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In order to clean the teeth effectively, you have to thoroughly remove the dental plaque that adheres on the tooth surfaces, false teeth and orthodontic appliances. The accumulation of plaque will cause Dental Caries and Periodontal Disease.

A. Clean the tooth surfaces by toothbrushing

Toothbrushing can remove dental plaque on tooth surfaces. We should brush our teeth in the morning and before bed at night everyday. Thorough removal of plaque can prevent Periodontal Disease.

1. Place the toothbrush at an angle towards the gingival margin
The head of the toothbrush should be placed with the tips of the bristles tilted at an angle towards the gingival (gum) sulcus at the gingival margin where plaque tends to accumulate.

2. Brush the teeth systematically

Firstly, brush the outer surfaces of the upper and lower teeth. The head of the toothbrush should be placed with the tips of the bristles tilted at an angle towards the gingival margin. Gently move the toothbrush in small scrubbing motion, working on two to three teeth at a time.
Then brush the inner surfaces of teeth in the same way as brushing the outer surfaces.
When we brush the inner surfaces of front teeth, we should hold the toothbrush upright using gentle motion scrubbing from the gingival margin towards the crowns of the teeth.
Finally, brush the chewing surfaces of the teeth with the toothbrush moving backward and forward.

3. Points to note

Even if you have grasped the toothbrushing technique, it is important to use appropriate toothbrush and toothpaste.
Toothbrushing cannot remove plaque from the adjacent tooth surfaces. They have to be cleaned by dental floss or floss holder.
The order of brushing and flossing does not affect the effectiveness of tooth cleaning. As long as we use the correct technique, we can achieve satisfactory results.

4. Solutions to common problems encountered during toothbrushing

Areas that are hard to reach by a toothbrush are difficult to be cleaned by toothbrushing. For example, the inner surfaces of lower teeth or crooked teeth:
The solution is to clean with a small head toothbrush or a single-tuft toothbrush. 。
Gagging when brushing:
Some people may gag when they brush their teeth. To improve this situation, you can choose to use a toothbrush with a small head.
Gingivae bleeds and hurts when brushing:
The accumulation of dental plaque causes gingival inflammation. In that case, the gingivae (gum) will bleed when brushing. You can choose to use a soft toothbrush to clean away the plaque in such areas. Gingival inflammation will slowly subside and the gingivae will become healthy when the oral hygiene has improved.

B. Clean the adjacent tooth surfaces by flossing

Toothbrushing cannot clean the adjacent surfaces of teeth. If we want to remove the plaque accumulated on the adjacent tooth surfaces, we must use dental floss daily. Parents or caregivers can assist children or people in need to clean adjacent tooth surfaces by using a floss holder.

1. Flossing technique

Use a piece of dental floss which is approximately 20-25 cm long. Tie both ends to make a loop. Use the thumbs and the forefingers of both hands to hold the floss, leaving about 2 cm of floss in between.
Use a sawing motion; gently slide the floss towards the gingival (gum) margin.
Wrap around one tooth making a "C" shape and gently slide it up and down against the tooth. Then wrap around the adjacent tooth and repeat the up and down motions.

2. Method of using floss holder

Move the floss holder left and right and slowly slide the floss towards the gingival margin. Pull the floss tightly against one of the adjacent tooth surfaces.
Start from the bottom of the gingival margin; gently slide the floss up and down to clean the adjacent tooth surface.
Pull the floss tightly against the other adjacent tooth surface.
Using the same technique, starting from the bottom of the gingival margin, gently slide the floss up and down to clean the other adjacent tooth surface.

Points to note:
In case of gingival recession due to Periodontal Disease, the gap between the roots of neighbouring teeth will be wide. Then, an interdental toothbrush may be used instead of dental floss.

