Medicine:Teeth cleaning

Short description: Oral hygiene practice

Poster encouraging tooth brushing with an elephant, (New Zealand, 1950s).

Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities (dental caries), gingivitis, and periodontal disease.

People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened deposits (tartar) not removed by routine cleaning. Those with dentures and natural teeth may supplement their cleaning with a denture cleaner.

Home care teeth cleaning refers to the daily oral hygiene habits practised by patients. It can be performed by tooth brushing and interdental cleaning, to disrupt the maturation of dental plaque to calculus (tartar).

Professional tooth cleaning refers to treatment that is conducted by dental professionals like the dental hygienist, therapist, and dentist. Processes like scaling and prophylaxis aim to remove plaque, calculus, and stain that cannot be removed through routine home care.

Brushing, scrubbing and flossing

Brushing

Careful and frequent brushing with a toothbrush helps to prevent build-up of plaque bacteria on the teeth. Toothbrushing is the gold standard of removing plaque & preventing plaque formation, which would otherwise lead to gum disease and tooth decay. Electric toothbrushes were developed, and initially recommended for people with strength or dexterity problems in their hands, but they have come into widespread general use. The effectiveness of electric toothbrushes at reducing plaque formation and gingivitis is superior to conventional manual toothbrushes.

Instructions
Source:

• Step 1: For the amount of toothpaste, place a smear (rice-grain size) of fluoride toothpaste for children <3 years and a pea-sized amount for ≥3 years and adults when brushing.
• Step 2: Place your toothbrush at a 45-degree angle to the gums..
• Step 3: Gently move the brush back and forth in short (tooth-wide) strokes.
• Step 4: Brush the outer surfaces, the inner surfaces, and the chewing surfaces of the teeth.
• Step 5: To clean the inside surfaces of the front teeth, tilt the brush vertically and make several up-and-down strokes.
• Step 6: Brush the tongue

• Tip: It is recommended to use a 2/2 strategy, which includes brushing for two minutes in the morning and two minutes at night, which is the main standard for healthy gums and teeth.

Flossing

Dental floss

In addition to brushing, cleaning between teeth may help to prevent build-up of plaque bacteria on the teeth. This may be done with dental floss or interdental brushes.

80% of cavities occur in the grooves, or pits and fissures, of the chewing surfaces of the teeth, however, there is no evidence currently showing that normal at-home flossing reduces the risk of cavities in these areas.

Special appliances or tools may be used to supplement toothbrushing and interdental cleaning. These include special toothpicks, oral irrigators, and other devices. A 2015 Cochrane review found insufficient evidence to determine whether the interdental brushing decreases the levels of plaque when compared to flossing.

Professional teeth cleaning

Dental hygienist polishing a person's teeth

Professional teeth cleaning (also known as Professional Mechanical Plaque Removal (PMPR)) is a procedure for the removal of tartar (mineralized plaque) that may develop even with careful brushing and flossing, especially in areas that are difficult to reach in routine toothbrushing. It is often done by a dental hygienist. Professional cleaning includes tooth scaling, tooth polishing, and debridement if too much tartar has accumulated. This involves the use of various instruments or devices to loosen and remove deposits from the teeth.

As to the frequency of cleaning, research on this matter is inconclusive. That is, it has neither been shown that more frequent cleaning leads to better outcomes nor that it does not. A review of the research literature on the question concluded "[t]he research evidence is not of sufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals". Thus, any general recommendation for a frequency of routine cleaning (e.g. every six months, every year) has no empirical basis. Professional dental cleaning reduces systemic inflammatory markers such as TNF-α, IL-6 and CRP, supporting a beneficial link between periodontal treatment and cardiovascular risk reduction.

Steps in professional teeth cleaning:

1. Scaling
   1. Removal of plaque and tartar from tooth surfaces, including between teeth and near the gums, using ultrasonic and hand instruments.
   2. Dental floss, interdental brushes, or air polishing may be used to clean between teeth and remove stains.
2. Polishing
   1. Teeth are polished with a rotating rubber cup or brush and polishing paste to smooth the surface and reduce bacterial attachment.
3. Fluoride treatment
   1. Fluoride gel or varnish is applied to strengthen enamel and protect against decay.

Professional Mechanical Plaque Removal (PMPR) alone may not reduce gingivitis if the patient's oral hygiene continues to be poor. Evidence suggests better outcomes when PMPR is combined with Oral Hygiene Instruction (OHI) compared to OHI alone, especially in generalised gingivitis cases (Farina et al., 2026)

Complications

• Improper tooth cleaning may lead to ineffective removal of bacteria and food debris, allowing them to accumulate and potentially cause various oral health issues.

