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General advice for cleaning teeth: rotation of cleansing routines

It may be useful to vary and rotate the "cleansing diet" you treat your teeth to. One reason is that you can observe how your own teeth respond to each treatment (teeth vary in their strength and other characteristics from person to person, and even "from time to time"), and thus find out by trial and error what works best for you. Another reason is that in this manner, you will (hopefully) ensure that the various cleaning/antiseptic agents applied actually continue to work.

This is based on the observation that noxious bacteria can develop resistance (apparently, even the body develops resistance to normally beneficial items if these are taken regularly), i.e. bacteria can learn to adapt to various (normally antibacterial) solutions. This is of course most true for substances produced in a laboratory based on precise chemical formulas - the consistency of their chemical constituents facilitates adaptation on the part of the pathogens. In contrast, natural essential oils extracted from plants will differ from batch to batch because like plant food, their exact chemical composition will vary according to the constantly changing environmental conditions under which the plants developed and were harvested. Still, "your" bacteria might develop resistance while you are using the same batch (of say tea tree oil). So personally, as a precautionary measure, I rotate what I use for cleaning my teeth (thankfully there are many natural agents available).

A third reason for rotating what one uses is that eg with any natural tooth cleaning methods which might be slightly abrasive, teeth may eventually suffer if used beyond what is helpful (plaque removal) to the point where the enamel is damaged.7

Unprotected teeth with damaged/dead pulp are the most important ones to keep clean

Should the pulp of one or more of your teeth have been damaged by physical or chemical trauma incl. any dental treatment5, it's possible that its centrifugal "dentinal fluid pump" doesn't work properly or not at all. This opens the tooth to ingress of foreign substances and makes it particularly urgent to meticulously clean and disinfect the tooth from the outside since its inbuilt self-defense mechanism has been obliterated.6

Interstitial cleaning to remove bacterial coatings from the crevices between adjacent teeth

There are several theories regarding the question where caries (tooth decay) actually starts, with the two major contestants being the "endogenic" versus the "bacteriogenic" theory of cariogenesis1,6,: one of the latter maintains that tooth decay begins between the teeth, in spots where food rests can't be removed by brushing and which subsequently fall prey to bacterial activity and their acid waste products.

In fact according to the German Stiftung Warentest magazine, a whopping 40% of the total tooth surface is located between the teeth.

Here the oft-recommended flossing comes in for which various floss products are available. (Please note however that Dr. Hulda Clark for instance warns against commercial floss varieties and writes in this context: "Don't use floss; use 2 or 4-pound monofilament fish line2. Floss has mercury antiseptics (with thallium pollution!.")

"Renegade dentist" Dr. Nara for one is an adamant proponent of religiously applied proper daily flossing as the only way to prevent deterioration of already compromised (or still healthy) teeth (see his book How to Become Dentally Self-Sufficient).

On the other hand, systematic reviews of research studies seem to point to benefits derived from flossing to be so small as to be "barely noticeable".8

One disadvantage of flossing is that it can make your gums bleed which will introduce mouth bacteria into your bloodstream (i.e. spread infection, a characteristic it shares with any "invasive" procedure causing mouth bleeding). In fact there are "alternative" dentists who are quite wary of flossing, especially when done on a constant basis and/or when combined with vigorous toothbrushing which can hurt both teeth and gums. In the worst-case scenario, the contacts between the teeth will be loosened and the gums between the teeth will start disappearing, visible as an apparently "black triangle" between the teeth. Particulary those with already compromised gums would be well advised to use less invasive ways of cleaning their mouth.

To help clean between teeth, alternatively one can use an oral irrigator such as the Waterpik, special interstitial brushes (interdental brushes) or a toothbrush such as the Perio toothbrush whose bristles are specially designed to be able to penetrate between the teeth (although I don't think the latter will/can remove all interstitial deposits). Interdental brushes are small, available in different widths and will clean between adjacent teeth (be careful to avoid forcing the brush into the crevices - the same caveats apply as above under "Flossing"). Failing all the foregoing, in my experience, repeatedly straining water through all my teeth and/or particularly oil pulling will powerfully dislodge much/all debris from inbetween the teeth.

If you have the discipline, floss and rinse your mouth after meals. In fact, an interesting testimonial to the potential power of flossing (and rinsing) found at Amazon relates the experience of a woman who "had a mouth full of bad teeth" for her first 20 years. She then started flossing twice a day and rinsing her mouth after meals. This effectively eliminated all her cavities 40 years ago. (Later she also began upgrading her diet and using only natural products to clean her teeth such as baking soda for toothbrushing, oregano oil3 on her gums, and Vademecum (a mostly herbal product) and occasionally hydrogen peroxide4 as a mouthwash.

Even more effective than rinsing with water can be "rinsing" with xylitol.

