Answers to your questions about oral care.

Many problems in the mouth are caused by plaque on and between the teeth. Plaque consists mainly of bacteria. If plaque is not removed, it can harden into tartar. It can also cause gum inflammation and cavities. Good oral hygiene reduces that risk.

For a healthy mouth, visit the dentist regularly for a check-up. There is also a lot you can do yourself at home. These seven tips will help.

7 tips for good oral hygiene

Do you feel nervous about sitting in the dentist's chair? You are not alone. A dental hygienist shares her tips.

Everyone is afraid of something. Some people are afraid of spiders, others of heights. Fear of the dentist is also very common. Many people feel ashamed of it, but there is no need. Someone who is afraid of public speaking or small spaces has no reason to feel ashamed either.

Fear is normal, but sometimes unhelpful

Fear is perfectly normal. Without fear, people would become reckless: driving without a seatbelt, racing through the village too fast or leaving the back door open at night. So fear often protects us. But it is unhelpful when you are afraid while there is no real danger, as at the dentist. A joke from the dentist such as “I won’t bite” usually does not help.

When is the fear at its worst?

Most people with dental anxiety are most afraid in the period before the treatment. Some even sleep badly because of it. Questions such as ‘What is the dentist going to do?’, ‘Will it hurt?’ and ‘How will my mouth feel afterwards?’ keep going round in their heads. Their heart beats faster and they start to sweat. Many people feel a tightness in the chest or feel sick.

Causes of dental anxiety

Dental anxiety can have a clear cause. Older people, for example, talk about bad experiences with the school dentist. Fear can also pass from parent to child. If a child sees its parents react strongly to a dental visit, the child becomes wary too. Sometimes the cause runs deeper. The practitioner can take time for this during the appointment.

Talk about your fear

It is fine to feel afraid. Dentists and dental hygienists regularly see patients who find it difficult. So you are not the exception. However, you cannot always tell from the outside how frightened someone is. Some people hide their fear well and may then, for example, come across as a little abrupt.

To avoid misunderstandings, it is wise to talk about your fear. Explain exactly what you are afraid of and what helps you.

Help with dental anxiety

Ideally, your fear will disappear completely. That may sound too good to be true. Yet there are people who used to shake with fear and now sit in the chair without any problem. It can also help to go to a dentist for anxious patients instead of a regular dentist. Some dentists have a special interest in helping anxious patients. Read more about the dentist for anxious patients.

An example from practice

The dental hygienist tells the story of an older patient with dental anxiety who almost fell asleep in the chair. She asked the patient to close her eyes and go back to the moment when the fear was at its worst. What thoughts came up? Where was the unpleasant feeling and what did it look like? The phrase “I don’t want this” came to her mind. It gave her a suffocating feeling, as if her windpipe was being squeezed shut.

The dental hygienist asked whether she wanted to keep that feeling or get rid of it. Together they turned the unhelpful phrase into a helpful one. Because she actually did want this: otherwise she would not have been there. In her imagination she cleared away the suffocating feeling and replaced it with something lovely: a garden where her grandchildren were playing. When the dental hygienist said: “…and there are the most beautiful sounds”, she broke into a broad smile. Slowly she drifted off and the treatment could continue. The atmosphere in the treatment room had noticeably changed.

Tips if you are afraid of the dentist

Map out your thoughts around an appointment. Do these thoughts help you and do you want to keep them? Or are they not true and do you want to get rid of them? Practising helpful thoughts makes the fear much less. You will find more tips, such as breathing and relaxation exercises or bringing your own music, on the page about the dentist for anxious patients.

Read more

• Anaesthetic at the dentist
• Your first visit to the dental practice

This article was written by a dental hygienist. Alongside her work in the dental practice, she regularly writes about her experiences.

About 80% of people in the Netherlands suffer from bleeding gums to a greater or lesser extent. Of these, 10 to 15 per cent have severe gum inflammation: periodontitis. Gum inflammation can lead to the loss of teeth. It also plays a role in cardiovascular disease, diabetes and premature birth. Dental hygienists and other oral care professionals who focus on prevention help you keep your mouth and your general health in good shape.

Gum inflammation and cardiovascular disease

A link has been shown between gum inflammation and cardiovascular disease. The inflammation allows bacteria from the mouth to enter the bloodstream. There they can damage the blood vessel walls and cause blood clots. Such a clot can lead to a heart attack or stroke, for example.

Gum inflammation and diabetes

People with diabetes have problems with their teeth and gums more often. Diabetes reduces the blood supply to various tissues. People with diabetes also more often have a dry mouth. As a result, inflammation and cavities develop more quickly. They also have a higher risk of cardiovascular disease. Gum inflammation can increase that risk further.

Gum inflammation and premature birth

During pregnancy, inflamed gums develop more easily. Inflammation releases substances that regulate the inflammatory process: inflammatory mediators. Large amounts of these can trigger early contractions. Harmful oral bacteria can also reach the placenta or the unborn baby through the bloodstream and cause an infection. Read more about pregnancy and your teeth.

Gum inflammation and other conditions

Inflamed gums can lead to inflammation in the brain. This can give rise to neurodegenerative conditions, such as dementia and Alzheimer's disease. Researchers at New York University made this link. They found that people with Alzheimer's disease had clearly more antibodies and inflammatory molecules from dental and gum disease in their bodies than other people.

Scientific research also shows a link between gum inflammation and rheumatism, pneumonia, cancer and the chronic lung disease COPD.

Sources

• ‘Mond is de spiegel voor de gezondheid’ (The mouth is the mirror of your health) – mijngezondheidsgids.nl
• ‘Gezond begint in de mond!’ (Health starts in the mouth!) – allesoverhetgebit.nl
• Nederlandse Vereniging van Mondhygiënisten (Dutch Association of Dental Hygienists)
• Medischdossier.org

At Tandartspraktijk DieverDiabetes and your mouth (in Dutch)

Vaping, using an e-cigarette, has become very popular in recent years, especially among young people. It is often seen as a ‘safer’ alternative to smoking. Yet vaping is far from harmless. E-cigarettes often contain nicotine and other chemicals that are harmful to the body. They affect the lungs, but also the teeth and gums. Below you can read why vaping is bad for your mouth and how you can limit the damage.

What is vaping?

When you vape, you inhale vapour from an electronic cigarette. This vapour usually contains nicotine, flavourings and other chemicals. Unlike with an ordinary cigarette, nothing is burnt. That does not mean vaping is safe. The substances in the vapour can be harmful. The mouth is often the first thing to be affected.

Dry mouth and a higher risk of cavities

Vaping leaves a film on the teeth in which bacteria easily settle. The mouth also produces less saliva. Saliva protects the teeth against acids and bacteria. People who vape regularly are more likely to get a dry mouth. The natural protection of the teeth then decreases. As a result, plaque builds up more quickly, with a risk of cavities and tooth decay.

Irritation of the gums and mucous membranes

The chemicals in vape liquid can irritate the gums and the lining of the mouth. This can lead to redness, swelling and sometimes even receding gums. Nicotine also narrows the blood vessels. This reduces the blood supply to the gums, so they get less oxygen and less protection against infection. In this way, vaping can contribute to gum inflammation. Superficial inflammation can turn into deeper inflammation that affects the jawbone.

Discoloured teeth and bad breath

Many people who vape think their teeth will not become discoloured, as they do when smoking tobacco. Yet the vapour can contribute to yellow teeth and staining. Some flavourings and chemicals stick to the tooth surface. Vaping can also cause persistent bad breath. Read more about fresh breath.

Extra risk for young people

For young people, the effects of vaping are particularly worrying. Their bodies and teeth are still developing. Nicotine can have a negative effect on the growth and development of teeth and gums. The risk of addiction is also high. This leads to long-term use and therefore to long-term damage.

Your dentist helps prevent damage

Vaping may seem harmless, but the risks to your mouth are considerable. A dry mouth, inflamed gums, discoloured teeth and a higher risk of cavities are just some of the effects. Your dentist can spot the first signs of damage early and advise you on how to protect your mouth. For example, by referring you to the (periodontal) prevention assistant or dental hygienist. Do you have questions about the effects of vaping on your teeth? Discuss them with your dentist.

Smoking releases harmful substances, such as nicotine and tar. All tissues that come into contact with tobacco smoke can be damaged by them, including in the mouth. Smoking has five negative effects on your oral health.

1. Wounds heal less well

In smokers and vapers, wounds in the mouth heal less well than in non-smokers. Smoking narrows the small blood vessels in the gums, which reduces the blood supply. A good blood supply is needed for wounds to heal.

2. Higher risk of losing teeth

Plaque forms on your teeth and along the gum line. Plaque consists of bacteria and food debris. If plaque is not removed in time, more bacteria get under the gum line. The space between the tooth and the gum becomes deeper and eventually the gums can become inflamed. Smokers have more plaque and tartar (hardened plaque) and therefore a higher risk of inflammation.

If the inflammation is not treated, teeth can become loose and eventually be lost. Because of the poorer blood supply, inflammation in smokers heals more slowly and is also noticed later. Smokers therefore have a higher risk of losing teeth.

3. Risks with implants

Smoking also brings risks with implants. An implant is an artificial root that is placed in the jawbone, where it must fuse firmly with the bone. Because of the poorer blood supply, the risk of an implant failing is almost three times higher in smokers than in non-smokers.

4. Higher risk of mouth cancer

Smokers have a higher risk of abnormalities in the mouth, tongue and throat. These abnormalities can eventually lead to mouth cancer. Smokers are two to four times more likely to develop cancer of the oral cavity than non-smokers. People who smoke and also drink alcohol are at even greater risk.

5. Discolouration and bad breath

Smoking discolours teeth and fillings. This smoking stain is similar to staining from coffee and tea, but much harder to remove. Smoking is also a common cause of bad breath. Smokers also have a poorer sense of smell and taste. After stopping smoking, these effects quickly decrease.

Stopping smoking

Smoking is addictive. Stopping is therefore difficult and can cause withdrawal symptoms. At first, your gums may bleed more, especially if there is inflammation. Even so, stopping has a positive effect on your oral health within two to six weeks. The blood supply to the gums improves, so there is less inflammation. The results of treatment also improve.

Would you like to stop smoking? Your dentist or dental hygienist can help you. Also read about the dangers of vaping for your oral health.

At Tandartspraktijk DieverSmoking and your mouth (in Dutch)

Care providers at the dental practice

At a dental practice, a treatment team works together. Each practitioner is qualified to carry out certain procedures. This way you always see the practitioner who suits the care you need. It does mean that you will not always be treated by the same person.

The practitioners are the (specialist) dentists, dental hygienists, periodontal prevention assistants and prevention assistants. They are supported by dental assistants and sterilisation assistants. There are also support staff, such as the office or practice manager and receptionists.

Who is my appointment with?

All practitioners are listed on the practice website with their first name and surname, BIG registration number, role and areas of special interest. At our practice, you can find this on the our practice page. In the practice, everyone can be recognised by a name badge showing their first name, surname and role.

Regulated by the BIG Act

Your dentist always remains in charge of your treatment. The dentist can delegate certain tasks to other staff at the practice. This delegation of tasks is regulated by the Individual Healthcare Professions Act (Wet BIG). It sets out who may do what and under which conditions.

Does the dentist delegate a reserved procedure to an assistant, such as taking an X-ray? Then that assistant has completed external training for it and passed a test. All of this is recorded in writing. The dentist must also always be present in the practice, so that he or she can step in if necessary.

Specialist, differentiation or area of special interest

Online you will often see the word ‘specialist’, but also ‘dentist with a differentiation’ or ‘dentist with an area of special interest’. These refer to a dentist with extra knowledge and experience in a particular field. However, the official meaning of ‘specialist’ is different from how the word is often used.

