The rinsing debate

22 December 2014
Volume 30 · Issue 5

Rachel Pointer asks what patients should be told.

There has been much debate over the years with regards to rinsing, and whether or not patients should rinse after brushing in order to maintain the best oral hygiene. Many people, including practising dentists, will find they fall into one of the two camps, often through habit more than anything else, but just which group is right – can rinsing really impact upon your oral health?

 

Evidence to date would seem to be weighing up in favour of the ‘no rinsing’ camp. A 2003 study published in the British Dental Journal recommends dentists: “Discourage rinsing with large volumes of water” due to the effect rinsing can have on the fluoride concentration in the mouth. Essentially, the study’s findings suggest that rinsing washes away the fluoride of the toothpaste. Rinsing, according to the study, is “an important determinant of anticaries efficacy of a fluoride toothpaste”.

 

More and more dental practices are now recommending against rinsing in their online advice for patients. Indeed in an article published in the national press, Phil Stemmer from The Fresh Breath Centre in London openly advised not to rinse due to the way it washed away the fluoride left over in the mouth after brushing.

 

With so much weight of feeling behind the ‘no rinsing’ side of the debate, it seems strange then that research into the matter isn’t as clear-cut as it might at first seem. As recently as 2002, one group of academics studying the effects of post-brushing rinsing on children found no significant change in the caries reducing effect of a fluoride toothpaste. What is perhaps most surprising about this result is not the result per se, but the size of the study carried out. This result in favour of rinsing came at the end of three years of research that involved 407 children – a comparatively large survey for this field of research.

 

More recently there has immerged a third side to the argument in favour of a ‘semirinse’.

Using a small amount of water to wash away the toothpaste on the tongue but still leaving a moderated film of fluoride on the teeth. However, rather than clarifying the discussion this third option has only served to add to the confusion.

 

Given the varied nature of professional opinion and research it is hard to know quite what to think. We are almost back where we began. And so while there is no definitive answer in the rinsing debate, we should not allow ourselves to be distracted from the wider issues surrounding oral health.

 

Data from the 2009 Adult Dental Health Survey suggests there is a noticeable lack of young people using floss regularly when they clean their teeth. While education in general oral hygiene has certainly improved in recent years, there is still arguably a long way to go. Perhaps the leastexploited area in this regard is in the arena of interdental brushing.

 

As any dental professional will know, ordinary brushing alone can only remove around 60 per cent of oral plaque – even less if a patient has an orthodontic appliance or other such oral device. To deal with the vast majority of the biofilm that accumulates, it is necessary to use instruments that give the greatest access to the interdental spaces. While floss may prove difficult to use correctly, and fiddly for those with dexterity problems, the interdental brush addresses many of the issues associated with flossing.

 

When used alongside other oral care adjuncts such as mouthwashes, interdental brushes greatly improve a patient’s ability to achieve higher standards of oral hygiene. Available in many sizes and suitable for a range of dentitions, interdental brushes such as the Flexi Ultrasoft from Tandex allow increased access around the oral cavity and are a means for patients who have trouble using floss to accomplish a quality clean, reducing the build up of plaque.

 

While there is no clear-cut answer on the horizon as far as rinsing goes, there is no end of evidence that supports brushing with a fluoride dentifrice as an effective means of plaque control. By adopting a methodical system of brushing, followed by interdental brushing as required, patients can be sure that, rinse or no rinse, their oral health will be in far better shape.

 

References available on request.