The HFG guide to oral hygiene

Strong teeth and gums are important for more than just a dazzling smile.

According to a 2009 survey, most respondents reported using oral health services only when we had a problem rather than for routine check-ups. And nearly one in four of us went without recommended routine dental treatment due to the cost.

Neglected teeth can lead to a host of health problems, and links are emerging between poor oral health and serious conditions like diabetes, heart disease, stroke and pneumonia.

The issue: Tooth decay

What causes it?

When bacteria-containing plaque and tartar on the teeth start to break down, acid is produced that destroys enamel (the hard coating on the outside of your teeth). The disease is called caries and results in cavities in your teeth needing fillings or crowns, or, if severe, infections, abscesses and lost teeth.

Diet is key here. There are two things to consider: what you’re eating, and how often you’re eating it. Each time you eat or drink something sugary the bacteria in your mouth produces acids that attack your teeth. Your saliva naturally neutralises that acid within an hour to protect enamel, but your teeth can only withstand a few of these acid attacks a day before the enamel starts to get damaged. So the more you snack, the more you risk tooth decay. Grazing on sugary snacks is the worst thing you can do for teeth.

And switching to diet drinks won’t help either. A recent study at the University of Melbourne found many sugar-free drinks, including flavoured mineral waters, are still acidic so they attack tooth enamel. All carbonated drinks contain carbonic acid, a by-product of the carbon dioxide that’s used to make them fizzy, but some also contain acidic additives such as citric acid (E330), or phosphoric acid (E338) – commonly used in both regular and diet soft drinks. The researchers concluded that ‘sugar-free’ labelling doesn’t necessarily mean a product is safe for teeth.

Easy fixes for tooth decay

Brush twice a day

Use a good toothbrush and consider using an electric one if you don’t already. They can help reduce the build-up of plaque more quickly than a manual brush and many have timers, helping make sure we brush for two minutes. Too many of us rush and end up missing whole areas, such as the back of the teeth.

Choose a fluoride toothpaste

Fluoride protects enamel and keeps it hard. The Ministry of Health recommends we brush teeth twice a day using fluoride toothpaste, yet while nearly two-thirds of 2–17-year-olds brushed their teeth at least twice a day, only 43 per cent were using a fluoride toothpaste each time. Adults were slightly better with nearly two-thirds using fluoride toothpaste at least twice a day.

Brush properly

Dental experts say we should hold the brush at a slight angle to our teeth and not forget to clean in between, otherwise we’ll leave as much as 40 per cent of the tooth surface of our mouths untouched and exposed to bacteria. And replace the toothbrush (or the head) every three to four months.

Get the timing right

Brushing within an hour of eating or drinking something acidic is not ideal. Our saliva is still doing its job of neutralising the acid and we’d literally be brushing away the softened enamel on our teeth. It’s better to brush our teeth as soon as we get up in the morning rather than straight after breakfast. Keep a toothbrush at work and brush again.

Don’t miss that check-up

See a dentist/hygienist for regular check-ups. It’s good to build up trust with someone who can show you the ways to look after your teeth. Early dental erosion can often be remineralised and reversed if caught in time, too.

Keep a check on sugar

It’s not always obvious how much sugar lurks in packaged foods. Remember, there are over 30 different names for sugar, including fructose, lactose, glucose, and syrups. Check diet drinks for things such as phosphoric or citric acid. When you eat between meals, choose teeth-friendly foods (see Food and drink your teeth will love, below).

Chew sugar-free gum

Chewing gum with xylitol after between-meals snacks boosts saliva production to help neutralise acid.

The issue: Bad breath

What causes it?

It’s commonly thought that bad breath originates from the digestive system. But according to dentist and bacteriologist Dr Harold Katz, the vast majority of cases are the result of bacteria in the mouth. “Almost all cases of halitosis and unpleasant tastes in the mouth involve a group of anaerobic, sulphur-producing bacteria that live below the surface of your tongue, in your throat and tonsils,” he explains.

“The problem comes when those bacteria react to changes in their environment by producing odorous volatile sulphur compounds (VSCs).” These changes may include:

• a dry mouth, thick saliva or excess mucus
• a high-protein diet
• medications that cause a dry mouth (some antidepressants, antihistamines or high blood pressure medication)
• alcohol or excessive use of alcohol or sodium lauryl sulphate (SLS)-containing oral products
• smoking
• diabetes

Of course, most people suffer ‘morning breath’, and many have borderline halitosis, where breath gets less fresh after certain foods or drinks. “Certain foods are packed with the proteins that bacteria in the mouth love,” says Dr Katz. “These include onions, garlic, milk, cheese and fish. Coffee contains high levels of acids that cause bacteria to reproduce more rapidly resulting in a bitter taste in the mouth and bad breath.”

Do you have bad breath?

Wipe the surface of your tongue with a cotton gauze and smell it to check for bad breath. You can also lick the back of your hand, let it dry for 10 seconds and then smell it.

Easy fixes for bad breath

Stay hydrated

“The only way to eliminate halitosis is to make your mouth less welcoming to the sulphur-producing bacteria,” says Dr Katz. “Avoid mouthwashes that contain alcohol as these just dry out the mouth, making bad breath worse.”

Clean your tongue

“As well as regular cleaning and flossing, use a tongue scraper (or your toothbrush) with a little toothpaste smeared on it to gently clean your tongue, going as far back as possible,” he advises.

The issue: Gum disease (periodontal disease)

The superficial inflammation you see as redness on the top level of your gums, close to the teeth, is called gingivitis. It’s caused by a build-up of plaque, which irritates the gums. If this inflammation is left, it can become the more serious periodontal disease, affecting the deeper ligaments around the teeth and bones. The risk is that this can start to destroy the jawbone, leading to loose teeth. Once you have periodontal disease all you can do is try to stop it getting worse — it can’t be reversed.

