Tooth brushing

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A man brushing his teeth while looking in a mirror. Man brushing teeth.jpg
A man brushing his teeth while looking in a mirror.

Tooth brushing is the act of scrubbing teeth with a toothbrush, usually equipped with toothpaste. Interdental cleaning (with floss or an interdental brush) can be useful with tooth brushing, and together these two activities are the primary means of cleaning teeth, one of the main aspects of oral hygiene. [1]



A photo from 1899 showing the use of a toothbrush. Toothbrush1899Paris.jpg
A photo from 1899 showing the use of a toothbrush.

As long ago as 3000 B.C., the ancient Egyptians constructed crude toothbrushes from twigs and leaves to clean their teeth. Similarly, other cultures such as the Greeks, Romans, Arabs and Indians cleaned their teeth with twigs. Some would fray one end of the twig so that it could penetrate between the teeth more effectively.

Modern day toothbrushing as a regular habit became prevalent in Europe from the end of the 17th century. The first mass-produced toothbrush was developed in England in 1780. In the United States, although toothbrushes were available at the end of the 19th century, the practice did not become widespread until after the Second World War, when US soldiers continued the toothbrushing that had been required during their military service. [2] [ better source needed ]. The first toothbrush mass produced was actually made in England in 1780. While languishing in jail, William Addis decided to drill holes into a sheep's tibia, and pulled through the bristles of boar hair. Which he made into a toothbrush which gave him the idea to mass produce it on the outside under the name Wisdom Toothbrushes. They stayed family owned until 1996.


Brushing teeth properly helps prevent cavities, and periodontal, or gum disease, which causes at least one-third of adult tooth loss. [3] If teeth are not brushed correctly and frequently, it could lead to the calcification of saliva minerals, forming tartar. Tartar hardens (then referred to as 'calculus') if not removed every 48 hours. [4] Poor dental health has been associated with heart disease and shortened life expectancy. [5] [6] [7]

Many serious problems result from not maintaining proper oral hygiene. Not brushing your teeth causes harmful bacteria to build upon your teeth and gums. [8] Bacteria growing in your mouth can infect your gums and then can travel into your blood vessels. When gingivitis and periodontitis bacteria move into your blood vessels, it can cause inflation and damaged vessels. It clogs blood vessels, making it hard for blood to flow and can lead to blood clots, heart attacks, and strokes. Although the study at Harvard Medical School has observed “remnants of oral bacteria within atherosclerotic blood vessels far from the mouth,” there are other factors including gender, alcohol consumption, diabetes, exercise, smoking, and family history of heart problems that could increase the risk of coronary artery disease as well. These factors make it hard to judge how much not brushing your teeth elevates your risk of coronary heart disease, but there is a proven correlation between poor oral health and coronary heart disease. [9] [8]

Another negative side effect of not brushing your teeth is halitosis or bad breath. According to The American Dental Association, not brushing properly allows remnants of food to collect on the teeth, gum line, and the surface of the tongue. Tooth plaque leads to gingivitis and periodontitis bacteria build-up, which produces bad smelling odors. Having bad breath is very common, and most people experience it, but not brushing your teeth makes you especially prone to bad odors. The ADA states that properly brushing your teeth to remove bacteria that contribute to oral odors will improve your oral hygiene and keep your breath smelling as fresh as possible. [10] [11]

Toothbrushing guidelines


A 2008 review [12] cites studies from 1969-1973 [4] that gum and tooth health were maintained if brushing removed dental plaque more often than every 48 hours, and gum inflammation happened if brushing happened at intervals longer than 48 hours. The 2008 review noted that toothbrushing can remove plaque up to one millimeter below the gum line, and that each person has a habitual brushing method, so more frequent brushing does not cover additional parts of the teeth or mouth. [12]

Dentists consider the extra abrasion of dentin from brushing multiple times per day to be insignificant, [13] since modern toothpastes have Relative Dentin Abrasivity below 250. [14]

