Maintenance of an adequate level of daily oral hygiene is essential for the prevention and control of diseases caused by oral biofilm (bacterial plaque). 

Oral biofilm is the leading etiological agent in caries development, as well as in the development of other oral diseases such as periodontal disease (gingivitis/periodontitis) or peri-implantitis (peri-implant mucositis/peri-implantitis). 

For effective caries prevention and dental health maintenance, it is important to approach caries from multiple angles, as it is caused by a combination of factors. 

Prevention should therefore focus on factors that foster caries development (biofilm, diet, individual, action time). Biofilm control is performed using mechanical methods and chemical agents. 

MECHANICAL METHODS 

Toothbrushing is the most common manner to remove oral biofilm that has accumulated on tooth surfaces. Toothbrushing includes both a proper brushing technique and an adequate toothbrush. 

Brushing technique 

Several different brushing methods exist, although there is no evidence that one technique is superior to another, as any brushing technique may be considered potentially acceptable. Dentists and hygienists are responsible for indicating the ideal brushing method and for teaching this method to their patients, depending on their particular anatomy and physiological features, as well as their motor skills. 

Besides a proper brushing technique, use of a suitable, quality toothbrush is also crucial. 

Toothbrush 

A toothbrush is the tool that allows us to effectively break up oral biofilm. Using a high quality toothbrush that is designed specifically for the needs of each person is recommended for maximum oral biofilm removal. 

A wide variety of toothbrushes are available on the market, but not all of them are the same. A proper toothbrush must have certain features, including a small brush head, allowing access to the more complicated to reach backmost areas of the oral cavity, and end-rounded and textured Tynex^® filaments that help in the removal of oral biofilm without damaging gums and tooth enamel. The handle should adapt to the palm of your hand for brushing comfort. VITIS toothbrushes meet all of these criteria, and are therefore considered the product of choice for maximum cleaning efficacy. 

Many people do not perform a proper brushing technique or do not brush as often or as long as recommended. A very useful way for people to check whether or not their oral hygiene is adequate is to use plaque disclosing products. These normally come in tablet or liquid form, such as, for example, Plac•Control, which reveals areas where biofilm exists by staining it red. 

Interproximal cleaning 

Spaces between teeth (interproximal areas) are hard to reach. In order to ensure effective removal of oral biofilm from these spaces, it is advisable to use oral hygiene tools other than the standard toothbrush, such as dental floss/tape, interproximal brushes or oral irrigators. 

CHEMICAL AGENTS 

Fluoride toothpastes and mouthrinses 

Caries prevention depends on the use of fluoride. Fluoride is a mineral that helps increase tooth hardness, by integrating into the structure of the enamel and turning the enamel's hydroxyapatite into fluorapatite, which is more resistant to acid attack. It also has a remineralising effect on early carious lesions that have appeared on the enamel, because it reacts with the calcium, thereby forming calcium phosphate which has a protective effect. 

Toothpaste is the most widely used self-application fluoride product. Toothpastes contain different ingredients with therapeutic effects, and the most common substance is fluoride. 

Complementing the mechanical act of brushing with the use of fluoride toothpaste prevents the onset of caries. The adequate supply of fluoride in toothpaste is 1,450 ppm starting at 6 years of age. For younger children, this should be lower due to possible accidental toothpaste intake. 

For people with multiple caries or for those who are at very high risk for caries, the amount of fluoride can be increased, and products with concentrations 2,500 ppm can be used, such as Fluor•Aid. 

Use of a mouthwash as an adjunct to mechanical oral hygiene is also recommended, as this is considered to be a very effective measure for enhancing the effects of toothbrushing with toothpaste, since it accesses hard-to-reach areas, thereby increasing removal of oral biofiom build-up on the tongue, gums, etc., while retaining active ingredients in the mouth for longer periods of time. 

Multiple mouthwash formulations are available on the market containing sodium fluoride for daily use (0.05%-225 ppm fluoride concentration) and for weekly use (0.2%-900 ppm fluoride concentration). These can be used by children over the age of 6 years, as long as they are able to rinse without swallowing the mouthwash. 

In conclusion, combining brushing with toothpaste, interproximal cleaning and an effective fluoride mouthwash, can ensure successful caries control and prevention.