Healthy Habits, Healthy Mouth: The Essentials of Home Dental Hygiene

Ashley

September 2, 2024

The importance of dental hygiene

Dental hygiene isn’t the most fun topic, but it’s so important! The non-negotiable essentials for dental hygiene should be brushing your teeth twice a day, flossing once a day, and seeing the dentist twice a year for a more advanced cleaning. To be transparent, I hate flossing and definitely do not floss every day. I’m trying my best to implement it as a habit, though. Today we will be focusing on the dental health basics at home and why it is a critical component of your healthcare routine. I’m preaching to myself as much as I am anyone else who’s reading this! 

Today’s essentials were not always essential… Why the change?

So why is brushing twice a day and flossing once a day so important? After all, less than 100 years ago brushing and flossing weren’t the norm. In the 1940s, processed foods and sugar became more common. Many families started taking part in these foods regularly due to convenience. The increased consumption of these types of foods and beverages led to a significant increase in cavities. This is due to how sugars break down in the mouth and cause tooth enamel demineralization more quickly than other foods. The buildup of bacteria from sugars forms plaque and eventually tartar. These larger groupings of bacteria are stuck to your teeth and work to demineralize your teeth, which is what causes cavities to form.

Cavities and dental decay are prevalent in every age group. If these concerns are left untreated, they can negatively affect quality of life. Often dental decay leads to pain, poor nutrition, and poor self-image. 530 million children worldwide have untreated tooth decay. On top of the negatives already mentioned, it can affect their development and even academic performance. Your body also recognizes the bacteria and tries to fight it like any other infection you might have. The challenge with this is the “inflammatory response” from your body to fight off the bacteria also causes the collagen and other fibers on the inside of your tooth to degrade. If this happens frequently enough, it can cause your teeth to fall out. Both brushing and flossing disrupt the buildup of bacteria on your teeth, which is why it’s an important dental hygiene practice!

The connection between dental health and overall health

Another reason for taking care of your oral hygiene is the connection between your oral health and general health. Periodontal disease causes damage to gums, bones, and tissues holding your teeth in place. It affects approximately 40% of adults today. Studies show links between periodontal disease and diabetes, stroke, high blood pressure, dementia, heart disease, arthritis, and Alzheimer’s. The mechanism for this is not yet clear. However, one suggestion is that the inflammatory response due to periodontal disease can cause bacteria and other molecules in the mouth to access other body parts which contributes to other inflammatory diseases. Periodontal pathogens have been found in cardiovascular disease and rheumatoid arthritis patients outside of the mouth, where you’d expect to see them!

Not only can your oral health influence other diseases to take form in your body, but other diseases or medication you’re taking can also have an impact on your oral hygiene. This is why it is important for your dentist to have a good understanding of your overall health history. Your mouth and its components should not be treated as a completely separate system from the rest of your body. Most dentists are aware of this connection, but most of their patients are not.

Choosing the best toothbrush: manual vs electric

Which is better – manual or electric toothbrushes? An 11-year study found that using electric toothbrushes, particularly those with oscillating heads, leads to healthier gums, less tooth decay, and less tooth loss compared to manual toothbrushes. That doesn’t mean a manual toothbrush is ineffective. It just takes more practice and intentionality to get a similar level of cleanliness with a manual toothbrush. Many people just don’t have the time or patience to learn it correctly!  

When it comes to the environment, an electric toothbrush will have a greater negative impact. Many electric toothbrushes have a rechargeable lithium battery, which has a host of its own environmental concerns as the batteries are rarely recycled or repurposed. Additionally, most are plastic and bulkier without a way to be recycled. Manual brushes are often plastic as well, but less bulky with no electric parts. You can also find compostable bamboo manual toothbrushes relatively easily these days. Personally, I struggle with brushing too hard and gum recession so an electric toothbrush with a pressure sensor is the right choice for me. My plastic electric toothbrush with plastic brush heads was a gift so I’ll continue using what I have. 

If you’re in the market for a new toothbrush…

If you’re in the market for a new toothbrush and don’t want to invest in an electric one, I’d recommend a compostable bamboo manual toothbrush. As nice as “compostable” sounds, I haven’t done research yet into the manufacturing process inputs. It’s possible that a compostable bamboo brush may have a similar net effect on the environment as a plastic manual toothbrush, after looking at all factors. If you choose manual, invest time into learning how to brush well to avoid damage to your teeth and gums. Also please make sure you figure out whether the entire toothbrush is compostable or if you need to remove the bristles! Many times only the bamboo handle is compostable.

