A big smile is now a luxury as dental issues have risen through the roof. Poor hygiene, lifestyle habits and eating choices affect your teeth worse than you think. In India, about 85% to 90% of adults have dental cavities, along with about 60% to 80% of children. This alone is a cause for concern. A lot of this also has to do with the lack of follow up or basic inspection visits with dentists, which should be a part of your base medical routine along with 6-month to annual physicals. In fact, something as simple as brushing your teeth is often done in an incorrect manner or not thoroughly enough, which is very revealing about the causes of our poor dental hygiene.

TC46 connected with Dental Surgeon Dr Arvind Thakur from Fortis Hospital & Fortis Hiranandani Hospital, Mumbai. Here, he discusses the importance of brushing your teeth the correct way, how to avoid some common dental hygiene mistakes, and shares tips to maintain good oral hygiene.

1. What is considered good oral hygiene & why is it important to brush your teeth every day?

Oral hygiene is the practice that keeps the oral cavity clean and prevents the onset and progression of common problems like:

  • Dental caries
  • Gingivitis
  • Periodontitis
  • Halitosis

Brushing teeth twice a day is extremely important. Brushing your teeth removes plaque, which is an invisible layer of bacteria on your teeth that contributes to decay and can cause cavities. Bacteria, if left in your mouth for twenty-four hours, results in damaging the enamel of your tooth that gradually weakens the gums and roots resulting in the decay of teeth. 

2. What are the reasons for poor oral & dental health in India? What contributes to our laidback attitude about dental health?

The reasons for poor dental care are:

  • Lack of awareness of dental care
  • Deleterious habits like tobacco chewing, smoking, and paan
  • Improper diet and lifestyle
  • Stress
  • Systemic diseases associated with oral health
  • Lack of community-based programs (community water fluoridation, school water fluoridation)

There are several barriers to oral healthcare in India as:

  • A lack of acknowledgement of the importance of oral health among the population, which perceives it as independent from and secondary to general health
  • No access for many to an oral health provider due to geographic distance
  • Cost of the treatment

3. What are some common mistakes we make while brushing our teeth?

Common mistakes while brushing your teeth may include: 

  • Not selecting a proper toothbrush: Use a toothbrush that has soft bristles specially designed to prevent pressure on gums
  • Wrong angulation of the bristles: Place your toothbrush at a 45-degree angle towards the gum line with a pea-sized amount of toothpaste
  • Incorrect pressure while brushing: People think that they need to brush hard to remove plaque from teeth, but it is not true. Applying too much pressure while brushing will hurt your gums and teeth. Gently brush your teeth without hurting your gums
  • Using an old toothbrush: When your toothbrush bristles become bent, discoloured, or begin falling out, it’s a good idea to make a change. You should also change your toothbrush after recovering from an illness. As a thumb rule, it’s a good idea to change your toothbrush every 3-4 months.

4. How do mouthwashes, flossing & tongue scrapers help in maintaining oral health?

Flossing: Periodontal disease begins in the interdental areas. Flossing helps clean the narrow spaces that the toothbrush cannot access. This involves passing a thread-like material in between the teeth.

Mouthwash: Mouthwash can go where toothbrushes and floss can’t; to rid your mouth of the same debris that irritates the gum line and causes Gingivitis. It prevents plaque accumulation and it also kills harmful bacteria.

Tongue Scraper: After brushing, bacteria can remain on the tongue. Brush or scrape your tongue as part of your daily routine. These bacteria are responsible for producing bad breath.

5. What are some tips to choose the right type of toothbrush?

Soft nylon bristle brushes should be used. The use of hard bristle toothbrushes, vigorous horizontal brushing, and the use of extremely abrasive toothpaste may lead to cervical abrasion and Gingival Recession.

6. Which ingredients should you look out for while picking a toothpaste?

Toothpaste is always preferred over toothpowder. The consistency of the paste should be fine. Avoid paste containing large size abrasive particles. While selecting the toothpaste, it’s essential to assess exactly what your requirements are – are the teeth sensitive, stained, prone to decay, and plaque?

Fluoride is the most effective ingredient for fighting cavities and strengthening enamel. Antibacterial qualities are provided by a variety of substances to inhibit the growth of germs in the oral cavity.

7. Do added ingredients like salt, charcoal, neem, tulsi in toothpaste help or are they just marketing gimmicks?

Toothpaste containing ingredients like Olive Oil, Betaine, and Xylitol can stimulate salivary secretion when at rest, thus increasing the basal rate of salivary secretion. Toothpaste containing natural plant extracts showed similar antibacterial effectiveness as Chlorhexidine containing toothpaste. 

There is little evidence available in the literature regarding ingredients like Salt, Charcoal, Neem, Tulsi in toothpaste and their beneficial effect on oral health. Further long-term research is needed to study their effect on oral health.

8. Could you share a step-by-step detailing how to brush your teeth the right way?

The right way to brush your teeth is that toothbrush bristles are placed at the gingival margin at a 45- degree angle to the tooth. This allows the bristle to extend into the Gingival Sulcus when pressure is applied to the brush in the horizontal direction. Start brushing from the last tooth in the arch and continue brushing to cover the last tooth on the opposite side. In this way, no tooth will be left from brushing.

Step by step guide to brushing your teeth the right way:

  1. The front surface of the teeth: Angle your brush at a 45-degree angle while brushing the outside surfaces of your teeth and gum line.
  2. The inside surface of the teeth: Move the brush to the inside surface of your teeth, while keeping the brush at a 45-degree angle to clean the gum line.
  3. Chewing surfaces: Brush the chewing surfaces of your teeth while holding the toothbrush flat on the top surface of the tooth.
  4. Clean your tongue: Clean the bacteria off your tongue, which often appears as a white buildup. This will help keep your breath smelling fresh.

Besides brushing your teeth, you can follow the following practice to maintain oral hygiene:

  • Floss every day
  • After brushing and flossing, use mouthwash
  • Drink plenty of water daily
  • Replace your toothbrush every 3-4 months
  • Schedule regular dental checkups

9. What are some lifestyle changes Indians need to adopt immediately for better oral health?

Some of the key points are:

  • Eat a healthy balanced diet
  • Limit intake of sugary food and drinks
  • Avoid frequent snacking and application of fluoride products
  • For those having artificial teeth/dentures, a constant visit to the doctors is a must
  • Abstain from alcohol and tobacco products as they affect the composition and appearance of your teeth and gums
  • For people with diabetes, put in extra effort to maintain control of the disease as it will decrease the chances of gum and dental diseases
  • For dry mouth, drink plenty of water, chew sugarless gum, avoid tobacco products and alcohol
  • Keep a tab on your medicines as certain medications affect the composition of the mouth
  • Follow a proper diet filled with calcium-enriched produce and leafy vegetables
  • It is best to avoid sugar, as it breaks down the enamel coating and results in tooth decay

10. How often should you brush your teeth? What are some signs of over-brushing?

Brush and floss at least 2 times per day for 2–3 minutes with gentle force. Vigorously brushing your teeth tear down the enamel and damage the teeth. A V-shaped defect is produced along the gum line. It pushes back the gums by exposing the sensitive root area. Receding gums can also lead to dental problems including Periodontal Disease, and cavities on the roots of teeth.