Teeth and gums – looking after them on any budget
Tooth decay is the most common chronic disease in South African children and largely preventable. What actually works, and what to skip.
Two problems, two different causes
Almost everything that goes wrong in a mouth is one of two things. Decay is caused by bacteria turning sugar into acid that dissolves the tooth. Gum disease is caused by plaque left along the gum line, which inflames and eventually destroys the tissue holding teeth in place.
They need different responses. Decay is mostly about how often sugar arrives; gum disease is mostly about how thoroughly plaque is removed at the gum line.
What genuinely works
- Brush twice a day with a fluoride toothpaste — this is the single most effective thing, and fluoride is the ingredient that matters.
- Spit, do not rinse. Rinsing with water washes the fluoride straight off. This one habit change is free and makes a measurable difference.
- Brush along the gum line at a slight angle, not just across the tops. Two minutes, gently — hard scrubbing wears away enamel and recedes gums.
- Clean between the teeth daily with floss or interdental brushes. A toothbrush cannot reach the surfaces where decay most often starts.
- Cut the frequency of sugar, especially between meals and in drinks.
- Do not brush straight after vomiting or an acidic drink — the enamel is softened and brushing scrubs it away. Rinse with water and wait.
Children's teeth
- Start cleaning as soon as the first tooth appears, with a smear of fluoride toothpaste.
- Brush for a child until they are around seven or eight — before that they cannot do it thoroughly, however willing they are.
- Never put a baby to bed with a bottle of milk, juice or cool drink. Bottle decay is common, severe and entirely preventable.
- Milk teeth matter. They hold the space for adult teeth, and an abscess in one is as painful and as dangerous as in any other tooth.
- Public clinics and school programmes offer dental care for children; ask at your clinic.
Signs that need a dentist
- Gums that bleed when brushing. This is not normal, and it is the earliest reversible stage of gum disease.
- Persistent bad breath, or a bad taste that does not clear.
- Sensitivity to hot, cold or sweet things.
- A tooth that hurts when biting, or aches without provocation.
- Loose teeth in an adult, or gums pulling back from the teeth.
- Any ulcer, white or red patch, or lump in the mouth lasting more than two weeks — this is how mouth cancer is caught early, and it is more common in people who smoke or drink heavily.
Painkillers manage the pain but do nothing about the infection — an abscess needs treatment at the source. A tooth knocked out completely should be handled by the crown, not the root, kept in milk or saliva, and taken to a dentist immediately; time is what decides whether it can be replanted.
Common questions
- Is an expensive electric toothbrush worth it?
- Technique and consistency matter more than the brush. Electric brushes do remove somewhat more plaque on average, largely because people brush longer with them, but a manual brush used properly twice a day with fluoride toothpaste is entirely adequate.
- Does mouthwash replace brushing?
- No. Mouthwash does not remove plaque, which is a physical film that has to be disturbed. It can be a useful addition, but using it instead of brushing simply leaves the plaque in place with fresher breath.
- My gums bleed when I brush. Should I brush more gently?
- Bleeding usually means inflammation from plaque left at the gum line, so brushing that area properly is the fix rather than avoiding it — the bleeding typically settles within a couple of weeks. If it does not, see a dentist.
Sources
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
- Oral health and sugars guidanceWorld Health Organization
Last reviewed 4 August 2026.