PLAQUE CONTROL FOR

THE PERIODONTAL PATIENT

TOOTHBRUSHING METHODS

Horizontal brushing is probably the most commonly used tooth brushing

method. It is most frequently used by individuals who never had instruction in oral
hygiene techniques.

Despite the efforts of the dental profession to instruct patients to adopt other
more efficient brushing techniques, most individuals use horizontal brushing since
it is simple. The head of the brush is positioned perpendicular to the tooth surface
and then a horizontal back and forth movement is applied. The occlusal, lingual,
and palatal surfaces of the teeth are brushed with open mouth. In order to reduce
pressure of the cheek on the brush head the vestibular surfaces are cleaned with
the mouth closed.
Vertical brushing (Leonard (1939) technique) is similar to the horizontal brushing
technique, but the movement is applied in vertical direction using up and down
strokes.

Circular brushing (Fones (1934) method): with the teeth closed the brush is placed
inside the cheek and a fast circular motion is applied that extends from the maxillary
gingiva to the mandibular gingiva using light pressure. Back and forth strokes are used
on the lingual and palatal tooth surfaces. The scrubbing
method includes a combination of horizontal, vertical, and circular strokes.
Sulcular brushing (Bass (1948) technique):

1. Place the head of a soft brush parallel with

the occlusal plane, with the brush head
covering three to four teeth, beginning at
the most distal tooth in the arch.

2. Place the bristles at the gingival margin,

pointing at a 45-degree angle to the long
axis of the teeth.

3. Exert gentle vibratory pressure, using short,

back-and-forth motions without dislodging the
tips of the bristles. This motion forces the
bristle ends into the gingival sulcus area as well
as partly into the interproximal embrasures.
The pressure should be firm enough to blanch
the gingiva
The Bass technique is widely accepted as an effective method for removing plaque not
only at the gingival margin, but also subgingivally.
Vibratory technique (Stillman (1932) method):
as originally described by Stillman the method was designed for massage and
stimulation of the gingiva as well as for cleaning the cervical areas of the teeth.
The head of the brush is positioned in an oblique direction toward the apex, with
the filaments placed partly in the gingival margin and partly on the tooth surface.
Light pressure together with a vibratory (slight rotary) movement is then applied to
the handle, while the filament tips are maintained in position on the tooth surface.
(a) The Charters method of tooth brushing.
The head of the toothbrush is placed in the left
maxilla. Note the angulation of the bristles
against the buccal tooth surfaces. The bristles
are forced into the interproximal areas. (b)
The palatal aspect of the incisor region in the
maxilla illustrating the penetration of the
bristles through the interproximal spaces
(arrows).
Modified Stillman technique: the Stillman methods were designed to concentrate on
the cervical portion of the teeth and adjacent gingival
tissues. Each of these methods can be modified to add a roll stroke. The brush is
positioned similarly to the Stillman technique. After activation of the brush head in a
back and forth direction, the head of the brush is rolled over the gingiva and tooth in
occlusal direction making it possible for some of the filaments to reach interdentally.
• https://www.youtube.com/watch?
v=5zEDhurn7zY&list=PL07STuKvDDmnfEsVexcA1U8Y-9pv2-u-
n&index=3