Patient Hygiene

Which toothbrush to choose?

Select a toothbrush with a small head; this will make it easier to reach the inside of the tooth, the wisdom teeth, and behind the back teeth. The bristles should be soft, thin and rounded so that they can reach larger areas of the tooth, especially between the teeth and at the gum line. Soft bristles are also gentle on the gums and on the neck of the tooth.

Brush your teeth gently. It is difficult to damage the enamel, but the dentine (a type of bone that makes up the majority of the tooth) that lies beneath it is not as resistant to overenthusiastic brushing with a hard brush. The gums are also very sensitive, and require gentle brushing with a soft brush. Use small, circular movements when brushing. Try to turn the toothbrush so that the bristles move below the gum line with each movement, removing the plaque from the tooth necks. Try to cover the whole surface of each tooth in this way, especially the places you might have missed before.

Harsh brushing with a foaming toothpaste may give you the impression of freshness and cleanliness, but this is far from the truth. Toothpaste plays a very small part in proper cleaning, and is mostly used for its fresh feeling. It is the mechanical action of cleaning that is most effective in maintaining your dental health. Avoid whitening toothpastes – they are too abrasive and have a minimal effect, and often cause tooth sensitivity.

Use a pea-sized amount of toothpaste when you brush. This is plenty, and the reduced foam will allow you to see better what you are doing.

For patients with gum problems

Gum disease (periodontal disease) is the most common cause of tooth loss in adults. Periodontitis is a chronically infectious inflammatory disease of the tissue that attaches the tooth to the bone. It is the cause of 70% of tooth loss in adults, and affects 3 out of 4 patients.

What causes periodontitis?

Bacterial plaque, a sticky, colourless film that is constantly generated on the teeth, is the major cause of periodontal diseases. If this plaque is not removed daily by brushing the teeth, it hardens to form a rough, porous substance called calculus. Toxins that produce and release bacteria in the plaque irritate the gum tissue, and cause decay underneath it, creating periodontal pockets that encourage the further accumulation of bacteria. As the disease progresses, the periodontal pockets become deeper, and bacteria move towards the root, destroying the bone and loosening the tooth.

Which other factors can cause periodontal disease?

These can be genetic, or related to lifestyle. Poor nutrition can lower immunity, as can stress. Smokers and users of other tobacco products are more susceptible to irritation of the gums. Gum disease occurs more frequently in patients with uncontrolled diabetes, and in these cases it is often more difficult to treat.

What are the warning signs of periodontitis?

Sensitive and swollen gums, bleeding during tooth brushing, separation of teeth and gums, pus between the teeth and gums, constant bad breath, changes to the bite, and changes to the spacing between teeth are all warning signs.

How is periodontitis treated?

In its early stages, treatment mainly consists of removing the supragingival (above the gums) and subgingival (below the gums) calculus, and polishing the surface and root of the tooth. Various oral antiseptics can be used to enhance this treatment. In its more advanced stages, a more aggressive surgical procedure may be required to save the remaining teeth. In these cases, patients will be referred to a periodontal specialist.

How canperiodontitis be prevented?

By the removal of plaque through daily brushing and use of dental floss, and regular visits to the dentist to remove calculus.

How important is maintenance of dental hygiene?

Patients should visit their dentist at least every 3–4 months for polishing, removal of calculus, and a general check-up. Teeth should be brushed and flossed at least twice a day. The tongue should also be brushed.

For patients with mobile prosthetics

Patients who wear complete or partial mobile prostheses may be susceptible to prosthetic stomatopathy. If this occurs, make an appointment with your dentist, and do not wear your prosthesis in the meantime. Rinse your mouth with a mild bicarbonate solution and sage tea.

For children

Parents often ask when the best time is for their child’s first visit to the dentist. This should be when the child is between 12 and 18 months old, so that he or she can become familiar with the practice and the dentist. The development of baby or milk teeth begins in utero, so the parents are the first to impart knowledge, advice, and good oral hygiene habits to the child. Some parents unconsciously work against their child’s teeth by allowing excess consumption of sweets and sugary drinks, and not observing proper oral hygiene after meals.

Children are not forbidden from drinking soft drinks, or eating chocolate or other sweets, but it is important that they brush their teeth afterwards. The milk teeth should be cleaned as soon as they erupt. This means wiping them with sterile gauze, and later brushing them with a child’s toothbrush (these are categorised by age) and a pea-sized amount of toothpaste. At this stage, parents play the most important role, as they usually brush their child’s teeth until the end of the 5th year, and supervise brushing until the child is 9. Only after that are children ready to brush their teeth independently. For the prevention of caries and the identification of carious lesions, children should have a regular dental check-up every three months, including fluoridation of the teeth. One of the biggest mistakes parents make is to assume that milk teeth are “not important”, because they will fall out and be replaced by permanent teeth. They allow the milk teeth to develop caries, which lead to complications including pain and swelling in the area of tooth decay. Most frequently, a child’s first visit to the dentist is to seek help in these painful situations, which can be traumatic both for the child and the dentist. To avoid this, a child’s first dental appointment should be made before problems occur.

During pregnancy

Because the development of a child’s teeth begins in utero, it is important to educate future mothers about dental care and oral hygiene during pregnancy. As well as worrying about her own teeth, a pregnant woman should think about her baby’s dental health.

The foundations for milk teeth are created in the 6th week of pregnancy. To ensure healthy development during this process, the mother should follow a balanced diet, supplemented with vitamins and minerals. Dairy products are particularly important, as calcium is vital to the growth of healthy teeth and bones.

In some cases, hormonal changes during pregnancy can cause bleeding of the gums. This is completely normal, and should not be a cause for concern. Simply use a soft brush, and brush the teeth and gums in a gentle circular motion. The mouth can be rinsed with sage tea, which is an excellent mild herbal disinfectant.

Many women experience nausea and vomiting during pregnancy, which exposes teeth to harmful stomach acid. If this occurs, you can rinse your mouth with water, but do not brush your teeth for an hour after vomiting. After this time, you can brush them with a soft toothbrush, and, if you wish, a toothpaste with a slightly higher fluoride content.

Future mothers should have regular check-ups, and dental interventions where necessary. RTG imaging should not be performed at this time, because iodising radiation is proven to cause harm to the unborn child, but visits to the dentist should not be avoided during pregnancy.

We recommend the use of fluoride supplements (NaF – 1 mg) from the 16th week of pregnancy, but only after consultation with a gynaecologist.