What Is Oral Hygiene 

  • Kate Benson Postgraduate Diploma , Global Public Health, Newcastle University

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Introduction

Oral hygiene refers to techniques you may or may not use to maintain appropriate oral health, such as toothbrushing.1 A good oral health promotes your well-being while deterring discomfort and embarrassment.2 All patients should receive oral health advice that incorporates behavioural changes alongside professional intervention by dental professionals.3

Poor oral hygiene can lead to common oral diseases such as tooth decay and periodontal disease.3 These can have an impact on your general health, wellbeing, oral functioning, and cause pain. Oral hygiene practices include toothbrushing, interdental brushing, and regular dental visits3. Read on to find out more.

Components of oral hygiene 

Brushing

Recommended frequency and technique 

It is recommended that you brush your teeth at least twice a day to ensure plaque, the soft substance that forms on your teeth and contains bacteria,24 is taken care of. Once as last thing at night and once again at another time throughout the day3 are the minimum required. After the night-time brush, you must not consume anything other than water,  as it is thought you produce less saliva when sleeping, which can increase bacteria and therefore risk of tooth decay.4

Ensure you clean all surfaces of your teeth -the chewing, inside and outside surfaces of your teeth,7 including along the gum line where the tooth meets the gum. Spit out your toothpaste, and do not rinse out your mouth. This leaves the toothpaste on your teeth for longer, therefore giving your teeth extra protection6. As a parent, you should brush your children’s teeth for them, and as they get older, they should still get supervision.3

Selection of toothbrush and toothpaste

Manual and power toothbrushes are both recommended for brushing. However, there is evidence to show that power toothbrushes remove more plaque than manual.6,7 The most important thing is the brushing and frequency, whichever brush you use.7

Different toothbrush heads are recommended in different situations.or example, sometimes,  for gum disease, a small head with a medium texture is recommended.3 Generally, a medium or soft bristle brushwith a small head5 represents the overall best choice.

Fluoride toothpaste is advised due to the evidence that it is effective in reducing tooth decay. It is advised to use fluoridated toothpaste of different concentrations depending on age. You can regulate its usage on the toothpaste label based on something known as ppm (parts per million).3 

  • A smear of at least 1000ppm for 0-3 as soon as teeth have erupted 
  • A pea-sized amount of at least 1000ppm for 3-6-year-olds
  • 1350-1500ppm for children at high risk of decay 0-6 years
  • 1350-1500ppm for 7-18-year-olds
  • 1350ppm - 1500ppm for all adults3

A dentist can prescribe high fluoride toothpaste for those at high risk of decay, either 2800ppm or 5000ppm depending on age and risk.

  • 10 years plus with active decay, prescribe 2800ppm
  • 16 years plus with active decay, prescribe 2800ppm or 5000ppm3

Interdental cleaning

Importance of interdental cleaning

The interdental space is the gap between two teeth where you floss. Interdental devices clean the surfaces that the toothbrushes cannot reach, which is an area that has a high risk for gathering plaque.8  This plaque is a cause of decay and gum disease. They remove plaque from between the teeth, while the toothbrush removes plaque from the visible surfaces of the teeth. Which one you use depends on the location you are based, advice from a dentist, and the size of the gaps between your teeth.8

 Interdental cleaning can come in the form of 

  • Interdental brushes 
  • Floss
  • Irrigation8

Methods and frequency 

It is recommended to use interdental brushes once a day, as some evidence shows they are more effective than flossing. It depends on the size of the gap between your teeth. The dentist should show you how to use it and advise you on which type to utilise. If you can fit a brush between your teeth, you should use this.3 The brushes come in different sizes and you will most likely need different sizes for the different sized gaps between your teeth. You need to test the size by placing the brush horizontally between your teeth, one at a time, to see if the fit is snug without the wire part of the brush touching your teeth. You can then try the bigger size to find the brush with the most resistance that yet does not feel like you are forcing it through. If the gaps in your teeth are too small for these brushes, you should use floss instead.6 

Mouthwash 

Standard fluoride mouthwash is recommended as an additional oral hygiene method of the patient’s choice and can help to reduce decay. It is advised that you do not use mouthwash straight after brushing and choose an alternative time, such as midday, to do this, as it will remove the toothpaste from your teeth. It is not a substitute for toothbrushing and manual plaque removal.5

