good oral health is very important. With this, you can prevent caries (cavities) and gum disease. Gum disease has a progressive course: from mild inflammation with little tartar to severe inflammation of the gums and bone where even teeth can be lost (periodontitis). That’s why it’s important to keep an eye on the condition of the gums. We do this by measuring the gums and removing the tartar that has formed.

Not only is maintenance important to keep teeth in the best possible condition but also because the mouth has an important influence on overall health. For example, inflammation of the gums affects early birth, cardiovascular disease, diabetes, respiratory (airway) disease, autoimmune disorders and cancer. 1–3

Also, teeth affect the intake of food, and thus have a major impact on being able to absorb vitamins, minerals and building blocks to have a healthy body.

In addition to all the health aspects, aesthetics play a role.

Teeth play an important role in self-confidence, social interaction but also in getting a job and partner. As dentists, this becomes especially clear to us in the radical aesthetic treatments we do. Patients come back to us after aesthetic treatment with the most extraordinary stories.

But better to prevent than to cure! Hence, much attention on our part to your oral health. Below you will find comprehensive information about cleaning and keeping your teeth and gums clean.

Plaque staining

Plaque is the cause of both caries and gum disease. Plaque is a deposit of bacteria on your teeth, among other things. We want to completely remove this layer at least once or twice a day to prevent cavities and gum disease.

Because plaque is also white, this is hard to see. But there is a way to make plaque visible. It is a simple method: a dye for plaque which you can buy at the drugstore.

In our practice, plaque staining is also used to increase the visibility and awareness of plaque left behind after brushing.

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plaque is difficult to see

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application of dye

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after rinsing out dye

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colors from the other side

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plaque visible where there is still pink

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cleaning of the teeth

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after treatment

The patient in these pictures had cleaned her teeth, but as can be seen, there is plaque particularly between the teeth and at the gum edges that still needs to be removed.

Brushing of teeth and gums

There are several methods of removing plaque but brushing is the most effective method. 4,5 Brushing teeth can be done with two different types of brushes, a manual toothbrush or an electric toothbrush. The electric toothbrush has a head start on getting rid of plaque.4,5 There are two different types of electric toothbrushes, one that rotates and one that vibrates sonically. In this, the rotary has a slight preference in removing plaque. 4

We recommend brushing the teeth with toothpaste twice a day for 2 minutes. Once before bed and the other time in the morning, preferably before eating or waiting 30 minutes after eating or drinking (sweet or sour).

The teeth have three sides: outside, top and inside. Therefore, make sure all three sides are cleaned thoroughly. Place the bristles of the brush toward the gums so that they are cleaned as well.

Tandpasta drop zo groot als een kikkererwt

toothpaste licorice as big as a chickpea

Manual toothbrush

buitenkant poetsen

Polish outsite

Bovenkant poetsen

Polish top

Binnenkant poetsen

Polish insite

Electric Toothbrush

Poetsen buitenkant electrische tandenborstel

Polish outsite

Bovenkant poetsen electrische tandenborstel

Polish top

Binnenkant poetsen electrische tandenborstel

Polish insite

Sticks (wood and plastic)

Teeth stoking is done to remove the bacteria that remain between the teeth. This gives significantly better plaque removal than brushing alone.6 Extensive tooth-brushing is only necessary once a day, preferably before you go to bed. The toothpick is used in narrow gaps where a brush will not fit.

A wooden toothpick is often triangular in shape with a long and short side and can therefore be used in places where there is a little more space between the teeth. We recommended a wooden or plastic toothpick, wood is more environmentally conscious.

Stick, wood, plastic and floss

Plastic stoker

Plastic stick

houten stoker om bacterien te verwijderen

Wooden stick long flat side

Houten stoker lange platte kant

Wooden stick long flat side

Houten stoker korte platte kant

Wooden stick short side

  • Wet the toothpick under the faucet or with saliva to soften it and make it more flexible between your teeth.
  • Using your thumb and forefinger, gently insert the tip of the toothpick between two teeth, with the small flat side against the gums.
  • When the flat side of the toothpick is snug against your gumline, slide the stick between your teeth.
  • Then sweep it back and forth about 5-10 times.
  • The sides of the toothpick clean your teeth.

Wooden Toothpick

Stoker niet recht insteken

Do not insert straight

Juiste insteekrichting: van tandvlees af

Correct insertion direction: away from gums

Masseer ook het tandvlees met de stoker

Also massage the gums

Plastic Toothpick

Insteken van de plastic stoker

Inserting the plastic stoker

Masseer het tandvlees met een tandenstoker

Massage the gums

Juiste insteekrichting plastic tandenstoker

Correct insertion direction

We discourage patients from stabbing at the top of the front teeth as this can create black triangles between the teeth. At the front teeth, we prefer to see you use floss.


