The Ideal Oral Health Routine

The Ideal Oral Health Routine
The
Ideal Oral Health
Routine
The definitive guide to maintaining excellent
oral fitness in healthy adults.
the
FreySmiles
Oral Health Network
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A Timeline of an Optimally Hygienic Day for a Typical Adult
Potential
Rebalance pH
• Baking Soda Rinse
• Suggested to
compensate for low
Calcium Concentration
in morning saliva
Protein Rich
Breakfast
Rebalance pH
• Baking Soda Rinse
• As Needed:
Dependent upon the
quality of snacks
Lunch
Morning
Xylitol Gum
• Chew gum with 2
grams of Xylitol
---May require more
than one piece
A Snack
with cheese
Dinner
Planned
Rebalance pH
• Baking Soda Rinse
• Needed to compensate
for low Calcium
Concentration in nighttime saliva
Late Snack
Bedtime
7 AM
11 PM
Xylitol Gum
• Chew gum with 2
grams of Xylitol
---May require more
than one piece
Cleaning (prior to food)
• Interproximal (in between
teeth) plaque removal prior to
brushing
• Toothpaste not required, but
suggested.
---- Can rebrush after pH
rebalancing if still concerned
with breath freshness
Xylitol Gum
• Chew gum with 2
grams of Xylitol
---May require more
than one piece
Rebalance pH
• Baking Soda Rinse
• As needed: Dependent
upon the quality of
Lunch
Cleaning
• Interproximal (in between
teeth) plaque removal prior to
brushing
• Follow with Fluoride Rinse,
preferably of alkaline pH
Rebalance pH
• Baking Soda Rinse
• As needed: Dependent
upon the quality of
Dinner
!
The above timeline is an example of an idealized daily
routine for maintaining excellent oral health in a normal adult.
The following sections will walk you through all the keys to a
sustainable smile and the science behind them.
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Table of Contents
Obtain Completely Clean Teeth & Gums
--------------------------------------------------------• Perform a Comprehensive Cleaning Twice Daily
• Use a Waterpik at Least Once Daily
• Clean Between Your Teeth Before You Brush
• Clean Your Teeth Before Breakfast and Before Going to Bed
• Never Brush Immediately Following Meals
• Use an Electric Toothbrush
• Replace your Toothbrush When it Shows Signs of Matting
• Use a Low Abrasive Fluoride Toothpaste
page 4
page 4
page 5
page 6
page 7
page 8
page 8
page 9
Keep Your Diet Tooth Friendly
------------------------------------------• Limit the Frequency of Dietary Acids and Sugars
• Change How You Drink Acidic Beverages
• Eat a Protein Rich Breakfast
• Eat Cheese with Snacks
• Avoid Late Night Snacks (~after 11pm)
page 10
page 10
page 11
page 12
page 12
Re-balance Your Oral pH
-----------------------------------•!Use a Baking Soda Rinse After Any Highly
Acidic Drinks, Meals, or Snacks
• Use a Baking Soda Rinse During Periods of
Compromised Salivary Flow
page 13
page 14
Supplement Your Routine
------------------------------------•!Chew Xylitol Gum
• Use a Low Fluoride Mouthwash Nightly Before Bed
page 15
page 15
Whiten Teeth Smarter
-------------------------------• Do Not Whiten Teeth Too Frequently
page 17
See Your Dentist
-----------------------• Regular Check Ups are Essential
page 19
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Obtain Completely Clean Teeth & Gums
-----------------------------------------------------------------------------Perform a Comprehensive Cleaning
Twice Daily
It is only necessary to completely remove plaque
once every 48 hours, so actually cleaning once a day
would be adequate; however, nobody is that good.
Even dentists can't remove all their plaque in one
cleaning, and doing things twice in a day dramatically
increases your odds of removing it all. Limiting
yourself to twice a day will help you avoid toothbrush abrasion from
brushing and flossing excessively (more often excessive force is the
problem). As a general rule you should spend around 2 minutes brushing,
but quality is more important than quantity.
Use a Waterpik at Least Once Daily
The first place plaque forms is around the gum-line and
between teeth. Additionally, the areas between teeth
aren’t self-cleansing (your cheeks and tongue rub a little
the on exposed smooth surfaces of teeth brushing off
plaque to a certain extent). Therefore, the most important
place to clean is between your teeth.
Floss has long been the standard for cleaning the
surfaces between your teeth. It is relatively cheap,
and it works well when used. However, even though
floss glides extremely well along smooth, convex
surfaces to remove plaque, it actually does a poor job
Flossing a concave surface
at removing food between teeth. Additionally, not
every surface of your teeth is convex, and floss may
not be able to reach all the way to the bottom of the pockets between your
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gums and teeth where bacteria collect. This means there are often areas
between teeth where floss can’t do its job.