That’s why it’s so important to get persistent bleeding, inflammation or soreness checked out by a dentist. Smokers should be especially vigilant as smoking can mask the signs of gum disease. The smallest blood vessels in the gums start to shut down so bleeding is less likely, although disease may still be present.

Easy fixes for early gum disease

Get into a brushing routine

Gingivitis is usually temporary and disappears if you brush and floss well. You can use floss or tape, interdental brushes or even an electric water-flosser.

Floss more effectively

“Take about half a metre of floss or tape, wind one end around the fore or middle finger of one hand, the rest around the finger on your other hand, and hold tightly,” explains Dr Katz. “Slide the floss between each pair of teeth, up to the gum line. Curve it against one tooth and rub gently to dislodge trapped food and polish the side of the tooth.” Use a new section of floss for each gap, and rinse afterwards to get rid of the dislodged particles.

The issue: Sensitive teeth

Sensitivity can involve a mild twinge to sharp pain lasting several hours. Women are more likely to be affected than men, and people between the ages of 20 and 40 are particularly susceptible.

It happens when the dentine (under your enamel) is exposed — usually at the root of a tooth where it meets your gum where the enamel is thinnest. Sensitivity can be caused by brushing too hard, to receding gums, cracked teeth or dental erosion. If you’re prone to it, you’ll typically feel it as soon as you eat or drink anything cold or hot, when you’re out in cold air and sometimes when you eat sugary or acidic food and drink.

Most people find the pain tends to come and go.

Easy fixes for sensitive teeth

Change your toothpaste

There are special toothpastes for relieving pain that you can also rub onto affected areas. Ask your dentist if the way you’re brushing is affecting your sensitivity. If it’s particularly bad or doesn’t respond to home treatment, the dentist may apply a fluoride varnish or seal the neck of affected teeth to cover exposed dentine.

Avoid very cold food

Avoid food and drink that brings on the sensitivity. Brushing your teeth with warm water helps too.

The biggest dental diet offenders

Smoothies and fruit juices

While these contain nutritious vitamins, they can also be very high in natural sugars and acids. If you enjoy juice, stick to half a glass a day and have it with meals, rather than in between. If you’re giving fruit juice to children, dilute one part juice to one part water.

Cereal bars and yoghurts

Many cereal bars and flavoured yoghurts are marketed as healthy and low fat even though they can be packed with sugar. Check packaging and choose low-fat natural or Greek yoghurt and sweeten it with fresh fruit.

Soft drinks, sports/energy drinks

Energy drinks can have 10–14 teaspoons of sugar in a bottle and are often even more damaging to teeth during a workout because your mouth is usually drier, lacking the saliva to protect against the sugar and acid. Stick with water — it’s unbeatable.  We have also written about the impact of artificial sweeteners in fizzy drinks.

Food and drink your teeth will love

Tea

A recent study in the Nutrition Bulletin hails tea — black and green — as a top drink for dental health, thanks to its natural fluoride content. Tea also contains polyphenols, which interact with plaque and kill bacteria. Four cups of regular black tea a day could take an adult’s fluoride level above the adequate intake — but well within the safe upper limit — helping to protect your teeth. Add milk and you’ll get a tooth-friendly dose of calcium, too.

Crunchy vegetable snacks

Not only are these low in sugar but veges such as raw carrot and celery massage your gums while you’re eating them, acting like a natural toothbrush.

Xylitol

This sweetener is made from birch or beech wood. It has a lower GI and far fewer kilojoules than sugar, but it tastes like it and can be used in the same way. It’s not just a good sugar-free option, though. Xylitol can actually promote dental health, too. Unlike sugar, when xylitol is broken down it creates an alkaline environment in the mouth. It helps reduce plaque, kill bacteria and even remineralise teeth.

A small piece of cheese is an ideal way to finish a meal because it neutralises acid in the mouth. Keep portions small so you don’t overdo the saturated fat.

Water

A dry mouth is the enemy of good oral health and hygiene, so drink water regularly. If you live in an area where tap water is fluoridated, so much the better as it gives an additional level of protection against tooth decay.

Whole fresh fruit

Better for teeth than the dried or liquid versions.

Oral health affects more than our mouths

There is now very strong evidence that severe gum disease is harmful to blood glucose control in people with diabetes, and also affects blood glucose levels in people who don’t have diabetes. Cardiovascular disease (CVD) and gum disease share several common risk factors, including cigarette smoking, age and diabetes.

This can explain why people with gum disease have a higher risk of CVD than people without gum disease.

Alzheimer’s disease is also on the list of diseases suspected as being associated with gum disease. A study of people with mild to moderate dementia found the presence of gum disease at the start of the study was associated with a six-fold increase in the rate of cognitive decline over a six-month follow-up period.

How a check-up could save your life

It’s critical to think about your overall mouth health, not just your teeth. That’s why regular check-ups are a must.

There are various health conditions a dentist can detect by looking in your mouth. Gum disease can sometimes indicate diabetes, and acid erosion can point to gastric problems. Patterns of cheek biting or tooth grinding can explain headaches or jaw pain. Most importantly, a dentist can spot early signs of mouth cancer or pre-cancerous cells. It’s one of the cancers where early detection means a much better outcome.

Always tell your dentist about anything in your mouth that looks and feels unusual: a lump in or under your tongue, soreness or an ulcer that doesn’t heal, for example. It may not be anything to worry about, but it’s always best to get it checked. Be aware, too, that the vast majority of oral cancer cases are caused by lifestyle factors and could therefore be prevented. Smoking, drinking alcohol and infection with the HPV virus are all strongly linked.