In a Nutshell:
- Brush twice a day for at least 2 minutes, ideally before breakfast and before going to bed.
- Use a rechargeable electric brush with a small round brush head.
- Clean between teeth using interdental brushes and/or floss once a day.
- Get your teeth professionally cleaned (every 6 months, or if you have gum disease every 3 to 4 months).
- Don’t smoke.
- Remove lip and tongue piercings.
- Also read our quick summary on how to prevent tooth decay.
For lots more information and handy tips, read on!
Table of Contents
- What is gum disease?
- Why do my gums bleed when I brush or floss?
- How can I prevent gum disease, or stop it from getting worse?
- Can I get rid of tartar myself?
- How do you remove plaque?
- Cleaning between teeth
- Professional cleanings
- How to stop smoking
- Lip and tongue piercings
What is gum disease and what causes it?
When you don’t brush your teeth for a while, you’ll notice a yellowish sticky paste forming. This stuff looks like food debris, but it’s actually a biofilm of bacteria called “plaque”.
These bad bacteria happily munch away at the same food you’re eating and then excrete toxins and enzymes – using the grooves where your teeth meet the gums as their toilet. Bacteria thrive in plaque and multiply until they make up nearly 100% of the mass of the plaque. It takes about 24 hours for plaque to form fully. This is why you should remove plaque from all tooth surfaces once a day.
Gum disease (also known as periodontal disease) is painless. As a result, most people are unaware that they have it. Over time, the bone which anchors the teeth in the jaw is gradually lost, making the teeth loose. If this is not tackled, the teeth may eventually fall out or have to be taken out because of pain.
Common types of gum disease
There are basically 2 types of gum disease: gingivitis and periodontitis. Both are caused by plaque.
Gingivitis is a local inflammation around the neck of the tooth. The gum might swell slightly and bleed when brushed. BUT the underlying support tissues, the bone and the periodontal membrane which holds the tooth in place are not affected. When the plaque is fully removed, healing occurs completely, and no long term damage is done.
Periodontitis affects the membrane and bone, causing the bone to be lost and a pocket to form between the tooth and the socket. It can be treated but once the damage is done, it basically doesn’t recover. In other words, the disease can be stopped but not reversed.
It is a long term chronic condition which seems to go in fits and starts and can take decades before teeth are lost through it.
When periodontitis isn’t treated, the bone and tissues which hold your teeth in place are destroyed, and the teeth may become loose or fall out (advanced periodontitis).
How does gum disease progress?
We used to think that gingivitis inevitably would progress to periodontitis over time. This now appears not to be the case, but we don’t know what makes one person get periodontitis and another just get gingivitis.
Some people are genetically predisposed to getting gum disease. This is especially true for aggressive forms of gum disease. There are specialist dentists for gums called periodontists who can help if you have aggressive types of gum disease or more advanced gum disease.
Why do my gums bleed when I floss or brush?
When your body notices the toxins that are excreted by the bacteria, it mounts a defence against them. It does this by creating lots of new little blood vessels to fight off the infection. It is these new blood vessels that make the gums look red and swollen. The bacteria attack the blood vessels, which then become fragile and bleed easily.
When this happens, you’ll probably think it’s best to stop brushing and flossing. After all, we’ve been taught that if something bleeds we should leave it well alone and let it heal!
But this is not how it works with gums. The somewhat counter-intuitive cure is to keep cleaning around and just below the gumline really well. This will eventually get rid of the toxins and stop the bleeding.
There are some systemic diseases (that is, diseases that affect several parts of the body) which can also lead to bleeding gums. However, most of the time, the bleeding is simply caused by plaque.
What can I do to stop my gums from bleeding, or to stop gum disease from getting worse?
Your mission is to remove the soft sticky biofilm deposit from every surface of every tooth (including just below the gum line). 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.
Plaque can start to harden within as little as 24 to 72 hours and turn into tartar – the exact amount of time it takes varies hugely from person to person. Some people are much more prone to tartar than others. They have saliva which is pretty rich in Calcium and Phosphate ions, which deposits onto the teeth like limescale on a kettle.
By removing the biofilm from all tooth surfaces every single day, tartar doesn’t get a chance to harden – even if you’re prone to it.
Can I get rid of tartar myself?
While there are some home kits sold on the internet, it’s never a good idea to try and remove tartar yourself. Unfortunately, it’s very easy to do permanent damage to your gums if you don’t have professional tools and the training required to use them correctly. Also, resist brushing harder – a toothbrush is never a match for tartar, and you don’t want to end up damaging your gums and teeth by brushing too hard.
Realistically, the only person who can safely and thoroughly remove tartar is a dentist or dental hygienist. An added benefit of a dental cleaning is that you will find it much easier to keep your teeth clean once the tartar has been removed.
