Month: May 2020

Are Mouthwashes healthy?

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Are Mouthwashes healthy? What does a dentist say?

The biggest enemy of a healthy mouth is dental plaque. Dental plaque builds up on the teeth very quickly. Plaque is made of bacterial colonies on your teeth mixed with food debris.Mouthrinse

The dental plaque is part of a bigger problem that faces your mouth and teeth: tooth decay, gum disease, bad breath and other issues.

The unfortunate reality is that plaque build-up is happening continuously. We can never have an antiseptic mouth, free of bacteria, because bacteria is present in large amounts in the mouth; and is waiting for reasons to flourish and grow.

[That’s why, when you have surgery inside your mouth, the surgeon doesn’t even attempt to sterilise the operation site, because that is almost impossible. Believe me, I have worked in operating theatres and I have observed this first hand.]

The most important method for removing dental plaque will continue to be the mechanical removal of the dental plaque carried out by the toothbrush. This is further supported with interdental flossing in the form of flossing or interdental brushes.

Maintaining healthy dental habits can help keep symptoms at bay and prevent dental conditions from starting or worsening.

In addition to the oral hygiene steps mentioned above, one can add a mouthwash to the process.

Functions of Mouthwash

Amongst others, mouthwashes have a number of functions:

a) freshen the mouth

b) deliver chemicals to help strengthen teeth

c) help with large scale removal of plaque deposits (for those who are really lacking in Oral Hygiene)

d) neutralise the acid environment

e) deliver chemicals which kill bacteria

f) deliver chemicals that help to inhibit or delay plaque formation

So, as you can see mouthwashes can do a lot. It might be difficult to find a single mouthwash that does all the above. However, one may also be alarmed to see that there is a big role for chemicals to play in mouthwashes. These mouthwashes can be an important part of a health mouth.

For plaque to do damage, bacteria have to be well colonised to cause gingivitis, tooth decay and bad breath. Mouthwashes work in many ways to fight bacteria that does this, by either strengthening your natural defences or by disrupting the bacteria – chemically and – to a lesser degree – mechanically.

 

Mouthwash as a second line of defence

As I stated above, the most important part of dental hygiene is the mechanical removal: this is the first line of defence against dental plaque. Mouthwashes – however – can act as a second line of defence in oral hygiene.

Used correctly, they can be a helpful adjunct to the hygiene of our oral tissues.

Mouthwash should be considered as one of the weapons that you have in your artillery in your battle against dental plaque.

 

The concept of Chemicals

Many people will hear the word “chemicals” and be alarmed. There has been a negative association between the word “chemical” and health. Generally, we have been programmed to think that all “chemicals” are bad and that life would be better without them.

I want to spend a moment or two, to remove the myth around chemicals.

Chemicals are a part and parcel of our existence. Our bodies are made of billions of chemicals. Our food is a complex makeup of chemicals. Simple ingredients are chemicals. Take your ordinary average table salt: that is a chemical named Sodium Chloride (NaCl). Water is a chemical (H20); and so on.

We have to therefore understand that the building blocks of life are all chemicals.

There are good chemicals as well as “bad” chemicals. There are useful chemicals and there are dangerous ones.

It is true that chemicals come in all forms, shapes and sizes. Some are dangerous and even lethal. Whilst others are healthy and vital. We have to learn how to differentiate between the two.

Which chemicals should I avoid?

It is difficult to discuss all the different aspects of a mouthwash, and we will come back to this in a future article.

One chemical that is good to avoid in mouthwashes is alcohol. For many decades, manufacturers have been adding alcohol to mouthwashes for some benefits that are thought to be produced by the alcohol, namely the bactericidal effect it has, and because alcohol is a good solvent for other chemicals.

With an increase in the awareness of how this chemical may be detrimental to oral health, there has been a substantial move to produce alcohol free mouthwashes.

A recent review[1] into the effect of alcohol mouthwashes concluded that alcohol-based mouthwash consumption significantly increases acetaldehyde levels in the first few minutes, but no evidence exists if long-term salivary acetaldehyde levels may increase with a high frequency of mouthwash use. The review went to state “There is still insufficient evidence of whether the use of alcohol-based mouthwash is an independent risk factor for oral or oropharynx cancer. Nonetheless, it does increase the risk when it occurs concomitantly with other risk factors such as smoking or alcohol.”

