Two minutes, twice a day — it’s a simple message that’s drummed into us from an early age. But the latest figures suggest many of us still don’t brush properly and our teeth and gums are suffering serious damage as a result.
One in four adults admits they don’t brush their teeth twice a day, according to the charity the Oral Health Foundation. Unsurprisingly, nearly 70 per cent of us have visible plaque — a build-up of bacteria and debris which is a chief cause of tooth decay.
And even if you do try to look after your teeth, how should you do it and what should you use? Last week Swiss researchers who analysed the effectiveness of certain toothpastes found some no more effective than saliva when it comes to preventing dental erosion.
This is when the tooth’s outer hard enamel coating is lost, exposing the dentine, which contains nerves, and leads to tooth sensitivity and pain.
Are you one of them? One in four adults admits they don’t brush their teeth twice a day, according to the charity the Oral Health Foundation
They analysed nine popular fluoride toothpastes that claim to help with sensitive teeth and dental erosion. None of the toothpastes tested were capable of preventing dental erosion or sensitivity alone, something the researchers from the University of Bern called a ‘concern’.
But selecting the right toothpaste isn’t the only issue. It’s not just your teeth that need attention — it’s your gums too.
In fact, even if you spend the recommended two minutes, twice daily, scrubbing your teeth — unless you’re also cleaning your gums, experts now say you could be entirely wasting your time. That’s because of the risk of gum disease, which affects three-quarters of British adults.
‘Much of the plaque-forming bacteria lurk on the gum line between gum and tooth, and need regular brushing in the same way as our teeth,’ explains Dr Reena Wadia, a periodontist (gum specialist) from RW Perio clinic in London. ‘If they’re not brushed away, bacteria react with sugars from food to create plaque, the sticky film which causes gum inflammation.’
She continues: ‘left untreated this inflammation of the gums (known as gingivitis) progresses to more serious gum disease — and that’s the real culprit when it comes to tooth loss in adults.’
‘Gums are incredibility important,’ adds Dr Uchenna Okoye, clinical director of London Smiling Dental Group. ‘They’re made from collagen fibres and act as shock absorbers for the teeth, protecting them when you chew and holding them firmly in place.’
Alarming: Last week Swiss researchers who analysed the effectiveness of certain toothpastes found some no more effective than saliva when it comes to preventing dental erosion
Neglecting to clean your gums allows plaque to grow beneath the gum line and between teeth until it eventually breaks down the bone and connective tissue anchoring our teeth. ‘It’s like losing the soil around the bottom of a picket fence,’ explains Dr Okoye. ‘Eventually the posts start wobbling and become looser and looser until they just fall out.’
Gum disease has also been linked to a whole host of serious health problems, including heart disease and diabetes.
And last month, a study by the University of Helsinki in Finland found a clear link between gum disease and cancer deaths, notably with pancreatic cancer, according to the British Journal of Cancer. Other similar studies have linked gum disease bacteria to cancers of the breast, throat and stomach. Scientists believe that bacteria in the mouth enters the bloodstream via the gums, damaging organs and contributing to the formation of tumours.
This all means knowing how to brush both your teeth and gums properly is much more important than just flashing a bright, white smile. Here, Good Health presents the definitive guide to brushing your teeth — and gums…
HOW TO BRUSH YOUR TEETH WELL
The first step to boosting tooth and gum health is simply learning to brush them properly. As well as clearing away harmful bacteria, brushing boosts blood flow to the gums, providing them with oxygen which strengthens and helps them repair and fight off future bacteria attacks.
‘You need to place the toothbrush at a 45-degree angle against the spot where the gums and teeth meet,’ explains Dr Wadia.
The ugly tooth: Unsurprisingly, nearly 70 per cent of us have visible plaque — a build-up of bacteria and debris which is a chief cause of tooth decay
‘Angle upwards for the upper teeth and downwards for the lower teeth — it should feel like you’re massaging your gums.
‘Spend around five seconds on the gum line of each tooth.’
IS AN ELECTRIC BRUSH BETTER?
Whether electric toothbrushes really do trump manuals has long been the subject of debate, and the answer seems to be that they do.
When the respected Cochrane research body analysed the outcomes of 432 studies on this subject in 2014 it concluded: ‘Powered toothbrushes reduce plaque and gingivitis more than manual tooth brushing.’ And most dentists agree: ‘If someone’s technique is perfect with a manual toothbrush then that’s absolutely fine to use,’ says Dr Wadia.
‘But the vast majority of people don’t have perfect technique.’
Indeed, the Cochrane review noted that one reason electric toothbrushes performed better over the long-term is that even manual users who begin with an efficient technique rarely keep up their technique effectively for the full two minutes that they brush their teeth.