When asked to brush "to the best of their abilities" young adults brushed longer, but did not cover any additional parts of their mouths. They brushed especially long on the grinding surfaces of back teeth (occlusal), which are the prime location for cavities in young children, but not in adults, where sides are more prone to cavities. [15]

A 2005 review of dental studies found consensus that a thorough toothbrushing once a day is sufficient for maintaining oral health, and that most dentists recommended patients brush twice a day in the hope that more frequent brushing would clean more areas of the mouth. [16]

A 2018 review noted that toothbrushing is the most common preventive healthcare activity, but tooth and gum disease remain high, since lay people clean at most 40% of their tooth margins at the gum line. Videos show that even when asked to brush their best, they do not know how to clean effectively. [15] Another 2018 study found that dental professionals did clean their teeth effectively. [17]


A 2012 literature review found that bacteria survive on toothbrushes over 24 hours in moist conditions, less so when air-dried, though they can pick up contamination from the surrounding environment. Brushes can be decontaminated by soaking for 20 minutes in mouthwash. Harmful bacteria are present on brushes of healthy and sick people, and can add to their infectious load. [18]

Mouthwashes themselves reduce plaque by an average of 35% if they contain essential oils or chlorhexidine gluconate. The research does not report the extent of simultaneous tooth brushing by participants in mouthwash studies. Side effects of mouthwashes with essential oils and alcohol include poor taste and oral irritation. Side effects of those with chlorhexidine gluconate include tooth stains, calculus, taste disturbance and effects on the mouth lining. [19]

Proper technique

Standard advice is that the front and backs of teeth should be brushed with the toothbrush at a 45 degree angle towards the gum line, moving the brush in a back and forth rolling motion that makes contact with the gum line and tooth. [20] To brush the backs of the front teeth the brush should be held vertically to the tooth and moved in an up and down motion. [20] The chewing surfaces of the teeth are brushed with a forward and back motion, with the toothbrush pointing straight at the tooth. [20]

Specialized advice for OralB rotating electric brushes is to follow the shape of each tooth and the gums, holding the brush against each tooth surface one at a time, [21] for 1-2 seconds per tooth. [22] Advice for Sonicare is to use a slight angle, so longer bristles can reach between the teeth, [23] [24] for 3-5 small circles in 1-2 seconds on each tooth. [22] Bristles conform to tooth shapes. [25]

Toothbrushing before breakfast/dinner

One study found that brushing immediately after an acidic meal (such as diet soda and common breakfast foods like orange juice, citrus fruit, dried fruit, bread, pastries [26] ) caused more damage to enamel and the dentin, compared to waiting 30 minutes. Flushing the acid away with water or dissolved baking soda could help reduce acid damage exacerbated by brushing. The same response was recommended for acid re-flux and other acidic meals. [27] Researchers and dentists have concluded that brushing immediately after consuming acidic beverages should be avoided. Better to brush before breakfast or dinner. [28] If brushing after a meal, wait at least a half hour after eating to prevent damage to your teeth. [29]

When you’re looking to protect your tooth enamel, brushing right after you wake up in the morning is better than brushing your teeth after breakfast. If you have to brush your teeth after breakfast, try to wait between 30 and 60 minutes before you brush. Brushing in the morning, whenever you’re able to do it, is still better than skipping the step of brushing your teeth at all. [30]


Head of a toothbrush Toothbrush 20050716 004.jpg
Head of a toothbrush

A toothbrush is an instrument used to clean teeth, consisting of a small brush on a handle. Toothpaste, often containing fluoride, is commonly added to a toothbrush to aid in cleaning. Toothbrushes come in manual and electric varieties. Although there is conflicting evidence as to which is more effective, most evidence points to electric toothbrushes with an oscillatory motion being more effective than manual toothbrushes, with toothbrushes lacking an oscillatory motion being equivalent. [31] A 2014 Cochrane review found moderate evidence that electric toothbrushing reduce plaque and gingivitis more than the manual one. [31] Overall, both manual and electric toothbrushes are effective, however, and it is often recommended that people use whichever one they feel comfortable with, determine what is affordable for them and will be more likely to regularly brush with. [32]