This review may not clearly state that alcohol based mouthwashes are detrimental to oral health, but as is the nature of scientific reviews they look at what can be termed “evidence”; and that doesn’t mean that the lack of evidence means there is no evidence.

As we now, have more and more options with alcohol free mouthwashes: then the wise choice would be to opt for these.

[1] Ustrell-Borràs M, Traboulsi-Garet B, Gay-Escoda C. Alcohol-based mouthwash as a risk factor of oral cancer: A systematic review. Med Oral Patol Oral Cir Bucal. 2020;25(1):e1‐e12. Published 2020 Jan 1. doi:10.4317/medoral.23085

Dental Floss vs Dental Tape? What works best?

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Interdental Cleaning

Cleaning in between your teeth is an important factor in the overall dental hygiene and it is part of the bare essentials of oral hygiene. It is critical that interdental cleaning is part of your daily dental health habits. When I ask my patients about their interdental cleaning habits, most of the time they tell me that this part of their routine has fallen by the wayside.

It is fortunate that there are many interdental products available on the market. There are a few options when it comes to cleaning in between the teeth.

In this article, I discuss the main question of dental floss vs dental tape. Other related topics, like flossing for bridges or use of water picks is discussed in another article.

Why Floss?

Dental Floss
Dental Floss

Flossing or using tape is essential to clean the area in between the teeth which is very tight. The space may be too tight to use any other appliance especially a toothbrush.

However, the space is large enough for bacterial plaque to form, giving rise to many issues including potential decay, tartar build up and mouth odour. Good oral hygiene demands that flossing is part of one’s daily routine.

Cavities and tartar build up will require dental intervention, which could cost you money and is not always a comfortable experience, especially as in most cases in can be avoidable.

Dental Floss vs. Dental Tape

Both dental tape and dental floss serve the same purpose of cleaning a person’s teeth, but they are different in their form and how they execute the job of cleaning teeth.

Dental floss is a thin strand or cord of twisted plastic monofilaments or nylon filaments. Dental tape is very similar to floss, but it is broader and flatter than dental floss. It’s also sometimes referred to as ribbon tape. It has a flat surface that allows it to pass in between teeth more easily and hence cleans this part thoroughly.

Dental floss has been in existence for over a long period ever since strings were made. The dental floss has over the years changed a bit as manufacturers added flavours like cinnamon and mint to it.

On the other hand, tape is a more recent invention compared to floss. Some people prefer dental tape to dental floss since it slides easily in and out between the gaps of the teeth. The dental tape does not also snap or harshly strike the gums the way dental floss at times does.

The decision on whether to use dental tape or floss depends on which is the most effective at cleaning between your teeth and which you find easiest to use.

Types of Dental Floss

Like many things in life, there is no one “right” floss for everyone. And in many cases, in the ONE mouth, there will be a need to have few types of flossing and interdental products. As each person has different arrangement of teeth, with varying spaces and access restrictions.

Finding the right dental floss for your oral hygiene needs might take some trial and error, as there are many varieties. However, it is important to try the different variations, and to consult your dentist or hygienist to see what is working for you to get good oral hygiene.

As stated before; no matter what type or variety you use, the vital thing is to clean in between your teeth daily.

Using Floss is key

There have been several studies to investigate what is the best product for flossing. Studies have been performed to assess the plaque-removing ability of different types of flossing products.

Whilst the results will vary, the main conclusion is that flossing products significantly improve plaque removal compared with tooth brushing alone.

Finding the Right Dental Floss

As stated before, you need not choose only one type of flossing product, as you many need a variety. Indeed, different members of your family may need or prefer certain types, which may or may not change over time.

If you’re not sure, ask your dentist or hygienist for some guidance; although ultimately, there will be a need for trial and error until you settle on a type that suits you.

Symptoms When Flossing

As a general rule, healthy gums do NOT bleed. And flossing – when done correctly – should not result in bleeding or pain.

If there is bleeding or redness occurring, then it may be a sign that something is going on, which may need investigated.

When you return to flossing, after you haven’t done so for a while, you will find that your gums will swell slightly and may even throb. This is because the accumulating dental plaque is being pushed into the gums, causing an irritation. Daily flossing will remove this symptom. If not, please consult your dentist.