High fluoride mouthwash can be prescribed by a Dentist in situations where patients have active decay present, from ages 8 and older until the decay is stable and risk has reduced.3

Chlorhexidine mouthwash is sometimes recommended by dentists in certain situations for periodontal disease and is in line with oral surgery such as implants. However, advice from a dentist is recommended due to allergy and staining risks.9 

Regular dental visits

The guidelines for regular dental visits are set by the dentist based on factors including your age and disease present. After a check-up or a course of treatment is complete, the Dentist will set an interval period between your reviews, which can change at each one.10

For children, it will be 3, 6, 9 or 12 months

For adults, it will be either 3, 6, 9, 12, 15, 18, 21, 24 months10

 It is important you see a dentist in the period they have set for you so that they can do an oral health check where they will check your teeth, gums, and soft tissues of the mouth, plan any treatment required and give you oral hygiene advice.11

Common oral health issues

Decay (caries) 

Causes and symptoms

Tooth decay happens when bacteria in your mouth use sugars from your diet to break down the tooth.8 It starts off small, which can sometimes be halted from spreading with the right oral hygiene and treatment, but left with poor oral hygiene, it can progress into deeper decay. It can be caused by high sugar frequency in your diet and a build-up of plaque. Factors such as a lack of saliva can increase the risk.8  This can cause a cavity, or hole, in your teeth as well as potential pain and discomfort.8

Prevention and treatment

Prevention
  • Good patient oral hygiene3
    • removing plaque via toothbrushing and interdental cleaning
    • Fluoride toothpaste - including high fluoride options that can be prescribed by your dentist 
  • Dietary changes, especially reducing the frequency of sugar consumption.3
  • Preventative treatments from dentist3
    • Fluoride varnish - a strong concentration of fluoride paste applied to protect teeth or prevent the progression of decay.
      • Age 3-6 years applied twice a year
      • Age 0-6 with a high risk of decay, applied 2 or more times a year 
      • Age 7 - 18, applied twice a year
      • Age 7 - 18 with a high risk of decay, applied 2 or more times a year
      • For adults with a high risk of decay, apply twice a year.3
    • Fissure sealants - coating of material that is placed in the fissures of adult molar teeth to provide a smooth surface that is less likely to gather plaque and food debris
      • Age 7-18 with a high risk of decay3
      • Adults - can be decided to seal in early decay in some cases13
Treatment 

The treatment of decay depends on whether this is in primary or permanent teeth.12 The dentist will assess the decay through clinical examination of the tooth and x-rays, if required, and discuss the treatment options with you. A treatment plan will then be made depending on how far the decay has spread, whether the nerve has been affected, and whether infection is present.13 Treatment could include:

Periodontal disease

Definition and symptoms

Periodontal diseases, also known as gum disease, consist of gingivitis and periodontitis, with different subgroups to these. The primary cause of these diseases is the presence of plaque on the teeth and around the gumline

Gingivitis is inflammation of the gums without losing the attachment of the gums to the underlying bones and structures:

  • Bleeding gums
  • Gums with red, shiny, puffy appearance6,8,15

 Periodontitis is where the supporting tissues of the teeth, including bone, are inflamed and destroyed, which can result in the loss of the teeth8 and includes:

  • Pain
  • Wobbly teeth 
  • Infection
  • Bone loss
  • Tooth loss6,8,15

Risk factors 

There are many factors that increase the risk of periodontal disease.

Plaque

Plaque contains bacteria that cause inflammation of the gums, and high amounts cause an imbalance between the plaque and the immune system, leading to periodontal diseases15. Certain factors can retain plaque and, therefore, also increase risk: 

Tobacco

 Both smoking and smokeless tobacco products have been found to increase risk of periodontitis and stop the responsiveness of treatment.15

Vaping 

While better than smoking tobacco, people who vape are at a higher risk of periodontal disease than non-smokers, and also may be past smokers and therefore will still present the lingering effects of smoking on periodontal disease.15 

Diabetes 

High blood sugar levels in people with uncontrolled Diabetes can increase the risk of periodontal disease and harm the response to treatment.15

Medications 

There are medications which impact periodontal health; for example, calcium channel blockers for heart disease can cause enlargement of the gums. This is part of the reason why it is important to give your dentist an up-to-date medical history.15

Hormonal changes 

Hormonal changes experienced during puberty and pregnancy have been associated with the development or worsening of gingivitis.22

Treatment

Prevention

Controlling risk factors to reduce risk forms the basis of the prevention of periodontal diseases. The same prevention applies to both gingivitis and periodontitis.15

Removal of plaque via good oral hygiene methods is vital for the prevention of periodontal disease.

