Cleaning advice and tips

Cleaning Advice

• Brush twice daily (in the morning and before going to bed) for 2 minutes with a ‘total care’ toothpaste. (‘Total care’ toothpaste contains fluoride, anti-bacterial agents and ingredients to fight plaque and prevent gum disease.) Remember to use an SLS (sodium lauryl sulphate)-free toothpaste if you suffer from dry mouth (see section on dry mouth). 
• If 2 minutes seems like a long time, you could brush along to your favourite song. Downloadable mobile apps such as Brush DJ can help you do this. 
• It is important to also clean in between the teeth (interdentally). Various tools are available for this – see ‘Oral hygiene aids’ below. 
• Don’t stop brushing or cleaning in between your teeth if the gums are bleeding; this is occurring because plaque is still present on the teeth. With a regular good oral hygiene regime, you will notice the bleeding start to decrease.

The only problem I think with RA is because I’m right-handed and my right arm has been affected…sometimes the mere act of cleaning the teeth I think “oh God!”

• If you find the toothbrush heavy or tiring to hold, you can rest your elbow on the bathroom basin to support the weight whilst brushing. 
• If standing at a basin is tiring, you can sit with a large bowl on your lap while cleaning your teeth. 
• Change your toothbrush every 3 months or when it’s showing signs of wear (whichever comes first). 
• Even if you no longer have teeth, it is important to keep your mouth clean. Brush the gum ridges (where your teeth used to be) and your tongue gently with a soft toothbrush, in order to prevent infections.

How to brush (Taken with permission from the Oral Health Foundation)

Click here to see the article in full

Brushing removes plaque and food particles from the inner, outer and biting surfaces of your teeth. Proper brushing takes at least two minutes. Most adults do not come close to brushing that long. To get a feel for the time involved, you can try using a stopwatch. Use a pea-sized blob of toothpaste when brushing.

	1. Place the head of your toothbrush against your teeth, then tilt the bristle tips to a 45-degree angle against the gumline. Move the brush in small circular movements, several times, on all the surfaces of every tooth.
	2. Brush the outer surfaces of each tooth, upper and lower, keeping the bristles angled against the gumline.
	3. Use the same method on the inside surfaces of all your teeth.
	4. Brush the biting surfaces of the teeth.
	5. To clean the inside surfaces of the front teeth, tilt the brush vertically and make several small circular strokes with the front part of the brush.

Brushing your tongue will help freshen your breath and will clean your mouth by removing bacteria. 

Remember to: 

• Pay extra attention to the gum line, hard-to-reach back teeth, and areas around fillings, crowns or other restorations (e.g. bridges). 
• Remove any partial dentures before brushing and clean them separately (see further below for denture cleaning information).

Toothbrushes 

Manual toothbrushes are light to use and economical; however, tend to have slim handles and huge heads which makes them hard to grip and to get right to the back teeth if jaw opening is limited. 

A grip can be wrapped around, such as tennis racket grip tape (this can be bought at a sports shop or online) or Dycem non-slip material (can be bought on a reel online), but would need replacing each time a new toothbrush was purchased. Your dental professional or occupational therapist can also make a personalised grip for your toothbrush using impression material. This can be removed from your toothbrush and cleaned in the dishwasher as necessary. 

Consider an electric toothbrush with a small (mini) head. They can be manoeuvred round the whole mouth with the lips still lightly closed, relying on touch sensation rather than feel (it’s not essential to open wide to see where the bristles are, you can feel this). 

Less technique and movement is required (as the head rotates/vibrates itself) which can help if twisting and scrubbing motions are tricky, or you can’t use your dominant hand. They also have a chunkier handle which makes them easier to hold. The latest electric toothbrushes are much lighter than before. 

Electric toothbrushes vary in design, so it would be helpful to refer to the brushing instructions supplied with the individual toothbrush. If in doubt, consult a dental care professional. Oral-B manufacture electric toothbrushes (which our authors recommend, as it has a small, round brush head making it easier to reach the back areas of your mouth), as do Philips and Colgate. 