How do you do remove plaque?
There are two elements to cleaning every surface of every tooth:
How to brush
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.
Electric toothbrushes are much more effective than manual ones for most people. The ones that come out on top for plaque removal in research studies are rechargeable oscillating rotating toothbrushes 1 – those in the Oral-B PRO, Smart, or Genius range.
You don’t need the top-of-the-range one – the difference in price is usually due to accessories, gimmicks and design. All the Oral-B brushes from the Pro 2000 upwards have the same number of rotations and oscillations and clean equally well. 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.
The other good thing about these toothbrushes is that they will warn you and stop if you brush too hard. You can do a lot less damage with an electric brush compared to a manual brush.
Choose one of the small round brush heads, rather than the oblong/oval brush heads – they make it easier to clean each individual tooth.
Here’s a tip:
Use two hands when you’re brushing, one to pull your lip out of the way so you can see what you’re doing and one to hold the brush. – Gordon Laurie, BDS
When brushing, make sure that you take your time and don’t rush – the key is to clean every surface of every tooth. This normally would take about 3 to 5 minutes.
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.
At the end, gently brush your tongue to remove bacteria which cause bad breath. You can also buy a dedicated tongue scraper if you prefer.
Spit out the remaining toothpaste and don’t rinse, so you get the full benefit of the fluoride for preventing tooth decay. Swallowing a small amount of toothpaste is not dangerous.
How often should I brush, and when?
You should brush twice a day – brushing much more often than that could cause damage to your teeth and gums.
Ideally, you should brush first thing in the morning (before breakfast) and before going to bed. If you brush last thing before bedtime, the fluoride has a chance to work undisturbed during the night.
Don’t brush for 30 minutes after eating, or after drinking acidic drinks! 2
The reason is that things that are high in sugar and acids (such as orange juice or sugary cereal) can lower the pH level in your mouth. This weakens the tooth enamel. If you brush straight after breakfast, you may scrape off the softened or weakened enamel.
Also, plaque builds up more quickly 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.
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 one other time during the day (20 – 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.
How to clean between the teeth
Your toothbrush only cleans about 60% of your teeth. The bristles can’t properly reach between teeth, especially the area just below the gumline where the gums meet the teeth. Also, they don’t reach in between the “contact points” where two neighbouring teeth meet.
There are several ways of cleaning these areas, depending on the size of your gaps and what you find easiest:
- Interdental brushes
- Interdental rubber brushes
Often, a combination of these methods works best. You may want to floss and then use interdental brushes where spaces are wide enough.
You may find it impossible to clean between your teeth if you haven’t had a professional cleaning for a while, because of the build-up of hard deposits aka tartar or calculus between teeth. Things will be much easier once these deposits have been removed. Ask your dentist or hygienist which interdental cleaning methods they recommend for your teeth!
Back teeth (molars and premolars) are kidney-shaped at their base, so floss doesn’t clean the surfaces in between teeth as well as interdental brushes do:
Interdental brushes come in lots of different sizes and you’ll likely 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) are right for your gaps, and how to use them.
The most popular brand of interdental brush is Tepe (see photo above).
Rubber interdental brushes
Not everyone is a fan of the bristled interdental brushes. If you keep poking the metal bit into your gums, you may find rubber brushes easier. They look like this:
- Wisdom Clean Between Brushes
- TePe EasyPick
- GUM Soft-Picks
Don’t use interdental brushes where the spaces in between teeth may be too narrow to safely accommodate them. If you’re unsure, ask your dentist or hygienist for advice!
If you have very narrow spaces between teeth and healthy gums, you may find that neither of the brushes above work for you. In that case, floss is the best option.
The other advantage of floss is that it gets in between the contact points where two neighbouring teeth touch. This is where plaque tends to accumulate, and it’s where cavities are most likely to form between teeth. Disrupting the biofilm in this area (when you slide the floss in and out) helps with preventing cavities in between teeth.
How to floss
- Take about half an arm to an arm’s length (depending on the length of your arm and how generous you feel) of dental floss. Wind most of it around your left middle finger or index finger. The middle finger is normally recommended, but whichever is easiest for you. Wind the remaining floss around the same finger of the opposite hand. This hand will take up the used floss as you go along. If you’re left-handed, you may want to wrap most of the floss around your right middle finger or index finger instead. It’s easier to use your dominant hand for doing the winding.
- Hold the floss tightly between your thumbs and index fingers.
- Gently slide the floss between two teeth, using a gentle side-to-side motion. Be careful not to snap the floss between teeth.
