Oulun ammattikorkeakoulu
ePooki 49/2019

Importance of Oral Self-Care

Metatiedot

Nimeke: Importance of Oral Self-Care. In A-L. Jussila & M. Oinonen (eds.) Oral Health Promotion

Tekijä: Elgbacka Suvi; Erola Ella-Liisa; Haikala Iida; Keskitalo Rosa; Manninen Hanne; Penttilä Jenna; Jussila Aino-Liisa

Aihe, asiasanat: suuhygienia, itsehoito, oral hygiene, self-care

Tiivistelmä: Tooth brushing is relevant for promoting good dental health. Teeth should be washed twice a day and it should last at least two minutes. Fluoride toothpaste prevents dental caries and it should be also used twice a day. Powered toothbrush is better at removing plaque than a manual brush. In addition to the right tools required for the cleaning of teeth, the right brushing technique must be in order. The brushing technique varies according to the brush, but the main thing is that all the places in the mouth cleaned.

Even if you brush your teeth properly you also need to floss or use another method to clean between your teeth. That is because toothbrush cannot reach interproximal areas and without flossing or interdental brushing these areas are left unclean. There are many different ways to clean between your teeth, for example flossing and interdental brushing. For everybody it will be found just right tools and ways to do that and in the article is told more about this.

Gingivitis is a common gum disease causing by poor oral hygiene that encourages plaque to form on teeth. Common symptoms are irritation, redness and swelling of gingiva. Gums can also bleed during brushing and flossing. Gingivitis can develop into periodontitis, which effects the supporting structures of the teeth, which can lead to loss of tooth and contribute to systemic inflammation. One of the most common and widespread diseases today is dental caries. It can prevent easily also with a great oral hygiene.

Julkaisija: Oulun ammattikorkeakoulu, Oamk

Aikamääre: Julkaistu 2019-06-28

Pysyvä osoite: http://urn.fi/urn:nbn:fi-fe2019061019770

Kieli: englanti

Suhde: http://urn.fi/URN:ISSN:1798-2022, ePooki - Oulun ammattikorkeakoulun tutkimus- ja kehitystyön julkaisut

Oikeudet: CC BY-NC-ND 4.0

Näin viittaat tähän julkaisuun

Elgbacka, S., Erola, E-L., Haikala, I., Keskitalo, R., Manninen, H., Penttilä, J. & Jussila, A-L. 2019. Importance of Oral Self-Care. In A-L. Jussila & M. Oinonen (eds.) Oral Health Promotion. ePooki. Oulun ammattikorkeakoulun tutkimus- ja kehitystyön julkaisut 49. Hakupäivä 9.12.2019. http://urn.fi/urn:nbn:fi-fe2019061019770.

Tooth brushing is relevant for promoting good dental and oral health. Periodontal diseases are quite common among young adults and they also have bigger need for periodontal treatment than for caries treatments. Gingivitis is a sign of poor oral hygiene and it can progress to periodontitis. Caries and periodontal diseases can be avoided by brushing teeth twice a day and cleaning tooth caps once a day.

We went to the Oulu International School on the 22nd of February 2019 to organize a teaching event there for ninth grade pupils. Our dental hygiene student group had four different stands there about the importance of oral self-care. We also made a quiz to the pupils. The pupils had quite good knowledge about oral self-care and most of them got right answers to most of the questions. If not, we told them the right answers. In the end of the event the pupils also filled a questionnaire about the event. (Photos 1–3.)

PHOTOS 1–3. Students of Oulu International School had very good knowledge about oral self-care (Photos: Haikala Iida)

Introduction

In this article we describe different issues about the importance of oral self-care. The purpose of this article is to provide general information about maintaining a good oral hygiene and teach how to clean your mouth. 

The content of this article is based on scientific articles and textbooks. We discuss about several topics that have influence on oral self-care. We introduce for example the importance of regular teeth brushing and how to keep your interdentals clean. We also introduce how to avoid different mouth diseases and describe the two biggest gum diseases – gingivitis and periodontitis. In the end we also discuss about dental caries. 