Since a waterflosser like Waterpik uses a
pressurized stream of water to wash away plaque,
you can clean wherever you can point it. Its cleaning
ability is not limited by concavities that may be
present on tooth surfaces between teeth, and it is
also able to flush out completely the pockets
between your teeth and gums. Refreshing these
“gingival pockets” has the added benefit of helping
to raise the pockets’ redox potential (chemistry
term), which in turn will inhibit growth of bacteria
that cause gum disease.
Another interesting benefit of using a waterpik is that you will not cross
contaminate one pocket with bacteria from another, which can happen with
floss (its why you wind it around your fingers to a fresh piece after flossing
one area). Not every pocket has the same bacteria, and some strains of
bacteria are nastier than others. The potential for cross contamination
becomes much more relevant in cases of serious gum disease, but its still
nice to know.
Although using a waterpik everytime you clean between your teeth would
be tremendous, it often is not practical. For best results use the waterpik at
least every night as part of your cleaning routine to flush out the plaque you
might have missed with flossing during your morning cleaning. I really like
the classic waterpik attachment on high pressure, which when used as
instructed really gets the job done.
Clean Between Your Teeth Before
You Brush
The major benefit of toothpaste is its fluoride
content. Topical exposure of your enamel to
fluoride will embed fluoride ions in its crystal
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structure making your enamel harder to dissolve in acids. Fluoride also
helps provide an additional buffer against acids through the formation of
calcium fluoride crystals along the surface of your enamel. They act as a
reservoir of calcium and fluoride to inhibit the demineralization of your tooth
enamel when your teeth are exposed to acid. To maximize the surface area
of your teeth that is exposed to fluoride, it is best to remove all debris
between the teeth before brushing.
To enhance the topical effects of fluoride further, do not rinse with water
after brushing so the toothpaste and fluoride will continue to coat your
teeth. This is not essential if you use a fluoride rinse daily, and it can make
your mouth feel a bit soapy which is undesirable.
Clean Your Teeth Before Breakfast
and Before Going to Bed
Bacteria in the oral cavity is the major cause of
cavities. Bacteria cause decay by releasing
acids that will demineralize your enamel and
deeper parts of the tooth. These acids are the
byproducts of bacterial metabolism of
carbohydrates.
Brushing before breakfast will eliminate as many bacteria as possible
before giving them their source of nutrition. Reducing the total number of
bacteria that can produce acid in your mouth before eating will limit the
potential drop in your oral pH and the total damage done by bacteria to
your teeth. Obviously how much acid the remaining bacteria will produce
also depends on what you eat for breakfast.
If you don't like the way toothpaste makes your food taste, brush without
toothpaste by just wetting your toothbrush (you need the toothpaste for the
fluoride not its cleaning ability). Brushing without toothpaste will still remove
bacteria. If you are concerned about fresh breath, you can use a
mouthwash or even quickly re-brush your teeth and tongue with toothpaste
following breakfast if you re-balance your pH first (covered below).
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Brushing before bedtime is also essential, and likely even more important
than brushing in the morning. Your salivary flow is lowest while you are
sleeping, and if you sleep with your mouth open this will dry your mouth
further. Your saliva buffers against acids produced by bacteria and
contains proteins that inhibit bacterial growth (in addition to the many other
beneficial things that it does). Therefore, sleep is an extremely vulnerable
time for your teeth. Brushing before bed will reduce the number of bacteria
in your mouth before an extended period of reduced salivary flow.
In addition to the above reasons, brushing before breakfast and before
bedtime is also important because of circadian variations in the calcium
and phosphate concentration of your saliva. Both minerals have an impact
on the solubility of your enamel, and drops in their concentration make your
enamel easier to dissolve. Salivary calcium concentrations are lowest in the
morning before lunch time, and inorganic phosphate concentrations are
latest late at night.
Never Brush Immediately Following Meals
The pH of your oral cavity is usually lower after eating, which makes your
tooth enamel “softer” and more susceptible to
abrasion. If you brush right after eating,
Oral pH Following Meals
you might think you are doing your teeth a
favor, but you will end up removing a great
deal of your enamel by scrubbing them
with a toothbrush. If you absolutely must
brush following a meal, wait about 30
minutes for your saliva to return your oral
pH to normal or use an alkaline rinse to rebalance your oral pH quickly (covered
below).
