze. If you like to use a product then this is the best one for you.

Some people use floss holders, forks, floss on plastic picks or floss threaders to help them make flossing easier (Fig. 4). Some areas in between teeth can be cleaned with other tools. There is even a new power flosser that vibrates in between teeth to loosen plaque.

People who have difficulty with floss or who have bigger spaces in between teeth have success removing plaque with small interdental brushes, end-tufted brushes, rubber tips, toothpicks on handles, wedge-shaped toothpicks (Fig. 5). These tools may also help to remove more of the plaque that sits on the roots or in the branch areas of the roots or under the gum line. Sometimes your dental hygienist may suggest that you use toothpicks on handles or interdental brushes to apply products with active ingredients to fight bacteria, decay or sensitivity.

Special types of floss and interdental brushes are made of plastic for implants. There are special threaders to get floss under fixed appliances, bridges or partial dentures. You may need to use fuzzy, textured or tufted floss in these areas to remove the stickier tooth and root plaque. There are also special brushes for dentures and for removable partial or orthodontic appliances.

Irrigators

Do you remember the condominiums that the bacteria like to form in colonies around the gum line and in between teeth? Pulsating oral irrigators (like the Waterpick™, Braun™) act like a typhoon or a hurricane to the colonies of bacteria.

An oral irrigator can help to remove loose plaque from above and below the gum line and from in between teeth. It is not very good at removing the sticky, cavity-making tooth and root-associated bacteria though. But the storm-like action of the irrigator can make the colonies of plaque produce less pollution and thus do less damage to the gums in particular. Irrigators are not a substitute for brushing and flossing but they are a great way to flush away bacteria that are already loosened from the teeth.

Toothpaste, gels and mouth rinses

There are a great many toothpastes, gels and rinses. Here are some ways to judge for yourself if they should be part of your mouth care. Ask yourself what you require from the product. If you want to whiten teeth, peroxides and abrasives can help. To kill bacteria, choose iodine, triclosan, cetylpyridinium chloride, sanguinarine, phenols or chlorhexidine.

Mint, zinc chloride or cinnamon can mask bad breath. Cavity reduction is improved by fluoride and chlorhexidine. To get rid of bleeding gums, try thymol, menthol, eucalyptol or chlorhexidine. Pain control can be found with essential oils or phenols.

The most important part to look for is the added 'therapeutic' or active ingredient that is always the first item to be named on the label at the back. Look for the name and the percentage of this item. You may find the alcohol content next. The lists of ingredients found here are just common examples as there are far too many to name. In Canada we are not required by law to put anything other than the active ingredient on our labels. In the U.S. labels tell you almost everything that is in your food or product.

Most mouthwashes are over 90 per cent water, next is about 10 to 30 per cent alcohol. Flavouring, colouring and sweetening and active ingredients may all be less than 1 per cent of your product. If you know the active ingredient, you can purchase a generic or house brand of this item or you can get a brand that is on sale. If you do not know what the chemical name means, ask a pharmacist or dental professional.

People who are alcoholic or who have dry mouth, sensitivity, cavities, porcelain crowns, sensitive tissue or other conditions will want to avoid mouthwashes with high alcohol content or that are acidic or highly abrasive. Tooth whiteners that you can buy over the counter may also be irritating or harmful to teeth and tissues.

Fluorides have been proven to reduce cavities and sensitivity. Chlorhexidine and the agents in Listerine™ and its generics (thymol, menthol, eucalyptol) are proven to reduce gingivitis. Toothpastes often have an anti-cavity ingredient like sodium fluoride. They may also have a desensitizer like stannous fluoride or strontium chloride.

You may see a tartar fighter like pyrophosphate or an antibacterial agent like triclosan, sanguinarine, hydrogen peroxide or stannous fluoride. Some products have detergent like shampoo (sodium lauryl sulfate) that causes them to foam. Abrasives like calcium carbonate, silica or baking soda are added to paste and gels to help remove plaque and polish and whiten teeth.

Please note that toothpaste or gels are mostly water, stabilizers and thickeners. Gels are an option to pastes and may be preferable to some. Some gels are less abrasive for sensitive teeth. Preservatives, sweetening agents, flavours, colours and stabilizers are also added.

Children

Children need to learn good dental habits at an early age. Regular brushing and flossing are very important. Parents and caregivers need to learn about early childhood cavities. They are often caused by children drinking juices, cow’s milk or sweetened liquids for an extended time, such as sucking them from a bottle. Lack of plaque control in a child’s mouth can also lead to problems. This serious form of early tooth decay can cause a child cavities, pain, tooth loss and other dental problems later in life. Never put a baby to bed with anything but water in the bottle or on a teething nipple.

Caregivers and parents need to clean the child’s teeth in the early years. Once the child is old enough to learn, teach the proper use of toothpaste and rinsing well after use. A pea-size amount of paste on a baby brush is plenty. Children often need assistance until about age eight.

Product information

Look for the American and Canadian Dental Association Seals of Approval (Fig. 7). These seals show that the products have been tested for safety and effectiveness and that their claims are true. Drug Information Numbers (DIN) are from Health Protection Canada. Their presence on a product proves that the main active ingredient is safe and has proven therapeutic effectiveness to cure a condition or a disease as it claims to do. Always discard products after the expiry date. Products are not as effective after these dates.

In conclusion, if you can form a team with your dentist and your dental hygienist, you will find the best tools to have a clean and healthy oral cavity. If you smoke, please consider quitting. Tobacco, in all of its forms, (cigarettes, smokeless tobacco, snuff, chewing tobacco, pipe, cigar) has been proven to cause or worsen gum disease, oral cancer, gum recession, cavities, tooth loss and halitosis. A healthy, varied diet with minimal sugar and a variety of Canada Food Guide choices, as described often in Family Health. will help maintain a healthy immune system to fight dental diseases. Healthy mouths can be gateways to healthy bodies. Care for them wisely and you will be smiling for life.

Dental Care Devices Choosing the best tools to care for your teeth