Fact sheet: Keeping teeth and gums healthy

Healthy teeth and healthy gums: they are essential for us to truly be able to enjoy all different types of food. Smiling without having to worry is also very important to most of us. When everything is alright as far as our teeth are concerned, we take it for granted. But if a tooth or our gums are giving us trouble, it can be painful – and expensive. There is a lot of advice about what we should do for our own dental health – and there are many different products available for purchase that are supposed to help. But which of them actually has a benefit, and what are the most important things we can do to keep our teeth and gums as healthy as possible?

How are dental plaque and inflamed gums able to cause so much damage?

In the worst case, having dental disease can mean losing the diseased teeth. In childhood, tooth decay (also referred to as caries or cavities) is the greatest threat to dental health. If tooth decay eats holes in the teeth it can hurt. The tooth has to be drilled open and filled to stop the decay. We can also get tooth decay later in life as well. Yet both children and adults can lower their risk of developing tooth decay by regularly cleaning their teeth with fluoride toothpaste or by using other products containing fluoride. Fluoride is a substance that strengthens the enamel, which protects it from decay. Having cavities filled, as long as they are still small, can save the teeth.

Tooth decay is caused by the interplay of bacteria in the plaque and frequent consumption of sugar. Plaque consists of layers of sticky film on the teeth that make the teeth feel “furry”. Plaque and food stuck between the teeth can also be a cause of bad breath (halitosis) – even though a layer of bacteria on the tongue is probably more likely to result in bad breath than plaque. Built-up plaque can harden to form tartar (calculus), creating favorable conditions for more bacteria to grow.

As we get older, gum disease becomes more common. The most frequent types of gum disease are inflammation of the gums (gingivitis) and the periodontium (periodontitis). The periodontium is made up of the necks and roots of the teeth and the jawbone, as well as the gums. If your gums bleed easily when you brush your teeth, they are probably inflamed in some places. Dentists can check whether you have gingivitis by examining the gums with a special instrument and checking their color. Whether a toothbrush with hard bristles damages the gums is not clear – but it cannot be ruled out that using toothbrushes that are too hard could cause gum injury.

Permanent (chronic) gingivitis can sometimes lead to periodontitis. This is an inflammation of the structures that anchor the teeth in the jawbone, and treatment can stop it from getting worse. If the condition does worsen, the tooth may lose its hold and fall out. Periodontitis may also lead to a receding gum line that exposes the necks of the teeth. It is easier for tooth decay to start there, and the teeth also become more sensitive to pain.

The main cause of gingivitis and periodontitis is bacteria. People who smoke also have an extra risk of developing periodontitis.

Does brushing your teeth every day help?

Brushing reduces plaque and keeps the teeth looking clean and feeling that way. Nevertheless, it is probably not just the brushing that prevents tooth decay, but the fluoride in the toothpaste. The teeth absorb the fluoride from the toothpaste, making them more robust.

It has been shown that daily tooth brushing with fluoride toothpaste can protect children and teenagers from tooth decay – just at the ages when the risk of tooth decay is greatest. Children need their parents to help teach them how to brush their teeth. You can read more about the safe use of fluoride with children here.

A good brushing technique will not only remove plaque better, it will probably also go easier on your gums. How to brush your teeth should match the person’s age and general dental health, among other things. You can talk with your dentist about what technique is best for you personally.

What kinds of toothbrushes and toothpastes are the best?

It is not clear what type of toothbrush is best. It is assumed that toothbrushes with hard bristles tend to harm the gums more than brushes of soft or medium hardness. When considering electric toothbrushes, how the electric cleaning head moves could play a role. Some have a head that moves back and forth quickly, while others have a head that rotates.

Fluoride toothpaste has been proven to be the most effective toothpaste for strengthening the teeth, and therefore also the best at protecting them from tooth decay.

If your teeth react sensitively to something either very hot or very cold, you may have hypersensitive (overly sensitive) teeth. There are toothpastes containing fluoride, potassium or calcium, which are intended to relieve hypersensitive teeth. But not enough research has been done to be able to say for sure whether these products can help people with hypersensitive teeth. Agents for bleaching your teeth (tooth whiteners) may make the teeth temporarily sensitive, so it might be a good idea to stay away from these products should you already have hypersensitivity.

Can dental floss, interdental brushes and mouthwash help?

Even though it is in general strongly recommended to also clean your teeth daily using dental floss or an interdental brush, it has not been proven that this type of dental hygiene makes a great difference for people who have good dental health. But this does not mean that this additional cleaning does not help in case of gum disease. It may be necessary to remove foreign material between the teeth with dental floss or an interdental brush. Using toothpicks has the risk of injuring the gums.

You need a lot of time and have to be highly motivated to treat all of your teeth thoroughly with dental floss every day. This might be one of the reasons, why it has not yet been possible to show that dental floss has any particular advantage: it is not used properly or carefully enough.

Using an interdental brush may be a good idea if you have larger gaps between your teeth or dentures like a bridge, for example. Your dentist can show you how to use it correctly so that you do not damage your gums.

Another common dental hygiene product is mouthwash. Some products contain fluoride, while others are manufactured using chlorhexidine (a disinfectant) or essential oils. Essential oils are the more common basis of the best-selling mouthwashes.

