Home Oral Care

Spending the right amount of time engaged in appropriate home oral care is essential to helping minimize the risk of caries and periodontal disease. An individual who visits the dentist twice a year for an oral exam and dental prophylaxis will spend approximately two hours per year in the dental chair. The time for that same person to brush and clean between his or her teeth each day might be estimated to be around 30 hours per year. This page discusses the scientific evidence that supports home oral care recommendations for patients.

Link to COTISEN

In , the ADA Council on Scientific Affairs identified three aspects of home oral care, which dentists may wish to discuss with their patients:

1. General recommendations that are applicable to most people;
2. Personalized recommendations specifically targeted to meet the needs of the individual patient, especially patients at increased risk of caries and/or gingivitis; and
3. Lifestyle considerations to enhance oral health and wellness.

The general and personalized recommendations were developed in accordance with a rapid evidence assessment methodology,1 meaning that the evidence examined was derived from existing systematic reviews. Lifestyle considerations comport with current ADA policy. This Oral Health Topic page is an executive summary of that work and relevant ADA policy.

General Recommendations for the Prevention of Caries and Gingivitis

1. Brush your teeth twice a day with a fluoride toothpaste for two minutes

   While a seemingly simple statement, the guidance for brushing twice daily with a fluoride toothpaste for two minutes weaves together a number of discrete components.

   Toothbrushing frequency
   Review of the scientific literature, along with guidance from governmental organizations and professional associations found sufficient evidence to support the contention that twice-daily brushing, when compared with lower frequencies, was optimal for reducing risk of caries, 2-4 gingival recession or periodontitis.5-7 It is important to recognize that in these studies, it was the frequency of tooth-brushing with a fluoride toothpaste that was evaluated rather than tooth-brushing alone.

   Fluoride toothpaste
   Although the measures used to assess the benefit varied, studies examining the effect of over-the-counter (OTC) fluoride dentifrice on caries incidence in children and adolescents found the fraction of caries prevented ranged from 16% per tooth to 31% per surface versus placebo or no dentifrice, and concluded that fluoride-containing toothpaste was effective in caries control. 4, 8, 9 In addition, high level evidence shows that 5,000 ppm fluoride (available with a prescription) results in significantly more arrest of root caries lesions than use of OTC levels of fluoride (1,000-1,500ppm).10

   Toothbrushing duration
   Data examining the question of optimal duration of daily tooth-brushing encounters relies on plaque indices, which are surrogate measures rather than direct measure of caries or gingivitis. Understanding that the use of surrogate measures decreases the certainty with which a recommendation can be made, the available systematic reviews found a brushing duration of two minutes was associated with greater reduction in plaque than brushing for a single minute. 11, 12 Two minutes per whole mouth can also be expressed as thirty seconds per quadrant or about four seconds per tooth. People can use egg/hourglass timers, music videos, or smartphone applications,13, 14 to help them accomplish two minutes of brushing activity. Some manual toothbrushes and many powered toothbrushes have built-in timers.15 Added features such as a built-in timer may help brushing for the recommended two minutes.

2. Clean between your teeth daily

   While cleaning between teeth is important in maintaining oral health, it is a concept that includes several barriers people encounter on the way to adoption. ”Flossing” is often used as a common, shorthand term for interdental cleaning, which can become problematic in the real world where many people report a strong distaste for that particular activity.16 Some people presume flossing is ineffective or unnecessary, which can also make it harder for them to adopt the daily habit. Flossing is a technique-sensitive intervention17 as exemplified by the disparity in benefit observed when comparing study designs involving self-flossing and professional flossing.18 Patients who do not see positive results from flossing may not continue to do so.

   Using “flossing” as shorthand for interdental cleaning can also be problematic in that patients may be unaware of alternative devices, which may be more pleasant or effective for them. A meta-review, which included the available devices developed for this purpose (i.e., dental floss, interdental brushes, oral irrigators, and woodsticks), addressed the question “What is the effect of mechanical inter-dental plaque removal in addition to toothbrushing on managing gingivitis in adults?” The strength of the evidence on the benefit ranged from weak to moderate depending on the device in question. 19

   Thus, there may not be one “best” interdental cleaning method; rather, the best method for any given patient will be the one that they will regularly perform. A guiding principle that is relevant to interdental cleaning is “best care for each patient rests neither in clinician judgment nor scientific evidence but rather in the art of combining the two through interaction with the patient to find the best option for each individual.” 20

