Tooth Brushing

Introduction to Toothbrushes and Toothbrushing Methods

  • Importance of plaque biofilm removal: - Complete removal can prevent dental caries and periodontal diseases.

    • The toothbrush is the most widely used tool for plaque biofilm removal.

Toothbrushing Objectives

  • Purpose: - Effective removal of plaque biofilm and disruption of its reformation.

    • Removal of food particles, debris, and stains.

    • Stimulation of gingival tissues.

    • Application of dentifrices that contain specific caries- or periodontal disease-targeting ingredients.

Manual Toothbrush Designs and Features

  • Structure: - Consists of a head with bristles and a handle.

  • Size Options: - Available in large, medium, and small.

  • Hardness Levels: - Available types include hard, medium, soft, and extra soft.

    • Soft or extra soft bristles are preferred for dental hygiene.

    • Bristle length should facilitate interproximal access.

Key Features of Toothbrushes

  • Profiles:

    • Four primary profiles:

    • Concave: Short bristles in the middle.

    • Convex: Long bristles in the middle.

    • Multilevel: Multiple lengths for improved cleaning.

    • Flat: Uniform bristle length.

  • Nylon vs. Natural Bristles:

    • Nylon is superior for its flexibility (10 times more) and resistance to splitting or abrasion.

    • Natural bristles vary in diameter and may not provide the same benefits.

  • Bristle Shape and Texture:

    • Thinner bristle diameters enable greater softness and resiliency.

    • Typical diameter ranges from 0.0070.007 to 0.0150.015 inches.

    • The stiffness of filaments increases as their length decreases; texture influenced by temperature, water uptake, and usage frequency.

    • End rounding of bristles is recommended to minimize trauma.

  • Handle Designs:

    • Curved and twisted designs facilitate access to hard-to-reach areas.

    • Handles are designed for ease of grip, considering users' dexterity, especially for children and the elderly.

    • Handles are generally plastic, water-resistant, and inexpensive.

Toothbrush Selection

  • Factors in toothbrush selection: - Patient's oral health status, gingiva condition, tooth positioning, exposed root surfaces, and personal preferences.

    • Importance of identifying worn brushes:

    • Worn bristles may be splayed, bent, or curled; patients should be taught to assess and replace their brushes accordingly.

Manual Toothbrushing Methods

Table 10-1: Manual Toothbrushing Techniques

  • Technique - Bristle Position - Brushing Motion - Effect Claimed: - Bass:

    • 45 degrees, tips in the sulcus - Vibratory, horizontal jiggle - Subgingival cleansing, gingival stimulation

    • Rolling:

    • Apical against attached gingiva - Swept in an arc toward the occlusal surface - Supragingival cleansing, gingival stimulation

    • Stillman:

    • Against apical part of gingiva and cervical part of tooth - Vibratory, pulsing strokes - Gingival stimulation

    • Charters:

    • Tips toward occlusal plane - Circular, vibratory strokes - Gingival stimulation, interproximal cleansing

    • Fones:

    • 90 degrees to tooth - Large circles over teeth and gingiva - Supragingival cleansing, gingival stimulation

    • Leonard:

    • 90 degrees to tooth - Vertical strokes - Supragingival cleansing, gingival stimulation

    • Horizontal:

    • 90 degrees to tooth - Horizontal strokes - Supragingival cleansing, gingival stimulation

    • Smith:

    • At occlusal surface - Sweep toward gingiva - Supragingival cleansing

    • Modified:

    • Combination of techniques - Sweep toward occlusal surface - Supragingival cleansing

Detailed Techniques
Bass Method

  • Applicable for all patients.

  • Toothbrush bristles positioned apically at a 45-degree angle to the long axis of the tooth.

  • Technique involves vibrating with short horizontal strokes covering 2–3 teeth at a time.

  • Indications: - Only effective method for sulcular cleaning.

    • Ideal for biofilm removal adjacent to & beneath gingival margin, exposed root surfaces, abutments, and periodontal patients.

    • Recommended to use approximately 10 strokes in each area, applying light pressure without bending bristles.

    • Vibratory back-and-forth jiggle motion involved.

Rolling Method

  • Most suitable for children.

  • Position bristles apically against the tooth's long axis, and roll the bristles towards the occlusal surface.

  • Emphasis not on gingival sulcus; effective for healthy gingival conditions, particularly for young children.

  • Can be combined with Bass, Stillman, or Charters methods after initial cervical cleaning.

Stillman Method

  • Position bristles apically along the tooth's long axis with the brush head touching the facial or lingual side.

  • Slightly rotate the brush at a 45-degree angle and use vibratory motion over the crown of the tooth.

  • Indications: - Useful for progressive gingival recession and for stimulating gingival tissues.

    • Use short back-and-forth vibratory strokes to apply gentle pressure to flex the filaments.

Charters Technique

  • Chang around orthodontic appliances.

  • Position bristles at a 45-degree angle toward the occlusal or incisal surface; use a circular vibratory motion.

  • Indications: - Effective for cleaning around orthodontic appliances and for stimulating marginal & interdental gingiva post-surgery or for loosening biofilm.

Fones Method

  • Target population mainly young children.

  • Clenching teeth with the brush inside the cheeks while moving in circular motions.

  • Indications: - Easy to learn but can be damaging with vigorous brushing.

Leonard Technique

  • Place the toothbrush at a 90-degree angle to the tooth axis and use a vertical motion up and down the teeth.

Smith Method

  • Physiological technique that mimics the food's path in the mouth; brush positioned on the occlusal surface and moved back and forth with gentle horizontal strokes for sulcus cleaning.

Scrub Technique

  • Involves using a combination of horizontal, vertical, and circular strokes along with vibration movements in specific areas.

Occlusal Brushing

  • Teeth are brushed in occlusal position, using either a slight circular motion or quick upward strokes to maintain cleanliness in those surfaces.

Power Toothbrushes

  • Advantages: - Generally more effective than manual brushing.

    • May improve patient compliance, particularly those in orthodontics or with physical limitations.

    • Power models feature a variety of motion types and speeds, including oscillation and reciprocation.

Tooth brushing Techniques

  • Evaluation:

    • Clinical effectiveness of new toothbrush designs may vary; results depend on individual brushing style, length, pressure applied, and consistency.

  • Frequency and Time:

    • Effective brushing time varies by individual due to personal habits and plaque accumulation tendencies.

Toothbrush Trauma and Maintenance

  • Soft & Hard Tissue Lesions:

    • Gingival recession due to harsh brushing with abrasive dentifrice.

    • Edward & Slit formations from improper force – termed as clefting or festooning.

  • Toothbrush Trauma:

    • Abrasion resulting from horizontal brushing may cause wedge-shaped indents around the CEJ (cervical enamel junction).

Maintenance of Toothbrush

  • Recommendations include replacement every three months, after illness, or when the bristles are worn. - Teaching good habits involving cleaning, storing, and contamination prevention is vital.

Tongue Cleansing

  • The role of tongue brushing in halitosis: - Volatile sulfur compounds (VSC) produced by anaerobic bacteria contribute to halitosis and may also initiate periodontal disease.

The American Dental Association

  • ADA's acceptance program confirms toothbrushes meeting established standards may display the ADA Seal, useful for marketing.

Summary

  • Understanding various toothbrush designs, types, objectives, and effective techniques is crucial for maintaining optimal oral hygiene.