Quitting smoking will reduce your risk, and your dentist or GP can give you crucial advice on quitting.

Diabetes control is very important and you should follow up with the doctor in charge of your care regularly,  as well as manage your diet to the best of your possibilities, regulate your medication, and exercise according to their advice.15

If required, your dentist can speak to your GP or appropriate doctor regarding a medication change if they believe that one you are taking is affecting your gum health.15

Diagnosis and treatment

During the dental check-up, the dentist will check your gum health using a “Basic Periodontal Examination” (BPE). The score will determine the further action taken.15

  • 0-2:
    • Do not have periodontitis, may have gingivitis
    • Prevention
    •  removal of plaque retentive factors (such as calculus), often known as scale and polish15
  • 3-4
    • Might have periodontitis
    • May require further examination, including probing of the gums, X-rays, and measuring plaque levels; may include referral to a hygienist 
    • Prevention and removal of plaque retentive factors required 
    • The dentist will use the findings to make a diagnosis 
    • Deeper cleaning may be completed, sometimes using local anaesthetic 
    • Regular monitoring required15

Tooth wear

Toothwear is caused by multiple factors which can fit under 3 categories;

  • erosion (chemical wear by acids)
  • attrition (physical wear from tooth-tooth, for example, grinding)
  • abrasion (physical wear from other objects such as brushing)16

Erosion

Causes

 include 

Attrition and abrasion

Causes
  • Grinding Teeth
  • Brushing too hard
  • Piercings
  • Opening things with teeth
  • Abrasive toothpastes16

Symptoms and treatment 

Symptoms

Can include: 

  • Pain
  • Unhappy with appearance
  • Inadequate functioning17

Prevention 

Gaining the advice of your Doctor or Dentist is important, and preventive treatment may include 

  • Altering your diet 
  • Medical advice regarding medical conditions and medications
  • Fluoride application - via high fluoride toothpaste or fluoride varnish
  • Tooth brushing instruction as part of oral hygiene advice (using soft- medium brush, no abrasive toothpaste) 
  • Mouthguards for grinding
  • Fillings to cover exposed layers of teeth 
  • Monitoring over time17

Oral cancer 

Oral cancer is cancer of the mouth, throat or lip and includes different types of cancer, including mouth cancer and oropharyngeal cancer.14

Risk factors

  • Smoking
  • Alcohol
  • Combination of smoking and alcohol
  • UV light (e.g sun exposure) 
  • HPV infection14

Symptoms

Dentists will routinely check for oral cancer within their checkups, which is one reason it is important to attend regularly. It is important to go to your dentist if you have any of these signs or symptoms (or the Doctor for more general symptoms).14

  • Lump in the head or neck
  • Ulceration or swelling in your mouth lasting more than 3 weeks 
  • Lump in the mouth or on the lip
  • Pain in the throat or on swallowing for more than 3 weeks
  • Constant hoarseness for more than 3 weeks
  • Red or red and white patches in your mouth 
  • The socket not healing after having a tooth extracted 
  • Tooth mobility 
  • Difficulty swallowing
  • Unexplained weight loss14

These symptoms may not be due to cancer, yet require assessment by a medical professional and sometimes a referral for a diagnosis.14

Further considerations

Systemic health connections

It has been found to be a connection between your oral health and systemic health, namely the health of the rest of your body. Periodontitis is linked to diabetes in both directions, with one condition affecting the other. There is also evidence of links between periodontitis and heart disease and potential conditions such as dementia. It is, therefore, important for your dentist to be aware of your medical history, to ensure you have regular checkups and treatment, and to practise good oral hygiene.18

Age

Different oral hygiene guidance is given to different age groups, as well as different treatments depending on age and whether you have primary or permanent teeth.3

If getting braces, usually in adolescence, you must demonstrate very good oral hygiene in order to be referred and have braces due to increased difficulty in removing plaque when brushing.19

As elderly patients, you can have medical conditions which can make it more difficult to brush your teeth or access the dentist, for example, arthritis and dementia. You are also more likely to be taking multiple medications, which may have side effects of dry mouth, increasing the risk of oral disease. More and more people retain their natural teeth as they age, making treatment more complex as you get older.20 The chronic diseases of ageing are those linked to oral health, as described above.

