What is it Good For?
Part 1 of a 2-part series
A recent study led by University of Washington dental professor Philippe Hujoel is popping up in newspapers and media reports across the United States. This scientific review comes to the conclusion that simply brushing the teeth does not decrease the risk of cavities. The implication is that fluoride is required to accomplish this goal. So is the study saying that you can just stop brushing your teeth and simply rinse every day with fluoride mouthwash?
The answer is an emphatic “No!” Although the study does help resolve a long-term dental science debate on “clean teeth” versus “strong teeth,” it does not conclude that brushing your teeth is a pointless activity. To the contrary, it is simply the role of the toothbrush that is called into question by this review. To understand why, let us first consider the nature of this review study.
What is a Systematic Review?
Dr. Hujoel and his team collected all the research articles they could find from 1950 to the present on the subjects of “oral hygiene” and “dental caries.” They then removed the experiments that featured fluoride, since they wanted to study only the effect of using a toothbrush on preventing tooth decay. After applying further standards to make certain that only the most rigorous studies remained, they narrowed down their reviewed articles to three that featured over seven hundred young participants.
In each study, fluoride toothpaste was not used and the subjects did not drink fluoridated water. Only the effect of oral hygiene with a toothbrush and floss was considered. Half of the participants were monitored to make certain that they brushed their teeth properly, the other half were not. Nearly all of the experimental participants used dental floss too.
Clean Teeth versus Strong Teeth
What it says to me is that the toothbrush is just a delivery system.” — Dr. Richard Niederman, New York University
The result demonstrated that cleaning the teeth alone is not sufficient to prevent cavities. Evidently, strong teeth are required to stop tooth decay. The researchers hypothesize that a toothbrush cannot reach the tiny cracks and imperfections found in tooth enamel. Although surface level plaque is removed and that part of the tooth is protected, the crevices in the tooth are missed, and plaque is left behind. This plaque, in the weak part of a tooth, is what causes dental caries.
Fluoride is therefore the primary means of preventing this type of tooth decay. It makes for strong teeth by improving the repair of tooth enamel, getting into the cracks and imperfections, and is believed to directly prevent the development of plaque. And the way to administer fluoride to your teeth is with fluoride toothpaste and a toothbrush, as suggested by Dr. Niederman above.
And while the Sacramento Dentistry Group certainly encourages patients to use fluoride mouthwash, mouthwash alone will not preserve your oral health. Dr. Hujoel concluded that the toothbrush, with or without fluoride toothpaste, still serves a very important role in oral hygiene. What the role is will be discussed in a future article.