3. Eat a healthy diet that limits sugary beverages and snacks

   While eating a healthy diet is important for overall health and well-being, a review of the literature found little in terms of the effects of micronutrients on the risk of caries or periodontal disease. However, the conclusion of numerous systematic reviews on the effect of the macronutrient content of the diet, specifically of sugar, is that there is an association between sugar intake and caries. 21-23 A review of the evidence supporting nine international guidelines recommending decreased consumption of sugar found consistent recommendations from all the groups while noting that they relied on different data and rationales. 21

4. See your dentist regularly for prevention and treatment of oral disease

   Viewed through the prism of the primary prevention of caries and/or gingivitis, a systematic review of the literature failed to arrive at consensus regarding optimal recall frequency to minimize either caries24, 25 or periodontal disease risk26 in part due to limited availability of studies addressing this topic. Nonetheless, in terms of the balance between resource allocation and risk reduction, it can be concluded that there is merit in tailoring a patient’s recall interval to individual need based on assessed risk of disease. 24, 27

   Previously, the ADA Healthy Smile Tips advised people to “Visit your dentist regularly.” However, dentists are doctors of oral health, which encompasses both the prevention and treatment of oral disease. The current recommendation goes a step further than its predecessor in articulating the duality of the dental visits.

Personalized Recommendations for the Prevention of Caries and Gingivitis

Dental care includes actions to reduce disease risk, as well as the formulation and execution of a treatment plan when disease is present. While generalized recommendations for home oral care may be appropriate to help optimize oral wellness for many patients, those found to be at elevated risk of caries and/or gingivitis, may ask their dentists to provide guidance on additional action steps that they can take to reduce their risk of oral disease.28 To help address this reality, dentists may wish to offer the following guidance:

• Design a home care regimen with specific recommendations for oral hygiene. This may involve consideration of not only the person’s individual oral disease risk but the needs and wants of the patient.
• Offer direction concerning lifestyle changes (this is addressed in the next section, entitled “Lifestyle Considerations”).
• Provide guidance on dental products and mechanical devices. This includes detailed suggestions that can help patients make decisions about dental hygiene practices and products. Patients may look to their dentists for guidance and recommendations to help discern among the plethora of home oral care products and mechanical devices that lay claim to oral health benefit. Dentists and patients can look to the ADA Seal of Acceptance program as a source of validated information regarding the safety and efficacy of many home oral care products.

The following sections provide evidence-based information to help inform decision-making between dentists and patients on products and mechanical devices that can be considered as adjunct therapies and modalities for the prevention of caries and/or gingivitis.

1. Antimicrobials

   For individuals with increased risk for gingivitis or periodontal disease, there is evidence that over-the-counter oral care products containing specific antimicrobial active ingredients can decrease risk of gingivitis. Systematic reviews found that mouthrinses containing an antimicrobial effective amount of a fixed combination of four essential oils (eucalyptol, menthol, methyl salicylate, and thymol) or cetylpyridinium chloride,29-31 and toothpastes containing triclosan or stannous fluoride, 32-34 were associated with decreased risk of gingivitis and periodontal disease.



2. Fluoride Mouthrinses

   With regards to caries risk reduction, there is strong evidence supporting the use of fluoride-containing mouthrinses by children at elevated caries risk 35 and low level evidence on the benefit of adults using fluoride mouthrinse to decrease their risk of root caries.10 All of the products available in the market that display the ADA Seal of Acceptance have been shown to have fluoride levels that are safe and effective.

3. Powered Toothbrushes

   Both manual and powered toothbrushes can provide effective removal of dental plaque and reduction in gingival inflammation when used appropriately.11, 12, 36-40 For patients seeking or needing improved plaque removal, such as for patients with special needs, those who require the help of a caregiver for activities of daily living, or those with manual dexterity deficit, consider a powered toothbrush.41-45



4. Interdental Cleaning Devices

Recent analysis using NHANES data found that adults who more frequently reported using floss or other devices to clean between their teeth were found less likely to have periodontitis.46 Because of the barriers to interdental cleaning, it may not be effective to tell patients that they must floss and expect it to become a regular part of their oral home care routine. Instead, dentists can support effective home oral care by gauging their patient’s level of understanding, learning about their motivation, and then serving as a “coach” by communicating and promoting daily cleaning between their teeth.47 Discussing the various interdental cleaning devices can help educate patients on available options and provide them with some of the skills necessary to be effective stewards of their own oral health.