Disability

Disabled people can have difficulty with oral hygiene. If you are disabled, access to dental practices and maintenance of oral hygiene may be difficult due to mobility problems, sensory needs and health reasons. For different sensory needs and disabilities, there are different types of toothpaste and toothbrushes.21 For example, toothbrushes with adapted grips, toothpaste with either alternative flavours or not at all, and those with no foaming are for people who cannot tolerate the feel or taste of standard mint toothpaste.22

Mental health plays a factor in oral hygiene, as it can be difficult for you to maintain good oral hygiene practices, you may be too anxious to attend the dentist or brush your teeth, or medications may cause dry mouth.23

Socioeconomic status 

Oral disease increases as socioeconomic status decreases, with these inequalities globally partly due to wealthy people being able to access and afford dental care more than those on a lower income. These inequalities cross over with other factors such as age and disability.18

Summary

It is important that you maintain good oral hygiene through tooth brushing with fluoride toothpaste, interdental cleaning, and mouthwash in certain circumstances. You need to visit the dentist regularly, if possible, according to the interval they set for you at each appointment so they can check your oral health. Common oral diseases include tooth decay, periodontal disease, tooth wear, and oral cancer, all of which have risk factors and preventive methods. Oral health is greatly linked to your general health, and therefore, good oral hygiene is essential for this reason, as well as the direct impacts on your oral health. Oral hygiene advice and considerations vary for disabled people and people of different ages. Socioeconomic status massively impacts oral health globally due to lower-income people being less able to access and afford dental care. 

FAQs

What is the meaning of oral hygiene?

Oral hygiene encompasses the techniques you use to maintain good oral health, including toothbrushing.

What is basic oral hygiene?

Remove plaque from teeth through toothbrushing and interdental cleaning, and use fluoridated toothpaste. 

What is poor oral hygiene?

Poor oral hygiene is the gathering of plaque on teeth due to not following oral hygiene practices which then can cause decay and periodontal disease. 

When should the brush be changed?

