Tooth brushing is the act of scrubbing teeth with a toothbrush 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] The recommended amount of time for tooth brushing is two minutes. [2]
Teeth-cleaning twigs have long been used throughout human history. [3] 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 also cleaned their teeth with twigs. Some would fray one end of the twig so that it could penetrate between the teeth more effectively.
The Indian method of using wood for brushing was presented by the Chinese Monk Yijing (635–713 A.D.) when he described the rules for monks in his book: [4]
Every day in the morning, a monk must chew a piece of tooth wood to brush his teeth and scrape his tongue, and this must be done in the proper way. Only after one has washed one's hands and mouth may one make salutations. Otherwise both the saluter and the saluted are at fault.
In Sanskrit, the tooth wood is known as the dantakastha—danta meaning tooth, and kastha, a piece of wood. It is twelve finger-widths in length. The shortest is not less than eight finger-widths long, resembling the little finger in size. Chew one end of the wood well for a long while and then brush the teeth with it.
Modern-day tooth brushing 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 by William Addis. 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 tooth brushing that had been required during their military service. [5]
Brushing teeth properly helps prevent cavities, and periodontal, or gum disease, which causes at least one-third of adult tooth loss. [6] 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. [7] Poor dental health has been associated with heart disease and shortened life expectancy. [8] [9] [10]
Many serious problems result from not maintaining proper oral hygiene. Not brushing teeth causes harmful bacteria to build up on teeth and gums. [11] Bacteria growing in the mouth can infect the gums and then can travel into blood vessels. When gingivitis and periodontitis bacteria move into the blood vessels, it can cause inflammation 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," [12] 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. [13] These factors make it hard to judge how much not brushing one's teeth elevates the risk of coronary heart disease, but there is a proven correlation between poor oral health and coronary heart disease. [14] [11]
Another negative side effect of not brushing one's 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. [15] Tooth plaque leads to gingivitis and periodontitis bacteria build-up, which produces bad-smelling odors. [16] Having bad breath is very common, and most people experience it, but not brushing one's teeth particularly increases the risk. The ADA states that properly brushing teeth to remove bacteria that contribute to oral odors will improve oral hygiene and keep breath smelling as fresh as possible. [17] [18]
A 2008 review [19] cites studies from 1969–1973 [7] 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 tooth brushing 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. [19]
Dentists consider the extra abrasion of dentin from brushing multiple times per day to be insignificant, [20] since modern toothpastes have relative dentin abrasivity below 250. [21] A 1997 study simulated six months of brushing with manual or sonic toothbrushes. Neither caused observable wear of tooth surface or fillings. Both caused a small loss of cement at the edge of gold inlays. [22] A 2017 study put composite fillings on both sides of extracted teeth. The study simulated seven years of brushing one side of each tooth with a sonic toothbrush, then measured microleakage around the fillings. No leakage was found at any bond between filling and enamel. At bonds between filling and cementum, there was sometimes leakage, and it happened to the same extent on the brushed sides of teeth and the unbrushed sides. [23]
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. [24]
A 2005 review of dental studies found consensus that a thorough tooth brushing 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. [25]
A 2018 review noted that tooth brushing 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. [24] Another 2018 study found that dental professionals did clean their teeth effectively. [26]
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. [27]
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. [28]
Gargle clean, fresh water a couple of times and rinse the toothbrush with water. [29] 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. [30] 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. [30] The chewing surfaces of the teeth are brushed with a forward and back motion, with the toothbrush pointing straight at the tooth. [30]
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, [31] for 1–2 seconds per tooth. [32] Advice for Sonicare brushes is to use a slight angle, so longer bristles can reach between the teeth, [33] [34] making 3–5 small circles for 1–2 seconds on each tooth. [32] Bristles conform to tooth shapes. [35]
There are several other techniques: [36]
As far as technique recommendations, the simpler Scrub and Fones techniques are recommended for use by children as they are likely easier to master than the more complex techniques. For adults, the more complex Bass and Modified Bass techniques are recommended. However, brushing techniques learned in childhood often carry over into adulthood and it is then difficult for adults to change these learned behaviours. Of high importance to note, is that more complex techniques are not necessarily more effective. While there are many different tooth brushing techniques, there is no evidence that any of them is superior to the others. [36]
One study found that brushing immediately after an acidic meal (such as diet soda or common breakfast foods like orange juice, coffee, citrus fruit, dried fruit, bread, or pastries [38] ) caused more damage to enamel and 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 reflux and other acidic meals. [39] Researchers and dentists have concluded that brushing immediately after consuming acidic beverages should be avoided. It is better to brush before breakfast or dinner. [40]
In addition, brushing before breakfast eliminates overnight bacteria buildup, preventing them from thriving on sugary breakfast foods and producing enamel-damaging acids, while stimulating saliva production to neutralize acidity and reinforce teeth with essential minerals. This practice secures dental hygiene within the morning routine, crucial for avoiding neglect due to the morning rush, particularly for families with children or those eating breakfast outside the home. [41]
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. [42] A 2014 Cochrane review found moderate evidence that electric toothbrushes reduce plaque and gingivitis more than manual ones. [42] Overall, both manual and electric toothbrushes are effective, however, and it is often recommended that people use whichever they feel comfortable with, determine is affordable for them, and will be more likely to regularly brush with. [43]
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%. [44]
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, commonly used in toothpaste, which can be a skin irritant. [45] The function of sodium lauryl sulphate is to form suds when teeth are brushed. Those with dentures may also use denture cleaner which can also come in powder form.
