The Handbook
The Handbook

No one wants to go to the dentist until they actually have to. Toothache is no fun and given that we’re in full swing of a national lockdown, thinking about having a dental issue that requires us having to go to the dentist is looking pretty grim.

So we spoke to one of London’s most sought-after dental hygienists, Anna Middleton, to find out how you can keep your gnashers in top condition until this passes. Read on for her pearls of wisdom, from flossing to the foods to avoid.

Brush your teeth and gums properly

Place the toothbrush bristles against the teeth at a 45-degree angle towards the gum line. Many of us forget to brush our gums when we brush our teeth, but brushing your gums is integral because this is where plaque will sit.

When brushing, hold the handle gently with a light grip and only apply light pressure. Glide the brush across your teeth and gums gently, allowing your brush to do must of the work – do not scrub.

TOP TIP: Spit, don’t rinse. Spit the toothpaste out but try not to rinse your mouth after as you will wash away the beneficial ingredients in toothpaste, such as fluoride which helps to prevent dental decay. If you choose to use a mouthwash, use it at a separate time to brushing your teeth.

Now is the time to invest in an electric toothbrush

There are a number of reasons why you should get an electric toothbrush:

  • You get a far more superior clean and effective plaque removal because you get more brush strokes per minute than you could ever generate yourself with a manual brush.
  • Using an electric toothbrush with the correct technique will prevent overbrushing, which causes irreversible and permanent wearing away of the gums, known as recession.
  • The exposed underlying tooth surface is not as strong as the tough outer enamel, leaving it more susceptible to further wear, dental decay, sensitivity and an unpleasing aesthetic appearance.
  • Electric toothbrushes have much smaller heads and are designed specifically to ensure each tooth is cleaned individually, helping you get to all the hard to reach areas.

There are also a number of different types of mechanisms, but to keep it simple the two best types are rotary/oscillating heads and sonic vibration heads.

  • Rotary/oscillating heads are small and round, rotating in one direction and then the other, one tooth at a time to sweep plaque away. Often these heads pulsate too.
  • Sonic heads vibrate at certain high speeds and frequencies to break down plaque as well as agitate the toothpaste and fluid in the mouth to clean between teeth and along the gumline.

Both these types will remove more plaque than a manual toothbrush, but in clinical trials, sonic brushes removed significantly more plaque – therefore are more effective. However, try to avoid battery operated toothbrush models. They are not effective and the tendency to ‘scrub’ with one still remains, which can lead to damage of the gums.

Use an electric toothbrush once in the morning and again at night-time for two minutes and ensure you are changing the brush head every three months. When brushing apply a small amount (about the size of a pea) onto your toothbrush before switching it on.

I would always recommend the Philips Sonicare Diamond Clean.

Choose the right dental products

I brush twice a day with my Philips Sonicare electric toothbrush and use Regenerate Enamel Science Toothpaste – as it protects against dental decay and reverses the early signs of enamel erosion. I then use a combination of floss and interdental brushes – once a day, at night before bed.

To fresh up after eating and drinking during the day I use Regenerate Foaming Mouthwash and once a month I use Regenerate Advanced Enamel Serum.

TOP TIP: Always wash your hands before and after cleaning your teeth.

Don’t neglect in-between your teeth

Toothbrushes are not capable of reaching in-between teeth to remove unwanted debris. In total, brushing only cleans about 60% of our teeth. However, interdental cleaning with floss or brushes helps prevent tooth decay and gum disease, which can occur when food and plaque are left lodged between teeth.

If you have the space between your teeth, then opt for interdental brushes and always use the biggest size possible – you may need more than one brush size. If your teeth are tight together then dental floss is recommended. Do this once a day, preferably at night and in front of the mirror.

Top tips if you’re flossing:

  • Take a piece as long as from your elbow to tip on index finger, wind the floss around your middle fingers leaving an inch or two to work with.
  • Hold the floss tight between your thumbs and index fingers. Using a gentle sawing action slide the floss between the teeth.
  • Go all the way below the gum line and gently curve the floss in a tight ‘C’ shape and rub up and down. Repeat this for the other side of the tooth before coming back up and out to move on to the next space.
  • Use a clean section of floss as you move between teeth.
  • If you get the floss in but cannot get it back out – do not panic. Just gently unravel from fingers and pull the floss through.
  • Do your interdental cleaning before you brush your teeth to remove debris and make this a daily practice.

Top tips for interdental brushes:

  • Choose the right size.
  • Insert between the teeth gently and move the brush back and forth a few times.
  • Change the size and curve of the brush if needed. I find it easier to keep it straight for the front teeth but angle/bend for the back teeth.
  • Change the brush when filaments have become worn – usually 4-7 days.