In dentistry there are only two recognised specialisms: oral and maxillofacial surgery and orthodontics. For example, only dentists who have specialised for 4 years at a recognised university after their basic training may call themselves an orthodontist. The practice clearly states whether you are being treated by a specialist or by a dentist with a differentiation. An overview of all differentiations can be found on tandarts.nl.

Want to know more?

Do you have questions about who is allowed to carry out which procedures? Discuss this with your dentist. You can also read more about dental care in the Netherlands.

Keeping your mouth healthy can easily mean using a lot of plastic: toothbrushes, interdental brushes, toothpaste tubes and packaging. A few choices can make your oral care more sustainable. Ask your dentist or dental hygienist whether an alternative is suitable for your oral health.

Tips for more sustainable oral care

• Use wooden toothpicks. If possible, choose FSC-certified wood. Look at the packaging too: some manufacturers pack toothpicks in cardboard instead of plastic boxes.
• Choose interdental brushes with less plastic or made from recycled plastic.
• Skip flossing if you do not need it. Flossing does not work for everyone. Read more about interdental brushes, toothpicks and floss.
• Do not use more toothpaste than you need. A pea-sized amount is enough.

Saving water

Turn off the tap while you brush your teeth. This saves around 1,460 litres of water a year. There is no need to rinse after brushing, which saves even more water.

Not everyone needs a mouthwash. If you use one without needing it, you can stop. That saves water and plastic in the bathroom. Find out whether you need a mouthwash.

Bamboo toothbrushes

Several brands sell toothbrushes made from bamboo or recycled material. There is still little sustainable choice in replacement heads for electric toothbrushes. Would you like to switch to a sustainable alternative? Ask your dentist or dental hygienist for advice.

Have regular check-ups

Regular check-ups are a sustainable choice too. At routine check-ups, problems are found early and are easier to treat. That saves trips to the practice, long treatments using a lot of material and high costs.

More about oral care

• How to make toothpicks and interdental brushes a habit
• Good oral care, also for your general health
• Time for a new toothbrush?

Scientists at King's College London discovered that the drug Tideglusib has a beneficial side effect for teeth. The drug was originally intended for people with Alzheimer's disease. It can promote the growth of tooth tissue and repair cavities. This is because the drug stimulates the stem cells in damaged teeth to produce new dentine. Dentine is the layer under the enamel.

How the treatment works

The researchers soaked a biodegradable sponge in the drug and placed it in a cavity. Within 6 weeks the cavity had healed. Lead researcher Professor Paul Sharpe of the Dental Institute at King's College London sees the drug as particularly suitable for large, deep cavities. As a result, fillings may be needed less often in the future.

When will the drug be available in the Netherlands?

At the time of the research, the drug was still being tested. It is not known whether or when it will become available in the Netherlands. Even then, good oral hygiene remains the most important thing: if you do not get cavities, they do not need repairing.

Read more about good oral hygiene and how to prevent cavities.

Sources

• Dental Info
• Nature

With a little preparation, you can keep your mouth healthy on holiday too. Below you can read what to do if a tooth is injured, how to keep up your brushing routine and when you need a dentist near where you are staying.

Tooth knocked out or broken

A loose or broken tooth, whether yours or your child's, is unpleasant, especially on holiday. What you should do depends on whether it is a baby tooth or a permanent tooth. Read more about dental injuries in children and about a broken tooth or molar.

Keep up your brushing routine

On holiday, your daily routine is often different from at home. Many people feel less like brushing. Yet good oral care remains important.

• Do you use an electric toothbrush at home? Take the charger with you and check whether you need a travel adapter in the country you are visiting. Would you rather use a manual toothbrush on holiday? Make sure you have a new, clean brush before you leave.
• The usual advice is to brush for 2 minutes, twice a day. On a campsite that may be harder. Plan at least one moment each day when you brush properly and also take time for toothpicks or interdental brushes. Ideally in the evening before bed.
• Do you have children under 10? Keep brushing their teeth after them once a day on holiday too. Especially now that they may be snacking more often.

No more than 7 times a day eating and drinking

On holiday, people usually pay less attention to what they eat and drink and how often. If you eat or drink too often during the day, your teeth do not get a chance to recover from the acid attacks on the enamel. That can cause cavities. So go easy on ice creams and other snacks. On holiday too, the advice is: eat and drink no more than 7 times a day.

For children, the maximum number of times they eat and drink depends on when they go to sleep. Read more about healthy food for children.

After vomiting: do not brush your teeth straight away, but rinse your mouth with water.

Frequently asked questions

Sources

• Richard Kohsiek (dentist, KNMT), summer series ‘Met een gezonde mond de wereld rond’ (Around the world with a healthy mouth), allesoverhetgebit.nl
• allesoverhetgebit.nl

Preventing cavities in children is less difficult than it seems, as long as parents follow a few basic rules. Not everyone knows these rules yet. That is the finding of a survey by the KNMT, the Dutch professional association of dentists.

What parents do know

Most of the more than 1,800 participants know that you start brushing as soon as the first tooth comes through. After that, you gradually build up to 2 minutes, twice a day. Many parents also know that after brushing, a child should not drink any more fizzy drinks or fruit juice, only water.

Almost half know the maximum number of eating and drinking moments

There is more confusion about the maximum number of times a day to eat and drink. Almost half of parents know that it should be no more than 7. That means 3 meals (breakfast, lunch and dinner) plus no more than 4 snacks. Only then can saliva neutralise the acids that attack the teeth in time, every time. This way, no cavities develop.

36% know when the first dental visit should be

Only 36 per cent of participants know that a child should go to the dentist from the very first tooth. The dentist, dental hygienist or prevention assistant can then give parents tips on brushing the little teeth. Many parents do not always find that easy. Parents are also told about the effect of food and (fruit) juices on, for example, the development of cavities.

Towards a generation with healthy mouths

The survey is part of the KNMT campaign ‘Een gezonde mond is kinderspel!’ (A healthy mouth is child's play!). With it, the professional association wants to help a generation grow up with healthy mouths. At the time of the campaign, more than 2 in 3 children in the Netherlands had at least 1 cavity before their 18th birthday.

The Dutch Society of Paediatric Dentistry (Nederlandse Vereniging voor Kindertandheelkunde) supports the campaign. Dentists want to show parents that cavities are not necessary. If you look after your teeth well and have regular check-ups, you do not have to get cavities.

6 basic rules for children

The campaign centres on 6 basic rules for healthy teeth. Oral care professionals share these rules in the waiting room and online. Youth health doctors and food banks are also taking part. Read more about oral care for your child and about food for children.

Sources

• KNMT press release
• allesoverhetgebit.nl

As people get older, the mouth becomes more vulnerable. At the same time, daily care often becomes harder. This may also apply to your father or mother.

Physical or mental decline can make brushing more difficult or cause it to be forgotten. Poor oral care often leads to problems in the mouth and therefore to a lower quality of life. This applies to people with their own teeth and to people with a denture.

What you can do

Pay attention to how your father or mother looks after their mouth and whether they need help with it. Read more about dental care for older people and the frequently asked questions about dental care for older people.

The De Mond Niet Vergeten! foundation

The De Mond Niet Vergeten! (Don't Forget the Mouth!) foundation works to ensure good oral care for vulnerable older people living at home. Its participants are the KNMT, NVM-Mondhygiënisten and the ONT. The foundation follows on from the De Mond Niet Vergeten! programme. That programme was an initiative of SBT, IDé, KNMT, ACTA and VU and was made possible in part by SAG/Zilveren Kruis.

Chewing well is important for your digestion and your oral health. With foods such as smoothies and breakfast drinks, chewing seems less and less necessary. Yet chewing well remains important for your saliva, your jaws, feeling full and your brain.

Chewing and saliva

Chewing makes you produce more saliva. Saliva makes food easier to digest and adds to its flavour. Less well known is that saliva protects your teeth and mouth. Saliva rinses the mouth clean, neutralises acids from food, repairs the enamel and kills bacteria.

Saliva contains enzymes, proteins, antibodies and electrolytes (salts), each with its own function:

• The enzyme lysozyme slows the growth of many bacteria.
• Histatins are proteins that fight bacteria and fungi. Among other things, they help wounds heal faster.
• The protein statherin binds calcium and helps protect the enamel surface. It is also antibacterial.
• Lactoferrin stops bacteria from sticking to the teeth.

Chewing and your jaws

Chewing is also important for your jaws. Dentists warn that weak chewing muscles weaken the jaws and make the teeth vulnerable. Do you have jaw problems that stop you chewing properly? This may be a sign of teeth grinding or jaw clenching.

Chewing and feeling full

Chewing helps you feel that you have eaten enough. If you do not chew, or chew too quickly, your brain does not have time to produce histamine. This satiety hormone is released 15 to 20 minutes after the first bite. As a result, you eat more than you need.

Chewing and the brain

More and more research suggests that chewing well may improve memory. Chewing improves blood flow to certain parts of the brain and raises the heart rate. According to Professor Erik Scherder, professor of Clinical Neuropsychology (VU Amsterdam) and Human Movement Sciences (University of Groningen), chewing well can help older people stay independent for longer.

Research also shows that in older people with a denture, who often chew less well as a result, the frontal lobe works less well. This part of the brain contains the higher control functions, such as impulse control and planning. These determine how independent someone can be.

Tips for chewing well

• Time: sit down calmly at the table and take your time over every meal.
• Chewing movements: count how many times you chew and try to increase that number. Take smaller bites. You can chew liquid food too, so that it mixes with saliva.
• Attention: do not read, watch TV or use a phone, computer or tablet while eating. Put your knife and fork down more often.
• Presentation: lay the table and use a smaller plate and smaller cutlery.
• Routine: follow the basic rules for a healthy mouth. Clean your teeth carefully twice a day, eat and drink sensibly and have your teeth checked and cleaned twice a year by the dentist or dental hygienist.

Read more about eating, drinking and healthy teeth.

Sources

• Dental Tribune: ‘Ook kauwen is een vorm van bewegen’ (Chewing is a form of exercise too)
• Plusonline: 5 questions about… saliva and dry mouth
• De Witte Tanden Winkel: saliva information sheet

Poor oral health increases the risk of pneumonia, hardening of the arteries and cardiovascular disease. Several studies also show that people with poor oral hygiene or periodontitis (severe gum inflammation) have a higher risk of brain conditions such as dementia and Alzheimer's disease. So a healthy mouth matters for your whole body.

Avoiding unnecessary health risks

More and more is known about the link between oral health and general health. Many conditions first become visible in the mouth, for example as pain, sores or inflammation. Conversely, conditions in the mouth can cause illnesses such as cardiovascular disease through bacteria in the bloodstream. Because the importance of a healthy mouth is often underestimated, people take unnecessary health risks.

How to keep your mouth healthy

• Oral hygiene: clean your teeth well every day. This keeps your teeth and gums healthy and prevents cavities and gum inflammation. Brush twice a day for at least two minutes with fluoride toothpaste. Also use, for example, toothpicks, interdental brushes or dental floss.
• A healthy diet: more and more oral care professionals advise eating and drinking no more than seven times a day: three main meals and no more than four snacks. This limits the number of acid attacks on your teeth.
• Regular visits to the dentist: at the routine check-up, the dentist or dental hygienist spots early cavities and gum problems. Where needed, you get advice on improving your oral hygiene.

Getting older and your teeth

In 2013, researchers at Karlstad University discovered that tooth loss and reduced chewing strength are directly linked to poorer brain function and weaker memory. This conclusion held up when the researchers corrected for age, sex and environment.

Researchers at the School of Medicine and Dentistry of the University of Central Lancashire came to similar findings. They examined brain tissue from people with and without dementia. In the brains of people with dementia, they found residues of a bacterium that indicates chronic periodontitis.

So besides your eating habits, getting older also affects your teeth. Keep looking after your teeth well and have your gums checked regularly. This also applies if you have a full denture.

