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. Gum disease is pretty common. 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 (called plaque) 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 very thoroughly at least once a day.

Gum disease is painless, and many people are unaware that they have it. 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 gum disease?

Your mission is to remove the soft sticky plaque deposit from every surface of every tooth. 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.

So how do you do it?

There are two elements to cleaning every surface of every tooth: brushing and flossing (or alternative methods of cleaning in between teeth).

How to brush your teeth well

Use a toothbrush with a small brush head (to get in hard-to-reach spots), and a pea-sized blob of toothpaste which contains 1350-1500ppm fluoride.

Ideally, you will want to invest in an electric toothbrush. The ones that come out top for plaque removal in research studies are the rechargable oscillating rotating toothbrushes – for example those in the Oral-B PRO or Genius range. Research shows that they work better for almost everyone than manual toothbrushes. Most dentists use these themselves.

You don’t need the top-of-the-range one – the difference in price is usually due to accessories, gimmicks 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.

Follow the instructions in the manual, or ask your dentist or hygienist for advice if you have any questions! And make sure that you take your time and don’t rush – the key is to clean every surface of every tooth. This may take you longer than 2 minutes (many electric toothbrushes have a timer built in, but just ignore the timer if you can’t get the job done properly within that time).

Watch how to brush teeth with an electric toothbrush:


It’s a good idea to choose an order in which you brush your teeth and stick to it. If you always brush in the same order, then you are unlikely to miss some areas while doing others twice.

Here is an example (feel free to do it in whatever order you like though):

  1. Clean the outer surfaces of your upper teeth, then your lower teeth
  2. Clean the inner surfaces of your upper teeth, then your lower teeth
  3. Clean the chewing surfaces of your upper teeth, then your lower teeth

Especially difficult or awkward areas should receive extra attention, as should those areas more prone to problems. These are different for different individuals – ask your dentist or hygienist.

Brushing with a manual toothbrush

If you prefer to use a manual toothbrush (or if you need one for your travels), choose a soft one with a small brush head. The small brush head will ensure that you can access all areas of your teeth, and the soft bristles will help prevent toothbrush abrasion. Plaque is a soft substance, and you don’t need to scrub hard to remove it.

  • Brush gently and thoroughly by moving the brush back and forth in short, tooth-wide strokes.
  • Gently brush the inner surface of your teeth back and forth using short circular motions. Then move to the outer surface and then the chewing surface on top. Pay particular attention to where the tooth meets the gum as this is where plaque builds up.
  • Take your time and don’t rush – the key is to clean every surface of every tooth (most people take 2 to 3 minutes).
  • At the end, gently brush your tongue to remove bacteria and freshen breath.
  • Spit out the remaining toothpaste and don’t rinse, so that you get the full benefit of the fluoride for preventing tooth decay.

How often should I brush, and when?

The general consensus is that you should brush twice a day – ideally first thing in the morning (before breakfast) and before bedtime.

Why before breakfast? Wouldn’t it be better to wait until afterwards to get rid of bits of food stuck between your teeth?

There are two reasons:

  1. Plaque builds up quicker as we sleep because we produce less saliva. Even if you brush your teeth before bed, there will be plenty more plaque in the morning. Brushing before breakfast gets rid of the buildup of plaque. This means that the sugars from your food won’t be able to mix with the bacteria from the plaque to form the acid which attacks tooth enamel for at least 20-30 minutes after eating. Also, the fluoride toothpaste will give an extra protective layer against the acid attack.
  2. The obvious solution – brushing straight after you’ve finished eating – unfortunately isn’t a good idea! Here’s why: eating breakfast, especially one high in sugar and acids, for example orange juice or sugary cereal, can lower the pH level in your mouth which weakens the tooth enamel. If you brush straight after breakfast, you may scrape off the softened or weakened enamel.

Although brushing your teeth before breakfast would be ideal, it doesn’t fit in with everyone’s schedule. Don’t worry too much if it doesn’t suit you – as long as you brush last thing at night and at least one other time during the day (at least 30 minutes after a meal), you’ll be fine.

If you’re worried about bits of breakfast being stuck between your teeth before heading out, try rinsing with water – this usually dislodges any food particles.

Cleaning between the teeth

The bristles of the toothbrush don’t normally reach between the teeth. There are several ways of cleaning between your teeth, depending on the size of your gaps and what you find easiest, for example:

  • Interdental brushes
  • Interdental rubber brushes
  • Floss

You may find it impossible to use interdental cleaning devices 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. Ask your dentist or hygienist which interdental cleaning method they recommend for your teeth!

Interdental brushes

The most effective method for cleaning between teeth is to use interdental brushes. They come in lots of different sizes and you will probably need to use a combination of sizes for different-sized spaces in between your teeth. They are colour-coded to make it easier to remember which ones to use where. They also come in different shapes to make it easier to access certain areas of your mouth. Ask your dentist or hygienist which size(s) and type(s) they recommend for your gaps!

