Is brushing twice a day necessary? Does it work as a ‘silver bullet’ to make up for whatever is eaten during the day? For children, where should we focus our attention?
I attended a meeting at the Royal Australasian College of Dental Surgeons where I listened to a very interesting lecture given by a Professor of Paediatric Dentistry. In the lecture, it was asked whether anybody could name a scientific paper to back up the claim that tooth brushing alone prevents dental cavities. Apart from papers sponsored by a major toothpaste manufacturer (unsurprisingly), nobody could.
It begged the question – what do we know of that prevents dental decay, especially in children, that also has evidence behind it? The answer was diet and fluoride. Both of these have an enormous amount of high quality evidence behind them, and all in the room agreed with this.
So…. Why do we spend so much time and effort as dental professionals telling parents and children to brush twice a day? Is it necessary? Or is it easier than getting into a discussion/argument with a parent about a child’s diet?
This got me thinking about the subject and the reasons that we do this. Firstly though, I want to keep telling all of my patients to brush twice a day. Mechanical removal of plaque by both brushing and flossing is vital, and there is a huge amount of evidence behind this for the prevention of gum disease (and systemic problems linked to this such as heart disease), halitosis and other dental problems. Also by brushing we are giving ourselves a twice daily application of fluoride directly onto the teeth, which we know is crucial in the prevention of caries.
But are we telling patients and parents to ensure twice daily brushing because addressing the other issue, namely diet, is in the ‘too hard’ basket? Do we as parents think that eating snacks, treats and so on is all fine as long as we brush afterwards? The evidence shows that it is not.
There are sugars in many, many foods: organic, processed, natural, raw, fast foods and so on. Sugar is present in many forms – in fruits as well as McDonalds. So is snacking and grazing on these healthier forms helping us?
It comes back to the question – what does the evidence tell us? It tells us that after every time food or drink (no matter how big or small) is consumed, the oral bacteria use it as food and produce acid, making the mouth an acidic place. Teeth are minerals (calcium based, like our bones) and like to live in a neutral pH environment, so having acid surroundings means that, like the metal dropped into acid in school chemistry experiments, the minerals in enamel dissolve. A hole forms after repeated attacks (aka snacks) and then the bacteria get inside the tooth and that’s when problems start.
The mouth has a natural acid buffer, saliva, but it takes about 40 minutes for it to turn the acidic environment back to a neutral one. So if someone is grazing constantly through the day the mouth is almost always acidic, and enamel is constantly dissolving out from the teeth.
The evidence shows us that the best option is to limit food intake to regular mealtimes, and to limit snacking in between. Those snacks should be healthy, no sugar ones and drinks should ideally be regular tap water. During mealtimes there is more flexibility, as there will be an inevitable ‘acid attack’, so it means that we don’t have to have a dull, fun free diet.
But this message is a lot harder to get out – see how long it took you to read the last 3 paragraphs. It’s much simpler, quicker and easier to tell parents to make sure the children brush twice a day than get into a conversation picking apart the family diet. There is another issue in that some younger clinicians feel nervous discussing this with a parent – “what would they know, they don’t have children?”. No they don’t, but they have University training in diet and dental care and by not getting this message to patients and parents we are doing everyone a disservice.
In summary, I believe we should continue to brush twice daily but I also feel that the evidence tells us that we need to pay more attention to our diets, and not think of brushing as some sort of silver bullet that will fix all the day’s bad food choices and constant grazing. Now that’s a challenge for everyone.
About the Author
Dr Alistair Graham is experienced in all areas of General Dentistry and is committed to ensuring that all patients get the highest possible care, individually tailored to your needs. Whether this means regular Active Maintenance or complex Restorative and Cosmetic work, Alistair’s attention to detail and gentle manner will mean that your visit will be a positive one.
Dr Alistair Graham is highly qualified and experienced in the field of implant dentistry, and is one a few dentists qualified to be able to provide patients with both the surgical and restoring phases of the treatment. This means that patients do not need to be referred to another Specialist dentist for part of their treatment.He lectures in implant dentistry, and also children’s dentistry. He is a mentor to a number of colleagues.