Chapter 28- Teeth cleaning- The Advanced Class. Tips and tricks.

Tooth decay [caries] is caused by this very simple little equation;- plaque + sugar = acid = cavities.

The bacteria in the plaque on your teeth metabolise the sugar in your diet and a by-product of this metabolising is acid. The acid demineralises the enamel of your tooth leading to tooth decay [caries]. Lots of different bacteria are involved.

So to stop decay you need to remove the plaque at regular intervals from your teeth, cut the amount and frequency of sugar in your diet and add fluoride into the mix.

Gum disease is caused by bacteria in plaque.

So it stands to reason that removing the plaque from your teeth effectively, efficiently, thoroughly and frequently is the key to success.

I would thoroughly recommend an electric toothbrush. You can wash your undies in the bathroom sink but it’s so much easier to put them in the washing machine. However if your budget doesn’t stretch that far or you really can’t cope with an electric one for some reason, a manual toothbrush will do the job just as well, just make sure you do it systematically [see the little video in Chapter 6].

Let’s say you haven’t been to the dentist for years for whatever reason, you don’t know where to start, you know your teeth are in a state, you know your gums are in a state because they bleed, you are worried about what the dentist might find etc. I suggest you invest in a basic entry level £30 electric toothbrush. Start with this, unless you’ve actually got raging tooth ache I suggest you start the process of sorting your teeth and gums out yourself! Start today, while you;- wait for an appointment, find a dentist you like, move house, have a baby, take your exams etc

Life gets in the way sometimes but you can make a start yourself.

It’s recommended that you brush your teeth for 2 minutes twice a day. But why 2 minutes? That’s 2 minutes for a tiny little 6 year old with 20 baby teeth and 2 minutes for an enormous gentleman with 32 enormous teeth, it doesn’t make sense. The time has to be prescriptive for the patient.

Some electric tooth brushes have timers to help you. If you’ve been to the dentist, your gums and your teeth are healthy then 2 minutes is fine but if your gums are bleeding because they are infected and inflamed then you are going to need to brush them for longer for a while. Just like wearing in a new pair of high heels around the house for a bit. The other problem with a timer is it lulls you into a false sense of security, your timer goes off you have a mouth full of spearmint flavoured toothpaste- you think your teeth are clean. But they may not necessarily be clean because you may not have brushed every section of your mouth for the same length of time, it’s very easy to just switch it on and idly stare out of the window for 2 minutes without concentrating on what you are doing.

Look at it like this- you are going to mop the kitchen floor, you don’t do a bit here and a bit there, you start in one corner and you mop systematically until you have done it all. You have to do the same with your teeth!

Both the major manufacturers of electric toothbrushes in the UK- Braun/ Oral B and Phillips have models with timers to help you. Not sure which one to buy? Take the plunge with one or the other, if your friend/ partner has one, buy a head of your own and borrow theirs to try it out. It’s no different to buying a match pot of paint to try out a colour on your walls. Personally I would recommend a Braun/ Oral B with a round head and at the time of writing it is the one most recommended by UK dentists. To me it seems logical to have a round head to clean the semi-circular shape of your gum margin but each to their own. The important thing is to use it correctly and thoroughly. The gadget and gismo marketing bits and bobs might be nice but they are unnecessary. Just because you own a fancy four wheel drive doesn’t mean you can drive or park it correctly as I am sure you will have noticed on many occasions!

So back to our kitchen floor, you need to clean every face of your teeth as effectively, efficiently and thoroughly as every other. They are all as important as each other. I’ve had patients who have had terrible gum disease because they didn’t realise you need to clean the back of your teeth as well as the front! So the best thing is to divide your mouth up into sections. Much easier to mop your kitchen floor if it’s got big square tiles or ‘floorboards’ on it as you can use the seams to help you.

Oral B and Phillips have made a brave attempt to do this by having a 30 second timer for each quarter [quadrant] of your mouth. The problem with this is most people spend most of the time allotted on the easy bit, the front of their teeth [the bit you see in the mirror] and the back of their teeth get a bit of a ’lick and a promise’. The other problem is we don’t turn our hands round at the midline, we actually turn our hands about by no 2 and no 3 on our dominant hand side, so the swap round section gets a bit left out, so we accumulate plaque here, we need to double do this bit. It’s a bit like having a cheap curtain track that always gapes at the midline, buy one with a cross over bar and your problem is solved.