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Use an Electric Toothbrush
Electric toothbrushes have been proven to be more
effective at cleaning than manual toothbrushes and
they help you to avoid toothbrush abrasion from
brushing too hard since they take care of the brushing
action for you. There are also many beneficial features
that electric toothbrushes offer so select one with the
features you like, some even time how long you brush
each area and monitor brushing pressure. Currently,
Sonicare has the most supporting research for its
cleaning ability.
Replace Your Toothbrush When it
Shows Signs of Matting
The traditional recommendation for toothbrush
replacement is at least every 3 months, and
some brush-heads have colored bristles to
approximate this timeframe. However, a better
indicator for replacement is when a brush-head
shows signs of matting. Matting of the bristles
reduces the brush’s ability to remove plaque.
Additionally, the frayed, matted bristles can retain bacteria and you want
your cleaning tools to be relatively clean. If you saw that Mythbuster's
episode about toothbrushes and fecal particles, you know exactly what I
am talking about.
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Use a Low Abrasive Fluoride
Toothpaste
Different toothpastes have varying grits of abrasives. While heavier grits
make your teeth "feel" cleaner they do more harm than good. Heavy
abrasives can wear at the root surface and cause stripping of the gums in
the same manner as brushing with too much force would. Additionally,
heavy abrasives remove some of the protein/enamel pellicle (like a skin for
your teeth), which helps make your teeth more acid resistant. Obviously,
your toothpaste should also contain fluoride otherwise you might as well be
dipping your toothpaste in water.
Pronamel Toothpaste is a very effective low abrasive toothpaste with
fluoride. If you want to use something else, consult our guide to toothpaste
abrasiveness, or try rubbing your toothpaste between your fingers or
chewing some between your teeth to get a sense of its abrasiveness (don’t
do this in the store). Whitening and Tartar control toothpastes traditionally
have the highest levels of abrasiveness and are best to avoid.
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Keep Your Diet Tooth Friendly
-----------------------------------------------------------------------------Limit the Frequency of Dietary Acids
and Sugars
Most studies suggest that the frequency and not
necessarily the size of sugary snacks is the biggest
factor in determining the acidic challenge presented
to your teeth. Obviously limiting your exposure to
sugary or acidic snacks to no more than once daily
makes the most sense, but this is no fun
whatsoever. There are ways to re-balance your pH and limit the impact of
acids that we will discuss.
Re-Balancing your oral pH and limiting the frequency of acidic challenges is
important for reasons other than their direct impact on your teeth. Frequent
acidic events can acid sensitize dental plaque, creating shifts in the
bacterial population toward more acid-producing bacteria. Limiting drops in
pH and even raising oral pH more frequently can encourage the growth of
more helpful bacteria which do not produce acids.
Change How You Drink Acidic Beverages
Sodas and sports drinks have pH levels of around 3, Kombucha (the
healthy organic drink) has a pH level that can be well below 3, and the pH
of wines can range from around 3-4. The lower the pH value the more
acidic the drink. To put those numbers in context, non-fluoridated enamel
will typically start dissolving at pH levels below 5.5, so you want to limit the
exposure of your teeth to acidic drinks as much as possible.
Obviously, avoiding any and all highly acidic drinks is an option, but you
can change how you drink them to reduce the amount of time the acids
spend in contact with your teeth.
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The absolute best way to
consume an acidic drink is to gulp
it down quickly instead of sipping
on it. If you are going to be
continuously drinking an acidic
beverage over an extended time
period, using a straw positioned
toward the back of your tongue
will help limit the amount of acid
that reaches your teeth. Rebalancing your oral pH (covered
below) immediately after drinking
will prevent acidic beverages from
continuing to do damage after
intake.
Shaded Areas Depict Intake of Acid Drinks
Try to avoid, at all costs, “holding” or swishing acidic drinks in your mouth. If
you going to be tasting wine definitely do it with cheese (covered below).
Eat a Protein Rich Breakfast
Starting your day off with a breakfast high in protein is
good for many reasons (energy, etc.), but it is also
great for your teeth. As we mentioned, the composition
of your saliva changes throughout the day. Since
salivary calcium levels are particularly low prior to
lunchtime, your enamel is more susceptible to acids
during this time. Eating proteins like eggs in the morning instead of toast
and OJ will give less food to acid producing bacteria and your enamel will
be safer.
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Eat Cheese with Snacks
Cheese has been shown to reduce to
drop in pH if eaten prior to sugary meals,
and also enhances the remineralization
process of teeth. Additionally, cheese is
beneficial to the health of your gums
because of proteins and nutrients that
help control inflammation.
