Oral hygiene


Oral hygiene is the practice of keeping one's oral cavity clean and free of disease and other problems by regular brushing of the teeth and adopting good hygiene habits. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease and bad breath. The most common types of dental disease are tooth decay and gum diseases, including gingivitis, and periodontitis.
General guidelines for adults suggest brushing at least twice a day with a fluoridated toothpaste: brushing before going to sleep at night and after breakfast in the morning. Cleaning between the teeth is called interdental cleaning and is as important as tooth brushing. This is because a toothbrush cannot reach between the teeth and therefore only removes about 50% of plaque from the surface of the teeth. There are many tools available for interdental cleaning which include floss, tape and interdental brushes; it is up to each individual to choose which tool they prefer to use.
Sometimes white or straight teeth are associated with oral hygiene. However, a hygienic mouth can have stained teeth or crooked teeth. To improve the appearance of their teeth, people may use tooth whitening treatments and orthodontics.
The importance of the role of the oral microbiome in dental health has been increasingly recognized. Data from human oral microbiology research shows that a commensal microflora can switch to an opportunistic pathogenic flora through complex changes in their environment. These changes are driven by the host rather than the bacteria. Archeological evidence of calcified dental plaque shows marked shifts in the oral microbiome towards a disease-associated microbiome with cariogenic bacteria becoming dominant during the Industrial Revolution. Streptococcus mutans is the most important bacteria in causing caries. Modern oral microbiota are significantly less diverse than historic populations. Caries, for example, have become a major endemic disease, affecting 60-90% of schoolchildren in industrialized countries. In contrast, dental caries and periodontal diseases were rare in the pre-Neolithic era and in early hominins.

Tooth cleaning and decay

is the most common global disease. Over 80% of cavities occur inside fissures in teeth where brushing cannot reach food left trapped after eating and saliva and fluoride have no access to neutralize acid and remineralize demineralized teeth, unlike easy-to-clean parts of the tooth, where fewer cavities occur.
Teeth cleaning is the removal of dental plaque and tartar from teeth to prevent cavities, gingivitis, gum disease, and tooth decay. Severe gum disease causes at least one-third of adult tooth loss.
Since before recorded history, a variety of oral hygiene measures have been used for teeth cleaning. This has been verified by various excavations done throughout the world, in which chew sticks, tree twigs, bird feathers, animal bones and porcupine quills have been found. In historic times, different forms of tooth cleaning tools have been used. Indian medicine has used the neem tree, or daatun, and its products to create teeth cleaning twigs and similar products; 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, has antiseptic properties and has been widely used since the Islamic Golden Age. Rubbing baking soda or chalk against the teeth was also common; however, this can increase gum and tooth sensitivity.
The Australian Healthcare and Hospital Association's most recent evidence brief suggests that dental check-ups should be conducted once every three years for adults, and one every two years for children. It has been documented that dental professionals frequently advise for more frequent visits, but this advice is contraindicated by evidence suggesting that check up frequency should be based on individual risk factors, or the AHHA's check-up schedule. In the UK, it is common practice to invite people for check-ups every 6 months; however, recent research has shown that this isn't necessary for people who have low risk of oral disease. Professional cleaning includes tooth scaling, tooth polishing, and, if tartar has accumulated, debridement; this is usually followed by a fluoride treatment. However, the American Dental Hygienists' Association stated in 1998 that there is no evidence that scaling and polishing only above the gums provides therapeutic value, and cleaning should be done under the gums as well. The Cochrane Oral Health Group found only three studies meeting the criteria for inclusion in their study and found little evidence in them to support claims of benefits from supragingival tooth scaling or tooth polishing.
Dental sealants, which are applied by dentists, cover and protect fissures and grooves in the chewing surfaces of back teeth, preventing food from becoming trapped and thereby halt the decay process. An elastomer strip has been shown to force sealant deeper inside opposing chewing surfaces and can also force fluoride toothpaste inside chewing surfaces to aid in remineralising demineralised teeth.
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 through careful, frequent brushing with a toothbrush, combined with the use of dental floss or interdental brushes to prevent accumulation of plaque on the teeth. Powered toothbrushes reduce dental plaque and gingivitis more than manual toothbrushing in both short and long term. Further evidence is needed to determine the clinical importance of these findings.
Patients need to be aware of the importance of brushing and flossing their teeth daily. New parents need to be educated to promote healthy habits in their children.

