Good Teeth

Back to basics

We've all been brought up to brush our teeth at least twice a day and floss regularly and perhaps even use a mouthwash, but are you sure you're brushing and flossing correctly? Do you know whether or not your toothpaste is suitable for your needs? Is your toothbrush doing its job properly? The key to a healthy, beautiful smile is getting the basics right: practising the best oral hygiene you can at home, and leaving the complicated procedures to your dentist.

In addition, while most of us focus on fighting cavities, it's gum disease we should be worrying about as adults. More teeth are lost through gum disease than through tooth decay, and it is estimated that nine out of 10 people start to show signs of gum disease by the time they are 25 years old.

Your teeth are supposed to last a lifetime, but cavities and gum disease are known to shorten their lifespan.

Fortunately, a sound oral-hygiene regimen protects your teeth against both cavities and gum disease. The key is to commit yourself to that regimen, and then implement it correctly and effectively. Doing so, just a few minutes a day, will ensure that your teeth last a lifetime.

ANATOMY 101

To best understand what you're doing when taking care of your teeth, it helps to have some knowledge of their basic anatomy. Your teeth have a complex, multilayered structure, as well as a supply of nerves and blood.

The tooth is divided into three main parts: the crown, the neck and the root. Enamel covers the crown of the tooth, and this smooth, hard coating is the hardest tissue in the body. It is not sensitive at all, and is usually translucent-white in colour. The main substance of the crown, neck and root of the tooth is dentine. This is a yellow-white colour, and is very sensitive, as it houses the tooth's nerve supply.

The gums, or gingiva, are the link between the teeth and the rest of the mouth. The tiny space between the teeth and the gums is known as the gingival sulcus, and is usually no thicker than 2mm (0.08in). However, as small as it is, this space is a common source of infection. The tooth is connected to the bone in your jaw by thin fibres (periodontal ligaments), which act as shock absorbers for your teeth. The periodontal ligaments attach to the thin layer covering the root, called cementum.

ANATOMY OF A TOOTH

THE ORAL CAVITY

Inside each tooth is a nerve cavity that houses the tooth's blood vessels and nerves. Blood vessels are vital because they transport essential nutrients to the tooth, and the nerves make the tooth sensitive, which is sometimes a good thing and at other times extremely painful. The nerves and blood vessels pass through the tooth into the nerve cavity by means of small channels called root canals.

Adults have 32 teeth, including four wisdom teeth, which can be divided into four types. Each of the four types has a different structure, position and function.

The eight incisors occur near the front of the mouth, and are typically used for biting. Moving outward from the centre, your canine teeth are sharper and more pointed than incisors, and help to tear off and hold your food while you are eating. They are also commonly called eye-teeth.

The premolars are next, and have two raised points that help to crush your food during chewing. Molars are a larger version of the premolars, and are used for grinding and pulping food. There are eight premolars and eight molars, plus the wisdom teeth that are simply an additional set of molars.

GOOD ORAL HYGIENE

Your brushing technique

Your teeth are supposed to last a lifetime, but cavities and gum disease often shorten their lifespan. The key to teeth that last is correct brushing and flossing on a daily basis. Here, prevention really is better than cure.

However, while we all probably brush our teeth at least once daily, and floss occasionally, the question is whether or not we are brushing correctly and effectively. A good brushing technique is vital if you are going to get into all the nooks and crannies between tooth and gum. So here's a basic guideline: hold the toothbrush in a comfortable grip and place the head at about 45 degrees to the surface of your teeth: this allows the bristles to get into the space between the gum and teeth. Starting at one side of your mouth, systematically brush first the outside of your upper and lower teeth, moving from one side of your mouth to the back of the other side. Then do the same for the inside of all the teeth, working from one side to the other, and repeat for the chewing surfaces.

The key to teeth that will last is correct brushing and flossing daily.

Fluoride strengthens teeth, but too much can actually discolour them.

Ensure you are holding your toothbrush firmly, but comfortably, with its head at a slight angle to your teeth, and systematically clean every surface.

Finally, wipe your tongue with two or three strokes from back to front, and use your tongue to test whether or not your teeth feel smooth and clean. If not, return to whichever areas need attention, and brush them again.

In the absence of fluoridated water, it is essential to use a toothpaste containing fluoride. Note that, unlike adults, if children ingest too much fluoride, it can discolour their teeth, so you need to find a good balance.

Fluoride strengthens their teeth in two ways: either from the inside, where it is systemically absorbed, or by direct application to the surfaces of teeth to make them more resistant to decay. The latter is what you are doing when you brush your teeth.

To get the balance right, start by brushing your teeth at least twice a day - three times if you can manage it. If you really can't get that right, then at least ensure that your once-a-day brushing occurs last thing at night. Bacteria accumulate on your teeth during the day, and saliva flow diminishes at night, so your teeth have less protection while you sleep. When you have finished brushing your teeth, don't rinse your mouth afterwards - simply spit out any excess toothpaste and leave the remainder on your teeth, so that the fluoride can do its work.

Choosing a toothbrush

Part of effective brushing is having a good toothbrush. Many people think that to do the job properly they need a good, hard brush, but in fact, all they are doing with a hard brush is damaging the enamel of their teeth and bruising their gums.

There are basic requirements for a good toothbrush: its head should not be longer than 20mm (0.8in). It should also have nylon bristles that are medium-soft rather than hard, and its tips should be rounded. While it may seem unimportant, a comfortable grip makes a huge difference. If your hand slips while brushing, you can injure your gums or palate, so it's worth finding a brush that is both comfortable to hold and unlikely to become slippery when wet.

Another option is the power or electric toothbrush: most dentists tell you that advances in this area have revolutionized how well we are able to brush our teeth at home. Power toothbrushes clean your teeth much better than you ever could, and are very gentle on the gums. Some people might find the sensation a little strange at first, as they vibrate fast, but once you've been using a power toothbrush for a while, a manual toothbrush simply won't seem to do the job well enough.

Power toothbrushes have been scientifically proven to modestly reduce plaque, gingivitis and secondary gum disease, which make them a good bet. They leave your teeth feeling fresher, smoother and cleaner than a manual toothbrush would. Remember, however, that they do not take away the need to have your teeth professionally cleaned by an oral hygienist as tartar cannot be effectively removed with either a manual or power toothbrush.

If you decide a power toothbrush is for you, here's a valuable tip: don't switch it on until it's in your mouth, or you will be mopping up toothpaste splatters on every surface in your bathroom! Also avoid using tooth-whitening toothpaste with an electric toothbrush; the combination is too abrasive and you may damage your teeth's surface enamel.

Electric toothbrushes are expensive and this is a major drawback for most people. The initial outlay is steep, but then it's not necessary to buy one for every member of the family. Most people buy one brush for the family, plus a multipack of refill heads: these usually come in packs of four, and each head has its own marker and colour. Each family member then simply puts on his or her own toothbrush head when they want to brush their teeth.

There are excellent electric toothbrushes on the market; find out from your dentist which brand is best, if this is something you would like to try. Whatever toothbrush you choose to use, remember that it won't last forever. Some toothbrushes have coloured bristles that fade to white when it's time to get a new one; otherwise, a good guideline is to buy a new brush every six weeks, or more often if it's starting to look worn. Note that your toothbrush is a weapon for fighting plaque build-up and oral disease, so it's vital that you get the best possible brush on the market.

SELECTING TOOTHBRUSHES

WHAT TO LOOK...