Dental Care

What is oral hygiene?

Oral hygiene amounts to all the small things you need to do to keep your mouth clean and free from gum disease and tooth decay.^4,5 For example, regularly brushing and flossing your teeth and visiting your dentist every six months for check-ups and cleanings.^4,5

As your mouth is full of germs, good oral hygiene is a vital part of taking care of your overall health.^1,4 While most of the germs in your mouth are harmless, they can sometimes lead to the development of disease.¹ Especially because your mouth is the entryway to your digestive and respiratory tracts.¹

While this may seem like an obvious fact, it’s an important reminder of the influence that your oral health can have on the rest of your body. Your digestive tract carries your food all the way from your mouth to your anus and your respiratory tract controls your breathing.¹ This means the germs in your mouth can travel throughout your body and lead to other health concerns, like heart disease and stroke.^1,5

Good oral care therefore helps to keep these germs under control.^1,5

Signs of a healthy mouth

Thankfully, if you want to know whether you have a healthy mouth, you can just look inside to see if you have:⁴

• Pink, moist lips, tongue, gums and cheeks
• A mouth moist with saliva
• No broken or loose teeth, fillings, or dentures
• No holes or other signs of decay
• No ulcers
• No red or white patches that you’ve not noticed before

It can also be helpful to ask someone you’re close to whether your breath smells bad or unnatural. If they can confirm it smells pleasant or neutral, you shouldn’t have anything to worry about.

Signs of an unhealthy mouth

Of course, it’s also useful to be able to tell whether there’s anything going on in your mouth that may be a cause for concern. For example, having:^4,5

• A dry mouth
• Sores or ulcers
• Problems with your dentures
• Bleeding and swollen gums
• Tooth decay or tooth loss 
• Loose teeth
• Receding gums
• Toothache
• A swollen jaw
• Creamy coatings on your tongue/palate
• Red or white patches
• Bad breath
• Tooth abscesses

What conditions are linked to oral health?

Having poor oral health can contribute to conditions such as:^1,5–13

• Infective endocarditis –an infection of the inner lining of the valves of the heart, called the endocardium. It can be caused when bacteria enter your bloodstream via your mouth and attaches to certain areas in your heart. This is more likely to occur if your teeth and gums are in bad condition or decayed
• Cardiovascular disease – an umbrella term for conditions that affect your heart or blood vessels. People with poor oral health have higher rates of cardiovascular disease. This may be because the bacteria that cause dental diseases, such as gingivitis and periodontitis, travel to blood vessels throughout your body and cause inflammation. Alternatively, the body’s immune response to such bacteria may cause widespread inflammation. However, no causal link between oral health and cardiovascular disease has been confirmed, so a third factor (e.g. Smoking) may be behind the link
• Pregnancy and birth complications –changing hormone levels during pregnancy can cause your body to respond differently to bacteria on your teeth. This can lead to bleeding, swollen gums, periodontitis and gingivitis. There is also a link between poor oral health during pregnancy and low birth weight
• Pneumonia – inflammation of the lungs caused by an infection. This may be caused by breathing the pathogenic bacteria in your mouth into your lungs
• Stroke – when the blood stops flowing to a part of your brain, causing changes in your ability to speak and move. People with gum disease are more than twice as likely to have a stroke. This is thought to be due to bacteria in your mouth entering your blood circulation

Inversely, certain health conditions can take a toll on your oral health. These include:^1,14–25

• Diabetes –when your blood sugar levels are too high. Diabetes can increase your risk of developing gum disease. This is thought to be because diabetes, and certain diabetes medications, can reduce your production of saliva which helps to protect your teeth and gums. Diabetes can also increase the amount of sugar in your saliva, which can contribute to tooth decay and gum disease
• Human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS) –HIV damages your immune system and makes it harder to fight off infections, such as those caused by the bacteria in your mouth. AIDS is the term used to describe the infections that occur due to this damage, such as gum disease
• Cancer – cancer patients have a high risk of oral problems. This may be because chemotherapy and radiotherapy upset the balance of healthy to unhealthy bacteria in your mouth, among other reasons
• Alzheimer's disease – a progressive disease characterised by memory problems. As Alzheimer's disease gets worse, it becomes increasingly difficult for the person affected to take care of their oral health
• Osteoporosis – a condition characterised by reduced bone density, which can increase your risk of tooth loss
• Eating disorders – mental health conditions that cause people to eat too much or too little food. Some people with an eating disorder self-induce vomiting, which can cause dental erosion
• Rheumatoid arthritis – a condition that causes pain, swelling and stiffness in your joints. Sjogren's syndrome is common in people with rheumatoid arthritis and damages the salivary glands. This leads to a reduction in saliva, which has proteins that reduce the bacteria in your mouth

