Determining the individual’s caries risk profile, followed by an individual-specific prophylaxis approach, is extremely important. Today there are many different oral care products, so it is necessary to recommend products suited to each individual’s needs. The use of oral care products alongside mechanical plaque control is essential — mechanical plaque control is the foundation of daily oral care, and it should be supplemented with the right oral care products.
It is important to maintain preventive approaches based on individual needs after assessing the caries risk profile. There are many different oral care products available today, and it is necessary to advise patients on the proper products based on their individual needs.
Mechanical plaque control is essential to maintaining daily oral hygiene, but it must be supported by oral care products. The dentist should give patients instructions about the most effective use of these products, their purpose, and the correct techniques.
In modern restorative dentistry, it is very important first to determine the individual’s caries risk profile and then their individual prophylaxis approach. Developing scientific technology provides consumers with a wide range of oral and dental care products.
The oral and dental health of each individual should be considered unique to that person, and care products should be consciously recommended for the continuity of dental and gum health.
In this article, oral care products — toothbrushes, toothpaste, mouthwashes, interdental brushes, tongue brushes, floss, gels and chewing gum — are evaluated in terms of the caries risk profile and their reported areas of use.
Toothbrushes
The plaque-removal effects of toothbrushes are continuously investigated, and various changes are made in line with these studies. The patient’s oral structure, gingival health and dexterity are all important in determining the type of toothbrush to recommend.
The size of the brush and the brush tip should be chosen according to the person and their age. There are three types of toothbrush — soft, medium and hard — depending on the stiffness of the bristles.
In general, manual brushes are recommended for people with normal dexterity, while electric brushes are recommended for individuals with poor dexterity, paediatric patients, and mentally and physically disabled individuals.
Rotary-head brushes should be avoided in cases of erosion. As a general guide: soft brushes for erosion cases; medium-hardness and rotating-head brushes for patients with a high risk of caries; soft or medium-hardness brushes for individuals with periodontal disease; corrugated brushes that grip brackets for patients undergoing orthodontic treatment; and denture brushes for patients using removable dentures. Brushes with bristles that change colour as they wear — reminding people not to use the same brush for too long — are also a good option.
Electric Toothbrushes
Electric toothbrushes produced today provide the opportunity to reach the maximum area on the tooth surface thanks to their back-and-forth movements. Studies have shown that the cleaning rate in interproximal areas is higher than with a manual brush. Effective, correct use of an electric toothbrush prevents dental plaque formation, and it has been found to be more effective for plaque cleaning, especially in orthodontic patients.
Using an electric toothbrush is different from using a manual one. The electric brush should be held at a 45-degree angle to the teeth and gum tissues, and no excessive pressure should be applied. Brushing the whole mouth with an electric toothbrush takes approximately four minutes. They can be used by more than one person, as the brush head can be changed.
When Should Children Start Brushing Their Teeth?
When a baby is 6–8 months old (i.e. when the first teeth appear), cleaning should begin. After breakfast and before bed at night, it is appropriate to wipe the teeth with clean gauze, a soft toothbrush made for babies, or a finger brush, using a paste-free cleaning technique.
It is very difficult to teach a precise brushing technique to preschool children. What is important at this age is to give the child the habit of brushing their teeth.
When children brush their teeth, they often only brush the visible or easily accessible surfaces. However, to prevent caries, the surfaces between the teeth and the chewing surfaces need to be cleaned much better — which is why parents should supervise brushing.
Toothpaste
Toothpaste is one of the most widely used substances for oral health in the world. Toothpaste contains abrasives, humectants, binders, foaming agents, sweeteners, preservatives, therapeutic agents and water. The size and quantity of the abrasive particles in toothpaste is directly proportional to the wear on the tooth surface during brushing, so recommending that patients change their toothpaste from time to time will prevent continuous exposure to the same abrasive.
