Introduction
The most common cause of many oral health problems is plaque. Plaque is a sticky film that forms in different areas of the mouth, such as on teeth, between teeth, and along the gum line.
Plaque can lead to tooth decay, gingivitis, and gum disease If not taken care of. These conditions can cause eating difficulties, bad breath, and tooth loss, and can impact general health.1 To prevent this, plaque must be regularly removed, especially in areas that are hard to reach.
According to experts, the best way to remove plaque is by brushing teeth twice a day with fluoride toothpaste.2 However, using the wrong brushing method can cause problems like leaving plaque behind, gum injury, and poor oral hygiene.
Fortunately, advanced methods have been developed to teach people how to brush their teeth properly and remove plaque effectively. By learning these advanced methods and using the right oral care products, there will be fewer chances of plaque buildup which can lead to better oral health.3
Understanding plaque and the role of toothbrushes
There are over 700 types of microbes inside the human mouth. While most of these microbes are harmless, some can damage teeth and gums. Whenever we eat, microbes feed on food high in carbohydrates and sugars, producing acids that gradually damage tooth enamel, causing tooth decay.
Plaque can also form under the gum line, potentially causing gum inflammation and damage to the bone supporting the teeth.4
Brushing your teeth is one of the simplest and most effective ways to remove plaque and prevent oral diseases. Toothbrushes are designed for multiple purposes, including
- Removing plaque and preventing its buildup
- Cleaning teeth of food, debris, and stains
- Stimulating gums to promote healthy blood flow
- Applying toothpaste with specific ingredients to prevent cavities, gum disease, or sensitivity
Most people adopt brushing methods, which usually involve basic horizontal, vertical, or circular motions without focusing on specific angles or movements. Although these methods can remove plaque from the outer and inner surfaces of the teeth, they can be harmful because excessive scrubbing can cause gum recession. Learning the right toothbrushing methods can help address this.
Advanced brushing methods
Advanced brushing methods involve precise angles and movements to remove plaque, especially in tricky areas. These methods can also stimulate gums and improve oral hygiene. These methods include: 5,6
Bass (sulcular) brushing method
The bass method is one of the most popular brushing methods recommended for adults. The Bass method allows thorough cleaning of areas under the gumline where plaque accumulates.
Start by holding the toothbrush parallel to your teeth, angled at 45 degrees, and gently use circular motions under the gumline. After this, brush the outer tooth surfaces and your tongue. To clean between your teeth, hold the toothbrush upright, making sure the bristles touch your gums
Stillman’s brushing technique
Like the Bass method, the Stillman method targets both tooth surfaces and the gumline. However, it uses short, back-and-forth strokes toward the chewing surface to remove debris between teeth.
Angle the toothbrush and brush under the gum line, paying attention to areas where food and plaque accumulate most
Charter’s brushing technique
The Charter method is great for people with gaps between teeth, exposed roots, or gum surgery. It's also good for people with orthodontic appliances, such as braces or partial dentures.
Angle the toothbrush bristles at 45 degrees toward the gumline, and use short circular or back-and-forth motions for about 15 to 20 seconds. Make sure to clean all tooth surfaces, including the inner and outer sides, and the chewing surfaces of the molars (posterior or back teeth)
Modified bass, modified stillman’s and modified charter’s
If you know the main brushing techniques like Bass, Stillman, and Charter these methods are easy to follow. Just follow the steps for each method, and after finishing, roll the brush bristles toward the chewing surfaces of the teeth. This guarantees the thorough cleaning of all tooth surfaces and minimises the risk of harming the base of the gum line
Fone's technique
The circular brushing method involves moving the toothbrush in circles around each set of teeth, before moving to the next. It's often taught to children, but adults can also use this technique.
However, it's not as effective as other methods mentioned earlier. To use this method, gently press the toothbrush bristles against the teeth and move them in circles around each set of teeth about 4-5 times before moving on.
Which brushing method should I use?
There is not enough evidence suggesting that one toothbrushing method is better than another in reducing and removing plaque. Generally, the American Dental Association recommends placing the toothbrush at a 45-degree angle against the gumline to remove plaque from above and below the gums and gently moving the brush back and forth.
For the inside of the front teeth, they suggest tilting the brush vertically and making up-and-down strokes. Regardless of the methods used, it's important to brush all surfaces and use a soft-bristled brush with gentle pressure to reduce the risk of gum injury.7,8
How to select the right brush and toothpaste
Picking the right toothbrush
Choosing the right toothbrush is important for keeping your teeth clean and healthy.
Here's what to think about:
- Bristles: Get a toothbrush with soft bristles to avoid hurting your gums and enamel. Soft bristles clean well without causing damage. But avoid extra-soft ones unless your dentist recommends them after surgery
- Head Size: Pick a toothbrush with a head size that fits your mouth well, so you can reach all your teeth easily
- Handle Grip: Look for a toothbrush with a comfortable, non-slip grip for easy brushing
Manual or electric toothbrushes
Both manual and electric toothbrushes work great, but some people might find electric ones easier to use. Electric brushes often have extra features like timers and pressure sensors to help you brush better.
