Are You Brushing Right?

A smile is worth a thousand words but what is a bad smile worth?

The importance of oral health is common knowledge. It is vital to every aspect of our lives- from eating, drinking, heart and bone health to that smile at first meet. This is perhaps the reason dental practises are instilled in so many; as early as childhood, the notion being that good dental hygiene practises from childhood ensure good teeth and gums for life. With all the information from dental health programs, it is no surprise that so many of us think we know just how to brush our teeth.

However, we may be wrong and our practices may not be keeping with new research and recommendations. According to the World Health Organisation’s (WHO) data, oral diseases are the most common non-communicable diseases worldwide. This also goes for Nigeria as WHO identified that a large proportion of the Nigerian population have poor oral health. WHO estimates that between 15% and 58% of Nigerians have periodontal disease (that is gum disease) and that up to 30% of Nigerians endure the pain of dental caries (cavities).

This is all so interesting, to put it mildly especially in light of the recent tweet by twitter user- OurFavOnlineDoctor. The influencer advised his 110,000 mostly Nigerian twitter followers to remember NOT to rinse their mouth after brushing but rather, spitting out what is left of the toothpaste. He further added that this gave the fluoride time to work on your teeth. The tweet is gaining quick traction and to date, has over 5,000 retweets and over 8,000 likes reads:

Verification

It is evident the precarious state most Nigerians are in with respect to dental health from the statistics outlined in the introduction. And while diet and underlying disease conditions are key factors, it is worth noting that poor daily brushing habits is the key factor for such conditions; hence our vested interest in Doctor Harvey’s recommendations.

Spit don’t rinse

A poll for National Smile month revealed that almost two in three of us rinse out the toothpaste after brushing our teeth. However, the Oral Health Foundation has directly advised people against this practice. The UK’s National Health Service (NHS) also lists this don’t rinse practice as a key recommendation for keeping your teeth clean.

While most people in their morning and night routines still prefer to rinse their mouth after brushing, it is, in effect, counterproductive as evidence shows.

Post brushing practices 

Most people know the right way to brush your teeth is to brush at least twice a day and for approximately 2 minutes. What you do after you brush your teeth is equally important. The new recommendation is that one should leave behind in the mouth a concentrated mixture of a crucial toothpaste component- fluoride.

READ ALSO: How diabetes patients can manage dental challenges

Fluoride is the single most important constituent of your everyday toothpaste. Fluoride remains on the teeth from your toothpaste. It inherently acts as a coating agent on the teeth so by not rinsing, this promotes fluoride retention and therein prolongs its beneficial effects in the mouth.

These benefits range from strengthening the enamel, preventing tooth decay and the growth of bacteria in the oral cavity.

Expert opinion 

Dubawa reached out to Dr Lawan Balami, a Community Dentistry Lecturer at the University of Maiduguri and a Public Health Practitioner with over 7 years of experience.

“in my years of experience, approximately 2 out of every 10 Nigerians know how to brush their teeth the right way. And this includes knowledge of post-brushing techniques.”

Dr Lawan Balami- Community Dentistry Lecturer at the University of Maiduguri

Dr Balami went on to note “when you rinse with water after brushing your teeth you are washing away part of the fluoride contained in the toothpaste which reduces its effectiveness in preventing tooth decay. Randomized control trials have shown the incidence of tooth decay to be higher in individuals who rinse with large volumes of water after tooth brushing compared to those who do not.”

Dr Balami says the benefit is that the method “helps maintain contact between teeth and fluoride contained in dentifrices (any agent used to clean the teeth such as a powder, paste or liquid) such as toothpaste longer than would be the case with mouth rinsing”.

What do studies say?

A Swedish study noted fewer cavities in a three year period for preschool children who rinsed with a “slurry”. It surmised a higher effect of fluoride retention in the children who used this method over children who did not.

Factors affecting fluoride retention

Another study found that factors which increased fluoride retention included fluoride concentration in toothpaste. So opt for toothpaste with a higher fluoride concentration. Dr Balami says the recommended fluoride concentration is “about 1350 – 1500ppm [parts per million] of Fluoride”. Similarly, the WHO notes a 6% increased benefit for every 500ppm. Any higher than 1,500 ppm and you might require a prescription in some countries.

