The Secrets to Cleaner, Healthier Teeth – Consumer Reports

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Here’s what matters when it comes to choosing the right toothbrush, a hardworking toothpaste, and the best possible brushing technique
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The advice from dental experts for keeping your teeth clean sounds simple enough: Brush twice a day and floss. But choosing among the many products available to help you do this can be daunting. Electric toothbrush or manual? Soft or hard bristles? String floss or water flosser? And what about mouthwash, dental cleanings, and whitening strips?
The right answers depend partly on your preferences. “Hopefully what you experience with any toothbrush is that you’re getting your teeth clean, and then you’re going to want to use it again,” says Edmond R. Hewlett, DDS, a professor at the UCLA School of Dentistry in Los Angeles and a consumer adviser to the American Dental Association (ADA).
But there are tooth-care products with clear advantages. Consumer Reports’ tests show, for example, that some electric toothbrushes are better than others at cleaning and are easier to use. Here, we explain which dental hygiene strategies work best and what to consider when picking products.
A. Most evidence suggests that they are, at least a little. But the real-life significance of that research—which is often funded by companies that make electric toothbrushes—might not mean much for your overall oral health. A 2014 analysis of previously published studies by Cochrane, an independent panel of experts, found that over several months, powered brushes removed 21 percent more plaque and reduced gum inflammation by 11 percent more than manual brushes. Two more recent studies, by scientists who had funding from companies that make toothbrushes, found similar results, including a 2019 study in the journal Clinical Periodontology that followed more than 2,800 people for 11 years. But that doesn’t mean everyone should switch to an electric toothbrush, experts say. It’s unclear, for example, what impact an 11 percent reduction in gum inflammation after three months would have on your lifelong oral health or overall risk of gum disease. In fact, even the 2019 study that favored electric brushes didn’t find a difference in the number of cavities between electric and manual toothbrush users.
Ultimately, your technique may matter more than whether you use a manual or electric brush. Both types of brushes can be “completely effective in plaque removal” and in helping to prevent gum disease, says Olivia Sheridan, DMD, a professor of clinical restorative dentistry at the University of Pennsylvania.
Still, electric brushes might be better for some people, Sheridan says, because they can be easier to use for those who lack manual dexterity or have braces or permanent retainers, or those who care for someone who needs help brushing their teeth.
Electric Toothbrush Features to Look For
Cleaning ability is key, and it’s the most significant factor in CR’s electric toothbrush scores. In our tests, we ask volunteers to skip any dental hygiene for 8 hours and then use one of the electric toothbrushes for 2 minutes. A dental hygienist measures plaque levels in the mouth before and after brushing to rate how well the brush cleans.
Along with strong cleaning ability, you should seek out brushes with features such as a 2-minute timer and a pressure sensor. The American Dental Association says that most people brush their teeth for less than a minute, so a built-in timer can help. Sheridan also recommends looking for brushes that pause when it’s time to move from one section of your mouth to the next. A pressure sensor can warn you if you’re pressing too hard with your brush, which can damage gums and enamel.
And what about brushes with multiple cleaning modes? Hewlett says they probably don’t make much of a difference in your oral health.
A. Although you’ll find manual toothbrushes with bristles ranging from extra-soft to hard, medium- or hard-bristle brushes are best reserved for tasks like cleaning the grout in your kitchen or bathroom tile. For your teeth, dental experts say you should use a soft- or extra-soft-bristle brush.
That’s because harder bristles can injure your delicate gum tissue. They can also potentially damage your teeth, says Clifton Carey, PhD, a professor at the University of Colorado School of Dental Medicine, Anschutz Medical Campus.
When gums recede, which can happen naturally as we age, they often leave the less-protected surfaces of your teeth’s roots exposed. Those sensitive areas can be damaged if you use harder bristles or brush too vigorously.
A. Both kinds can do a great job of cleaning your teeth. Rotating toothbrushes have a round head that rotates or oscillates. Sonic brushes have a more typical elongated head shape resembling a manual brush, with bristles that move side to side so quickly they produce an audible hum.
Some research suggests that rotating toothbrushes may have a slight edge over sonic types. But again, much of this research could be biased by manufacturer funding. And even if rotating brushes do work slightly better in scientific studies, the differences might not be noticeable to consumers. A 2021 analysis in the Journal of the American Dental Association designed to assess real-world effectiveness concluded there wasn’t enough evidence to pick a winner.
CR’s testing concurs: We found models of both types that performed well. Though our top-rated toothbrush is a rotating model, four of our six recommended electric toothbrushes are the sonic type.
If you’re not sure which type of electric brush you’ll like, check to make sure that you can return it if you decide it’s not right for you. Oral-B and Philips Sonicare offer 60- and 90-day money back guarantees, for example.
See our picks of the best electric toothbrushes, below.
A. Yes. You may have rejoiced over headlines a few years back that claimed there’s not much evidence supporting flossing. And in 2019, even the Cochrane panel characterized the evidence showing that flossing helps reduce gum disease as “low certainty,” with inconsistent results.
