For 20 Years I Told My Patients With Arthritis to Buy an Electric Toothbrush. Then I Saw My Own Mother's X Ray.

Why arthritis in your hands can leave your back teeth uncleaned, even when you brush twice a day.

By Dr. Richard Hale, DDS*Dramatized dentist perspective · Composite character

For twenty years, I gave every patient with arthritis in their hands the same advice.

"Get an electric toothbrush. Let it do the work."

I must have said it a thousand times. I believed it. I even bought one for my own mother.

During one of my mother's appointments, I reviewed her X rays while she was still in the treatment chair.

The bone around two of my mother's back teeth was wearing away.

My mother is 77. She has brushed twice a day her whole life. She has never once skipped a cleaning. And her own son, a dentist, never saw it coming.

What I learned over the next few weeks changed what I tell every patient with stiff or painful hands. If you have arthritis in your hands, or someone you love does, please read this to the end.

Because the problem I'm about to describe doesn't hurt. Not until it's very late.

"I brush twice a day." She wasn't lying.

My mother, Margaret, has had arthritis in both hands for about nine years. Three Christmases ago, when her fingers started getting worse, I gave her a good electric toothbrush. I thought that took care of it.

I asked her if she was using the brush. “Twice a day, honey,” she said.

She’d also stopped staying overnight at our house during the holidays. She said she slept better in her own bed. I believed her.

I showed my mother the images while she was still in the treatment chair. Then I handed her a toothbrush and asked her to show me how she brushed.

She held it with her right hand and pressed the button with her left thumb. It took her two tries to turn it on.

The front teeth went fine.

Then she had to turn her wrist to reach the back. I watched her face tighten. The buzzing of the handle went straight into her swollen knuckles. After about twenty seconds she switched it off and set it down.

She had stopped before she could finish the back teeth.

She had been telling me the truth. She did brush twice a day. She brushed every tooth her hands could still reach. Her back teeth didn’t hurt, so she had no reason to think anything was wrong.

Why the damage went unnoticed

She couldn’t see the buildup around her back teeth. And because they didn’t hurt, she thought they were fine.

What happens to the teeth your brush can't reach

Most people think a few missed teeth mean bad breath. If only that were all.

Here's what actually happens, step by step. I've watched it unfold in my chair for twenty years.

Within minutes

A new film starts to form

A thin protein film begins forming on teeth soon after cleaning. Bacteria can attach to it and form plaque. If an area keeps getting missed, that plaque can build up.

24 to 72 hours

The bacteria shift, and you feel nothing

In one study, 40 adults paused their oral hygiene. Within 24 to 72 hours, researchers measured changes in plaque bacteria, their activity and the body’s immune response, before obvious symptoms appeared.

Huang et al., mBio, 2021

12 days

Plaque scores up 59%. Gum bleeding scores up 126%.

In another study, adults stopped oral hygiene for 12 days. Average plaque scores rose by 59 percent. Gum bleeding scores rose by 126 percent.

Sreenivasan & Haraszthy, Contemporary Clinical Trials Communications, 2021

About 3 weeks

Gingivitis: the gums swell and bleed

In classic experiments, visible gum inflammation appeared within roughly 10 to 21 days once cleaning stopped. Red, swollen gums that bleed when touched. That's gingivitis.

Here's the good news: up to this point, it can still be reversed. Clean those teeth properly again, and the gums can calm down.

⚠ This is the line you don't want to cross.

If gum disease progresses

Periodontitis: the body starts dissolving its own bone

If gum disease progresses to periodontitis, inflammation can damage the tissues below the gumline. The body’s response to the infection activates cells that break down bone. Over time, the bone that holds your teeth in place starts to break down.

The tooth can become loose as it loses support. If the tooth is too damaged to save, your dentist has to pull it out. You’re left with a gap where one of your own teeth used to be. Replacing it with an implant can cost around $5,000 per tooth, depending on the treatment needed.

This is where my mother's X ray was.

At the same time

Bleeding gums are open doors

When gums bleed, mouth bacteria can enter the bloodstream. In a study of 194 people, those with heavy plaque or tartar had about 4 times the odds of bacteria in their blood after brushing. Bleeding all over the mouth, compared to one area, came with about 8 times the odds.

In a study of 138 older adults who depended on others for care, 64.5% had potential respiratory pathogens in their dental plaque. This does not mean they all developed pneumonia. It shows how plaque can become a reservoir for bacteria that may cause lung infections if they are breathed into the lungs.

Lockhart et al., JADA, 2009 · Sumi et al., Archives of Gerontology and Geriatrics, 2007

When a cavity reaches the nerve

The tooth stops hurting. That's the bad sign.

Plaque left on teeth can cause decay. If decay reaches the tissue inside the tooth, the nerve can die. Pain may ease even though the infection is still there, and the tooth can become darker. A tooth that stops hurting has not necessarily healed.

An infection can then form around the root tip. That is a dental abscess, and it needs treatment from a dentist.