Flossing is best for teeth that are close together. Floss is in fact thin enough to fit between your teeth. We also recommend floss for the front teeth in the upper jaw because black triangles can appear when using brushes or sticks. Waxed floss often works the easiest. Proper flossing is often tricky, though.

Flossing teeth: how does it work?

  • Take a piece of floss about 40 cm long and wrap the ends around your middle fingers.
  • Hold the floss taut between your thumb and forefinger and push the thread between your teeth.
  • Move the floss up and down along the tooth as if you were brushing the tooth from the side.
  • Use a clean piece of the floss at each space.
  • Repeat at all teeth where possible.
Om de tanden heen flossen

Floss around the teeth

Niet midden door de ruimte tussen de tanden maar om de tanden heen

Not in the middle through the gap but around the teeth

Andere tand flossen

Other tooth flossing


Rags are round brushes that are suitable for cleaning between teeth where the gap is quite large. Ragers are available in different sizes and shapes. It is important to choose the right width to ensure that bristles touch the surfaces properly. Be careful that the metal core does not damage teeth or gums! A dentist or dental hygienist can help you determine the proper size of the brush.

Teeth ragging: how does it work?

  • Hold a rager between your thumb and forefinger. Support your jaw with your middle finger so you can steer.
  • Insert the brush from the outside between your teeth.
  • Move it straight and then back and forth slightly diagonally.
  • Repeat for all spaces between molars (possibly teeth).
Insteken van rager in de tussenruimte

Inserting rag into the gap

Heen en weer beweging rager om plaque te verwijderen

Back and forth motion to remove plaque

een rager van een bepaalde dikte

Different thicknesses of rags

Tongue Scraping

A normal tongue is pink in color and may have a white, thin deposit on the rough part, near the uvula. The thickness of the stop may vary. With periodontitis, changes in diet, decreased saliva production, medication use, or inadequate oral hygiene, these deposits may thicken, discolor, and smell. 7 There are more than 500 different types of bacteria present in tongue deposits and only a few are responsible for smelly breath. As long as their numbers remain low, there is nothing to worry about. When the balance between these tongue microbes is disturbed, odor-producing bacteria take over and you smell out of your mouth.

A tongue cleaner is the most effective way to rid the tongue of deposits. Tongue scrapers can be purchased at drugstores and pharmacies.

How do you use a tongue cleaner?

  • Clean the tongue 1-2 times a day
  • Stick the tongue out of the mouth as far as possible.
  • Place the tongue cleaner as far as possible towards the rear tongue area
  • Apply light pressure to the tongue and slowly pull the tongue cleaner forward into the mouth (Tongue cleaning does not have to be hard, this prevents tongue damage).
  • Clean the cleaner under running water
  • Repeat 3-4 times
  • Clean and dry the scraper well


  1. Jain P, Hassan N, Khatoon K, et al. Periodontitis and systemic disorder—an overview of relation and novel treatment modalities. Pharmaceutics. 2021;13(8). doi:10.3390/pharmaceutics13081175
  2. Gare J, Kanoute A, Meda N, Viennot S, Bourgeois D, Carrouel F. Periodontal Conditions and Pathogens Associated with Pre-Eclampsia: A Scoping Review. Int J Environ Res Public Health. 2021;18(13). doi:10.3390/ijerph18137194
  3. Sanz M, Kornman K, Working group 3 of joint EFP/AAP workshop. Periodontitis and adverse pregnancy outcomes: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Clin Periodontol. 2013;40 Suppl 14:S164-9. doi:10.1111/jcpe.12083
  4. Thomassen TMJA, Van der Weijden FA, Slot DE. The efficacy of powered toothbrushes :‐A Systematic Review and Network Meta‐Analysis‐. Int J Dent Hyg. 2021;20(1):3-17. doi:10.1111/idh.12563
  5. Wang P, Xu Y, Zhang J, et al. Comparison of the effectiveness between power toothbrushes and manual toothbrushes for oral health: a systematic review and meta-analysis. Acta Odontol Scand. 2020;78(4):265-274. doi:10.1080/00016357.2019.1697826
  6. Graziani F, Palazzolo A, Gennai S, et al. Interdental plaque reduction after use of different devices in young subjects with intact papilla: A randomized clinical trial. Int J Dent Hyg. 2018;16(3):389-396. doi:10.1111/idh.12318
  7. Seerangaiyan K, Jüch F, Winkel EG. Tongue coating: its characteristics and role in intra-oral halitosis and general health-a review. J Breath Res. 2018;12(3):034001. doi:10.1088/1752-7163/aaa3a1

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