Importance of regular teeth brushing

Brush your teeth every morning and evening 

Tooth brushing is important for promoting good dental and periodontal health. The effectiveness of plaque removal is affected by brushing technique, duration and force. Professional recommendations say that teeth should be cleaned at least twice a day. Brushing your teeth should last at least two minutes. Ganss, C., Klimek, J., Preiss, S. & Schlueter, N. 2008. Tooth brushing habits uninstructed adults- frequency, technique, duration and force. Clinical Oral Investigations 13, 203. Referred 29.1.2019. https://doi.org/10.1007/s00784-008-0230-8 Fluoride toothpastes are clinically proven to prevent and control dental caries. Fluoride toothpaste should be used twice a day. After brushing your teeth with fluoride toothpaste you should not rinse your mouth with plenty of water. Davies, G. M., Davies, R. M. & Ellwood, R. P. 2004. The rational use of fluoride toothpaste. International Journal of Dental Hygiene 1 (1), 3–. Referred 8.2.2019.  https://doi.org/10.1034/j.1601-5037.2003.00001.x

The powered toothbrush is significantly more effective in removing plaque than the manual toothbrush Boccaneala, S., De Boever, J, A., Illiescu, A. & Lazarescu, D. 2003. Efficacy of plaque removal and learning effect of a powered and a manual toothbrush. Journal of Clinical Periodontology 30 (8), 726–731. Referred 29.1.2019. https://doi.org/10.1034/j.1600-051X.2003.00361.xAgarwal, P., Cao, Z., Chinta, SK., Corby, P., Fisch, GS., Frisina, AC., Nemenlivsky, M., Nightingale, KJ. & Norman, RG. 2014. Toothbrush efficacy for plaque removal. International Journal of Dental Hygiene 12 (4), 251–256. Referred 24.1.2019. https://doi.org/10.1111/idh.12081. When you use a manual toothbrush correctly appropriate amount of time it can be very effective in removing plaque.

Right technique is a base of everything

According to the studies, toothbrushes that use rotation oscillation motion, do remove considerably more plaque in short and long term. Because of that, it is better to use powered toothbrush. A powered toothbrush does the rotation oscillation motion by itself. For that reason, you have to move it slowly. As was mentioned before, the powered toothbrush is better in removing plaque than a manual toothbrush. Agarwal, P., Cao, Z., Chinta, SK., Corby, P., Fisch, GS., Frisina, AC., Nemenlivsky, M., Nightingale, KJ. & Norman, RG. 2014. Toothbrush efficacy for plaque removal. International Journal of Dental Hygiene 12 (4), 251–256. Referred 24.1.2019. https://doi.org/10.1111/idh.12081 According to the studies, the mechanical plaque removal is necessary in the prevention of dental diseases like dental caries, gingivitis and periodontitis. As said before, a manual toothbrush can be effective in removing dental plaque, when used right and for the right amount of time. Agarwal, P., Cao, Z., Chinta, SK., Corby, P., Fisch, GS., Frisina, AC., Nemenlivsky, M., Nightingale, KJ. & Norman, RG. 2014. Toothbrush efficacy for plaque removal. International Journal of Dental Hygiene 12 (4), 251–256. Referred 24.1.2019. https://doi.org/10.1111/idh.12081

When you use a manual toothbrush, the brush should be angled at 45 degrees to the line of your gums. Then you have to gently move the brush back and forth in short strokes. You have to be careful not to push too hard and brush outer, inner and chewing surfaces of your teeth. You can brush the inside of the front teeth more efficiently if you tilt the brush vertically and make up and down strokes. Remember to clean your tongue too. Heikka, H. 2015. Hampaiden puhdistaminen. Terveysportti, Terve suu. Referred 29.1.2019. https://www.terveysportti.fi/dtk/tod/avaa?p_artikkeli=trv00021&p_haku=hampaiden%20harjaus

Remember also clean your interdentals

Floss once a day 

It is well known that the two most important oral diseases, caries and periodontal disease, are caused by bacteria. This bacterial layer, known as plaque, should be removed daily to promote oral health care. Levin, L. 2016. Quintessence International Editorial. To floss of not to floss? Is that the question? Quintessenz Journals 47 (8), 635. Referred 29.1.2019. https://qi.quintessenz.de/qi_2016_08_s0635.pdf Even if toothbrushing is a profitable and most common method to remove dental plaque, it alone is not an adequate way to prevent periodontal diseases. That is because toothbrush cannot reach interproximal areas and without flossing or interdental brushing these areas are left unclean. Berchier, CE., Haps, S., Slot, DE. & Van der Weijden, GA. 2008. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. International Journal of Dental Hygiene 6 (4), 265–279.  Referred 29.1.2019. https://doi.org/10.1111/j.1601-5037.2008.00336.x According to report of the American Dental Association (ADA), up to 80 % of plaque may be removed by flossing Berchier, CE., Haps, S., Slot, DE. & Van der Weijden, GA. 2008. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. International Journal of Dental Hygiene 6 (4), 265–279.  Referred 29.1.2019. https://doi.org/10.1111/j.1601-5037.2008.00336.x.

