Oral Cavity Hygienization

Untreated bacterial plaque leads to the destruction of periodontal tissue and tooth loss, and periodontal diseases are associated with chronic inflammation affecting the entire body [1, 3]. Proper oral hygiene is therefore not only an element of dental prophylaxis but also a factor significant for the patient’s overall health.

Good oral health has a proven impact on the health of the entire body. A systematic review of studies indicates that regular toothbrushing and the use of dental floss are associated with a reduced risk of developing cardiovascular diseases and type 2 diabetes. It has been shown, among other things, that there is a significant reduction in the risk of hypertension and diabetes (HR 0.54; p < 0.001) in people who take care of their oral cavity, as well as a reduction in mortality in patients with coronary heart disease (HR 0.25; p = 0.03) [3]. On the other hand, the lack of hygiene combined with periodontal infection promotes the intensification of systemic inflammation, which may contribute to the exacerbation of chronic diseases such as atherosclerosis or diabetes. It is emphasized that simple hygiene habits can significantly reduce the risk of cardiovascular and metabolic diseases [3]. Additionally, oral diseases affect the quality of life—pain, discomfort, or bad breath reduce the comfort of functioning and can lead to dietary restrictions or psychosocial problems.

Home Oral Hygiene Methods

Toothbrushing

The basic method of removing dental plaque is toothbrushing. It is recommended to brush teeth at least twice a day for 2 minutes, using sweeping motions from the gum line toward the crown of the tooth, with a soft toothbrush and fluoride toothpaste. It has been proven that regular brushing significantly reduces the risk of developing periodontal disease—systematic reviews indicate that a person with poor oral hygiene has even 2–5 times higher risk of developing periodontitis than a person with good hygiene [2].

A 2014 Cochrane review showed that oscillating-rotating electric toothbrushes reduce dental plaque and gingivitis more effectively than manual ones, both in the short and long term [4]. Other types of drives (sonic or ultrasonic) appear to be less effective than oscillating-rotating toothbrushes [4]. In practice, this means that for patients who have difficulty (due to motor coordination disorders) with thorough cleaning, electric toothbrushes are recommended. Regardless of the type of toothbrush, the key is to teach the patient the correct technique—instruction on brushing, using a mirror or educational models, significantly improves cleaning effectiveness [5, 6]. Studies comparing different brushing techniques (Bass, Stillman, Fones, etc.) indicate that all can reduce plaque, but the differences between them are minor. One randomized study showed that the modified Bass method removes significantly more subgingival plaque than the vertical (Rolling) technique after 4 weeks of practice, although overall the effectiveness of all techniques was similar [5]. Therefore, the most important factors are thoroughness and regularity of brushing—careful brushing twice a day yields better results than the method itself.

The Bass method (modified Bass technique) involves positioning the toothbrush at an angle of about 45 degrees to the tooth surface, so that the bristle tips are partially in the gingival sulcus and at the gum-tooth junction. Then, gentle, short horizontal vibrating motions are performed, which are intended to "sweep out" bacterial plaque from the gingival sulcus and the cervical surface of the tooth.

A modification of this method (modified Bass) additionally introduces a sweeping motion upward or downward (depending on the dental arch) to better clean the tooth surfaces and reduce the risk of gum injury.

Toothbrush Selection

The choice of toothbrush should take into account the condition of the gums: for most patients, toothbrushes with soft bristles (or a soft head) are recommended to reduce the risk of gum injury and recession. The literature has noted that hard bristles can cause micro-damage and gum recession, while soft bristles are equally effective in removing plaque with the correct technique [6]. It is also important to regularly replace the toothbrush—every 2–3 months or earlier if the bristles become frayed, to maintain cleaning effectiveness.

Toothpastes

Toothpastes serve two main functions: mechanical support in removing plaque (due to the content of abrasive substances) and chemical action to prevent caries and gingivitis. The most commonly used ingredient to prevent caries is fluoride. Numerous meta-analyses confirm that toothpaste containing fluoride (most often 1000–1500 ppm) significantly reduces the progression of carious lesions compared to non-fluoride pastes. Twetman et al. showed in a systematic review that daily brushing with fluoride toothpaste meets the criteria for anti-caries effectiveness, and toothpaste with a higher fluoride concentration (1500 ppm) provides an additional, albeit smaller, effect in younger populations [7]. The conclusion is that fluoridated toothpaste should be used daily, especially in children and adolescents. Additionally, it has been proven that a systematic, supervised brushing process (e.g., in children) further reduces the development of caries [7].

