Introduction

Who can forget the daily morning ritual? Tooth brushing is the primary method to maintain daily oral hygiene. It includes mechanical and chemical plaque control methods. Both manual or powered brushes are used with toothpaste to remove harmful bacteria from tooth surfaces and prevent caries, gum diseases, and bad breath (Halitosis). This article discusses the role of the brushing technique and the materials used to protect the enamel. 

Understanding the tooth

Enamel is the hardest substance in the human body and lies over the soft dentin core of a tooth. A layer of cementum covers the tooth root and anchors it to the jaw bone. The tooth has nerves and blood vessels in the pulp. The pulp is present in the pulp cavity within the tooth.

Enamel consists of hydroxyapatite crystals and an organic protein matrix. These hydroxyapatite crystals are fracture-resistant and susceptible to chemical actions. This means that the crystals will break down and cause a cavity to develop in the presence of chemical environments. (e.g acidic environments caused by drinks with high sugar content combined with the presence of bacteria on the tooth surface.)

A coat of biofilms

Biofilms¹ are bacterial populations in a salivary matrix that adhere to the tooth surface. The bacteria condition the surface of teeth, forming a pellicle of salivary glycoproteins. When left undisturbed, it becomes tenacious. It develops along the fissures in teeth, causing tooth decay. Along the gingival margins, it causes infection and gum disease.

Oral environment and dental diseases

Bacterial microorganisms thrive in the mouth as this is the perfect habitat for them. It is warm, and moist and provides all the nutrition they require. The dynamic oral environment supports microbial flora through feasts and famines. When microbial communities such as dental biofilms flourish in such environments, causes a shift in the natural balance of dental flora.

Dental plaque is a causative agent for dental diseases. The most common dental problem worldwide is dental decay, also known as dental caries.

An adaptive and proactive plan for plaque control goes a long way in preventing dental diseases. A prerequisite for protecting enamel is good oral hygiene practices.

Factors influencing enamel protection

Tooth brushing

A toothbrush, dental floss, and toothpaste are aids for oral prophylaxis. The effective duration of brushing is 30-45 seconds per quadrant or a total time of 2-3 minutes. The mouth is divided into four quadrants, left and right upper jaw (maxilla) and left and right lower jaw (mandible). Brushing removes plaque and prevents biofilm formation, accumulation of food debris, and stain formation.

Essential features of brushing:

• A manual or powered toothbrush with soft nylon bristles removes plaque well
• The force applied during brushing should be small
• Brushing twice a day is optimal
• Use fluoride-containing toothpastes

Consequences of improper tooth brushing

Improper brushing leads to gingival recession, tooth abrasion, and poor oral hygiene. Damage done to the enamel depends upon the frequency of tooth brushing, pressure applied, hardness of bristles, and duration.

Ineffective brushing leads to plaque build-up which affects the supporting tissues of teeth over an extended period. (e.g. gum disease and loss of supporting bone)

Fluoride treatment of enamel

Demineralization is the process which describes the breaking down of the hydroxyapatite crystals that make up the enamel structure. Breaking down of this structure will lead to cavity formation and tooth surface erosion. Fluoride treatment³ protects against demineralization of the tooth surface.

Calcium or calcium-containing materials in oral care products increase fluoride retention. Saliva is rich in calcium and phosphate ions and acts as a buffer to neutralize acid. At pH values above 5.5² calcium phosphate precipitates from the oral environment. This process remineralizes the demineralized tooth tissue.

Role of diet

A deficiency of vitamins A and D during the pre-eruptive stage leads to incomplete or underdevelopment of enamel. This is evident as lines and white spots on the crown surface. 

Dental fluorosis occurs due to excessive intake of fluorides. This occurs as a result of over-administration of systemic fluoride supplements or increased intake from the local external environment, e.g. natural water sources. 

Dietary acids like citric, ascorbic, carbonic, and oxalic acids etch the enamel surface, making it more susceptible to breakdown These acids are found in fruit juices and beverages. Dental erosion caused by these dietary acids alters tooth morphology and the sheen.

Role of chemicals

Pit and fissure sealants are used in deep grooves to guard against tooth decay. 

Fluoridated mouthwash rinses act as an additional defense. They permeate every nook and corner of the oral cavity.

Brushing techniques

Many techniques exist in our armour for protecting teeth. Bass, Stillman, Charter, and Roll methods are some brushing techniques. Modified Bass Technique⁴ and Roll technique are the recommended ones.

The truth is that most people practice their own toothbrushing method. It is a 'scrub' method using vigorous horizontal, vertical, and circular movements. It removes plaque from surfaces but often causes gums to recede.

Modified Bass technique of brushing

Modified Bass Technique removes plaque better than other tooth brushing techniques.

• Begin with your teeth's outer surfaces. Take three teeth at a time. Brush your upper and lower teeth gently by placing the brush 45° to the long axis of the tooth surface. Bristles should contact both the tooth and gum lines. Move the brush in a circular, jiggling motion. After that, give a vertical sweeping outward stroke
• Use a small back-and-forth vibratory motion with the brush to clean the inside surface of the back teeth
• Use small up and down strokes to clean the inside surface of the front upper and lower teeth by tilting the brush vertically
• Move the brush in a back-and-forth motion to clean the biting surfaces

Proper tooth brushing is an aid to protect the teeth and preserve that 'Beautiful Smile' you have.

The world today glamorizes nothing more than a beautiful smile. The radiance of this smile depends upon a white cover over the teeth. To outshine, we need to protect what shines: the enamel of our teeth.

FAQs

Which is the most acceptable technique for brushing?

Modified BassTechnique is the technique advised by most dentists all over the world.

How often should I visit a dentist?

Twice a year is acceptable, even if you have no complaints.

Are there any home remedies to suggest proper care of teeth?

Tooth brushing is the single most accepted home care method.

How soon should I visit a dentist if I suspect a cavity?

As soon as possible. A small cavity is restored easily, quickly and without any pain.

Summary

Uncared for teeth are a gateway to oral diseases. We should protect the enamel by removing plaque from the tooth surfaces and maintaining a healthy, low sugar, diet.

Tooth brushing plays a role in maintaining oral health. The technique and materials keep a balance in maintaining oral health.