Oral Hygiene: The Routine That Actually Prevents Problems

The daily routine, in order

Good oral hygiene keeps your mouth clean, prevents tooth decay, controls gum disease and stops bad breath. It also matters beyond your mouth, because gum inflammation is linked to heart disease, diabetes and other conditions.

1. Clean between your teeth first, with floss or interdental brushes. Doing this before brushing lets the fluoride reach the surfaces you just opened up.
2. Brush for two minutes with a fluoride toothpaste, last thing at night and one other time in the day.
3. Spit out the excess toothpaste. Do not rinse with water, and do not rinse with mouthwash straight after brushing.
4. Leave it. Avoid eating or drinking for about 20 minutes afterwards so the fluoride can do its work.

Night brushing is the one that counts most. Saliva flow drops while you sleep, so anything left on your teeth at bedtime has all night to cause damage.

How to brush so it actually works

Technique matters more than pressure, and more than the price of the brush.

• Angle the bristles at 45 degrees to where the tooth meets the gum. That junction is where plaque collects and where gum disease begins.
• Use short, gentle strokes or small circles. Hard scrubbing wears away enamel at the gum line and makes gums recede, which causes sensitivity.
• Cover every surface: outside, inside and the biting surfaces. The inside of the lower front teeth and the outside of the upper back molars are the two most commonly missed spots.
• Soft bristles, always. Medium and hard brushes do more harm than good.
• Replace the brush every three months or sooner if the bristles splay. A flattened brush cleans poorly.

Electric or manual is less important than doing it properly for the full two minutes, though an electric brush with a timer makes the two minutes easier to keep honest. If you have gums that bleed when you brush, that is not a reason to brush less. It is usually a sign of gum inflammation that improves with better cleaning, and if it continues past two weeks it should be checked.

Cleaning between your teeth

A toothbrush reaches about three of the five surfaces of each tooth. The two it cannot reach are the ones facing your neighbouring teeth, and those two surfaces are where a large share of cavities and gum problems begin.

Both floss and interdental brushes work. A 2019 Cochrane review found that using either one in addition to brushing reduces gum inflammation more than brushing alone, and that interdental brushes may be more effective than floss where the space allows one to fit. The practical rule: use the largest interdental brush that slides in without forcing, and use floss where the teeth are too tight for a brush. Our page on flossing covers the technique in detail.

Source: Cochrane review on home use of interdental cleaning devices (2019).

What you eat, and how often

Sugar is the fuel for decay, but frequency does more damage than quantity. Every time sugar reaches the plaque on your teeth, the bacteria in it produce acid for roughly 20 to 30 minutes. One dessert after dinner is one acid attack. The same amount of sugar sipped through the afternoon in a bubble tea is a rolling series of them, and your saliva never gets the chance to neutralise anything.

The World Health Organization recommends keeping free sugars under 10 percent of daily energy intake, and ideally under 5 percent, specifically to reduce the risk of tooth decay across life.

Source: World Health Organization, sugars and dental caries.

One more thing about acid: after anything acidic, such as citrus, vinegar or a fizzy drink, wait about an hour before brushing. Enamel is temporarily softened and brushing straight away scrubs some of it away.

Mouthwash, tongue scrapers and the rest

Mouthwash is optional and it is not a substitute for anything. If you use a fluoride rinse, use it at a different time from brushing, since rinsing immediately after brushing washes away the much more concentrated fluoride from your toothpaste. Antibacterial rinses such as chlorhexidine are useful for short courses when a dentist prescribes them, but they stain teeth with long term use and are not meant for permanent daily use.

Cleaning your tongue helps with bad breath, since the coating at the back of the tongue holds a large share of the bacteria responsible. A tongue scraper or the back of your brush is fine. Do not gag yourself chasing the very back.

As for home remedies: hydrogen peroxide rinsing, oil pulling, charcoal powders and baking soda scrubs are popular searches and poor investments. Charcoal is abrasive, and none of them replaces removing plaque mechanically. Stick to products that carry approval from a recognised health authority.

Common mistakes we see

• Rinsing after brushing. The single most common way people undo the benefit of their toothpaste.
• Brushing harder to get teeth whiter. It does the opposite, by thinning the enamel and exposing the darker dentine underneath. If whitening is the goal, professional whitening is the safe route.
• Skipping the between-teeth clean because the gums bleed. Bleeding usually settles within a week or two of consistent cleaning.
• Only brushing in the morning. Night brushing matters more.
• Assuming no pain means no problem. Decay and gum disease are both painless until they are advanced. That is the entire argument for regular check-ups.

What we do at a check-up

A routine visit is an examination plus a clean. We check every tooth for decay, measure the gum pockets, look at the soft tissues of your mouth for anything unusual such as spots or sores that have not healed, and take x-rays when they are needed to see between and beneath the teeth. Then scaling and polishing removes the hardened plaque that no brush can shift.

Most people are on a six to twelve month interval. If you smoke, have diabetes or have been treated for gum disease, you will usually be asked to come more often. Bring your CHAS, Merdeka Generation or Pioneer Generation card if you have one, because subsidies apply to routine scaling and polishing at participating clinics, and many Singaporeans never claim them.

Frequently asked questions

Related reading

More in this series: bad breath, flossing and interdental cleaning, cavities and tooth decay, mouth spots and sores and TMJ and jaw pain.

Sources: World Health Organization on sugars and dental caries, Cochrane review of interdental cleaning devices (2019), Cochrane review of fluoride toothpaste concentrations (2019).