Toothbrushes are offered with varying textures of bristles, and come in many different forms and sizes. Most dentists recommend using a toothbrush labelled "soft", since firmer bristled toothbrushes can damage tooth enamel and irritate gums as indicated by the American Dental Association.[ citation needed ] Toothbrushes are often made from synthetic fibers, although natural toothbrushes are also known in many parts of the world. Those with dentures may also brush their teeth with traditional tooth brushes, specially made denture brushes or denture cleaners. The first mass produced toothbrush was made in England in 1780. While languishing in jail, William Addis decided to drill holes into a sheep's tibia, and pulled through the bristles of boar hair. Which he made into a toothbrush which gave him the idea to mass produce it on the outside under the name Wisdom Toothbrushes. They stayed family owned until 1996.[ citation needed ]


Modern toothpaste gel Toothpaste.jpg
Modern toothpaste gel

Toothpaste is a paste or gel dentifrice used to clean and improve the aesthetic appearance and health of teeth. It is almost always used in conjunction with a toothbrush. Toothpaste use can promote good oral hygiene: it can aid in the removal of dental plaque and food from the teeth, it can aid in the elimination and/or masking of halitosis when tonsil stones are not the cause, and it can deliver active ingredients such as fluoride to prevent tooth and gum (gingiva) disease.

There is evidence that the addition of xylitol to fluoride-containing toothpastes reduces incidence of tooth decay by about 13%. [33]

Tooth powder (or 'toothpaste powder') is an alternative to toothpaste. It may be recommended for people with sensitive teeth. Tooth powder typically does not contain the chemical sodium lauryl sulphate which can be a skin irritant. [34] The function of sodium lauryl sulphate is to form suds when teeth are brushed. It is a common chemical in toothpaste. Those with dentures may also use denture cleaner which can also come in powder format.

See also

Related Research Articles

Mouthwash Liquid rinse for oral hygiene

Mouthwash, mouth rinse, oral rinse, or mouth bath is a liquid which is held in the mouth passively or swilled around the mouth by contraction of the perioral muscles and/or movement of the head, and may be gargled, where the head is tilted back and the liquid bubbled at the back of the mouth.

Human tooth Calcified whitish structure in humans mouths used to break down food

The human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

Periodontal disease Medical condition

Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen, red, and may bleed. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Bad breath may also occur.


A toothbrush is an oral hygiene instrument used to clean the teeth, gums, and tongue. It consists of a head of tightly clustered bristles, atop of which toothpaste can be applied, mounted on a handle which facilitates the cleaning of hard-to-reach areas of the mouth. They are usually used alongside floss.

Toothpaste Paste or gel dentifrice used to clean and maintain the health of teeth

Toothpaste is a paste or gel dentifrice used with a toothbrush to clean and maintain the aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it is an abrasive that aids in removing dental plaque and food from the teeth, assists in suppressing halitosis, and delivers active ingredients to help prevent tooth decay and gum disease (gingivitis). Salt and sodium bicarbonate are among materials that can be substituted for commercial toothpaste. Large amounts of swallowed toothpaste can be toxic.

Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities, gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened deposits (tartar) not removed by routine cleaning. Those with dentures and natural teeth may supplement their cleaning with a denture cleaner.

Tooth decay Deformation of teeth made by acids from bacteria

Tooth decay, also known as dental caries or cavities, is the breakdown of teeth due to acids made by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation.

Dental floss is a cord of thin filaments used to remove food and dental plaque from between teeth in areas a toothbrush is unable to reach.

