Many different designs have been manufactured Patients usually uses brushes selected on the basis of cost, availability, advertising claims, family tradition, or habit Because of the variety in shapes, sizes, textures, and other characteristics Dental professionals must become familiar with the many available products to advise patients appropriately

Characteristics of an effective toothbrush Conforms to individual patient requirements Easily and efficiently manipulated Is readily cleaned Is durable and inexpensive Flexible, soft, and of strength, rigidity and lightness of the handle Has end rounded filaments or bristles

I. Influencing factors Patient Gingiva Position of teeth Shape of teeth and exposed roots Personal preferences Method selected

II. Toothbrush size and shape Must be able to adapt to all facial, lingual, palatal, and occlusal surfaces for bacterial plaque removal

III. Soft nylon brush More effective in cleaning the cervical area Less traumatic to the gingival tissue Can be directed into the sulcus and interproximal areas Applicable around fixed orthodontic appliances

Prevention of tooth abrasion and/or gingival recession More effective use for sensitive gingiva in severe gingivitis, ANUG, or during healing stages

Complete tooth brushing instruction for patients involves teaching; What, when, where and how The grasp of the brush The sequence and amount of brushing Supplementary brushing for occlusal surfaces and the tongue Effect from improper brushing Care of the tooth brushings

The emphasis in patient education should be placed on complete plaque control rather than on number of brushing At least two brushing with interdental cleaning is recommended for control of bacterial plaque and halitosis prevention A night brushing before bed time should be encouraged

Sulcular:Bass Roll: Rolling stroke, modified Stillman Vibratory:Stillman, Bass, Charters Circular Vertical Horizontal Scrub-brush

Purpose and indications For bacterial plaque removal adjacent to and directly beneath the gingival margin For open inter proximal areas, cervical areas and exposed root surfaces For adaptation to abutment teeth, under the gingival border of a fixed partial denture and orthodontic appliances

Problems Change the very short strokes into vigorous scrub that causes injury to the gingival margin Dexterity requirement may be too high for certain patients

Two brushes for home use and a third in a portable container for use at work Frequent replacement recommended Brushes should be replaced before filaments become splayed, frayed or lose resiliency Clean thoroughly after each use Brushes should be kept in open air with head in an upright position, apart from contact with other brushes.

Purpose and indications Cleaning gingiva and bacterial plaque without emphasis on gingival sulcus Meant for children Useful in preparatory instruction for Modified Stillman method

Problems Brushing too high during initial placement can lacerate the alveolar mucosa Use too quickly results in no brushing for the cervical third of the tooth Brush with filaments tip directed into gingiva causes gingival laceration

Purpose and indications Bacterial plaque removal from cervical areas and exposed proximal surfaces General application for cleaning tooth surfaces and massage of the gingiva

Problems Without careful placement and using a brush with end-rounded filaments, tissue laceration can result. Light pressure is needed Patient may try to move the brush too quickly and the vibratory effect may be ineffective at the gingival margin

Purpose and indications Loosen debris and bacterial plaque Massage and stimulate marginal and interdental gingiva Removes plaque from proximal areas Adapt to cervical areas and to exposed root surfaces Cleanse orthodontic appliance

Problems Brush end do not engage the gingival sulcus to remove subgingival bacterial plaque accumulation In some areas, the correct brush placement is limited or impossible Requirements in digital dexterity are high

Electrical tooth brushes are equally effective in removing plaque, prevent calculus, and reduce the incidence of gingivitis to the manual tooth brushes The motion of the brush varies from rotational, counter-rotational and oscillating counter- rotational The speed varies from low to high among the different models

Purpose and indications To facilitate mechanical bacterial plaque removal Especially helpful for people who lack the manual dexterity Patients with special dental treatment

Problem areas Facially displaced teeth Inclined teeth Exposed roots Overlapped teeth or wide embrasures Surface of teeth next to edentulous area Exposed furcation area Right canine and lateral incisor Distal surfaces of most posterior teeth

Objectives Loosen plaque microorganisms packed in pits and fissures Removes plaque deposit from occlusal surfaces of teeth out of occlusion or not used during mastication Remove plaque from margins of restorations Clean pits and fissures to prepare for sealants

Total mouth cleanliness includes tongue care Microorganisms of the tongue Effects of cleaning the tongue Brushing procedures Tongue scraper

Acute oral inflammation or traumatic lesion Following periodontal surgery Acute stage of ANUG Following dental extraction Following dental restoration

Two brushes for home use and a third in a portable container for use at work Frequent replacement recommended Brushes should be replaced before filaments become splayed, frayed or lose resiliency Clean thoroughly after each use Brushes should be kept in open air with head in an upright position, apart from contact with other brushes.