Editing Tooth decay (section)

===Oral hygiene===
The primary approach to dental hygiene care consists of tooth-brushing and [[dental floss|flossing]]. The purpose of [[oral hygiene]] is to remove and prevent the formation of [[dental plaque|plaque]] or dental biofilm,<ref>[http://www.dentistry.leeds.ac.uk/OROFACE/PAGES/micro/micro2.html Introduction to Dental Plaque] {{webarchive|url=https://web.archive.org/web/20060623041937/http://www.dentistry.leeds.ac.uk/OROFACE/PAGES/micro/micro2.html |date=2006-06-23 }}. Hosted on the [[Leeds Dental Institute]] Website. Page accessed August 14, 2006.</ref> although studies have shown this effect on caries is limited.<ref>{{Cite journal|last1=Hujoel|first1=Philippe Pierre|last2=Hujoel|first2=Margaux Louise A.|last3=Kotsakis|first3=Georgios A.|year=2018|title=Personal oral hygiene and dental caries: A systematic review of randomised controlled trials|journal=Gerodontology|language=en|volume=35|issue=4|pages=282–289|doi=10.1111/ger.12331|pmid=29766564|s2cid=21697327|issn=1741-2358|doi-access=free}}</ref> While there is no evidence that flossing prevents tooth decay,<ref>{{Cite journal|last1=Sambunjak|first1=Dario|last2=Nickerson|first2=Jason W|last3=Poklepovic|first3=Tina|last4=Johnson|first4=Trevor M|last5=Imai|first5=Pauline|last6=Tugwell|first6=Peter|last7=Worthington|first7=Helen V|date=2011-12-07|title=Flossing for the management of periodontal diseases and dental caries in adults|journal=Cochrane Database of Systematic Reviews|issue=12|pages=CD008829|doi=10.1002/14651858.cd008829.pub2|pmid=22161438|s2cid=70702223 |issn=1465-1858}}</ref> the practice is still generally recommended.<ref name="Oli2017">{{cite journal|last1=de Oliveira|first1=KMH|last2=Nemezio|first2=MA|last3=Romualdo|first3=PC|last4=da Silva|first4=RAB|last5=de Paula E Silva|first5=FWG|last6=Küchler|first6=EC|title=Dental Flossing and Proximal Caries in the Primary Dentition: A Systematic Review|journal=Oral Health & Preventive Dentistry|year=2017|volume=15|issue=5|pages=427–434|doi=10.3290/j.ohpd.a38780|pmid=28785751}}</ref>

A toothbrush can be used to remove plaque on accessible surfaces, but not between teeth or inside pits and fissures on chewing surfaces. When used correctly, dental floss removes plaque from areas that could otherwise develop proximal caries but only if the depth of [[Gingival sulcus|sulcus]] has not been compromised. Additional aids include [[interdental brush]]es, [[water pick]]s, and [[mouthwash]]es. The use of rotational electric toothbrushes might reduce the risk of plaque and gingivitis, though it is unclear whether they are of clinical importance.<ref>{{Cite journal|doi=10.1002/14651858.cd004971.pub2|pmid=21154357|title=Different powered toothbrushes for plaque control and gingival health|journal=Cochrane Database of Systematic Reviews|issue=12|pages=CD004971|year=2010|last1=Deacon|first1=Scott A.|last2=Glenny|first2=Anne-Marie|last3=Deery|first3=Chris|last4=Robinson|first4=Peter G.|last5=Heanue|first5=Mike|last6=Walmsley|first6=A Damien|last7=Shaw|first7=William C.|volume=2020|pmc=8406707}}</ref>