Cleaning your tongue

The tongue can harbour many bodily excretions which as hinted at by their smell, aren't healthful for the body. One can gently remove these layers by getting a specialised tongue scraper or cleaner (which reaches far back to the tongue's root and is available online or in health food stores etc.), but simpler implements (such as a tablespoon or your toothbrush) will help keep your tongue clean as well. In a pinch or hurry, even your own teeth or fingers can help cleanse part of your tongue. Ayurveda, the world's oldest known healing system, also stresses the importance of tongue cleaning as a daily practice.

Interestingly, as proven by scientific studies, the tongue can be swarming with "caries bacteria" (cariogenic pathogens) such as streptococcus mutans. See for instance "The effect of tongue scraper on mutans streptococci and lactobacilli in patients with caries and periodontal disease" at www.ncbi.nlm.nih.gov/pubmed/16032940 and "Tongue scraping as a means of reducing oral mutans streptococci" at www.ncbi.nlm.nih.gov/pubmed/14969377?dopt=Abstract.

The first study (published in "Odonto-stomatologie tropicale" in March 2005) showed a significant decrease in salivary levels of streptococcus mutans and lactobacilli after twice-daily tongue scraping for a period of time, with the added bonus of reduced bad breath. The second study (published in the Journal of Clinical Pediatric Dentistry in winter 2004) aimed at determining the most effective oral hygiene technique for reducing streptococcus mutans counts, with the three treatment options investigated being tongue scraping, rinsing for 30 seconds with a saline solution (salt water) or applying a listerine strip, respectively. Surprisingly (or not), the winner was tongue scraping, with salt water rinses coming in second and the least effective hygienic measure being the listerine strip.

Studies such as the above really bring it home just how important it is to clean one's tongue.

Overbrushing causes enamel damage

Beware of too much of a good thing. You can damage your enamel and possibly gums by brushing too often (even with an electric toothbrush) or using a brush whose bristles are too hard too vigorously, leading for instance to your teeth becoming sensitive. Similarly, even natural materials used for cleansing purposes may be too abrasive if overused or if your teeth are "delicate". Don't be fooled by the seeming hardness of your teeth and observe them to see whether they are of the stronger or weaker variety. One clear indication of weaker enamel can be incisors that are flattened (abraded) at the tip (unless you eat large amounts of hard food). Be particularly careful to avoid hard brushes when you find that your teeth are indeed of the weaker type.

That said, teeth of course can both be weakened and strengthened, such as via diet etc.

Avoid brushing immediately after contact with acidulous foods or drinks, simply rinsing your mouth with clear water may be best (and perhaps adding some baking soda to raise pH). The same may be true after eating sugary foods. If you have them available, xylitol products may be very helpful, and one of the best practices after eating "forbidden" foods is rinsing with xylitol sugar.

Check for "coated" teeth in the day

Teeth becoming blunt such as after a snack or meal signify the action of many bacteria busying themselves with home (plaque) building on your teeth (and/or are the result of an "acid attack"). So after meals in particular, run your tongue over your teeth to see how they feel. If they feel smooth like porcelain, you should have no bacterial plaque buildup. If they feel blunt or furry, however, do one or several of the things suggested here until your teeth do feel smooth again. Combined with flossing, this is "principiis obsta" (resist the beginnings) since tooth decay can thus be halted where it often begins.

Brushing teeth in the morning vs. night

It makes less sense to brush in the morning since typically, there will be no new plaque buildup overnight. Generally, mornings call for a good rinse and tongue cleaning only, as appropriate. Cleaning your mouth of food rests and plaque buildup before bed however is important since otherwise, bacteria will have free reign to multiply while you sleep, when no proper salivary flow interrupts their feeding on food remnants in your mouth.

Xylitol, one of the best dental cleaning agents

Using xylitol or xylitol products is particularly convenient if you snack at times when you are unable to clean your teeth or tongue. See Xylitol, the miracle sugar and Rinsing and brushing teeth with xylitol has healed periodontal disease and tooth decay. Xylitol rinses have even been used as an effective stand-alone dental hygiene treatment before bed.

Footnotes

1 Compare eg Dr. Herbert Shelton on the true causes of tooth decay.

2 Personally I use simple thread when I do floss.

3 Compare the notes on oregano oil under Natural toothache remedies: Herbs and plants for pain relief

4 Compare the warning re hydrogen peroxide under Healthier ways to brush your teeth.

5 See Drilling & filling teeth: an unwise choice?.

6 For detailed background explanations, see Dentinal fluid transport theory of caries resistance.

7 The true danger still might only be lurking in conventional toothpaste, see Toothpaste abrasiveness index and Toothpaste: hazardous to dental and bodily health?.

8 See e.g. http://bigstory.ap.org/article/f7e66079d9ba4b4985d7af350619a9e3/medical-benefits-dental-floss-unproven .

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