Oral hygiene





Oral hygiene is the practice of keeping one’s mouth clean and free of disease and other problems.



It requires regular brushing and flossing.



Oral hygiene be carried out on a regular basis prevents dental disease and bad breath. 



Dental disease includes: tooth decay and gum diseases, including gingivitis, and periodontitis.



General guidelines for oral health: suggest brushing twice a day: after morning meal and before going to bed.



Ideally the mouth should be cleaned after every meal. 



Cleaning between the teeth is called interdental cleaning.



 Interdental cleaning is as important as tooth brushing.



 Brushing removes about 50% of plaque from the surface of the teeth, but cannot reach between the teeth and therefore only removes about 50% of plaque from the surface of the teeth.



The oral microbiome in essential in dental health, as commensal microflora can switch to an opportunistic pathogenic flora.



Modern oral microbiota are significantly less diverse than historic populations.



Caries, have become a major endemic disease.



Caries affect 60-90% of schoolchildren in industrialized countries.



Over 80% of cavities occur inside fissures in teeth where brushing cannot reach food left trapped after eating.



In these fissures 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.



Professional cleaning includes tooth scaling, tooth polishing, and, if tartar has accumulated, debridement.



Dental sealants, cover and protect fissures and grooves in the chewing surfaces of back teeth, preventing food from becoming trapped and thereby halt the decay process. 



Good oral hygiene is essential for preventing tartar build-up which causes the above   mentioned problems.



This is done through frequent brushing, combined with the use of dental floss or interdental brushes to prevent accumulation of plaque on the teeth.



Powered toothbrushes reduce dental plaque more than manual toothbrushing.



Dental plaque is also known as dental biofilm.



Dental plaque is a sticky, yellow film consisting of a  range of bacteria which attaches to the tooth surfaces and can be visible around the gum line. 



Dental plaque starts to reappear after the tooth surface has been cleaned.



A high-sugar consumption encourages the formation of plaque. 



Sugar, as fermentable carbohydrates, is converted into acid by the plaque. 



The acid then causes the breakdown of the adjacent tooth, leading to tooth decay.



If plaque is left on a subgingival surface there an increased risk of tooth decay, and irritation  the gums: gingivitis.



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 calculus is not treated, the inflammation will lead to the bone loss and will eventually lead to the affected teeth becoming loose.



Tooth brushing is the principal method of preventing many oral diseases, and the most important activity to reduce plaque buildup.



Controlling plaque reduces the risk of 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.



Tooth brushing should be done for a minimum of two minutes, and be practiced at least twice a day.



Toothbrushing can only clean to a depth of angle the bristles at a 45-degree angle towards the gums, and using small circular motions at that angle, increases the effectiveness of the technique in removing plaque at the gum line.



There are two main types of electric toothbrushes are the sonic type which has a vibrating head, and the oscillating-rotating type in which the bristle head makes constant clockwise and anti-clockwise movements.



Sonic or ultrasonic toothbrushes vibrate at a high frequency, small amplitude, and a fluid turbulent activity.



These factors  aid in plaque removal.



It is not known if rotating electric brushing reduces plaque and gingivitis compared to manual brushing, significantly.



With vibrating brushing the vibratory movements of the bristles help break up chains of bacteria up to 5mm below the gum line.



The oscillating-rotating electric toothbrush on the other hand uses the same mechanical action as produced by manual tooth brushing.



The oscillating-rotating electric toothbrush remove plaque via mechanical disturbance of the biofilm, however,  at a higher frequency.



Electric tooth brushes is less complex in regards to brushing technique, making it a viable option for children, and adults with limited dexterity. 



With manual brushing the bristle head is guided from tooth to tooth slowly, following the contour of the gums and crowns of the tooth.



Tooth brushing alone will not remove plaque from all surfaces of the tooth as 40% of the surfaces are interdental.



Flossing can remove plaque and food particles from between the teeth and below the gums. 



Up  to 80% of plaque may be removed by flossing.



Cleaning between the teeth is recommended as part of one’s daily oral hygiene regime.



Types of floss: 



Unwaxed floss: Unbound nylon filaments that spread across the tooth. 



Plaque and debris get trapped for easy removal with untaxed floss.



Waxed floss: less susceptible to tearing or shredding when used between tight contacts or areas with overhanging.



Polytetrafluoroethylene (Teflon): Slides easily through tight contacts and does not fray.



Flossing procedure: 



Floss length: 15–25 cm wrapped around middle fingers.



For upper teeth the floss is grasped with thumb and index finger, and for lower teeth with both index fingers. 



The floss is eased between the teeth using a back and forth motion.



The floss is securely wrapped around the interdental surface of the tooth in a C shape.



Floss is taken below the gum margins using a back and forth up and down motion.



Interdental brushes are equally or more effective then floss when removing plaque and reducing gum inflammation.



An interdental brush is a small brush specially designed to clean between the teeth, where a regular toothbrush does not reach. 



The tongue contains numerous bacteria which causes bad breath, and tongue cleaners are designed to remove the debris built up on the tongue. 



Single-tufted brushes are tools in conjunction with tooth brushing.



Single-tufted brushes are designed to reach the inaccessible areas within the mouth. 