Consequences of poor oral care

Some conditions and symptoms can be recognised early in the mouth. Examples are rheumatism, throat, stomach and bowel problems, diabetes, stress and lowered resistance. Problems linked to poor oral health include:

• People with diabetes have a higher risk of gum disease and other mouth problems. Diabetes can make gum inflammation worse. Conversely, gum disease can make it harder to keep diabetes under control.
• With poor oral hygiene and periodontitis, bacteria can cause pneumonia, especially in people at higher risk. Of all older people in care homes, 43% have bacteria in their mouth that can cause pneumonia.
• Periodontitis is increasingly seen as a risk factor for heart attack and, to some extent, for stroke.
• People with infections in the mouth decline cognitively (in thinking and memory) faster than people with a healthy mouth.
• Older people with gum inflammation have a 17% higher risk of cardiovascular disease. Under the age of 65, this risk is as much as 44% higher.
• Rheumatism, diabetes and being overweight are all linked to poor oral care to a greater or lesser extent.

Sources

• “Gevaarlijke gaatjes” (Dangerous cavities), article in Elsevier magazine of 18 January 2014, pages 71 and 72
• AD article: “Invloed mondgezondheid op algehele gezondheid onderbelicht” (Impact of oral health on general health overlooked)

Baby teeth (primary teeth) are temporary. Yet healthy baby teeth are important: they predict how healthy the permanent teeth will be. Teeth can decay in young children, toddlers and even babies. Below you can read why baby teeth matter and how to keep them healthy.

Oral care from the start

Every parent wants their child to have a good start, including a healthy mouth. At the child health clinic (consultatiebureau, part of the Centrum Jeugd en Gezin), the youth health nurse and the youth health doctor raise the subject of oral care. Because time is limited, they often cannot go into it in depth. That is why the clinic refers parents and carers to a dental practice nearby. Read more about oral care tips at the child health clinic.

To the dentist from the first teeth

The advice is to bring your child into contact with a dentist or dental hygienist as soon as the first teeth come through. Newly erupted baby teeth are still weak. That is the moment to make sure they stay healthy.

Why baby teeth matter

• Poor baby teeth often also lead to cavities in the permanent teeth.
• Some baby molars stay in the mouth for a very long time and are only replaced well into puberty.
• Young children can suffer a lot from toothache. As a result, they eat less well. This can mean they stay smaller and have difficulty learning.
• Young children often cannot yet say clearly what they feel. Parents may then go on for a long time with a child without understanding what is wrong.

How many baby teeth are there?

A complete set of baby teeth has 20 teeth. Once the jaws have grown enough, the permanent teeth come through. This is usually around the age of six. The front teeth then start to change and four new molars also appear. With good guidance on brushing, all 20 teeth and the new molars stay healthy.

How often should you brush baby teeth?

Brush twice a day from the moment the first tooth comes through. It is not always easy to get the toothbrush into your child's mouth. Around the first birthday it can become harder, because children learn to say ‘no’. The dentist or dental hygienist can show you how to brush your child's teeth properly, ideally before they start to resist.

Brushing your teeth removes plaque and bacteria and reduces the risk of cavities. But a toothbrush cannot properly clean the spaces between your teeth. Plaque builds up there. That can lead to cavities and gum inflammation. Toothpicks and interdental brushes remove the plaque between your teeth.

At first, using these aids can be awkward or painful. Your gums may bleed easily, because they are still inflamed. If you use them every day, the inflammation and bleeding gradually decrease. When your gums no longer bleed when you use interdental brushes and toothpicks, they are healthy.

Advice on cleaning between your teeth

The dental hygienist can advise you on using toothpicks and interdental brushes and will work out with you which approach suits you best.

Using interdental brushes

Interdental brushes are small brushes. The spaces between your teeth vary. That is why you sometimes need interdental brushes in different sizes. An interdental brush is the right size if it does not slide between the teeth too easily and the metal core does not scrape along your teeth.

• Hold the interdental brush between your thumb and index finger. Rest your other fingers on the neighbouring teeth.
• Push the brush between the teeth from the outside. Move it back and forth a few times until you can feel it on the inside.
• Does the brush move back and forth too easily? Then use a slightly thicker one. You should feel a little resistance. Ask your dentist or dental hygienist which interdental brushes work best for you.

Also read how to make toothpicks and interdental brushes a habit.

Using toothpicks

A good toothpick is made of wood, triangular with a flat side and comes to a point. Toothpicks come in different thicknesses. For larger gaps you use a thicker toothpick, for narrower ones a thin one. Round toothpicks (cocktail sticks) are not meant for cleaning teeth. You can, however, use them to remove bits of food after eating.

• Moisten the tip with saliva. This makes the wood more flexible and less likely to break.
• Hold the toothpick close to the tip between your thumb and index finger. Rest your other fingers on the neighbouring teeth.
• Place the narrow flat side on the gum, below the point where the teeth touch. Insert the toothpick between the teeth as close to a right angle to the row of teeth as possible.
• Push the toothpick firmly between the teeth three times. Change direction slightly each time, in the shape of an X. This way you reach a larger part of the tooth.
• Clean every gap that a toothpick fits into in this way.
• Use a toothpick only once and then throw it away.

Using floss

Flossing has too little effect to prevent tooth decay and gum problems. Floss is useful, however, for removing bits of food stuck between the contact points of your teeth. For people with implants, flossing is sometimes recommended. Ask your dentist or dental hygienist for advice.

At Tandartspraktijk DieverCleaning between your teeth (in Dutch)

Many people want healthy teeth. Once they have achieved that, they are sometimes still disappointed, because they expected a healthy mouth to come with white teeth. But white teeth are not automatically healthy and healthy teeth are not automatically white.

Are white teeth healthy?

The colour of teeth says little about their health. Yet people are quick to judge teeth that are a little crooked or more yellow: they soon think that person is not fresh. If you have worked hard for a healthy mouth, you want to get rid of that judgement.

Be careful with tips from the internet

There are safe ways to make your teeth whiter. But be careful with tips from TikTok, for example. Toothpastes, gels and home remedies, such as brushing with baking soda or biting into a strawberry, can cause damage over time. They contain substances that are too abrasive or even dissolve your teeth. The enamel then becomes thinner and the dentine underneath, which is always yellow, shows through more. Your teeth actually become more yellow. Your gums can also get burnt.

Safe whitening under supervision

A safe option is whitening your teeth at home under the supervision of the dentist or dental hygienist. You are given a whitening product that is only available through dental professionals and is tailored specifically to you.

Ask for advice first

Some celebrities go abroad and come back with a strikingly white smile. That may look good, but the results are not always positive. Sometimes a lot of tooth has been ground away, which causes problems later. Or the crowns are too thick, causing the jawbone to disappear. Would you like whiter teeth? Discuss it with your dentist.

More about teeth whitening

• Whitening your teeth at home
• Teeth whitening by the dentist
• Frequently asked questions about teeth whitening
• Costs of teeth whitening

With healthy teeth, you can eat, drink and smile without any problems. The basis is removing plaque. This whitish-yellow layer forms on and between your teeth and along the gum line. Plaque consists of bacteria and their waste products.

Almost all food contains sugars and starch. Sugars are added to many products, such as fizzy drinks, but also occur naturally in fruit, for example. Bacteria in your mouth turn sugars and starch into acids. These acids cause cavities.

Healthy gums

If you do not remove plaque properly, your gums can become inflamed. Plaque that stays on your teeth can harden into tartar. New plaque sticks easily to tartar, so the gums become more and more inflamed. The inflammation can spread to the jawbone. Eventually so much bone can be lost that your teeth become loose.

Brush twice a day

Brushing is the basis of good oral hygiene. Brush carefully twice a day, but not too hard, with fluoride toothpaste. Fluoride makes tooth enamel stronger and less sensitive to acid. A good brush takes two minutes.

• Choose a soft toothbrush with a small brush head.
• Replace your toothbrush every three months, or sooner if the bristles start to splay.
• An electric toothbrush lets you brush very effectively. The brush makes the right movement itself, so you can concentrate on where the brush head is.

A toothbrush, manual or electric, does not always clean the spaces between your teeth properly. Your dentist or dental hygienist may advise you to clean these spaces once a day with interdental brushes, floss or toothpicks. Ask which aid suits you best and how to use it.

See the dentist regularly

Visit the dentist or dental hygienist twice a year. Your teeth are checked and you get guidance on keeping your mouth healthy. From time to time X-rays are taken. These help detect problems that cannot be seen with the naked eye in good time.

Eating and drinking for healthy teeth

Fizzy drinks, fruit (juice), yoghurt drinks and wine contain sugars and acids. Acids attack the tooth enamel, causing your teeth to wear. This wear is called dental erosion. Dental erosion happens gradually and is difficult to repair. The risk of dental erosion does not only depend on how many acidic products you eat or drink. The more often you do so and the longer the acid stays in your mouth, the greater the risk. The way you eat and drink also plays a part.

• Eat or drink no more than seven times a day: three main meals and no more than four snacks. This gives your teeth enough time to recover.
• Have acidic fruit no more than twice a day.
• Drink fizzy drinks and other acidic drinks in moderation. Water, coffee and ordinary tea without sugar do not harm your teeth.
• Do not eat or drink acidic products in the hour before brushing. Acid attacks the enamel and the toothbrush and toothpaste are abrasive. If you brush straight after something acidic, you can brush the enamel away.

The plaque test

With a plaque disclosing tablet, you can check whether you have brushed well. Chew the tablet after brushing and spread the dye over your teeth with your tongue. Rinse away the excess dye with a small sip of water. Can you still see red patches? That is plaque you still need to brush away.

Sugar-free chewing gum protects your teeth

Saliva protects your teeth against dental erosion, because it neutralises acids from food and drink. Sugar-free chewing gum stimulates saliva production. Xylitol is a natural sweetener. Xylifresh chewing gum with 100% xylitol helps prevent plaque and is recommended by the Ivoren Kruis, the Dutch oral health foundation.

Sources

• Ivoren Kruis information leaflet on a fresh and healthy mouth

In summer, ice cubes in your drink help you cool down. Chewing on an ice cube after your drink seems harmless. Yet it is better not to.

Chewing ice wears your teeth down

An ice cube does more damage to your teeth than you might expect. Ice cubes are very hard. Teeth are made to bite through things, but when you chew ice, your teeth keep striking it until the cube breaks. This makes your teeth wear faster, leading to toothache.

Chewing ice can also damage tooth enamel, fillings and crowns. Your teeth can become sensitive. That can hurt with cold or hot drinks and meals.

A comparison with a blender

Because ice is easy to break, you may not think about the consequences. A blender has special blades for crushing ice, because ordinary blades quickly go blunt. Teeth are a lot stronger than blades, but in the long run the damage is similar.

Leave ice cubes in the glass

You do not have to give up ice cubes. In warm weather they are refreshing. But leave them in your glass as much as possible to avoid damaging your teeth. Read more about eating, drinking and your teeth.

Sources

• Quest
• Optimalegezondheid.com
• Dental Plans

Healthy teeth start with healthy gums. Keep your gums clean by carefully cleaning your teeth twice a day. The dental team can explain how best to remove food debris and plaque with a toothbrush, interdental brushes, toothpicks or floss.

At the routine oral examination (PMO), the dentist checks your entire oral health in 10 steps, including your gums. The dentist looks for oral diseases such as tooth decay (caries) and gum diseases such as periodontitis.

Assessment with the PPS score

During the routine oral examination, the dentist assesses your gums using the PPS (Periodic Periodontal Screening). Your gums are given a score from 1 to 3. Based on that score, treatment may or may not be needed.

If you have gum problems, a treatment plan follows according to the Paro Preventie Traject (periodontal prevention pathway) or the Paro traject (periodontal treatment pathway). These pathways have been set by the Dutch Society of Periodontology (NVvP).