With an electric toothbrush, that’s made a huge difference because you can get different sizes [of handles].

Oral hygiene aids 

RA in finger joints will affect how well things can be gripped, which can make cleaning your mouth all the more difficult. The following are examples of products for helping keep your mouth clean and are suitable for use if you have reduced manual dexterity/grip strength. They can be purchased at dental surgeries, pharmacies, supermarkets and online. 

NRAS do not endorse any specific brands or products but have included some specific examples in order to give you a good idea of the types of product available. As always, it is encouraged that you shop around to find the best products for you as an individual: 

I make the handles of my brushes bigger cos they’re easier to hold, and I’m sure there is something easier that slips on [the handle of] your brush …

TePe Extra Grip has been developed to help patients with reduced manual strength and dexterity. It provides a comfortable, stable grip and weighs only 30 grams. It fits most TePe toothbrushes and special brushes and can be cleaned in the dishwasher.

^{TePe Extra Grip was developed in conjunction with qualified occupational therapists at the Center for Technical Aid, Department of Rheumatology and Department of Hand Surgery at Skåne University Hospital, Sweden.} 

Interdental brushes, dental floss or gadget flossers can be used to clean in between teeth. 

Many different sizes of TePe interdental brushes are available. Your dental team will be able to recommend and show you which size to use and how often. The sheath can also be attached to the bottom to extend the length of the handle.

Alternatively, Wisdom ProFlex Interdental Brushes come with a slightly longer curved handle to help access hard to reach areas in the mouth. Currently, they are only available in 4 sizes.

TePe Angle is an interdental brush designed for excellent access to all interdental spaces. It has an angled brush head and a longer handle.

Remember, you can always get someone to wrap some gripping material on the handles to make them easier to hold.

	Wisdom Easy Floss Daily Flosser comes with disposable flossing heads which you insert into the handle. The long handle and angled head makes it easier to reach the back teeth. Inserting the flossing heads can be fiddly, so you may need someone to do this for you.
	Gadget flossers such as Philips Air Floss are a good alternative to conventional methods though are more costly. They can be loaded with water or mouthwash and are useful to wash out dirt from pockets (gaps between the tooth and gum) and areas of infection/inflammation.

There is now a range of water flossers/oral irrigators on the market. For a review and comparison of features, you can visit bestreviewer.   

Optional Extras 

Tongue cleaners can be used to safely remove build-up of food debris, bacteria, fungi and dead cells from the surface of the tongue. This can also help if bad breath is an issue. The example in the image is the ‘ora-brush’, which has a smallish, flathead, which can be helpful if you have limited jaw opening.

Mouthwashes can also help to fight plaque, prevent gum disease and bad breath. They should be used after cleaning your teeth and gums. Choose one which contains fluoride and is anti-bacterial and alcohol-free. 

Denture cleaning

Dentures can harbour food debris and bacteria, so it is important to clean them regularly and thoroughly. If you suffer from dry mouth, are on immunosuppressants and wear dentures, you are at an increased risk of oral infections such as oral thrush (candida). Good oral and denture hygiene can help prevent this. For advice on how to clean your dentures click here. 

What if I’ve just had joint surgery? 

When you’ve had hand surgery, and you cannot use your dominant hand, it’s really hard, and you have to practise for a long time, and I can get that side with that hand, but I literally can’t get to that other side.

If you’ve had an operation on your dominant shoulder, arm or hand; brushing can be harder to do as well as painful. Brush as well as you can with either hand (if you feel comfortable, you can ask someone to brush for you) and rinse vigorously for 1 minute twice a day with an anti-microbial, alcohol-free, fluoride-containing mouthwash. Alternating hands and taking rest breaks when brushing may be beneficial. 

If brushing twice a day proves too much, one brush a day will suffice as long as it’s a good, thorough brush. Get back to your normal cleaning routine as soon as you feel able to. If you are unable to do any cleaning for a number of weeks after having surgery or if you notice your gums start to bleed more, it may be worthwhile discussing extra hygiene visits with your dental care team.