Rarely, but it happens

From a tooth to the emergency room

In rare cases, a dental infection can spread into the neck or bloodstream. That can require hospital treatment, sometimes intensive care. It is uncommon, but an untreated dental infection can become a medical emergency.

Why missed areas can be more serious as you get older

Many older adults take medicines that cause dry mouth. With less saliva to wash away food and help protect the teeth, the risk of decay rises.

Diabetes adds another concern. When blood sugar is poorly controlled, gum disease can be more severe and healing can be slower. Gum disease can also make blood sugar harder to control.

When painful hands leave the same teeth uncleaned day after day, these other problems can make the consequences more serious.

Gum disease needs treatment from a dentist. Daily cleaning at home matters too. Antibiotics alone do not remove the plaque left on those teeth.

The part no X ray shows

Losing teeth is rarely just about teeth. I've watched patients switch to soft food because chewing hurts. Steak goes, then apples, then nuts. Some lose weight because eating has become difficult. They start laughing with a hand over their mouth. They say no to dinners and family photos.

For many of my older patients, the teeth are the first piece of independence they lose. Rarely the last.

Everything I tried first

My mother needed treatment for her gums. She also needed a way to clean her back teeth at home. I tried the options I had been recommending to my patients.

1. A foam grip on her electric toothbrushEasier to hold. I'll give it that. But she still had to steer it and turn her wrist to reach the back teeth.
2. A bigger electric toothbrush with a thicker handleEasier to grab, but heavier. Her wrist gave out even sooner.
3. Brushing her teeth for herI can't be there twice a day. And she wouldn't have it anyway. "I changed your diapers," she told me. "You are not brushing my teeth." She wanted to do it herself. That was the whole point.
4. More cleanings at my officeEvery three months instead of six. It helps. But four cleanings a year can't replace 730 brushings.

None of these options gave her a way to keep brushing on her own at home.

What Walter was doing differently

A few weeks later, Walter came in for his checkup. He was 81 and had arthritis in both hands.

His fingers were stiff and swollen. But when I examined his teeth, even the ones at the back were clean.

“How are you managing to brush at home, Walter?” I asked.

“My granddaughter bought me a different toothbrush,” he said. “I brought it with me so you could take a look.”

He opened the case and showed me.

Inside was a U shaped mouthpiece on a small handle.

I'll be honest: my first thought was gimmick. I'd seen U shaped brushes before, mostly for kids, and I wasn't impressed by most of them.

So I asked him to show me. He put it in, bit down gently, pressed the button once, and rested both hands on his knees.

His hands didn't do anything. That was what stopped me.

Walter’s back gums had been bleeding at his last visit. This time they looked calmer. I also wanted to understand how well the brush cleaned, so I looked at Dentarel’s own evaluation. The company reports 85% more plaque removed than a regular manual toothbrush. These are results reported by Dentarel.

But what really convinced me wasn't a number. It was the principle.

Brushing without holding and guiding a handle

The Dentarel U Brush is a U shaped mouthpiece that sits over your top and bottom teeth at the same time. The back ones too. It looks a bit like a mouthguard.

You don't hold it. Your bite holds it in place. You don't steer it, and you don't turn your wrist. Once it's running, your hands can rest in your lap.

The handle changed. She still couldn’t reach her back teeth.

What she tried	What she still had to do
Regular toothbrush	Keep gripping the handle and move the brush around every tooth.
Foam grip	Hold a thicker handle, but still turn her wrist to reach the back.
Electric toothbrush	Let the motor move the bristles, but still position the brush herself.
Dentarel U Brush	Bite down gently, press the button and let her hands rest while it brushes.

A thicker handle was no use if she still couldn’t reach her back teeth. Neither was a motor if she still had to turn the same painful wrist. She needed a way to brush without holding and guiding a toothbrush the whole time.

Holding and guiding a brush

Dentarel U Brush

Even with a thicker handle, you still have to hold and guide the brush. With U Brush, your hands can rest.

What using it actually looks like

My mother tried it at her next appointment

I ordered one for my mother and brought it to her next appointment. I showed her how to use it, then let her try it herself. She took it home that day.

Eight weeks later, I examined her again. The back gums no longer bled when touched.

That Christmas, my mother stayed overnight at our house for the first time in two years. Before bed, she sat on the edge of the guest bed with her U Brush while my daughter told her about school.

The next morning, she told me why she’d stopped staying overnight.

"I didn't want the kids to watch their grandmother fight with a toothbrush."

She could stay with her family and still take care of her own teeth.

Who I recommend it to now, and who doesn't need it

I no longer ask only whether my patients are brushing.

If you can only reach the front teeth, you need a way to clean the back ones too, with the hand movement you can still manage.

Trustpilot

4.9 out of 5

35,129 happy customers

Dentarel U Brush

$74.95 · one time purchase · ships from our U.S. warehouse

• Cleans the back teeth you struggle to reach.
• Your hands rest while it brushes
• Starts with one press of a button
• 30 day money back guarantee

Keep caring for your own teeth.

Give your hands a rest.

30 day money back guarantee

Check availability & apply discount →

Questions my patients ask me