Possible next steps after the PPS score

Depending on the score, the dentist refers you to one of the following care providers.

To the (periodontal) prevention assistant

Do you have superficial gum inflammation or plaque that needs removing? Then you see the (periodontal) prevention assistant. This is a dental assistant trained to carry out preventive treatments that keep your oral hygiene up to standard. You can also go to this assistant for an explanation of how to care for your teeth.

To the dental hygienist

A clean and healthy mouth is the basis for good dentistry. The dental hygienist is an expert in preventive and curative oral care. Preventive care is, for example, a thorough professional clean to reduce harmful bacteria in your mouth. Curative care is the treatment of tooth decay and gum disease, such as periodontitis.

To the periodontist

If you have advanced gum disease, the dental hygienist may refer you to a periodontist. This is a dentist who has specialised in gum disease through a three-year full-time postgraduate programme. The periodontist focuses entirely on treating periodontal problems (problems with the gums and jawbone around the teeth).

How do you explain to your child, in a fun way, that sugar and acid are bad for their teeth? An episode of the Dutch children's programme Het Klokhuis can help. In this episode, the programme visits paediatric dentist Nicole, and children learn about plaque, cavities (caries) and erosion (wear of the enamel caused by acid).

Presenter Tirsa also practises with a drilling robot at ACTA, the dental school in Amsterdam. She learns what you need to do to keep your teeth healthy. The episode lasts 15 minutes and can be watched online.

Preventing cavities in children's teeth

Would you like to know more about children's teeth and preventing cavities? Read also:

• Fewer cavities in children with the Gewoon Gaaf method
• Nutrition tips for children

Sources

• NTR – Het Klokhuis, 10-01-2023

There are many children's books about brushing teeth and going to the dentist. A bedtime story makes learning how to prevent cavities a lot more fun. Especially if your child is not very keen on brushing their teeth.

Children's books about brushing teeth

• De grote tandenpoetsdag (Sophie Schoenwald)
• Zelfs monsters poetsen hun tanden! (Jessica Martinello)
• Ik kan al tandenpoetsen (Ester Kerkhoff)
• Anna poetst haar tanden (Kathleen Amant)
• Bumba: Tandjes Poetsen Is Leuk (Gert Verhulst)
• Marcs grote gevaarlijke tanden (Jarvis)

Children's books about the dentist

• De tandarts (Liesbet Slegers)
• Kaatje naar de tandarts (Liesbet Slegers)
• Anna bij de tandarts (Kathleen Amant)
• Woezel en Pip – Naar de tandarts (Guusje Nederhorst)

More tips

Read more about brushing children's teeth and the dentist for children.

Looking for something to do with your child during the Christmas holidays? Crafts are a fun way for your child to learn about oral care. Your child is happily occupied and learns how to prevent cavities at the same time.

Brushing away monsters

Draw or print a mouth on a white sheet of paper. Slide the sheet into a plastic sleeve. Use a marker to draw monsters on the teeth: these are the bacteria in plaque. Let your child brush the monsters away with an old toothbrush.

Food and drink for healthy children's teeth

Cut out pictures of food and drink from magazines and let your child stick them on a board. Then talk together about which foods are good for the teeth and which foods are best not eaten too often to prevent cavities.

A mouth full of teeth

Draw a mouth on a large sheet of paper. Let your child stick on the right number of teeth using pieces of paper. You can find more craft ideas on Pinterest and YouTube, among other places.

Experiments with toothpaste

You can also find many experiments for children online. In the ‘Brush an egg’ experiment, for example, your child investigates what the fluoride in toothpaste does.

Children's books about the dentist and brushing teeth

After the crafts, reading (or reading aloud) is a good idea. Take a look at the best children's books about brushing teeth.

People who are dependent on alcohol are three times more likely to have serious gum disease than occasional drinkers. If alcohol dependence goes hand in hand with smoking, the risk is even greater. This is shown by research published in the Journal of Clinical Periodontology.

Alcohol and smoking threaten oral health

Gum disease is the main cause of tooth loss in adults. Poor oral health has also been linked to strokes, heart disease, inflammation of the membranes around the brain (meningitis), lung infection (pneumonia) and mouth cancer.

According to Dr Nigel Carter, chief executive of the British Dental Health Foundation, this research should be a warning to people who drink (too) much alcohol. There is growing evidence that the amount of alcohol considered safe is too high, especially in combination with smoking. People who drink little or no alcohol can also develop health problems. Almost 1 in 5 people in the study had serious gum disease, which was made worse by smoking.

Good oral hygiene remains the basis

Good oral hygiene can prevent many oral problems. A fixed routine helps to prevent health problems. The three most important pieces of advice from the British Dental Health Foundation are:

• Brush twice a day for two minutes with fluoride toothpaste.
• Eat and drink as little sugar as possible.
• Visit your dentist or oral care practice regularly (as often as recommended).

Cleaning between your teeth (with toothpicks, interdental brushes or floss), using mouthwash and chewing sugar-free gum with xylitol also help.

Read more about the effect of smoking on your oral health.

Sources

• dentalinfo.nl

Most children start losing their baby teeth at around the age of six. This follows a fixed pattern. The last teeth are replaced at around the age of twelve. So baby teeth (primary teeth) last a long time, but they are a less complete set than the permanent teeth. These are the differences.

Baby teeth

• 20 teeth and molars: development already begins in the sixth week of pregnancy.
• Usually whiter: the crystals in the enamel are unevenly distributed. As a result, the yellow dentine hardly shows through.
• Higher risk of cavities because of the enamel: the enamel is thinner and less strong, so cavities develop more easily.

Permanent teeth

• 32 teeth and molars: including four wisdom teeth. These are the last molars to come through. Some people never get wisdom teeth.
• Usually more yellow: the crystals in the enamel are evenly distributed. As a result, the yellow dentine shows through.
• Higher risk of cavities because of grooves: the large molars have deep grooves that are difficult to keep clean. The enamel of a newly erupted molar is still porous and vulnerable. So brush the tips of new molars straight away. Your dentist or dental hygienist can assess whether your child's chewing surfaces need sealing (fissure sealants), which means covering them with a protective layer.
• New molars at around the age of twelve: more permanent molars come through behind the first permanent molars. These are also extra prone to cavities just after they come through.

Read also where the tooth root goes when baby teeth fall out.

Preventing cavities

Baby teeth and permanent teeth both need good care. So have your child's teeth checked regularly from the very first tooth. Do you need help keeping the teeth clean? Your dentist and dental hygienist can help you.

One method that helps children grow up with a healthy mouth is Gewoon Gaaf. This prevention method was developed by the Ivoren Kruis, the Dutch foundation for oral health education. Scientific research shows that Gewoon Gaaf can lead to up to 40% fewer cavities in children. Read more about caring for baby teeth.

Mouthwash can be an addition to your daily oral care. Not everyone needs it. Your dentist or dental hygienist can assess whether a mouthwash is useful for you and which product suits you best.

A mouthwash may be recommended, for example, if you have an early cavity (caries) or have just had gum treatment. There are many types for sale, each with its own effect.

Types of mouthwash

• Against cavities. Mouthwashes with fluoride strengthen the tooth enamel. They are mainly recommended for people with a higher risk of cavities.
• Against inflammation and infections. These mouthwashes contain, for example, chlorhexidine. You usually use them for a short time: 1 to 2 weeks. Your practitioner may prescribe them after gum treatment, for acute gum inflammation or to prevent infections after surgery in the mouth.
• Against bad breath. You can kill the bacteria that cause bad breath with a gargle or a mouth spray. Examples are Halita and Meridol Halitosis. Ask your dentist or dental hygienist whether you need such a product.
• Against a dry mouth. A dry mouth is caused by a lack of saliva. Saliva substitutes, such as moisturising liquids or gels, can help.
• Against dental erosion. A mouthwash can help protect your teeth against dental erosion: tooth enamel being dissolved by acids. Read also how to prevent dental erosion.

How to use mouthwash

• Use a mouthwash in consultation with your dentist or dental hygienist. It is not useful for everyone.
• A mouthwash never replaces brushing or cleaning between your teeth with interdental brushes or toothpicks.
• A mouthwash gives a fresh taste. That is not the same as fresh breath. The fresh taste only partly masks bad breath (halitosis), and usually only for a short time. Read more about fresh breath.
• How often and how long you rinse depends on the product. Follow the package leaflet or your practitioner's advice.
• Adults can use a mouthwash containing alcohol. Not sure whether to choose one with or without alcohol? Ask your practitioner for advice.
• Rinsing with water afterwards is usually not necessary. The package leaflet or your dentist or dental hygienist will tell you how best to use the product.

At Tandartspraktijk DieverMouthwashes (in Dutch)

Brushing alone is often not enough for healthy teeth. Brushing removes plaque and reduces the risk of cavities. But a toothbrush cannot properly clean the spaces between your teeth and molars, however carefully you brush.

It is precisely between the teeth that plaque builds up. That is why cavities often develop there. You can also get gum inflammation. If it lasts a long time, your teeth and molars may eventually become loose. There are various aids for cleaning between your teeth.

Floss for very narrow spaces

Between some teeth and molars the space is very narrow. Dental floss is a handy aid in that case. Even so, few people floss well enough at home to prevent cavities and gum problems. Toothpicks and interdental brushes are therefore often more effective.

Toothpicks for on the go

If there is a little more space between your teeth, a toothpick is suitable. A toothpick is easy to use after eating and easy to take with you.

• First moisten the toothpick in your mouth. This prevents splinters.
• Hold the toothpick at a right angle to your teeth, with the flat side towards the gum.
• Insert it between your teeth until it stops and move it back and forth a few times.
• Finding it hard to reach your back molars? Close your mouth slightly. This creates more space between your teeth and your cheek.

Interdental brushes for larger spaces

An interdental brush is a small brush. You use it when there is more space between your teeth. Hold the interdental brush by the handle and gently move the brush back and forth between your teeth and molars. Here too, closing your mouth slightly helps you reach the back molars.

Interdental brushes come in various types and sizes: wide ones for large spaces and narrow ones for hard-to-reach places. Try out which ones you find most comfortable, or ask your dentist or dental hygienist for advice. Read more about using interdental brushes, toothpicks and floss.

Making it a habit

Do you find it hard to remember every day? Then read how to make using toothpicks and interdental brushes a regular habit.

At the child health clinic (consultatiebureau) you may meet a dental hygienist who gives advice on caring for your child's teeth. In a number of cities, oral care coaches were deployed at child health clinics during the Gezonde Peutermonden (Healthy Toddler Mouths) project. This produced positive results. That is why national politicians want to extend this to all child health clinics in at-risk neighbourhoods.

A good start at the child health clinic

Katarina Jerković-Ćosić, professor of Public Health and Oral Care, explains in an article by Dental Info why oral care at the child health clinic is so important. About 98% of children visit the child health clinic. Until the age of four, this contact is frequent. It is precisely in this period that children learn healthy eating and oral care habits.

The dental hygienists at the child health clinic guide and coach parents. This way, a child learns healthy habits before an unhealthy lifestyle develops. They also put children in touch with a local oral care practice before their fourth birthday.

6 in 10 toddlers rarely or never go to the dentist

Figures from the research agency Vektis show that an oral care coach at the child health clinic is badly needed. More than 60% of children aged 2 and 3 rarely or never go to the dentist. There are big differences between provinces. Flevoland has the fewest toddlers going to the dentist: there, 67.5% do not go for check-ups. This percentage is also high in Noord-Holland and Zuid-Holland.

Cavities in baby teeth can be prevented

Many children only see the dentist or dental hygienist once they already have (many) cavities and toothache. Yet cavities can be prevented if you brush well from the very first tooth and pay attention to what and how often your child eats and drinks.