- When the floss reaches the gum line, pull both ends of the floss in the same direction to form a C shape against one tooth. See the round close-up between pictures 3 and 4 in the illustration above? Basically, you pull the floss tightly and gently slide it up and down against one tooth, and especially below the gum line. Repeat this motion a few times so you know that you’ve cleaned the tooth’s surface thoroughly.
- 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, and behind the very back teeth.
- Each time you move on to next space, use a fresh segment of floss and wrap the used one around the finger that starts off with the short end of the floss.
- Once you’re finished, throw the floss away.
Some more tips:
- A lot of websites say that it only takes a couple of minutes to floss. This can be disheartening if it takes you a lot longer – and if you have a small mouth, teeth which aren’t perfectly straight, very tight spaces or less-than-stellar dexterity, it almost certainly will take longer. It’s not a race, so take your time. You will probably find that you do get a bit faster as time goes on.
- Have a road map of what order you’re going to floss your teeth in, and stick to it.
Which type of floss should I use?
The easiest floss to use is non-shredding floss made of PTFE (Teflon): this includes Colgate Total Pro Gum Health Interdental Floss or Oral-B Pro-Expert Premium Floss in the UK, and Oral-B Glide in the US. Admittedly, there are some environmental and potential health concerns with PTFEs 6. But for ease of use, it can’t be beaten.
Alternatively, some people swear by fluffy expanding floss, which is excellent for cleaning purposes but has a tendency to shred. Examples include Corsodyl Daily Expanding Floss, Sensodyne Gentle Floss Expanding, or GUM Access Floss.
Most research appears to show that the type of floss is less important than actually using it. So choose a floss that works for you!
There are also special types of floss for use with implants, bridges, and braces. Examples include Oral-B Superfloss and Oral-B Glide Threader Floss.
Should I clean between teeth before or after brushing?
It doesn’t really matter. On the one hand, interdental cleaning before brushing removes gunk from between teeth, so that might make it easier for the fluoride in your toothpaste to get in there. On the other hand, brushing before interdental cleaning means that your teeth are still covered with fluoride, and the interdental brush or floss might then distribute some of the fluoride into the spaces.
So either option is fine. Interdental cleaning before brushing does have the advantage that you’re less likely to skip it.
Should I clean between teeth in the morning or at night?
It doesn’t matter. The most popular time seems to be before brushing last thing at night, but the important thing is to do it once a day. Find a time that suits you.
If once a day feels overwhelming at first, start off by 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!).
The floss keeps shredding and getting stuck!
Ideally, the floss should smoothly glide between the teeth. If you’re having problems with floss shredding between certain teeth, let your dentist and/or hygienist know so they can have a look at the problem for you. There can be many reasons, for example
- the floss might snag on dental tartar that’s built up, and simply removing this tartar will stop the shredding (and make flossing much easier)
- there could be an overhang or leftover cement from previous dental work – sometimes trimming or buffing the offending edge to make it smoother can solve or at least help with the problem
Your dentist or hygienist may also be able to show you an alternative technique to use in these spots.
Keep the floss taut when inserting and removing it from each gap. Hold it firmly against the side of the tooth to keep shredding to a minimum. Having plenty of floss makes it easier to keep it wrapped around your fingers and pulled tight.
My gums bleed when using interdental brushes or flossing!
If you haven’t used interdental cleaning methods before, or only once in a while, your gums will probably bleed – at least the first few times. This is because the bacteria which have been allowed to thrive have attacked the blood vessels, leaving them fragile and prone to bleeding. Your gums may also feel tender and sore after interdental cleaning.
The good news is that if you keep using interdental brushes or flossing gently, most of the bleeding will usually stop within a week or two.
Is flossing pointless?
Flossing has received a bad press in recent years following the release of an Associated Press report in August 2016 under the headline “Medical benefits of flossing unproven”, which looked at research carried out over the last decade. For example, a review of 12 randomized controlled trials 7 found only “very unreliable” evidence that flossing might reduce plaque after one and three months (the review did find though that flossing in addition to toothbrushing reduces gingivitis compared with toothbrushing alone).
The European Federation of Periodontology’s guidelines state that interdental brushes are essential for treating and preventing gum disease, and that floss is of little value unless the spaces between your teeth are too tight for the interdental brushes to fit without hurting or causing harm. 8
However, the poor research evidence for flossing doesn’t mean that flossing is “pointless” or “doesn’t work”. It’s more likely that people didn’t floss very effectively (or perhaps even skipped it altogether), or that the research wasn’t very well designed.
If you’ve been successfully flossing up until now, don’t give up! Anecdotal evidence certainly suggests that daily flossing has a really positive effect on gum health. The key is to do it right. And between those pesky kidney-shaped molars, try using interdental brushes if at all possible.
What about mouthwash?