An alternative to fluoride is biomimetic hydroxyapatite. Modern reviews have shown that toothpastes with nano-hydroxyapatite are as effective as fluoride toothpastes in caries prevention [8]. A 2024 meta-analysis indicated that hydroxyapatite salts contained in toothpaste inhibit the development of caries in people of different ages, making them a safe alternative to fluoride—especially in children, where the risk of fluoride ingestion raises concerns. In summary, for normal caries risk, the primary toothpaste should be fluoridated, but in special cases (young children, fluoride sensitivity), a toothpaste with hydroxyapatite may be a good choice [7, 8].

Mouthwashes (Rinses)

Mouthwashes are used as a supplement to mechanical cleaning and can have anti-caries or disinfectant properties. Fluorides used in mouthwashes (e.g., 0.05% NaF daily or 0.2% once a week) act remineralizingly, similar to toothpaste, and are recommended especially for the prophylaxis of children and adolescents. Cochrane review: Marinho et al. showed that regular, supervised fluoride rinsing in children significantly reduces the rate of new carious lesions—with an average reduction of 26% D(M)FS (an index determining the number of tooth surfaces affected by caries, removed, or filled) compared to no rinsing [9]. The effect was visible both at low and high caries prevalence, meaning that fluoride rinsing is an effective supplementary strategy for caries prevention in younger populations. However, it should be remembered that fluoride rinses do not replace toothbrushing and should be used regularly and according to recommendations—usually once a day.

For reducing plaque and gum inflammation, antiseptic mouthwashes are used. The best-studied substance is chlorhexidine (CHX). Systematic review: Van Strydonck et al. showed that mouthwashes containing 0.12–0.2% chlorhexidine, used in patients with gingivitis, significantly reduce plaque and gingivitis indices compared to placebo [10]. For example, the use of CHX led to an average reduction in plaque by 33% and gingivitis by 26% [10]. However, the disadvantage of chlorhexidine is the risk of tooth and saliva discoloration and taste disturbances—therefore, it is recommended for short, one-time, or temporary use (e.g., 2–4 weeks) in cases of severe gingivitis, not as a daily long-term solution.

In summary, mouthwashes with active substances can support hygiene but never replace mechanical cleaning. They are particularly recommended when it is difficult to reach subgingival areas with a toothbrush alone or in cases of gum swelling.

Dental Floss and Other Interdental Aids

A toothbrush alone removes plaque mainly from the chewing, buccal, and lingual surfaces, leaving a significant amount of deposit in the interdental spaces and at the necks. Assessments have shown that a single brushing removes an average of only about 42–60% of plaque. Especially the areas between the teeth are critical—food debris easily accumulates there, promoting the development of caries and periodontitis [6]. Therefore, the use of dental floss or interdental brushes in addition to brushing is crucial for comprehensive oral hygiene.

The recommendations of most societies (e.g., ADA, EFP) emphasize that interdental cleaning should be performed at least once a day. Dental floss allows manual removal of plaque from tight tooth contacts and subgingival areas. There is evidence that adding dental floss to brushing leads to a small but statistically significant reduction in gingivitis—meta-analyses, however, say that the clinical effect is small [6]. This is because proper flossing is difficult to master and time-consuming, and many people do it inaccurately. Nevertheless, the ADA recommends daily flossing as a simple method to reduce inflammation and improve periodontal health. It is worth spending time with the patient and teaching them the correct flossing technique. This task can also be performed by a hygienist. To achieve success, the technique should be practiced with the patient during subsequent check-up visits and discussed about the difficulties the patient encounters.

