Home Dental Care Best toothbrushes, optimal teeth-cleaning: Experts offer dental advice

Best toothbrushes, optimal teeth-cleaning: Experts offer dental advice

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The advice from dental experts for keeping your teeth clean sounds simple enough: Brush twice a day and floss. But choosing among the many products available to help you do this can be daunting. Electric toothbrush or manual? Soft or hard bristles? String floss or water flosser?

The right answers depend partly on your preferences. “Hopefully what you experience with any toothbrush is that you’re getting your teeth clean, and then you’re going to want to use it again,” says Edmond R. Hewlett, a professor at the UCLA School of Dentistry in Los Angeles and a consumer adviser for the American Dental Association (ADA).

But there are tooth-care products with clear advantages. We explain which dental hygiene strategies work best and what to consider when picking products.

Q: Are electric toothbrushes better for your teeth?

A: Most evidence suggests that they are, at least a little. A 2014 analysis of previously published studies by Cochrane, an independent, London-based panel of experts, found that over several months, powered brushes removed 21 percent more plaque and reduced gum inflammation by 11 percent more than manual brushes. Two more recent studies, by scientists who had funding from companies that make toothbrushes, found similar results.

But the real-life significance of that research might not mean much for your overall oral health. Electric brushes might be better for some people, says Olivia Sheridan, a professor of clinical restorative dentistry at the University of Pennsylvania, because they can be easier to use for those who lack manual dexterity or have braces or permanent retainers, or those who care for someone who needs help brushing their teeth. But your technique may matter more than whether you use a manual or electric brush. Both types of brushes can be “completely effective in plaque removal” and in helping to prevent gum disease, says Sheridan.

What features should you look for? Cleaning ability is key, and it’s the most significant factor in Consumer Reports’ electric toothbrush scores. You should also seek out brushes with features such as a two-minute timer and a pressure sensor. The ADA says that most people brush their teeth for less than a minute, so a built-in timer can help. A pressure sensor can warn you if you’re pressing too hard with your brush, which can damage gums and enamel. Sheridan also recommends looking for brushes that pause when it’s time to move from one section of your mouth to the next.

Q: What kind of bristles are ideal?

A: Although you’ll find manual toothbrushes with bristles ranging from extra-soft to hard, medium- or hard-bristle brushes are best reserved for tasks such as cleaning the grout in your kitchen or bathroom tile. For your teeth, dental experts say you should use a soft- or extra-soft-bristle brush.

That’s because harder bristles can injure your delicate gum tissue. They can also potentially damage your teeth, says Clifton Carey, a professor at the University of Colorado School of Dental Medicine at Anschutz Medical Campus.

Q: Which is better, a rotating or a sonic electric toothbrush?

A: Both kinds can do a great job of cleaning your teeth. Rotating toothbrushes have a round head that rotates or oscillates. Sonic brushes have a more typical elongated head shape resembling a manual brush, with bristles that move side to side so quickly they produce an audible hum.

Some research suggests that rotating toothbrushes may have a slight edge over sonic types. But a 2021 analysis in the Journal of the American Dental Association designed to assess real-world effectiveness concluded there wasn’t enough evidence to pick a winner. And testing by Consumer Reports concurs: We found models of both types that performed well.

If you’re not sure which type of electric brush you’ll like, check to make sure that you can return it if you decide it’s not right for you.

Q: Do you really need to floss?

A: Yes. You may have rejoiced over headlines a few years back that claimed there’s not much evidence supporting flossing. And in 2019, even the Cochrane panel characterized the evidence showing that flossing helps reduce gum disease as “low certainty,” with inconsistent results.

But don’t toss out your dental floss yet. Although the evidence might not be especially rigorous, regular flossing is supported by basic biology, experts say. When done correctly, flossing removes bacteria in parts of your mouth that brushing can’t get to. Good flossing technique generally involves gently rubbing the floss strand in a C-shape against both sides of each tooth and at the gumline.

Q: Which toothpaste should you use?

A: Any toothpaste that has fluoride should do the trick. That’s the most important ingredient because it prevents cavities and helps you avoid tooth decay by strengthening the enamel. Fluoride is so important that the ADA doesn’t provide its Seal of Acceptance to fluoride-free toothpastes.

There are other ingredients in some toothpastes that you may want to stay away from. For example, research has found that people who frequently get canker sores may get fewer ones when they avoid toothpastes that contain sodium lauryl sulfate.

Various toothpaste ingredients fall in and out of fashion. “We have to be very careful of those fads,” says Dawn Smith, chair of the Department of Dental Hygiene at Howard University’s College of Dentistry in D.C. That’s because it can take a while for researchers to discern whether a particular ingredient is safe and effective.

One newer trend has little evidence to support it: activated charcoal toothpastes, which are often marketed as whiteners. But some could cause damage, according to a 2019 paper in the British Dental Journal. Charcoal can be abrasive, which can wear down your enamel, damage your gums, and lead to tooth sensitivity. And many charcoal toothpastes don’t contain fluoride.

Q: Should you use mouthwash?

A: It’s fine to use mouthwash, says Smith, but it’s not strictly necessary and can’t take the place of brushing and flossing.

Certain types of mouthwash can help with specific conditions. For example, prescription rinses with chlorhexidine, an antimicrobial, can help people who have periodontal disease or are at high risk for tooth decay, Hewlett says.

And if you live in an area where your water isn’t fluoridated (or you don’t drink tap water), you may want to consider adding a fluoridated mouth rinse to your family’s daily dental care routine, Smith suggests. That’s especially true if you have kids, and it’s something that can be helpful even if there’s fluoride in your toothpaste.

Q: Are teeth whiteners worth trying?

A: Some of the stains on the outside of your teeth can be removed during a typical dental cleaning. But you might wonder about bleaching your teeth, either at your dentist’s office or by using an at-home kit.

The active ingredient in most tooth bleaching products isn’t the household bleach you use for laundry but hydrogen peroxide (or a related compound).

At-home bleaching, which can involve products such as bleaching strips or gels and trays, can be effective, says Kenneth Markowitz, an associate professor at the Rutgers School of Dental Medicine in Newark. But it generally takes longer to see results with those treatments than with professional whitening, because in-office treatments are done with higher concentrations of peroxide.

Still, it’s best to avoid trying to whiten your teeth quickly, he says. That’s because the higher the concentration of bleaching agents used, the more likely you are to experience the main side effects of whitening: gum irritation and tooth sensitivity (which often involves a tingly feeling of pain). High concentrations could even damage teeth.

Instead, bleaching is best if done slowly over time, using low concentrations of bleaching agents. Carey recommends that people who bleach at home read the product’s directions and follow them exactly.

Q: How often do you need a teeth cleaning?

A: You’ve probably heard you should get cleanings every six months. But a 2020 Cochrane review found that adults who timed their visits based on their risk factors (which you can discuss with your dentist) did no worse than people who followed the six-months rule.

The ADA says tailoring your visits to your individual health risks is a good one.

If you’re not at high risk for cavities — your teeth are otherwise healthy and you don’t eat a lot of sweets, for example — seeing a dentist once a year may be sufficient for you, Carey says.

On the other hand, people at higher risk may need to go in more often. If you struggle with a dry mouth, for instance, a common occurrence for people who are taking multiple medications, Carey says you may need to see your dentist more frequently, because saliva is one of the biggest protectors of teeth.

Copyright 2022, Consumer Reports Inc.

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