Caring for your teeth: 8 steps to dental health

The problem this addresses

A report from the Australian Institute of Health and Welfare (AIHW) found that the dental health of Australians is not improving.

Despite growing awareness of decay culprits such as high sugar consumption:

• there has been a rise in the average number of children’s baby teeth affected by decay
• nearly half of all children aged 12 had decay in their permanent teeth
• over one-third of adults have untreated decay
• more than 50% of people aged 65 and over have gum disease
• one in five have complete tooth loss

The direction of travel is the concerning part. Awareness has risen; outcomes have not followed. How does tooth decay develop?, the stages of dental decay and how do I prevent dental decay? cover the disease behind those numbers.

Two structural reasons sit behind that, and neither is about willpower. Cost is the most commonly reported reason Australians delay or avoid dental care, and dentistry sits largely outside Medicare — the price guide is published for that reason. Fear is the second — how can I ease my anxiety about visiting the dentist? and dental anxiety. Any honest account of why the numbers look like this has to start there rather than with individual habits.

Why it matters beyond your teeth

Poor oral health is linked to:

• heart infections
• coronary heart disease
• stroke
• poor outcomes in pregnancy
• aspiration pneumonia

The mouth is not a sealed compartment. Chronic oral infection is a chronic systemic inflammatory load, which is why these associations exist.

One caution about how to read that list. Most of these are associations, and association is not proof that treating gum disease prevents heart attacks. The relationship with the strongest evidence is the diabetes one — which runs in both directions, with gum disease worsening glycaemic control and poor control worsening gum disease. That one is worth acting on.

Aspiration pneumonia in dependent older people is the item most often assumed to be equally settled, and it is not. The association is established and the mechanism is plausible, but the current systematic review — Oral care measures for preventing nursing home-acquired pneumonia, Cochrane Database of Systematic Reviews 2022, Issue 11, CD012416, covering six randomised trials in 6,244 nursing home residents — found "insufficient evidence of a difference" in whether residents developed pneumonia at all, rated low-certainty evidence. Its one positive finding was narrower and also low-certainty: from two trials totalling 454 residents, professional oral care may reduce deaths from pneumonia at 24 months, risk ratio 0.43 (95% CI 0.25 to 0.76). All six trials were at high risk of bias and none was Australian. So helping someone who cannot clean their own mouth is still plainly worth doing — for pain, infection, tooth loss and the ability to eat — but it is not evidence of pneumonia prevention, and this page previously said it was. The rest of the list are reasons to take your gums seriously, not reasons to panic. See diabetes and dental health: the two-way street, diabetes and oral health, health problems linked to poor oral hygiene and dental health and general wellbeing; on the pregnancy item specifically, pregnancy and dental health explains why “linked to” is the accurate phrase there too.

The eight steps

1. Brush your teeth twice a day for two minutes.

Two minutes is longer than most people brush. Time it once and you will see how far short the usual effort falls. How often should I brush my teeth?, what is the ideal daily routine for oral hygiene? and before or after breakfast?

The night-time brush is the one that matters most. Salivary flow falls during sleep, so the mouth’s own defence is at its lowest for eight hours. And the step almost nobody is told: spit, don’t rinse. Rinsing with water afterwards washes away the fluoride that would otherwise keep working for another hour or more. This is a free improvement to every brush you will ever do — the benefits of fluoride explains why.

2. Use a soft-bristled toothbrush.

Firm bristles do not clean better; they wear gums and enamel, and gum recession does not reverse. Technique matters more than force: angle the bristles about 45 degrees into the gum line and use small movements rather than scrubbing. How much pressure should I apply when brushing my teeth? and over brushing: what can it do to my teeth?

An electric brush is a reasonable upgrade, particularly oscillating-rotating designs, and particularly for anyone with reduced dexterity. It is not essential; a soft manual brush used well is enough. Which toothbrushes do dentists recommend? and how to care for your toothbrush

3. Floss once a day.

Brushing reaches roughly three of the five surfaces of each tooth. Flossing reaches the other two — which is where a large share of decay and gum disease begins. Is flossing really that important?

Where the gaps are wide enough to admit them, interdental brushes have better evidence than floss and are easier to use well. Floss remains right where teeth are tight. The tool that gets used daily is the correct one. Should I be using mouthwash as well as brushing and flossing? answers the next question people ask.

4. Visit your dentist every six months.

The purpose is finding problems while they are still small and reversible. By the time a tooth hurts, the cheap options have usually passed — can you reverse tooth decay? and why do I need a filling?

Worth knowing: six months is a convention, not a clinical law. The better-evidenced approach is a risk-based interval — someone with low decay risk, healthy gums and no history may safely go longer, while someone with active disease, dry mouth or a high-sugar diet may need three-monthly. Ask what your interval should be and why. It is a more useful question than accepting the default. How often should I go to the dentist?, dental cleans with our hygienists, when do you need deeper cleaning? and understanding your treatment.

5. Use products containing fluoride.

Fluoride is what allows early enamel demineralisation to remineralise rather than progress. This is the single most effective thing in preventive dentistry.

• Standard fluoride toothpaste for most adults — selecting a toothpaste: fluoride or non-fluoride?
• Lower-strength children’s toothpaste until about six, a smear under three and a pea from three to six, supervised — kids’ teeth cleaning tips and protecting your child from dental disease
• High-fluoride toothpaste (5000 ppm) is prescribed for people at high risk — dry mouth, exposed root surfaces, high decay rate. My mouth is always dry — does it affect my teeth?
• Melbourne’s water is fluoridated, which contributes continuously and at no cost — fluoridated water: is it good for you? and, for the other side of the debate, fluoridated water: why I worry

6. Eat a balanced diet.

With one dental-specific addition: calcium, phosphate and vitamin D matter for the tissues around teeth, and severe dietary restriction shows up in the mouth. Eating disorders in particular produce a characteristic pattern of acid erosion on the inner surfaces of the upper front teeth, and dentists are often the first to see it. How does your diet affect your teeth? and what can I do to strengthen my teeth?

