Oral Hygiene Aids

Definition

Oral hygiene aids are the tools used in the mouth to remove food residue and plaque, a bacterial film that causes tooth decay (dental caries ), periodontal disease, and halitosis (bad breath).

Bacterial plaque must be removed daily. The toothbrush and dental floss are the primary oral hygiene aids for this process. The toothbrush is a brush used to clean the teeth by removing plaque from the teeth and stimulating the gums. Dental floss is thin, thread-like material used to clean the areas between teeth and under the gum line. A dental toothpick may be used to clean between teeth.

Also used in conjunction with mouth care are toothpaste and mouthwash. Toothpaste is a preparation used on the toothbrush to clean teeth. Some of the ingredients of toothpaste are as follows:

• polishing agents that aid in cleaning
• fluoride, to prevent dental caries
• antitartar agents, to prevent buildup of calculus
• antiplaque/antigingivitis agents, to control plaque and gingivitis
• whiteners, to remove dental stains
• sensitivity agents, to decrease sensitivity to heat, cold, and sweets

Mouthwash is a liquid product that patients gargle or use as a rinse to fight bacteria. It is used to control:

• halitosis
• plaque
• gingivitis
• tartar and calculus

Most mouthwashes contain fluoride, which helps to control caries.

Purpose

Oral hygiene aids such as the toothbrush, dental floss, mouthwash, and toothpicks are used in the daily battle against germs that live in the mouth. Plaque is formed when bacteria in the mouth feed on the food residue—particularly sugar residue—and dead epithelial cells (the covering of internal and external body surfaces). Depending on the bacterial pathogen present in the plaque, plaque can cause tooth decay or periodontal disease. When periodontal disease is not treated, it can lead to the loss of teeth when the supporting tissue that keeps teeth in the jaw is destroyed.

Although oral hygiene aids date back thousands of years, many people don't correctly use preventive tools like toothbrushes and interdental aids. In the United States, one-third of people in all age groups have untreated tooth decay, according to Oral Health 2000, the United States Surgeon General's report from May 2000. By age 17, 78% of youths have a cavity and 7% have lost at least one tooth, according to the report by the Surgeon General at the time David Satcher, M.D. His report also stated that 48% of adults between the age of 35 and 44 suffer from gingivitis.

Oral hygiene's long history

People have been concerned about oral health for thousands of years. Ancient civilizations used urine as a mouthwash. The earliest record of this usage dates back to China 5,000 years ago when the rinse was used for toothaches and bleeding gums. Although this form of mouth rinse seems disgusting, urine is sterile in a healthy person. Furthermore, historians believe that the urine rinse may have aided in preventing tooth decay.

Ancient civilizations used the toothpick to clean the teeth. The Roman poet, Pliny, wrote in the first century about cleaning the gums with a toothpick made from the bones of puffin fish. Other toothpick materials included gold, ivory, and bronze.

Toothbrushes were in use by the 18th century. While some people cleaned their teeth with small sponges, others used brushes made from the root of a marshmallow. People also brushed their teeth with horsehair bristles.

Contemporary oral hygiene

In modern times, the toothbrush and dental floss are the most important oral cleaning aids. The American Dental Association (ADA) calls brushing and flossing the "dental care twins," the activities crucial to a healthy mouth. The dental toothpick and interdental brush may sometimes be utilized in place of floss, and the household toothpick can be used to remove food from the teeth.

The ADA Seal of Acceptance on products indicates that they were tested for safety and effectiveness.

Contemporary oral hygiene aids are used to remove food residue that can create plaque and cause tooth decay. The residue, especially that from sugar, provide nutrients for germs.

BRUSHING AND INTERDENTAL CLEANING. The toothbrush and dental floss are used to remove plaque. The toothbrush is used to remove plaque from the teeth and stimulates the gums. Dental floss or a dental toothpick is used to remove plaque and food from the areas between teeth. Plaque is a waste product that causes tooth decay. If not removed, it calcifies (hardens) and forms tartar (calculus). This hard, calcified substance must be removed by a dentist or dental hygienist.

