The Overlooked Essential: Why Dentists Say Tongue Cleaning Matters
For generations, the mantra of brushing teeth twice daily has been ingrained in our collective consciousness. However, dental professionals now assert that a critical component of oral hygiene is being consistently neglected by the majority. "Everyone needs to be educated about cleaning the tongue," emphasizes Dr. Maria Figueroa, a dentist and program director at NYC Health + Hospitals/Lincoln. "This is as important as your teeth."
The Challenge of Adding Another Step
Incorporating an additional task into an already established routine presents a significant hurdle. "I'll be transparent: it's very difficult just to get people to floss," acknowledges Dr. Thomas Salinas, a prosthodontist and chair of dental specialties at the Mayo Clinic in Rochester, Minnesota. Despite this challenge, the importance of the practice remains undiminished. Tongue cleaning is described by Salinas as "a reasonable and helpful thing to do." He advocates for a comprehensive approach: "We should be brushing and flossing our teeth and cleaning our tongues."
Understanding the Benefits of Tongue Cleaning
While brushing targets tooth surfaces and flossing addresses the interdental spaces, both work to remove the biofilm that accumulates on and around teeth, thereby reducing risks of decay and gum disease. Biofilm, as explained by Robert Shields, an oral microbiologist and assistant professor at the University of Florida College of Dentistry, is a complex aggregation of bacteria, viruses, and food debris.
This biofilm also colonizes the tongue's surface. Shields notes that dental biofilm consists of different bacterial species than those found in tongue biofilm, as these microorganisms adapt to thrive either on hard tooth enamel or the warm, textured environment of the tongue.
The tongue is covered with numerous papillae, small bumps essential for functions like speech and chewing. Biofilm accumulates between these structures, creating a reservoir for bacteria. Dr. Luana Dias, a dentist-scientist in Shields's lab, explains that this reservoir can allow bacteria to spread to other oral areas, potentially contributing to conditions like gum disease.
Emerging research suggests possible associations between this bacterial reservoir and systemic health issues, including diabetes and cardiovascular disease, though further investigation is required. Additionally, an overgrowth of bacteria on the tongue is a primary cause of bad breath. When sulfur-producing bacteria break down, they release compounds responsible for unpleasant odors. Indicators such as a white coating or persistent metallic taste may signal this overgrowth, which gentle tongue cleaning can help mitigate.
Selecting the Right Tools for Tongue Cleaning
Dr. Salinas advises that using a dedicated tongue scraper is preferable to employing a toothbrush. Cross-contamination risks arise when the same tool is used for both teeth and tongue. "It's not wrong to use a brush, but it's better to use a tongue scraper if you can," he states.
Dr. Figueroa cautions that toothbrush bristles may be too abrasive for the delicate tongue tissue, citing instances where overzealous brushers have developed scar tissue from excessive cleaning. Dr. Dias recommends metal scrapers, such as those made from stainless steel or copper, over plastic alternatives. Plastic can degrade and may cause micro-scratches, while copper has been traditionally associated with toxin removal, though scientific backing for this claim is limited, notes Salinas.
Figueroa expresses a preference for scrapers but acknowledges the convenience of toothbrushes with integrated rubber scrapers on the reverse side of the head. A general guideline is to replace rubber, plastic, and bristle oral care tools every three months. Metal scrapers can be sanitized, but consulting a dental hygienist for personalized advice is recommended.
Mastering the Technique of Tongue Cleaning
Dr. Figueroa advocates for integrating tongue cleaning into daily routines, akin to facial washing, ideally twice daily—morning and night—alongside brushing and flossing. However, Shields advises moderation, as the impact of cleaning on the oral microbiome is still debated. Some experts worry that excessive cleaning might remove beneficial bacteria involved in nutrient processing alongside debris.
For those particularly concerned about bad breath, adding a non-alcoholic mouthwash at the end of the routine can provide freshness without disrupting the oral microbiome or damaging cells. When cleaning, extend the tongue and focus on the anterior portion, which is typically manageable even for individuals with a sensitive gag reflex. Employ a gentle raking motion across the surface.
If using a scraper, a thin, white layer of biofilm will be collected. Salinas stresses the importance of gentle pressure to avoid tongue damage, rinsing the scraper between passes. After cleaning, thoroughly rinse the tool and allow it to air dry to prevent bacterial growth.
An Additional Health Check
Dr. Salinas highlights an opportunistic preventive measure: while the tongue is extended, examine its sides and underside for any irregularities, such as lumps or sores, which could be early signs of oral cancer. "If you see any irregularities, you should definitely see a professional for evaluation," he urges. "That's probably the most important tip."
