Review Article Int J Clin Prev Dent 2020;16(4):149-153ㆍhttps://doi.org/10.15236/ijcpd.2020.16.4.

149

ISSN (Print) 1738-8546ㆍISSN (Online) 2287-6197

Proper Tooth-Brushing Technique According to

Patient’s Age and Oral Status
1 2
Hye-Jeong Bok , Cheon Hee Lee
1
Department of Dental Hygiene, Busan Women's College, Busan, 2Department of Dental Hygiene, Andong Science College,
Andong, Korea

Tooth brushing is a basic technique to prevent major oral diseases (e.g., dental caries and periodontal disease). Several meth-
ods of tooth brushing technique devised by some dental scholars have been introduced. However, some guidelines to select
the proper method are needed for an individual patient considering age and oral status. Methods such as rolling, Fones’,
Bass, Stillman, Charters, Watanabe’s tooth-pick, and other modifications have been introduced. The rolling technique was
recommended for general use, the Fones’ technique for preschool children, the Bass technique for the patient with gingivitis
with gingival sulcus problem, the Stillman technique for widespread gingivitis, and the Charters technique for bridge wearer.
Moreover, fixed-type orthodontic appliance wearer is recommended to use the mix-type methods as Bass, rolling, and
Charters. Moreover, the Watanabe’s technique would be available for patients with a dental implant or periodontal problem.
The denture wearer should clean the denture with a partial denture brush for a partial denture and a full denture brush for a
full denture with the rolling method or its modification. The selection of the proper tooth brushing method suggested in this
article would be one of the guidelines for clinical use of tooth brushing instruction for preventive measures.

Keywords: tooth brushing, oral status, simple plaque score, dental caries, periodontal diseases

Introduction circulation and increase the keratinization of the epithelial

Tooth-brushing is the basic method for prevention of dental
caries and periodontal disease, through eliminating dental pla-
que deposition at the tooth surface [1]. The aims of tooth-
brushing has been known as 2 big things as removal of dental
plaque from the tooth surface and gingival massage to promo-
tion of the early inflammatory gingiva to enhance the blood
Corresponding author Cheon Hee Lee
E-mail: arisu0515@hanmail.net
https://orcid.org/0000-0002-3203-8025
Received December 3, 2020, Revised December 17, 2020,
Accepted December 26, 2020
cells at the gingiva [2]. It has been introduced many methods
of tooth-brushing technique as horizontal scrub, rolling, Bass,
Stillman, Charters, Fones’, Watanabe’s method, etc., sug-
gested several scholars who were interested in the preventive
dentistry in clinical [3]. It would be different skill for techni-
que and objectives for tooth-brushing goals. So it had better to
choose the proper method for individual dental patient as dif-
ferent age group and oral state, by using the different type of
tooth-brush and oral hygiene devices. Even though tooth-
brushing is the fundamental and basic method of preventive
dental measures, lots of dental professions didn’t know the ex-
act method of each brushing method and the proper selection
for individual patient. First of all, the training should be per-
formed for tooth-brushing technique exactly frequent exercise

