The single most important plaque control method for cleaning the flat surfaces of the teeth is toothbrushing. The precise technique and choice of toothbrush is less important than the result, which is that plaque is removed regularly and effectively without causing damage to the teeth and gums.
Two minutes is the recommended minimum time required to achieve reasonable plaque removal.
It is generally agreed that the basic requirements for an effective toothbrush are:
A small brush head
Small to medium bristles
Round ended filaments.
If the brush head is too large, it will not reach all the surfaces of the posterior teeth. If the bristles are too hard or the filaments are non-rounded, they could damage the gums if the patient brushes with too much pressure.
The addition of different filament lengths and rubber filaments may encourage the user who prefers the ‘feel’ of the brush and thus use it more effectively.
However, the most important aspect of toothbrushing is the duration.
Power toothbrushes contain small electric motors that cause the brush head to move.
Modes of action of the brush head include:
Rotation-oscillation (side-to-side and up and down) – the head spins back and forth in quick bursts
Counter oscillation – tufts of bristles rotate in different directions simultaneously.
It is generally accepted that patients with manual dexterity problems (e.g. arthritics or those with damaged hands), patients who wear an orthodontic appliance and those who have marked toothbrush abrasion, may benefit from using a powered toothbrush.
In some studies, the rotation-oscillation brushes have been shown to outperform manual brushes. However, the principal advantage of powered toothbrushes is the addition of a timing device which encourages users to brush for a full two minutes.
There are a variety of specialist toothbrushes:
Orthodontic / Implant Brushes
These are designed to facilitate easy access and effective plaque removal in narrow spaces around implants or surfaces close to orthodontic wires.
They may help compliance as patients appreciate what they perceive are tailored solutions to their specific oral hygiene needs.
Special Care Brushes
These are targeted at specific groups such as patients with acutely sore mouths or with problems in gripping the handle of a conventional toothbrush. These brushes come with standard / special needs adapted handles and small / medium heads with super soft filaments. The large, customised handles help the patients concerned to grip them more easily.
Toothbrushing for Infants
It is important that babies are introduced to a toothbrush as soon as their teeth start to erupt. This usually occurs at about four months but may be earlier or later.
Using a suitable small brush, the baby’s teeth should be very gently brushed before sleeping periods during the day and last thing at night.
As the infant grows older, a very small amount of special infant low fluoride toothpaste should be placed on the brush prior to its use.
Children are usually unable to clean their teeth satisfactorily until they can tie their shoelaces adequately. This means that their teeth should be brushed for them by a parent or carer, until they have acquired the skill at around eight years of age.