With NHS treatment becoming increasingly scarce, Esther Walker highlights the simple steps you can take to help keep your mouth healthy - and avoid all the pain and expense
Brushing: Most tooth decay is a result of insufficient brushing or poor brushing technique. "You should brush at least twice a day," says Janet Clarke, a member of the executive board of the British Dental Association.
"I recommend after breakfast and last thing at night. You need to do it for at least three minutes, which is much longer than people think it is. In areas where there isn't fluoride in the water, it can be a good idea to just spit out the toothpaste but not rinse with water, so that there is a thin coating of fluoride from the toothpaste over the teeth left overnight.
"A lot of people use too much toothpaste. They're encouraged by adverts that show a huge glob of toothpaste on the brush. But actually, most of it goes down the plughole. It doesn't do anything better for you and it's a waste of money. All you need is a pea-sized amount, or even a smear. We tend to recommend a fluoride toothpaste, but other than that, the kind of toothpaste is really up to the individual. All that matters is that you don't choose a paste that makes it unpleasant to brush your teeth. Children can dislike some of the very strong-flavoured mint pastes."
Perhaps even more important than brushing regularly, Clarke says, is brushing properly. "Sawing backwards and forwards is not good - it can develop ridges on the teeth and if you brush too hard, you can cause your gums to recede, which is quite hard to treat and can cause sensitivity. The right way to brush is in circles. To help, divide your mouth up into sections and brush methodically so that you don't miss anything out. The area where the gums meet the teeth is where most plaque collects and does the most damage, so that's a key area. But you mustn't brush too hard or you will damage the gums."
A toothbrush with a large head might seem as if it will do twice the work in half the time, but alas not. "A toothbrush with a small head is best," Clarke says. "A lot of people use a brush with a very big head and I'm not sure why but it's not very effective. There have been lots of tests about the effectiveness of electric toothbrushes - they are more effective than manual brushing, but only if they are used in the right way. Not used properly, they're no better than not-very-good manual brushing."
Toothbrushes need to be changed every three months, definitely before they become tatty. "If your toothbrush is splayed out at the sides, it may be that you are brushing your teeth too hard."
Who hasn't lied to their hygienist about how much they floss? Let's face it, it's pretty boring. But you should really give it a chance, Clarke says. " I am a big fan of flossing, and I think there are lots of benefits. Most people don't like doing it because they have a bad initial experience and then don't want to do it again. Often, they start off with dental floss rather than waxed dental tape. The floss shreds between the teeth, and they saw away at their gums until they bleed, and then understandably think, 'That was horrible, I don't want to do that again'.
"Actually, flossing should be done quite gently. You should wrap the tape between each thumb and forefinger of both hands and then ease it, rather than jam it, between the teeth, and wrap it around each tooth and move the tape gently from side to side, so that you are cleaning the surface area where the teeth meet each other.
"Another mistake people make is to miss out the teeth further back because they're harder to get to. But it's because they are harder to get to that it's important that they are cleaned. That's where you do most of your chewing and where all the food gets stuck."
Mouthwashes are used for two different reasons: to prevent bad breath and to kill plaque (or prevent its build-up). Mouthwashes became popular in the 1960s after a doctor in Denmark discovered that a chlorhexidine compound could prevent the build-up of dental plaque. Since then, the mouthwash market has capitalised. Most brands contain all sorts of active ingredients that claim to reduce plaque build-up. Many also include such a hefty amount of alcohol that it is possible to fail a breathalyser test after rinsing with them.
"Some of the mouthwashes with fluoride are very good, and there are some fantastic mouthwashes available," Clarke says. "However, you shouldn't make the mistake of thinking that they are a substitute for brushing and flossing. Most mouthwashes are useful for making the breath fresh, which is a good thing - it's all part of the grooming process."
Since sugar-free gums came on the market, directly advertised as being good for your teeth, people are chewing with impunity. But as well as costing councils millions of pounds to remove from pavements, chewing gum is controversial as an essential dental health product. "Some gums are helpful, as long as they are sugar-free," says Clarke. "Although, again: chewing gum isn't a substitute for brushing. The gum works by triggering the production of saliva, which neutralises acid in the mouth, so the most effective time to chew gum is just after eating. But it's questionable as to how nice a habit chewing gum is."
Most sugar-free gums are sweetened with xylitol, a sweetener made from birch trees. Some people believe that it can actively help repair minor cavities.