‘Electric toothbrushes are just far more effective at removing plaque because they’re designed to gently massage teeth and gums correctly,’ adds Dr Wadia, ‘they do all the hard work for you.’
DON’T OVER-BRUSH THE GUMS
Although gums need brushing you mustn’t attack them too vigorously, as you can wear them away.
This will eventually leave tooth roots (containing the nerve and blood supply) exposed, causing sensitivity and increasing the likelihood of gum disease as plaque bacteria can easily take hold in the gap created by the receded gum.
Health matters: In 2014, Brazilian researchers reviewed 24 previous studies and found overwhelming evidence that people under stress were at greater risk of gum disease
Dr Wadia recommends ‘holding your toothbrush with a gentle grip, as if you’re holding a pen, and brush using your wrist rather than your whole arm’.
‘Gums in good health are one of the fastest-healing tissues in the body,’ says Dr Richard Marques, a dentist at Wimpole Clinic in London. ‘Their cells (made of the connective tissue collagen) repair twice as quickly as normal skin cells’. But once tissue has been completely worn away there’s nothing left to regenerate.
In this case, a ‘gum graft’ is the only answer. The hour-long procedure takes tissue from the roof of your mouth and stitches it into place over the exposed tooth root. But it doesn’t come cheap, at around £400 to £600 per tooth.
CHOOSE THE RIGHT BRISTLE
When it comes to picking your brush head, avoid brushes with hard bristles.
‘Too firm can wear the gums, but too soft (as with some brushes aimed at sensitive teeth) and it won’t remove all the plaque and food debris properly,’ says Dr Marques. ‘I always recommend a medium brush.’
If you’re going for an electric Dr Wadia suggests one with a pressure sensor — ‘this warns you by beeping if you’re pressing too hard’, she says.
BACTERIA PILLS GOOD FOR GUMS
Good and bad bacteria live side-by-side in your mouth, just like in your gut, with over 700 species flourishing there.
Generally, the ‘good’ kind keep the ‘bad’ in check. But if they get out of balance — as a result of poor oral hygiene — the harmful ones can lead to gum disease.
Scientists have recently been looking at whether probiotics — supplements containing good bacteria that restore balance in the gut could also could help fight gum disease.
A 2017 study published in the Journal of Oral Microbiology added helpful gut bacteria lactobacilli to chewing gum and asked people to use it daily.
After two weeks the amount of plaque on the teeth and gum line had significantly reduced.
Similarly, a German study by University Hospital Jena published in The Journal of Clinical Periodontology found a daily shot of any probiotic drink could reduce bleeding and inflammation in gums.
SHOULD WE BE FLOSSING DAILY?
Insight: Good and bad bacteria live side-by-side in your mouth, just like in your gut, with over 700 species flourishing there
Long-standing advice for maintaining healthy teeth and gums was to floss daily.
However, in 2016 a flurry of reports began to question the science, prompting Public Health England to change its guidance to say: ‘There is no strong evidence that flossing makes any difference to oral hygiene compared with brushing with toothpaste.’
These days, most experts recommend interdental brushes, which fit between the teeth like pipe cleaners.
‘Teeth aren’t straight and uniform,’ explains Dr Nigel Carter, chief executive of the Oral Health Foundation charity, ‘so the bristles on the interdental brush are more effective than floss — as floss can’t penetrate small pits and concaves surfaces.’
HOW RED WINE MIGHT HELP
This notorious teeth-stainer might not sound good for oral health, but a study in February found that two antioxidants in red wine could prevent plaque bacteria sticking to gums.
Scientists at the Spanish National Research Council in Madrid were quick to point out that they tested antioxidants in much higher concentrations than in a normal glass of wine — but there is hope the results could influence future toothpaste formulations.
The British Dental Association, meanwhile, advises drinking wine in moderation and with a meal, as its acidic nature may otherwise damage enamel.
YOGA ‘GOOD’ FOR DENTAL HEALTH
In 2014, Brazilian researchers reviewed 24 previous studies and found overwhelming evidence that people under stress were at greater risk of gum disease.
Stress appears to dampen the immune system, reducing its ability to fight the bacteria that cause gum inflammation.
Last year a study by the Dental Clinic & Research Centre in India found that people who practised yoga regularly had lower rates of gum disease.
Researchers put this down to the fact yoga relieved stress, which helped improve the body’s inflammatory response to bacteria in the mouth.
SUPPLEMENT TO BOOST GUMS
Many studies have found that the gums of people with periodontitis have decreased levels of coenzyme Q10 (CoQ10).
This nutrient and antioxidant occurs naturally in the body and is found in foods such as liver, whole grains, oily fish and peanuts. CoQ10 helps oxygenate tissues, but we naturally produce less as we get older.
