Each tooth has a crown that projects above the gum margin and a root that is embedded in bone beneath the gum. Structurally, each tooth is composed of the pulp in the centre; the dentine surrounding the pulp and the enamel which covers the crown of the tooth.

The pulp is a loose tissue containing nerves and blood vessels. It is responsible for the "life" in the tooth. All sensations whether of pain, hot or cold are all due to pulp. The dentine is a calcified material containing spiral tubules that radiate from the pulp. The outer most layer is of enamel which is the hardest substance in the body.

Selecting the right toothbrush:
Toothbrushes vary in size and design, as well as in length, hardness and arrangement of bristles. The type of brush is purely a matter of individual preference but the following points must be considered:

• It should be able to reach and efficiently clean most areas of the mouth.

• Ease of manipulation

• Arrangement of teeth in the jaw

• Patient's perception that the brush works well.

Another point of controversy is the hardness of the bristles. Use of hard-bristle brush is linked enamel wear. But the fact is that it is the manner in which the brush is used and the abrasiveness of the toothpaste that affects enamel abrasion to a greater degree than the bristle hardness itself.

Overzealous brushing can lead to gum recession, painful ulceration of gingiva and triangular-shaped defects in the neck area of the tooth.

To maintain the cleaning effectiveness, toothbrushes must be changed as soon as bristles begin to fray. Generally with regular use, brushes wear in about 3 months time. If all the bristles are flattened after 1 week of use, probably the brushing is too aggressive; if the bristles are straight even after 6 months of use then either the brush is not regularly used or brushing is very gentle.

The recommended brush for most people should have a short-head with round-ended, soft to medium nylon bristles arranged in 3 to 4 rows of tufts are recommended.

Manual vs Powered toothbrushes
Powered toothbrushes are recommended for

• Small children, handicapped or hospitalized patients who need to have there teeth cleaned by someone else.

• Individuals lacking fine motor skills

• Patients with orthodontic appliances although anybody who prefers them can use it.

Best results are obtained when the operator is instructed in its proper use. It can be valuable replacement for manual brush if used properly and regularly,

However, when tooth cleaning ability is compared it offers no superiority over manual toothbrushes

Which toothpaste to use?
Toothpaste aid in cleaning and polishing teeth. They contain abrasives such as silicon oxide and aluminum oxide; water; humectants; detergent; flavoring and sweetening agents; therapeutic agents as fluorides; and coloring agents and preservatives.

Use of a particular brand is purely a matter of personal preference.

How frequently should I brush?
If the efficiency is good i.e. it removes all deposited plaque, brushing once a day is sufficient. However, if the efficiency is less than optimum, a second brushing will help.

Toothbrushing technique
Place the bristles at the gum margin, establishing an angle of 45 degrees to the long axis of the teeth. Exert gentle vibratory pressure, using short back-and-forth motions without dislodging the tip of the bristles. Complete approximately 20 strokes in the same position.

Continue around the arch, brushing around three teeth at a time, then use the same method to brush the inner surfaces of the teeth. To help reach the inner surfaces of the front teeth, insert the brush vertically.

Press the bristles firmly into the chewing surfaces of the teeth and brush with about 20 back-and-forth strokes.

Flossing removes plaque from in between tooth surfaces. Again the use of a particular brand is based on ease of use and personal preference.

Technique:
Start with apiece of floss long enough to grasp securely; 12 to 18 inches is usually sufficient. Stretch the floss tightly between the thumb and fore-fingers.

Pass the floss gently through each contact area of the tooth with a firm back-and-forth motion

Once the floss is below the contact area between the teeth, wrap the floss around the proximal surface of one tooth, and slip it under the gum margin. Move the floss firmly along the tooth up to the contact area and gently down into the gum margin again, repeating this up and down stroke several times.

Mouth Rinsing
The use of tooth brushing and dental floss will loosen many particles of food and tooth plaque bacteria. These can be removed by vigorous rinsing with water. Repeated rinsings also results in a rapid lowering of sugar level in saliva.

It is therefore recommended, that following ingestion of sugar rich snacks, one should rinse one's mouths vigorously two or three times with as much water as can be adequately held in the mouth. It is especially important to do this if it is impractical to brush the teeth at such a time.

Bad breath
Bad breath (also called as Halitosis) is caused primarily by volatile sulfur compounds, specifically hydrogen sulfide and methyl mercaptan, which result from degradation of sulfur containing proteins.

The foul smell may have its origin within the mouth or might be caused by certain extra oral factors. Contributing factors within the mouth include retention of odoriferous food particles on and between the teeth and or tongue, artificial dentures, smoker's breath and healing surgical or extraction wounds. Any disease of gums or tooth decay may also cause an unpleasant mouth odor from accumulated debris. Extra oral sources of mouth include infections of the respiratory tract (bronchitis, pneumonia etc.) and odors secreted in breath from aromatic substances in bloodstream (alcoholic breath, odor of diabetes and uremic breath that accompanies kidney dysfunction.