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Three plastic toothbrushes Toothbrush x3 20050716 001.jpg
Three plastic toothbrushes

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 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.


They are available with different bristle textures, sizes, and forms. Most dentists recommend using a soft toothbrush since hard-bristled toothbrushes can damage tooth enamel and irritate the gums. [1]

Because many common and effective ingredients in toothpaste are harmful if swallowed in large doses and instead should be spat out, the act of brushing teeth is most often done at a sink within the kitchen or bathroom, where the brush may be rinsed off afterwards to remove any debris remaining and then dried to reduce conditions ideal for germ growth (and, if it is a wooden toothbrush, mold as well).

Many toothbrushes have plant based handles, often bamboo. However, numerous others are made of cheap plastic; such brushes constitute a significant source of pollution. [2] [3] Over 1 billion toothbrushes are disposed of into landfills annually in the United States alone. [4] Bristles are commonly made of nylon (which, while not biodegradable, as plastic is, may still be recycled) or bamboo viscose.


The horsehair toothbrush was said to have been used by Napoleon Bonaparte (1769-1821) Napoleon's toothbrush, c 1795. (9660576547).jpg
The horsehair toothbrush was said to have been used by Napoleon Bonaparte (1769–1821)

Before the invention of the toothbrush, a variety of oral hygiene measures had been used. [6] This has been verified by excavations during which tree twigs, bird feathers, animal bones and porcupine quills were recovered.

The predecessor of the toothbrush is the chew stick. Chew sticks were twigs with frayed ends used to brush the teeth [7] while the other end was used as a toothpick. [8] The earliest chew sticks were discovered in Sumer in southern Mesopotamia in 3500 BC, [8] an Egyptian tomb dating from 3000 BC, [7] and mentioned in Chinese records dating from 1600 BC. The Greeks and Romans used toothpicks to clean their teeth, and toothpick-like twigs have been excavated in Qin Dynasty tombs. [8] Chew sticks remain common in Africa, [9] the rural Southern United States, [7] and in the Islamic world the use of chewing stick miswak is considered a pious action and has been prescribed to be used before every prayer five times a day. [10] Miswaks have been used by Muslims since the 7th century.[ citation needed ] Twigs of Neem Tree have been used by ancient Indians. [11] [12] In fact, even today, Neem twigs called datun are used for brushing teeth in India, although not hugely common. [13]

The first bristle toothbrush resembling the modern one was found in China. Used during the Tang Dynasty (619–907), it consisted of hog bristles. [14] [15] The bristles were sourced from hogs living in Siberia and northern China because the colder temperatures provided firmer bristles. They were attached to a handle manufactured from bamboo or bone, forming a toothbrush. [7] In 1223, Japanese Zen master Dōgen Kigen recorded in his Shōbōgenzō that he saw monks in China clean their teeth with brushes made of horsetail hairs attached to an oxbone handle. The bristle toothbrush spread to Europe, brought from China to Europe by travellers. [16] It was adopted in Europe during the 17th century. [17] The earliest identified use of the word toothbrush in English was in the autobiography of Anthony Wood who wrote in 1690 that he had bought a toothbrush from J. Barret. [18] Europeans found the hog bristle toothbrushes imported from China too firm and preferred softer bristle toothbrushes made from horsehair. [7] Mass-produced toothbrushes made with horse or boar bristle continued to be imported to Britain from China until the mid 20th century. [6]

'Indexo' finger toothbrush, New York, United States, 1901-1919. It is made entirely of rubber, which has been shaped to fit over the index finger. 'Indexo' finger toothbrush, New York, United States, 1901-19 Wellcome L0058113.jpg
'Indexo' finger toothbrush, New York, United States, 1901–1919. It is made entirely of rubber, which has been shaped to fit over the index finger.
A photo from 1899 showing the use of a toothbrush. Toothbrush1899Paris.jpg
A photo from 1899 showing the use of a toothbrush.