It is generally received opinion that sugar is the worst thing for your pearly whites. It converts in the mouth to acid, which attacks the teeth. " During the Second World War, when sugar and sweets were rationed, the dental health in the country improved enormously," Clarke says. "The population of the island Tristan de Cunha in the South Atlantic had no access to sugar before it was discovered by the West, and they had perfect dental health until they started eating sugar. So it can't be emphasised enough, the impact of sugar on the teeth. And there is sugar in all sorts of unexpected things, like baked beans, breakfast cereals and processed food. A lot of people say that they don't eat any sugar, but what they mean is that they don't eat sweets. There might be a lot of sugar in their diet from hidden sources they aren't aware of."
If you do have a really sweet tooth, the best time to eat sugar is at mealtimes, when you have already been producing a lot of saliva, thus neutralising the acid from the sugar. And if you want to eat an entire bag of toffees, it's less damaging to eat it all at once than over a long period of time.
"Dentists are always the ones telling their children at Easter to eat their eggs all in one go, although that's not necessarily very healthy," Clarke says. The worst thing you can do is eat a series of sweets (sticky ones are the worst because they get stuck between the teeth) in 20-minute intervals, because the pH of your mouth is raised to acidity for 20 minutes after eating something sweet. "Things like apples are technically acidic and contain a fruit sugar, but I would never knock eating apples," Clarke adds.
As well as damaging your nervous system and your wallet, it seems that prescription and recreational drugs can damage your teeth, too.
"There are three reasons why I can see that drug-taking can cause problems with your teeth," Clarke says. "The first is that that some drugs, including Ecstasy, dry the mouth out. If there is a lack of saliva then the acid in the mouth isn't neutralised. Second, some drugs can make you crave sugary food - and the combination of sugar and no saliva to neutralise it is bad. Third, if you are taking a lot of recreational drugs, it could just be the case that you're not really in the mood to brush your teeth carefully twice a day.
"But there are also some prescription drugs, such as anti-depressants, that can cause a dry mouth. Sometimes people who get that are recommended to suck polo mints, which is a disaster for their teeth if the polos aren't sugar-free."
Cocaine also dries the mouth out, and when rubbed on the gums can erode the enamel. Both heroin and cannabis cause sugar cravings. Methamphetamine, or speed, is very acidic and cause rapid tooth decay. This last has even led dentists to coin a term: "meth mouth".
Fluoride is the only supplement that has been shown to improve dental health. "Once your teeth have grown and they are outside the gums, doing things like taking calcium supplements or drinking lots of milk are pretty redundant," Clarke says. "If you have a proper calcium deficiency, it will be obvious long before your teeth are affected."
Fluoride is a form of fluorine. It is added to toothpastes and mouthwashes because it increases the resistance of enamel to decay. Water fluoridation in the UK started in the 1960s following successful trials showing an improvement in the oral health of children.
In 2003, a law was passed obliging all water companies to fluoridate their water if asked to by the Strategic Health Authority. At the moment, not all areas of the UK receive fluoridated water. Maps of the concentration of fluoride can be obtained from the Department for Environment, Food and Rural Affairs. Adding fluoride to public water supplies has been controversial, as there were arguments that over-exposure to fluoride causes bone cancer.
Fluoride is available in tablet form, but even if there is little or no fluoride in your local water supply, as long as you are using a fluoride toothpaste there shouldn't be a need to take a supplementary tablet unless advised.
The holistic market advises against using commercially bought dental products, such as flosses, toothpastes and mouthwashes, as it believes that they are contaminated with all sorts of nasties: mercury and petrochemical-based wax in dental flosses and tapes; parabens (a preservative) in toothpastes; isobutene in mouthwashes.
One alternative to store-bought floss is 2-4lb monofilament fishing line. You can also make your own toothpaste and wash (see below). For the complete green experience, buy a recycled toothbrush. The company Preserve makes toothbrushes that are both recycled and recyclable, and are available for ?2.99 from www.victoriahealth.com.
The way to a natural smile
Make your own toothpaste
25ml or 2 tbsp vegetable glycerine
50ml or 4 tbsp of bicarbonate of soda
Five drops of an essential oil such as peppermint, lemon or fennel
Shake up the mixture and store it in a jar or ina squeezable bottle from a chemist. While the essential oil used will act as a natural preservative, it is best not to make more toothpaste than 75ml at a time.
Make your own mouthwash
1 tbsp lavender tincture
1 tbsp calendula tincture
2 tbsp aloe juice
2 tbsp cooled boiled water
2 tbsp vegetable oil
5 drops peppermint essential oil
The mixture will keep for up to six months. Gum infections can benefit from substituting echinacea, myrrh or goldenseal for the lavender.
(Source: What's In This Stuff? by Pat Thomas)