Dental plaque doesn’t just cause cavities and bad breath. Poor oral health has also been linked to serious problems such as heart disease and stroke. In this article, I’ll share the teeth-cleaning routine I give to my patients, based on the latest scientific evidence.
This routine involves five key steps to help remove and prevent plaque buildup, reduce the risk of gum disease, and protect overall health. I’ll also discuss why factors like diet, lifestyle habits, and certain nutrients are important for keeping our teeth and gums in top condition.
Table of Contents
1.4 Choosing the Right Toothpaste
2.2 Strengthening Natural Defenses
Section 1: The Regimen
The approach has five key steps. Each is simple, and you can start incorporating them right away to provide better protection for your teeth and gums. Cavities, gum disease, and other issues develop slowly, so our strategy is to target the early stages of these processes and stop them before they turn into serious problems.
1. Flossing First
We begin by addressing what’s happening between our teeth.
Cavities and gum disease are primarily caused by bacteria in our mouths. These bacteria use sugars and starches in the foods we eat as fuel, which helps them grow. As bacteria mix with food particles and saliva, they form a sticky film called plaque. Between our teeth, this leads to two major issues:
1. The bacteria in plaque produce acid that can eat away at tooth enamel, eventually causing cavities.
2. The bacteria also irritate our gums, which can lead to gingivitis, an early stage of gum disease.
To remove food particles and plaque from these hard-to-reach areas, we need dental floss. It’s the first part of the regimen my patients use to avoid plaque. And I’m going to reveal the top-recommended kind of dental floss in a moment — particularly when we consider “forever chemicals” like PFAS.
Dental floss clears away plaque and food debris that a toothbrush can’t reach. Studies show it makes a difference. One looked at older adults over a five-year period and found those who flossed had fewer cavities and lower rates of gum disease [1].
I recommend flossing first because research suggests the order matters. A study found that flossing before brushing allowed for significantly less plaque between the teeth compared to brushing first [2]. By flossing beforehand, it lets toothpaste penetrate those tight spaces more effectively.
Choosing the Right Floss
According to ConsumerLab.com (an independent testing organization), a top pick is Reach Mint Waxed Floss. It’s budget-friendly, fits well between teeth, and doesn’t shred easily. A wax coating often makes flossing easier because it helps the floss slide smoothly. Plus, it’s free from PFAS. These are chemicals that have been linked to negative health effects, such as immune dysfunction, liver disease, and certain cancers. Some brands include PFAS in their floss to reduce friction. While overall exposure may be small, it’s wise to avoid it in a product we use daily inside our mouths.
2. Using a Water Flosser
Before brushing, there’s another tool I recommend. If the spaces between our teeth are hard to reach, so is the gumline — the narrow area where our gums meet the teeth. Plaque and food debris can collect there. Over time, bacteria multiply, causing inflammation. In the early stages, gums become red and may bleed. As things progress, the bacteria and their byproducts start to erode the enamel and surrounding tissues, creating more spaces for bacterial buildup.
To stop the process early, we can use a device called a water flosser. This handheld tool blasts a focused stream of water around and between the teeth and along the gumline. Review articles note that water flossers can be more effective at managing gum disease compared to other methods [3].
Personally, I use a brand called Waterpik, but other brands are also excellent. I’ve tried substituting regular floss entirely with a water flosser, but I don’t find that it cleans as thoroughly. My preference is to use traditional floss and then follow with the water flosser.
3. Brushing Effectively
Now we come to the third part of the anti-plaque regimen: brushing. Although brushing is the most familiar step, how we brush makes a major difference. An important detail many people overlook is brushing duration. The average brushing time is only about 45 seconds, but we should aim for 2–3 minutes. Research shows that brushing for 3 minutes removes 55% more plaque than brushing for 30 seconds, and even 2 minutes removes 26% more plaque than the typical 45 seconds [4].
Electric vs. Manual Toothbrush
If we want to further improve how much plaque we remove, an electric toothbrush can help. A comprehensive review concluded that powered toothbrushes remove more plaque than manual ones, resulting in a 21% greater plaque reduction over the long term [5].
But which electric toothbrush is best? There has been debate over rotating versus vibrating heads. A review published in 2021 suggests that vibrating toothbrushes have an edge over rotating brushes in the long term [6]. I personally use a Philips Sonicare. You can pick up their basic model for around $25, and it works very well.