Conclusion

Generally, I tend to recommend dental tape as in my experience it is easier to handle and less traumatic for the inexperienced user. Dental tape is also easier to handle for those who have large fingers. I personally like Glide Pro-Health floss. Although it is called “floss” it is more like a tape; and this is one that I use in my dental practice.

 

For those whose teeth are tightly pressed together, floss might be a better option, and more so the waxed version, as that is easier to glide in between the teeth.

Whilst there is no added benefits for have the floss enriched with fluoride or flavours; some people find that flavours freshen their mouth more.

Oral Hygiene Aids – The Bare Necessities

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This article discusses the necessities to consider when looking after your teeth and maintaining good Oral Hygiene. What are the necessary aids that you need to get good results.

Toothbrush

The most essential aid in your oral hygiene aids is the toothbrush. A good toothbrush is key. Here some people will naturally ask “Should I get a manual or electric?”. Read more about electric toothbrushes in my post, by clicking here.

However, the important points to note is that the toothbrush needs to be of a small enough size to

give “personalised” brushing for each tooth; and large enough, so that it is effective and efficient in your daily routine. You don’t want to be using a tiny one-tufted toothbrush to clean ALL your teeth, as that would take ages.

For most people, the toothbrush needs to be medium in texture and in size. A simple shaped toothbrush is more than adequate; although a fancy tufted and pronged toothbrush may help in some instances.

Your basic toothbrush is your oral hygiene aid that will do most of the cleaning for you. It is much more important than the type of toothpaste that you will use.

Here’s one that does the job, and I recommend.

Toothpaste

Toothpaste for good oral hygiene

There are tens – if not hundreds – of toothpastes on the market. Toothpastes are there to deliver three essential functions

1) Act as a detergent; to give you that foam which makes it easier to use the toothbrush

2) Deliver certain chemicals to the teeth; this may include Fluoride, antibacterial agents, or other chemicals

3) Work on other functions like whitening or anti plaque surfacing.

When choosing the right toothpaste, there are a few factors to look for. That is discussed in another article.

A 2016 poll conducted by the Oral Health Foundation, found that more than 62% of respondents rinse after brushing. Nigel Carter, the organisations CEO called rinsing our mouth after brushing “very bad” as it “washes away the protective fluoride left behind by brushing.” The benefits of the toothpaste need to remain in contact with the teeth as much as possible. So, don’t rinse with water; and also avoid rinsing with mouthwash after toothbrushing.

Interdental Aids

The toothbrush will allow you to get rid of up to 90% of food residues and dental plaque. It will not reach the areas in between the teeth, which are termed interdental spaces. To access these spaces, you will another dental hygiene aid. This can be in the form of dental floss (tape being an alternative) or interdental brushes.

The main criterion on which to use is the space in between the teeth. If you have tight gaps, then floss is what you need. For larger gaps, then you will need to use interdental brushes. The interdental brushes come in a range of sizes and formats.

The two main formats are small handles or the larger handle. As for the sizes, then these are around 10 in number.

More on these in another article.

Mouthwash

There is much debate about what dental mouthwash add to one’s oral hygiene. If proper care is taken, then a toothbrush and interdental aids can get rid of all dental plaque.

However, mouthwashes add an extra level of protection.

Firstly, most people may not remove all the dental plaque stuck on the teeth, and the mouthwash helps with providing some help in reducing the harm of dental plaque, but not eliminating it, as this can only be done with mechanical removal.

Secondly, mouthwashes – like toothpastes – deliver certain chemicals to the oral cavity to aid oral hygiene.

Thirdly, for those who have mouth odour: mouthwashes act like a perfume for the mouth. But, similarly as perfumes are not an alternative to having a shower, mouthwashes are not an alternative to brushing.

These are the bare essential for maintaining good oral hygiene.

NOTE: it is best not to rinse with a mouthrinse straight after brushing your teeth. As we mentioned before, it is best to spit the toothpaste out and not rinse it away; and so rinsing with a mouthwash will also rinse the contents of toothpaste away.

So, you are best using mouthrinse as a separate adjunct at different times.

Conclusion

In this article, I mention the essential aids in maintaining good oral and dental hygiene. These are essentially toothbrush and toothpaste, interdental aids and mouthwash.

The article gives simple guidance, and there is more information to be sought in relation to other aspects of good oral hygiene.