Lifestyle Considerations for Improved Oral Health

Dentists can provide, promote or direct patients to information about lifestyle behaviors and/or services that can aid in reducing the risk of problems and improving overall oral health.

Beyond the general and personalized recommendations above, specific ADA policies that address lifestyle considerations to help reduce risks to oral health. Four policies are discussed below:

1. At-Home Orthodontic Treatments

   At-home orthodontic treatments, such as direct-to-consumer (DTC) and do-it-yourself (DIY) orthodontia are both forms of orthodontic treatment discouraged by the ADA due to patient safety concerns. DTC orthodontic treatment services allow consumers to order teeth straightening kits directly from a supplier and often rely on patient-supplied impressions or photographs. Unlike impressions and radiographs taken by an experienced, licensed dental professional, patient-supplied impressions may be more likely to result in user error, which can ultimately lead to an improper fit of orthodontic appliances. A poor fit can cause the gum tissue to be impinged or stripped, and may also increase the chances of tooth loss or misalignment; or problems with the temporomandibular joint (TMJ). In addition to assuring proper fit, dental professionals can provide pre-treatment dental evaluations and take radiographs. These play an important role in planning treatment and identifying underlying problems, such as periodontal disease, which can impact both oral health and orthodontic results.48 For example, while patients who undergo orthodontic treatment are more likely to experience root resorption than those who do not, 49 the process may be exacerbated by periodontal disease.50 Regular dental visits during orthodontic treatment helps ensure the well-being of the teeth being treated. Regular dental visits, including radiographs, as part of the orthodontic treatment plan can help identify tooth structure loss or other problems as they occur and address the problem in real time. The use of rubber bands and paper clips to adjust teeth is ill advised. DIY orthodontia commonly involves using household items and can result in permanent damage and/or require corrective measures to avoid adverse results, such as tooth loss or misalignment.51 Citing concern about patient harm and the importance of dental oversight throughout orthodontic treatment, the ADA passed a resolution discouraging the use of DIY orthodontic treatment in (Do-It-Yourself Teeth Straightening (Trans.:266)).52

   The use of rubber bands and paper clips to adjust teeth is ill advised. DIY orthodontia commonly involves using household items and can result in permanent damage and/or require corrective measures to avoid adverse results, such as tooth loss or misalignment.49 Citing concern about patient harm and the importance of dental oversight throughout orthodontic treatment, the ADA passed a resolution discouraging the use of DIY orthodontic treatment in (Do-It-Yourself Teeth Straightening (Trans.:266)).50

2. Consumption of Fluoridated Water

   Much of the literature evaluated in systematic reviews examining the association between consumption of fluoridated water and reduced levels of caries in primary and permanent dentition derives from studies conducted before the s. 53 One experiment, in which a Canadian community discontinued its community water fluoridation to allow for the comparison of caries rates within a socioeconomically similar, adjacent community that maintained its water fluoridation demonstrated a significant increase in primary tooth decay and an increasing trend for increased decay in permanent dentition 2.5 – 3 years post cessation among residents who reported usually drinking tap water. 54 In , the U.S. Surgeon General expressed the view that community water fluoridation was an important component for developing a culture of disease prevention and helping to ensure health equity for all. 55 The ADA’s most recent resolution supporting community water fluoridation was passed in (Operational Policies and Recommendations Regarding Community Water Fluoridation (Trans. :673; :273)).52

3. Use of Tobacco Products

   While the various forms of tobacco have a variety of health consequences, the oral consequences of cigarette smoking 56 and use of smokeless tobacco products 57 can include adverse effects on gingival health, enamel discoloration and erosion, and oral cancer. For these reasons, the ADA has long advocated for smoking and tobacco cessation initiatives both at the policy (Policies and Recommendations on Tobacco Use (Trans.:323))52 and practice levels.

4. Oral Piercings

   The literature on the oral consequences of oral piercings show tooth fracture, tooth wear and gingival recession among the commonly reported adverse events, and the ADA established policy discouraging oral piercing in (Policy Statement on Intraoral/Perioral Piercing and Tongue Splitting (Trans.:743; :481; :309; :469; :300; :164).52

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ADA Resources

Related Oral Health Topics

The following related Oral Health Topic pages contain current scientific reviews of subjects that relate to home oral care, including:

Are you interested in learning more about Gingival Brush? Contact us today to secure an expert consultation!