When brushing teeth, using toothpaste that contains fluoride is recommended. There are different recommendations for the amount of toothpaste used based on age:
Toothbrushing should begin as soon as teeth begin to erupt into the mouth and should be done twice daily (morning and night). It is very important that caregivers supervise children's brushing to minimize swallowing of toothpaste. (ADA) For children at high risk of developing cavities, a dietary fluoride supplement (ADA) or professionally-applied fluoride varnish can be considered. [46] Fluoride is a safe and effective way to prevent and control cavities. [46]
Mouthwash, mouth rinse, oral rinse, or mouth bath is a liquid which is held in the mouth passively or swirled 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 teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. 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.
A toothbrush is an oral hygiene tool 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 should be used in conjunction with something to clean between the teeth where the bristles of the toothbrush cannot reach - for example floss, tape or interdental brushes.
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). Owing to differences in composition and fluoride content, not all toothpastes are equally effective in maintaining oral health. The decline of tooth decay during the 20th century has been attributed to the introduction and regular use of fluoride-containing toothpastes worldwide. Large amounts of swallowed toothpaste can be poisonous. Common colors for toothpaste include white and blue.
Bad breath, also known as halitosis, is a symptom in which a noticeably unpleasant breath odour is present. It can result in anxiety among those affected. It is also associated with depression and symptoms of obsessive compulsive disorder.
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, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors, from yellow to black. Symptoms may include pain and difficulty 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 in interdental cleaning to remove food and dental plaque from between teeth or places a toothbrush has difficulty reaching or is unable to reach. Its regular use as part of oral cleaning is intended to maintain oral health.
Abrasion is the non-carious, mechanical wear 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.
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.
The miswak is a teeth-cleaning twig made from the Salvadora persica tree. The miswak's properties have been described thus: "Apart from their antibacterial activity which may help control the formation and activity of dental plaque, they can be used effectively as a natural toothbrush for teeth cleaning. Such sticks are effective, inexpensive, common, available, and contain many medical properties".
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.
Tooth loss is a process in which one or more teeth come loose and fall out. Tooth loss is normal for deciduous teeth, when they are replaced by a person's adult teeth. Otherwise, losing teeth is undesirable and is the result of injury or disease, such as dental avulsion, tooth decay, and gum disease. The condition of being toothless or missing one or more teeth is called edentulism. Tooth loss has been shown to causally reduce overall health and wellbeing as it increases the probability of depression.
Oral hygiene is the practice of keeping one's oral cavity clean and free of disease and other problems by regular brushing of the teeth and adopting good hygiene habits. 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.
A tongue cleaner is an oral hygiene device designed to clean the coating on the upper surface of the tongue. While there is tentative benefit from the use of a tongue cleaner it is insufficient to draw clear conclusions regarding bad breath.
Tooth remineralization is the natural repair process for non-cavitated tooth lesions, in which calcium, phosphate and sometimes fluoride ions are deposited into crystal voids in demineralised enamel. Remineralization can contribute towards restoring strength and function within tooth structure.
Gingivitis is a non-destructive disease that causes inflammation of the gums; ulitis is an alternative term. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms that are attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced.
Gingival disease is a term used to group the diseases that affect the gingiva(gums). The most common gingival disease is gingivitis, the earliest stage of gingival-related diseases. Gingival disease encompasses all the conditions that surround the gums, this includes plaque-induced gingivitis, non-dental biofilm plaque-induced gingivitis, and periodontal diseases.
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 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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