Parents often put off a visit to the dentist because they are worried about the costs. There is no need: until your child turns 18, dental check-ups and preventive treatments are covered by basic health insurance (basisverzekering). Read more about the costs of the dentist for children. Another barrier can be that a parent does not go to the dentist themselves out of fear.

Your child can see the dentist from the very first tooth. The dentist or prevention assistant checks how the teeth are coming through and gives tips to make brushing easier. The dentist can also help with stopping thumb-sucking or using a dummy. If your child, or you yourself, are afraid of the dentist, help is available.

Up to 20% fewer cavities at the age of 5

Children who are referred to the dentist or dental hygienist from the moment their first tooth comes through (at around 6 months) have up to 20% fewer cavities by the age of five. They are compared with children who are not referred and often receive oral care for the first time much later. This is shown by research from the UMCG, TNO and Erasmus University.

Sources

• Dental Info: Mondzorg voor kinderen moet terug in de publieke gezondheidszorg
• TP: Kuipers wil mondhygiënist op consultatiebureau
• Hogeschool Utrecht: Gezonde Peutermonden
• GigaGaaf! study by the UMCG, TNO and Erasmus University

Almost a quarter of children's drinks contain more sugar than cola. This is shown by research from Foodwatch. According to the organisation, too much sugar can lead to type 2 diabetes, heart disease and strokes. Sugar also has a big effect on your teeth: it is the main cause of cavities.

Yoghurt drinks contain a lot of sugar

Foodwatch examined 194 drink cartons from the five largest supermarkets: Albert Heijn, Jumbo, Lidl, Aldi and Plus. Many schoolchildren drink these cartons every day.

• One carton (200 ml) contains an average of 16.2 grams of sugar. That is four sugar cubes. The same amount of cola contains five sugar cubes.
• 45 of the cartons examined (almost a quarter) contained more sugar than a glass of cola.
• The yoghurt drinks from Albert Heijn, Jumbo, Plus and Aldi in particular contain a lot of sugar: six sugar cubes per carton.
• Drinks with 2.5 to 4 sugar cubes are often also sweetened with artificial sweeteners.

Foodwatch recommends eating more plant-based food and drinking fewer sugary drinks. This keeps the harmful effects of sugar as small as possible.

Read more about nutrition and healthy children's teeth.

Chewing gum turns out to be good at trapping bacteria. This was found by Stefan Wessel, a PhD researcher at the UMCG. With his team, he investigated how many bacteria are found on and in a piece of chewed gum.

A hundred million bacteria on chewing gum

Five test subjects chewed gum for between 30 seconds and ten minutes. The researchers then counted the bacteria in and on the gum. After thirty seconds of chewing, it contained the most bacteria: about a hundred million. That is comparable to the number of bacteria on a used piece of dental floss.

The longer the test subjects chewed, the more types of bacteria the researchers found. The total number of bacteria did go down, however. According to Wessel, this is probably because the gum becomes less sticky as more saliva enters the mouth.

Chewing gum does not replace brushing

According to Wessel, chewing gum mainly removes bacteria from the chewing surfaces. Flossing and brushing really reach between your teeth and along the gums. So brushing well and cleaning between your teeth are still necessary.

Chewing gum after a meal can, however, help keep your teeth cleaner. Chewing produces more saliva. This washes away food remains between your teeth and strengthens the tooth enamel. This only works with sugar-free gum. Gum with sugar actually increases the number of bacteria.

Read more about flossing, interdental brushes and toothpicks.

Sources

• University of Groningen

Sleeping with your mouth open is bad for your teeth. This is shown by research by New Zealand sleep expert Joanne Choi. The effect is as harmful as drinking a fizzy drink before going to bed.

Breathing through your mouth dries it out, so the saliva disappears. Saliva protects against acid-producing bacteria. Without saliva, the acidity in your mouth rises. This increases the risk of dental erosion (enamel being dissolved by acid) and tooth decay. The molars in particular are damaged, because the back of the mouth dries out the most.

A chip measures acidity during sleep

Choi works at the University of Otago. She developed a chip that measures the acidity in the mouth. The chip was attached to the teeth of 10 volunteers. Wearing a nose clip, they breathed through their mouths while sleeping.

The normal acidity (pH value) in the mouth is 7.7. In the volunteers, it dropped to an average of 6.6 and sometimes even to 3.6. Such a low pH value has the same effect on tooth enamel as a glass of fizzy drink or an orange before going to bed.

Men sleep with their mouths open more often

This is a problem for men in particular: 30% of men sleep with their mouths open, compared with 5% of women. In the Journal of Oral Rehabilitation, Choi writes that this is the first study to record the pH value in the mouths of healthy people over several days. According to her, the results support the idea that mouth breathing is a cause of dental conditions such as dental erosion and cavities (caries).

Snoring and teeth grinding

• How snoring develops and how an anti-snoring device (MRA) can help
• Teeth grinding and jaw clenching

Sources

• Daily Mail

Healthy gums are the basis for strong and healthy teeth. Below you can read how the dentist checks your gums, what periodontitis is, how it is treated and what you can do yourself.

Chronic gum inflammation

Many people have chronic gum inflammation. Gum inflammation is usually painless. As a result, it is often discovered too late. Without treatment, it can lead to periodontitis: an inflammation that can lead to the loss of teeth and molars.

More and more scientific research shows that gum problems can also have an adverse effect on your general health. The sooner you are treated, the smaller the risk of further consequences for your health and the greater the chance that you keep your teeth and molars.

How do I know whether my gums are healthy?

Your dentist checks this during the periodic oral examination (check-up). For this, the profession uses the Periodiek Mondonderzoek (Periodic Oral Examination) practice guideline of the Radboud University Medical Center in Nijmegen as a basis. This guideline focuses on prevention and detecting problems early. The dentist looks out for risks such as tooth decay (caries) and gum disease.

The health of your gums is measured and expressed as a PPS score. PPS stands for Periodieke Parodontale Screening (Periodic Periodontal Screening), previously known as DPSI.

What is periodontitis?

A PPS score of 3 means periodontitis. If gum inflammation is left untreated, the inflammation at the gum line can get worse and spread to the jawbone. The gum then comes away from the teeth and molars. Plaque forms in the space this creates (the pocket).

The inflammation goes deeper and deeper. The jawbone around the roots breaks down and the pockets become deeper. Eventually so much jawbone can be lost that teeth and molars become loose and fall out. Periodontitis can also affect your general health. That is why treatment is necessary. Read more about periodontitis.

How is periodontitis treated?

The treatment follows a fixed protocol, based on the guideline of the Dutch Society of Periodontology (Nederlandse Vereniging voor Parodontologie). First, the (periodontal) prevention assistant or dental hygienist carries out a further examination. Based on this, you receive a proposal for a treatment plan.

The treatment plan consists of a number of treatments, interim measurements and aftercare. The result depends to a large extent on your own daily oral care.

What can I do myself?

Good oral care prevents gum disease. Clean your teeth carefully twice a day. Your dentist or dental hygienist can explain how best to remove food remains and plaque with a toothbrush, interdental brushes, toothpicks or floss.

In addition, visit your dentist regularly to have your gums checked. This way, problems are detected and treated early.

Are your gums red, do they bleed when touched (for example when brushing), are they swollen and no longer fitting snugly around your teeth and molars? Then you probably have gum inflammation (gingivitis). This is a bacterial infection that needs to be treated in time.

Treatment by the prevention assistant

If you have gingivitis, the dentist will refer you for preventive treatment by the prevention assistant. The prevention assistant examines how inflamed your gums are and records this in a bleeding score. For healthy gums, this score is 15% or lower*. If necessary, the prevention assistant also determines a plaque score.

Plaque consists largely of bacteria. These bacteria cause the inflammation. It is therefore important to reduce the number of bacteria in your mouth as much as possible.

Based on the scores, the prevention assistant proposes a treatment to get your gums healthy again. If there is tartar, it is also removed during the treatment. After the treatment, the prevention assistant looks at whether follow-up treatment is needed, together with you and in consultation with the dentist. This depends on the degree of inflammation.

Periodontitis and risks to your health

If the inflammation is not treated, it can develop into periodontitis. This can affect the jawbone. Teeth and molars can become loose and eventually be lost.

Scientific research suggests that gum problems can also have an adverse effect on your general health. The sooner you are treated, the smaller the risk of further consequences for your health and the better your teeth and molars can be preserved. Read more about gum inflammation.

*In smokers, the bleeding score gives a distorted picture. Smoking narrows the blood vessels, so the gums bleed less and the degree of inflammation is harder to determine.

Several studies show a link between vitamin C and periodontitis, a serious inflammation of the gums and the jawbone. Vitamin C is an antioxidant that is important for the immune system. As a result, it has an indirect effect on the tissues of the mouth. Experts advise getting 200 mg of vitamin C a day for an optimal blood level.

Absorption of vitamin C

People with periodontitis turn out to have a lower level of vitamin C in their blood plasma. It has also been shown that people absorb vitamin C differently, especially if they get little of it from their diet. This may be due to a genetic variation in the proteins that transport vitamin C.

Only at an intake of 100 mg of vitamin C does everyone's blood level rise above 4 mg/L. At that point, nobody is deficient any more. At 200 mg a day, everyone has a plasma level above 10 mg/L. That is the amount needed for optimal function.

Nutrition for healthy gums

A weakened immune system is not good for your gums. Healthy food helps keep your immune system up to standard. Chewing properly also contributes to your general health in several ways. These nutrients are important for healthy gums:

• Calcium: a deficiency can lead to bone loss. Calcium is mainly found in milk and cheese. Wholemeal bread, vegetables, pulses and potatoes also contain calcium.
• Magnesium: people with periodontitis have a lower magnesium level. Magnesium is found in cocoa, shellfish, prawns, soya beans and nuts. Vegetables and unrefined grains are also rich in magnesium. Water can be an important source too.
• Omega 3: the body uses this to produce an anti-inflammatory substance. Meat, refined sugars and alcohol break this substance down. Meat also leads to the production of a substance that is partly responsible for the breakdown in periodontitis. So preferably eat plenty of fish, nuts and linseed.
• Fibre: fibre can reduce periodontitis. Wholemeal bread is a good source.
• Vitamin D: promotes the absorption of calcium and makes the gums less prone to inflammation. Your body makes vitamin D when you are outdoors. It is also found in oily fish, margarine, low-fat spread and baking and frying products. An extra 10 micrograms of vitamin D a day is recommended for people who rarely go outdoors, for women over 50 and for men over 70.
• Vitamin E: reduces the inflammatory response in periodontitis. Vitamin E is found in vegetable oils and in grains, nuts, seeds, vegetables and fruit.
• Zinc: has an indirect effect on the tissues of the mouth. Zinc is found in wholegrain products, meat, fish, nuts, pulses and rice.

Read more about nutrition and healthy teeth.

Sources

• Report of a lecture by Drs T.M.H. de Jong, written by the dental hygienist for dental INFO, May 2014
• Article ‘Welke voeding bij parodontitis?’ (Which foods for periodontitis?) on dental INFO

Healthy teeth start with healthy gums. Research also shows a link between gum problems and conditions such as diabetes and cardiovascular disease. So keep your gums healthy. You do this with good oral hygiene and by having your gums checked regularly. Plaque below the gum line can then be removed.

How do gingivitis and periodontitis develop?

The mouth contains bacteria that attach themselves to the teeth and molars. This layer is called plaque. Plaque can cause a bacterial inflammation of the gums: gingivitis. As a result, the gums come away from the teeth and molars.

If the inflammation spreads to the jawbone, this is called periodontitis. So much jawbone can then be lost that teeth and molars become loose and fall out. So it is important not to let it get that far.