• Toothpastes
• Toothbrushes
• Mouthrinse (Mouthwash)
• Floss/Interdental Cleaners
• Fluoride in Water
• Oral Piercing/Jewelry

Information Sheet on pH of Home Oral Care Products

ADA Seal of Acceptance
Search for related products with the ADA Seal of Acceptance, including:

• Interdental Cleaners
• Mouthrinses
• Toothbrushes
• Toothpastes

Patient Education

For the Dental Patient is a JADA column that is geared toward patient education and intended to facilitate discussion between dentists and patients. The following items can help facilitate conversations related to the ADA’s home oral care recommendations:

• Helping your child fight tooth decay (February )
• The word on vaping: don’t start (March )
• Fluoride helps fight cavities (January )
• Keeping your smile healthy (October )
• Key Points for Your Child’s Teeth (January )
• Shopping smart: looking for the Seal (May )
• Returning to Good Health Care Can Start with a Smile (August )
• Oral Piercing and Gems: Know What You’re Getting Into (December )

Additional ADA Resources
Search the following databases for additional resources related to home oral care:

• JADA (scientific articles) 
• ADA Store (educational/office products)
• ADA Library Services (scientific articles)

Prepared by:

Research Services and Scientific Information, ADA Library & Archives.

Equipping You to Understand and Prevent Gum Disease

What would you do if we said that there’s an oral health condition that the majority of American adults have? You’d want to know more, right? Well, it’s true! Gum disease is one of the most common oral health issues out there—gingivitis alone affects 75% of American adults. That’s a high incidence for any condition, so it’s important to learn more about gum disease and what makes it so common.

After all, the more you understand about gum disease, the better you’ll be able to protect yourself from it in the future. To help you do just that, we’ve answered 10 of the most common questions we get about gum disease.

1. What is gum disease?

Gum disease is an infection of the gums that is caused by the same oral bacteria that forms plaque and, eventually, cavities. These bacteria release acid, which attacks and damages your gums, causing them to become irritated and inflamed. There are two types of gum disease: gingivitis and periodontitis.

Gingivitis is the first, most common, and mildest form of gum disease. It’s much easier to treat and the effects of gingivitis are often reversible. If it’s not treated, however, it can develop into periodontitis, which is the next and much more serious stage of gum disease. If gum disease is left untreated, these bacteria can do permanent damage to your gums and even to the supporting structures of your teeth.

2. What are the stages of gum disease?  

There are four main stages to the progression of gum disease. Gingivitis is the first stage and is characterized by irritated or easily bleeding gums. Stage two is mild periodontitis, which is when your gums become so irritated that they begin to pull away from your teeth, breaking the seal that your gums usually create to protect your tooth roots from bacteria. Without that seal, bacteria make it beneath your gum line, where they begin to attack, not just your gums, but your tooth roots and the other supporting structures of your teeth. Because of this, stage two is where you begin to see slight bone loss in your jaw.

In stage three, which is moderate periodontitis, there’s continued and more extensive bone loss and damage to gum tissue, which can make your teeth appear longer and may even cause them to feel loose. The final stage is stage four, which is advanced or severe periodontitis. The symptoms of other stages of periodontitis are often still easy to miss if you’re not paying attention, but it’s at this stage that symptoms become impossible to miss, potentially leading to permanent tooth loss.

3. What causes gum disease?

The most common and well-known cause of gum disease is a poor oral hygiene routine, especially a lack of flossing, which leads to the buildup of plaque and hardened tartar around your gum line. The bristles of your toothbrush simply can’t clean around your gum line and between your teeth very well, so when you don’t floss, you just aren’t cleaning those parts of your teeth, which allows bacteria to flourish there.

4. What are the risk factors for gum disease?

While a poor oral hygiene routine is the most common cause of gum disease, several other risk factors can increase your likelihood of developing it, sometimes even if you stick to a good oral hygiene routine. These include:

• Any form of tobacco use, smoking marijuana, or vaping.
• Obesity.
• Genetics.
• Older age.
• Hormonal changes, such as those that happen during puberty, menstrual cycles, pregnancy, and menopause.
• Poor nutrition.
• Dry mouth.
• Certain health conditions like diabetes or autoimmune diseases.
• Some medications, including those that impact immune function or cause dry mouth.
• Previous history of gum disease.

Not all of these risk factors are within your control, but some are. Reducing or eliminating the risk factors that you can control will help you decrease your risk of developing gum disease, keeping you healthier in the long run.