However, oral hygiene is effective at preventing gum disease (gingivitis / periodontal disease). Food is forced inside pits and fissures under chewing pressure, leading to carbohydrate-fuelled acid demineralisation where the brush, fluoride toothpaste, and saliva have no access to remove trapped food, neutralise acid, or remineralise tooth enamel. (Occlusal caries accounts for between 80 and 90% of caries in children (Weintraub, 2001).) Unlike brushing, fluoride leads to proven reduction in caries incidence by approximately 25%; higher concentrations of fluoride (>1,000 ppm) in toothpaste also helps prevents tooth decay, with the effect increasing with concentration up to a plateau.<ref>{{Cite journal|last1=Walsh|first1=Tanya|last2=Worthington|first2=Helen V.|last3=Glenny|first3=Anne-Marie|last4=Marinho|first4=Valeria Cc|last5=Jeroncic|first5=Ana|date=4 March 2019|title=Fluoride toothpastes of different concentrations for preventing dental caries|journal=The Cochrane Database of Systematic Reviews|volume=3|issue=3 |pages=CD007868|doi=10.1002/14651858.CD007868.pub3|issn=1469-493X|pmc=6398117|pmid=30829399}}</ref> A randomized clinical trial demonstrated that toothpastes that contain [[arginine]] have greater protection against tooth cavitation than the regular fluoride toothpastes containing 1450 ppm alone.<ref>{{Cite journal|last1=Kraivaphan|first1=Petcharat|last2=Amornchat|first2=Cholticha|last3=Triratana|first3=T|last4=Mateo|first4=L.R.|last5=Ellwood|first5=R|last6=Cummins|first6=Diane|last7=Devizio|first7=William|last8=Zhang|first8=Y-P|date=2013-08-28|title=Two-Year Caries Clinical Study of the Efficacy of Novel Dentifrices Containing 1.5% Arginine, an Insoluble Calcium Compound and 1,450 ppm Fluoride|url=https://www.researchgate.net/publication/256289867|journal=Caries Research|volume=47|issue=6|pages=582–590|doi=10.1159/000353183|pmid=23988908|s2cid=17683424|doi-access=free|access-date=2018-05-26|archive-date=2020-05-10|archive-url=https://web.archive.org/web/20200510055506/https://www.researchgate.net/publication/256289867_Two-Year_Caries_Clinical_Study_of_the_Efficacy_of_Novel_Dentifrices_Containing_15_Arginine_an_Insoluble_Calcium_Compound_and_1450_ppm_Fluoride|url-status=live}}</ref> A Cochrane review has confirmed that the use of fluoride gels, normally applied by a dental professional from once to several times a year, assists in the prevention of tooth decay in children and adolescents, reiterating the importance of fluoride as the principal means of caries prevention.<ref>{{Cite journal|last1=Marinho|first1=Valeria C. C.|last2=Worthington|first2=Helen V.|last3=Walsh|first3=Tanya|last4=Chong|first4=Lee Yee|date=2015-06-15|title=Fluoride gels for preventing dental caries in children and adolescents|journal=Cochrane Database of Systematic Reviews|volume=2021|issue=6|pages=CD002280|doi=10.1002/14651858.CD002280.pub2|issn=1469-493X|pmid=26075879|pmc=7138249}}</ref> Another review concluded that the supervised regular use of a fluoride mouthwash greatly reduced the onset of decay in the permanent teeth of children.<ref>{{Cite journal|last1=Marinho|first1=Valeria C. C.|last2=Chong|first2=Lee Yee|last3=Worthington|first3=Helen V.|last4=Walsh|first4=Tanya|date=2016-07-29|title=Fluoride mouthrinses for preventing dental caries in children and adolescents|journal=Cochrane Database of Systematic Reviews|volume=7|issue=2|pages=CD002284|doi=10.1002/14651858.CD002284.pub2|issn=1469-493X|pmid=27472005|pmc=6457869}}</ref>

Professional hygiene care consists of regular dental examinations and professional prophylaxis (cleaning). Sometimes, complete plaque removal is difficult, and a dentist or [[dental hygienist]] may be needed. Along with oral hygiene, radiographs may be taken at dental visits to detect possible dental caries development in high-risk areas of the mouth (e.g. "[[bitewing]]" X-rays which visualize the crowns of the back teeth).

Alternative methods of oral hygiene also exist around the world, such as the use of [[teeth cleaning twig]]s such as [[miswak]]s in some Middle Eastern and African cultures. There is some limited evidence demonstrating the efficacy of these alternative methods of oral hygiene.<ref>{{cite journal |vauthors=al-Khateeb TL, O'Mullane DM, Whelton H, Sulaiman MI | year = 2003 | title = Periodontal treatment needs among Saudi Arabian adults and their relationship to the use of the Miswak | journal = Community Dental Health| volume = 8 | issue = 4 | pages = 323–328 | pmid = 1790476 | issn = 0265-539X }}</ref>