Vol.

1 Issue 2

November 2009

TOOTH BRUSH AND TOOTH BRUSHING

1
1

Dr. Preeti Gupta, 2Dr. Gaurav Gupta

Department of Prosthodontics, 2Department of Conservative Himachal Institute of Dental Sciences, Paonta Sahib Dist. Sirmour (Himachal Pradesh)

Dental Plaque is established as the principal etiological agent of dental caries and periodontal disease. Prevention of these two oral diseases is mainly based on the effective removal of plaque on daily basis. Despite the wide range of available methods, mechanical plaque removal with a tooth brush remains the primary method of maintaining good oral hygiene. Today, different types of tooth brushes are available in the market. But for most patients, short-headed brushes with straight cut, round-ended soft to medium nylon bristles arranged in 3-4 rows of tufts are recommended. INTRODUCTION Microbial plaque plays a dominant role in causation of both dental caries and periodontal disease. Most preventive measures are directed towards elimination of plaque or minimization of its effects. One of these methods is, Oral physiotherapy. It refers to those procedures practiced on regular basis by individual to maintain good oral health and the fundamental tool for oral physiotherapy is a tooth brush. MANUAL TOOTH BRUSHES Manual tooth brushes are most commonly used oral hygiene aids because of its cost effectiveness and ease of availability. A variety of tooth brushes are commercially available with different designs and angulations, to serve specific requirements of patients. (Fig.1) TOOTH BRUSH SELECTION The choice of brush is a matter of individual preference, there is no demonstrated superiority of any one type of brush. Ease of manipulation by patient is an important factor in brush selection. The effectiveness of and potential injury from different types of brushes depends to great degree on how the brushes are used.

ADA specification for acceptable brushes are as follow: Length 1-1.25 inches. Width 5/16-3/8 inches. Surface area 2.54-3.2 cm. Number of rows 2-4 rows of bristle. Number of tufts 5-12 tufts per row. Number of bristle 80-85 bristle per tuft. POINTS TO REMEMBER - Angled tooth brushes give definite advantages of increased tactile sensation and increased accessibility to posterior area. Multi-tufted brushes show better cleaning ability. Round ends of bristle produce fewer lacerations. Tooth brushes with curved bristles are reported to be better than conventional brushes in plaque removal ability.

Fig 1: Different types of toothbrushes and various bristle configurations.

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Tooth brush with wear reminder are also available, usually a blue dye on some of the bristle that fade off with use. Tooth brushes with nylon filaments are superior in term of homogenicity, uniformity of bristle size, elasticity resistance to fracture and repulsion of water and debris. Difference in tooth brush design permits the brushes to carry more tooth paste while brushing, contribute to abrasion more than brush bristle themselves. Use of hard brush and abrasive dentifrice may lead to cervical abrasion of teeth and recession of gingiva. For effective cleaning the tooth brushes must be replaced as soon as the bristle begin to fray. Usually there is a tendency to use a brush for as long as possible. Repeated oral hygiene instruction and introduction of electric tooth brush or new manual brush enhances the plaque control significantly. With the powered tooth brush, the cleaning ability increased from 33%-64% and with manual brushes from 26%-44% within 18 weeks. The results encourages the use of powered toothbrush. Periodic assessment and reinforcement of oral hygiene practices are necessary for most people to establish and maintain effective levels of self care.

BASS METHOD Bass technique is efficient and can be recommended for any patient with or without periodontal involvement. (Fig. 2)

Fig 2: The Bass method of toothbrushing. The head of the toothbrush is in this illustration placed against the buccal surfaces of the posterior teeth of the right maxilla. Note the angulation of the bristles against the tooth and the direction (arrows of the motion)

Advantage - The short back and forth motion is easy to master because it is a simple movement familiar to most patients who brush using a scrub technique. It concentrates the cleaning action on the cervical and interproximal portion of teeth.

