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Toothbrushing By Pamela Larrabee RDH, BAS

History of Toothbrushes and Brushing Napoleon’s Toothbrush In ancient times, people used chew sticks to brush their teeth. These chew sticks were wooden sticks that were frayed at one end. Sometimes you can see some of the cast members on Survivor using a chew stick to clean their teeth. In the mid 1800’s, the first toothbrush was made, and then by the early 1900’s, toothbrushes were being produced.1 The recommendation for tooth brushing was to brush in the morning and after each meal. A person was to brush with a hard bristle brush with a heavy pressure against the gums and teeth.1

Characteristic of a Electric and Manual Toothbrush Proper shape, size, texture, and weight Easy to operate Cost effective Long battery life 2-minute timer Pressure sensor Replaceable heads Easy to clean Manual Proper shape, size, texture, and weight Inexpensive Durable Easy to use Easy to clean Easy to hold Soft bristles End-rounded bristles (Filaments)

Reasons Why You Would Recommend an Electric or Manual Toothbrush The client may have a difficult time with dexterity because of arthritis, tremors, or Parkinson’s disease Your client has braces. Using an electric toothbrush makes it easier to clean around the brackets to remove plaque (biofilm) Your client might not be the best brusher. The electric toothbrush offers features, such as a small head, two-minute timer, or a sonic or spin action Your client might have recession. Some electric toothbrushes are sensitive to excessive pressure from brushing, so they won’t allow your client to brush to hard Manual Your client has no dexterity issues Your client might not like the vibration of the electric toothbrush Your client’s home care is good—he/she brushes and flosses regularly Your client doesn’t want to spend the money on an electric toothbrush Your client has areas where he/she is just not getting with the electric toothbrush Your client has had some type of periodontal surgery and needs to use special care when brushing

Toothbrushing Instructions Brush for two minutes Brush two to three times a day: After breakfast After lunch Before bedtime Use a soft bristle toothbrush Brushing plane should be end-rounded to avoid trauma to the gums and teeth Use a toothbrush that is the right size and fit Use gentle pressure Start in one quadrant of the mouth and work your way to the other quadrants, both facial, lingual, and the occlusal plane

Brushing Tecniques Bass (Sulcular) Stillman Charter Roll Stroke Modified Bass, Stillman, and Charter Fones

Bass (Sulcular) The toothbrush is at a 45˚ angle towards the apex of the tooth and parallel to the occlusal plane (When brushing the lingual surface of the anterior teeth, turn the toothbrush so that it is perpendicular to the occlusal plane) Gently place the bristles into the sulcus area covering about two teeth Use approximately 10 vibratory strokes Lift the brush and move on to the next two teeth Repeat steps 1-4 until all teeth are brushed, both facial and lingual surfaces

Bass Technique https://www.youtube.com/watch?v=Hbf7ddBvNE4

Stillman The Stillman technique is for patients who have recessed areas. The toothbrush is at a 45˚ angle towards the apex of the tooth and parallel to the occlusal plane (When brushing the lingual surface of the anterior teeth, turn the toothbrush so that it is perpendicular to the occlusal plane) Gently place the bristles partially on the gums and partially on the cervical part of the tooth Use approximately 10 vibratory strokes Lift the brush and move on to the next two teeth Repeat steps 1-4 until all teeth are brushed, both facial and lingual surfaces

Stillman and Modified Stillman Technique https://www.youtube.com/watch?v=hAkhNL8sFu4

Charter The Bristles (Filaments) are angled opposite of the Bass or Stillman techniques. This technique is for the facial and buccal surfaces of the teeth on both the upper and lower arch. This technique is used mainly for people with orthodontics or fixed bridges. Angle the toothbrush towards the occlusal so that the bristles are partially on the gum and cervical part of the tooth Use back-and-forth vibratory strokes 3. Use about 10 vibratory strokes 4. Lift the brush and move on to the next two teeth Repeat steps 1-4 until all four quadrants are brushed image source:quizlet.com via Google For lingual surfaces, use the Modified Bass or Stillman techniques

Charter Technique https://www.youtube.com/watch?v=6fj-IXzzH1o

Roll Stroke Technique The roll technique is meant for children or in conjunction with the Bass, Stillman, and Charter techniques. The toothbrush is angled apically and rolled towards the occlusal surface of the teeth Repeat stroke about four or five times Lift toothbrush and place it on the next two teeth and repeat the roll stroke Continue steps 1-3 until both maxillary and mandibular teeth are cleaned on both the facial and lingual surfaces

Roll Technique . https://www.youtube.com/watch?v=FDtsIJyNTdo

Modified Bass, Stillman, and Charter The Modified Bass, Stillman, and Charter techniques simply add the Roll technique to the existing Bass, Stillman, and Charter techniques, thus adding the term “Modified.” Clean the cervical area and massage the gums with the preferred method of brushing After you have cleaned the cervical area then roll the toothbrush downward Lift toothbrush and repeat steps 1-2 until both the maxillary and mandibular arches are clean

Modified Bass https://www.youtube.com/watch?v=AvI8yNQ9N1s

Fones The Fones technique is good for young children who still have a primary dentition. The Fones technique is appropriate for patients that lack the dexterity to use either the Modified Bass or Stillman techniques. This technique involves a circular motion while using light pressure against the tooth surface.

Fones Technique https://www.youtube.com/watch?v=BB6CeOYzGKc

Brushing Occlusal Surface Toothbrush should be parallel to the occlusal surface of the teeth Place bristles so that they lie on the occlusal surface against the grooves of the teeth There are two ways to clean the occlusal surface: In a circular and vibratory motion, move the toothbrush back-and-forth against the occlusal surface Move the toothbrush in a back-and-forth motion while applying firm pressure

Toothbrush Maintenance Replace a toothbrush every three months If the bristles (Filaments) are starting to show signs of wear, such as flaring out of the bristles, then replace the toothbrush sooner than three months Replace your toothbrush if you have been sick; It’s best to use disposable toothbrushes while your sick After use, rinse the toothbrush under warm water making sure any particles are removed from between the bristles Store the toothbrush so that the head of the toothbrush is facing upwards and is exposed to open air

Electric Toothbrush There are four types of electric toothbrushes: Battery operated Disposable Needs a power source Rechargeable

Electric Toothbrush Heads Brush Trims Brush Shapes Bilevel Multilevel Orthodontic Regular Teardrop Rectangle Round Round angled Photo source: Commons, Wikimedia via Google images

Electric Toothbrush Motions Circular (one directional) Oscillating and rotating (moves in two opposite directions, and in some cases, the bristles move in and out) Side-to-side (a lateral movement) Sonic (Uses sound waves to move the bristles in a side-to-side motion or an up and down movement Ultrasonic (uses an ultrasonic frequency to move the bristles in a vibratory motion)

Electric Toothbrush Maintenance Replace the toothbrush head every three months If the bristles (Filaments) are starting to show signs of wear, such as flaring out of the bristles, then replace the toothbrush head sooner than three months Replace your toothbrush head if you have been sick; It’s best to use disposable toothbrushes while your sick After use, rinse the toothbrush under warm water making sure any particles are removed from between the bristles Store the toothbrush so that the head of the toothbrush is facing upwards and is exposed to open air

Sources Darby, M. L., & In Walsh, M. M. (2015). Toothbrushing In Dental hygiene: Theory and practice (4th ed., pp. 397-405). St. Louis, MO: Elsevier Saunders. Wilkins, E. M., & Wyche, C. J. (2013). Oral Infection Control: Toothbrushes and Toothbrushing. In Clinical practice of the dental hygienist (11th ed., pp. 386-407). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.