Preventive Care

Here are a few simple tips for oral care at home that can prevent the build-up of plaque and cavities, and can decrease bad breath:

Brushing and Flossing

• Brush your teeth at least twice a day with a soft-bristled toothbrush. Use fluoride toothpaste (but only use very little – that is all you need) to remove food particles and plaque from the tooth surfaces. Also be sure to brush the top surface of your tongue; this will remove any extra plaque-causing food particles, and help keep your breath fresh!
• If you want, use an electric toothbrush.  Buy from a trusted brand, such as Sonicare or Oral B.  A good electric brush costs about $100 and up, and they can be found on sale at drugstores, Walmart, Costco, and online.   They are excellent if you need motivation, have limited manual dexterity, or need help changing a habit of brushing too hard.
• Clean between your teeth by flossing at least once a day.  Decay-causing bacteria can linger between teeth where toothbrush bristles can’t reach. Floss will help remove plaque and food particles from between the teeth and under the gum line.
• No matter what, try to make sure you brush and floss right before bed – this way your mouth will be clean throughout the night, when your mouth is normally dry and bacteria cause more damage if there is any food left behind.
• If your dentist or hygienist has advised it, use rubber tips, proxabrushes, sulcabrushes, and other prescribed tools to clean your teeth and massage your gums.
• In order to avoid wearing away your enamel after eating, wait 20 minutes after you eat before you brush.

What toothbrush should I use?

A manual or electric brush can both do a very good job, as long as you use them properly.  Make sure the bristles are soft, and if you use a manual brush, do not brush hard and  do not brush side to side with a lot of force.  Ideally, use circular or sweeping motions to brush so you don’t cause harm to your gums (recession).

You can use your toothbrush to clean the top of your tongue as well, or you can use a tongue cleaner.

An electric brush is a great tool for patients with decreased manual dexterity (eg. Parkingson’s, arthritis), and can be used by care givers easily.   They are also a good option for patients who are brushing too hard and with poor technique with a manual toothbrush and find it hard to change their habits.  Some electric brushes come with a pressure sensor so that they beep when you brush too hard.

Excellent electric toothbrushes are made by Sonicare (Philips), and Oral-B (Braun).  Their best models tend to be costly (upwards of $100) but can be found at less cost at stores like Costco and Walmart, and usually go on sale around Christmas time.

What toothpaste do I use?

We recommend using a toothpaste that contains fluoride.  For kids that can’t spit well yet, use a non-fluoride toothpaste as ingestion of too much fluoride can be toxic.

Whitening toothpastes generally do not work.  Don’t waste your money.  And be careful because the abrasive content can cause toothpaste abrasion (wearing away of tooth structure at the gumline due to mechanical trauma).

Flossing

Flossing (or lack thereof) seems to be many patient’s guilty confession.  It can be tough to get into the habit, but once you do, you will not feel clean without it!

Floss thread is the best way to floss as it lets you maneuver around your teeth most efficiently.  For those that find it difficult to do, or have decreased manual dexterity (this includes young kids!), flosser or flossing sticks can be very useful.  Your hygienist can show you how best to use them.

What about mouthwashes?

Mouthwash use is usually not necessary for good oral care, but it is fine to use if used in addition to proper blushing and flossing.  It does not replace the need to properly brush or floss, even if it does make your mouth smell good, for a while.

Your dentist may prescribe special mouth rinses, such as a fluoride mouthrise, or a Chlorhexidine mouthrinse for treating gum infections.  These are discussed further in this page, or in the dental services section under Periodontal Treatment.

Patients with frail gums or certain mouth conditions should avoid mouth washes with alcohol as it can dry your tissues.

Patients with dry mouth syndrome (eg. Sjorgren’s)  or chronic dry mouth due to medication use, can at times be prescribed special mouthrinses to help keep the mouth moist.  Speak to your dentist if you have dry mouth.

Diet

• Eat a balanced diet, and try to avoid extra-sugary treats, and the sticky “disguised sugars” (such as the starch is potato chips – even though they are salty, they have sugars because of the starch, and they are super sticky which makes it easier to stick to the teeth for the bacteria to thrive on). Nutritious foods such as raw vegetables, plain yogurt, cheese or fruit can help keep your smile healthy.
• Healthy foods can also cause cavities (eg. fruit), because of the sugars found in them; however, the benefits of healthy foods like fruit are many, so go ahead and eat them, just make sure you clean your teeth afterwards.
• Minimize snacking, as the FREQUENCY of contact of your teeth and food is one of the most important factors in causing cavities.  The longer a cavity causing food stays on your tooth, the more opportunity it has to cause cavities.
• Drink water over other drinks (juice, pop).  Water not only does NOT cause cavities, but it also flushes away food that might be on your teeth.

Risk Factors

When it comes to oral health, there are many risk factors to consider.

1. Host Factors – including your genetics, family history, your overall health and ability to fight infection, the alignment or location of your teeth, etc.
2. Environmental factors – including diet – an increased frequency of eating and eating of starchy sugary foods and sugary drinks cause more cavities; oral hygiene; whether you play sports and use a mouthguard; using of a nightguard if you clench or grind; as well, the availability of fluoride in the water or absence of it.
3. Bacterial factors – important in the formation of cavities and gum disease – some bacteria are more aggressive.

Host Factors:

• Genetics – some of us have a predisposition to gum disease, and depending on who our primary caregiver is, our mouth is colonized with their bacteria; no matter what your genetics or who your family is, you can keep your mouth healthy by following good home care, eating well, and getting proper professional dental care.
• Overall health – people who are immunosuppressed (eg. HIV positive; organ transplant recipients; severely diabetic) have a harder time healing and therefore are more prone to infection.  Cavities and gum disease are bacterial infections.  This is one of the reasons a complete health history is reviewed with your dentist.  More aggressive preventive measures are taken with these patients, and they usually require close monitoring.
• Alignment of your teeth and other tooth factors – kids that have “buck teeth” are more prone to breaking these teeth since when they fall they are the first to take the blow; people that grind their teeth can cause a lot of damage to the teeth (wear, fracture) and the gum/bone surrounding the teeth (recession).  For both of these cases, we can help.  Orthodontics can help better align teeth, leading not only to a more pleasing smile but also a more protected smile.  The use of nightguards can help protect the teeth from grinding.

Environmental Factors:

• Diet and oral hygiene habits as described previously.
• If you play sports, this can put your teeth in danger of trauma; we advise the use of a sports mouthguard to protect your teeth.
• Fluoride in the water has been a proven effective method of decreasing cavities in the community.  If your community does not have fluoridated water you may be at higher risk of tooth decay.  Combined with your cavity history and oral hygiene habits, your dentist may recommend fluoride treatments at home or at the office.
  For more information on fluoride, click here.

Bacterial Factors:

• Cavities are caused by many bacteria and one of the most common ones is strep mutans.  Babies are born without  bacteria in their mouth.  Their mouths usually get colonized by the oral bacteria of their primary caregiver, either through kisses, or exchange of saliva by the adult licking their pacifier or sharing food utensils.  For this reason, we recommend to new parents or parents-to-be, that the parent with the least cavities but worse oral home care (yes, that is correct; the parent  that has the best teeth despite being less careful) should be the one to kiss the baby on the mouth or lick their pacifier or bottle nipple.  Most children will have their mouths fully colonized by bacteria by the age of 18 months; until about that time, the parent that is cavity prone should be careful not to pass their saliva to their child.  This is another good reason to limit who can kiss your baby on the lips or hands, and keeping a watchful eye as to which toys a child licks or sucks on as another child may have their saliva on it already and you don’t know if their mouth bacteria is of the more aggressive kind.