An alternative or supplement to floss is interdental brushes. Studies show that interdental brushes are at least as effective as floss in reducing dental plaque, and often more effective [6]. Especially in people with wide interdental spaces or periodontal disease, brushes are easier to use and effectively clean areas where floss may not reach. Ethan Ng’s review showed that brushes are “at least as good, if not better” than floss in removing plaque and reducing gingivitis [6]. In large spaces, interdental picks or irrigation fluids are also recommended as additional aids. Rinsing the mouth with water after meals or using an orthodontic irrigator can additionally reduce food debris. In summary, interdental cleaning should be tailored to the patient’s needs: narrow spaces—floss; wider spaces—brushes; with implants—brushes and rinses.

The recommendations of dental societies (ADA, EFP, Polish Dental Society) clearly emphasize the need to clean interdental spaces. The use of floss or brushes is recommended as a supplement for all patients [11]. Moreover, based on systematic reviews, it is known that adding an interdental aid to routine brushing leads to a greater reduction in plaque and gingivitis than brushing alone.

Professional Hygienization in the Dental Office

Professional hygienization (dental prophylaxis) includes hygiene instruction and teeth cleaning procedures performed by medical staff—a hygienist or dentist. Above all, it involves removing tartar and deposits from the surfaces of teeth and roots, as well as polishing teeth (sandblasting or polishing with rubber/paste). Clinical studies have repeatedly shown that tartar removal in the office significantly improves gum health. Classic studies by Axel Lindhe showed that children who received very frequent (even every few weeks) professional cleaning with hygiene instruction almost did not develop gingivitis [12]. In the group without additional treatments, the inflammatory condition worsened. Other studies (once a year vs. every 4 months) suggest that more frequent prophylaxis provides greater benefits—but even annual professional cleaning in the office reduces gingivitis more than instruction alone [12]. However, it is emphasized that the long-term maintenance of healthy gums depends primarily on the patient’s daily hygiene—professional cleanings are helpful, but their effects are short-lived if there is no proper patient engagement [12].

In practice, the dental hygienization procedure includes: explaining and demonstrating the correct brushing technique and interdental cleaning to the patient, followed by the removal of dental deposits. In the office, ultrasonic and manual scaling are most commonly used to remove supra- and subgingival tartar. Then, sandblasting or polishing with a rubber cup and prophylactic paste is performed. Sandblasting uses a stream of water with micro-powder (e.g., erythritol or glycine), which very effectively removes soft deposits and discoloration from the tooth surfaces.

The indications for a specific procedure depend on the patient’s oral condition. Scaling is necessary where there is supra- and subgingival tartar, deep pockets, or advanced periodontitis. The recommendation is to thoroughly clean the roots within the diseased pockets. Sandblasting, on the other hand, can be used as daily prophylaxis during frequent visits, especially in patients without advanced tartar, for cosmetic purposes (removing surface stains from coffee, tea), and as a gentle cleaning method during check-up visits. Sandblasting is also recommended before tooth fluoridation (it cleans the enamel well). In the literature, there is evidence of the effectiveness of sandblasting in patients in supportive treatment—a comparison of scaling and subgingival sandblasting with erythritol showed that both procedures significantly improve periodontal health. Scaling slightly increased gum attachment regeneration in the short term, but patients experienced significantly less discomfort during sandblasting [13]. The conclusion from this study is that sandblasting (especially with erythritol) can be used as an effective and gentler method for maintaining the effects of periodontal treatment, although in very deep pockets, traditional scaling still has the advantage.

Studies also indicate that simply removing tartar is not enough—patient education during the visit is extremely important. Hygiene instruction and quality control of brushing (e.g., using a plaque-disclosing agent) can multiply the effectiveness of subsequent home hygiene. In one study, about 7–10 days after professional hygienization, the greatest decrease in the gingivitis index was observed, indicating that the procedure provides an immediate clinical effect [12]. However, without further follow-up visits and maintaining cleaning habits, the condition of the mucosa quickly returns to its previous state. Hence, hygiene protocols provide for maintenance visits every few (or no more than a dozen) months—often every 6 months for people with healthy periodontium, more frequently for patients with advanced gum disease.

The conclusions from the studies prove that professional preventive procedures are a key supplement to home hygiene. Removing tartar and polishing reduce inflammation and maintain gum health, provided that the patient continues proper home care [12].

Summary

Oral cavity hygienization is an integral element of dental prophylaxis. Its goal is to minimize dental plaque through daily brushing and interdental cleaning, as well as periodic professional procedures in the office. Scientific studies clearly confirm that systematic oral hygiene reduces the occurrence of caries and periodontal diseases [2, 7]. Good hygiene habits also contribute to reducing the risk of systemic diseases [2, 3].