3. Solutions to common problems encountered when using dental floss

Difficult to control the dental floss:
The further the distance between the two fingers holding the floss, the more difficult it will be to control it. Therefore, you should keep the distance between the fingers at about 2 cm and you can tighten up the floss when flossing. This will help improve the situation.
Difficult to clean the posterior teeth:
To clean the adjacent tooth surfaces of posterior teeth, you will need to use the forefingers to control the floss inside the mouth.
Improper use of dental floss causes injury to the gingivae:
Correct use of dental floss will not cause any damage to the gingivae. Remember you have to slowly “slide” the dental floss into the interdental space, pull the floss taut against one side of the adjacent tooth surfaces, start from the bottom of the gingival margin, and pull the floss up and down to clean the surface. This will not injure the gingival tissue.
Difficulty in sliding the floss into the interdental space:
This can be caused by the accumulation of calculus. The situation will be improved once the calculus has been removed by scaling. Remember to brush and floss your teeth daily after the calculus has been removed.

C. Clean the false teeth (bridge and denture)

If you are wearing false teeth, do not neglect the hygiene of the false teeth because dental plaque also forms on them.

1. Cleaning a removable denture
Dental plaque forms on the surface of a denture. In order to maintain the hygiene of the mouth and denture, the denture should be taken out for cleaning every night.

Denture cleaning

First, fill the washing basin with some water (to prevent accidental drop and fracture of the denture). Apply some detergent onto the toothbrush. Then clean every surface of the denture.
Before bedtime, immerse the cleaned denture into a cup of water overnight.

Consequences of poor denture hygiene
Wearing a unclean denture for a long period of time may lead to inflammation of the soft tissue under the denture with redness, swelling, pain, ulceration etc. This condition is called "Denture induced Stomatitis".

Points to note

Avoid using toothpaste to clean the denture. The coarse particles in the toothpaste may scratch the surfaces of denture and enhance plaque accumulation.
The unworn removable denture should be immersed in a cup of plain water to avoid warping of the denture.
If the denture is accidentally dropped and broken, you should pick up all broken parts and take them to the dentist for assistance.

2. Cleaning a fixed bridge
As dental plaque also accumulates on the surface under the bridge, people wearing bridges should use superfloss to clean the area daily.

Fixed bridge cleaning

Firstly, insert the stiffened end into the area beneath the bridge.
Then, gently thread the spongy floss between the gum and the bridge, use a soft back-and-forth motion to remove plaque.
Finally, slowly pull it out from the space between the gum and the bridge.
The regular floss is used to remove the plaque from the adjacent tooth surfaces for the rest of the teeth.

Consequences of unclean bridge
Poor bridge hygiene may affect the health of the adjacent teeth, resulting in Dental Caries and Periodontal Disease.

D. Cleaning orthodontic appliances

People wearing orthodontic appliances should clean the appliances everyday as dental plaque also adheres to the appliances.

1. Removable orthodontic appliances
The user must take it out and clean it thoroughly to remove the dental plaque in the morning and before bed at night.

Cleaning removable orthodontic appliance
Take out the removable orthodontic appliance, use a toothbrush and some detergent to clean every surface of the appliance. After cleaning, the appliance can be worn again.

Points to note:
When the orthodontic appliance is not worn, it should be cleaned and immersed in a cup of water.

2. Fixed orthodontic appliances
It is rather difficult to clean the teeth with the fixed orthodontic appliance in place. People wearing fixed orthodontic appliances should pay special attention to their oral hygiene to reduce the chance of developing Dental Caries. You should clean your teeth and the appliance everyday in the morning and before bed at night as well as after each meal.

Cleaning fixed orthodontic appliances

Firstly, brush the area between the orthodontic appliance and gingivae (gums). Then, brush the area between the appliance and the crown of the teeth.
Finally, insert an interdental brush into the area between the tooth and the appliance to clean.

Flossing is difficult for people wearing fixed orthodontic appliance. Hence, superfloss can be used to facilitate the removal of dental plaque in the adjacent tooth surfaces.

Push the stiffened end through the space between the teeth and the orthodontic appliance.
Then wrap the floss ends around middle fingers, hold it tightly between the thumbs and forefingers of both hands, leaving about 2 cm of floss in between.
Gently slide the floss into the adjacent tooth surface using a sawing motion.
Wrap the floss around one tooth in a "C" shape, moving up and down to clean the tooth surface. Then wrap around the other adjacent tooth and repeat the cleaning.

