Patient Brushing Instruction

When teaching any new oral hygiene skill, the dental professional must assess the patient’s knowledge, attitudes, values and psychomotor skills. The patient’s particular situation, such as their socio-economic status and stress levels also should be assessed. Establishment of new oral hygiene practices are dependent on active participation of the patient. Dental professional instruction given directly with the patient is the best because it allows for immediate feedback. Self-instructional materials can also be used by patients at home in addition to face-to-face instruction. The patient should be involved in the instructional process.52 One great way to facilitate patient involvement and compliance is with self-evaluation. For example: patients can use disclosing tablets after brushing to show the areas that need more attention.

One advantage of power toothbrushes is that the patient only has to focus on the placement of the brush, not the brushing action; therefore the power toothbrush supports a more effective plaque removal versus a manual tooth brush. It is imperative that the dental professional review the manufacturer’s instructions due to the vast number of designs available. Note the manufacturer’s suggestions for use and care of the brush.

Some electric toothbrushes like oscillating-rotating toothbrushes with remote displays also coach the patient to brush more thoroughly, longer, and without applying too much pressure.

General instructions for power toothbrushes include selecting a brush with soft, end-rounded filaments and a dentifrice within the accepted RDA range (<250 ADA recommended limit). Instruct the patient to spread the dentifrice over several teeth before starting to brush to prevent splashing of the dentifrice when the brush is turned on. Not turning the power brush on until the brush is in the oral cavity also reduces the spattering of toothpaste. The patient should vary the brush position to reach each tooth surface, including the distal, facial, mesial and lingual surfaces. The angulation may need to be altered for access to malpositioned teeth. Be sure to instruct the patient to “feel” the toothbrush on all surfaces of the teeth. After awhile this will become second nature and the patient will not have to think about it. For brushing the occlusal surfaces, place the toothbrush with filaments pointing into the occlusal pits at a right angle. The patient can move the brush head in a slight circular motion while the filaments are in the occlusal pits or can press moderately (not bending the bristles) so the filaments go straight into the pits and fissures. The strokes for the occlusal surfaces are sharp and quick. The toothbrush should be lifted after each stroke to dislodge any loosened debris.

Tongue cleaning can also be done with a power toothbrush, and is important because it retards plaque formation and total plaque accumulation. Some toothbrushes have specific brush heads designed for tongue cleaning. With the tongue extruded, the brush head should be placed at a right angle to the midline of the tongue with the bristles pointing toward the throat. With light pressure, the sides of the filaments are drawn forward toward the tip of the tongue. This procedure should be repeated 3-4 times until the tongue surface is clean.53