Guide to Safe and Effective Dental Health and Hygiene

An effective dental health routine can help to prevent long-term issues such as cavities, gingivitis, and gum disease. The American Dental Association (ADA) recommends that you clean between your teeth using floss, or another interdental cleaner, once each day. They also recommend that you brush your teeth twice a day for two minutes with fluoride toothpaste. Fluoride mouthrinse can also be used on a daily or weekly basis to prevent tooth decay. It is important not to swallow products that contain fluoride due to the risk of fluorosis.

It can be difficult to establish consistent habits and find products that work for you. Additionally, some people such as those with arthritis or young children may struggle more than others when it comes to establishing an effective dental health routine. There are many factors to consider, but luckily, you really only need to use a few key items. It is best to consult with your dentist regarding the best dental care routine for you. It is also recommended to see your dentist and dental hygienist regularly for professional cleanings, usually every 6 to 12 months.¹ Keep reading to find out what you should know regarding effective dental care.

Dental floss recommendations for dental health

Brushing is important, but flossing is the best method to get rid of plaque in between the teeth. Bacteria that are present in the plaque release an acid that can eat away at your enamel (the hard outer shell of your teeth) and cause cavities. Also, plaque that is not removed can eventually harden into tartar. Unfortunately, this can collect on your gums and lead to gingivitis. The gingiva are the part of the gum surrounding the base of the teeth.¹ Gingivitis is associated with swollen and bleeding gums.¹ If left untreated, gingivitis can lead to tooth decay, periodontitis, and tooth loss.¹ Periodontitis is gum disease that spreads to underlying tissue and bone.¹

Floss types and methods

Generally, the best time to floss is up to you. One study published in the Journal of Periodontology found that flossing before brushing was more effective at removing plaque, rather than the other way around. ² However, the exact order and number of times you should floss depends on your preference. If possible, it may be a good idea to floss more than once a day, especially after eating. There are many different types of dental floss and tools for interdental cleaning available. These include unwaxed floss, waxed floss, dental tape, polytetrafluorethylene floss (PTFE), and super flosses.³ Disposable dental flossers are also available.

The best type of floss and flossing method to use is up to personal preference. If regular floss does not work or is difficult, using a floss holder and/or electric flosser may be a better alternative. ³ To read more on this, click here. Most electric flossers have ergonomic handles and some types have angled heads to make reaching back teeth even easier.³ Also, electric flossers promote oral health by gently stimulating the gums.³ However, young children, older adults or anyone who has a very unsteady grip should not use an electric flosser unsupervised.³

How to use dental floss

When using a flosser, follow the same basic technique as when using regular floss.³ To use dental floss picks, move the flosser handle so the piece of floss curves around the tooth in a “C” shape.³ Gently work the floss under the gum line and slide the floss up to the top of the tooth, going up and down several times.³

Fluoride toothpaste guidance for dental health

Fluoride toothpaste represents more than 95% of toothpaste sales in the U.S.⁴ Fluoride is the ionic form of the trace element fluorine.⁴ Fluoride works to prevent cavities in different ways. First, it slows down demineralization and promotes the remineralization of emerging enamel lesions. Specifically, fluoride remineralizes the calcium hydroxyapatite structure in enamel by forming calcium fluorapatite, which is more resistant to acid attacks.⁴ Second, fluoride interferes with bacterial metabolism, reducing the growth of plaque bacteria.⁴

The American Dental Association recommends the use of fluoride toothpaste displaying the ADA Seal of Acceptance.⁴ You can search for a list of accepted products here. Currently, I have been using Native toothpaste. Although it is not included in the list of accepted products, Native toothpaste does contain 1100 ppm of fluoride. It is also made without triclosan, SLS, parabens, or artificial preservatives. The active ingredient in fluoride-containing toothpastes can be sodium fluoride, sodium monofluorophosphate, or stannous fluoride.⁴ In particular, Native toothpaste contains sodium fluoride.

