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27-12-2017

Brushing your teeth: what if you’ve been given the wrong advice all these years?

mouth care When it comes to dental hygiene, we’re sure you’re not the kind of person who ignores expert advice. You brush your teeth three times a day, with an electric toothbrush, then floss, and even use the latest brush or scraper to clean your tongue. However, it seems you’d do well to rethink your routine: at its latest conference, the l'Association Dentaire Française (French Dental Association) has just rejected this kind of advice which so often - and misguidedly it seems - appears in dental health-related advertising.

Twice a day is enough!

You’re probably aware that your mouth is host to billions of microorganisms. There are actually more than 1000 different species, the majority of which are beneficial to our health. Some float in the oral milieu, while others adhere to surfaces such as the tongue or teeth. When you rinse your mouth after brushing, proteins instantly attach to your tooth enamel, forming the salivary biofilm on which the first bacteria stick together. These 'pioneer colonisers' are quickly followed by other species, forming a complex habitat where they coexist and play a protective role against pathogenic bacteria1. Together, their secretions form a defensive barrier which becomes increasingly robust as the hours pass2.

In itself, plaque does not present an immediate risk since the bacteria of which it is comprised are generally beneficial3. The problem is that at any moment, the harmonious balance created can be disrupted, promoting the development of pathogenic bacteria.

Such imbalances can occur when we eat high-carbohydrate foods, particularly simple carbs such as sucrose. Sugary residues cling to dental plaque to the benefit of pathogenic bacteria such as Streptococcus mutans and Streptococcus sobrinus. These are able to not only convert it into lactic acid, a compound which creates an environment hostile to other bacteria and which damages the teeth, but also to form huge sugar chains which ensure the cohesion of the germs between them. The greater the intake of sugar, the more these bacteria thrive and proliferate, completely disrupting the equilibrium of the bacterial populations. This is how dental caries start to form.

Brushing the teeth thus helps to remove the biofilm which plays host to disease-causing bacteria, and to get rid of the bits of sugary food which enable the development of these bacteria. In the absence of repeated, excessive intake of sugars, consumption of which only really began during the Neolithic period, dental caries have no chance of developing.

But recently, it has been shown that dental plaque forms more slowly than was previously thought: the latest studies suggest it takes around 12 hours to develop. It is also known that excessive brushing produces long-term damage to the tooth’s surface. That’s why the UFSBD (Union Française pour la Santé Bucco-Dentaire - a French organisation devoted to promoting oral health) now recommends brushing your teeth twice a day, morning and evening, and tochew gum after lunch to benefit from the natural properties in saliva.

Stimulating saliva production: the benefits of chewing gum

The accumulation of dental biofilm occurs mainly in 'static' areas of the mouth which are untouched by movements of the tongue and saliva flow.
Saliva flow is very important for oral health: it reduces the contact time between carbohydrates and the tooth’s surface and has a natural anti-bacterial action due to lactoperoxidase, which induces substances toxic to bacteria, and lactoferrin, which inhibits the iron metabolism necessary for their growth. It can also lower the acidity of the oral milieu, acid being beneficial to pathogenic bacteria. Furthermore, it plays an essential role in maintaining equilibrium in the mouth when the glands are affected by disease and ageing.
The body therefore has the means of preventing dental caries, but it still has to enable their use! In addition to containing too much sugar, modern diets are also more fluid in nature, considerably reducing the need for mastication and thus secretion of saliva, which in turn promotes the development of caries and gum disease. Repeated ingestion, linked to snacking, and the increase in consumption of sticky, sugary foods and fluids (such as fizzy drinks) which remain in the mouth for longer, overwhelm the buffering capacity of saliva.

Hence the revival of chewing gum (sugar-free, obviously)! To date, no other food has been shown to encourage salivation to the same extent with almost zero calories. By encouraging mastication, saliva is able to combat the progress of dental biofilm and reduce its acidity.
Which one should you choose? The best option is chewing gum that contains xylitol such as Mastic Gum Elma 50. Studies show that this compound boosts saliva’s anti-bacterial strength4. Simply chew it for 30 minutes after a meal or a sugary snack.

Electric toothbrushes are better, right? Maybe not

Electric toothbrushes are supposed to remove more dental plaque than manual ones, but the studies that support such claims, often funded by electric toothbrush manufacturers, are based on the fact that people who manually brush their teeth tend not to apply as much pressure. Other studies show that over time, electric toothbrushes are very abrasive and damage tooth enamel. These days, when increasing numbers of over-75s still have their own teeth, this is an issue that needs to be addressed.