TOP TIP: REPLACE YOUR BRUSH AFTER YOU’VE HAD A COLD!
The recommendations about of how often you need to change your toothbrush or brush head vary, but typically changing them every three to six months is about right, say dentists.
‘However, when you’ve been sick with cold or flu, or if you’ve had a mouth or throat infection, you should replace your toothbrush even if it’s new,’ says periodontist Dr Reena Wadia.
This is because while you can’t catch the same cold virus twice, your bugs can spread to bathroom surfaces or other nearby toothbrushes, putting other family members at risk.
Many studies, including one by the Institute of Dental Sciences in India in 2015, have found taking a supplement that provides around 100mg of CoQ10 per day, can significantly reduce gum disease.
Dentist Dr Mark Burhenne recommends the most readily absorbed form, ubiquinol, for anyone with gum disease, and for those taking cholesterol-lowering statins which have been found to lower levels of CoQ10.
GARGLE WITH SALT WATER
‘A great natural way to look after your gums is to do regular warm salt water mouth rinses,’ says Dr Marques.
‘Use a teaspoon of salt in a 200ml cup of warm water, 10 minutes after meals and swill it all around your mouth a few times for around 20 seconds’. Salt acts as a natural antibacterial and an anti-inflammatory, which can help to improve and maintain gum health.
A 2016 study on the Public Library of Science One Journal found salt water gargles could indeed speed up gum healing.
TREAT BLEEDING AS A WARNING
Most of us know that spotting blood on the toothbrush is a sign that our gums are damaged. Yet a study by Corsodyl last year found that despite 84 per cent of people being aware that bleeding gums were a sign of gum disease, nearly half would still ignore blood if there was no pain associated with it.
This could be a serious mistake, as gum disease is painless until it reaches the later stages.
Bleeding gums is one of the first signs of gingivitis which leads to gum disease.
When gums become inflamed by bacteria, tiny blood blisters form inside the pockets of tissue surrounding the teeth, once these blisters are disturbed they break and bleed.
‘You wouldn’t ignore bleeding from any other part of your body, so treat gums the same way,’ advises Dr Wadia.
CAN YOU REALLY GET AWAY WITH BUYING A 75P TOOTHPASTE?
When researchers at the University of Bern tested nine popular fluoride toothpastes, they found that some were were no better than saliva.
‘Brushing with a fluoride toothpaste alone is not a magic wand when it comes to preventing enamel erosion, you also need to reduce acid-forming sugary foods and drinks,’ explains Dr Uchenna Okoye of the British Dental Association.
Indeed how you clean your teeth is as important, if not more, than what you clean it with, she adds. ‘Patients often ask me if toothpaste is absolutely necessary and the simplest answer is no.’
‘People ask if they can use products such as baking soda, coconut oil, even water. The real key is a good technique and to brush often to remove plaque and reduce bacteria on the gum line.’
But toothpaste’s main benefit is it contains fluoride, which strengthens teeth.
‘Despite the new Swiss findings, dentists still largely agree that regular topical fluoride application in the form of toothpaste helps strengthen enamel and reduce dental cavities,’ says Dr Okoye.
A study by Which? in 2015 found that a long as a toothpaste has the recommended level of fluoride (1350-1500ppm for adults, as found in most products), it will keep teeth healthy.
Although toothpastes now come in a variety of different flavours and make a number of different claims there’s no guarantee that expensive toothpastes will leave the teeth any cleaner.
So unless you have a specific problem with sensitive teeth, say, your most basic Boots own product for just 75p will do the job just fine.
But what exactly is in toothpaste anyway? We look at one popular product, Colgate Total Whitening Toothpaste . . .
Aqua: One of the main ingredients, aqua, or water, helps make it a paste.
Glycerin: This lubricant is used to prevent toothpaste drying out as well as giving the paste a smooth texture. Glycerin is also found in the liquid in vape pens and is the active ingredient in dynamite.
Hydrated Silica: An abrasive used to remove plaque as well as whiten teeth.
Microcrystalline cellulose: Extracted from wood pulp, this is used to thicken products such as pre-shredded cheeses as well as toothpaste.
Triclosan: This antimicrobial chemical is used to reduce plaque and heal bleeding gums. Triclosan is currently banned in hand soaps and body wash in the US because of animal studies suggesting possible health risks.
Sodium Flouride: Makes teeth more resistant to decay and the bacteria that cause cavities. Fluoride comes from the mineral fluorite, found world wide by especially in South Africa.
Sodium Hydroxide: A caustic chemical better known as lye or caustic soda.
Found mostly in household cleaning products, sodium hydroxide is used to neutralise the acidity caused by other the other chemicals in toothpaste that could potentially harm the enamel.