Post on 16-Jul-2015
CONTENTS :2
1. Introduction
2. History
3. Manual Toothbrushes
4. Toothbrushing Techniques
5. Power Toothbrushes
6. Toothbrushing for Special Conditions
7. Effects of Toothbrushing
8. Care of Toothbrushes
9. Modern toothbrushes
4
The toothbrush is the principal instrument in
general use for removal of dental biofilm and is
a necessary part of oral disease control.
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Toothpicks as Toothbrushes6
3000 B.C - Mesopotamia
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
History of Periodontology ; Fermin carranza, Vincenzo Guerini
7
Omar Khayyam
(1025 – 1123)
William Shakespeare
(1564 – 1616)
Erasmus
(1466 – 1526)
Chewstick8
1600 B.C. – China
Religious ritual
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Middle ages9
Tang Dynasty (619 - 907)
1223 – Dōgen Kigen
1498
1728 – Pierre Fauchard(Le Chirurgien Dentiste)
History of Periodontology ; Fermin carranza, Vincenzo Guerini
DuPont de Nemours12
24 FEB, 1938 – First nylon bristle toothbrush.
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Electric Toothbrush13
The first electric
toothbrush, the
Broxodent, was
invented in
Switzerland in 1954
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Toothbrush :15
According to American Dental Association Council on Dental Therapeutics
‘The toothbrush is designed primarily to promote cleanliness of teeth & oral
cavity.’
OBJECTIVES:
1. To clean teeth and interdental spaces of food remnants, debris & stains.
2. To prevent plaque formation.
3. To disturb and remove plaque.
4. To stimulate and massage gingival tissues.
5. To clean the tongue.
6. Halitosis control
7. Sanitation of oral cavity
Essentials of preventive & Community Dentistry; Soben Peter
Characteristics :16
1. Conforms to individual patient requirements in size, shape &
texture.
2. Easily & efficiently manipulated.
3. Impervious to moisture ; readily cleaned & aerated.
4. Durable & Inexpensive.
5. Has prime functional properties of flexibility, softness, & of
strength, rigidity & lightness of the handle.
6. Is designed for utility, efficiency & cleanliness.Clinical Practice of The Dental Hygienist; Esther M. Wilkins
ADA Specification :18
Brushing Surface:-
1 to 1.25 inches in length (25.4 to 31.8 mm
long)
5/16 to 3/8 inches in width (7.9 to 9.5 mm
wide)
2 to 4 rows of bristles
5 to 12 tufts per row Essentials of preventive & Community Dentistry; Soben Peter
Manufacturing :19
Handle
Durability
Moisture
Appearance
Cost
Maneuverability
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
20
Shape :
Grasp
Projections
Weight
Strength
† A Twist, curve, offset, or angle in the shank with or without thumb rests
may assist the patient in the adaptation of the brush to difficult-to-reach
areas.
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Factors Influencing Stiffness :22
1. Diameter
2. Length
3. Number
4. Angle
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Toothbrush Selection :24
Ability of the patient
Manual dexterity of the patient
Age of the patient
Size & Shape
Professional personnel
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Soft Nylon Brush25
1. More effective in cleaning.
2. Less traumatic to the gingival tissue.
3. Can be directed into the sulcus & into interproximal areas.
4. Applicable around appliances.
5. Tooth abrasion &/or gingival recession can be prevented.
6. Effective use for sensitive gingiva.
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Guidelines :27
A. Grasp of Brush :
Objectives –
1. Grasp & manipulate the brush for successful removal of
dental biofilm.
2. Control of brush during all movements.
3. Sensitivity to the amount of force applied.
4. Effective positioning.
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Procedure –
1. Grasp handle in the palm of the hand with thumb against the
shank.
2. Position filaments in the proper direction for placement on the
teeth.
3. Adapt grasp for various positions of the brush head.
4. Apply appropriate pressure for the removal of the dental biofilm.
28
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
30
C. Amount –
The Count System :
1. Count 6 strokes in each area for modified Stillman or other
method in which a stroke is used.
2. Count slowly to 10 for each brush position while brush is
vibrated & filament ends are held in position for the Bass,
Charters, or other vibratory method.
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
31
The Clock System
1. Some patients brush thoroughly while watching a
clock or a egg timer.
Built-in timers
1. Signals may be set for 30seconds, one or two
minutes.
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
32
D. Frequency –
Emphasis in patient education is placed on complete
biofilm removal daily rather than the number of
brushings.
Atleast two brushings, are recommended for the control
of dental biofilm, oral sanitation & for halitosis control
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Methods of Toothbrushing :33
1. Sulcular (Bass) Method & Modified Bass Method
2. The Stillman Method & Modified Stillman Method
3. Charters Method
4. Roll : Rolling Stroke Method
5. Circular : Fones
6. Vertical : Leonard
7. Physiologic : Smith
8. Horizontal
9. Scrub – brushClinical Practice of The Dental Hygienist; Esther M. Wilkins
Modified Bass & Bass Method :34
Indication
Limitation
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Modified Stillman & Stillman
method 35
Indication
Limitations
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Charter’s Method :36
Indication
Limitation
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Rolling Method 37
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Indication
Limitation
Circular : Fones Method38
Indication
Limitation
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
Vertical : Leonard Method39
Given by Hirschfeld
With teeth edge-to-edge, place the brush filaments against
the teeth at right angles to the long axes of the teeth.