Ingredients such as fluoride, menthol, sodium fluoride and triclosan are added to increase the effects of toothpaste. Around 90% of the toothpaste produced in the USA, Canada and other developed countries contains fluoride. The presence of fluoride in dental plaque, dental structures and saliva is extremely important for remineralisation, and research has shown that the incidence of tooth decay is reduced in populations using a fluoride toothpaste. Many different kinds of toothpaste are offered to consumers.
These include toothpaste for children, toothpaste for sensitive teeth and gums, toothpaste to prevent dry mouth, toothpaste to reduce halitosis, and toothpaste for smokers. From the dentist’s point of view, there is no single best or ideal paste — the patient’s oral condition should be taken into consideration when recommending one. In adult patients with a low caries risk, toothpaste of 1,000–1,450 ppm fluoride is sufficient to prevent caries. Toothpaste containing fluoride and antiplaque agents (up to 5,000 ppm) should be recommended for adult patients with a high risk of caries.
In addition to antibacterial toothpaste, herbal and anti-tartar pastes can be recommended for individuals with periodontal disease. In cases of gingival recession, where the cementum is exposed, a gel-type toothpaste with minimal abrasive properties should be preferred. In patients receiving orthodontic treatment, antibacterial toothpaste should be combined with mouthwashes. For patients with a dry mouth, toothpaste containing fluoride and special salivary enzymes, with low or no sodium lauryl sulphate and abrasives, should be preferred; soft toothbrushes should also be recommended, along with other products that increase saliva flow (mouthwash, chewable tablets, sprays, moisturising gels). Whitening toothpaste should be used only for a short time, as a support for professional teeth whitening.
Which Toothpaste Should Children Use, and How Much?
Toothpaste is not recommended for infants and children with a low caries risk until the age of two, because of the risk of swallowing. Toothpaste should be used after two years of age, and a lentil-sized amount is enough. Toothpaste containing fluoride at a concentration of 500 ppm or less is suitable for children under six with a low caries risk. Standard 1,000 ppm toothpaste can be used for children under six who are at high risk of caries.
Mouthwashes
In dentistry, mouthwashes are used to prevent and treat conditions and to assist professional practice. Mouthwashes should be evaluated according to their contents and recommended to patients according to their individual needs. Dental biofilm — a complex, dynamic microbial ecosystem — plays an important role in the development of dental caries and periodontal disease. Mechanical cleaning is essential for the continuity of oral health, and oral care products are only beneficial when applied together with mechanical cleaning.
Mouthwashes are used:
- As an adjunct to remineralisation
- For acute mucosal and gum infections
- During recovery after periodontal surgical procedures
- After surgical procedures
- For children with a high risk of caries and disabled individuals older than six years
Mouthwashes generally have a similar content to toothpaste and, unlike pastes, do not contain abrasives, but they may contain a preservative and alcohol. Active ingredients in mouthwash include fluoride and fluoride compounds, calcium and phosphate, sodium lauryl sulphate, triclosan, metal ions (zinc, tin), hydrogen peroxide, essential oils (menthol, eucalyptol), chlorhexidine, pyrophosphate and potassium salts. Many mouthwashes reduce the number of bacteria in the mouth thanks to their antibacterial agents, and are used therapeutically to treat gingivitis and periodontitis — for this purpose, mouthwashes containing chlorhexidine and benzydamine HCl are preferred.
Mouthwashes can relieve the symptoms of painful conditions such as aphthous ulcers and candida infections. Chemotherapeutic methods for preventing dental caries are also recommended for people at high risk of caries. This approach uses two well-known products — fluoride and chlorhexidine — for antimicrobial protection. Both have a strong antimicrobial effect against mutans streptococci, providing long-term suppression.
Clinical observations have shown that topical fluoride is one of the most successful anti-caries agents. Solutions, gels, toothpaste and mouthwashes are the topical agents used. With these agents, the contact time with the enamel surface is important for effectiveness, because short-term contact does not deliver the required amount of fluoride, and some of the fluoride is washed away by saliva.
