What are the Different Techniques of Brushing
One’s Teeth for a Healthier Oral Health?
Tooth brushing is defined as the act of scrubbing, cleaning and removing of plaque and food debris with the use of a toothbrush and a toothpaste.
In 3000 BC, the ancient Egyptians have started the habit of brushing one’s teeth using crude toothbrushes constructed from twigs and leaves. Similarly, other cultures such as the Greeks, Romans, Arabs and Indians cleaned their teeth with twigs. Some would even fray one end of the twig so that it could more effectively penetrate between the teeth.
Modern day tooth brushing became prevalent in Europe by the end of the 17th century and, the first mass-produced toothbrush got developed by the English in 1780. In the United States, toothbrushes became only available by the end of the 19th century. The practice of tooth brushing did not become widespread until after the Second World War when US soldiers were required to do so during their military service. Today, tooth brushing is a widespread and normal routine part of oral hygiene.
Various brushing techniques have been studied and introduced by researchers to further clean the teeth in order to prevent tooth cavities and gum diseases. The oldest brushing technique was described by Fones in 1913 and recommended mainly for children. On this post, we will discuss these tooth brushing techniques that we can choose from and teach our patients for better oral care practice. These are the following Tooth Brushing Techniques:
BASS OR SULCUS CLEANING METHOD
It is the most accepted and effective method for the removal of dental plaque found adjacent and underneath the gingival margin.
- ➢Those with open interproximal areas at the cervical surface beneath the height of contour of enamel and exposed root surfaces.
- ➢For patients who had periodontal surgery but not immediately after surgery.
- ➢For patients with or without periodontal involvement.
- ➢The toothbrush bristles are placed at gum line and are tilted at an angle of 45. They are then moved in a circular action.
- ➢The circular movement should be small, covering 3 teeth at a time. Each set of 3 teeth should be brushed about 15-20 times.
- ➢The same action is carried out on the inner side of the teeth, the only difference being that the brush is put inside in a vertical position and the bristles are angled at about 45 degrees.
- ➢The chewing surfaces of the teeth are also brushed in a circular motion.
- ➢For those who find it difficult to tilt the bristles can also place them parallel to the teeth.
- ➢Effective method for removing plaque.
- ➢Provides good gingival stimulation.
- ➢Easy to learn.
- ➢Overzealous brushing can result to scrub technique of brushing that may injure the gingival margin.
- ➢Time consuming.
- ➢On certain patients, dexterity requirement to reach all tooth surfaces can be challenging.
MODIFIED BASS TECHNIQUE:
This method differs from bass technique as it is done in sweeping motion from cervical to incisal or occlusal surface. The use of a soft toothbrush is recommended for this technique.
- ➢As a routine oral hygiene measure.
- ➢For intra-sulcular cleansing.
- ➢It is recommended for patients with or without periodontal involvement.
- ➢It is recommended for cleaning areas with progressive gingival recession and root exposure as it prevents further abrasive tissue destruction.
- ➢This technique combines the vibratory & circular movements of the Bass technique with the sweeping motion of the Roll technique.
- ➢The toothbrush is held in such a way that the bristles are at 45° to the gingiva.
- ➢Bristles are gently vibrated by moving the brush handle in a back & forth motion.
- ➢The bristles are pointed apically with an oblique angle to the long axis of the tooth.
- ➢The bristles are then swept over the sides of the teeth towards their occlusal surfaces in a single motion.
- ➢The bristles are positioned partly on the cervical aspect of tooth and partly on the adjacent gingiva.
- ➢The bristles are activated with short back and forth motion and simultaneously in coronal direction.
- 20 strokes are applied and procedure is repeated systematically on adjacent teeth.
- ➢This brushing technique is excellent for cleaning the sulcus.
- ➢Good interproximal and gingival cleaning.
- ➢It cleans tooth surfaces and massages the gingiva provideing good gingival stimulation.
- ➢Dental plaque removal from the cervical areas below the height of contour of enamel and from exposed proximal surface.
- ➢Dexterity of wrist is required to achieve its brushing strokes.
- ➢Time consuming.
- ➢Improper brushing can damage the epithelial attachment.
STILLMAN’S BRUSHING TECHNIQUE:
This technique is similar to the Bass technique except that the bristles are placed partly over the cervical portion of the teeth and partly on the adjacent gingiva.
- ➢For spongy gingival tissue where massaging is valuable.
