Cleaning your teeth properly

Brushing twice a day

Brush last thing at night and at one other time in the day, for about two minutes each time. The night-time brush matters most: saliva, which helps protect the teeth, flows less during sleep.

Clean every surface of every tooth: the outer side, the inner side facing the tongue, and the biting surface. Tilt the bristles towards the gum line, where plaque collects and where gum disease starts, and use short, gentle strokes or small circles. Pressing hard does not clean better, and over time it can wear the gum and the tooth.

A brush with a small head and soft or medium bristles suits most adults. Manual and electric brushes both work well when used properly, and some people simply find an electric one easier. Replace the brush, or the brush head, about every three months, and sooner if the bristles are splayed.

Fluoride toothpaste: how much, and for whom

Fluoride makes enamel more resistant to the acid that causes decay. The strength is printed on the tube in parts per million (ppm).

• Adults and children from 7: a toothpaste with 1,350 to 1,500 ppm fluoride.
• Children from 3 to 6: a pea-sized amount of toothpaste with at least 1,000 ppm fluoride. A family toothpaste is fine.
• Children under 3: a smear of toothpaste with at least 1,000 ppm fluoride, from the time a baby's teeth start to come through.

Children need an adult to brush their teeth, or to watch them brush, until they are at least 7. Do not let them eat or lick toothpaste from the tube. A dentist may recommend a higher-strength toothpaste for someone who is particularly prone to decay.

After brushing, spit out the toothpaste but do not rinse with water. Rinsing washes away the fluoride left on the teeth and reduces its protective effect.

Cleaning between the teeth

A toothbrush does not reach the sides of the teeth where they touch, and this is where both decay and gum disease often begin. UK guidance advises cleaning between the teeth once a day, down to just below the gum line, before brushing.

1. Interdental brushes. Where there is room, UK guidance prefers a small interdental brush to floss. It should fit snugly without being forced. Some people need more than one size for different gaps, and a dentist or hygienist can show which.

2. Floss or tape. For tight gaps, slide the floss gently between the teeth, curve it into a C-shape around each tooth and move it up and down. Do not snap it into the gum.

3. Then brush. Cleaning between the teeth first lets the fluoride from the toothpaste reach the spaces that have just been cleared.

Gums that are not used to it may bleed at first. This usually settles with regular cleaning; if it does not, tell your dentist. Wooden toothpicks are not a good substitute, as they can injure the gum.

Tongue and mouthwash

Bacteria also collect on the tongue and can contribute to bad breath. Brushing the tongue gently, or using a tongue scraper, removes that coating.

Mouthwash is optional. It does not replace brushing or cleaning between the teeth. A fluoride mouthwash can help people who are prone to decay, but use it at a different time from brushing, for example after lunch, and do not eat or drink for 30 minutes afterwards, as the NHS advises.

Sugar: how often matters

Decay starts when the bacteria in plaque turn sugars from food and drink into acid, which dissolves the tooth over time. Each sugary snack or drink sets off a new acid attack, so how often sugar is eaten matters as well as how much.

• Keep sugary foods and drinks to mealtimes rather than grazing between them.
• Avoid sugary food and drink at bedtime, when there is less saliva to protect the teeth.
• Between meals, water and plain milk are the drinks kindest to the teeth.
• For children who take medicine often or for a long time, ask for a version without sugar.

Braces, implants and bridges

Fixed braces trap food and plaque around the brackets and wires. Interdental brushes and small single-tufted brushes reach where an ordinary brush cannot, and the orthodontic team usually shows which aids to use.

Under a bridge, the false tooth sits against the gum. Special floss with a stiff end, or an interdental brush, can be passed underneath it to clean the gum below.

Implants need the same care as natural teeth. They cannot decay, but the gum and bone around them can become inflamed, so clean around and between them with a brush and interdental aids, and keep to the check-ups your dentist recommends.

Check-ups

Regular check-ups find decay and gum disease early, when they are simpler to treat, and a hygienist can remove hardened deposits (tartar) that brushing cannot. How often someone needs a check-up is not a fixed rule: the dentist sets the interval according to that person's own risk of disease.

How decay starts and what stops it is explained on the page about tooth decay. The same daily routine protects the gums, as described under gum disease.