The secret to shinier, healthier teeth may just be a Walk on the Wild Side first thing in the morning and last thing at night. Damien Walmsley, who is a spokesman for the British Dental Association and professor of restorative dentistry at the University of Birmingham, uses a phone app to make sure he doesn’t skimp on brushing his teeth. It plays him a two-minute burst of Lou Reed to accompany his brushing. “You put on your favourite song and it plays it for two minutes to make sure you brush your teeth properly,” Walmsley says.
Research shows that many of us overestimate how much time we spend brushing our teeth, so timers and apps are a useful way to make sure we are cleaning them properly. But is the two minutes recommended by the NHS enough?
Dentists have been telling us for decades to aim for two minutes of brushing and that is the NHS recommendation. But last week Josefine Hirschfeld, an academic clinical lecturer in restorative dentistry at the University of Birmingham, suggested that we might only be doing half the work we need to do to keep fangs as they should be.
Her review of the scientific literature for the Conversation, an online academic news site, concluded that to remove as much plaque as possible three or four minutes of brushing could be required.
Hirschfeld said that there is still a lack of research into whether brushing for more than two minutes is linked to better long-term oral health. We asked some dentists what they advise.
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How long should you brush your teeth?
Walmsley says that it is notoriously difficult to persuade people to spend two minutes cleaning their teeth, especially if they are in a rush in the morning.
He says it is important to have a system so that you make sure to brush every accessible part of every tooth. “You want to teach patients to systematically clean their teeth. You need to have a routine that you and your hygienist or dentist will work out. But there’s no speedy way of doing it.”
Walmsley, a devotee of the Brush DJ timing app, agrees with Hirschfeld that ideally we would spend a little more than two minutes. “I think it’s a good idea if you can do more, but really two minutes is without doubt a good baseline for everybody to follow.”
Paul Woodhouse, who has two dental practices in Stockton-on-Tees and is a board member of the British Dental Association, is more ambitious for his patients. “Two minutes is an absolute minimum,” he says.
Plaque is made up of a biofilm of bacteria that sticks to the teeth. Woodhouse recommends brushing first without toothpaste because the paste, which is vital for applying fluoride, can act like a lubricant between the bristles and the teeth. “I always say to my patients two minutes without toothpaste and then two minutes with toothpaste. That’s the gold standard.
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“Most people aren’t even doing two minutes when brushing their teeth. That’s why we’ve got such a high prevalence of dental disease in this country. We don’t do a good enough job of looking after ourselves.”
He admits that it is easy to think you’ve done a comprehensive clean. “I know myself when I’m brushing in the morning, sometimes I think I’ve done a good job and I look at the toothbrush and it’s flashing to me that I’ve done 1 minute 30, so it goes back in.”
He recommends using a phone timer, an electric brush with a timer on it or even one with a Bluetooth link to a timing device that you can attach to the wall.
Woodhouse suggests to his patients that they use an electric toothbrush if they can afford it and says that if you look out for sales you can pick up a decent one for about £30. “It doesn’t have to break the bank.” Walmsley still uses a manual toothbrush.
When should you brush?
“The good times to do it are when you get up and when you go to bed at night. But it’s up to you,” Walmsley. says. “The way to think about it is 2 x 2: twice a day, two minutes.”
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Woodhouse says brushing in the morning should be before breakfast. Bacteria in your mouth break down any leftover food debris and when they metabolise sugars they produce acid. This can weaken tooth enamel when brushed into the teeth so it is best to wait an hour after eating.
“If you’re brushing during that period, you’re just scrubbing that acid into your teeth. So we like a little bit of a delay between eating and brushing. I would do it first thing in the morning and then last thing before you go to sleep at night.
“But as I say to my gum disease patients, bacteria don’t wear wristwatches. So as long as they are getting a good solid clean twice a day, it doesn’t really matter what time of day it is. If the biofilm is not reaching any level of maturity, it’s not getting the chance to do that much damage to you.”
But of course if you don’t brush first thing in the morning you may find yourself less popular with anyone else you come into close contact with. “The Germans have got a phrase that goes along the lines of: you brush your teeth in the morning to keep your friends, you brush your teeth at night to keep your teeth.
“I do get some patients who are a little bit gung-ho and are brushing four or five times a day. At that point, you’re crossing the boundary into damaging the teeth, with the abrasive nature of toothpaste and toothbrush bristles.”
What technique is best for cleaning teeth?
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Like many dentists, Woodhouse recommends what is known as the modified Bass technique for brushing. The brush is held at a 45-degree angle to the tooth and moved in a circular motion, targeting the area where the tooth meets the gum — “where most of the problems develop” — and then given a downwards flick (for teeth in the upper jaw) or an upwards flick (for those in the lower jaw) as you finish working on each tooth. Walmsley says it is important to discuss your technique with your dentist — and then keep to your system.
Should you floss?
Using interdental brushes or floss is very important for many people, but must be discussed with your dentist or hygienist, Walmsley says.
Some of Woodhouse’s patients with gum disease spend up to ten minutes on their cleaning regimen using floss or interdental brushes — or both. “Toothbrushes only hit about 60 per cent of the tooth surface. The bits between the teeth are where gum disease problems really, really hit. With interdental brushes, you can be spending five minutes just getting those beauties around the mouth.”
If spending ten minutes, morning and night, attending to your ivories sounds like a chore, there are alternative courses of action down the road, but they may be even less palatable. “You don’t get a second set of teeth,” Woodhouse says. “Unfortunately, no matter how talented a dentist you are, whatever we make is not as good as a real tooth.”