Fluoride concentrations in toothpaste

Fluoride toothpaste that can be purchased over the counter in the U.S. generally contains a fluoride concentration of 1,000 to 1,500 parts per million (ppm).⁴ “High fluoride” toothpaste containing more than 1,500 ppm F (usually 5,000 ppm F) are available by prescription for older children and adults at increased risk of cavities.⁴ Fluoride concentrations may not be reported as ppm on product labels. Colgate provides a useful conversion chart which can be viewed here. A simplified table is provided below for reference.

Brushing recommendations for dental health

For the majority of people, it is recommend to brush twice a day with a fluoride toothpaste, once in the morning and once before going to bed.⁴ It is recommended to supervise children’s brushing.⁴ For children younger than 3 years, parents and caregivers should begin brushing children’s teeth as soon as they begin to come into the mouth by using fluoride toothpaste in an amount described as no more than a smear or as the size of a grain of rice.⁴ For children 3 to 6 years of age, parents and caregivers should dispense no more than a pea-sized amount of fluoride toothpaste.⁴

According to a 2005 independent study, rechargeable electric toothbrushes were found to be more effective at removing plaque compared to regular manual toothbrushes.⁵ They may also be easier to use because they provide the brushing action for you.⁵ For these reasons, I prefer using electric toothbrushes, specifically Oral-B electric toothbrushes.⁵ They also include many features such as a built-in two-minute timer so it is simple to know when to stop brushing.⁵

How to use flouride mouthrinse

Fluoride mouthrinse is a concentrated liquid solution that can be used daily or weekly.⁴ Mouthrinse should be swished or rinsed in the mouth and then spit out. ⁴ The most common fluoride compound used in mouthrinse is sodium fluoride.⁴ The fluoride from mouthrinse is retained in dental plaque and saliva and helps prevent tooth decay.⁴ Over-the-counter solutions of 0.05% sodium fluoride (230 ppm fluoride) for daily rinsing are available for use by those older than 6 years of age; use in persons younger than 6 years of age is not recommended because of the risk of fluorosis if the rinse is swallowed.⁴ A dentist or physician must prescribe higher strength mouthrinses (e.g., 0.2% neutral sodium fluoride to be used once a week) for those at high risk of tooth decay.⁴

Fluorosis

Fluorosis of permanent teeth occurs when an excess quantity of fluoride is ingested for a sufficient period of time during the time that tooth enamel is being mineralized.⁴ The level of fluoride intake between the ages of about 15 and 30 months is thought to be most critical for the development of fluorosis of the maxillary central incisors.⁴

The mechanisms by which fluoride changes tooth development are not fully understood; but may result from alterations in protein metabolism disrupting the crystal organization in the developing tooth.⁴ Excess fluoride exposure can be reduced by using the recommended amount of toothpaste and by storing toothpaste where young children cannot access it alone.⁴ Parents should also be strongly advised to supervise their child’s use of fluoride toothpaste to avoid overuse or ingestion.⁴

References

1. Gingivitis. Mayo Clinic. November 16, 2023. Accessed June 25, 2024. https://www.mayoclinic.org/diseases-conditions/gingivitis/symptoms-causes/syc-20354453.

2. Mazhari F, Boskabady M, Moeintaghavi A, Habibi A. The effect of toothbrushing and flossing sequence on interdental plaque reduction and fluoride retention: A randomized controlled clinical trial. Journal of Periodontology. 2018;89(7): 824-832. doi:10.1002/jper.17-0149

3. Dental Floss types – the pros and cons. Oral-B. Accessed June 25, 2024. https://oralb.com/en-us/oral-health/why-oral-b/floss/dental-floss-types-the-pros-and-cons/.

4. Fluoride: Topical and systemic supplements. American Dental Association. Accessed June 25, 2024. https://www.ada.org/en/resources/ada-library/oral-health-topics/fluoride-topical-and-systemic-supplements.

5. The benefits of electric toothbrush vs. Manual. Oral-B. Accessed June 25, 2024. https://oralb.com/en-us/oral-health/why-oral-b/electric-toothbrushes/benefits-of-electric-toothbrush/.

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