Fluoride Mouthwashes
Fluoride-containing mouthwashes are recommended for their effects on remineralisation and bacterial plaque. Fluoride mouthwashes for individuals over six years of age are recommended daily (0.05% NaF) or weekly (0.20% NaF). They are recommended during orthodontic treatment, for a high risk of caries, and for the management of dry mouth and radiation therapy. As for the usage protocol, the mouthwash is swished around the mouth and then completely spat out. Mouthwashes cannot be recommended in preventive programmes for children under six because the oral muscles at this age lack the coordination both to swish for the required time and to expel the mouthwash completely without swallowing.
Fluoride-Containing Gels and Foams
Fluoride-containing gels and foams can be applied with application trays or brushed onto the teeth. These products should be applied by the dentist in the practice environment; however, children and adults with a high risk of caries may also be advised to use them at home. When home care is recommended for paediatric patients, it should be carried out under adult supervision. Mouthwash, gel or varnishes combined with fluoride toothpaste have been reported to be around 23% effective in preventing caries in individuals with a high risk.
Products Containing Chlorhexidine
Chlorhexidine is one of the most studied antimicrobial agents, researched for more than 40 years. In dentistry, it is used in mouthwash, toothpaste and varnish as an antiplaque and anti-caries agent. Chlorhexidine is a broad-spectrum antibacterial agent that acts on both Gram-negative and Gram-positive bacteria, with streptococci reported to be more sensitive than staphylococci. Studies on individuals with a high risk of caries have shown that it suppresses mutans streptococci for a long time and reduces caries formation. Chlorhexidine is also effective against yeasts and viruses. To reduce the number of mutans streptococci and Porphyromonas gingivalis in patients with root-surface caries, it is used in patients with herpetic mouth lesions, prosthetic patients with candida infections, and patients undergoing radiotherapy and chemotherapy for head and neck cancers. It is also effective against HIV and hepatitis B.
The advantage of chlorhexidine over other agents is its ability to bind to many surfaces in the oral cavity. Positively charged chlorhexidine binds mostly to the oral mucosa, to microorganisms, and to anions such as sulphate, phosphate and carboxyl groups in the pellicle, binding especially well to soft tissues. This allows it to bind to bacterial surfaces, affect adhesion, and initiate bacterial destruction. It provides a long-lasting effect through its ability to bind within plaque and to accumulate in and release from soft tissues, which are important structures for the retention of chlorhexidine. Chlorhexidine levels in saliva increase for up to 24 hours after use. The bactericidal effect when chlorhexidine is first applied becomes a bacteriostatic effect as it is adsorbed onto the pellicle covering the enamel surface. S. mutans can be suppressed for a long time with chlorhexidine gels or mouthwashes, but this depends on the concentration and the frequency of exposure. Long-term use of antiplaque agents carries a risk of changes to the ecology of the oral flora and the formation of resistant bacterial strains.
Combination of Fluoride and Chlorhexidine
Some researchers have reported that the combined use of chlorhexidine and fluoride has a longer-lasting antibacterial effect. The mechanisms of action of fluoride and chlorhexidine differ, and their combined use has been reported to produce synergistic effects, with optimum protection of enamel and dentine achieved through uniform varnish application. Another advantage of combined use is that it can be applied at a lower concentration than either agent alone. Fluoride applications have been reported to aid chlorhexidine in suppressing mutans streptococci, and it is reported that chlorhexidine does not interfere with the physicochemical effects of fluoride on enamel or with fluoride uptake by enamel. In-vivo plaque deposition has also been reported to be inhibited more by the combined use of chlorhexidine and fluoride than by fluoride mouthwash alone. Because of these advantages, the combined use of chlorhexidine and fluoride is recommended for patients with a high risk of caries.