Gums and general health

According to the US Centers for Disease Control and Prevention, half of Americans over the age of 30 have periodontitis. Other estimates assume that 70 to 80% of the population has some form of periodontitis. In science, there is growing awareness that periodontitis brings risks for general health. Some facts:

• Periodontitis increases the risk of thrombosis.
• Periodontitis puts a strain on the immune system. It increases the risk of inflammation in, for example, the joints, heart, lungs, liver and brain.
• People with periodontitis are 25% more likely to have an ischaemic stroke.
• Periodontitis increases the risk of heart conditions.
• In people with diabetes and periodontitis, the diabetes is harder to control.
• Periodontitis affects how medicines work, such as antidepressants, contraceptives, immunosuppressants and corticosteroids.

Read also more about gum inflammation.

Tongue and lip piercings cause serious damage to young people's teeth. The rings and studs through the lip or tongue lead to broken teeth, tooth wear and receding gums. This was reported by the Health Care Insurance Board (College voor Zorgverzekeringen, CVZ), now Zorginstituut Nederland, in its Signalement Mondzorg 2011 (Oral Care Report 2011) to the then Minister of Health, Edith Schippers.

Concerns about tongue and lip piercings

According to the CVZ, the number of young people with an oral piercing had risen sharply since 2003. The board described the popularity of piercings that damage the teeth as ‘a cause for concern’. Dentists have long been concerned about the damage caused by oral piercings.

Playing with the piercing damages your teeth

Teeth that often come into contact with the piercing can break and wear down. Small pieces of enamel can chip off, but so can large parts of a tooth or molar. Most damage is caused by playing with the piercing. Read what you can do if you have a broken tooth or molar.

At Tandartspraktijk DieverOral piercings (in Dutch)

Since 1 January 2019, the principle of ‘shared decision-making’ has been included in the Dutch Medical Treatment Contracts Act (Wet op de Geneeskundige Behandelingsovereenkomst, WGBO). Your dentist must inform you about your treatment. In addition, consultation between dentist and patient has become increasingly important.

Which treatment suits you?

With shared decision-making, you and your dentist choose together the treatment that suits you. This way, you get the right treatment.

Talk to your practitioner

For example, tell your practitioner what you expect from the treatment. Is there something you do not understand? Ask for more explanation. You can find more tips for a good conversation with your practitioner on the website Begineengoedgesprek.nl.

Read also about care goals and care plans.

Even while you sleep, the processes in your mouth carry on. At night you do not chew, and your teeth are not exposed to acid attacks from food and drink. Even so, a lot can happen. For some people this causes no problems; for others, dental problems develop. Below you can read which oral problems are most often related to sleep.

Snoring

Snoring now and then does no harm. It becomes a problem if you regularly wake up with a start from your own snoring or your partner lies awake because of it at night. Are you tired during the day, or do you find it hard to concentrate at work or in traffic? Then seek help. Your dentist can, for example, discuss an anti-snoring device (MRA) with you.

Teeth grinding and jaw clenching

Stress, among other things, can make you grind your teeth or clench your jaw, often without noticing. This is also called bruxism. Teeth grinding mainly happens at night. Jaw clenching can happen both at night and during the day.

If you do this for a long time, your teeth can wear down and fillings can break. You can also suffer from muscle pain, problems with the jaw joint or chronic headaches. Read more about teeth grinding and jaw clenching.

Sleeping with your mouth open increases the risk of cavities

Breathing through your mouth dries it out, so the saliva disappears. Saliva protects the mouth against acid-producing bacteria. Without saliva, the acidity in your mouth rises. This increases the risk of dental erosion and tooth decay. The molars in particular are damaged, because the back of the mouth dries out the most. Read more about sleeping with your mouth open.

What can you do?

Are any of these problems keeping you awake? Then discuss this with your dentist at your next check-up. Together you can look at a treatment plan that suits you. If necessary, your dentist will refer you to a specialist, such as a jaw physiotherapist.

One in four people suffers from bad breath, also known as halitosis. Research has shown this. The cause is usually in the mouth. Your dentist can help you solve the problem.

Bad breath in one in four people

In 2011, dentist and university associate professor Winkel carried out research into bad breath together with Albert Tangerman. Of the 50,000 people surveyed, a quarter said they suffered from bad breath. Half answered ‘sometimes’ or ‘I don’t know’. The older the participants, the less they were affected. 8.4 per cent said they had bad breath every day. According to Winkel, that is not too bad: many publications report a higher figure.

Winkel recommends discussing bad breath with your dentist. Patients often do not raise it themselves, because they do not know the dentist can help. And if the dentist is wearing a face mask, he or she will not notice the problem.

Coating on the tongue causes bad breath

The cause is almost always the layer of bacteria on the tongue (tongue coating). These bacteria produce three sulphur-containing gases: methyl mercaptan, hydrogen sulphide and dimethyl sulphide. These gases also seem to play a role in gum inflammation (gingivitis, mainly hydrogen sulphide) and periodontitis (mainly methyl mercaptan).

The solution is usually to reduce the tongue coating. You can do this with a tongue scraper or, if the problem is more severe, with a mouthwash such as Halita. Read more about mouthwashes.

How to get the best results

• Before rinsing, remove as much tongue coating as possible. Run the flat side of a tongue cleaner over your tongue four to five times. Do not do this more often, to avoid damaging your tongue.
• Gargle so that the mouthwash reaches the back of your tongue. To do this, stick your tongue out while gargling.
• Tongue cleaners and mouthwash are available over the counter at the pharmacy.

Other causes of bad breath

In ten per cent of cases, bad breath has a different cause. Examples include a liver disorder, diabetes (the breath then smells of acetone), uraemia (kidney poisoning), a problem with the throat, nose or ears, or fish odour syndrome. The latter occurs because the body does not break down the substance trimethylamine properly. Winkel and Tangerman also researched ‘bloodborne halitosis’: here the odour comes from the blood and is breathed out through the lungs, nose and mouth.

Also read our tips for fresh breath.

Sources

• Report by dental INFO, written during the Dental Review 2011
• Article ‘Slechte adem meestal eenvoudig door de tandarts te behandelen’ (Bad breath usually easy for the dentist to treat)

At Tandartspraktijk DieverBad breath (in Dutch)

Diet and health are inextricably linked. This is stated in the report ‘Smakelijk weten. Trends in voeding en gezondheid’ (Trends in diet and health) by Statistics Netherlands (CBS). By changing their eating habits, people can maintain or improve their health. What you eat and drink is also very important for your oral health.

Diet and (oral) health

In the Netherlands there is plenty of varied and affordable food. As a result, deficiency diseases and malnutrition are rare. However, this wide choice brings new problems. In 2011, for example, a growing number of Dutch people were overweight: 6 million adults. In 2011, 4.7% of the population had diabetes, almost twice as many as in 2001 (2.8%). Dentists also report that more and more people show signs of dental erosion. Dental erosion is the dissolving of tooth enamel by acids. It is caused by the increasing consumption of acidic foods and drinks.

Tips to prevent dental erosion

• Eat or drink no more than seven times a day: three full meals plus a maximum of four snacks or drinks in between. Eat acidic fruit no more than once or twice a day. If you have a drink with your meal, that counts as one moment.
• Have as few acidic drinks and acidic foods as possible. Choose water, plain tea (without sugar and not fruit or herbal tea), coffee (without sugar) or milk instead. Dilute fruit juice and soft drinks with water or sparkling water.
• Keep acidic products in your mouth for as short a time as possible. Do not swish a drink around your mouth. If you like, drink acidic drinks through a straw. Do not suck on sour sweets or other acidic products.
• Rinse your mouth with water or milk after acidic food. This neutralises the acid.
• Chew sugar-free chewing gum with xylitol regularly. This also neutralises acids.

Acidic foods

Almost all drinks are acidic, except water, plain tea (without sugar) and milk. Be especially careful with drinks with an acidity (pH) below 4, such as apple juice (2.8) and diet cola (2). For comparison: water has a pH of 7 and milk of 6.8.

• Acidic fruits such as citrus fruits, blackberries, berries, apples, grapes and kiwis. Also products made from them, such as fruit juice, apple syrup and jam.
• Acidified products such as salad dressing, mayonnaise and gherkins.
• Products containing vitamin C. These are slightly acidic in themselves and are often flavoured with sweetener and, for example, citric acid.

Brushing and oral care

• Brush your teeth twice a day with a soft (electric) toothbrush and fluoride toothpaste. Fluoride makes tooth enamel stronger and less sensitive to acid.
• Clean the spaces between your teeth and molars once a day with interdental brushes, dental floss or toothpicks.
• Do not eat or drink acidic products in the hour before brushing. Acid softens the surface of your teeth and molars. If you brush straight afterwards, you can brush away part of the enamel.
• Do not brush too hard. A little pressure is enough.
• Have your teeth and gums checked twice a year by your dentist or dental hygienist.

Read more about eating, drinking and healthy teeth.

Sources

• ‘Smakelijk weten. Trends in voeding en gezondheid’, report by Statistics Netherlands (CBS), December 2012

People have been brushing their teeth for around 7,000 years. It started with a twig from a tree or plant with healing properties. After that, people brushed with their fingers and a little salt. Later came the first tooth powder. This was eventually replaced by toothpaste.

The first tooth powder

After twigs and salt, the Egyptians began making tooth powder to scrub their teeth with, 5,000 years before Christ. This first tooth powder consisted of crushed eggshells, ground bones or pumice, ash and myrtle. The Egyptians are therefore regarded as the founders of tooth powder.

The Greeks and Romans used a different mixture: they brushed with ground tree bark and charcoal. To combat bad breath, they added herbs to the powder.

In the 18th century, tooth powder was still not good for oral health. Doctors in Great Britain at the time recommended tooth powders containing ground earth and porcelain, among other things.

The first toothpaste

In 1824, an American pharmacist made a toothpaste that actually cleaned the teeth for the first time. This paste consisted of soap and glycerine. It had to be spread onto the teeth with a stick.

In 1850, the first toothpaste similar to today’s appeared: Dr. Sheffield’s Creme by the British dentist Washington Sheffield. This paste consisted of soap and chalk. At first it was only sold in glass jars. From 1892 it was also available in tubes.

Read more about fluoride and about oral hygiene.

Dental erosion is the dissolving of tooth enamel by acid. It is usually caused by acids from food and drink, with sweets and soft drinks as the main culprits. Stomach acid, for example from vomiting, can also cause erosion.

Dental erosion became much more common between 2003 and 2009. In 2003, one in ten 21-year-olds was affected; in 2009, one in three. Erosion is less well known than cavities (caries), but just as harmful. The enamel can become thinner and thinner and even disappear completely. Enamel that has worn away does not come back.

Erosion occurs on clean teeth in particular

Saliva protects the teeth against erosion, because it neutralises acids. When you brush your teeth, part of that protective layer disappears. As a result, acid can act directly on clean tooth surfaces. If you brush straight after eating or drinking something acidic, the surface roughened by the acid wears away more quickly.

How much acid do drinks contain?

Acidity is expressed as pH. At a pH below 5.5 in the mouth, tooth enamel can dissolve. The more acidic the drink, the more harmful it is to your teeth. A drink with a pH below 4 can therefore damage the enamel. The way you brush, the way you drink (for example through a straw) and how quickly you swallow also determine how fast and where erosion develops.

The pH of a number of drinks:

• Tea (plain): 7.1
• Water: 7.0
• Semi-skimmed milk: 6.8
• Herbal tea: <6.0
• Buttermilk: 4.4
• Beer: 4.3
• Yoghurt (drink): 3.8
• Sports drink: 3.4
• Red/white wine: 3.4
• Children’s cola: 3.3
• Lemon-lime soft drinks: 3.2
• Orange juice: 3.2
• Squash (cordial): 3.0
• Blackcurrant soft drink: 3.0
• Diet cola: 2.9
• Apple juice: 2.8
• Gastric juice: 2.0

Which foods damage the enamel?