Copyright ⓒ 2020. Korean Academy of Preventive Dentistry. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/
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International Journal of Clinical Preventive Dentistry
would be needed to become habitual. This study could suggest
the guide-line for selecting proper tooth-brushing method for
individual [4].
Tooth-Brushing Method
1. Horizontal scrub method
It has been the most popular motion for tooth-brushing
technique by uneducated people. It is a motion for scrub
tooth-surface with horizontal movement as back and forth
ward. It can be occurred the accumulation of micro-debris at
the inter-dental area and happen the cervical abrasion or hyper
sensitive dentin through the using this motion for a long time
as 20 or 30 years (Figure 1).
2. Rolling method
Rolling method of tooth-brushing is world-wide spread
Figure 1. Horizontal scrub method.
Figure 2. Rolling method.
150 Vol. 16, No. 4, December 2020
method recommending for general peoples who have not spe-
cific oral problems. It had been once recommended by World
Health Organization as well as the Ministry of Health and
Welfare in Korean government for general people. It has been
suggested the movement of rolling through wrist the hand
which had hold a tooth-brush. Sweep the tooth surface from
up to down movement with rolling the hand-wrist in upper
teeth, and from down to up in lower teeth. Insert the
tooth-brush straight with obliquely at inner side of frontal
teeth, both in upper and lower teeth, and sweep the brush from
inside to outside and horizontal movement as back and forth
for occlusal surface of posterior teeth, both upper and lower.
Rolling technique is known as comparatively easy for learn-
ing and effective for removal of plaque even at proximal area
(Figure 2).
3. Bass technique
Bass technique of tooth-brushing has been recommended
for periodontal problem dental patient, even though it had
been some difficult to perform. It needed for soft and 1 or 2
lane tooth-brush to vibrate shortly and lightly with holding
tooth-brush handle with lightly. Short and light vibration
would be needed inserting one lane of tooth-brush into the gin-
gival sulcus or periodontal pocket which had been some in-
flammatory tissues. Vibratory action could induce the plaque
removal and gingival massage effect at the gingival sulcus, in
order to subsid the gingivitis. Recent years, the modification
of Bass method as adding the rolling motion together to Bass
method has been recommended for subsid gingivitis as well as
plaque removal effectively (Figure 3) [5].
4. Stillman method
Stillman method would be applied for gingival inflam-
Figure 3. Bass method.
 Hye-Jeong Bok and Cheon Hee Lee：Proper Tooth-Brushing Technique According to Patient’s Age and Oral Status
mation area with relatively wide spread. Short zig-zag move-
ment with soft bristled and 3 or 4 lane tooth-brush holding
with lightly, from up to down ward sweep with short vibration
on the gingiva at the upper jaw and from down to up at the low-
er jaw. Gingival massage effect would be great to increase the
blood circulation on the inflammatory gingival area. Also
modification would be performed by adding the rolling mo-
tion after zig-zag vibration at gingiva (Figure 4).
5. Fones’ method
Dr. Fones was a pediatric dentist and try to supply the prop-
er and easy method for tooth-brushing for preschool child as
sweeping with small sized kids tooth-brush with motion as
drawing continues circle on the teeth with closing the mouth
slightly. It could be easier to change the rolling method after
school aging than in horizontal scrub method. Horizontal
scrub action would be accomplished on brushing on occlusal
site and lingual site (Figure 5) [6].
Figure 4. Stillman method.
Figure 5. Fones’ method.
6. Charters method
This method of tooth-brushing is emphasize to clean the in-
terdental area especially. Insert tooth-brush tip with perpen-
dicular direction to longitudinal tooth axis at the proximal area
or revers 45 degrees from the gingiva to tooth direction. And
then, short vibration would be needed focusing on the prox-
imal area. But, this method is a little bit hard to perform at lin-
gual side of the tooth surface. This method is effective for
bridge wearer and well done at the bottom of the artificial
tooth on bridge area. Of course, it could be applied as modified
method by adding the rolling motion (Figure 6) [7].
7. Watanabe’s, tooth-pick method
Dr. Watanabe has suggested that plaque removal and gin-
gival massage would be very important for periodontal prob-
lem patient or dental implant patient, and they should elimi-
nate the plaque through the tooth-brushing movement of
pushing action from buccal side to lingual side with short vi-
bration, so we call as tooth-pick method. It might be some hard
Figure 6. Charters method.
Figure 7. Watanabe’s, tooth-pick method.
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Table 1. Recommend tooth-brushing method according to patient age or oral status

