You probably brush your teeth at least twice a day, you are also cautious about what you eat, and even limit sugary foods or beverages, just to keep your teeth strong. To your surprise, during a dental check-up, the dentist says your teeth require proper cleaning as you risk getting infections or worse. So, what are you not doing right? 

Dr Roger Anamali, a dental surgeon in Kigali, says that some people use a stiff bristled toothbrush, believing that more abrasion will make brushing more effective. 

"This is wrong! In fact, it is best to avoid toothbrushes with hard bristles, as these damage your teeth and gums,” he says.

He adds that toothbrushes with soft bristles allow more efficient brushing, as they help better dislodgement of plaque and food debris, squeeze slightly under the gum and between the teeth, and adapt easily to the rounded shapes of each tooth.

"When you’re in a hurry, brushing quickly by exerting strong pressure on your toothbrush is ineffective. Indeed, to give the toothpaste time to work and to properly clean all areas of the teeth, brushing your teeth should take at least two minutes.  To make sure you’re brushing long enough, don’t hesitate to use a timer,” Dr Anamali says.

He says that pressing hard on the toothbrush when brushing wears down the gums and leads to loosening of the teeth, as well as tooth sensitivity. Sooner or later you may need a gum draft (a type of dental surgery performed to correct the effects of gum recession) or you may lose teeth.  So take it easy, brushing should be done with very light pressure.

How to ensure effective oral hygiene

Dr AbduKadir Mamataliev, a dentist at Deva Medical Center-Nyarutarama, says that many people forget, or do not brush their tongue, but brushing the tongue is a very important step in the dental hygiene routine. 

It removes built-up bacteria and prevents bad breath. Many toothbrushes have a tongue cleaner on the opposite side of the bristles, which makes it easy for tongue cleaning. You can also invest in a tongue scraper for more thorough cleaning.

Dr Mamataliev says, even though flossing is everyone’s least favourite part of their dental routine, it is a must. Flossing removes built-up tooth-decaying bacteria, food particles, and plaque that can linger in-between teeth, even after you have brushed them. Flossing also helps to remove particles from your gum line that can cause irritation, redness, and swelling.

"Some people store tooth brushes improperly. You are probably one of the millions of people that store their toothbrush in the bathroom near the toilet. Every time you flush your toilet the contents of the bowl splash in all directions, including your toothbrush. Keep your toothbrush away from your toilet. Consider storing your toothbrush in your medicine cabinet or bedside table. Make sure the toothbrush is not in an airtight container, as this can cause bacteria to grow more rapidly,” Dr Mamataliev says. 

Dr Anamali warns against keeping your toothbrush for too long. He urges change of toothbrush every three months, or more often if its bristles are damaged, to keep it as effective as possible.  After this time, the bristles may be blunt, reducing their effectiveness.  A new toothbrush removes more plaque than a used one.

Also, care to rinse the bristles of your toothbrush after each brushing and store it upright to avoid the proliferation of bacteria, he adds.

Dr Anamali says that you shouldn’t brush immediately after eating as it is advisable to wait a while after finishing your meal, because when we eat, the bacteria on the surface of the teeth produce an acid that temporarily softens the enamel.  Thus, it is best to wait for the pH in the mouth to stabilise.  While waiting to brush, simply rinse your mouth with water.

Dr Anamali also suggests not to make horizontal movements when brushing. Many people brush their teeth using horizontal movements (left to right, or right to left) with their toothbrush.  However, this technique is not ideal.  In this sense, it does not properly reach the places where dental plaque is proliferating, in addition to traumatising the gums.

The proper technique is to perform vertical movements, from the gum to the tooth, on the outer surfaces of your teeth and horizontal movements on the part that is used for chewing, he adds.

According to Dr Anamali, some people rinse the mouth after brushing, a thing that is not advisable. 

He advises that after brushing your teeth, you should only spit out the excess toothpaste and foam, without rinsing your mouth.  By gargling, you eliminate the active ingredients present in toothpaste, including fluoride, preventing them from exercising their protective action properly on the outer surface of your teeth.

In his view, marketing leads us to believe that mouthwash is essential for fresh breath because it kills the bacteria that cause it.  However, the advertisements do not mention that its use also kills the good bacteria, which naturally defend us against bad bacteria, viruses and fungi. In addition, mouthwashes, especially those with alcohol, dry out the mouth, which can cause bad breath.  

"Some people believe that they should only visit the dentist when they are in pain or have an apparent oral problem, which is wrong. However, even if you may not feel any pain or notice any abnormalities, it does not mean that everything is fine in your mouth. Only a dentist, together with a hygienist, can detect early-stage conditions,” Dr Anamali says. 

He also highlights that regular visits to the dentist help to remove hardened plaque as well as tartar that always ends up settling.

Mamataliev notes that although effective oral hygiene is essential for the maintenance of healthy teeth and supporting tissues, overly vigorous tooth-brushing or using the wrong type of brush for the technique, often leads to cervical tooth abrasion, gingival irritation, and gingival recession, or all.

He adds that uncontrolled or overly vigorous dental flossing may lead to irritation, ulceration, or defects of the gum. 

The dentist also says that dentifrices, mouthwashes, and chewing gum may elicit allergic or toxic reactions in susceptible persons. These reactions take a variety of traumatic injuries, especially if used at high pressure. Perhaps, detailed individual instruction should be given by dental personnel before use.

Abscess of gum tissues may occur from implantation of fragments of such oral hygiene aids, like toothbrush bristles and toothpicks.