Disadvantage Bass technique requires patience and placement of the tooth brush in many different positions to cover the full dentition. Patients need to be instructed to brush in a controlled and systematic sequence to optimize plaque removal. MODIFIED STILLMAN METHOD This method may be recommended for cleaning in areas with progressing gingival recession and root exposure to minimize abrasive tissue destruction. Advantage - Good interproximal cleaning Good gingival stimulation Disadvantage - Difficult to learn and implement. CHARTERS METHOD This technique is usually recommended for cleaning in areas of healing wounds periodontal surgery. This technique was designed to gently massage the gingiva.

TOOTH BRUSHING METHODS Many methods for brushing the teeth have been described and promoted as being efficient and effective. But no one method of tooth brushing has been found superior to others. The best method in one that suits the individual needs and ability and the responsibility of dentist is to instruct the patient as to how to perform the task thoroughly. VARIOUS BRUSHING A. Sulcular: Bass B. Roll: Rolling stroke, Modified stillman. C. Vibratory: Stillman, Charter,Bass D. Circular: Fones TECHNIQUES E. Vertical : Leonard F. Horizontal G. Physiologic: Smith H. Scrub-Brush

Advantage - Excellent stimulation of gingiva. Disadvantage - Do not clean interproximal areas. Difficult to learn and implement. FONES METHOD This method is usually recommended for young children with minimal manual dexterity. Main advantage of this technique is its ease to learn, but it may traumatize the gingiva and ineffectiveness in cleaning interproximal areas. THE ROLL METHOD The roll technique is easily performed by many people. It is most appropriate when the patient is in normal health. Advantage - Easy to learn. Good gingival stimulation Disadvantage - Poor sulcular cleaning. FREQUENCY OF TOOTH CLEANING Numerous studies have reported improved periodontal health associated with increasing frequency of brushing up to twice per day. Three or more cleaning per day did not produce significantly better periodontal conditions. For practical purpose, two brushing per day, one of them performed very thoroughly, are recommended. INTERDENTAL BRUSHES These are cone shape brushes made up of bristles mounted on handles, unitufted, or miniature bottle brushes. Interdental brushes are particularly suitable for cleaning large, irregular or concave tooth surface adjacent to wide interdental spaces. The diameter of brush should be slightly larger than gingival embrasure so that the bristles can exert pressure on the tooth surface. (Fig. 3) POWERED TOOTH BRUSHES Electrically powered tooth brushes were introduced in 1880s and intended to make plaque control easier for patents to master. All powered tooth brushes rely on mechanical contact between the bristles and the tooth to remove plaque. (Fig. 4)

Fig 3: Interdental brushes

INDICATIONS - Children and adolescent. -

Fig 4: Powered tooth brush.

Children with physical or mental disability. Hospitalized patient, including older adults. Patients with fixed orthodontic appliances.

Some researchers have reported that powered tooth brushes remove more plaque than manual tooth brushes, reduce calculus accumulation and improve gingival health. IONIC TOOTH BRUSHES In an effort to achieve better plaque removal, a manual ionic action tooth brush was developed, by Hukuba Dental, known as Hy G Ionic tooth brush. While using this brush the tooth polarity changes from negative to positive. Thus positively charged tooth ions repel the positively charged plaque ions. A recent study by Swol R.L.V et al, have shown significant improvement in gingival and plaque index scores with ionic tooth brushes as

compared to manual tooth brushes. CONCLUSION Plaque control is one of the key elements of practice of dentistry. It permits each patient to assure responsibility for his/her own health on a daily basis. Mechanical plaque removal with tooth brushes remains the primary method of maintaining good Oral hygiene. The type of tooth brush is a matter of individual preference but no one method of tooth brushing have been found superior to others. Any brushing technique, if properly performed can accomplish excellent plaque control.

REFERENCES
1. Allen, McFall: Oral physiotherapy. In: Periodontics for Dental Hygienist. 4th Edn. 172-176. 2. Lazarescu D, Boccaneala S: Efficacy of plaque removal and learning effect of a powered and manual tooth brush. J Clin Periodontol 2003; 30:726-731.

3. Peter S: Plaque Control. In: Eessentials of preventive and community dentistry. Edn. 1, 352-370. 4. Perry DA: Plaque control for the periodontal patient. In: Newman MG, Takei HH, Carranza F. Clinical periodontology. 9th Edn. 2003; 651-674.