According to the Finnish Dental Association, interdental cleaning should be done once a day and teeth brushing twice a day. Interdental cleaning should be done properly by using the right tools. Levin, L. 2016. Quintessence International Editorial. To floss of not to floss? Is that the question? Quintessenz Journals 47 (8), 635. Referred 29.1.2019. https://qi.quintessenz.de/qi_2016_08_s0635.pdf The main problem with using dental floss is that flossing can be difficult to do effectively, especially if you do not know how it should be done. Because of that, it is very important to make sure with dental professionals, that you know and are trained well to clean your tooth gaps properly with the right tools. Levin, L. 2016. Quintessence International Editorial. To floss of not to floss? Is that the question? Quintessenz Journals 47 (8), 635. Referred 29.1.2019. https://qi.quintessenz.de/qi_2016_08_s0635.pdf

Interdental cleaning is most effective when it is done before brushing. Consequently, the bacterial layer is removed from tooth gaps and fluoride of the toothpaste can be spread into the tooth gaps. Heikka, H. 2015. Hampaiden välipintojen puhdistus. Duodecim Terveyskirjasto, Terve suu. Referred 29.1.2019. https://www.terveyskirjasto.fi/kotisivut/tk.koti?p_artikkeli=trv00028 It does not matter, which time of day you clean your interdentals. The most important thing is, that cleaning tooth gaps with floss or another interdental cleaner is done daily. It can be done at morning or before going to sleep at night. American Dental Association (ADA). 2017. Oral Health topics. Floss/Interdental Cleaners. Referred 29.1.2019. https://www.ada.org/en/member-center/oral-health-topics/floss

Different ways of cleaning the tooth gaps

There are many ways to clean interdentals. You can use floss, interdental brush or toothpick. Floss is a good way to remove plaque from the tooth gaps, when the interdentals are narrow and have very small gaps. There are a wide range of flosses, and usually the floss is made of waxed or unwaxed nylon. Waxed floss slides better in interdentals so it's easier to use between closely spaced teeth. You can also choose between flavored or unflavored and wide or regular size floss. Delta Dental. Facts about flossing. Referred 24.1.2019. https://www.deltadentalins.com/oral_health/flossing3.html

If you find using floss with fingers hard, you can made flossing easier with holders. There are different kind of floss picks, which hold the floss for you making it very easy since you only have to use one hand. Jeffersson Dental Care. 2014. The Different Types of Floss & How to Floss Properly. Blog 21.8. Referred 24.1.2019. https://www.jeffersondentalclinics.com/blog/the-different-types-of-floss-how-to-floss-properly You can choose if you want short- or long-handled floss holder and there is also different models and colors available. Long-handled pre-threated flossers are particularly good for cleaning the back of your mouth. 

If you have big gaps between your teeth, interdental brushes can be better than floss. There are many different sizes of interdental brushes between 0,4 mm to 1,5 mm. Brushes look like little bottle cleaners. Herreras-Fortuny, M. 2016. What is interdental cleaning? Referred 24.1.2019. https://www.bupa.co.uk/newsroom/ourviews/what-is-interdental-cleaning You can clean tooth gaps also with wooden or plastic interdental toothpicks, that can be round or triangular.

What happens if you don't take care of your mouth?

Gingivitis

Epidemiologic studies indicate consistently, that the gingival inflammation is a highly prevalent condition. It is a common gum disease, that causes irritation, redness and swelling of gingiva. Symptoms of gingivitis are also that gums are tender and receding. Healthy gums are firm, pale pink and fitted tightly around the teeth. Gums can also bleed easily during brushing and flossing. When considering gingivitis, the most investigated self‐reported symptom is "bleeding from gums". A sign of gingivitis can also be a bad breath. Gingival inflammation is a ubiquitous finding in children and adults worldwide. Farina, R., Tatakis, D., Trombelli, L. & Silva, C. 2018. Plaque‐induced gingivitis: Case definition and diagnostic considerations. Journal of Clinical Periodontology 45 (Suppl 20), S44–S67. Referred 24.1.2019. https://doi.org/10.1111/jcpe.12939

Gingivitis can occur only within two to ten days, if the plaque is allowed to accumulate on the teeth. Gingivitis is a common problem in the adult population. In the Finnish dental adult population, gingivitis occurs in 74 %. Men have gingivitis little more often than women. Smoking reduces blood vessels and therefore with people that smoke may gingivitis leave unnoticed. Hiiri, A. 2015. Ientulehdus (gingiviitti). Terveysportti. Referred 29.1.2019. https://www.terveysportti.fi/dtk/tod/koti?p_haku=gingiviitti

At the end of the event we held a feedback survey to find out, whether the pupils remembered anything they were taught. There were two questions about oral self-care. We asked "How can you avoid inflammation in your gums?" and if you have inflation in your gums what kind of symptoms do you have? A total of 45 students responded to the feedback survey.