MOUTHWASH AND TOOTHPASTE. The ADA recommends that people use mouthwash and toothpaste that contain fluoride, a mineral that helps fight tooth decay. Toothpaste is used on the brush to clean teeth. Mouthwash is used as a rinse. While a fluoridated toothpaste is essential for daily oral health care, mouthwash can supplement a mouth care regimen and is best recommended on a patient-need basis.

Oral hygiene in the 21st century

In June 2000, the ADA announced that research was under way on new oral hygiene aids, such as chewing gums and mouthwashes that would reverse early tooth decay. In 2000, scientists at the American Dental Association Health Foundation's Paffenbarger Research Center investigated calcium phosphate-based technologies to remineralize hard tooth tissue or possibly slow down caries-producing demineralization. Center director, Frederick Eichmiller, D.D.S., announced in 2000 that other research included the study of toothpaste that strengthened and restored tooth minerals.

Description

Within the general categories of toothbrush, interdental aids and mouthwash, the choices can be over-whelming. Because of the vast number of products available, it is important for the dentist and the dental hygienist to advise patients about what type of products to purchase, based on individual needs. Along with that advice, the patient must be reminded to brush and clean interdental areas properly.

Both child and adult patients should use toothpaste and mouthwash containing fluoride, the mineral used to fight tooth decay. Fluoride helps strengthen the tooth's outer surface, and it can stop small areas of decay from spreading.

Proper use of oral hygiene aids will remove plaque, the film of bacteria that forms on teeth. The bacteria creates toxins that irritate the gums and demineralize tooth structure. If left untreated, plaque can initiate damage to the gums and bones supporting the teeth.

Manual toothbrushes

The toothbrush is the oral hygiene aid used to clean teeth. A manual toothbrush is activated by hand and not powered by electricity or batteries. The ADA recommends that people use a toothbrush with soft, rounded filaments (bristles). These brushes are better than those with hard filaments for removing plaque.

A toothbrush with soft bristles is recommended because tooth enamel could be worn away by intense scrubbing. When enamel is worn away, it can promote tooth decay, hypersensitivity, and gum recession. The size of the toothbrush and design of the head are less important than the patient's commitment to using it properly.

Powered toothbrushes

Powered toothbrushes are operated by batteries or electricity. Powered toothbrushes have heads that move in a counter-rotational, rotary, or up-and-down manner; they work at a speed of 4,200 times per minute. Powered and manual toothbrushes are equally effective in removing plaque if used properly. On the other hand, studies have shown that people with poor oral hygiene or limited dexterity may benefit from using a powered toothbrush. Other studies have shown that some powered brushes are more effective in controlling stain and tartar. For children, this type of brush can be fun to use. For adults, the purchase of a powered-toothbrush could represent a commitment to improving oral hygiene habits.

No matter what type of toothbrush is used, the ADA recommends that patients use a toothpaste containing fluoride.

Toothpaste

Toothpaste is a preparation used to clean the tooth surface and remove plaque. Toothpaste flavor is a matter of consumer preference, and dental professionals advocate any flavor that stimulates people to brush at least twice a day. The ADA and the surgeon general recommend the use of a toothpaste containing fluoride to prevent tooth decay. Other effective ingredients of toothpaste are detergents and abrasives that help to remove plaque when teeth are brushed. Toothpastes that have the ADA Seal of Acceptance have a mild abrasive that is useful for plaque removal.

Tartar-control toothpaste that bear the ADA Seal of Acceptance can reduce tartar formation above the gum line. However, these products were not shown to have a "therapeutic effect on periodontal disease."

For people with receding gums and sensitive teeth, the ADA recommends brushing with a toothpaste that includes a desensitizing ingredient. These toothpastes reduce the painful effects of thermal, chemical, and mechanical stimuli on people with dental hypersensitivity.

Dental floss and picks

Dental floss is a thin, thread-like oral hygiene aid used to clean between teeth and under the gum line. Both waxed and unwaxed flosses are effective at fighting plaque. The important criteria when using floss is that it does not shred. Some patients prefer waxed floss, dental tape, or durable diameter floss, believing that they are gentler and easier to manipulate between teeth. For those who find shredding a problem, there are nonshred flosses.

