Oral Hygiene Health Article

Definition

Oral hygiene is the practice of keeping the mouth clean and healthy by brushing, flossing, and using appropriate therapeutic aids to prevent caries (tooth decay) and periodontal disease.

Purpose

The goal of proper oral hygiene is to control plaque, the sticky bacterial film that continually forms on teeth. Plaque adheres to the crevices and fissures of teeth and, when not removed on a regular basis, generates acids that can decay the enamel surface of teeth. Plaque is also a physical and a chemical irritant to the periodontium, the tissues investing and supporting the teeth.

Toothbrushing and flossing remove plaque from teeth, and antiseptic mouthwashes kill some of the bacteria in plaque. Fluoride—in toothpaste, drinking water, or dental treatments—also protects teeth by binding with enamel to make it stronger. Despite a patient's best efforts, plaque formation can lead to calculus formation. Calculus, also called tartar, is an adherent, calcified deposit made up of dead bacterial cells from plaque. Calculus does not cause tooth decay, but is a primary cause of periodontal disease. Calculus can only be removed by a dental professional, therefore regular dental visits are essential to good oral hygiene.

Precautions

Brushing should be performed thoroughly and gently with the correct brush, refraining from "scrubbing" at the teeth with too much force. Brushing that is unnecessarily vigorous can cause gum irritation, gum recession, and abrasion of tooth structure. Flossing can also be performed too vigorously. A patient who inserts floss between teeth, then "saws" back and forth with downward force can create fissures in gum tissue that destroy the attachment of gum to tooth.

As deciduous (primary) teeth erupt, caregivers should develop the habit of brushing children's teeth after every meal. Since excess ingested fluoride can cause dental fluorosis, a mottled discoloration of tooth enamel, care should be taken that the child does not swallow any toothpaste. A pea-size amount of fluoridated toothpaste is all that is necessary to clean a child's teeth. Fluoride-free toothpaste for children is available.

Patients with full or partial prostheses are not exempt from the need for good oral hygiene. Dentures should be removed daily, cleaned with a brush and rinsed or soaked in a denture cleansing bath. Gum tissue should be brushed and rinsed to remove food particles and bacteria. If possible, dentures should be left out at night to allow the tissues to breathe without pressure from the prosthesis. When not in use, dentures should be covered with water or a denture cleaning solution to prevent drying. Dentures should be adjusted, relined, and replaced when necessary by a dentist.

Fixed prostheses such as bridges and implants require special cleaning tools for proper maintenance and to prevent failure of the prosthesis.

Using a toothbrush

Ideally, patients should brush after every meal and snack with a fluoride toothpaste. Following a set routine ensures that no teeth are missed. A recommended sequence is to start on the upper right outside surfaces, continue to the upper left, switch to the inside left surfaces and return to the inside right. Then brush the occlusal (chewing) surfaces of the back teeth, move to the bottom and repeat the same sequence. The tongue should also be brushed to remove odor-causing bacteria. A thorough tooth brushing should take two to three minutes.

The American Dental Hygienists' Association recommends the following technique:

• Place toothbrush bristles along the gumline at a 45-degree angle. Bristles should contact both the tooth surface and the gum.

• Gently brush the surfaces of two or three teeth using a vibrating, back and forth rolling motion. Lift the brush, move it to the next group of two or three teeth, and repeat.
• Behind anterior teeth, tilt the brush vertically. Make several up and down strokes using the front half of the brush.
• Place the brush against the occlusal (chewing) surface of the teeth and use a gentle back and forth scrubbing motion.

Consumers should look for a toothbrush with soft, nylon, end-rounded bristles in a size and shape that allows them to reach all tooth surfaces easily. Power toothbrushes are available in various styles, and have been proven to be as effective as manual toothbrushes. Research has found no significant differences in plaque reduction between manual and powered tooth brushing.

For those with limited use of their hands, toothbrush handles can be inserted in a small ball, bicycle grip, or sponge hair curler for easier gripping. Children's toothbrushes typically have larger handles, and may be appropriate for adults with less flexibility.

Toothbrushes should be replaced every three to four months, since bristles lose their integrity and don't clean as well after a period of time. In addition, toothbrush bristles and handles collect microbes that can cause colds, the flu, herpes, and periodontal infections. Some brushes have colored bristles that lose their coloration gradually, prompting a patient to replace it when the color is gone.