Q: Can you brush your teeth too hard?
A: Yes, brushing too hard can ultimately lead to decay and sensitive teeth.
Our expert: Dr Peter Alldritt
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Do you take the gentle or tough approach when it comes to brushing your teeth?
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Ever since we were children, we've been told that brushing our teeth properly is important to protect against cavities.
So plenty of us approach the task with the enthusiasm of an army cadet trying to clean his dirty boots – we figure the harder we scrub, the better the result will be.
But brushing your teeth requires a more delicate approach, says Dr Peter Alldritt, chairman of the Australian Dental Association's oral health committee.
"People can literally kill their teeth with kindness," says Alldritt.
While teeth themselves are hard, they're surrounded by gums, which are not. You do need to clean along the line where the gum meets your teeth, but brushing with too much pressure (or with too firm a toothbrush) can actually do more harm than good because it can wear away the thin top layer of gum.
"Once you cause the gum to recede, which means it shrinks away from the neck of the tooth, it's usually irreversible. It won't grow back."
This exposes the neck of your tooth, where there is no hard enamel covering the soft inner tooth layer called dentine. The enamel, which helps protect against decay, covers only the part of the tooth that sits above the gum.
Once the dentine is exposed, it means the tooth is then more vulnerable to decay from bacteria feeding on remnants of food. It can also cause your teeth to become highly sensitive because of exposed nerve endings in the porous dentine.
This can make it difficult to eat or drink anything cold, hot or sweet.
"Even breathing cold morning air, your teeth can react to that. It can be very uncomfortable."
Eroded gums can also look unpleasant because the exposed dentine is a dull yellow colour, compared to the shinier, white appearance of enamel covered areas of teeth.
How thick are your gums?
A factor known as your "dental biotype" can also influence how careful you need to be about not brushing too hard. Some people are born with thinner gums (and jaw bones) than others and they are likely to be more prone to gum recession. If you are the opposite, a 'thick' biotype, your jaw bones are more substantial and your gums are more "thick and fleshy looking", Alldritt says. "People who have a thick biotype could probably get away with brushing a bit harder and it might not cause any damage."
Go softly on plaque
The aim of brushing your teeth is to remove plaque, the white- or cream-coloured sticky material which causes decay. Plaque is made up of bacteria, residues from saliva, and bits of food.
"People think the harder you brush, the better you're going to clean that plaque off. But plaque is actually soft."
It is often confused however with a harder substance called tartar or calculus, which builds up when plaque has been left too long on teeth and starts to absorb calcium out of your saliva. Plaque can become tartar in as little as a week.
Tartar can be removed only by a dentist using a special tool called a scaler and won't come off with a toothbrush at all.
To remove plaque, it's good brushing technique, rather than brushing hard that matters most.
"Your toothbrush needs to be aimed at the gum line. That's the most important thing," Alldritt says. "If you're not getting your toothbrush at the gum line, you're not reaching where the plaque starts to grow."
You should also use a circular brushing motion and "never a back and forth motion like you're scrubbing your shoes with a brush. The upwards stroke of the circle is hopefully going to sweep the plaque away."
Choose the right toothbrush: Soft, medium or firm?
While the availability of soft, medium or firm toothbrushes might suggest the choice is simply a matter of personal taste, Alldritt says you should only ever choose a soft brush.
"Sure a harder toothbrush will get the plaque off, but it will get some of the gum and dentine off too. We haven't got any power over what companies put on the shelves unfortunately. But we always recommend using a soft toothbrush."
The brushes on electric toothbrushes are always soft, he points out. They also work using the desired circular brushing motion. But with the right technique, a soft manual toothbrush should work just as well as an electric one.
Once damage is done
If you've already got some gum recession from overbrushing, all is not lost.
"We can't make the gum grow back but there is some promise in gum surgery techniques. We may be able to do some regrafting. [To investigate this] your dentist may refer you to a periodontist."
To improve the pain and discomfort of sensitivity, there are specialised toothpastes, mouth rinses, varnishes and gels which may be helpful. These contain desensitising agents that block the pores (known as tubules) in dentine, helping to stop pain sensations from reaching the tooth nerves, and disrupting the transmission of pain signals from tooth nerves to the brain.
However Alldritt cautions against self-diagnosing sensitive teeth as due to overbrushing; there can be many other causes including cavities, inflamed nerves, cracked teeth, broken fillings and even clenching and grinding your teeth.
"I wouldn't want people to assume just because they've got sensitive teeth, it's from gum recession and think 'oh well I'll just use sensitive toothpaste'. It's important to get the problem diagnosed."
Sensitive teeth can also be the result of the enamel being worn away higher up the tooth, but this is usually from brushing too soon after consuming acidic foods and drinks rather than purely from brushing too hard. Wait 30 minutes after consuming anything acidic as this gives time for the tooth enamel to re-mineralize or harden before you brush.
Dr Peter Alldritt is chairman of the Australian Dental Association's oral health committee. He spoke to Cathy Johnson.
Published 18/