As usual use the toothbrush to clean the inner surfaces and chewing surfaces of all the teeth.

E. Assisting people with special needs to brush

People with special needs should also learn toothbrushing techniques. However, they need to be taught individually through a longer period of time with repetitive practices in order to master the techniques. Parents and nurses need to assist them before they can completely master the techniques in toothbrushing.

1. Method

First, let them face a mirror with you standing behind them. Using one hand to support their chin, and the other hand to help them brush.
If they can hold their own toothbrush, let them brush on their own. You need to supervise, observe and correct their brushing technique.

2. Possible difficulties encountered when assisting people with special needs to clean their teeth

If the person doesn't know how to spit, it is difficult for him to rinse after toothbrushing.
You can first let him wear an apron to avoid getting his clothes wet. Prepare a glass of drinking water for him to rinse. When he needs to rinse, teach him to first open his mouth and then slowly pour the water into his mouth. Let the water flow out from his mouth so that the foam from toothpaste will be rinsed out from his mouth naturally.

Swallowing toothpaste while brushing
Use only a pea-sized blob of toothpaste to brush his teeth. No harm will be done to his body even if he accidentally swallows the toothpaste. Fluoride is effective in preventing dental caries and strengthening teeth, therefore it is essential that fluoride toothpaste is used. If you are worried that the fluoride content in toothpaste is too high, you might consider using children's fluoride toothpaste which contains only half of the fluoride content as the regular adult fluoride toothpaste.

Involuntary wobbling of the head
You may stand behind him, use one hand to wrap around his head, and gently support his chin to stabilize his head. Remember to do this only if he is willing, otherwise he will refuse to brush or floss his teeth.

Protruding tongue which interferes with toothbrushing
Tongue protrusion during toothbrushing is a natural reflex. You may first ask him to calm down and start toothbrushing for him as soon as he relaxes his tongue. There is only a short period of time while he relaxes his tongue. Therefore you may need to precisely place the toothbrush inside his mouth and speed up the brushing process to make toothbrushing more pleasant for him. You may also consider using an electric toothbrush to shorten the time needed for brushing. However, you should use a correct brushing technique with care in order to avoid damaging his teeth and gum.

Biting on toothbrush
You may use some supplementary tools (e.g. a few chopsticks wrapped by a towel) for him to bite on one side of his mouth so that his mouth will stay opened. You can then place the toothbrush inside his mouth and start brushing on the other side of his mouth for him.

Being impatient
You may start by brushing the easiest areas such as the outer surfaces. This can be done even if he is closing his teeth together. Then ask him to open his mouth so that you can brush the chewing surfaces and inner surfaces of his upper teeth. Finally, you can brush the inner surfaces of his lower teeth.

Refuse toothbrushing
Find out the reason why he refuses to brush, then target at this reason to help him overcome his hard feelings towards brushing. If toothbrushing brings him discomfort, his gum may be sensitive due to gum inflammation. You may first choose a softer toothbrush and let him try to get used to brushing only a few teeth. After he gets used to brushing, you can then try to brush the rest of his teeth. Ask him to raise his hand when he feels uncomfortable and stop brushing to let him take a rest. It is important that you must not try to brush all his teeth by force. Otherwise, it will be difficult to change his attitude toward toothbrushing in the future.

Gagging when he brushes his teeth
You may use a toothbrush with a smaller head. When you are brushing his molars, try not to place the toothbrush too far back as long as you can brush his last tooth in order to avoid gagging. If there are sensitive areas which make him gag, you should brush those areas last.

Crooked teeth which are difficult to clean
You may use a toothbrush with a small head. Pay special attention to areas of irregularity to make sure that the bristles have touched the gingival margins. This could ensure that the teeth are thoroughly cleaned.

Difficulty in inserting the dental floss into the interproximal area (area between the teeth)
Difficulty in inserting the dental floss into the interproximal area may be caused by the accumulation of calculus. The situation will improve once the calculus has been removed by the dentist. Remember to floss daily after the calculus has been removed in order to avoid accumulation again.