7. Limit your intake of sweet and acidic food and drinks.

Frequency matters more than quantity — one dessert finished in a sitting is less damaging than the same sugar sipped across an afternoon. Sugar: what does it do to your teeth?, how does sugar affect your dental health? and six foods to avoid for healthy teeth

The acid point is separate and less well known. Enamel dissolves below about pH 5.5, and most soft drinks sit between pH 2.5 and 3.5 — including sugar-free versions, because the damage is from the phosphoric or citric acid rather than the sugar. Sports drinks, energy drinks, wine and citrus are all in this range. See are sugar-free soft drinks better for my teeth?, what are sports drinks really doing to your teeth?, what impact does wine have on my teeth? and how does acidic food affect your teeth?

And do not brush straight after anything acidic. The surface is temporarily softened; brushing then removes it. Rinse with water, wait an hour, then brush. What is acid wear and how can I avoid it? and what is dental erosion and how is it addressed?

8. Chew sugarless gum for 20 minutes after meals.

This stimulates saliva flow, which neutralises acid and helps remineralise enamel. It is the cheapest and most underused item on this list. Gum containing xylitol has additional evidence behind it — does chewing sugar-free gum really help prevent cavities?

The steps that are missing from most lists

Three more, which matter as much as the eight above:

9. Do not smoke, and know that it hides the warning sign. Smoking is the largest modifiable risk factor for gum disease — and nicotine constricts blood vessels, so smokers’ gums bleed less. Bleeding gums are the earliest warning sign, and in a smoker it is suppressed, so the disease is routinely more advanced than it looks. The same applies to vaping, for the same reason — the effects of vaping on your oral health and are e-cigarettes bad for my teeth?, where the honest position is that the long-term evidence base is much younger than the tobacco one. Quitline is 13 7848.

10. Tell your dentist about your medications. Hundreds of common medications reduce saliva, and dry mouth accelerates decay dramatically. This is the commonest cause of sudden decay in someone who has never had a cavity — my mouth always feels dry! What can I do?

11. Any ulcer, white patch, red patch or lump that has not healed in three weeks needs examining. Oral cancer is far more survivable when found early, and it is frequently painless at the stage it is most treatable. This is the one item on this page that can save a life rather than a tooth. Note that many clinicians and cancer bodies set that threshold at two weeks rather than three — the difference is caution, not disagreement, and nothing is lost by going early. Oral cancer: signs, risk factors and how your dentist can help, how your dentist helps with early detection and the cause of mouth ulcers and their usual treatments.

If cost is the barrier

Say so plainly to the practice. Sequencing treatment over time, prioritising what is urgent, and choosing the more conservative option are all legitimate clinical decisions, and a practitioner who knows the constraint can plan around it.

• Eligible children can receive basic dental services under the Child Dental Benefits Schedule. The benefit is capped over a two-year period and the cap is indexed annually — confirm the current amount with Services Australia rather than relying on any figure published on a website. See Child Dental Benefit Schedule and how does the Child Dental Benefits Schedule operate?
• Victoria has a public dental system through community dental agencies and the Royal Dental Hospital of Melbourne, with eligibility-based access for concession card holders and children.
• Emergency care is triaged by clinical urgency. Say clearly if you are in pain — what is considered a dental emergency? and emergency dentistry.
• For financial hardship generally, the National Debt Helpline is 1800 007 007, free and independent.

Payment plan options are available. Where a plan is advertised as interest free, that describes the plan term only — a deposit may be required, an establishment fee and ongoing account fees may apply, and charges can apply if the balance is not cleared within the agreed period. The applicable terms depend on the provider and the amount financed, and are set out in writing before you commit — ask what the deposit and the establishment fee are, in dollars, and what the total will be by the end. Payment Plans.

Common questions

Is an electric toothbrush worth it? For most people, a modest improvement; for anyone with arthritis, tremor or reduced dexterity, a substantial one.

Does mouthwash replace flossing? No. It reaches nothing a brush cannot, and it does not disturb plaque between teeth. The truth and myths about mouthwashes

Do I need to floss if my gums bleed when I do? Bleeding usually means inflammation from plaque that has been left there, and it typically settles within a week or two of daily cleaning. Bleeding that persists beyond that needs examining — what is gum disease? and periodontal (gum) disease.

Is charcoal toothpaste better? No. It is abrasive, most versions contain no fluoride, and it removes enamel rather than stain. Home whitening and charcoal whitening: does it work? Is it safe?

Related pages: Dental Cleans and Hygienists, Bleeding Gums, Bad Breath, Child Dental Benefit Schedule.

Related reading

• 10 ways to avoid ruining your teeth
• Top ten teeth tips
• Top tips on how to avoid dental problems
• Three oral hygiene tips you need to know
• Dental myths exposed
• What to do if you suffer from sensitive teeth
• Children’s dentistry
• General dentistry

Practical details

None of these steps is difficult or expensive. What they require is consistency — which is why the AIHW numbers look the way they do despite widespread awareness.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. The clinical team is listed by name.

Every practitioner’s registration can be verified free on the AHPRA public register at ahpra.gov.au.

Published 23 December 2014. Statistics are attributed to the Australian Institute of Health and Welfare as reported at that date and may since have changed. General information only — it is not a diagnosis, a treatment plan or a promise of any particular outcome, and it does not replace advice from your treating practitioner. Government scheme amounts and eligibility change; confirm current details with Services Australia. Payment plan terms are set by the credit provider and change; confirm current terms directly before you commit.

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