The most popular brand of interdental brush is Tepe.

Rubber interdental brushes

If you find interdental brushes difficult to use, for example because your gaps are too narrow or because you keep poking the metal bit into your gums, you may find rubber brushes easier, for example:

Wisdom Clean Between Brushes

TePe EasyPick


If you have very narrow spaces between teeth, you may find that neither of the devices above work for you. In that case, floss may well be the very best option!

Flossing has received a bad press in recent years. For example, a review of 12 randomized controlled trials published in The Cochrane Database of Systematic Reviews in 2011 found only “very unreliable” evidence that flossing might reduce plaque after one and three months. In 2016, the latest dietary guidelines for Americans, issued by the Departments of Agriculture and Health and Human Services, quietly dropped any mention of flossing without notice, because of insufficient evidence regarding its effectiveness.

However, this does not mean that flossing is “useless” or “doesn’t work”. It is more likely that

  1. the available studies didn’t include enough people and failed to examine gum health over a significant amount of time and/or
  2. the people in these trials didn’t do a great job flossing (or skipped it altogether).

Anecdotal evidence certainly suggests that daily flossing has a very positive effect on gum health, so the key is to do it correctly.

How to floss well

  • Take about 30cm of dental floss (or more, if you prefer) and wrap one end around each of your middle fingers.
  • Using your thumbs and index fingers as guides, gently slide the floss between two teeth, using a saw-like motion. Be careful not to snap the floss between teeth.
  • At the gum line, pull both ends of the floss in the same direction to form a C shape against one tooth. Pull the floss tightly and gently move it up and down against one tooth.
  • Pull the floss against the other tooth and repeat the motion.
  • Be very gentle and try not to scrape the floss too hard against your gums.

  • Repeat this wherever two teeth are touching.

  • Floss once a day and remember to insert the floss gently with a side-to-side motion – don’t snap it into place.

You can see some illustrations here:

Which type of floss should I use?

There are many different types of floss available – waxed and unwaxed, thin floss and tape – but the type of floss is less important than actually using it. So choose a floss that that works for you! If you don’t get on with one type of floss, try another (and another, until you find one that suits you).

There are also special types of floss for use with implants, bridges, and braces (e.g. Oral-B Superfloss and Oral-B Glide Threader Floss).

Should I floss and/or use interdental brushes before or after brushing?

It doesn’t really matter. On the one hand, interdental cleaning before brushing removes debris from between teeth and thus may allow the fluoride in your toothpaste to penetrate the spaces better. On the other hand, brushing before interdental cleaning means that your teeth are still covered with fluoride, and the interdental brush or floss then distributes some of the fluoride into the spaces in between teeth.

So either option is fine. Interdental cleaning before brushing does have the advantage that you’re less likely to skip it.

It also doesn’t matter whether you clean between your teeth at night or in the morning (or in the afternoon for that matter, if that’s when you usually brush).

Ideally, interdental cleaning should be done once a day – but if that feels too much, try and start off with alternating days, or doing the bottom teeth one day and top teeth the next, until it becomes easier. Flossing in particular requires a degree of dexterity that doesn’t come naturally to everyone, but practice makes perfect (eventually!).

What else can I do to keep my gums in good shape?

If you currently use tobacco products (cigarettes or smokeless tobacco such as snus), then cutting down or better yet quitting is a great way of improving gum health. Smoking causes people to have more dental plaque. It also causes gum disease to get worse more quickly, because smoking causes a lack of oxygen in the bloodstream, so the infected gums don’t heal.

How to quit smoking

While a lot of people do manage to quit cold turkey, many others struggle with this approach. After all, it takes a while to become a fully fledged 20 a day smoker, so it shouldn’t be surprising that breaking the habit of a lifetime won’t happen overnight.

Traditional nicotine replacement products tend to be pretty vile. Luckily, in recent years e-cigarettes have really taken off. They have helped many people who thought they lacked willpower to finally quit. There are many different models of e-cigarettes on the market, and even more flavours, especially online but also in vape shops. The e-cigarettes found in pharmacies tend not to be so effective.

The beauty of e-cigarettes is that they allow the quitting process to be broken up into easy, manageable stages.

For example, you can start off with e-liquids containing a fair amount of nicotine and gradually reduce the amount (over weeks or months) until you are able to use nicotine-free liquids. You can then continue using these, and gradually reduce the amount you vape over a period of weeks, or months, or years – whatever suits you.

If you’re finding it difficult to go without a cigarette for more than a few hours, the first week of switching to e-cigarettes will still require some willpower – in that case, you could have the occasional cigarette during the first week or so (cutting down each day until by the end of the week, you have entirely replaced them with your e-cigarette).

For more ideas on quitting smoking, visit Smokefree (NHS).