5. What are the signs of gingivitis?

Gingivitis has milder symptoms than periodontitis, making it incredibly easy to miss the signs at home if you aren’t paying attention or don’t know what to look for. Since knowing what signs to look for could be the key to diagnosing gum disease early, it’s important to be able to identify them. Common signs of gingivitis include:

• Gums bleeding easily, particularly when you floss.
• Irritated or tender gums.
• Swollen gums.
• Gums that have darkened in color to red.
• Persistently bad breath.
• Receding gums.

6. What are the signs of periodontitis?

Although periodontitis is a more severe form of gum disease, many of its symptoms are still easy to miss until it becomes advanced. It shares many of the same symptoms as gingivitis, but as the condition progresses, these symptoms worsen and new ones appear. If you have periodontitis, you might notice symptoms like:

• Gums bleeding easily, including when you floss or even simply brush your teeth.
• Swollen gums.
• Tender, irritated, sore gums.
• Dark red or purplish gums.
• Persistently bad breath.
• Receding gums, which may make your teeth look longer than before.
• Pus between your teeth and gums.
• Difficulty or pain when chewing.
• A change in the way your bite fits together.
• Deep pockets between your teeth and gums, which may get food stuck in them.
• Development of spaces between your teeth.
• Teeth suddenly feeling loose or unstable.
• Tooth loss.

7. How does gum disease affect my overall health?

Your mouth is just as connected to the rest of your body as any other part of it, so periodontitis has a significant impact on your overall health. When bacteria make it underneath your gum line, they can also make it into your bloodstream, which can increase your risk of developing a surprising number of overall health issues. These include issues like high blood pressure, cardiovascular disease, heart attack, stroke, endocarditis, and complications in pregnancy or childbirth.

Periodontitis can also make it harder to control existing health conditions like diabetes, and inhaling oral bacteria increases your likelihood of developing pneumonia or other respiratory conditions.

8. How is gingivitis treated?

The good news with gingivitis is that, as the mildest form of gum disease, it’s usually incredibly easy to treat! In most cases, all you need to do to treat gingivitis is commit to a great oral hygiene routine. This includes brushing your teeth for two minutes twice a day, flossing at least once a day, and using a mouthwash daily. You may want to use a mouthwash that is specifically designed to help treat gingivitis to give this routine a little more kick. This routine usually resolves your gingivitis within a couple of weeks!

9. How is periodontitis treated?

Since periodontitis is more severe than gingivitis, treating it is more difficult. There are several different treatment methods, including both nonsurgical and surgical periodontal therapy treatments—which is best for you depends on the severity of your case.

One common nonsurgical method is called scaling and root cleaning. During this treatment, dental lasers are carefully used to clean bacteria from beneath the gum line and to smooth the surface of your tooth roots, which makes it harder for bacteria to grow on them in the future. We may also prescribe oral antibiotics or use Perio Protect trays to deliver antibiotics below the gumline—directly where you need them!

More advanced cases of periodontitis, however, may need surgical treatments to open up your gums and clean the roots of your teeth more directly or remove infected gum tissue. You may also need treatments to repair damage from periodontitis, such as gum grafts, bone grafts, or tooth restorations like dental implants. These restorative treatments can be an equally important part of periodontitis treatment, helping to restore the function, health, and appearance of your smile while also helping protect it from future oral health issues.  

10. How can you prevent gum disease?

Thankfully, despite how serious gum disease can be, it’s incredibly easy to prevent! Preventing it is usually as simple as sticking to a great oral hygiene routine, which means brushing your teeth for two minutes twice a day, flossing at least once a day, and using mouthwash daily.

You should also make sure to schedule a regular dental appointment every six months. It’s during this appointment that your dentist gives you a thorough dental cleaning, which actively helps prevent gum disease by removing plaque and hardened tartar from your teeth. During your dental exam, your dentist will also be able to spot any early signs of gum disease, so it can be essential to identifying signs of gingivitis in its earliest stage. 

It’s also a great idea to be aware of your risk factors for developing gum disease. This is especially true if you’ve had gum disease before, as having it once does make you more likely to develop it again. When you know your risk factors, you can take steps to minimize or eliminate them, better protecting yourself from gum disease. This is another aspect of gum disease prevention that your dentist can help you with! They can discuss your risk factors with you, answer any of your questions about them, and give you tips on how to manage or minimize them. 

For more information, please visit Dental Sectional Matrix System.

Davis Family Dental Care is your first line of defense against gum disease.