If you’re interested in investing in an electric toothbrush, there are more sustainable options out there. Sustainable Tomorrow and Etee have bamboo electric toothbrush options. FOREO has silicone electric toothbrush options. Lastly, SURI has a plant-based plastic and aluminum combination which they will repair and/or recycle when necessary. I use my plastic electric toothbrush that was a gift and have not tried any of these brands. Don’t forget to check out the reviews before making a purchase!

Whichever option you choose, choose one with soft bristles. Harder bristles can damage your gums, or even your tooth enamel. Lastly, don’t forget to replace your toothbrushes or brush heads! Ideally you should replace them every one to three months. The bristles change as you use them (particularly if you brush on the harder side) and can actually damage your enamel if you use them for too long.

Choosing the best toothpaste: fluoride vs hydroxyapatite

Believe it or not, toothpaste doesn’t do that much to clean your teeth. The act of brushing and disturbing particles is really what’s critical to keep your teeth clean and healthy. Most of us probably prefer to use toothpaste to help with morning breath and give us the minty fresh feeling that we associate with clean teeth. Many recommended toothpastes contain fluoride to prevent cavities. Check out my Effects of Fluoride Exposure post to learn more about fluoride and determine if it’s something you want to incorporate into your brushing routine. 

To find a good toothpaste you’ll not only want to be cognizant of fluoride, but there are other ingredients typically used in toothpaste and other personal care products like parabens, surfactants (Sodium Lauryl Sulfate and Cocamidopropyl Betaine are most common), artificial colors, PEGs, etc. that you may want to avoid. Overall, these ingredients are slightly less concerning when used in toothpaste because you spit the majority of it out. There will be some residual left in your mouth, however. Additionally, young children are more likely to inadvertently swallow toothpaste while they’re brushing. Risewell, Dr. Bronner’s, and Pure Haven are all great brands that offer fluoride-free toothpaste.

The one downside of these brands is that you’re buying toothpaste in a tube that’s going to get thrown away. For a more environmentally friendly option, you can look for toothpaste tablets! We use BITE toothpaste bits through their subscription service. We get new bits every 3 months in compostable packaging to refill our glass jars at home. The only potential concern with their fluoride-free formulation is the use of nano hydroxyapatite. This is an alternative to fluoride, which you can learn more about in the Effects of Fluoride Exposure post. BITE also offers fluoride options for those that want to use a fluoride toothpaste!

How to brush your teeth

Maybe this seems a little silly to talk about considering you’ve been brushing your teeth for years. When was the last time you thought about how to brush your teeth properly? It’s important to know how to brush your teeth properly to avoid damage to your teeth and gums. After wetting your toothbrush, add a pea-sized amount of toothpaste to your toothbrush or pop a toothpaste tablet in your mouth and bite down on it a few times until it mostly dissolves. Make sure to hold your toothbrush at a 45-degree angle towards your gum line. If you’re using a manual brush you’ll want to brush gently and in circular motions across your teeth. If you’re using an electric brush you’ll want to pause briefly on each tooth for the brush to do its job. Make sure to brush the outside, inside and bottom parts of the teeth. Then spit out your toothpaste in the sink when you’re done (especially important if you’re using fluoride toothpaste).

It’s not only important to know how to brush, but also when and how often we should brush. If you brush too much or too often, it could cause damage to your gums and enamel. You should brush your teeth twice per day, ideally once when you wake up and once before bed. You should brush for two minutes, spending roughly 30 seconds in each quadrant of your mouth. Most electric toothbrushes now have timers built in for this. The most critical time to brush your teeth is before bed. Leaving food particles in your teeth overnight increases the risk for tooth decay. “Ask the Dentist” also recommends waiting 30-45 minutes after eating to brush your teeth. This is particularly true after eating a meal or snack full of carbohydrates and sugars. Brushing right after you eat can actually push the food particles further into your teeth, rather than removing them. 

The importance of flossing

Flossing is another non-negotiable that is just as important as brushing. The purpose of flossing is interdental (between the teeth) cleaning. Brushing alone removes only approximately 40-60% of plaque buildup. Brushing typically only cleans the surfaces of your teeth so without some type of interdental cleaning, there is no way to remove all the bacteria and plaque buildup that occurs. Interdental plaque buildup is a known cause of periodontal diseases. Some examples are gingivitis, which causes inflammation in the gums and causes them to bleed easily, as well as periodontitis, which destroys the tissues holding your teeth in place. 

There are more options than standard dental floss!

