There are many issues people can tolerate about their friends but bad breath can never be one of them. To the dismay of the sufferers, the realisation of the problem takes long and that is after experiencing several incidences of rejection from the society. But why would oral hygiene remain a challenge in an era where everyone can afford to own a toothbrush?

It is a fact that many people brush at least once every day, according to Epimak Kayiranda, a dentist at University Teaching Hospital in Kigali, but the bigger problem lies in the way people do it.

"Most people brush their teeth, at least every morning, but the way they do it is not good enough. Some rush through the brushing process while others use poor quality toothbrushes,” says Dr Kayiranga.

The dentist also recommends that proper brushing should last a minimum of two minutes if all the plaque is to be removed. Unfortunately, most people who brush in the morning do so hurriedly only to leave food particles in the mouth.

"Complete removal of these particles requires a certain pattern of brushing. It should be an up and down pattern on the upper teeth, and down to up for lower teeth, which helps to remove all food particles trapped between the teeth,” he adds.

Most dental experts, therefore, believe that being defective in such practices is the source of bad breath and other oral problems around the world.

Why Oral problems are common in developing countries

Oral problems such as gingivitis (inflammation of the gums) are common among adults, especially in developing countries, according to World Health Organisation. This is because limited access to oral health services forces people with bad teeth to stay with them untreated or have them extracted.

Several studies have also shown that people rarely consult dentists on top of the poor patterns of brushing.

Brushing after meals is supposed to help remove food particles before they form layers on the surface of the teeth, but it is nearly impossible that every time someone eats, they will brush.

Dr Archile Manirakiza, a trainee in clinical oncology in Tanzania, explains that it is worsened by the food sticking in the gaps between teeth and on the surface of the tongue.

"If it is not removed, it is this mass that provides the necessary nutrients for bacteria colonization which eventually causes oral problems,” he says.

Although most people consider the mouth to be the cleanest part of the body, Dr Manirakiza is fast to point out that it contains more germs than any other part of the body.

"It is these organisms that get involved in a number of reactions when someone overlooks oral/dental hygiene.

The risks are many, ranging from simple infections to irreversible damages and dental caries, among others,” adds Dr Manirakiza.

Bleeding gums and dental decay

Poor oral hygiene does not only stop on infecting the teeth but gums that are improperly cleaned constantly bleed from infections.

Dr Rachna Pande, an internal specialist at Ruhengeri Hospital, explains that when the gums contract infections they swell and become painful.

"Without proper oral hygiene individuals risk a combination of swelling, pain and toothache, which can even result into other complications,” says Dr Pande.

Another growing concern is that while losing teeth should only be a result of natural consequences like ageing, the trend is changing because of poor dental health.

As a result of weakness, infected teeth may fall off because sometimes the roots holding them deep into the jaw are eaten away by anaerobic bacteria or corroded by the acid from the fermentation of sugars.

Proper care for teeth

While many people prefer to brush teeth in the morning, Dr Pande also emphasises that food residues from night meals provide breeding ground for infections such oral fungal infections, pharyngeal infections and even sepsis.

"It is important to clean the teeth at least twice daily; one time preferably before going to bed,” she adds.

Dentists also warn that using toothbrushes for long, especially those that have worn out bristles, is very dangerous for teeth.

They instead suggest that brushing should be combined with flossing to keep the teeth very clean and avoid bad breath.

"Even when you practice the best methods of cleaning teeth, a tooth brush with worn out bristles will let you down. An old toothbrush is not different either. The only helpful thing is if flossing is done regularly as it helps to remove trapped food particles, bacteria and debris from teeth,” says Dr Kairanga.

Flossing is recommended at least 3-4 times per week, and it should be followed by rinsing. It is good to rinse the mouth thoroughly after each meal to remove food particles sticking on the teeth, he adds.

Although most people rarely notice dental problems at an early stage, several studies show that good nutrition and proper oral hygiene practices keep teeth free from cavities.

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