Abrasion (dental) Medical condition

Abrasion is the non-carious, mechanical wears of tooth from interaction with objects other than tooth-tooth contact. It most commonly affects the premolars and canines, usually along the cervical margins. Based on clinical surveys, studies have shown that abrasion is the most common but not the sole aetiological factor for development of non-carious cervical lesions (NCCL) and is most frequently caused by incorrect toothbrushing technique.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

Dentifrice Agent used to clean and polish teeth

Dentifrices, including toothpowder and toothpaste, are agents used along with a toothbrush to clean and polish natural teeth. They are supplied in paste, powder, gel, or liquid form. Many dentifrices have been produced over the years, some focusing on marketing strategies to sell products, such as offering whitening capabilities. The most essential dentifrice recommended by dentists is toothpaste which is used in conjunction with a toothbrush to help remove food debris and dental plaque. Dentifrice is also the French word for toothpaste.

Dental plaque is a biofilm of microorganisms that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found between the teeth, on the front of teeth, behind teeth, on chewing surfaces, along the gumline, (supragingival) or below the gumline cervical margins (subgingival). Dental plaque is also known as microbial plaque, oral biofilm, dental biofilm, dental plaque biofilm or bacterial plaque biofilm. Bacterial plaque is one of the major causes for dental decay and gum disease.

Oral irrigator Dental care device

An oral irrigator is a home dental care device which uses a stream of high-pressure pulsating water intended to remove plaque and food debris between teeth and below the gum line. Regular use of an oral irrigator is believed to improve gingival health. The devices may also provide easier cleaning for braces and dental implants. However, more research is needed to confirm plaque biofilm removal and effectiveness when used by patients with special oral or systemic health needs.

Dentin hypersensitivity is dental pain which is sharp in character and of short duration, arising from exposed dentin surfaces in response to stimuli, typically thermal, evaporative, tactile, osmotic, chemical or electrical; and which cannot be ascribed to any other dental disease.

Gingival and periodontal pocket

Gingival and periodontal pockets are dental terms indicating the presence of an abnormal depth of the gingival sulcus near the point at which the gingival tissue contacts the tooth.

Bleeding on probing (BoP) which is also known as bleeding gums or gingival bleeding is a term used by dentists and dental hygienists when referring to bleeding that is induced by gentle manipulation of the tissue at the depth of the gingival sulcus, or interface between the gingiva and a tooth. BoP is a sign of periodontal inflammation and indicates some sort of destruction and erosion to the lining of the sulcus or the ulceration of sulcular epithelium. The blood comes from lamina propria after the ulceration of the lining. BoP seems to be correlated with Periodontal Inflamed Surface Area (PISA).

Oral hygiene Cleaning the mouth by brushing the teeth and cleaning in between the teeth.

Oral hygiene is the practice of keeping one's mouth clean and free of disease and other problems by regular brushing of the teeth and cleaning between the teeth. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease and bad breath. The most common types of dental disease are tooth decay and gum diseases, including gingivitis, and periodontitis.

Gingivitis Inflammation of the gums

Gingivitis is a non-destructive disease that causes inflammation of the gums. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms that is attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced.

Oral disease is one of the most common diseases found in dogs. It is caused by the buildup of various anaerobic bacteria in the mouth which forms plaque, eventually hardening into tartar on the teeth along the gum line, and is related to the development of gingivitis. Since small and toy breeds have a much smaller jaw but contain the same number of teeth, crowding allows higher bacterial build up and puts them at higher risk of developing periodontal disease.

Interdental cleaning or interproximal cleaning is part of oral hygiene where the aim is to clean the areas in between the teeth, otherwise known as the proximal surfaces of teeth. This is to remove the dental plaque in areas where a toothbrush cannot reach. The ultimate goal of interproximal cleaning is to prevent the development of interproximal caries and periodontal disease. The combined use of tooth brushing, and mechanical and manual interdental cleaning devices has been proven to reduce the prevalence of caries and periodontal diseases.


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