How to protect your oral health

To protect your oral health:^1,5,26

• Brush your teeth at least twice a day – for two minutes each time, using a brush with soft bristles and fluoride toothpaste. Make sure you brush all the surfaces of your teeth, including the back and sides. And brush at a 45-degree angle toward your gums, to sweep away plaque and bacteria at the gum line
• Floss once per day – brushing alone cannot reach the spaces between your teeth. Dental floss can help you clean these areas. Wrap a long piece of floss around your middle fingers and guide it between two teeth. Clean between each tooth using around 10 up and down strokes. If you have dexterity issues, you can use dental floss with a pick to clean between your teeth or an interdental toothbrush
• Brush your tongue – when you brush your teeth you should also brush your tongue, as it holds a lot of bacteria. You can also use a tongue scraper for this
• Reduce your intake of sugar – as sugar contributes to tooth decay. However, the sugars found naturally in whole fruit are less likely to lead to tooth decay
• Stop smoking – smoking can stain your teeth and is a leading cause of gum disease and oral cancer
• Visit your dentist regularly – you should visit your dentist once every six months for a check-up. They may suggest having dental cleaning, which can help you maintain your oral health

Cosmetic dental care

Teeth whitening is not necessary for promoting good oral health, but it can help you to feel more confident about your smile. Teeth whitening is a form of dentistry and should only be carried out by a qualified dentist.²⁷ Some beauty salons offer teeth whitening, but this is illegal if there is no dental professional present.²⁷ You can also buy DIY home whitening kits, but these tend to be less effective than professional whitening products and carry some risks.^2,27

A dentist may recommend whitening your teeth with a mouthguard and a whitening gel for teeth.²⁷ You can wear your mouthguard with the teeth bleaching gel for up to 8 hours at a time, depending on the strength of the dental whitening gel you’re using.²⁷ Your dentist may alternatively recommend laser whitening, which combines a dental bleaching gel with a laser to activate it.²⁷ This form of whitening only takes an hour.²⁷ 

Overall, teeth whitening is considered extremely safe.³ The main side effect of teeth whitening is increased sensitivity.³ This tends to go away on its own.³ However, you can reduce sensitivity by using sensitive toothpaste and spacing out your whitening treatments to give your teeth time to recover in between.^3,28

Whichever method you choose, you should always follow the guidance of your dentist to avoid any damage to your teeth.

Sources

1. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475
2. https://health.clevelandclinic.org/how-to-whiten-teeth
3. https://health.clevelandclinic.org/is-teeth-whitening-safe
4. https://www.tewv.nhs.uk/about-your-care/health-wellbeing/oral-health/
5. https://my.clevelandclinic.org/health/treatments/16914-oral-hygiene
6. https://www.guysandstthomas.nhs.uk/health-information/infective-endocarditis
7. https://www.health.harvard.edu/diseases-and-conditions/gum-disease-and-the-connection-to-heart-disease
8. https://www.nhs.uk/conditions/cardiovascular-disease/#:~:text=Cardiovascular%20disease%20(CVD)%20is%20a,increased%20risk%20of%20blood%20clots.
9. https://pmc.ncbi.nlm.nih.gov/articles/PMC6883753/
10. https://www.cdc.gov/healthcare-associated-infections/hcp/prevention-healthcare/oral-health-pneumonia-toolkit.html
11. https://www.nhs.uk/conditions/pneumonia/
12. https://www.dovepress.com/periodontitis-as-a-risk-factor-for-stroke-a-systematic-review-and-meta-peer-reviewed-fulltext-article-VHRM
13. https://www.nhs.uk/conditions/stroke/
14. https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/complications/gum-disease
15. https://www.nhs.uk/conditions/diabetes/
16. https://www.nidcr.nih.gov/health-info/hiv-aids
17. https://www.nhs.uk/conditions/hiv-and-aids/
18. https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq
19. https://www.alzheimers.org.uk/get-support/daily-living/dental-mouth-care
20. https://www.nhs.uk/conditions/alzheimers-disease/
21. https://pmc.ncbi.nlm.nih.gov/articles/PMC10749737/
22. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-023-00778-z
23. https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/
24. https://www.hopkinsarthritis.org/arthritis-news/5-dental-tips-for-the-ra-patient/
25. https://www.nhs.uk/conditions/rheumatoid-arthritis/
26. https://www.nhsinform.scot/healthy-living/dental-health/taking-care-of-your-oral-health/
27. https://www.nhs.uk/tests-and-treatments/teeth-whitening/
28. https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/sensitive-teeth/faq-20057854