- ➢For cleansing areas with the progressive gingival recession and root exposure to minimize abrasive tissue destruction.
- ➢As compared to Bass technique where the bristles' end enter the gingival sulcus, the Stillman’s technique avoids the penetration of the bristle into the gingival sulci.
- ➢The brush is activated with 20 short back-and-forth strokes and is simultaneously moved in a coronal direction along the attached gingiva, gingival margin and tooth surface.
- ➢The advantage of this brushing technique is that it provides gingival stimulation along with plaque and debris removal from cervical margins of the teeth and wide embrasures.
- ➢Similar to the Bass technique of tooth-brushing, this technique requires patience for placing the toothbrush in many different positions throughout the dentition while brushing.
MODIFIED STILLMAN’S BRUSHING TECHNIQUE:
- ➢Indications are the same as discussed in Stillman’s techniques
- ➢The technique is indicated for patients with gingival recession because it provides good gingival massage.
- ➢The technique is the same as Stillman’s technique with the addition of a sweeping movement of the bristles in a coronal direction.
- ➢This techniques offers good gingival and interproximal cleaning.
- ➢The technique is difficult to learn and implement.
CHARTER BRUSHING TECHNIQUE:
This brushing technique of tooth brushing was recommended by Charter in 1848.
- ➢For patient with fixed prosthodontic or orthodontic appliance and those who recently undergone periodontal surgery.
- ➢Recommended following periodontal surgery.
- ➢Suitable for cervical areas below the height of contour of the crown and exposed root surfaces.
- ➢In this brushing technique, the brush is placed is at an angle of 45 º to the long axis of the teeth in an opposite direction.
- ➢After adaptation of the brush in place, the bristles point away from the gingiva but towards the interproximal surface of the teeth.
- ➢After placing the bristles at the gingival margin, short back and forth vibratory strokes are given.
- ➢The bristles of the brush are then pressed on the occlusal surface of the teeth and using a slight rotary motion, pits and fissures are cleaned.
- ➢It helps loosen debris and bacterial plaque.
- ➢This brushing techniques aids in cleansing fixed orthodontic appliance.
- ➢It massages and causes stimulation of marginal and interdental gingiva
- ➢This brushing technique is useful in removing bacterial plaque from the abutment teeth under the gingival border of fixed partial denture or from the under surface of the fixed bridges.
- ➢Massages and stimulates the marginal and interdental ginginva.
- ➢After periodontal surgery, this technique gently massages the wounded area and promotes healing.
- ➢Brush ends do not engage in the gingival sulcus to remove subgingival bacterial accumulations.
- ➢The correct brush placement is limited or sometimes impossible, therefore, modification becomes necessary which add to the complexity of the procedure.
- ➢Requires a high digital dexterity for brushing ones teeth.
THE ROLL TECHNIQUE:
This method of brushing is also known as the Rolling Stroke method or the Sweep method.
- ➢It works fairly well for patients with anatomically normal gingival tissues.
- ➢Best taught to children.
- ➢Adult patient with limited dexterity.
- ➢Useful as preparatory step leading to the use of modified Stillman’s technique since the initial brush placement is the same.
- ➢The bristles are placed at a 45° angle.
- ➢Toothbrush is rolled across the tooth surface towards the occlusal surface.
- ➢This technique requires some flexibility around the wrist.
- ➢Provide gingival massage and stimulation.
- ➢Brushing too high during initial placement can lacerate the alveolar mucosa.
- ➢There's a tendency that a quick and sweeping strokes are produced, so, the brush tips passes over the cervical third and interproximal area of the tooth, thus, resulting to a failure of cleaning these areas.
- ➢Replacing the brush with filament tips directed into the gingiva may produce punctuate lesions.
In conclusion, any technique is a plausible technique to use in brushing our teeth, but, what’s more important for us, as dental professionals, is educating our patients about their oral health. Providing our patients information of basic oral hygiene such as tooth brushing is a necessity to prevent the spread of oral and dental diseases. Daily tooth brushing at the technique convenient and effective for your patient can contribute to a lifetime of having an optimal oral health. It is after all one of the most effective tools to keep teeth clean and gums healthy. So, make it part of your constant habit of teaching your patients to brush their teeth regularly during their visit they’ll thank you for it.
Dr. Bryan Anduiza - Writer
Dr. Jean Villanueva - Editor