This is the most important factor in having healthy teeth and gums. It is broken down into 2 categories:

1) Home Care 
2) Professional Care 

Home Care

This is a combination of:  

i) Brushing correctly (min. twice a day)

ii) Cleaning interdentally with floss or interdental brushes

iii) Use of correct fluoride toothpaste

iv) Use of mouthwash

v) Tongue cleaning  

vi) Diet 

vii) Acid Erosion 

 

Brushing:

The decision to use a manual or an electric toothbrush should be a decision made by yourself and your dentist. If your cleaning is adequate with a manual brush then you can continue to use it until the bristles wear away (generally recommended to change at least every 3 months). 

If brushing manually try to use small circular movements over all surfaces of the teeth. If you brush very hard try to change to a softer bristle toothbrush to avoid your gums from receding. 

If brushing with an electric adopt the same policy of replacing the bristles and make sure all surfaces of the teeth are still covered. Generally electric toothbrushes can help you brush the trickier to reach places in your mouth such as the wisdom teeth and also can be helpful if your dexterity is limited.

Try to brush at least 2 times a day after eating. Brushing and general cleaning of your teeth and gums before sleep is essential as your mouth dries at night due to reduced saliva production, which can leave teeth susceptible to decay if not clean.

Cleaning Interdentally (between your teeth):

This is often the most forgotten about process when cleaning teeth, but is just as important as brushing. Bacteria that cause gum disease can grow in the gum pockets if not cleaned regularly. 

It has also been scientifically proven that cleaning in between the teeth can directly reduce your risk of developing heart disease. 

It is best done at least once a day and especially at night. Many people state that flossing is difficult, however there are many aids now that can help. The introduction of assorted sized interdental brushes has made the process even easier.

Toothpaste:

This combined with effective a brushing technique can help reduce the bacterial plaque levels in your mouth. It is important that the toothpaste you use contains fluoride (at least 1000 parts per million) as fluoride makes teeth more resistant to tooth decay. 

It is important to go to your dentist and find out what toothpaste is best for you as more fluoridated toothpaste may be needed if you are at a higher risk of getting decay. If you are deemed high risk your dentist may prescribe a special high fluoride toothpaste and advised the use of a fluoride mouthguard. 

Mouthwash:

Alcohol free fluoride mouthwashes can help with regards to removing any plaque debris and can help keep the mouth and gums cleaner. 

If you have severe gum disease your dentist will direct you with regards to specific mouthwashes than have anti-bacterial benefits.  

Tongue Cleaning:

Another aspect often forgotten about is tongue cleaning. Many toothbrushes have a rubber aspect to them for tongue scraping. If yours does not a manual one can be used to gently brush the top surface of the tongue. The tongue is a massive area that can harbour bacteria, we would advise you to clean it every day using a special D shaped cleaner (click on this link  for example) or if you have an electric toothbrush you should be able to get a special attachment for tongue cleaning for it. 

The benefit of cleaning the tongue can help reduce bad breath as bacteria can coat the surface and grooves of your tongue.

Diet:  

No matter how well you clean your teeth if you frequently consume sugars (fermentable carbohydrates) you can end up with multiple cavities. Examples of foods that can cause this include chocolates, toffees, caramels, nuts and crisps. One must be aware that some medicines are sugar or syrup based and this can have a detrimental effect on teeth. 

If you frequently consume such foods they end up creating an acidic environment in your mouth that if not neutralised can lead to acid creating holes in your teeth. 

If you intend to have such foods try to limit them to once a day only and try to brush your teeth afterwards. If you do not have a brush handy try to rinse with water and use sugar free chewing gum. This with the aid of saliva will neutralize the acid levels in your mouth.  

Nutritional deficiencies can manifest as problems in the mouth so it is important to consult with your general medical practitioner to check that you are having a balanced diet with the right amount of vitamins needed to have a healthy mouth. 

Acid Erosion: 

This involves acidic wear of the teeth from acidic sources such as fruit juices and fizzy drinks containing carbonic acid. It can be as a result of acid produced from your own body such as acid reflux. The result can lead to your teeth becoming thinner, shorter and more translucent. 

It is important that you discuss your risks of getting decay and acid erosion with your dentist to determine what is the best solution for you. It may be helpful to do a 7-day diet sheet recording all the foods and drinks you have per day and brushing times. 


GUM DISEASE

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There are many reasons why you may have gum disease i.e. diet; inadequate cleaning; smoking; medical; drugs related and genetic factors. Hence there are different degrees of this condition your dentist should go through with you individually about your causes and treatment options. 

In brief gum disease is broken down into 2 forms:

i)              Gingivitis  (mild form of gum disease)

ii)             Periodontitis (severe form of gum disease)

If bacterial plaque builds up around the gums and is not cleaned away within 24 hours inflammation; swelling; redness and bleeding can occur around the gums due to the bacteria being left (leading to gingivitis). 

After several days if the bacteria are still not removed a pocket in the gum develops harboring more aggressive bacteria. If these bacteria are left for a longer period and are still not cleaned away more damaging conditions can develop. These include deeper gum pockets containing more harmful bacteria that can lead to loss of bone around the teeth and permanent loss of gum attachment to the associated tooth (periodontitis).  Once bone and gum have been lost it can eventually lead to infection or mobility of the teeth if left. 

The main factors that can accelerate this process are inadequate cleaning especially interdentally (between teeth); smoking; poorly controlled diabetes; certain medications; reduced immunity. Your dentist will evaluate you individual risks on examination. 

Treatments will vary depending on your diagnosis

i)              If no major gum disease is reported a scale and polish may be all that is needed with oral hygiene advice by your dentist or hygienist. 

ii)             If gum disease if noted a deep clean may be needed under local anaesthetic (whilst numbed) where the pockets of bacteria will be cleaned out and any hard plaque above and below the gum will be removed.

iii)           If very severe gum disease you may need to be referred to see a gum specialist (periodontist) who may prescribe treatment and medication depending on the severity.

The key to controlling gum disease is trying your best to clean your teeth especially in between almost becoming fastidious about your regime. Generally if done well the gum disease process should become more stable and less detrimental.