Every 3 - 4 months, or when it appears worn out.25

References

  1. Oral Hygiene | National Institute of Dental and Craniofacial Research [Internet]. [cited 2023 Dec 5]. Available from: https://www.nidcr.nih.gov/health-info/oral-hygiene.
  2. Oral health [Internet]. [cited 2023 Dec 5]. Available from: https://www.who.int/health-topics/oral-health.
  3. Delivering better oral health: an evidence-based toolkit for prevention. GOV.UK [Internet]. 2021 [cited 2023 Dec 5]. Available from: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention.
  4. Llena-Puy C. The rôle of saliva in maintaining oral health and as an aid to diagnosis. Med Oral Patol Oral Cir Bucal. 2006; 11(5):E449-455. Available from: The rôle of saliva in maintaining oral health and as an aid to diagnosis - PubMed (nih.gov)
  5. How to keep your teeth clean. nhs.uk [Internet]. 2022 [cited 2023 Dec 5]. Available from: https://www.nhs.uk/live-well/healthy-teeth-and-gums/how-to-keep-your-teeth-clean/.
  6. Periodontal care | Scottish Dental Clinical Effectiveness Pr [Internet]. [cited 2023 Dec 5]. Available from: https://www.sdcep.org.uk/published-guidance/periodontal-care/.
  7. Wang P, Xu Y, Zhang J, Chen X, Liang W, Liu X, et al. Comparison of the effectiveness between power toothbrushes and manual toothbrushes for oral health: a systematic review and meta-analysis. Acta Odontol Scand. 2020; 78(4):265–74. Available from: Comparison of the effectiveness between power toothbrushes and manual toothbrushes for oral health: a systematic review and meta-analysis - PubMed (nih.gov)
  8. Worthington HV, MacDonald L, Pericic TP, Sambunjak D, Johnson TM, Imai P, et al. Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database of Systematic Reviews [Internet]. 2019 [cited 2023 Dec 5]; (4). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012018.pub2/full.
  9. Poppolo Deus F, Ouanounou A. Chlorhexidine in Dentistry: Pharmacology, Uses, and Adverse Effects. Int Dent J. 2022; 72(3):269–77. Available from: Chlorhexidine in Dentistry: Pharmacology, Uses, and Adverse Effects - PubMed (nih.gov)
  10. Overview | Dental checks: intervals between oral health reviews | Guidance | NICE [Internet]. 2004 [cited 2023 Dec 5]. Available from: https://www.nice.org.uk/guidance/cg19.
  11. Feea PA, Rileya P, Worthington HV, Clarkson JE, Boyers D, Beirne PV. Recall intervals for oral health in primary care patients. Cochrane Database of Systematic Reviews [Internet]. 2020 [cited 2023 Dec 5]; (10). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004346.pub5/full.
  12. Caries in children | Scottish Dental Clinical Effectiveness [Internet]. [cited 2023 Dec 5]. Available from: https://www.sdcep.org.uk/published-guidance/caries-in-children/.
  13. Cheng L, Zhang L, Yue L, Ling J, Fan M, Yang D, et al. Expert consensus on dental caries management. Int J Oral Sci [Internet]. 2022 [cited 2023 Dec 5]; 14(1):1–8. Available from: https://www.nature.com/articles/s41368-022-00167-3.
  14. Chapter 6: Oral cancer. GOV.UK [Internet]. [cited 2023 Dec 5]. Available from: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-6-oral-cancer.
  15. Chapter 5: Periodontal diseases. GOV.UK [Internet]. [cited 2023 Dec 5]. Available from: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-5-periodontal-diseases.
  16. Chapter 7: Tooth wear. GOV.UK [Internet]. [cited 2023 Dec 5]. Available from: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-7-tooth-wear.
  17. Dental Update - Tooth wear guidelines for the bsrd part 1: aetiology, diagnosis and prevention. Dental Update [Internet]. [cited 2023 Dec 5]. Available from: https://www.dental-update.co.uk/content/restorative-dentistry/tooth-wear-guidelines-for-the-bsrd-part-1-aetiology-diagnosis-and-prevention/.
  18. Patel J, Wallace J, Doshi M, Gadanya M, Ben Yahya I, Roseman J, et al. Oral health for healthy ageing. Lancet Healthy Longev. 2021; 2(8):e521–7. Available from: Oral health for healthy ageing - PubMed (nih.gov)
  19. Orthodontics. nhs.uk [Internet]. 2017 [cited 2023 Dec 5]. Available from: https://www.nhs.uk/conditions/orthodontics/.
  20. Improving oral health for adults in care homes | Quick guides to social care topics | Social care | NICE Communities | About. NICE [Internet]. [cited 2023 Dec 5]. Available from: https://www.nice.org.uk/about/nice-communities/social-care/quick-guides/improving-oral-health-for-adults-in-care-homes.
  21. Oral health and physical disabilities. Oral Health Foundation [Internet]. 2017 [cited 2023 Dec 5]. Available from: https://www.dentalhealth.org/oral-health-and-physical-disabilities.
  22. Oral care and people with learning disabilities. GOV.UK [Internet]. [cited 2023 Dec 5]. Available from: https://www.gov.uk/government/publications/oral-care-and-people-with-learning-disabilities/oral-care-and-people-with-learning-disabilities.
  23. Mental illness and oral health. Oral Health Foundation [Internet]. 2017 [cited 2023 Dec 5]. Available from: https://www.dentalhealth.org/mental-illness-and-oral-health.
  24. Tooth plaque. GOSH Hospital site [Internet]. [cited 2023 Dec 8]. Available from: https://www.gosh.nhs.uk/conditions-and-treatments/general-medical-conditions/tooth-plaque/.
  25. Use & Handling of Toothbrushes | FAQs | Infection Control | Division of Oral Health | CDC [Internet]. 2020 [cited 2023 Dec 8]. Available from: https://www.cdc.gov/oralhealth/infectioncontrol/faqs/toothbrush-handling.html.

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Kate Benson

Postgraduate Diploma , Global Public Health, Newcastle University

Kate is a qualified Dentist with a Global Public Health Postgraduate Diploma, with who has moved into a career in the charity sector as a Communications Officer. She has gained writing experience over several years and been published in the British Dental Journal, Newcastle University newspaper and Insider magazine. She is passionate about reducing Health Inequalities and ensuring everyone has access to health information.

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