REVEALED: The truth about your toothbrush

You don’t need toothpaste to keep your teeth clean. Put your brush in the dishwasher. And yes, electric IS best. Brace yourself for...

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 charity the Oral Health Foundation. Unsurprisingly, nearly 70% 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?

Recently Swiss researchers who analysed the effectiveness of certain toothpastes found some

were no more effective than saliva when it comes to preventing dental erosion (where the tooth’s hard outer coating of enamel is lost, exposing the dentine, which contains nerves, leading to tooth sensitivity and pain).

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 do spend the recommended two minutes, twice daily, scrubbing your teeth, if you are not also cleaning your gums, experts say you could be entirely wasting your time. That’s because of the risk of gum disease.

‘Much of the plaque-forming bacteria lurk on the gum line between gum and tooth, and the gums need regular brushing in the same way as our teeth,’ explains Dr Reena Wadia, a periodontist (gum specialist). ‘If they’re not brushed away, bacteria react with sugars from food to create plaque, the sticky film which causes gum inflammation.’

SHE continues: ‘If it is 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 dental expert Dr Uchenna Okoye. ‘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.’

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.

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 — gums . . . and

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.

‘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.’

BUT 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.

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 dentist Dr Richard Marques. ‘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 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, with some dentists charging between €500 and €1,500.

CHOOSE THE RIGHT SORT OF 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 ARE GOOD FOR YOU

GOOD and bad bacteria live sideby-side in your mouth, just like in your gut, with more than 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 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 study by University Hospital Jena in Germany 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?

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, with the resulting, widely accepted conclusion that flossing is no better for oral hygiene than 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 oral health expert Dr Nigel Carter, ‘so the bristles on the interdental brush are more effective than floss — as floss cannot penetrate small pits and concave 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 that the results could influence future toothpaste formulations.

General dental advice suggests 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 concluded that the gums of people who have periodontitis have lower 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 of it as we get older.

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 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, ten minutes after meals and swill it all around your mouth a few times for around 20 seconds’. Salt acts as a natural antibacterial and anti-inflammatory, which can help to improve and maintain gum health. A 2016 study in the Public Library of Science One Journal found salt water gargles could speed up gum healing.

TREAT BLEEDING AS A WARNING

MOST of us know that blood on the toothbrush is a sign our gums are damaged. Yet a study by Corsodyl last year found that despite 84% of people being aware that bleeding gums were a sign of gum disease, nearly half would ignore blood if there was no pain.

This could be a mistake, as gum disease is painless until it reaches the later stages. Bleeding gums are one of the first signs of gingivitis, which leads to gum disease.