All acidic foods can damage your teeth, especially acidic fruit, citrus fruits and berries. Acidified products (containing acetic acid, citric acid or food acids) can also be a problem. Sucking vitamin C tablets is very harmful to the enamel.

Tips to prevent dental erosion

• Have fewer acidic drinks and products. Choose water, plain tea, coffee (preferably without sugar) or dairy instead.
• Also pay attention to how often you eat and drink. Limit the number of times you eat and drink to seven a day. It is better to have a full meal with a drink than something small throughout the day.
• Do not keep acidic drinks and products in your mouth for long. Preferably drink through a straw. Do not suck on sour sweets, vitamin C tablets or acidified products.
• Neutralise the acid by rinsing with water or milk afterwards or by chewing sugar-free gum.
• Do you drink fruit juice with breakfast? Then it is best to brush before breakfast.
• Use toothpaste with fluoride, preferably with bicarbonate. Rinsing daily with a 0.05% fluoride solution may be advisable.

Read more about diet and healthy teeth and about dental erosion as a threat to your teeth.

Sources

• NRC Handelsblad, 28–29 April 2012, Science supplement (bijlage Wetenschap)
• Tandartsplein, conditions section

At Tandartspraktijk DieverDental erosion (in Dutch)

Dentists and dental hygienists in the Netherlands are seeing more and more dental erosion. That is why the KNMT, the Dutch professional association of dentists, has officially warned about dental erosion as a threat to healthy teeth and a healthy body.

A gradual process

With dental erosion, tooth enamel dissolves because of acids. These acids come from sweets, drinks, food or stomach acid. Over time, the enamel can disappear completely. Enamel that has gone does not come back.

The main culprits are soft drinks, alcohol and fruit juice. These often contain ‘hidden’ acids: because of added sugar or sweetener, you can hardly taste the high acidity. Acids from food and sweets also damage your teeth. Many people do not know that fruit and fruit juice often contain acidic ingredients. Eating plenty of fruit is healthy, as long as you do it in the right way.

Eating habits

According to the KNMT, the sharp rise in dental erosion is due to eating habits. People drink soft drinks, sports drinks and fruit juice more often and in larger amounts. The acids in them are very harmful to oral health. The damage to the teeth builds up and leads to pain and poorly functioning teeth. According to the KNMT, the consequences for psychological and social well-being are also considerable. The KNMT expects the rise in dental erosion to lead to unnecessary healthcare costs for treatments such as white fillings, inlays and crowns.

Permanent damage

At first you notice little of dental erosion. Only later may your teeth become sensitive when eating and drinking. By then the enamel has already dissolved and the dentine is exposed. The appearance of your teeth can also change.

Your teeth are the only part of the body that cannot repair itself: lost enamel never grows back. The damage is permanent. That is why you need to change your eating and drinking habits. Also visit your dentist or dental hygienist regularly. They can spot erosion before you notice any sensitivity.

Tips to combat dental erosion

• Limit the number of times you eat and drink to a maximum of seven a day. Eating or drinking throughout the day is very bad for your teeth. Have sweets, fruit or other acidic food and drinks at no more than one or two of those moments. This gives your enamel the chance to recover.
• Do not have acidic drinks or food before going to bed.
• Drink mainly water. Water, milk and tea, as it were, rinse the acid away. You can drink water throughout the day. Chewing sugar-free gum with xylitol is also fine throughout the day.
• Preferably drink acidic drinks through a straw. That way the drink has less contact with your teeth.
• Visit your dentist or dental hygienist once or twice a year. They can see whether erosion has already started.

Brushing your teeth

• Fluoride makes enamel strong. Brush your teeth for two minutes at least twice a day with fluoride toothpaste. Clean the spaces between your teeth and molars with interdental brushes or toothpicks.
• Do not brush straight after a meal: you would, as it were, rub the acids into the enamel. Preferably brush an hour after eating. If that is not possible, brush before the meal.
• Breakfast often contains sweet and sour products that damage the enamel, such as orange juice. Your teeth are then extra vulnerable. If you give your mouth an hour to neutralise the acid, less damage occurs.

Read more about preventing dental erosion and about eating, drinking and healthy teeth.

Sources

• allesoverhetgebit.nl

The advice is to replace your toothbrush every three months. Many Dutch people do not do this, according to research by the research institute TNO. After three months, a toothbrush already carries an average of 7 million bacteria. What is more, you brush less effectively once the bristles wear and splay.

According to TNO, 44% of Dutch people aged 20 to 49 use the same toothbrush for longer than three months. 14% even keep one brush for nine months or longer. At the same time, 70% of the group studied think that brushing with an old toothbrush is unhealthy.

Bacteria and fungi on your toothbrush

For the TNO study, 37 volunteers were given a new toothbrush three times: at the start, after one month and after three months. On some of the brushes the researchers found the E. coli bacterium. They also found fungi and streptococci. According to TNO, these results say nothing about any possible risk of infection.

How long does a toothbrush last?

A good toothbrush lasts three months. After that, the bristles wear and splay, so you brush less effectively. This applies to both manual and electric toothbrushes.

The main job of a toothbrush is to remove food debris and plaque. When choosing one, look out for the following:

• The brush is not too hard: preferably choose medium or soft.
• The bristles are made of nylon and are rounded, so they do not damage your gums.
• The smaller the brush head, the easier it is to reach difficult areas.

Preventing plaque and tartar

Plaque constantly forms in the mouth, especially along the gum line. If you do not remove plaque properly, it turns into tartar. Tartar is rough. This means new plaque sticks to it easily and becomes increasingly difficult to remove.

You can prevent this by brushing thoroughly twice a day. A visit to the dental hygienist twice a year also helps to prevent plaque and tartar.

Ask for your PPS score

At every regular check-up, the dentist, dental hygienist, periodontal prevention assistant or prevention assistant checks how healthy your gums are. He or she also checks whether the fillings fit properly and whether spaces have formed below the gum line (pockets).

Your gums are then given a score according to the Periodic Periodontal Screening (PPS, Periodiek Parodontaal Screenen). This score ranges from 1 to 3 and is recorded in your patient file. Based on the score, the practitioner proposes a treatment plan.

Read more about good oral hygiene.

What are mouth ulcers?

Mouth ulcers (aphthous ulcers) are painful small sores or blisters in the mouth, three to four millimetres across. They are greyish-white or thick yellow spots with a red, inflamed edge. They appear on the inside of the lips and cheeks or under the tongue.

Mouth ulcers cause a stabbing pain, especially when eating acidic or hot food. Some people can feel an ulcer coming: they recognise the painful sensation that goes with it. Sometimes the lining of the mouth is also red at that point.

Mouth ulcers occur in both young people and adults. Some people suffer from them regularly. The cause is not entirely clear, but mouth ulcers do not cause any lasting harm to your health.

Frequently asked questions about mouth ulcers

At Tandartspraktijk DieverMouth ulcers (in Dutch)

By brushing properly and cleaning between your teeth and molars every day, you remove plaque and food debris. There are several methods that work well. The most important thing is not to miss a single spot.

Brush twice a day, for at least two minutes each time. This cleans your teeth and molars and gives the fluoride in the toothpaste time to protect your teeth against cavities.

General tips

• Use a fluoride toothpaste. Fluoride makes tooth enamel stronger and less sensitive to acids from food and drink.
• Stick to a fixed order: inside, outside, top.
• Clean your tongue every day with a tongue scraper. This removes bacteria and food debris from the back of the tongue. Research shows that a tongue scraper works better for this than a toothbrush.
• Clean the spaces between your teeth and molars once a day with interdental brushes, toothpicks or floss. Your dentist or dental hygienist can advise you on which aid suits you best.
• Do not eat or drink acidic products in the last hour before you brush. Acid temporarily softens the surface of your teeth and molars. If you brush straight after something acidic, you can damage the enamel.

Electric or manual toothbrush?

Several studies show that brushing with an electric toothbrush works better than with a manual toothbrush:

• The small brush head makes it easier to reach difficult areas in your mouth.
• You remove more plaque on and between your teeth and molars and along the gum line.
• You usually brush for longer, so your teeth get cleaner. This is thanks to the built-in timer and because electric brushing is easier and less tiring.
• Most electric toothbrushes have a pressure sensor. It gives a signal if you press too hard, for example a red light or a vibration. This helps prevent damage to your gums. Brushes with a pressure sensor are more expensive, though.

Brushing with an electric toothbrush

There are two types of electric toothbrush, each with its own technique:

• Oscillating-rotating: the brush head turns back and forth in small movements. The head is relatively small and round, so you can easily reach areas that are hard to get to. Angle the brush well and follow the shape of each tooth and molar. Hold the brush still for a few seconds on each tooth or molar.
• Sonic: this brush has the same shape as a manual toothbrush. The technique is therefore similar to brushing by hand. The brush moves rapidly back and forth with a sideways motion. The advice is to brush along with light pressure and back-and-forth movements.

For both types:

• Place the brush at a slight angle on the tooth surface, just over the gum line.
• The brush makes the brushing movement for you. You only need to position it properly on your teeth and molars.
• Hold the brush still for a few seconds on each tooth or molar.

Brushing with a manual toothbrush

One of the methods for removing plaque with a manual toothbrush:

• Place the brush at an angle (45 degrees) on the edge of the gums. Make small back-and-forth movements without pressing hard.
• Brush the inside of your teeth and molars in the same way. For the inside of your front teeth, you can also hold the brush vertically and move it up and down.
• Then brush the tops of your teeth and molars. Finish with the chewing surfaces of your molars.

Checking how well you brush

Plaque is usually the same colour as your teeth, which makes it hard to see. A plaque disclosing tablet makes plaque visible. This is a dye in tablet form that shows where plaque is still present. This lets you check how well you have brushed. Disclosing tablets are available from the chemist.

At Tandartspraktijk DieverElectric brushing (in Dutch)

An unpleasant smell from the mouth can be caused by insufficient oral hygiene, certain foods, gum disease or a dry mouth. According to research, bad breath originates in the mouth in 80–90% of cases. In 10–20% of cases the cause lies elsewhere, for example in an underlying illness. To give the right treatment, the dentist or dental hygienist first looks for the cause by examining your mouth.

How to keep your breath fresh

• Brush twice a day for at least two minutes with fluoride toothpaste.
• Clean the spaces between your teeth and molars with interdental brushes, toothpicks or floss.
• Clean your tongue with a tongue cleaner, for example from Scrapy or Lactona. You can read below how to do this.
• Go easy on foods that cause bad breath, such as onion and garlic.
• You can also use a mouthwash, for example Halita. This does not contain alcohol. Gargle in the right way, so that the product reaches the bacteria at the back of your tongue.
• Do you still have bad breath despite good oral hygiene? Then talk to your dentist or dental hygienist.

Using a tongue scraper

1. Stick your tongue out as far as possible.
2. Place the tongue scraper as far back on your tongue as possible.
3. Scrape with light pressure from back to front. Scrape across the full width of your tongue: in the middle and on the left and right sides.
4. Repeat this about 5 times.
5. Rinse the tongue scraper with water in between.
6. Clean the tongue scraper after use and let it dry.

At first you may gag. This gets better as you do it more often and learn how best to position the scraper.

Also read about discussing bad breath with your dentist.

Many people have inflamed, bleeding gums. In a large proportion of them, the space between tooth and gum has become deeper in one or more places. This was shown by a gum check carried out by dental hygienists.

Results of the gum check

During the Nationale Gezondheidsbeurs (national health fair) in January 2010, dental hygienists carried out a gum check on 249 participants. The results:

• In 99%, the gums were inflamed (bleeding).
• In 66%, the space between tooth and gum had deepened in one or more places. This can indicate advanced inflammation and loss of supporting tissue and jawbone.
• 95% were under the care of a dentist, but 65% had never been to a dental hygienist.

