What it is
Oral hygiene is much more than brushing: manual and electric toothbrushes, cleaning between the teeth (floss, interdental brushes, water flossers), fluoride toothpaste and mouthwashes.
At the counter, customers rarely ask about hygiene: they come in with bleeding gums, bad breath or sensitivity. Your job is to recognise that these are often signs of hygiene that could be better, to teach the technique and to know when to refer to the dentist.
Plaque: enemy number one
Inflamed gums and decay come from bacterial plaque. Hygiene products act at different levels:
- MECHANICAL: brushing removes plaque. In systematic reviews, oscillating-rotating electric toothbrushes remove somewhat more plaque than manual ones in the long term.
- INTERDENTAL CLEANING: floss, interdental brushes or a water flosser reach the surfaces between the teeth, where a toothbrush does not reach well.
- CHEMICAL: chlorhexidine reduces plaque, but it is used in short courses.
- PREVENTION: the fluoride in toothpaste strengthens enamel and prevents decay.
At the counter
When to recommend it
- Teach cleaning between the teeth: it is the part people forget most
- Electric toothbrush: a good option, especially with poor manual dexterity
- Chlorhexidine in short courses (about 2 weeks) when the dentist advises it or after a procedure
- Gums that bleed and do not improve with good hygiene: refer to the dentist
When not to
- Do not use chlorhexidine continuously: it stains the teeth and alters taste
- Do not promise that a mouthwash will sort out inflamed gums: mechanical cleaning is needed
- Do not fail to refer persistent bleeding, a loose tooth or a mouth ulcer that has not healed in two weeks
Warnings
- Important INTERDENTAL CLEANING: it is what people forget most and what shows most in the gums.
- Important CONTINUOUS CHLORHEXIDINE: it stains the teeth (the stain comes off with a professional clean) and alters taste. Short courses.
- Caution ELECTRIC TOOTHBRUSH: not essential, but it helps, especially with poor dexterity.
- Caution PRESSURE: brushing too hard damages the gums and enamel. Teach gentle brushing.
- Worth knowing FEAR OF FLUORIDE: at toothpaste doses it is safe and it is the measure with the most evidence against decay.
Pharmacokinetics
- Absorption
- The actives (chlorhexidine, fluoride) act locally in the mouth.
- Distribution
- Fluoride is incorporated into the enamel; the rest acts locally.
- Metabolism
- Chlorhexidine is minimally absorbed; most of it acts locally.
- Elimination
- After brushing, spitting without rinsing with water keeps more fluoride in the mouth.
Oral hygiene: what each piece adds
| Aspect | What it adds | Without it |
|---|---|---|
| Toothbrush | Removes plaque from the accessible surfaces | Plaque builds up |
| Interdental cleaning | Reaches between the teeth | Inflamed gums and decay between the teeth |
| Mouthwash | An extra | Little difference if the mechanical part is done well |
| Fluoride | Strengthens enamel | Higher risk of decay |
| Chlorhexidine (short course) | Intensive plaque control | Slower recovery after a procedure |
Oral hygiene is a package: no single product replaces brushing and cleaning between the teeth.
Self-assessment
Three questions. When you check your answers you will see the explanation for each one.
-
Plaque builds up between the teeth where the brush cannot reach. That is why floss or interdental brushes are part of daily hygiene.
-
Used continuously it stains the teeth and alters taste. It is kept for short courses, usually advised by the dentist.
-
The mouthwash helps, but it is the mechanical work that removes plaque. If it does not improve with good hygiene, they should see the dentist.
Training content. It does not replace the summary of product characteristics or clinical judgement.