Fluoride mouthwash can prevent tooth decay in children and teenagers, just as fluoride gels do. Yet it has not been proven that it can provide better protection than daily brushing with fluoride toothpaste. You can read more about research on fluoride mouthwash, gels and other products here.

Many people use antiseptic mouthwash (this means that it is effective against bacteria, viruses and fungi) that also refreshes their breath at the same time. The strongest antiseptic active ingredient is chlorhexidine. It can reduce the amount of plaque and relieve gingivitis, but when used for a longer period of time it causes teeth stains. One mouthwash produced on the basis of an essential oil (trade name “Listerine”) has proven effective against gingivitis in trials.

What good are dental check-ups?

Twice a year, once, or less often? Experts from around the world have been debating the issue of how often you have to go to the dentist for a check-up for more than 30 years. Perhaps the most common recommendation is to go to the dentist every six months. In some countries it is recommended that people with healthy teeth and intact gums only go in once a year or every two years for preventative care – while people who have dental problems are urged to have check-ups more frequently. Some experts recommend deciding on the appropriate length of time between examinations on an individual basis with your dentist.

In general, a routine dental examination can mean getting dental problems treated earlier. This could be an advantage. Another advantage might be the check-up helping to get some people to pay more attention to their teeth and gums. No trial has proven yet that it would be generally better for people’s dental health to go for an examination every six months. People who take very good care of their teeth and gums might profit less from going to the dentist more often than people who tend to be more negligent when it comes to dental hygiene. So it is probably best to discuss your individual check-up needs with your dentist.

What does a check-up at the dentist’s involve?

A routine dental check-up for adults often includes the removal of dental plaque and tartar (also called “scaling”), as well as polishing the teeth. It is assumed that doing this prevents gum disease – yet this has not been proven. The bacteria in plaque and tartar could indeed contribute to gum disease, but it is not certain whether professional removal of plaque once or twice a year does prevent disease.

Tartar may contain bacteria, making daily dental hygiene less effective. When scaling, dentists or dental hygienists scrape the teeth clean by using a special instrument manually and/or by using ultrasound. This makes it possible to remove plaque, tartar and stains on the teeth. Polishing the teeth with the help of an electrical instrument clears up remaining deposits and stains. There is a small rubber piece or brush at the instrument’s tip where an antibacterial paste is applied.

Although some researchers have tried to answer the question of whether scaling or polishing once or twice a year can improve dental health, there is not enough good-quality research on this topic. So it is still not known whether this type of check-up is really worth the trouble. One adverse effect of this procedure could be damage to the gums. As soon as more reliable research results become available, we will keep you informed.

One of the positive effects of professional tooth cleaning is the removal of stains on the teeth. To make the teeth whiter or brighter, your dentist can also use other methods, like permanent cosmetic teeth treatment.

Do bleaching kits for home use work, and are they safe?

Many different types of cosmetic tooth whitening products are available, such as gels, toothpastes, paint-on films or whitening strips. Some products also involve the use of a special lamp to speed up their effect. The two most important bleaching agents that they contain are hydrogen and carbamide peroxide.

Researchers analyzed trials on these products and found out that they can very often cause temporary adverse effects, for example increased teeth sensitivity or irritated gums. The higher the dose of bleach is, the more frequent the adverse effects are (in probably up to 60% of users; that is, in up to 6 out of 10). At least for some types of tooth discoloration they seem to help, but the trials do not offer any information about users’ long-term satisfaction with the results they produce. How well these whiteners work over a longer period of time, including possible damage to the teeth, is not yet clear.

As soon as more research is available on bleaching agents or toothpastes that aim to whiten the teeth by using abrasive agents, we will inform you. You can read more about the latest evidence on this topic and about other options for tooth whitening here.

One of the best ways to keep your teeth bright is to avoid things that can discolor your teeth. These include above all smoking, but also excessive consumption of black tea, coffee and red wine.

So what are the best options for protecting my teeth and gums?

Bacteria in plaque and frequent consumption of sugar are the main causes of damage to the teeth and gums. This means that one important precaution is limiting your consumption of foods, drinks, candy or chewing gum that have been sweetened with sugar. Chewing gum that instead of sugar contains ingredients that could be effective against bacteria (like xylitol) is another option that may have a benefit. As soon as research results on this topic become available, we will inform you about them – as well as other dietary options for protecting your teeth.

There are also tooth sealants (also called “fissure sealants”) for children and teenagers. Tooth decay is mostly a problem for the molars (back teeth). Bacteria can get stuck in the dents and grooves of the teeth (called fissures). Dentists apply a sealing agent so that bacteria are unable to settle there, which could lower the risk of tooth decay. You can read more about sealants here.

Fluoride still remains the most effective known way of preventing tooth decay. Regularly brushing your teeth with fluoride toothpaste, along with visits to the dentist in order to detect any dental problems early on and then to have them treated, is the basis of good dental hygiene. If you keep a careful eye on your dental health, you have a good chance of keeping your teeth and gums as healthy as possible.

More about dental health: here

Author: Institute for Quality and Efficiency in Health Care (IQWiG)

© IQWiG (Institute for Quality and Efficiency in Health Care)