Avoid Late Night Snacks
(~after 11pm)
Aside from the fact that late night snacks are
typically unhealthy ones, the level of total
phosphates and the level of inorganic
phosphates in your saliva is lower late at
night than throughout the day. Phosphates
have a role as a minor buffer in your saliva, and inorganic phosphates in
particular help to determine the solubility of your enamel. When the two are
at low levels not only is the buffering capacity of your saliva reduced, but
your enamel will tend to dissolve more readily in the face of acids.
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Re-balance Your Oral pH
-----------------------------------------------------------------------------Use a Baking Soda Rinse After Any Highly Acidic
Drinks, Meals, or Snacks
Your teeth are constantly undergoing cycles of demineralization and
remineralization naturally. Cavities result as an imbalance in these cycles
toward more mineral loss from your enamel.
When consuming highly acidic drinks or eating a sugary meal or snack that
will result in significant acid production and
Oral pH Following Meals
demineralization, you should not rely on
your saliva alone to correct imbalances in
pH. The process of bringing your oral pH
back to normal is far from immediate and
typically it takes about 30 minutes.
Additionally, studies have shown that in
locations where plaque is a few days old,
the pH in that area can remain acidic for
several hours (one more reason why
adequately cleaning your teeth is
important).
Since your saliva’s major buffer is bicarbonate (just like the baking soda in
your cupboard), using a bicarbonate rinse with an alkaline pH can correct a
drop in oral pH quickly and predictably. Consult our recipe to make your
own. Anytime there is a concern about the acidic nature of a meal or snack,
be safe and swish with a baking soda rinse afterwards.
An additional benefit of maintaining a non-acidic oral pH, is that you will
create environmental pressures favoring the growth of beneficial oral
bacteria over the long term. Acid producing bacteria are more suited for
growth at low pH’s, and they cannot grow as well as their non-acid
producing cohabitants at normal and alkaline pH.
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Use a Baking Soda Rinse During Periods of
Compromised Salivary Flow
Typically, demineralization of enamel is favored when your oral pH dips
below 5.5, and remineralization is favored when your oral pH above this
level. However, the exact level is affected by the calcium and phosphate
concentration of your saliva. Put simply, if there is a lot of calcium and
phosphate ions in your saliva calcium and phosphate are more likely to
stay in your enamel since your saliva is
“crowded.”
Saliva Calcium
The opposite is also true. When calcium
levels in your saliva are low in the
morning (about ! of normal), and
phosphate levels in your saliva are low
late at night your enamel is at a greater
risk of demineralizing. Therefore, after
breakfast and after a late night snack if
you choose to have one, you want to
quickly return your oral pH to neutral
with a baking soda rinse. Consult our
recipe to make your own.
If you have been diagnosed with
xerostomia, your salivary flow is
compromised (or non-existant) at all
times and you will need will need special
management of your diet and hygiene.
We’ll be covering efficient management
of dry mouth in another guide.
Saliva Inorganic Phosphates
Saliva Total Phosphates
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Supplement Your Routine
-----------------------------------------------------------------------------Chew Xylitol Gum
Chewing sugarfree gum increases
the production of saliva by 10x the
normal rate. This can be especially
helpful after meals.
Xylitol gum has the added benefit of inhibiting the growth of acid producing
bacteria. Make sure that however much gum you chew adds up to 6-10g of
xylitol chewed each day. This is easiest if you do it right after meals; it is
also most effective then. Chew enough gum so that you have have about 2
grams of xylitol after all three meals (you often have to chew more than one
piece). Xylitol has only been proven effective against cavities in chewing
gum. Also if you have too much (>14g) it can give you diarrhea, so stick to
the formula. Keep in mind children will get diarrhea with less because they
weigh less, so don’t let them have too much.
Epic Gum has about 1 gram of xylitol per piece so keeping track of how
much you have chewed is easy.
Use a Low Fluoride Mouthwash
Nightly Before Bed
Daily use of a fluoride mouthwash creates
sustained low levels of fluoride in your saliva,
likely from coating soft tissues and incorporating
into bacterial plaque (it usually takes two weeks to
reach an equilibrium concentration). Not only is
this essential to maintain the strength of your
enamel, fluoride does have mild antimicrobial
effects on acid producing bacteria.
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Although the end goal of fluoride products is to form fluoridated enamel, the
initial product under most conditions is a coating of calcium fluoride (as well
as some calcium hydroxide) on the surface of your enamel, and it serves
as an intermediate in the fluoridation process. Low levels of fluoride in your
saliva from daily use of a fluoride mouthwash are essential to make calcium
fluoride, and naturally fluoride, available on the surface of your enamel. The
calcium fluoride coating acts as a reservoir of calcium and fluoride and will
allow the natural conversion of non-fluoridated enamel to fluoridated
enamel during typical daily variations in oral pH. This also means that the
negative effects of acids on your teeth throughout the day will be reduced.
