Six-hundred years ago, the Emperor of China embedded hog bristles in a bone handle and used his invention to clean his teeth. One drawback? Hog bristles were expensive and the whole family had to use the same toothbrush. Boy, have times changed.
Now the average supermarket shelf has endless choices -- from an array of brushes (manual, electric, large, small, those with contorted handles), to special flosses, electric flossers, mouthwashes, dentifrices (toothpaste to you), and every squirter, whitening tray, mouthguard, and weird appliance imaginable. It looks like a road company of The Marathon Man in there!
So what's hip and what's hype?
"The best toothbrush is the one that works best for you," says Kimberly A. Harms, DDS, a consumer spokeswoman for the American Dental Association (ADA) and dentist in private practice in Farmington, Minn. "Dentists, however, recommend everyone use a soft toothbrush, fluoridated toothpaste, and floss. This is enough."
Many dentists recommend a soft toothbrush. "Hard ones can wear away your enamel," Harms warns, but notes that patients do sometimes tell her they feel they are getting their teeth cleaner with a harder toothbrush.
As for all those newfangled bristle angles, Gordon L. Douglass, DDS, a Sacramento, Calif., periodontologist, says most toothbrushes now have longer bristles at the end for reaching back teeth. He recommends you select the right size toothbrush head for your mouth -- if it's too tightly stuck in there, you can't get to the back teeth effectively. "Medium sized is best," he says.
Some toothbrushes have a detection area that changes color when the toothbrush needs to be replaced. "You could just look at the brush," Harms ventures. "If the bristles are bent or curled, it's time for a new one. Usually every three months or less is best." Douglass says, "If your brush is curled, you're brushing too hard."
Speaking of brushing, if you're of a certain age, you probably aren't brushing incorrectly. Remember how your mother told you to brush "up and down?" "We used to think stimulating the gums by brushing them was good," Douglass says. "Now scientific studies show you should place the brush where the tooth and gum come together and then use a back and forth or rotary motion over the tooth itself. Yes -- back and forth!
As for those toothbrushes -- electric or manual -- that come with cartoon characters on them, if they make you remember to brush or increase the time spent waggling the brush around in there, Harms is all for them; kids like them, too! The same goes for those brushes with large, chunky handles. Kids and people with arthritis find them easy to hold.
"We haven't wiped out decay yet," says Harms, "so we recommend a fluoridated toothpaste (even in cities with fluoridated water). Even older adults, who might have worn surfaces, can get cavities." Over time, she explains, fluoride soaks in and strengthens teeth, even though it may be slathered on the tooth surface for only a minute or two at a time.
"Everyone's mouth is different," Harms says. "For some, a sensitive toothpaste can help prevent mouth pain -- it works." Other people tend to build up tartar quickly. For them, Harms says, tartar control is a help, not hype.
What about whitening? Harms explains that there are two kinds of whitening, those with mild abrasives to remove stains and those with bleach to take out deep-down discoloration. "(Whitening) toothpastes are not on your teeth long enough to bleach, but can take out some stains," she says. Douglass dismisses worries that whitening toothpastes can be too abrasive. "Most are low in abrasion and contain a form of peroxide," he says.
As for whiteners in general, including those applied by dentists, Douglass declares that they seem to be fine. Harms recommends seeing a dentist before using an over-the-counter brand to be sure your teeth are free of cracks or exposed root surfaces. "If your gums get irritated, stop using the product," Douglass says.
Both dentists had the same reaction on the subject of flosses: "We don't care what you use, just use some!" Harms notes that people could make such great strides in their dental health if they would just floss more -- or at all.
As with all dental products, Harms recommends checking on the floss packages for the ADA seal of approval, which shows the product has been independently tested and shown to be safe and effective.
Some people's teeth are very tight and those people should use thin, Teflon-coated tape. Usually, Douglass says, a lightly waxed or unwaxed floss is better -- when the space between the teeth becomes really clean, the floss makes a noise. "Squeaky clean!" he yelps.
How about those little brushes that go between teeth? "They are good for patients with space between their teeth or an area with space between," Harms says.
Douglass says no mouthwash kills all the bacteria that cause gum disease. However, he does admit that mouthwashes containing essential oils, can slow the formation of plaque -- those amazingly successful, tight-knit globs of cooperating bacteria that can coat teeth and cause decay.
"Every little bit helps," Douglass says. "Rinsing with an essential oil mouthwash or even with plain water after brushing and flossing can cut plaque a little, although rinsing is no substitute for brushing and flossing."
Reminds Harms: "Every 24 hours a new crop of germs emerges." She also cautions that you must rinse the amount of time stated on the label. One last piece of advice. Don't overuse mouthwash. The American Academy of Periodontology says overuse can produce "sloughy, stinky tissue that is worse than what your breath is already like."
Dentists often prescribe mouth guards to stabilize jaws in people who grind their teeth at night. Generic guards are available at the drugstore and prescribed ones can cost hundreds of dollars. "I wouldn't treat this on your own," Harms says. "It is amazing the force your jaw can exert on your teeth. The specially measured guards can prevent other problems from arising by keeping teeth evenly apart."
Irrigators, Douglass says, can also be useful for people with special needs, such as bridges, braces, or extensive gum problems such as deep pockets. "Your dental hygienist can tell you if this is a good investment," he says.
Speaking of investments, how could we best spend our dental dollar? "Prevention, prevention, prevention," chants Harms. Brush, floss, and see the dentist, he says.
All the rest is optional, although work is on-going to fine-tune electric toothbrushes and automatic flossers to make them easier to manipulate. Eventually, Harms says, scientists will discover a way to break up plaque and make all these gizmos work better.
"The problem is," Douglass says, "we all have only a certain amount of time to spend on our teeth. If you have six devices sitting there, you may use all six, but you will still take only five minutes of time."
At least you're not in ancient China with someone waiting in line to use the toothbrush!