Good oral habits help to prevent and reverse gingivitis. The most common cause of gingivitis is poor oral hygiene that encourages plaque to form on the teeth causing inflammation of the surrounding gum. Plaque forms on your teeth, when starches and sugars in food interact with bacteria in your mouth. Plaque, that stays on your teeth can harden also under your gumline into tartar. Tartar makes plaque more difficult to remove, creates a protective shield for bacteria and causes irritation along the gumline. The longer the plaque and tartar remain on teeth, the more they irritate the gingiva, the part of your gum around the base of teeth, causing inflammation. If not treated, gingivitis can lead to much more serious gum disease called periodontitis and tooth loss. Mayo Clinic. 2017. Gingivitis. Referred 24.1.2019. https://www.mayoclinic.org/diseases-conditions/gingivitis/symptoms-causes/syc-20354453

Unknown periodontitis

Sometimes gingivitis develop into periodontitis Timmerman, M.F. & Van Der Weijden, G.A. 2006. Risk factors for periodontitis. J Dent Hygiene 4, 2–7. Referred 29.1.2019. https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1601-5037.2006.00168.x. Periodontitis is inflammation in the gingiva. It effects the supporting structures of the teeth, which can lead to loss of tooth and contribute to systemic inflammation. Primarily periodontitis is adult's disease, but also children may have it. Kinane, D., Stathopoulou, P. & Papanou, P. 2017. Periodontal diseases. Nature Reviews Disease Primers 3, 17038. Referred 24.1.2019. https://www.nature.com/articles/nrdp201738

Periodontal disease begins of the dental plaque. Then it interacts with the immune defenses of the host, leading to the inflammation and disease. The situation will last until the microbial biofilm is therapeutically removed and the inflammation settle or affected tooth is extracted. Kinane, D., Stathopoulou, P. & Papanou, P. 2017. Periodontal diseases. Nature Reviews Disease Primers 3, 17038. Referred 24.1.2019. https://www.nature.com/articles/nrdp201738

The severity of the periodontal disease depends on environmental and host modifiable and non-modifiable risk factors. Daily self-performed oral hygiene and professional removal of the dental plaque are prevention for periodontal disease. Kinane, D., Stathopoulou, P. & Papanou, P. 2017. Periodontal diseases. Nature Reviews Disease Primers 3, 17038. Referred 24.1.2019. https://www.nature.com/articles/nrdp201738

Dental caries

Dental caries is a multifactorial disease. It cannot be attributed to a single cause. There are three main factors that are related to the causation of dental caries. Main factors are oral bacteria in dental plaque, presence of fermentable carbohydrates and tooth surface. Oral hygiene habits, shape of the tooth, surface characteristics, eating habits and quality and quantity of saliva can also increase or decrease the speed of decay of teeth. Dhillon, J. & Mathur, V. 2017. Dental Caries: A Disease Which Needs Attention. The Indian Journal of Pediatrics 85 (3), 202–206. Referred 8.2.2019. https://doi.org/10.1007/s12098-017-2381-6

As time passes, the acids in the dental plaque can demineralize enamel and dentin. The first sign of dental caries is the so-called white spot lesion. If the demineralization can continue the surfaces of the white spot will cavitate causing a cavity. Titanoff, N. 2019. Dental Caries. In N. Titanoff (ed.) Pediatric Dentistry. Infancy Through Adolescence. 6th ed., 169–179. Referred 8.2.2019. https://www.sciencedirect.com/science/article/pii/B9780323608268000122

Conclusions

You must have right tools and ways to take care of your mouth, so that you can have a good oral health. That is how you can prevent gingivitis, periodontitis and dental caries. In our article there is told how you can keep your oral health at a good level with right brushing technique and interdental cleaning. 

Generally, the pupils of Oulu International School knew oral self-care well. They knew the right answers to the questions because oral self-care is quite familiar thing to them. Pupils were particularly interested when we told them about gingivitis. Pupils were interested in how gingivitis is created and how it could be prevented. Most of the pupils knew the symptoms of gingivitis and we think that is a good thing.

References

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