Your best bet is to use ACT Restoring Mouthwash. Although it has a slightly
acid pH (6.6), which is not completely ideal, it isn’t terribly acidic and most
mouthwashes are much more acidic since it helps with shelf-life. You won’t
be creating the same favorable environmental pressures on oral bacteria
that your alkaline rinses will produce (pH ~8.0), but the benefits of
sustained fluoride release are significant.
Rinse with before bed when salivary calcium is high and salivary phosphate
is low. These conditions are most favorable to formation of calcium fluoride
on the surface of your teeth, and create a “loading dose” of calcium fluoride
for your teeth.
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Whiten Teeth Smarter
-----------------------------------------------------------------------------Do Not Whiten Teeth Too Frequently
While white teeth are often associated with healthy smiles and will increase
your self-confidence, frequent whitening/bleaching is not necessary to
maintain your sparkly whites.
Studies have shown that color stability from at-home tray bleaching and
Crest White Strips typically lasts between 6-12 months.
It is important to keep in mind that ‘whitening’ and ‘bleaching’ products do
fundamentally different things, and that whitening/bleaching when it is not
necessary does more harm than good.
• True bleaching agents penetrate the tooth's enamel to alter the tooth's
color in the dentin layer beyond its natural shade and usually contain either
carbamide peroxide or hydrogen peroxide. They can cause alterations in
the outer enamel surface when overused (this is more evident if using
concentrations above 10% carbamide peroxide). Although this may actually
enhance the whitening effect, it is probably not all that good for your teeth
(it hasn't been evaluated long term, which is why the ADA recommends
only 10% carbamide peroxide solutions). Bleaching agents can also
cause sensitivity, and this is related to dose.
• Whitening agents are not the same as true bleaching agents. They only
affect stains embedded in the enamel pellicle (the protein skin of your
teeth) and do nothing to alter a tooth’s base color. They typically depend on
abrasives and acids to removing stains, and although they will make your
teeth appear whiter the acids and abrasives will wear away at your enamel
if frequently used.
• Additionally, both whitening and bleaching agents alter the enamel pellicle
and will temporarily decrease the acid resistance of your teeth. Ironically,
polyphenols, the molecules in coffee, tea, etc. that are responsible for
stains on the outside of your teeth modify your enamel pellicle to make your
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teeth more acid resistant and also have antimicrobial properties (ever
wonder why people on national geographic with really stained teeth don't
have cavities).
To responsibly whiten your teeth, take at least 2 months off between
treatments (ideally 6-12 months off), avoid Whitening Toothpastes, and opt
for whitening products provided by your dentist whenever possible.
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See Your Dentist
-----------------------------------------------------------------------------Regular Check Ups are Essential
The health of any fillings and sealants should definitely be monitored and
maintained, Your dentist also has special tools to remove any tartar/
calculus with minimal collateral damage to the teeth, medicaments to
manage other special conditions, and is equipped to thoroughly cleanse
any tricky tooth morphology which may require occasional maintenance.
Even if you are completely filling-free, your dentist is still the best person to
monitor and maintain your overall oral health. They also are needed to
provide you with the most effective upkeep of tooth whiteness and enamel
fluoridation.
• A carefully controlled, slightly acidic environment with significant available
fluoride concentrations, is needed to favor replacement of existing layers of
non-fluoridated enamel with harder fluoridated enamel. This controlled
reaction is most effectively achieved at your dentist’s office after an
extremely thorough cleaning (to avoid acid-sensitization of existing
bacteria). Additionally, acidic fluoridation is not needed frequently.
Maintenance of low levels of fluoride in the saliva by using a fairly neutral
(or better still alkaline) low fluoride mouthwash once a day will avoid acidsensitization of bacteria, and allow formation of calcium fluoride on the
surface of your teeth. The calcium fluoride reservoir will then promote a
natural conversion to fluoridated enamel during daily variations in oral
pH,and maintain the fluoridation of enamel that you receive at the dentist’s
office.
• In-office dental bleachings, and bleaching products available in at-home
kits from your dentist, provide the greatest long-term color stability. Better
color stability reduces the frequency with which you need to refresh the
whiteness of your smile. Less frequent whitening is healthier for your
enamel and it allows you to retain the acid resistant benefits of your enamel
pellicle.
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For More Amazing Guides &
Oral Health Answers Visit Us
@ www.freysmiles.com/blog
the
FreySmiles
Oral Health Network
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