Toothbrushing techniques in detail
Good oral hygiene is important in order to help prevent periodontal disease and dental caries. In the video in the previous step, Chris received oral hygiene instruction from Jill, a Hygienist. This article will describe in more detail the method Jill introduced to Chris, and also some information about other tooth-brushing techniques.
First, choose a toothbrush
There are many different aids to help maintain good oral hygiene, the most essential being effective tooth brushing with a good quality toothbrush. So what makes a good toothbrush?
- Small compact head (to get into the small spaces)
- Soft, round ended filaments that are made of nylon
Many different tooth brushing methods have been introduced over the years. Described below are the techniques used most frequently, with the names commonly used to describe them. The descriptions use the common dental terms for directions and surfaces, so refer to the glossary in step 2.2 if you need a reminder.
A quick reminder from Jill that the best method is the one that is working for you, so don’t change your method (or your brush type) unless you are experiencing problems.
This is the method demonstrated to Chris in the video, and requires good manual dexterity so may not be suitable for everyone. Holding the toothbrush between fingers and thumb, place the bristles at a 45° angle to the teeth so that they point towards the junction of the tooth crown and gingiva (gum). By doing this the bristles can penetrate up to 3mm subgingivally (below the gum) in a healthy mouth, and even deeper into the pocket where periodontal disease is present. Once in the correct position, the head of the brush is vibrated in a small circular action. In order to clean the lingual surface of the anterior teeth, the toothbrush should be placed in a vertical position. The occlusal surface is brushed using the scrub technique.
This technique is usually adopted by children or by adults who have not received any advice on tooth brushing, but should only be used by children or those with poor manual dexterity. The toothbrush is simply swept along the teeth backwards and forwards, often in long strokes, covering all the surfaces including the occlusal. The problem with this method is that abrasion cavities may be caused by over brushing certain areas and by being too heavy handed. To overcome this, change the grip from a palm grip to a finger grip, and use short movements covering one tooth at a time. The advantage of this method is that it is easy to follow.
A technique recommended for young children, as it is easy to learn. Always use a soft toothbrush to avoid gingival damage. The teeth are closed together and with the toothbrush at 90° to the teeth, a small circular action is used covering the maxillary and mandibular posterior teeth. For the anterior teeth the incisors are placed edge to edge and the mouth is opened to clean the remaining surfaces. The occlusal surfaces are cleaned using the scrub technique.
With this technique the bristles are placed at the junction of the crown of the tooth and the gingiva (gums) pointing apically (towards the tooth roots). The head of the brush is then rotated upwards on the lower teeth and downwards on the upper teeth towards the occlusal surface. The occlusal surfaces are cleaned using the scrub technique. The advantage of this method is that pressure can be applied to the gingiva without causing gingival recession; however the disadvantage is that it does not clean subgingivally. This method is often shown to patients with recession, often combined with the BASS technique.
And there is also the ‘MODIFIED BASS’
Carried out exactly the same as the bass technique but at the end the operator uses the roll technique. This method can be used by someone who needs to clean subgingivally, but who also has some areas of gum recession.
Techniques for Powered Toothbrushes
There are many designs on the market, and some vibrate whilst others rotate. In recent studies it has been proven that powered toothbrushes with a rotation-oscillation action remove more plaque than a manual toothbrush (see link at bottom of page). They are very good for the young, the elderly, mentally and physically disabled people with poor manual dexterity, and for those people who would otherwise have a poor brushing technique. They are not used the same as a manual toothbrush, but should be held against the tooth to let the toothbrush do the work. Very little pressure is placed on the tooth with these brushes and so they are useful for patients who have a tendency to over brush some areas, causing abrasion cavities.
How to brush babies’ and children’s teeth
This is not an easy task but it needs to be done on a regular basis! Parents need to clean the baby’s mouth after feeding, initially with something like a wet cotton bud and then when the first teeth erupt, with a soft baby’s brush and a smear of toothpaste containing no less than 1000ppm fluoride.
To clean children’s teeth, stand behind them or sit them on your knee. Tilt the child’s head back so you can see into their mouth. Gently but thoroughly clean all the surfaces of the teeth. When you have finished, let the child have a go with the toothbrush. If the child won’t open their mouth, place your fingers in the child’s mouth and very gently apply pressure at the back of the mouth behind the molars using your thumb and first finger, this should open the jaw with no discomfort to them. Children need to be helped or supervised by an adult when cleaning their teeth until the age of at least 7 and encouraged to spit out excess toothpaste and not rinse.
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