How to brush and floss your teeth: a daily oral care guide

Brushing and cleaning between your teeth are the most useful things you can do at home to protect your mouth. This article explains how to do them well, what to look for in toothpaste, and how everyday choices such as diet and tobacco affect your teeth. It draws on advice from the NHS, the US National Institute of Dental and Craniofacial Research (NIDCR), MedlinePlus and the World Health Organization.

1. Introduction

Plaque is a sticky film of bacteria that builds up on the teeth. If it is not removed, it can lead to tooth decay and gum disease ^{[2, 4]}. The World Health Organization reports that oral diseases affect an estimated 3.7 billion people, that most are largely preventable, and that brushing twice a day with fluoride toothpaste is recommended ^[3]. Fluoride helps enamel, the hard outer layer of the tooth, repair itself and helps prevent decay ^{[2, 3]}.

2. Brushing

The NHS gives this advice ^[1]:

• Brush twice a day for about 2 minutes, including last thing at night.
• Clean the outside, inside and chewing surface of every tooth.
• Electric and manual brushes both work well if you clean all surfaces thoroughly. An electric brush may be easier for some people.
• For most adults, a small brush head with medium or soft bristles is suitable.

After brushing, spit out the extra toothpaste but do not rinse with water. The NHS explains that rinsing washes away the fluoride that is still working on your teeth ^[1]. The NHS also advises replacing your toothbrush every 2 to 3 months ^[6].

3. Choosing toothpaste

Choose a toothpaste that contains fluoride, because it lowers the risk of decay ^{[1, 2, 3]}. The NHS notes that a dentist may suggest a stronger fluoride toothpaste if you need extra protection ^[1]. Check the pack or ask your dentist or pharmacist if you are unsure which one suits you or your child.

4. Cleaning between your teeth

NIDCR advises cleaning between the teeth daily with floss or another interdental cleaner ^[2]. The NHS says regular flossing can reduce gum disease, tooth decay and bad breath by removing plaque along the gum line ^[1].

The NHS describes how to floss ^[1]:

• Use about 30 to 45 cm of floss or dental tape.
• Curve it into a C-shape around each tooth and slide it gently up and down.
• Floss before brushing.

Interdental brushes, which are small brushes that fit between the teeth, can replace floss, especially where there are gaps between teeth, and they should fit snugly. The NHS advises against wooden toothpicks, because they can damage the gums and lead to infection ^[1]. The NHS advises seeing a dentist if your gums bleed when you brush or eat hard food ^[4].

5. Mouthwash

Fluoride mouthwash can help prevent decay, but the NHS says not to use it straight after brushing, because it can wash away the toothpaste fluoride. Use it at a different time of day, for example after lunch, and avoid eating or drinking for 30 minutes afterwards ^[1].

6. Food, drink and tobacco

NIDCR and the WHO both advise limiting sugary food and drink ^{[2, 3]}, and NIDCR also advises limiting snacking ^[2]. The WHO recommends water as the main drink and a diet low in free sugars ^[3]. Free sugars are sugars added to food and drink, plus those in honey, syrups and juices.

The WHO lists tobacco use as a risk factor for oral diseases, including gum disease and oral cancer ^[3]. NIDCR and the NHS advise avoiding tobacco and smoking ^{[2, 4]}. The WHO includes areca nut (betel quid) among the leading causes of oral cancer and advises stopping all forms of tobacco use, including areca nut chewing ^[3].

7. Special groups

Children

The NHS says children need help or supervision when brushing until at least age 7. A smear of toothpaste is advised for children under 3 and a pea-sized amount for ages 3 to 6, and children should not swallow or lick toothpaste from the tube ^[1]. The NHS says children do not need a special toothpaste, and that a dentist may recommend a higher-fluoride one if needed ^[1].

People who are pregnant or have diabetes

The NHS highlights regular dental check-ups during pregnancy and for people with type 2 diabetes, because gum disease is linked with pregnancy and type 2 diabetes ^[4].

People with dry mouth

NIDCR explains that saliva helps protect teeth, so a persistently dry mouth raises the risk of cavities. Talk to a dentist or doctor if your mouth is often dry ^[5].

8. When to see a doctor

See a dentist regularly, as often as they advise. The NHS says to book a check-up if you have not had one in two years, or one year if you are under 18, even if nothing hurts ^[4]. See a dentist sooner if you have tooth pain, bleeding or swollen gums, or bad breath that does not go away ^[4], and seek urgent dental care for very sore or swollen gums, loose teeth, mouth ulcers or red patches, or a lump in the mouth or on the lip ^[4]. If you think you have a dental abscess, ask for an urgent dentist appointment. Go to a hospital emergency department or call for emergency help if you have trouble breathing, speaking or swallowing, or cannot open your mouth ^[6].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Good oral care is simple: brush for about two minutes twice a day with fluoride toothpaste, spit but do not rinse, clean between the teeth daily and limit sugary food and drink. Avoid tobacco and attend regular dental check-ups. A dentist or hygienist can show you the technique that suits your mouth.