The advice from the Department of Health concerning oral health in their new booklet1 has a glaring omission, which is the lack of specific advice or recommendation for gingival/periodontal care. Given the incidence of tooth support loss and subsequent tooth loss this omission is puzzling. Our patients, quite rightly, expect us to provide them with advice, so what can be offered which is both reasoned and reasonable?

Load bearing improves bone density. Tendons and muscles strengthen with work. Keratinised tissue responds to abrasion/wear by thickening. My own observation of both human and animal dentitions has convinced me that the 'use it or lose it' phrase applies to the hard and soft tissues more than may be acknowledged.

For example, there is a well documented difference between the periodontal condition of feral and domestic cats, in which diet plays a major part. The former have to get what they can catch or pick up and the killing, skinning and chewing all help to toughen up the periodontal and alveolar apparatus. The latter often get tinned or packaged 'meat' which requires little effort to eat resulting in heavy calculus deposits and acute periodontal disease. So, in this context the lifestyle of the feral cat seems to promote a healthy mouth.

If we all adopted the 'don't brush too hard or you will damage your gums' philosophy and applied it to the rest of the body, many sports and hobbies would never be taken up because of some initial discomfort – try playing a steel string guitar for the first time – it hurts. But, of course, the body adapts, within limits. So is 'gentle brushing' of the gums a good idea? Is it enough? I was taught that gum shrinkage with no associated pathology was caused by inappropriate or excessive brushing. Now I am not so sure.

I have yet to see a patient destroy their gums by brushing too much but I have seen plenty of patients improve their gum condition by vigorous brushing. The gums rely on the bone for support so strong bone is an advantage. Bruxists have very tough dental support tissues presumably because the increased loading on the bone builds it up. The bone is strong – so are the gums.

Although popular marketing for mouthwashes and certain sonic brushes emphasises the removal of bacteria as essential, perhaps it is approaching the problem from the wrong direction. Could it be that if the gums are strong then the bacteria will be 'shrugged off'? Therefore, stimulation of the gums should arguably be the first goal of oral hygiene, with 'tooth' cleaning a close second, because I believe that the two are not necessarily inseparable.

Some bruxists that I have seen have poor oral hygiene yet admirably strong dental support. On the other hand, many patients of Oriental ancestry that I have seen, who have good oral hygiene, nevertheless also seem to have a predisposition for periodontal collapse. Their diet often consists of very small pieces of food that require no chewing. Is there a connection?

If it is accepted that the aim of our advice is to encourage the patient to adopt a care programme that strengthens support then, perhaps, we should not only promote gum care but some kind of chewing/clenching exercises.

By adapting some simple and short 'jaw exercises' particularly those involving firm chewing/clenching it is possible to noticeably increase the strength of the main 'chewing' muscles within two to three weeks: the occlusion feels more 'even' and 'more efficient'. These are findings from my patients – purely anecdotal, of course, but fitting in with what I would hope and expect to happen.

I wonder whether some TMJ problems could be prevented by simply 'tightening up' the TMJ area in this fashion particularly if, from childhood, the diet and/or lifestyle encourage it. Unfortunately twenty-first century existence seems to be making us 'soft' – I now hear that it is possible to buy bread without crusts. Use it or lose it?