Toothbrushing

Toothbrushing with both manual and power brushes, has been shown to be effective in the removal of plaque on tooth surfaces.78,79 Time spent toothbrushing is associated with a significantly greater amount of plaque removal up to approximately two minutes.80 Most individuals, however, brush for significantly shorter periods of time.81,82 Softer toothbrush bristles are associated with superior plaque removal subgingivally and interproximally and result in less gingival recession and abrasion to oral soft tissues than hard toothbrush bristles.83,84 Similarly, high amounts of force are not necessary for adequate plaque removal and can cause trauma to hard and soft tissues in the mouth.82 It is important to replace toothbrushes regularly as bristle wear after 9 weeks of normal use can affect the efficacy of plaque removal.83

Figure 5.
Infographic showing facts about toothbrushing.

Power toothbrushes have been shown to be as effective as manual toothbrushes and power brushes with oscilating rotating action have been shown in several systematic reviews conducted by the Cochrane Collaboration, to remove significantly more plaque and reduce gingival bleeding than manual toothbrushes.84,85 Acceptance of powered toothbrushes among patients of all ages has been reported to be high86,87 and thus recommending a power toothbrush to patients, particularly those who demonstrate difficulty in motivation, may be beneficial. Patients who have dexterity issues may also see an additional benefit from powered toothbrushes as there is evidence that powered toothbrushes improve gingival health and plaque removal for 1) children and adolescents, 2) children with physical or mental disabilities, 3) hospitalized patients, including older adults who need to have their teeth cleaned by caregivers, and 4) patients with fixed orthodontic appliances.88,89

While no randomized controlled studies demonstrate that toothbrushing itself is effective in caries prevention, observational studies demonstrate that plaque accumulation is associated with increased rates of caries and proper toothbrushing has been shown to reduce plaque biofilms and improve gingival health.1,53,77,78