Rinse, brush, floss, scrape, and repeat

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One of the best things you can do for your overall health as you age is a daily routine you've followed since childhood.

"Maintaining good dental health not only protects against gum disease but also helps ward off many other age-related diseases," says Dr. Leonard Brennan, co-director of the Harvard School of Dental Medicine's Geriatric Fellowship Program. "Good oral health helps you enjoy life by allowing you to chew, taste, swallow, speak, and smile. The chances are in your favor that you can keep your teeth for a lifetime if you maintain your oral health."

The most common form of gum disease is gingivitis (gum inflammation). It begins when bacteria buildup in the mouth causes plaque and tartar to form on teeth, which, if not removed, can lead to tooth decay. "The amount of bacteria in the mouth doubles every four to five hours," says Dr. Brennan.

Gingivitis also can lead to red, swollen, and bleeding gums. If left unchecked, gingivitis can advance to more serious periodontitis, which can cause bone deterioration and tooth loss, and reduce the ability to speak and chew properly.

Gum disease can affect other aspects of one's health. Research suggests it can increase the risk of diabetes, cardiovascular disease, stroke, and dementia.

Because regular dental care can be expensive (particularly for older people, as Medicare doesn't routinely cover dentist visits), self-care is the best preventive medicine. "Daily dental care to remove bacteria from the teeth, gums, and tongue is relatively inexpensive compared with costly dental treatments," says Dr. Brennan.

A proper dental routine consists of five steps: rinsing, brushing, flossing, tongue scraping, and a final rinse.

Most people should see their dentist for a regular checkup at least once a year, but ideally twice for cleanings and x-rays as needed. Still, the frequency depends on your overall oral health. "If your teeth and gums are healthy and you don't have issues, you can often stretch out dental exams to once a year," says Dr. Leonard Brennan, co-director of the Harvard School of Dental Medicine's Geriatric Fellowship Program. "The ideal interval for routine dental exams is not clear cut and depends on the dental and medical health of each patient."

Before you brush, dislodge food particles by thoroughly swishing and rinsing your mouth with plain warm water.

Brush at least twice a day, suggests Dr. Brennan. With brushing, focus on quality rather than quantity. "Focusing on how well you brush the front and back of each tooth can help remove the most bacteria," says Dr. Brennan.

Dr. Brennan recommends using an electric toothbrush over a regular one. "Studies have found that they are better at removing plaque, as you can get more strokes from the brush's vibrations than from your hand motion," he says. Use a brush head with soft or extra-soft bristles and replace every three to four months, or more often if the strands are visibly matted or frayed.

To brush properly, tilt the toothbrush at a 45° angle. Beginning with the upper teeth, take several up-and-down short strokes from the gum line to the chewing surface of the tooth. Do one tooth at a time before moving on to the next. To clean the inside surfaces of the front teeth, hold the brush vertically and make several up-and-down strokes. Repeat the process for the lower teeth.

If you have arthritis that makes it hard to hold a toothbrush, or if it's challenging to reach the back teeth, invest in grip aids that slide over your brush's handle. (You can find them at drugstores or online.) "They make it easier to hold the brush and extend the length to help with the hard-to-reach back teeth," says Dr. Brennan.

For toothpaste, choose one with the American Dental Association (ADA) Seal of Acceptance, which verifies it contains decay- and plaque-fighting fluoride. While the ingredients can differ slightly, all toothpastes have the same general components: mild abrasives, humectants, flavoring agents, thickening agents, and detergents.

Natural toothpastes are also popular, but again, look for the ADA seal. The word "natural" indicates certain ingredients are omitted, such as artificial flavors, colors, preservatives, and sweeteners. It also means that certain active ingredients that help with cleaning are derived from plant sources. Toothpaste comes in gel, paste, or powder forms. They all work equally well, so choose the one you like best. Some brands also contain other ingredients that improve oral health. They might reduce tooth sensitivity, combat gingivitis or tartar buildup, prevent enamel erosion, or whiten teeth. Ask your dentist for a recommendation for these specific issues.

Dr. Brennan says you can floss before or after brushing using either waxed or unwaxed floss. "But, if possible, try to floss routinely after a meal to remove food particles that can hasten bacteria buildup." To floss correctly, wrap the floss around your middle fingers, which helps you reach the back teeth. Loop the floss around each tooth so it makes a C shape. Beginning at the gum line, slide it up and down the tooth several times. Avoid just moving the floss back and forth in a sawing motion. You miss cleaning the entire tooth, and the friction can cut and irritate the gums.

"If gum bleeding occurs, don't stop flossing; just be more gentle around that area," says Dr. Brennan. If traditional flossing is difficult, try over-the-counter tools, such as floss picks, pre-threaded flossers, tiny brushes that reach between the teeth, or water flossers.

Next, do tongue scraping, which can further eliminate bacteria. Sold in drugstores and online, tongue scrapers are small tools made of stainless steel, silicone, or plastic. (You could also use a spoon.) Make a gentle raking motion several times from the back of the tongue to the front.

Finish up with another rinse, using an over-the-counter alcohol-free mouthwash with fluoride, which can help protect against tooth decay. "Some products are available that help reduce tooth sensitivity and strengthen teeth," says Dr. Brennan. Ask your pharmacist or dentist for suggestions.

Image: © Nes/Getty Images

Matthew Solan , Executive Editor, Harvard Men's Health Watch

Howard E. LeWine, MD , Chief Medical Editor, Harvard Health Publishing

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