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Your tool kit for fighting gum disease

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Do you need an electric toothbrush? What about a water flosser or specialty mouthwash? Here are the best ways to brush, floss and rinse.
Written by Jennifer Thomas
Updated on January 24, 2022

You’ve been doing this teeth-and-gum-care thing for a while now, so you probably think you’ve mostly got it figured out. You brush twice a day and floss at least once. You get your teeth cleaned twice a year and try to avoid foods that are so crunchy they could crack a crown.

All that brushing and flossing is needed to remove the gum disease–causing plaque that builds up on your teeth.

“Gum disease is 100% preventable with proper oral hygiene, brushing and flossing,” says Robert S. Glickman, DMD. He’s a professor of oral and maxillofacial surgery at New York University College of Dentistry in New York City.

But a recent academic review from the University of Buffalo that looked at the best oral care products for fighting gum disease came up with some results that might surprise you. Based on that research, here are 5 useful tools to have in your gum disease–fighting arsenal.

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1. A basic toothbrush

If you’re worried that your manual toothbrush is a little, well, basic, you can rest easy. The University of Buffalo review found that a run-of-the-mill toothbrush works just as well at removing plaque and reducing gingival inflammation as an electric one.

The key: Brushing twice a day with a soft-bristled toothbrush. Soft-bristled brushes clean just as well are hard-bristled versions. And they’re much easier on gums and tooth enamel.

2. Floss, water flosser or interdental brush

Along with brushing the surfaces of your teeth, it’s also important to clean between your teeth. That’s called interdental cleaning. The kind of interdental cleaning that most people do is with dental floss.

But the University of Buffalo review found strong support for 2 other types of interdental cleaners: water flossers (better known by the brand name Waterpik®) and interdental brushes. (Probably because it’s widely regarded as the gold standard, less research has looked specifically at floss.)

But before you use a water flosser or interdental brush, check with your dentist, says Jose Arauz-Dutari, DMD. He’s a periodontist and director of dentistry at the Carolina Dental Specialty Center.

Water flossers work by spraying a stream of water in between the teeth. They can be especially useful for people with braces, crowns or bridgework. Interdental brushes, meanwhile, have the body of a tiny toothbrush and a head that looks like a mascara wand. The small bristles can be used to reach into nooks and crannies between your teeth and around your gumline.

“Interdental brushes are a great tool for people who have suffered bone loss, gum recession or treatment for periodontal disease,” says Dr. Arauz-Dutari.

3. Chlorhexidine gluconate

Almost half of adults age 30 and older have some form of gum disease, says the National Institutes of Health. In the early stages, called gingivitis, it can cause swelling, redness and bleeding gums.

Chlorhexidine gluconate (Peridex®), or CHX, is a prescription mouth rinse that’s used to treat gingivitis. It helps reduce the amount of bacteria in your mouth. Research shows that using CHX can cause large reductions in plaque, gingival bleeding and periodontal pockets (spaces under the gumline that can trap bacteria).

But because it can cause multiple side effects, including staining the teeth, it should be used only when prescribed, Dr. Arauz-Dutari says.

Related reading: Bleeding gums? Here’s what it could mean for health.

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4. Cetylpyridinium chloride

Mouthwashes don’t just give you fresh breath. The research review found support for cetylpyridinium chloride (CPC), which is a compound found in many over-the-counter rinses.

CPC works by stopping dental plaque from maturing. It penetrates the cell membrane, causing cell components to leak, which eventually leads to cell death (kind of like letting the air out of a balloon).

Pairing the use of a mouthwash that contains CPC with brushing your teeth can help prevent plaque and gingivitis. Check with your dentist to make sure you should use these rinses, Dr. Glickman says.

5. Essential oil mouthwashes

Some commercial mouthwashes have essential oils that can help reduce plaque and gingivitis, the research review suggests. This includes tea tree oil and eucalyptus. In some of the studies, adding an essential oil–based rinse was found to be more effective than just brushing alone.

There’s some evidence that other natural compounds can help remove plaque left behind after brushing and flossing, too. Look for these on the ingredients label:

  • Green tea extract
  • Hydrogen peroxide
  • Sodium benzoate
  • Stannous fluoride
  • Hexetidine
  • Delmopinol

Both Dr. Glickman and Dr. Arauz-Dutari recommend that you work with your dentist to come up with the right oral care routine for you. No matter what that is, it should be a multistep effort.

“The bottom line is that there’s no replacement for the mechanical removal of bacteria by proper brushing, flossing and rinsing,” Dr. Arauz-Dutari says. “They should all be done together.”

Your teeth deserve your attention. (After all, they help you smile, talk and eat your favorite foods.) Another thing that you should pay attention to? The Optum Perks mobile app. It’ll help you find the best discounts on prescription drugs — anytime, anywhere.

Additional sources
University of Buffalo review on best plaque-fighting strategies:
Journal of the International Academy of Periodontology (2021). “Proven Primary Prevention Strategies for Plaque-Induced Periodontal Disease – An Umbrella Review”
Gum disease by the numbers: National Institutes of Health