How do we choose a type of interdental cleaning device? Typical types of interdental cleaning devices are: dental floss, interdental brushes, tooth cleaning sticks (wooden or rubber toothpicks), and oral irrigators. The majority of studies available had a high risk of bias due to funding by companies that produced one of the devices. Additionally, the studies were completed within less than one year, so it’s difficult to measure long-term improvements with any devices. Here’s a summary of all devices from these studies:

  1. Dental Floss is a thin “string” that you insert between teeth to clean interdentally, and under the gums. Dental floss requires dexterity, many people are unlikely to comply with daily flossing recommendations, and it can be used regardless of space between teeth. Using dental floss and brushing regularly was found likely to reduce gingivitis in the short/medium-term compared to brushing alone. It was unclear whether or not plaque was reduced. Studies have shown that many people do not floss correctly, so this could influence why relatively inconclusive results were seen.
  2. Interdental Brushes are thin wires coated with nylon bristles that are inserted between teeth for cleaning. Interdental brushes typically require a larger space between teeth to utilize them, but they are easier to use than floss. Using interdental brushes and brushing regularly was found likely to reduce gingivitis and plaque in the short-term compared to brushing alone. This is typically one of the preferred methods if you have dental implants.
  3. Tooth Cleaning Sticks, often referred to as toothpicks, are wooden or rubber sticks typically used by older generations to remove food particles. Using tooth cleaning sticks in addition to brushing regularly had inconclusive evidence of their effectiveness. Wooden sticks potentially reduced gingivitis but not plaque. Rubber sticks potentially reduced plaque but not gingivitis compared to brushing alone.
  4. Oral Irrigators are devices that deliver a high pressure stream of water to remove food particles and bacteria buildup from tooth surfaces and between teeth. Using an oral irrigator in addition to brushing regularly did not show any difference in plaque but may reduce gingivitis in the short-term compared to brushing alone. This is typically one of the preferred methods if you have dental implants. It’s also important to note this method is typically not recommended as a stand alone by dentists. It is less effective than flossing.

How to choose an interdental cleaning method that works for you

Out of all the options, the interdental brushes show the highest rates of success in preventing disease and removing plaque. However, keep in mind no long-term unbiased studies were completed. I would say the best option is whichever option you’ll use most frequently. It’s clear that we need interdental cleaning for our best oral health, so buy what you’ll actually use! If you’re also looking to choose the most environmentally friendly option, I would suggest compostable floss and/or an oral irrigator. I personally use both of these options. I hate flossing, so using this combination makes it more realistic that I will clean between my teeth almost every day.

If you’re going to go with traditional floss, there’s a few additional things to be aware of. Many flosses are single use plastic. While you’re likely not using much of it, if you’re using it everyday it can certainly add up. Companies like BITE offer a compostable floss which is uses polylactic acid (you can read more about why they chose this, why it’s the best option available, how to compost it, etc. on their website). Additionally, many flosses have tested positive for organic fluorine by Mamavation, which is an indicator of PFAS. PFAS is also known as “forever chemicals” because they build up in our bodies and the environment over time, and some of them are known to be harmful to human and animal health. Mamavation’s testing results and brands she recommends can be found here.

How to floss between your teeth

Flossing correctly is key to gaining the benefits of flossing. Ideally we should be flossing once per day in the evening right before we brush our teeth. This way we’re disrupting all the bacteria, food particles, and plaque right before we brush which should help to further remove them. When flossing, it’s important to get all the way under the gum line. You’ll want to make sure you move the floss up and down multiple times around each tooth before moving onto the next space.

If you choose an interdental brush, a lot of the same flossing tips apply. You’ll just be using a brush instead of a string. For using toothpicks, these should not go in between your teeth. You should use them to move visible plaque or food particles out from between your teeth. Lastly, if you’re using oral irrigators, use it similarly to an electric toothbrush where you move the water stream slowly between your teeth. Make sure to keep your mouth closed and spit out the water when needed! I can’t tell you how many times we have accidentally turned the water on before we were ready, or tried to talk while using it, and it leaves a bit of a mess to clean up!

Take care of your oral health!

Having a dental hygiene routine that enhances our oral health can’t be ignored. It is an important aspect of our overall health. Even though going to the dentist is seen as a “separate” activity from our general health practitioner due to the way insurance is handled in the United States, our entire body is connected. An issue in one area of the body can easily influence many other areas. While today we covered the essentials for taking care of your teeth and gums, follow along for Part 2 next week where we will cover aesthetic and other oral practices beyond the essentials.

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