4. Choosing the Right Toothpaste
So what toothpaste should we use with our brush? This question, especially in light of recent debates, often comes down to fluoride.
Why Fluoride?
When bacteria feed on sugars, they produce acids that break down our tooth enamel. Our bodies do try to repair this damage by using calcium in our saliva. Fluoride supercharges this repair process and helps rebuild enamel stronger than before. A large body of research supports fluoride’s ability to prevent cavities.
A comprehensive review by Cochrane found that fluoride toothpaste reduced tooth decay more than non-fluoride toothpaste. It also reported an added benefit to higher fluoride concentrations, up to about 1,500 ppm [6]. (Note: This is separate from the debate over fluoridated drinking water, which involves different concentrations and absorption.)
I typically use a fluoride toothpaste at about 1,500 ppm. One inexpensive choice recommended by testing organizations is Colgate Cavity Protection Toothpaste with Fluoride. It meets the fluoride concentration recommended by the American Dental Association (ADA) and is widely available.
What About Xylitol?
Another interesting ingredient for oral health is xylitol. It’s a sweet-tasting compound found naturally in fruits and vegetables. But unlike sugar, xylitol doesn’t fuel cavity-causing bacteria. Studies indicate it can even help prevent tooth decay and gum disease by reducing bacterial acid production [7]. Xylitol in chewing gum, for instance, can offer an extra layer of defense for our teeth.
5. Regular Dental Visits
Even with excellent flossing, water flossing, brushing technique, and the right toothpaste, some plaque will inevitably harden into tartar. Tartar must be removed by a dental professional.
The fifth part of the anti-plaque protocol is to schedule regular dental visits for cleaning. Most dentists suggest every 6–12 months, depending on your specific needs. This not only minimizes tartar buildup but also gives your dentist a chance to detect early signs of gum disease and other issues — making them easier to address.
Summary of the Anti-Plaque Routine
- Floss daily (ideally before brushing) with a product like Reach Mint Waxed Floss.
- Use a water flosser (e.g., Waterpik) to clean along the gumline.
- Brush thoroughly for 2–3 minutes. Consider using an electric toothbrush with a vibrating head.
- Use a fluoride toothpaste (up to 1,500 ppm).
- Visit the dentist every 6–12 months for cleaning and exams.
Please consider sharing this article with anyone you care about, so they can also benefit from better oral health. This is more important than many of us realize. Poor dental hygiene is linked to serious health problems like stroke [8] and heart disease [9]. Making these daily habits a priority can pay off with both a brighter smile and a healthier body.
Section 2: Reducing Problems
So far, we’ve focused on removing plaque and tartar. Now let’s look at ways to reduce plaque formation in the first place and bolster our body’s defenses against oral health challenges.
6. Avoiding Key Risk Factors
The biggest and most obvious factor is diet. Bacteria thrive on sugars and starches, so it makes sense to limit sugary drinks and junk food. Acidic beverages can also wear down enamel; be mindful not to consume too many carbonated drinks.
Another key risk factor is smoking. One study found that cigarette smokers were more likely to suffer gum disease, loose teeth, and tooth loss [10]. Excessive alcohol use also has negative effects on dental and gum health [11]. Reducing or eliminating these habits can significantly improve oral hygiene outcomes.
7. Strengthening Natural Defenses
Our bodies have their own natural defense systems. Calcium is critical for building and repairing teeth, but it relies on other nutrients like vitamin D3 (which helps us absorb calcium) and vitamin K2 (which directs calcium to our bones and teeth). Ensuring sufficient intake of these vitamins can further support healthy teeth.
Personally, I take a supplement that includes vitamins D3 and K2, partly for the dental benefits. But even if you don’t supplement, focusing on a nutrient-dense diet is a great way to maintain strong teeth and gums.
Reference List
Below are the sources referenced in this article:
1. https://pmc.ncbi.nlm.nih.gov/articles/PMC7375740/
2. https://pubmed.ncbi.nlm.nih.gov/29741239/
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC10771714/
4. https://jdh.adha.org/content/jdenthyg/83/3/111.full.pdf
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC7133541/
6. https://www.mdpi.com/1660-4601/18/4/1468
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC4232036/
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC9572898/
10. https://pmc.ncbi.nlm.nih.gov/articles/PMC9856400/
11. https://pubmed.ncbi.nlm.nih.gov/29228416/