Floss also varies in flavor. Some people find mint-flavored floss refreshing; others say that cinnamon is invigorating. Furthermore, floss widths vary. People with plaque problems may be advised to use the wider "tape" type of dental floss.

Wide spaces between teeth can also be cleaned with dental toothpicks, small pieces of material like soft orangewood, or interdental brushes. In fact, the American Academy of Periodontology recommends the interdental brush when space between the teeth exists.

Mouthwash

A fluoride mouthwash can be used in conjunction with brushing and flossing to help fight tooth decay. A patient may be advised by the dentist to use an antimicrobial mouthwash to control buildup and gingivitis.

Mouthwashes that promise fresher breath provide temporary relief of a condition that may be socially uncomfortable. However, unless these products contain fluoride, these rinses are not effective oral hygiene aids.

Furthermore, the dentist and dental hygienist know that bad breath can be a symptom of gum (periodontal) disease. The odor can be caused by the bacteria created when food particles are not removed from teeth.

Operation

The habit of brushing and flossing is more important than whether a manual or an electric toothbrush, or waxed or unwaxed floss, is used. In addition, many people do not know how to brush or floss correctly, so the dentist and dental hygienist play important roles in preventive patient care. The proper use of oral hygiene aids can be demonstrated and effective products can be recommended by either of these professionals.

Brushing the teeth

Teeth should be brushed at least twice daily, ideally after eating. The dentist and dental hygienist should advise patients to use toothpaste containing fluoride and to spend two minutes brushing their teeth.

BRUSHING THE TEETH MANUALLY. When brushing the teeth, people should use gentle circular motions to massage and scrub the tooth and gums. It is best to have a systematic approach to ensure all teeth are brushed.

The toothbrush is angled 45 degrees so that the bristles touch the teeth and gums. The person moves the brush back and forth with small strokes. Only a few teeth are brushed in this way, and the person brushes several times in one spot until moving on to the next set of teeth. This is done until all teeth are brushed. Then the tongue should be brushed to remove plaque and dead epithelial cells. The next step is to floss the teeth or use the interdental cleaner apropriate for the client.

BRUSHING WITH A POWER TOOTHBRUSH. The power toothbrush, also known as the electric tooth-brush, moves the brush with faster strokes than a person can when brushing by hand. However, that speed doesn't contribute to mouth health. The person must brush for two minutes. That is the same amount of time required when brushing manually. However, some power toothbrushes come with two-minute timers, so that people can be aware of how long brushing is needed.

Flossing

Flossing may be done prior to or after brushing. In the dental office, a teeth cleaning appointment may end with the dental hygienist flossing the patient's teeth to remove particles of tartar and abrasive agents that might be left behind by the hygienist. Since flossing is a crucial part of dental health, the hygienist will generally describe this process so that the patient knows how to floss correctly.

DENTAL FLOSS. To clean between teeth with dental floss, the person takes an 18-in (46-cm) length of dental floss and wraps an end around the index or middle finger of each hand. The person inserts the floss in the gap between two teeth and gently moves it back and forth. The floss should rub against the front and back surfaces of each tooth. In addition, the floss up should be worked up and under the gum line to remove food and plaque. When the floss is moved to another area of the tooth, it should be adjusted, so that a clean area of the floss is used. When flossing for the first time, there may be slight gum bleeding. If bleeding persists, the patient should consult a dentist.

TOOTHPICKS. Toothpicks should be regarded as temporary oral hygiene aids. Household toothpicks can be used to remove food from teeth. Dental toothpicks made of material, such as soft orange wood, can be used to stimulate gums or to reach plaque in the wide spaces between teeth. They can be an effective cleaning device in people with wide spaces between their teeth. However, toothpicks should not be used in place of flossing with dental floss in people with a normal interdental anatomy. Furthermore, patients should be cautioned by dentists and dental hygienists not to chew on toothpicks, as they can damage teeth.

Mouthwash

A fluoride mouthwash used in the morning and evening can help to fight plaque. Patients should be advised to look for products bearing the ADA Seal of Acceptance.