Other factors that affect fluoride attention include brushing duration (2 minutes being the recommendation) and toothpaste quantity. Additionally, the clearance of saliva and rate of salivary flow are also consequential to fluoride retention. This is something we can’t help, but it’s worth knowing.

Alternatives for the die-hard rinsers 

Fret not, there are other post-brushing practises that could extend fluoride retention.

Conserve that aqua 

A study provided some consolation for people who do not want to leave the remaining toothpaste in their mouth. This alternative is to rinse but only with a small amount of water. This reduces the minty toothpaste taste that bothers so many; yet allowing a small amount of fluoride to remain in the mouth.

One study correlated fluoride retention with how many times participants rinsed. Participants who rinsed three times had a lower retention than those who rinsed once. A 1996 study had the same results. It showed a higher retention of fluoride when participants rinsed with a teaspoon quantity of water for a minute than participants who rinsed briskly with a sizeable quantity three times!

Try mouthwash 

Secondly, opting for fluoride-containing mouthwash is a good call too. A study noted that fluoride-containing mouthwashes have “simpler formulations and can have better oral fluoride retention profiles than fluoride toothpastes, depending on post-brushing rinsing behaviour”.

However, be sure to wait 30 minutes before eating or drinking for the full effect.

You are also encouraged to use it at a different time than when you just brushed your teeth. This is because the mouthwash (though fluoride-containing), has the ability to get rid of some of the concentrated fluoride in your teeth from regular brushing.

Less is more

Lastly, another method is to find a toothpaste without a chemical called- sodium Laureth sulfate. Anecdotal evidence tells us that a major deterrent for not engaging in the spit not rinse method is the strong minty flavour of toothpaste which lingers. Sodium Laureth sulfate as an ingredient in toothpaste is responsible for this strong flavour; interestingly, it also suppresses your taste bud receptors (this is why food tastes bad afterwards). Also, using toothpaste without this ingredient has an added benefit of less lather. This is because sodium Laureth sulfate is responsible for toothpaste foaming. So in essence, you get no foam to rinse and no unpleasant taste- win-win.

The implications of poor oral health in Nigeria

The complications that can arise as a result of poor oral hygiene include but not limited to tooth loss and decay, heart disease, respiratory infection as well as accompanying pain, discomfort and facial disfigurement. Poor oral hygiene can also result in less known complications including some non-communicable diseases such as:

• Dementia
• Diabetes
• Cancer
• Kidney disease
• Rheumatoid arthritis
• Pregnancy complications
• Erectile dysfunction and infertility

The suboptimal state of healthcare services in the country is an important reasons Nigerians ought to take responsibility for their oral health. The limited access to services and the fact that the cost of healthcare is mostly out-of-pocket means that the needs of people with poor oral health are often, not met.

Indeed, the Dentist to population ratio in Nigeria is estimated at 1 dentist for every 38,600 Nigerians as of 2017. Dr Balami made note of this by saying “This indicates that a high percentage of the population has oral health care needs and for the oral health care sector to match this demand with supply, there is need for adequate funding as well as manpower. ” Also “access to dental healthcare is costly for Nigerians, making up around 20% of out of pocket expenditure”.

These are just some of the reasons for the growing cry for oral health to be included in the Basic Health Care Provision Fund. This scheme is the most recent and far-reaching mechanism for meeting the health needs of all Nigerians. Suggestions have been made for oral health to be included in the child and family health services to be provided by the Fund while it is in a pilot stage.

Conclusion

The spit don’t rinse claim is true as seen in the foregoing. Making a habit of this practice will put one in good stead with good oral health. Still, you should be cautious when practising this spit not rinse method. Avoid actually swallowing your toothpaste as this can be toxic, harmful and lead to fluorosis especially in children. Interestingly, this is the reason health authorities advise to use a pea-size dollop of toothpaste. By limiting and keeping your toothpaste to only a needed amount you reduce the risk of actually ingesting it.

It is also important to note that this claim serves as a microcosm in a larger context of the growing concerns for dental health in the country. Trends discussed and statistics reviewed all highlight the need for self-action- such as the “spit don’t rinse” policy- amid the inadequacy of the health sector. Remember, health is wealth and the same goes for your oral health.