To overcome this problem you could;-

Be aware of it, stain with disclosing tablets so you can see exactly where it is and where you are missing.
Use your 30 second timer to clean the outside/ front surface [the bit you see in the mirror] all the way round and then use the next one to clean the inside/ back surface of your arch. The same top and bottom. Hold your toothbrush vertically on the top arch when you get to your front teeth and you will make a smoother transition from one side to the other. See Adrian Giles in the Guardian 4th Feb ’21.
If you use it on each quadrant [as designed] start on the inside surfaces/ back surface of each side and count to 15 seconds [elephants] and then do the outside surfaces/ front side of the arch. Then the 30 seconds will be used equally on both surfaces.

The next common fault is people have their mouths too wide open when they try to clean their teeth. If you think of your skull as a box to hold your brain, your top jaw and all the little bones in between around your eyes and your cheeks are fixed to the bottom of this box. The moveable bit of your skull is your bottom jaw which hinges just in front of your ears. If you open your jaw really wide and then try and put your finger along the outside of your top teeth you will find there is no space but if you half close your mouth and swing your bottom jaw over to that side you will find you have made a space to put your toothbrush in. This is where debris sits- like a hamster’s cheeks! This goes for a manual or an electric toothbrush. Tip- when cleaning your children’s teeth, just pull their cheek out and their jaw will automatically move to one side.

Another common fault if you are using a manual toothbrush is to have a toothbrush that is too long, a couple of centimetres is big enough, any more you can clean your bike chain but you can’t clean your teeth properly! If you have a long narrow arch with a bit of a hair pin bend at the front, hold your toothbrush vertically when cleaning the back of your lower front teeth. If you hold it horizontally you can’t manoeuvre it properly.

With an electric toothbrush personally I think it’s better to divide your mouth into more little sections. Look at it like this- you are buttering a piece of toast, you can butter a small piece of toast in one sweep, but if you have a really large piece of toast, unless your butter is very soft you will need several strokes [this is the best analogy I can think of at the moment I may think of a better one in the future]. So it is when cleaning your teeth, it is very difficult when cleaning a long sweep of teeth, all the way round or even just a quarter to maintain even pressure and momentum especially as you are sweeping round a curve. Better I think to divide your teeth into sextants like this- canine to canine as one section, canine backwards as another section on both sides. 3 sections on the front/outside of your arch and 3 sections on the back/inside. Top and bottom, 12 sections in all, are you with me so far! Brush each section slowly and steadily for 10 seconds [a slow count of ten]. This will be 2 minutes in all. Teach yourself an order so you don’t miss bits out, whatever order is logical to you. Do each section in the same order for ‘ever and ever’. Then you will have brushed each section of your mouth for the same length of time, because every section is as precious as every other. Reverse the order every so often and start at the end.

An important point about tooth brushing is this- your gum is like a little windowsill, the bacteria live on this little windowsill [gum margin] and they make it all swollen, inflamed and miserable. When they have been on this little windowsill for some time they drop down the back of the windowsill and ‘eat away the bone around your teeth’. When cleaning your teeth with whatever type of toothbrush you use, you have to say to yourself all the time ‘can I feel the bristles on my gums’ because what you are trying to do is sweep the bugs off the windowsill.

If you were a little bird and you wanted to build a nest you would not build it on a branch that bounces up and down all the time, you would build it somewhere safe. It is the same with the bacteria on your teeth, you have to have really dirty teeth for bacterial plaque to be on the smooth shiny surface, it’s designed to shed the dirt. The bacteria live where they are not going to get knocked off- on the little windowsill and in between your teeth so these are the most important bits to clean.

A tooth where there isn’t one next door. When you put your little brushes through between your teeth you are not cleaning the gap- its air! You are cleaning the 2 teeth on either side of the gap. So when one of those teeth is missing for some reason you still have to clean across this surface or it will never be cleaned and a big slug of plaque will sit on the bony ridge behind your tooth resulting in a cavity there. Use a little brush [a fairly large size] across that surface just as if you had a tooth next door. By the same logic you need to floss down the back of your last standing tooth, your floss is just a scraper, like scraping frost off a car windscreen with a credit card.