Mouthwash is taken full strength and used as a rinse. The person follows directions on the product. For one ADA-approved rinse, the person measures out 4 tsp (20 ml) of mouthwash and places it in the mouth. The rinse is swirled around for 30 seconds in the mouth and then expelled.

Oral hygiene aids for children

An oral hygiene program should begin when a baby gets his or her first tooth, according to the ADA. At this time, the infant's baby or primary teeth start to surface. Newly erupting teeth can be cared for by the parents, using an infant toothbrush or a clean washcloth to scrub away any plaque. The ADA recommends that the child's first appointment with the dentist be scheduled by the time the baby is one year old. At this time, the dentist or dental hygienist can provide guidance about proper brushing and flossing.

At age three, most children have 20 primary teeth. By the time children are six years old, their jaws are growing to accommodate permanent or "adult" teeth. Those teeth will grow within the next six years and replace the primary or baby teeth.

TOOTHBRUSHING. For an infant, a parent can use a baby toothbrush or a soft cloth.

Children age six and younger should be supervised brushing their teeth. The parent should place a pea-sized amount of toothpaste on the toothbrush. This small amount helps to minimize the risk of swallowing toothpaste. The parent should still clean the child's mouth once a day to ensure proper cleaning.

When a child is seven and permanent teeth are growing, the ADA advises that children can brush their own teeth. However, an adult should supervise this process. And the dentist or hygienist may recommend that parents set the example by brushing along with the child

FLOSSING. The ADA recommends that children's teeth should be flossed when any two teeth are touching. By age eight, most children are old enough to floss on their own. Children with orthodontic appliances may not be able to floss in those areas.

MAKING ORAL HYGIENE EASIER. A disability, an injury, or illness can make it difficult for a person to brush or floss. Patients experiencing difficulty can get recommendations from their dentists or dental hygienists regarding commercial products and self-designed modifications that make the process easier.

When a patient has trouble brushing, the dentist or dental hygienist may advise the patient to purchase a powered toothbrush. If the patient's preference is to brush manually, the ADA recommends self-designed modifications and adaptations; for example, the patient can attach the toothbrush to the hand with an elastic band, using a sponge or rubber ball to widen the handle, and lengthening the handle by attaching a ruler or tongue depressor to it.

If the patient has difficulty flossing due to bridge-work, a commercial floss holder or threader can be used to pull floss between teeth. In addition, tiny interdental brushes can be used to clean the area between teeth.

Maintenance

Maintenance is relatively simple for the oral hygiene products used for mouth care.

Toothbrushes

After use, a toothbrush should be allowed to dry in the air. It should not touch other toothbrushes, and people should not share toothbrushes because diseases can be transmitted. For occasional cleaning, the tooth-brush can be soaked in a household bleach solution for about 10 minutes and rinsed thoroughly, or can be washed in dishwasher.

The toothbrush should be replaced after three or four months. Since many people do not remember when they bought a toothbrush, they can be told by dentists and dental hygienists to replace the tooth-brush when the bristles are worn, bent or at the first sign of wear.

Furthermore, patients should also be advised to dispose of the toothbrush after an illness to prevent the spread of germs. The same procedures should be followed for the brushes used in a powered toothbrush. The brush should replaced after three or four months. Other maintenance will be based on the manufacturer's specifications.

Other hygiene aids

Products such as floss and toothpicks should be disposed of after usage. Toothpaste and mouthwash can be expelled from the mouth after the person rinses or brushes.

Health care team roles

Although oral hygiene aids like the toothbrush, dental floss, mouthwash, and toothpicks are household items, they are not used to fight plaque effectively. As a result, patients may be given instruction about the correct use of these aids by members of the dental team, such as the dentist or dental hygienist. Most dental offices and clinics maintain an inventory of sample products that can be used for demonstration.

A new toothbrush may be used by the dentist to demonstrate effective brushing techniques, such as how to angle the brush. Upon conclusion of the cleaning appointment, the teeth are usually flossed by the dental hygienist to remove particles of tartar and abrasive agents that may be left behind. This process may be described by the hygienist during the flossing.