Cause and consequences of gum inflammation

Inflamed gums are reddish and bleed easily. The cause is a number of types of bacteria in plaque. These bacteria also play a role in the development of cavities (caries).

If the inflammation lasts a long time, there is a high chance of periodontitis. In this condition, fibres and jawbone are broken down. Deeper pockets form, which fill up further with plaque and tartar. Scientific research also shows a link between gum inflammation and cardiovascular disease, premature births and complications of diabetes.

Preventing gum inflammation

By removing plaque every day, you prevent inflammation and cavities. Depending on the size of the spaces between your teeth, you also use interdental brushes, toothpicks or floss for this.

Do you have bleeding or painful gums? Then the advice is to visit the dental hygienist twice a year. The dental hygienist treats your mouth and gum problems and helps you prevent new ones.

Read more about gum inflammation.

Sources

• Nederlandse Vereniging van Mondhygiënisten (NVM, Dutch association of dental hygienists), 1 February 2010

According to research by Pharos, fifteen per cent of children aged four to seventeen do not visit the dentist. For toddlers the figure is as high as 60 per cent. In 2020 the share rose to almost one in five children (18%). This was probably due to the coronavirus lockdown: even afterwards, parents were afraid of infection and postponed dental visits.

If a child does not go to the dentist, problems in the mouth are often discovered too late. Untreated cavities are painful and can lead to the loss of baby teeth. Later in life they can also cause chronic health problems.

Large regional differences

Public figures are available per municipality and per neighbourhood on the number of children who do not have regular dental check-ups. The differences between regions are large. Children stay away from the dentist especially in Zeeland, Groningen, South Limburg and parts of Flevoland. In North Brabant, Gelderland, North Holland and the Bollenstreek, on the other hand, children go relatively often.

Twice a year to the dentist?

The advice used to be to visit the dentist twice a year. Nowadays the number of visits depends on a personal treatment plan. That plan is tailored to your child’s teeth, the risk of cavities and their age. It starts as soon as the first tooth comes through.

During the check-up, the dentist indicates the risk of cavities with a colour: green (low risk), yellow (high risk) or orange (very high risk). This is called the NOCTP score. Based on this score, the dentist advises how often your child should come and which practitioner will help your child.

When did your child last see the dentist?

Regular check-ups help your child grow up without cavities. You usually do not need to worry about the dental costs for your child: basic health insurance (basisverzekering) covers almost all dental care for children. Has your child fallen out of the routine? Then book a new check-up.

Sources

• Pharos news item, 20 March 2022: 'Vijftien procent van kinderen gaat niet naar tandarts' (Fifteen per cent of children do not visit the dentist)

From around the age of six, baby teeth start to be replaced. This is an important stage in the development of the permanent teeth. But where do the roots of the baby teeth actually go?

How does the root of a baby tooth disappear?

The permanent teeth form underneath the baby teeth. These teeth slowly grow upwards and press against the roots of the baby teeth. This pressure makes the body produce special cells: osteoclasts. These cells dissolve the roots of the baby teeth.

Once the root has dissolved, the baby tooth becomes loose and eventually falls out. The permanent tooth then has enough room to move into place.

Read more about dental care for children and baby teeth (primary teeth).

Sources

• Quest

Laughing is healthy. Research shows that a real, genuine laugh can extend your life. Laughing also has other positive effects on the body.

Laughing releases happiness hormones

When you laugh, your body produces more happiness hormones. These hormones give a feeling of contentment and happiness and relieve pain. Laughing is also relaxing, gives you energy and helps you look at problems more positively. The brain does not know the difference between a real and a forced laugh. So a forced laugh also brings these benefits.

Laughing reduces the risk of a heart attack

People who laugh for half an hour a day are less likely to have a heart attack. Laughing does not rule out a heart attack, but it does reduce the risk. Researchers at the Loma Linda School of Medicine discovered that laughing inhibits the production of cortisol.

Cortisol is a stress hormone that plays an important role in the development of various conditions, including cardiovascular disease. It causes the coronary arteries to stiffen. If the coronary arteries stiffen less, blood flow is better and the risk of a heart attack is lower. 1 minute of laughing even stimulates the heart and circulation as well as 10 minutes of rowing.

Falling ill less often

People who laugh regularly have a better-functioning immune system. Laughing increases the number of antibodies and so-called natural killer cells in the blood. As a result, you fall ill less often and recover more quickly.

Laughing as a workout for the body

When you laugh, you use a lot of muscles: 15 in your face, plus the muscles in your abdomen and diaphragm. Laughing for 10 to 15 minutes burns around 50 calories.

Plenty of reasons to laugh more often. Read more about good oral hygiene for healthy teeth.

Do you have a full denture? Then it is best to avoid chewing gum. Chewing gum does not stick to natural teeth, but most types of chewing gum do stick to the teeth of a denture. This is not serious, but it is annoying.

The difference between natural teeth and a denture

The cause lies in the main ingredient of chewing gum: gum base. Gum base repels water. The enamel on the outside of natural teeth, on the other hand, attracts water. As a result, there is always a moist layer on natural teeth, to which food and chewing gum do not stick.

The teeth of a denture have no enamel and also repel water. Two water-repellent surfaces attract each other. The result: the chewing gum sticks to the denture.

Sources

• Quest

Sometimes you suddenly bite your tongue while eating. It is unpleasant and can be quite painful. Why does it happen?

Thousands of chewing movements a day

The Dutch newspaper de Volkskrant put this question to oral physiologist Andries van der Bilt of UMC Utrecht. According to Van der Bilt, what is actually surprising is how often it goes right. People make thousands of chewing movements a day and only rarely bite their tongue.

Chewing requires precise coordination between the jaws and the tongue. When you open your jaws, your tongue places the food between your teeth. When you close your jaws again, your tongue has to pull back in a flash.

How nerve cells control chewing

American scientists studied how the jaws and tongue are coordinated. One group of nerve cells controls opening the jaw and sticking out the tongue. Another group controls closing the jaw and pulling back the tongue. This happens without you thinking about it.

As long as both groups of nerve cells work properly, you do not notice anything. Very occasionally something goes wrong and the tongue does not pull back quickly enough. Then you bite your tongue. Van der Bilt compares it to walking: you also do that without thinking. Yet you sometimes trip.

A natural brake

The jaw muscle is the strongest muscle in the body. So if the tongue accidentally gets between the jaws, the impact is great. Without protection, a person could even easily bite right through their tongue. A natural brake prevents this. When you bite your tongue, a signal goes to the brain. The brain briefly switches off the force of the jaw muscles, so you can pull your tongue back.

If your tongue is numb, for example after a visit to the dentist, this signal does not come. So wait to eat until the anaesthetic has worn off.

Read more about eating, drinking and your teeth.

Sources

• de Volkskrant

Sunlight is harmful if you do not protect yourself properly. Yet the sun is also healthy: sunlight stimulates the production of vitamin D in the body. And vitamin D is needed for, among other things, a healthy mouth.

An important vitamin

Vitamin D has many functions in the body. It plays a role in regulating blood pressure and in muscle strength. It is also involved in absorbing calcium. That is exactly why vitamin D is so important for the mouth.

Calcium is a mineral needed for strong bones and strong teeth. The jawbone and teeth can only absorb calcium if there is enough vitamin D in the body. A lack of vitamin D is one of the factors that increase the risk of cavities (caries) and gum inflammation.

Getting enough vitamin D

Your skin makes about two thirds of the recommended amount of vitamin D under the influence of sunlight. In summer, sitting in the sun briefly with bare arms, legs and face is already enough. Do apply sunscreen well first.

In the winter months there is too little sun to make enough vitamin D. Fortunately, vitamin D is also found in food, such as oily fish, meat, eggs and full-fat dairy products. This keeps your vitamin D level up and your teeth strong.

Read more about oral hygiene and how to keep your mouth healthy all year round.

Sources

• Oergezonde Mond

Antibiotics are medicines that help with infections caused by bacteria. They kill the bacteria or slow their growth. If you have a bacterial infection like this, antibiotics may sometimes be needed.

Antibiotics do not work against an infection caused by a virus, such as flu or a cold. Antibiotics are also not needed for most dental treatments.

What is antibiotic resistance?

If antibiotics are used too often, bacteria can become insensitive to them. They have learned to protect themselves against the medicine's effect. When bacteria are no longer sensitive to one or more types of antibiotic, this is called antibiotic resistance. The antibiotics then no longer work and it is harder to get better.

Using antibiotics wisely

Antibiotics only keep working well if everyone uses them wisely. These tips help:

• Only use antibiotics if your doctor or dentist thinks they are necessary. The doctor or dentist decides which medicine works against the infection. Always follow the advice of your doctor, dentist or pharmacist.
• Do not ask for antibiotics if the doctor or dentist says they are not needed. Antibiotics are not painkillers. For pain, the doctor or dentist can recommend or prescribe a painkiller.
• Take the antibiotics correctly: the prescribed amount every day, at the right times. Never skip a dose.
• Do not stop a course of antibiotics on your own initiative. Always check with a doctor first whether stopping early is possible.
• Never take someone else's antibiotics and do not use leftovers from an earlier course.
• Always tell your doctor or dentist if you take any medicines. Antibiotics can affect how other medicines work.

Sources

• RIVM

After brushing, food debris and plaque remain between your teeth. You remove them with toothpicks or interdental brushes. Dentists and dental hygienists can floss well, but few people floss well enough at home to prevent cavities and gum problems. In practice, toothpicks and interdental brushes are therefore more effective.

Four tips for a fixed habit

Cleaning the spaces between your teeth is also called interdental cleaning. The advice is to do this once a day. That is easier said than done. Many people forget or put it off. In the morning there is too little time and in the evening you are tired. These tips will help make using toothpicks or interdental brushes a fixed habit.

Tip 1: start today

You only learn a new habit by starting it. So do not put it off: start today.

Tip 2: choose a fixed moment

An action becomes a routine more quickly if you repeat it at the same moment every day. Link it to something you already do daily, for example in the evening before brushing your teeth. Keep the toothpicks or interdental brushes where you can see them. Do you do it before brushing? Then put them next to your toothbrush. Would you rather do it in the evening in front of the television? Then keep them there. This way you are reminded every time and are less likely to forget.

Please note: do not use toothpicks or interdental brushes straight after eating or drinking. The acid in food and drink temporarily softens the surface of your teeth, so you could damage the enamel. Wait at least one hour after eating or drinking.

Tip 3: make a chart

Make a simple chart with the days and weeks. Cross off every day on which you have used toothpicks or interdental brushes. This helps you keep track. What is more, every crossed-off day feels like a small reward.

Tip 4: give yourself time

Did you forget once? Do not be too hard on yourself: it happens. But do pick it up again every day straight away in the days that follow. Otherwise you are less likely to keep it up. Learning a new habit takes time. You have only really learned a habit once you have done it every day for at least 6 months.

The dental hygienist can help

Do you have sensitive teeth, bleeding or receding gums, bad breath or slightly loose teeth? Then the dental hygienist can help you. Also read how to use interdental brushes, toothpicks and floss.

Are you pregnant or trying to get pregnant? Then pay extra attention to your teeth. Hormonal changes make problems more likely, especially with your gums. These problems are harmful to you and can also pose risks to your baby's health.

Pregnancy gingivitis

Gum inflammation during pregnancy is also called pregnancy gingivitis. It mainly develops from the third month onwards. During pregnancy, the body reacts more strongly with inflammation. As a result, some women react more severely to plaque. The gums may then be redder and swollen and bleed when you brush.

You prevent gum inflammation by removing plaque as well as possible, or having it removed. Make sure you have good daily oral hygiene and visit the dental hygienist.

Frequently asked questions

Sources

• Ivoren Kruis
• allesoverhetgebit.nl

At Tandartspraktijk DieverPregnancy and your teeth (in Dutch)