The protocol for using chlorhexidine mouthwash in individuals at high risk of caries and in older children is to rinse for 30 seconds with 10 ml of mouthwash before bed for two weeks, repeated every three months. The use of alcohol-containing preparations in children is contraindicated. Yellowish discolouration and taste disturbances with long-term use have been reported as side effects of chlorhexidine. Dry mouth can develop for many reasons, but it is a common finding in patients receiving radiotherapy. The main approach in preventing dental caries is the use of fluorides with mechanical plaque control. Neutral fluoride preparations and chlorhexidine preparations are often used in these patients; preparations with NaF are preferred in patients undergoing radiotherapy, as they are at a neutral pH and can be used together with other mouthwashes.
Dental Floss
It is not possible to reach every surface of the teeth with a toothbrush and toothpaste alone — interproximal areas, in particular, cannot be cleaned with a manual toothbrush. Auxiliary hygiene materials should be used to clean these areas, and dental floss is the most commonly used. Special dental flosses are made for cleaning under prosthetic restorations. These products play an important role in oral care, especially for patients who have dental implants or dental veneers. The surfaces of fillings and prosthetic teeth must be cleaned carefully with floss, because food accumulation and calculus formation increase in these areas, causing decay beneath restorations and gum problems. Floss is held between the thumbs or index fingers of both hands and inserted between the teeth to clean the surfaces of both adjacent teeth. In the case of a dental bridge, the area underneath the pontic can be cleaned with special floss designed for the purpose. When using floss, patients should be shown the correct method, as it can otherwise irritate the gums.
Interdental Brushes
These are special brushes used to clean between the teeth and under bridges. Interdental brushes effectively clean large gaps, teeth and areas under bridges thanks to a specially angled handle and interchangeable brush heads. They make oral hygiene easier for people who have gaps between their teeth due to periodontal disease. In orthodontic treatment, a toothbrush is often insufficient, and an interdental brush should be used to clean around the wires. The tapered or cylindrical interchangeable heads allow effective, safe cleaning of bacterial plaque. Soft, spongy brush tips can be used for post-operative care, implant care, oral lesions and wounds, and for applying medication.
Tongue Brushes
When oral and dental health is considered as a whole, the tongue is an organ that also needs to be cleaned. Research has found that the tongue is one of the predominant causes of bad breath: the papillary structure of the tongue provides a suitable environment for the growth of microorganisms, and its anatomy is the most suitable site for the sulphur compounds that produce odour. For these reasons, cleaning the tongue — removing bad breath and reducing the number of microorganisms — is important for preventing and reducing intra-oral infections. After each brushing, cleaning the tongue with an appropriate brush can be recommended, especially for patients who suffer from bad breath. Tongue brushes are used by brushing the upper surface of the tongue from back to front.
Keeping Your Smile Healthy for Life
The right oral-care routine — matched to your individual caries risk — is the foundation of long-term dental health, and it matters just as much for protecting fillings and restorations as it does for your natural teeth. Regular professional cleaning also removes the tartar that home care can’t; you can read more about our scale and polish treatment, the benefits of regular dental check-ups, and the simple 2-2-2 rule for daily care.
If you have questions about caring for your teeth, dental Implants or restorations, start a free online dental consultation — our team is happy to help, with no obligation.
Uğur Gültekinler D.D.S. graduated with his dental degree from the Faculty of Dentistry in Izmir, Turkey, in 2003. With over two decades of experience, he has developed a deep passion for cosmetic dentistry, using only the finest techniques and most advanced materials to create beautiful smiles.
Co-founder of Smile Dental, one of Turkey’s most advanced dental clinics, Uğur Gültekinler D.D.S. is our lead smile designer — combining years of hands-on expertise with cutting-edge digital smile design technology. Working closely with each patient, he tailors treatments to individual goals using his extensive knowledge in dental crowns and veneers.
Uğur Gültekinler D.D.S. is fluent in Turkish and English.