Do not brush your tongue: it’s completely counterproductive

In the mouth, everything is a matter of harmony and balance: when this is disturbed, pathogenic bacteria start to colonise.
And there’s nothing worse for this balance than brushing your tongue! Its surface is colonised by microorganisms which are constantly fighting pathogenic bacteria: scraping it with a toothbrush is thus the most effective way of reducing its inbuilt defences and the efficacy of the taste buds6. And if you’re worried that your tongue might be causing bad breath, rest assured that in almost all cases, this is linked to dental plaque, dentures or other removable prosthetics7. Which is why the Association Dentaire Française has just come out and advised against this practice.

Oral probiotics to address all oral health problems

Far from eliminating beneficial bacteria, one of the most promising therapies consists of promoting its growth: oral probiotics.
Clinical trials have shown that certain oral probiotics (in particular, those of the genus Lactobacillus Bifidobacterium spp.) are able to control the development of the pathogenic microorganisms responsible for dental caries8. Two mechanisms are involved:
  • Direct interaction with dental plaque, as a result of fierce competition with other bacteria for nutrients. The probiotics help rebalance the different populations by preventing the growth of bacteria occupying too much space9
  • Modulation of the immune system: probiotics are able to rehabilitate immune cells compromised by pathogens, modulate the production of chemical messengers and reduce levels of inflammation, factors responsible for many mouth problems.
In other words, these probiotics are a real blessing for those prone to oral health problems (dental caries, bad breath and gum disease, in particular), as well as for those who produce insufficient saliva - often the over-60s and smokers.

As we grow older, so too do our saliva glands and there is a general decline in our ability to chew. This paves the way for colonisation by pathogenic bacteria and disease, leading inevitably... to tooth loss. It cannot be repeated often enough that it is not old age that causes teeth to become loose but mainly bacterial disease!

45 % of people over 75 are thought to have lost all their teeth: how many of them could have prevented this by being better informed and prepared? How many wish they could have benefited from revolutionary treatments such as Oral Health, a combination of the most widely-studied probiotic species beneficial to oral health? Given how easy it is to use (simply empty the contents of one stick into the mouth once a day), it would be a shame to deny them...

References
1. Christian Mouton, Jean Claude Robert, Luc Trahan. Bactériologie bucco-dentaire. Abrégés d'odontologie et de stomatologie. Publisher, Masson, 1994. Original from, the University of Michigan. Digitized, Jul 17, 2008.
2. Dupont GA, Understanding dental plaque; biofilm dynamics. J Vet Dent. 1997 Sep;14(3):91-4.
3. Carranza, Michael G. Newman. Clinical Periodontology, Edition, 8, illustrated. Publisher, Saunders, 1996.
4. Tanzer JM. Xylitol chewing gum and dental caries. Int Dent J 1995 Feb;45:65-76.
5. Bizhang M, Schmidt I, Chun Y-HP, Arnold WH, Zimmer S (2017) Toothbrush abrasivity in a long-term simulation on human dentin depends on brushing mode and bristle arrangement. PLoS ONE 12(2): e0172060. doi.org/10.1371/journal.pone.0172060
6. Kobayashi J, Saito T, Ito T, Yoshimura H, Matsuda S, Yoshida H, Fujita R, Sano K. Association of tongue brushing with the number of fungiform taste buds and taste perception: A preliminary study using confocal laser scanning microscopy in combination with a filter-paper disc method. Arch Oral Biol. 2017 Dec;84:145-150. doi: 10.1016/j.archoralbio.2017.09.025. Epub 2017 Sep 28.
7. Ileri Keceli T, Gulmez D, Dolgun A, Tekcicek M.The relationship between tongue brushing and halitosis in children: a randomized controlled trial. Oral Dis. 2015 Jan;21(1):66-73. doi: 10.1111/odi.12210. Epub 2013 Dec 16.
8. Meurman JH. Probiotics: do they have a role in oral medicine and dentistry? Eur J Oral Sci. 2005;113:188-96.
9. Robert P. Allaker & Abish S. Stephen, Use of Probiotics and Oral Health, Curr Oral Health Rep (2017) 4:309-318, doi.org/10.1007/s40496-017-0159-6
Order the nutrients mentioned in this article
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Further reading
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There are many things we like to put off till the next day, but for some strange reason, taking care of our teeth seems to...
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