Plaque

, also known as dental biofilm, is a sticky, yellow film consisting of a wide range of bacteria that attaches to the tooth surfaces and can be visible around the gum line. It starts to reappear after the tooth surface has been cleaned, which is why regular brushing is encouraged. A high-sugar diet encourages the formation of plaque. Sugar, is converted into acid by the plaque. The acid then causes the breakdown of the adjacent tooth, eventually leading to tooth decay.
If plaque is left on a subgingival surface undisturbed, not only is there an increased risk of tooth decay, but it will also go on to irritate the gums and make them appear red and swollen. Some bleeding may be noticed during tooth brushing or flossing. These are the signs of inflammation that indicate poor gum health.

Calculus

Dental calculus is composed of calcium phosphate minerals with live microorganisms that is covered by a unmineralized layer. The longer that plaque stays on the tooth surface, the harder and more attached to the tooth it becomes. That is when it is referred to as calculus and needs to be removed by a dental professional. If this is not treated, the inflammation will lead to the bone loss and will eventually lead to the affected teeth becoming loose.

Preventive care

Tooth brushing

Routine tooth brushing is the principal method of preventing many oral diseases, and perhaps the most important activity an individual can practice to reduce plaque buildup. Controlling plaque reduces the risk of the individual with plaque-associated diseases such as gingivitis, periodontitis, and caries – the three most common oral diseases. The average brushing time for individuals is between 30 seconds and just over 60 seconds. Many oral health care professionals agree that tooth brushing should be done for a minimum of two minutes, and be practiced at least twice a day. Brushing for at least two minutes per session is optimal for preventing the most common oral diseases, and removes considerably more plaque than brushing for only 45 seconds.
Toothbrushing can only clean to a depth of about 1.5 mm inside the gingival pockets, but a sustained regime of plaque removal above the gum line can affect the ecology of the microbes below the gums and may reduce the number of pathogens in pockets up to 5 mm in depth.
Toothpaste with fluoride, or alternatives such as nano-hydroxyapatite, is an important tool to readily use when tooth brushing. The fluoride in the dentifrice is an important protective factor against caries, and an important supplement needed to remineralize already affected enamel. Currently, there is insufficient evidence to evaluate the caries inhibiting characteristics of slow release fluoride glass beads. However, in terms of preventing gum disease, the use of toothpaste does not increase the effectiveness of the activity with respect to the amount of plaque removed.
Population studies shown that regular tooth brushing is associated with reduced risk of cardiovascular diseases and better blood pressure profile. Moreover, professional dental cleaning reduces serum levels of early inflammatory markers such as TNF-α, IL-6 and CRP.

Manual toothbrush

The modern manual tooth brush is a dental tool which consists of a head of nylon bristles attached to a long handle to help facilitate the manual action of tooth brushing. Furthermore, the handle aids in reaching as far back as teeth erupt in the oral cavity. The tooth brush is arguably a person's best tool for removing dental plaque from teeth, thus capable of preventing all plaque-related diseases if used routinely, correctly and effectively. Oral health professionals recommend the use of a tooth brush with a small head and soft bristles as they are most effective in removing plaque without damaging the gums.
The technique is crucial to the effectiveness of tooth brushing and disease prevention. Back and forth brushing is not effective in removing plaque at the gum line. Tooth brushing should employ a systematic approach, angle the bristles at a 45-degree angle towards the gums, and make small circular motions at that angle. This action increases the effectiveness of the technique in removing plaque at the gum line.