Single-tufted brushes are best used behind the lower front teeth, behind the back molars, crooked teeth and between spaces where teeth have been removed.



Single- tufted brush has an angled handle, a 4mm diameter and rounded bristle tips.



Gum stimulators are  designed to massage the gum line and the bases of the areas between the teeth, stimulating  increases in  circulation to the gum line clearing  away bacteria which might not be removed by brushing and flossing alone.



Eating a balanced diet and limiting sugar intake helps prevent tooth decay and periodontal disease.



Water fluoridation is the addition of fluoride to adjust the natural fluoride concentration of a community’s water supply to the level recommended for optimal dental health, approximately 1.0 parts per million.



Fluoride is a primary protector against dental cavities, that also makes the surface of teeth more resistant to acids during the process of remineralization. 



Green and black tea are endowed with polyphenols that acts as a suppressor of the bacterias that cause dental plaque.



Green and black tea helps to sustain


oral health and is advisable during or after a meal.



Foods high in fiber, such as vegetables, may help to increase the flow of saliva and improve oral hygiene.



Fiber in the diet can force saliva into trapped food inside pits and fissures on chewing surfaces where over 80% of cavities occur.



Sugars are commonly associated with dental carries. 



Sticky sugary foods are more likely to cause more damage to teeth than those that are less so.



Sucrose is most common sugar associated with cavities. 



Frequent sugar consumption increases the time during which the tooth is exposed to low pH levels, at which point demineralization occurs.



The demineralization point is below 5.5 pH for most people.



Infrequent consumption of food and drinks containing is encouraged sugar so that teeth have a chance to be repaired by remineralization and fluoride. 



To reduce the incidence of cavities, consuming sugar containing foods and drinks should be confined to meal times.



Sugars from fruit and fruit juices- glucose, fructose, and maltose can cause carries. 



Streptococcus mutant bacteria use sucrose to produce biofilm.



When exposed to acids contained in juice, vinegar, and soft drinks that lower the pH of the oral cavity it causes the enamel to demineralize.



Therefore the ingestion of drinks such as orange juice or coolers throughout the day will increase the risk of dental caries.



A risk for the development of cavities is the stickiness of foods. 



Foods or sweets may stick to the teeth reduce the pH in the mouth for an extended time.



Teeth should be cleaned at least twice a day, with a toothbrush and fluoride toothpaste, to remove any food sticking to the teeth. 



Chewing gum assists oral irrigation between and around the teeth.



Chewing gum can clean and remove particles between teeth.



With teeth that are in poor condition gum chewing may damage or remove loose fillings.



Chewing sugar-free gum stimulates saliva production, which helps to clean the surface of the teeth.



Solid objects such as ice can chip teeth, leading to  tooth fractures. 



Drinking dark-colored beverages such as wine or beer may stain teeth.



Dry mouth, results in little saliva to protect the teeth from plaque and bacteria.



Smoking is a major factor associated with periodontal diseases: impairing and alters normal immune responses, inhibiting reparative responses promoting the incidence and development of periodontal diseases.



Acid erosion associated with recurrent vomiting as seen with bulimia and morning sickness can cause significant dental damage.



There are three types of mouthwash: saline, essential oils and chlorhexidine gluconate.



Saline is usually recommended after procedures like dental extractions. 



Use of saline reduces the prevalence of alveolar osteitis (dry socket) after extraction. 



Essential oils, (Listerine), contains eucalyptol, menthol, thymol, and methyl salicylate. 



Essential oils lowers plaque and gingivitis levels as a mouthrinse, when used as an adjunct to mechanical plaque removal.



Chlorhexidine gluconate is an antiseptic mouthrinse that should be used in two-week time periods because it can lead to brown staining on the teeth and tongue.



Chlorhexidine is more efficacious in controlling plaque levels compared to essential oils, but has no better effect on gingivitis.



Sodium hypochlorite, a common household bleach, can be used as a 0.2% solution as an effective means of combating harmful bacteria. 



Dentures must be cleaned mechanically twice a day with a soft-bristled brush and denture cleansing paste. 



For dentures toothpaste is not recommended.



Toothpaste is too abrasive for acrylic, and leaves plaque retentive scratches in the surface.



Dentures should be taken out at night.



Leaving dentures overnight is linked to poor oral health. 



If dentures are left in during sleep it 


reduces the protective cleansing and antibacterial properties of saliva against Candida albicans and denture stomatitis; the inflammation and redness of the oral mucosa underneath the denture.



Wearing a denture during sleep has been proven to greatly increase the risk of pneumonia.



Dentures should be stored in a dry container overnight.



Keeping dentures dry for 8 hours significantly reduces the amount of Candida albicans on an acrylic denture.



A weekly soaking of a denture  


overnight with an alkaline-peroxide denture cleansing tablet, reduces bacterial mass and pathogenicity.



Retainers should be washed properly at least once a day, to be soaked overnight with an alkaline-peroxide denture cleansing tablet once a week. 



With braces, it is recommended to use a small-sized or specialized toothbrush with a soft head to access hard-to-reach areas. 



With braces brushing  after every meal is highly advisable. 



With braces regular flossing is as important as brushing, as it helps to remove any plaque build-up, as well as smaller food particles that are stuck in your braces or between the teeth. 




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