• Using improper tools such as plastic toothpicks, hard-bristle toothbrushes, or even fingernails can harm both your gums and tooth enamel. These objects may cause small tears in the gum tissue, which can trigger inflammation and increase the risk of infection. Over time, this can escalate into more severe issues, like periodontal disease, which affects not only your mouth but your overall health.

• Improper tooth cleaning increases the potential for gingival injury, especially if horizontal movements are performed.
• Observational studies have shown that the use of simple, non-complex brushing techniques, such as the horizontal scrub method, and applying excessive brushing force are linked to the onset and progression of gingival recession. Additionally, brushing more frequently and using toothbrushes with harder bristles have also been associated with a higher risk of developing gingival recession.

Disinfection

• Disinfection is important for the removal of microorganisms from surfaces and tools in a dental clinic/office for infection control in dental practices to prevent cross-contamination and the transmission of various diseases among patients and healthcare professionals.
• The goals of infection control are:
  • To minimize amount of infectious pathogens to a certain level where the body's immune system is capable of resisting the infection
  • To disrupt the pathway of infection & stop cross-contamination
  • To protect patients and practitioners from infections
• It often involves the use/application of disinfectants on a surface or object (ex: dental instruments, dental chair).
  • Disinfectants used in dental practices includes :
    • Aldehydes
    • Chlorine products
    • Alcohols
    • Synthetic phenols
    • Iodine products
• Disinfection of dental instruments
  • The disinfection & sterilization method used will depend on the dental instruments used :
    • Critical - instruments that go into/pierce the mucosal tissue should be sterilized (ex: scalers, scalpels)
    • Semi-critical - instruments that come in contact with mucosal tissue should be sterilized (ex: pliers)
    • Least critical - instruments & surfaces that are touched during dental treatment should be disinfected (ex: dental chair light handles)

Acidity and decay relationship

• Tooth decay, also known as dental caries, is the destruction of enamel and dentine caused by acids produced by bacteria when they break down sugars.

• Examples of bacteria which cause decay
  • Streptococcus mutans
  • Lactobacillus
  • Actinomyces
• When sugary foods are consumed, bacteria in dental plaque break down the sugars and produce acids. These acids lower the pH of the plaque and cause the loss of minerals from the tooth surface. If this process happens frequently, it leads to the development of tooth decay.
• Saliva helps to protect teeth by:
  • Washing away food particles and acids
  • Neutralizing plaque acidity
  • Providing calcium and phosphate ions for remineralization
  • Controlling bacterial growth because it contains antibacterial substances
• Demineralization vs Remineralization
  • Demineralization
    • Occurs when acids remove minerals from the enamel
  • Remineralization
    • Occurs when minerals are restored by saliva
  • Tooth decay develops when demineralization exceeds remineralization over time.
• Prevention and management
  • Prevention of dental caries:
    • Maintaining good oral hygiene
    • Reducing sugar intake
    • Using fluoride products to strengthen enamel.
  • Management of dental caries:
    • Removing decayed tooth structure
    • Restoring the tooth with appropriate dental materials

History

1. Early Methods of Teeth Cleaning

• Teeth cleaning practices date back thousands of years.
• Early humans used toothpicks made from wood, bone, or quills to remove food particles between teeth.
• Archaeological evidence from the Indus Valley civilization (around 7000 BCE) shows early dental procedures such as tooth drilling.
• These findings suggest that oral hygiene and dental treatment were recognized even in prehistoric societies.

2. Teeth Cleaning in Ancient Civilizations

• Ancient Egyptians and Babylonians used "chew sticks", which were twigs with frayed ends acting as primitive toothbrushes.
• Early tooth powders were made from abrasive materials such as crushed pumice, eggshells, and ashes.
• These substances helped clean teeth, remove plaque, and improve breath.
• Similar oral hygiene practices were later used by Greeks, Romans, Chinese, and Indians, showing that dental care was common across many cultures.

3. Development of Modern Teeth Cleaning

• Modern professional teeth cleaning developed in the early 20th century with advances in dentistry.
• In 1906, Alfred C. Fones trained Irene Newman to perform dental prophylaxis (professional teeth cleaning).
• This led to the first dental hygiene school in 1913 in Bridgeport, Connecticut.

Professional teeth cleaning today involves scaling and polishing to remove plaque and calculus, helping prevent cavities and periodontal disease.

External links

• World Health Organization site on oral health
• Cosmetic Dentistry Clinic site on Dental Hygienist

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