Basic Oral Hygiene

It is important to make oral hygiene recommendations to patients based on their individual needs. The process of care is a standard that dental professionals should follow in the treatment of patients and includes an implementation phase to provide patients with education and recommendations. According to the American Dental Hygienists’ Association’s 2025 Standards for Clinical Dental Hygiene Practice guidelines, post-treatment instructions included in the implementation phase should include evidence-based oral hygiene practices and products.⁵ This also includes helping patients choose the best type of toothbrush, toothpaste, and interproximal cleaning aids.

Two toothbrushes that are given as options for patients are manual and power toothbrushes. Studies have shown that power toothbrushes are more effective in removing dental plaque.⁶ There is also evidence to support that oscillating-rotating power brushes are slightly more effective at removing dental plaque than high frequency sonic power brushes.⁶

When choosing a manual toothbrush, a soft bristled toothbrush is usual for most patients due to the risk of trauma with harder bristled brushes. While there are many different brushing methods, the method commonly recommended to healthy patients is a sulcular brushing method known as the Bass method. The Bass method is widely accepted as an effective method for dental biofilm removal.⁴ The procedure for this method includes directing toothbrush bristles apically at a 45° angle to the long axis of the tooth into the gumline, pressing lightly, and using vibratory strokes. For the occlusal surfaces of the teeth, a 90° angle is recommended. It is also standard to recommend brushing at least 2 times per day for at least 2 minutes each session.

When choosing a power toothbrush, soft bristles are still recommended. When using a power toothbrush, the power brushing method is used. This method involves placing the head of the toothbrush at the gumline and slowly moving the brush after a few seconds around each tooth. The recommended brushing time is two minutes twice daily and it is recommended to change the toothbrush head every three months or after you have been sick.

Flossing is the standard recommendation for interproximal cleaning for many patients but is most effective when interdental papillae are present and there has not been loss of attachment with root surface exposure.⁴. Although there are several different types of dental floss, research shows that there is no difference between waxed and unwaxed floss on the effectiveness of biofilm removal.⁴ The method for flossing that is typically recommended is to use 18 inches of floss wrapping it around the middle fingers of both hands and using index fingers and thumbs to gently guide the floss past each contact area without causing trauma to the interdental papilla. Once the floss has passed the contact area, the floss should be adapted to both tooth surfaces one at a time using a C-shape then sliding up and down over the tooth surface at least twice. It is recommended to floss at least once per day prior to toothbrushing.

Figure 4
Use about 18 inches of floss, so you have a clean piece to use on each tooth in the cleaning process

Figure 4
Use about 18 inches of floss, so you have a clean piece to use on each tooth in the cleaning process

Oral Irrigation is another highly recommended form of interproximal cleaning that has been found to be safe and well-accepted when used appropriately.⁷ Oral irrigation has been shown to reduce periodontal inflammation and has shown great benefits in populations with dental implants and special needs.⁷ Other popular uses for oral irrigation include orthodontic treatment, permanent retainers, dental bridges, gingivitis, and as an alternative for poor dental flossing compliance.

When it comes to choosing a toothpaste, stannous fluoride was shown to be the most effective of all the fluoride additives used in toothpaste.⁸ Stannous fluoride has been shown to protect against tooth decay, gingivitis, and sensitivity. Many current toothpastes containing stannous fluoride have been developed to be effective without causing staining on the teeth.