But don’t toss out your dental floss yet. Though the evidence might not be especially rigorous, regular flossing is supported by basic biology, experts say. The reason you need to brush your teeth twice a day is that very quickly after you finish brushing, bacteria begin to collect on them, UCLA’s Hewlett says. If this develops undisturbed, it can cause tooth decay. When you brush, you scrape away bacteria and clear away the food and drink residue they thrive on. But brushing can’t reach every bit of a tooth’s surface. And that’s where flossing comes in.
When done correctly, flossing removes bacteria in parts of your mouth that brushing can’t get to. Good flossing technique generally involves gently rubbing the floss strand in a C-shape against both sides of each tooth and at the gumline.
CR tells you how well water flossers like Waterpik work.
A. Any toothpaste that has fluoride should do the trick. That’s the most important ingredient because it prevents cavities and helps you avoid tooth decay by strengthening the enamel. Fluoride is so important that the ADA doesn’t provide its Seal of Acceptance to fluoride-free toothpastes.
There are other ingredients in some toothpastes that you may want to stay away from. For example, research has found that people who frequently get canker sores may get fewer ones when they avoid toothpastes that contain sodium lauryl sulfate.
Various toothpaste ingredients fall in and out of fashion. “We have to be very careful of those fads,” says Dawn Smith, chair of the department of dental hygiene at Howard University in Washington, D.C. That’s because it can take a while for researchers to discern whether a particular ingredient is safe and effective.
One newer trend has little evidence to support it: activated charcoal toothpastes, which are often marketed as whiteners. But some could cause damage, according to a 2019 paper from the British Dental Association. Charcoal can be abrasive, which can wear down your enamel, damage your gums, and lead to tooth sensitivity. And many charcoal toothpastes don’t contain fluoride.
Older toothpastes designed to whiten teeth, sometimes called “smokers’ toothpastes,” have sparked similar concerns. But Kenneth Markowitz, DDS, an associate professor at the Rutgers School of Dental Medicine in Newark, N.J., says that most mainstream products on the market today aren’t as abrasive as some whitening toothpastes once were. Of course, that means modern whitening toothpastes may provide minimal actual, well, whitening.
A. It’s fine to use mouthwash, but it’s not strictly necessary. While rinsing with a mouthwash can decrease the amount of bacteria in the mouth, it can’t take the place of brushing and flossing, Smith says. “A lot of people, they want to skip the big stuff,” she says.
Certain types of mouthwash can help with specific conditions. For example, prescription rinses with chlorhexidine, an antimicrobial, can help people who have periodontal disease or are at high risk for tooth decay, Hewlett says.
And if you live in an area where your water isn’t fluoridated (or you don’t drink tap water), you may want to consider adding a fluoridated mouth rinse to your family’s daily dental care routine, Smith suggests. That’s especially true if you have kids, and it’s something that can be helpful even if there’s fluoride in your toothpaste.
A. Some of the stains on the outside of your teeth can be removed during a typical dental cleaning. But you might wonder about bleaching your teeth, either at your dentist’s office or by using an at-home kit.
The active ingredient in most tooth bleaching products isn’t the household bleach you use for laundry but hydrogen peroxide (or a related compound).
At-home bleaching, which can involve products like bleaching strips or gels and trays, can be effective, Markowitz says. But it generally takes longer to see results with those treatments than with professional whitening, because in-office treatments are done with higher concentrations of peroxide.
Still, it’s best to avoid trying to whiten your teeth quickly—ahead of a big event like a wedding, for example, he says. That’s because the higher the concentration of bleaching agents used (whether at home or professionally administered), the more likely you are to experience the main side effects of whitening: gum irritation and tooth sensitivity (which often involves a tingly feeling of pain). High concentrations could even damage teeth. Instead, bleaching is best if done slowly over time, using low concentrations of bleaching agents. Carey, the University of Colorado professor, recommends that people who bleach at home read the product’s directions and follow them exactly.
A. You’ve probably heard you should get cleanings every six months. But a 2020 Cochrane review found that adults who timed their visits based on their risk factors (which you can discuss with your dentist) did no worse than people who followed the six-months rule.
The American Dental Association says tailoring your visits to your individual health risks is a good one.
If you’re not at high risk for cavities—your teeth are otherwise healthy and you don’t eat a lot of sweets, for example—seeing a dentist once a year may be sufficient for you, Carey says.
On the other hand, people at higher risk may need to go in more often. If you struggle with a dry mouth, for instance, a common occurrence for people who are taking multiple medications, Carey says you may need to see your dentist more frequently, because saliva is one of the biggest protectors of teeth.
Consumer Reports can help you figure out which brushes have the most important features, do the best job cleaning, and are easy to use.
Editor’s Note: This article also appeared in the March 2023 issue of Consumer Reports magazine.
Catherine Roberts
As a science journalist, my goal is to empower consumers to make informed decisions about health products, practices, and treatments. I aim to investigate what works, what doesn’t, and what may be causing actual harm when it comes to people’s health. As a civilian, my passions include science fiction, running, Queens, and my cat. Follow me on Twitter: @catharob
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