How to prevent gum problems

Why is it important to prevent gum problems?

More teeth are lost because of gum problems than because of tooth decay, so it is important to take care of your gums. Most adults have some degree of gum disease. Usually it progresses slowly and can be stopped from getting worse. Some people are genetically predisposed to developing gum problems.

What is gum disease and what causes it?

When you don’t brush your teeth for a while, you will notice a yellowish sticky paste that accumulates on them. This material looks like food debris, but it’s actually a film of bacteria which forms on the surface of the teeth and gums every day.

Many of these bacteria are harmless. But others happily munch away at the same food you’re eating and then excrete toxins and enzymes – using the grooves where your tooth meets the gum as a toilet of sorts. Bacteria thrive in the plaque environment and multiply until they account for nearly 100% of the mass of the plaque. This is why it’s important to remove it.

When your body notices the toxins, it mounts a defense against them by creating lots of new little blood vessels in the area to fight of the infection. The new blood vessels make the gums look red and swollen. But the bacteria attack the blood vessels, which then become fragile and bleed easily.

This first stage of gum disease is called gingivitis, and it is easily reversed by simply cleaning the teeth thoroughly once a day.

But gum disease is painless, and many people are unaware that they have it (most adults do have some degree of gum disease). As it progresses, the bone which anchors the teeth in the jaw is lost, making the teeth loose. If this is not treated, the teeth may eventually fall out or have to be taken out because of pain.

What can you do to prevent it?

The trick is simple:

Clean the teeth thoroughly once per day (preferably last thing before going to bed).

The usual advice is to brush twice per day because sometimes people may skip a brushing or not do it thoroughly, because they are in a rush or because they are too exhausted at the end of a long day.

How to thoroughly clean your teeth

Quality Brushing

The requirements for Quality Brushing are the same as the requirements for doing any job well. You need to know what you are trying to achieve and then to employ the best means for achieving your goal. Don’t be in a hurry to get it done because this will mean cutting corners and making mistakes.

Slow down – do it well and you can then forget about it until tomorrow.

Your mission is to remove the soft sticky plaque deposit from every surface of every tooth. This plaque is very soft and easy to remove. You may have removed it with your nail at some time or other. If it does not come away easily, it is not plaque.

Such a hard deposit is tartar, also known as calculus, and no amount of brushing will remove it. A dentist or dental hygienist can remove it for you during a dental cleaning. Resist brushing harder, as this can cause toothbrush damage.

Toothpaste is NOT a major item.

It is only an aid which adds some flavour – cleaning can be done without it if you prefer. If you use toothpaste, choose one which contains fluoride to help prevent tooth decay. Some dentists recommend toothpastes containing at least 1350 ppm (parts per million) of fluoride, but anything containing over 1000 ppm is probably ok.

So how do you do it?

Use a soft toothbrush with a small brush head (to get in hard-to-reach spots), and a pea-sized blob of toothpaste.

Good Technique – Focus On The Gum

This involves putting the focus of cleaning on the little ditch called the sulcus, which is situated between the tooth and the gum around each tooth. This little ditch is the place where gum disease begins.

Because quality brushing is focused on the prevention of gum disease, the brush is angled at a 45 degree angle to the gum (into the little ditch). Obviously, this is 45 degrees upwards for the upper teeth and 45 degrees downwards for the lower teeth.

The movement of the brush should be a backwards and forwards vibration or short circular movements (similar to the cleaning action of a washing machine). No scrubbing please – this may cause damage to both gum and tooth tissue and should be avoided.

Many people find manual toothbrushes difficult to use properly. In this case, you may want to invest in an electric toothbrush. Not all electric toothbrushes are created equal. The ones that come out top for plaque removal in the available research are the rechargable oscillating rotating toothbrushes – for example those in the Braun Oral-B Professional series.

You don’t need the top-of-the-range one – the difference in price is usually due to accessories and design. Of course, they are still more expensive than manual ones (and the replacement brush heads are quite expensive), but there are often special offers both in shops and on Amazon.

Good Method – The Bus Route Rule

Use a specific direction for cleaning and sticking to it – the ‘Bus Route Rule’. This means always starting in the same place and always finishing in the same place with the direction in between always the samejust like the bus.

Any route that reaches every surface of every tooth is fine. The important thing is that whatever route you choose stick to it. If the bus (brush) always goes in the same direction then you are unlikely to miss some areas while doing others twice.

Especially difficult or awkward areas should receive extra attention, as should those areas more prone to problems. These are different for different individuals so you should consult with a dentist or hygienist.

You now have all you need:

  • Plenty of time
  • Soft brush (and pea-sized blob of tooth-paste)
  • Focused technique (45 degree angle into the little ditch – with vibration or short circular movements)
  • Definite method (Bus Route Rule – every surface of every tooth)

Watch how to brush teeth with an electric toothbrush:


Cleaning between the teeth

The bristles of the toothbrush don’t normally reach between the teeth. You can clean between teeth by using floss. Not everyone is familiar with dental floss or how it works. If you haven’t used floss before, ask your dentist or hygienist to show you how it’s done (once you work up the courage to see one).

You may find it impossible to use floss if you haven’t had a professional cleaning for a while due to fear, because of the build-up of hard deposits (tartar/calculus) between teeth. You will find things much easier once these hard deposits have been removed.

It’s important that you use it properly – snapping it between the teeth and hitting your gums does more harm than good – so if you’re unsure, ask for advice!

You can watch how to floss here:


There are many different types of floss available – waxed and unwaxed, thin floss and tape – but the type of floss is much less important than actually using it. So choose a floss that that works for you! Generally speaking, waxed floss is easier to use than unwaxed, but even amongst waxed flosses there are huge differences. If you don’t like one type of floss, try another.

It doesn’t matter whether you floss before or after brushing – there are arguments to be made for either option, and even dentists don’t agree on which way may be best.

Ideally, flossing should be done once a day – but two or three times a week is better than not flossing at all.

Help – I can’t use floss!

You may have trouble using floss, for example due to a bad gag reflex or because you find it too fiddly (although this can often be overcome with practice).

Let your dentist or dental hygienist know and they will be able to recommend alternatives to you – for example, interdental brushes (TePe brushes), floss holders (floss on a stick), or thin toothpicks.

Further reading:

Prevention (Ask Doctor Spiller)



© The “How to Thoroughly Clean Your Teeth” section has been adapted with permission from Philip Christie (M.Dent.Sc.)’s book “Something To Chew On – A Mouth Map to Health”