Unless your dentist has prescribed you a mouthwash for a specific purpose, there is no need for it. Mouthwash is not normally necessary for maintaining good oral health or for preventing gum disease. In fact, it can even be counterproductive: using mouthwash after brushing your teeth will wash away the fluoride from the toothpaste (remember the “spit and don’t rinse” rule).
Most dental professionals would recommend having your teeth cleaned every 6 months (or more often if you have periodontitis). This is also your chance to get advice for keeping your teeth and gums healthy. Everyone’s mouth is different, and you can get tailored tips from your hygienist or dentist.
In the UK, dental hygienists can provide these services directly, without the need to go through a dentist for a referral. So you can pick anyone you like – they don’t have to work at the same practice as your dentist.
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 lowers the level of oxygen in the bloodstream. This means that gum infections don’t heal well, making gum disease worse. 9
How to quit smoking
Smoking is one of the biggest factors linked to gum disease. But giving up smoking is not easy. Firstly, nicotine is incredibly physically addictive. Secondly, there can be many other benefits, such as feeling more alert and productive, being soothed by the sucking motion, and hanging out with fellow smokers. Consequently, you do need a fair bit of motivation to quit – something which offsets the positives of smoking.
Reasons for quitting
Some possible reasons for quitting include:
- concern about your own health
- concern about the impact of smoking on your family
- the cost and potential savings
- a dislike of the tobacco industry and its tactics.
It can be useful to decide on one or more of these reasons to quit and read up on them using Google.
One book which has helped many people quit almost overnight is Allen Carr’s “Easy Way to Stop Smoking”.
While a lot of people do manage to quit virtually cold turkey using the Allen Carr approach, others find it doesn’t work for them. After all, it takes a while to become a fully-fledged 20, 30 or 40 a day smoker, so it’s not 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 the willpower to finally quit.10 There are many different models of e-cigarettes on the market, and even more flavours, especially online but also in vape shops. If you want to wean yourself off nicotine, then a system where you can use your own liquids is best. That way, you can gradually reduce the nicotine content.
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 Quit Smoking (NHS).
Lip and tongue piercings
Lip and tongue piercings often cause trauma to the gums and localised gum disease. The best thing to do is to remove them. 11
You may also like:
Visit our forum for support and help with dental phobia, fear and anxiety!
- Guidelines for Effective Prevention of Periodontal Diseases – Advice from the European Federation of Periodontology.
- Scottish Dental Clinical Effectiveness Programme SDCEP (2014). Prevention and Treatment of Periodontal Diseases in Primary Care – Dental Clinical Guidance (PDF, 116 pages)
- Periodontal Disease and Treatment – FAQs answered by the British Society of Periodontology
- BSP Implementation of European S3 – level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice – The official guidance for perio treatment for the UK
Sources of Information
- Yaacob M, Worthington HV, Deacon SA, Deery C, Walmsley AD, Robinson PG, Glenny AM. Powered versus manual toothbrushing for oral health. Cochrane Database of Systematic Reviews 2014, No 6.
- Guidelines for Effective Prevention of Periodontal Diseases – Patient/Public Guidance
- Slot DE, Dörfer CE, Van der Weijden GA. The efficacy of interdental brushes on plaque and parameters of periodontal inflammation: a systematic review. International Journal of Dental Hygiene. 2008;6(4):253-264.
- Imai PY, X.; MacDonald, D. Comparison of interdental brush to dental floss for reduction of clinical parameters of periodontal disease: A systematic review. Canadian Journal of Dental Hygiene. 2012;46(1):63-78
- Poklepovic T, Worthington HV, Johnson TM, Sambunjak D, Imai P, Clarkson JE, Tugwell P. Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults. Cochrane Database of Systematic Reviews 2013, Issue 12
- Boronow, K.E., Brody, J.G., Schaider, L.A. et al. Serum concentrations of PFASs and exposure-related behaviors in African American and non-Hispanic white women. J Expo Sci Environ Epidemiol 29, 206–217 (2019). https://doi.org/10.1038/s41370-018-0109-y
- Sambunjak D, Nickerson JW, Poklepovic T, Johnson TM, Imai P, Tugwell P, Worthington HV. Flossing for the management of periodontal diseases and dental caries in adults. Cochrane Database of Systematic Reviews 2011, Issue 12.
- European Federation of Periodontology (2014). Guidelines for effective prevention of periodontal diseases.
- Kinane DF, Chestnutt IG. Smoking and periodontal disease. Crit Rev Oral Biol Med 2000;11:356-65.
- Hartmann-Boyce J, McRobbie H, Lindson N, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Butler AR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2020, Issue 10. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub4.
- Lip piercing: prevalence of associated gingival recession and contributing factors. A cross-sectional study. Kapferer I, Benesch T et al. J Periodont Res 2007; 42: 177–183