Brush vigorously with light pressure & mostly up and down
strokes with a slight rotation or circular motion after striking
the gingival margin with force.
Use enough pressure to force the filaments into the
embrasures, but not enough to damage the brush.
Detrimental Methods :40
A. Horizontal –
1. An unlimited sweep with a horizontal scrubbing
motion.
2. Can produce tooth abrasion.
3. Interproximal areas not touched.
41
B. Scrub-brush –
1. Consists of vigorously combined horizontal, vertical &
circular strokes, with some vibratory motions for certain
areas.
2. Can encourage gingival recession & tooth abrasion
Power Toothbrushes :43
The heads of these toothbrushes oscillate in a side to side motion or in
rotary motion. The frequency of the oscillations is around 40Hz in an
ordinary powered toothbrush.
ADVANTAGES
1. It increases patient motivation resulting in better patient compliance.
2. Increased accessibility in interproximal and lingual tooth surface
3. No specific brushing technique required
4. Uses less brushing force than manual toothbrushes
5. Brushing timer is incorporated in some brushes to help the patient in
brushing for the required duration.
Power v/s Manual :
McKendrick, A.J.W., et al. : A Two-year Comparison of Hand & Electric Toothbrushes, J.Periodontol. Res.,
3,224,1968
44
Biofilm removal & reduction of gingivitis¹
Current power brushes move in speeds & motions
that cannot be duplicated by manual brushes.
Safety of powerbrushes as compared to manual-
brushes has been well established.
Self-included timers.
Indications :45
1. Ineffective manual biofilm removal techniques
2. Reduce calculus & stain buildup
3. Undergoing orthodontic treatment
4. Aggressive brushers
5. Patients with disabilities or limited dexterity
6. Patients unable to brush
Acute Oral Inflammatory/Traumatic
lesions :54
Brush all areas of mouth that are not affected
Rinse with warm, mild saline solution to
encourage healing & debris removal.
Resume regular biofilm control measures on the
affected area as soon as possible.
Following periodontal Surgery :55
Brush occlusal surfaces of the teeth & use light
strokes over the dressing.
Avoid direct vigorous brushing.
Brush over teeth & gingiva, not involved in
surgery.
ANUG :56
In acute stage oral tissues are sensitive to any
touch, toothbrushing is therefore neglected.
Soft brush recommended along with careful
brush placement.
Dental abrasion60
Abrasion is the varying away of tooth structure.
Incorrect brushing especially with an abrasive
toothpaste is the most common cause.
Primarily on facial surfaces – canines, premolars
or any tooth in buccoversion or labioversion
Cervical areas – most abraded areas.
Brush Replacement :62
Frequent replacement recommended; every 3 months
Brushes need to be replaced before filaments become
splayed or frayed or lose resiliency.
Brush contamination occurs with use.
Patients who are debiliated, immunosuppresed, have a
known infection can be advised to disinfect their brushes or
use disposable brushes.
Cleaning Toothbrushes :63
Clean thoroughly after each use.
Hold brush under strong stream of warm water from faucet to force particles, dentrifice and bacteria from between the filaments.
Tap the handle on the edge of sink.
Use one toothbrush to clean another brush.
Rinse completely & tap out excess water.
Brush Storage :64
Open air – upright position, apart from contact with other
brushes.
Portable brush containers – with sufficient holes.
At least 6 feet away from the toilet.
Sonic Toothbrushes : 66
These types of toothbrushes produce high frequency
vibrations (1.6MHz)which leads to the phenomenon of
cavitation and acoustic microstreaming. This
phenomenon aids in stain removal as well as disruption
of the bacterial cell wall (bactericidal).
Ionic Toothbrushes : 68
Ionic toothbrushes change the surface charge of a tooth by
an influx of positively charged ions.
The plaque with a similar charge is thus repelled from the
tooth surface & is attracted by the negatively charged
brush.
73
C.G.Daly, C.C.Chapple et al. To investigate the effect of
progressive toothbrush wear on plaque control. J Clin
Periodontol – 1996; 23: 45-49
Akshay Vibhute, K.L. Vandana. The effectiveness of
manual v/s powered tootthbrushes for plaque removal &
gingival health- A meta analysis. JISP – 2012, vol 16, issue
– 2
M.F. Timmerman et al. Comparitive analysis of high & low
brushing force in relation to efficacy and gingival abrasion.
J Clin Periodontol 2004, 31 : 620 - 624
References : 74
Clinical Practice of The Dental Hygienist; Esther M. Wilkins
History of Periodontology ; Fermin carranza, Vincenzo Guerini
Essentials of preventive & Community Dentistry; Soben Peter
McKendrick, A.J.W., et al. : A Two-year Comparison of Hand & Electric Toothbrushes, J.Periodontol. Res., 3,224,1968