It is also helpful to give the patient a mirror so that the person can see areas which should be flossed. Another option is to stand in front of the patient and demonstrate the technique for proper flossing or brushing. It is always best to use the patient's own mouth as a model.

The dental professional may then have the patient angle the brush or floss several teeth. The dentist or hygienist then gives the toothbrush or a sample package of floss to the patient. The same process is effective with aids such as floss holders or toothpicks.

Most dental patients rinse their mouths during an appointment. However, the dentist or dental hygienist may need to explain about the types of mouthwash, as well as the amount of time needed for rinsing at home.

Training

Training is required to use oral hygiene aids such as the toothbrush, dental floss, mouthwash, or tooth-picks effectively. Since improper use of oral hygiene aid products can lead to tooth decay and gum disease, it is important for the dentist and dental hygienist to provide patients with instructions about the most effective use of these products, their purposes, and techniques for use.

Furthermore, continuing education courses allow dentists, dental hygienists, dental assistants, and others in the dental office to keep informed about advances in dental care, oral hygiene, and new products.

KEY TERMS

Calculus— Calcified bacterial plaque.

Caries, dental— The decalcification and destruction of the tooth by microorganisms. Also known as tooth decay.

Cavity— A hole in the tooth.

Fluoride— A mineral that helps fight tooth decay.

Gingivitis— The inflammation of the gingiva (gums).

Periodontitis— The inflammation of the area surrounding the teeth. These areas include the gingiva (gums), the periodontal ligaments that attach teeth to sockets and the alveolar bone, the part of the jaw bone that holds the roots of teeth.

Plaque— A transparent material in the mouth that contains bacteria and causes tooth decay.

Tartar— Plaque that has calcified and hardened on the teeth. Also known as calculus.

Resources

BOOKS

Alvarez, Kathleen H. William & Wilkins' Dental Hygiene Handbook. Philadelphia, PA: Lippincott, Williams & Wilkins, 1998.

Guerini, Vincezo. A History of Dentistry From the Most Ancient Times Until the End of the Eighteenth Century. Boston, MA: Longwood Press, 1977.

Leonardi Darby, Michele, ed. Mosby's Comprehensive Review of Dental Hygiene. St. Louis, MO: Mosby, Harcourt Health Sciences, 1998.

Nielsen Nathe, Christine. Contemporary Practice for the Dental Hygienist. Upper Saddle River, NJ: Prentice Hall, 2000.

Senzon, Sandra. Hygiene Professional. Tulsa, OK: PennWell Book, 1999.

Wilkins, Esther M. Clinical Practice of the Dental Hygienist. Philadelphia, PA: Lippincott, Williams & Wilkins, 1999.

PERIODICALS

Warren, Paul R.; Smith Ray, Tonya; Cugini, Maryann; Chater, Bernard. "A Practice-Based Study of a Power Toothbrush: Assessment of Effectiveness and Acceptance." Journal of the American Dental Association (March 2000), 〈http://www.ada.org/adapco/prof/pubs/jada/archives/0003/index.html〉.

ORGANIZATIONS

American Dental Association. 211 E. Chicago Ave., Chicago, IL 60611. (312) 440-2500. 〈http://www.ada.org〉.

American Dental Hygienists' Association. 444 N. Michigan Ave., Suite 3400, Chicago, IL 60622. (312) 440-8900. 〈http://www.adha.org〉.

Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Prevention. Division of Oral Health, MS F-10. 4770 Buford Highway, NE. Atlanta, GA 30341. 1-(888)-CDC-2306. 〈http://www.cdc.gov〉.

International Federation of Dental Hygienists. 55 Kemble Road, Forest Hill, London, SE23 2DH, UK. Tel.: +44 208-699-3531. 〈http://www.ifdh.org〉.

National Institute of Dental & Craniofacial Research. National Institutes of Health. Building 45, Room 4AS-18. 45 Center Drive MSC 6400, Bethesda, MD 2089-6400. 〈http://www.nidr.nih.gov/〉.