Patient state Characteristic Recommended method Site Device tooth-brush Effect

General No specific problems Rolling Buccal/Lingual Medium hardness Plaq.Rem
over age 7 Horizontal scrub Occlusal G. Massa
Sweep in to out Inn.Front.Teeth Prev Calc
Preschool Under age 6 Fones’ (circular) Lab/Buccal Smal. size Easy
Horizontal scrub Occ/Lingual Habit Ch
Perio. Problem Local.Gingivi M. Bass Gingival sulcus 2-lane brush Sulcus cl.
Perio pocket Ging.Ma.
Gingivitis Wide gingivitis M. Stillmans Gingival Soft bru Ging. Ma
Hypersen. Premolar. Can Rolling Cervical abrasi. Soft des Desensit.
Bridge wearer Interdental M. Charters Br.tip -45 dege. Zig-zag B. Prox. Cle
Pontic bottom Bucc to Lingual Super fl. Pontic. C
Fixed Orthodo. Bracket site Horiz.＋Charters Labial/Buccal Concave head. Bracket cleaning
appliance Gingival site Bass Labial/Buccal Proxa B. Ging.ma.
Proximal Interd. Brush Interdent.area Wat. Pik Prox. Cle
Lingual Rolling Lingual
Implant. Interdental Watanabe, T.Pik Proximal 2lane Br Periimpl.
Denture wearer Partial denture Modif. Rolling Partial denture Part.Bru Denture
Full denture Full denture Full. Bru Cleaner
Perio.probl: periodontal problem patient, Orthodo: orthodontics, Gingiv.: Gingivitis, Perio pocet: periodontal pocket, Horiz.: horizontal scrub,
Interd. Br.: interdental brush, Inn. Front Tooth: inner site of frontal tooth, M: modification, Occ: occlusal surface, Br.tip: bristle tip, 45 dege.: 45
degrees, Interd.: interdental, Hardne.: hardness, Hypersen: hypersensitivity, Can: canine, Smal. Siz: small size, Bru: brush, Prox.B: proximal brush,
Part.b: partial denture brush, Full Bru: full denture brush, Plaq. Rem: plaque removal, Prev. calc,: prevention of calculus deposit, Abrasi: Abrasion,
Soft des.: soft brush, desensitization dentifrice, Desensit: desensitization effect, Habit Ch,: habit for child, Ging.Ma.: gingival massage, Prox cle:
proximal cleansing, Periimpl: peri-implantitis.

for patient to perform by oneself at the first without pro-

4. Gingivitis-wide area with periodontitis
fessional person aid., and it needed some trainings from the
dental professions (Figure 7). Modified Stillman’s method would be recommended with
short and soft zig-zag vibration by moving the vibration from
Clinical Application of Proper Method apical to coronal direction and then, the rolling movement
for Each Patient would be added (Table 1).

1. General dental patients
For the general dental patients age from over 7, and without
any special problems or wearing the special dental appliance,
rolling method is recommended to perform and to be habitual
use (Table 1).
2. Preschool age child
For preschool child, Fones’ technique is recommended for
easy learning to use and changing it with rolling technique in
the later (Table 1).
3. Gingivitis-gingival sulcus
Modified Bass technique would be available for gingivitis
dental patient for cleansing in the gingival sulcus and gingival
massage (Table 1).
5. Bridge wearer
At bridge portion, Charters method would be available to
clean the inter-proximal and the bottom of the pontic area, as
short vibratory action with inserting the bristle tip into the
proximal or bottom of the pontic area by locating the head of
tooth-brush with reverse 45 degrees from the long axis of the
tooth (Table 1).
6. Fixed orthodontic appliance patient [8,9]
At first, horizontal scrub would be applied on the labial sur-
face to clean upper and lower of the bracket, and then short vi-
bration action would be applied at upper, lower and sub-
gingival sulcus from 1 tooth by the other tooth, by use of con-
cave form of the bristle head tooth-brush. Rolling motion
would be done at lingual surface and back and forth stroke at
the occlusal surface. It should be needed to use the interdental