Choosing the right toothpaste
Picking the right toothpaste for your needs is important for keeping your mouth healthy. Here's what to consider:
- Fluoride: Make sure your toothpaste has fluoride to prevent cavities and strengthen your teeth
- Special Formulas: If you have specific dental issues, like sensitive teeth or gum problems, choose a toothpaste designed for those needs
- Product certification: When looking for toothpaste, look for certification from reputable dental associations or regulatory bodies. This means the product has been evaluated and meets established safety and effectiveness standards
- Flavour: Choose a toothpaste with a flavour and texture you like to make brushing more enjoyable
Types of toothpaste
- Fluoride: This type of toothpaste contains fluoride, a mineral that helps strengthen tooth enamel and prevent cavities. It's suitable for everyday use and recommended by dentists worldwide
- Tartar control: Tartar control toothpaste is formulated to prevent the buildup of tartar, a hard mineral deposit that can lead to gum disease and tooth decay. It is helpful for those prone to tartar buildup
- Desensitising: If you have sensitive teeth, desensitising toothpaste can help ease discomfort by blocking nerve signals
- Whitening: Whitening toothpaste can help brighten your smile by removing stains. For tough stains, professional bleaching might be needed
- Children's: Kids' toothpaste comes in different fluoride levels for different ages and usually has fun flavours to make brushing fun
Toothbrushes and toothpaste for dentures
Using the right toothbrush and toothpaste for dentures is important to keep them clean and in good shape. Use a soft-bristled brush to avoid damaging dentures. Use toothpaste specifically made for dentures to clean them properly without causing damage.
Recommendations for proper brushing
Here are some recommendations from dental professionals for successful toothbrushing.2
- Brush your teeth at least twice a day, ideally before bedtime and once during the day, to remove plaque and maintain fluoride levels
- Brush your teeth for enough time to clean all surfaces properly, focusing on thorough cleaning rather than a specific time limit
- Use proper brushing techniques, like the Bass or Fones method, as the effectiveness of toothbrushes depends on how you brush
- Children should be supervised while brushing until they can do it on their own and develop correct brushing habits
- Avoid rinsing your mouth immediately after brushing to keep fluoride toothpaste in your mouth and giving it time to act effectively. However, using mouthwash at other times may be helpful, especially for those at high risk of dental diseases
Tips to control plaque
In addition to brushing your teeth every day, there are some things you can do to help control plaque, such as:
- Flossing: Flossing once a day can help remove plaque and debris from between the teeth and along the gum line, where toothbrushes cannot reach
- Diet: Sugary and acidic foods and beverages can contribute to tooth decay and enamel erosion. Reducing these foods can protect your teeth from damage and maintain oral health
- Using fluoride products: Fluoride strengthens the tooth enamel and helps prevent tooth decay. Use fluoride toothpaste and mouthwash to protect your teeth against cavities and to maintain strong, healthy enamel
- Regular dental check-ups: Visit your dentist for routine dental check-ups and professional cleanings. Regular dental visits allow for early diagnosis and treatment of dental diseases
Summary
Plaque is a sticky film that forms in different parts of the mouth. It is important to remove plaque regularly, as it can lead to oral diseases such as dental caries and gingivitis.
The best way to prevent this and get rid of plaque is by learning to brush your teeth properly. Advanced brushing methods, such as the Bass, Stillman’s, and Charter’s methods, along with their modifications, help remove plaque compared to the normal brushing methods.
While the way we brush our teeth is important, choosing the right toothbrush and toothpaste, flossing daily, maintaining a healthy diet, and seeing your dentist regularly can also help control plaque and prevent dental problems.
References
- Marsh PD, Bradshaw DJ. Dental plaque as a biofilm. Journal of Industrial Microbiology [Internet]. 1995 [cited 2024 Feb 27]; 15(3):169–75. Available from: https://academic.oup.com/jimb/article/15/3/169/5988575.
- FDI releases a consensus on toothbrushing recommendations | FDI [Internet]. [cited 2024 Mar 10]. Available from: https://www.fdiworlddental.org/fdi-releases-consensus-toothbrushing-recommendations.
- Glenny A-M, Walsh T, Iwasaki M, Kateeb E, Braga MM, Riley P, et al. Development of Tooth Brushing Recommendations Through Professional Consensus. International Dental Journal [Internet]. 2023 [cited 2024 Mar 10]; S0020653923009632. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0020653923009632.
- Mouth Microbes. NIH News in Health [Internet]. 2019 [cited 2024 Mar 10]. Available from: https://newsinhealth.nih.gov/2019/05/mouth-microbes.
- Department Of Periodontology, Chandra Dental College & Hospital, Barabanki, India, Agrawal S. Toothbrushes and Tooth Brushing Methods: A Periodontal Review. J Clin Stud Med Case Rep [Internet]. 2022 [cited 2024 Mar 10]; 9(1):1–12. Available from: https://www.heraldopenaccess.us/openaccess/toothbrushes-and-tooth-brushing-methods-a-periodontal-review.
- Pindobilowo, Umi Ghoni Tjiptoningsih, Dwi Ariani. Effective Tooth Brushing Techniques Based on Periodontal Tissue Conditions : A Narrative Review. FJAS [Internet]. 2023 [cited 2024 Mar 10]; 2(7):1649–62. Available from: https://journal.formosapublisher.org/index.php/fjas/article/view/4838.
- Zanatta FB, Bergoli AD, Werle SB, Antoniazzi RP. Biofilm removal and gingival abrasion with medium and soft toothbrushes. Oral Health Prev Dent. 2011; 9(2):177–83. Available from: https://pubmed.ncbi.nlm.nih.gov/21842020/
- Cifcibasi E, Koyuncuoglu CZ, Baser U, Bozacioglu B, Kasali K, Cintan S. Comparison of manual toothbrushes with different bristle designs in terms of cleaning efficacy and potential role on gingival recession. Eur J Dent [Internet]. 2014 [cited 2024 Mar 10]; 08(03):395–401. Available from: http://www.thieme-connect.de/DOI/DOI?10.4103/1305-7456.137655.