Don’t ignore bleeding gums

If you notice bleeding when using an interdental brush or floss, don’t worry too much and keep going! Bleeding gums are caused by plaque – the white sticky film that forms in all our mouths. Plaque is filled with bacteria – some of these bacteria are good and some are bad. If plaque is left behind after a period of time, it starts to irritate the gums and cause inflammation.

Healthy gums are typically pink, any change in its natural colour is a sign of poor health. However, when they are red and swollen, this is an indication that something is amiss. Sore, tender, bleeding gums are a sign of gum disease. These symptoms generally indicate gingivitis, which is an early stage of gum disease. This stage is reversible, but if proper oral care is not taken, it will advance to severe stages of gum disease known as periodontitis.

There are a number of things you can do to help prevent gum disease and look after your teeth:

  • When brushing, place the toothbrush bristles against the teeth at a 45-degree angle towards the gum line. Often, we just brush the teeth, but it is important to include the gum line because this is where the plaque sits. Hold the handle gently with a light grip and only apply light pressure. Glide the brush across your teeth and gums gently, allowing the brush to do all the work. There is no need to scrub with an electric toothbrush.
  • Toothbrushes are not capable of reaching in between teeth to remove unwanted debris. Brushing cleans only about 60% of your mouth, so interdental cleaning with floss or brushes is crucial. Cleaning between the teeth regularly helps prevent tooth decay and gum disease, which can occur when food and plaque are left lodged between teeth. If you have the space between your teeth, then opt for interdental brushes and always use the biggest size possible – you may need more than one brush size. If your teeth are tight together then dental floss is recommended. Do this once a day, preferably at night before you brush your teeth. Stand in front of the mirror so you can see your teeth, and most importantly, ensure you commit to this daily practice.

Watch what you’re eating during lockdown

We’re all isolating at home and are unable to make the decisions we usually do, so making the right food choices can be tricky. However, by making some conscious changes you can help reduce damage to your teeth.

  • When making food choices try to keep all sugars and acids to only mealtimes and aim for no more than three to four sugar/acidic attacks per day.
  • Use a straw for drinks – avoid plastic ones and try and rinse your mouth with water after consuming dark coloured foods and drinks.
  • Brush 30 minutes after eating of drinking to reduce the risk of enamel erosion.
  • To maintain optimal oral health through foods, eat things like oily fish, milk, broccoli, spinach, oranges, nuts, carrots, eggs and avocado. Safe snacks in between meals include nuts, cheese, fresh vegetables and yoghurt.
  • As part of an overall balanced diet, ensure you eat plenty of plants, lean protein, nuts and healthy fats. Avoid processed foods and refined carbohydrates including white bread, pasta and processed meats.
  • If you can, cut back on red wine and coffee. Your body will thank you and so will your teeth.

TOP TIP: Chewing gum is not just for freshening breath. Sugar free gum or mints increase salivary flow, which can neutralise plaque acids, help remove debris, strengthen teeth and reduce dry mouth. Opt for products containing Xylitol as an ingredient, as it can help fight tooth decay.

Know the services available

Due to the COVID-19 pandemic, dental practices around the world are closed, opening their doors only for patients experiencing dental emergencies. Dental emergencies are classed as:

  • Dental trauma
  • Toothache not improving with medication
  • Facial swelling
  • Bleeding after an extraction

If you are worried contact your dentist or hygienist who can help give you advice and triage your problem to the appropriate treatment method during this time or call NHS 111.

 Choose the right pain relief

 If you are experiencing pain, over the counter painkillers can help such as paracetamol but make sure they are taken in accordance with the instructions on the packet.

For tooth sensitivity to hot or cold, try switching up your toothpaste to a sensitive one (Such as Sensodyne Repair and Protect, Sensodyne Rapid Relief or Colgate Pro-Relief. Rub some toothpaste onto the directly affected area if need be.

If you have wisdom tooth pain, this can be extremely painful. As much as possible try to continue thorough cleaning (even if painful) with a small brush, like a single tuft brush, or interspace brush. Following brushing, dip a brush or cotton bud into some mouth wash and clean teeth. I would use something like Corsodyl/Curasept or Peroxyl, but make sure you only use for a maximum of three days as it can stain teeth brown.  Alongside this to help manage wisdom teeth main, try to eat soft foods, rinse with saltwater throughout the day and you can also try over the counter painkillers.

If you develop a fever or have difficulty swallowing or swelling in your cheek, you may need antibiotics. Make sure you call your dentist or NHS 111 if you are concerned. 

 


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