It is crucial to provide the patient with reliable information and teach basic skills: how to brush teeth correctly, how to use toothpaste and dental floss, when to use mouthwashes, etc. It is also necessary to plan and perform professional hygienization in the office—remove tartar, perform polishing, and provide tips for daily home hygiene. For example, a useful tip to increase focus during toothbrushing may be to recommend changing hands. Performing this daily activity with the non-dominant hand can help the patient eliminate bad habits, such as excessive pressure or incorrect movements from the lingual surfaces. Another useful tip may be to start brushing from a different quadrant of the dentition each day to eliminate the one that is always neglected in most patients because it is usually cleaned last, in a hurry, without engagement and focus.

In summary, comprehensive care—based on scientific evidence and in line with national and international standards—is the foundation for maintaining the oral hygiene of our patients.

References:

1. GBD 2017 Oral Disorders Collaborators; Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study. J Dent Res. 2020 Apr; 99(4): 362–373.
2. Lertpimonchai A, Rattanasiri S, Arj-Ong Vallibhakara S, Attia J, Thakkinstian A. The association between oral hygiene and periodontitis: a systematic review and meta-analysis. Int Dent J. 2017 Dec; 67(6): 332–343.
3. Church L, Franks K, Medara N, Curkovic K, Singh B, Mehta J, Bhatti R, King S. Impact of Oral Hygiene Practices in Reducing Cardiometabolic Risk, Incidence, and Mortality: A Systematic Review. Int J Environ Res Public Health. 2024 Oct 4;21(10):1319.
4. Yaacob M, Worthington HV, Deacon SA, Deery C, Walmsley AD, Robinson PG, Glenny AM. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014 Jun 17;2014(6):CD002281.
5. Weng L, Wen J, Cui G, Liang J, Pang L, Lin H. Comparison of modified bass, rolling, and current toothbrushing techniques for the efficacy of plaque control – A randomized trial. J Dent. 2023 Aug;135:104571.
6. Ng E, Lim LP. An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dent J (Basel). 2019 Jun 1;7(2):56.
7. Twetman S, Axelsson S, Dahlgren H, Holm AK, Källestål C, Lagerlöf F, Lingström P, Mejàre I, Nordenram G, Norlund A, Petersson LG, Söder B. Caries-preventive effect of fluoride toothpaste: a systematic review. Acta Odontol Scand. 2003 Dec;61(6):347–55.
8. Pawinska M, Paszynska E, Amaechi BT, Meyer F, Enax J, Limeback H. Clinical evidence of caries prevention by hydroxyapatite: An updated systematic review and meta-analysis. J Dent. 2024 Dec;151:105429.
9. Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;(3):CD002284.
10. Van Strydonck DA, Slot DE, Van der Velden U, Van der Weijden F. Effect of a chlorhexidine mouthrinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review. J Clin Periodontol. 2012 Nov;39(11):1042–55.
11. ADA Recommendations – https://www.ada.org/resources/ada-library/oral-health-topics/floss
12. Bosma ML. Maintenance of gingival health post professional care. Int Dent J. 2011 Aug;61 Suppl 3(Suppl 3):1–3.
13. Ulvik IM, Sæthre T, Bunæs DF, Lie SA, Enersen M, Leknes KN. A 12-month randomized controlled trial evaluating erythritol air-polishing versus curette/ultrasonic debridement of mandibular furcations in supportive periodontal therapy. BMC Oral Health. 2021 Jan 21;21(1):38.

Authors:

• Dr. Michał Paulo – Graduate of the Medical University of Lublin, currently employed at the Department and Clinic of Periodontology at the Medical University of Lublin. He obtained his PhD with a thesis on the diagnosis of disorders in the masticatory system. He completed postgraduate studies and obtained the title of ICI Coach.
• MSc Eng. Piotr Szymański – Graduate of Warsaw University of Technology. Journalist. Editor-in-Chief of the magazine "Nowy Gabinet Stomatologiczny."

Article published in issue 6/2025 of the magazine "Nowy Gabinet Stomatologiczny."