152 Vol. 16, No. 4, December 2020

 Hye-Jeong Bok and Cheon Hee Lee：Proper Tooth-Brushing Technique According to Patient’s Age and Oral Status
brush for cleaning the proximal area and around the bracket.
Water pick is also recommended to use to clean the interdental
area and around the bracket (Table 1).
7. Hypersensitive dentin [10]
Rolling technique should be educated for the hypersen-
sitive dentine with cervical abrasion, owing to habits for
tooth-brushing with horizontal scrub for a long time (Table 1).
8. Implant patient
Watanabe suggested tooth-pick method for implant patient
as well as severe problem at the interdental area. Insert the
brush tip into the proximal area of the implant tooth with per-
pendicular or reverse 45 degrees to the long axis of the tooth
and push it with zig-zag vibration action from buccal to lin-
gual direction, like using the tooth-pick. It could be hard to
perform for lingual surface and rolling method would be rec-
ommended if it could be hard (Table 1).
9. Denture cleaning
Partial denture should be cleaned by use of partial denture
brush and full denture for full denture brush, with holding the
denture on the water base or towel. Brushing method would be
a modification of rolling technique and specific cleansing at
the specific part as like a clasp. Denture should be storage with
in the water with denture cleaner tablet when sleeping at night
time (Table 1).
Conclusion
Tooth-brushing is the basic and the nest way to prevent ma-
jor oral diseases as dental caries and periodontal disease
through the elimination of plaque deposition and gingival
massage effect. It would be cleaver to select the proper techni-
que of tooth-brushing method in consideration of patient age
or oral state. This paper would be one the guide-lines to select
the adequate method of tooth-brushing technique for each
dental patient in clinical, in order to removal of the dental pla-
que and gingival massage effect effectively.
Conflict of Interest
No potential conflict of interest relevant to this article was
reported.
ORCID
Hye-Jeong Bok, https://orcid.org/0000-0001-5458-5532
Cheon Hee Lee, https://orcid.org/0000-0002-3203-8025
References
1. Budiharto, Adyatmaka I. The effects of dental health educational
method to the changing of dental health behavior on mothers and
preschool children. Int J Clin Prev Dent 2009;5:141-5.
2. Chang YS, Park EJ, Kim HJ. Cor-relation co-efficient between
the toothbrushing frequency or caries activity and the dental ca-
ries or periodontal state. Int J Clin Prev Dent 2013;9:225-30.
3. Paik DI, Kim HD, Jin BH, Park YD, Shin SC, Cho JW, et al.
Clinical preventive dentistry. 5th ed. Seoul: Komoonsa;
2011:43-64.
4. Chun JA, Cho MJ. The standardization of toothbrush form for
Korean adult. Int J Clin Prev Dent 2014;10:227-35.
5. Shin SC, Jwa SK, Park SH, Lee PH, Chang YS. Clinical study
on plaque removal and gingival subside effect with technique of
tooth-brushing, by use of the vibratory action toothbrush. Int J
Clin Prev Dent 2012;8:81-7.
6. Hwang JH, Yu KJ. Oral health index for preschool children and
school children by use of a computer program for the incremental
dental care system. Int J Clin Prev Dent 2016;12:65-72.
7. Park HW, Kim ES, Na EJ, Yun MH. The artificial plaque removal
effect at the gingival sulcus by use of newly designed sulcus
cleansing tooth-brush. Int J Clin Prev Dent 2017;13:129-34.
8. Na EJ, Kim YM, Choi YH. A comparison of the residual amount
of bacteria according to cleansing methods of removable ortho-
dontic appliances. Int J Clin Prev Dent 2012;8:127-32.
9. Na HJ. Removal of dental plaque from orthodontic brackets us-
ing a fixed orthodontic bracket electric toothbrush. Int J Clin
Prev Dent 2019;15:108-11.
10. Singla MG. Dentin hypersensitivity- a vexing clinical problem.
Int J Clin Prev Dent 2013;9:245-51.
www.ijcpd.org 153