In the UK, William Addis is believed to have produced the first mass-produced toothbrush in 1780. [16] [19] In 1770, he had been jailed for causing a riot. While in prison he decided that using a rag with soot and salt on the teeth was ineffective and could be improved. After saving a small bone from a meal, he drilled small holes into the bone and tied into the bone tufts of bristles that he had obtained from one of the guards, passed the tufts of bristle through the holes in the bone and sealed the holes with glue. After his release, he became wealthy after starting a business manufacturing toothbrushes. He died in 1808, bequeathing the business to his eldest son. It remained within family ownership until 1996. [20] Under the name Wisdom Toothbrushes, the company now manufactures 70 million toothbrushes per year in the UK. [21] By 1840 toothbrushes were being mass-produced in Britain, France, Germany, and Japan. [22] Pig bristles were used for cheaper toothbrushes and badger hair for the more expensive ones. [22]

Hertford Museum in Hertford, UK, holds approximately 5000 brushes that make up part of the Addis Collection. The Addis factory on Ware Road was a major employer in the town until 1996. Since the closure of the factory, Hertford Museum has received photographs and documents relating to the archive, and collected oral histories from former employees. [23]

The first patent for a toothbrush was granted to H.N. Wadsworth in 1857 (U.S.A. Patent No. 18,653) in the United States, but mass production in the United States did not start until 1885. The improved design had a bone handle with holes bored into it for the Siberian boar hair bristles. Unfortunately, animal bristle was not an ideal material as it retained bacteria, did not dry efficiently and the bristles often fell out. In addition to bone, handles were made of wood or ivory. [24] In the United States, brushing teeth did not become routine until after World War II, when American soldiers had to clean their teeth daily. [19]

A child being shown how to use a toothbrush. Toothbrush teaching 1.jpg
A child being shown how to use a toothbrush.

During the 1900s, celluloid gradually replaced bone handles. [14] Natural animal bristles were also replaced by synthetic fibers, usually nylon, by DuPont in 1938. The first nylon bristle toothbrush made with nylon yarn went on sale on February 24, 1938. The first electric toothbrush, the Broxodent, was invented in Switzerland in 1954. [25] By the turn of the 21st century nylon had come to be widely used for the bristles and the handles were usually molded from thermoplastic materials. [6]

Johnson & Johnson, a leading medical supplies firm, introduced the "Reach" toothbrush in 1977. [26] It differed from previous toothbrushes in three ways: it had an angled head, similar to dental instruments, to reach back teeth; the bristles were concentrated more closely than usual to clean each tooth of potentially cariogenic (cavity-causing) materials; and the outer bristles were longer and softer than the inner bristles. Other manufacturers soon followed with other designs aimed at improving effectiveness. [27] In spite of the changes with the number of tufts and the spacing, the handle form and design, the bristles were still straight and difficult to maneuver. In 1978 Dr. George C. Collis developed the Collis Curve toothbrush which was the first toothbrush to have curved bristles. The curved bristles follow the curvature of the teeth and safely reach in between the teeth and into the sulcular areas. [28]

Patented in 1985, curved bristles allow for safe and easy brushing of the teeth and the gingival sulcus. Patented curved bristles of the Collis Curve toothbrush.jpg
Patented in 1985, curved bristles allow for safe and easy brushing of the teeth and the gingival sulcus.

In January 2003, the toothbrush was selected as the number one invention Americans could not live without according to the Lemelson-MIT Invention Index. [29]

Types of toothbrush

Electric toothbrush

Various electric toothbrush heads So Many Choices (11693539025).jpg
Various electric toothbrush heads

It has been discovered that compared to a manual brush, the multi-directional power brush might reduce the incidence of gingivitis and plaque, when compared to regular side-to-side brushing. These brushes tend to be more costly and damaging to the environment when compared to manual toothbrushes [30] . Most studies report performances equivalent to those of manual brushings, possibly with a decrease in plaque and gingivitis [31] . An additional timer and pressure sensors can encourage a more efficient cleaning process. [32] Electric toothbrushes can be classified, according to the speed of their movements as: standard power toothbrushes, sonic toothbrushes, or ultrasonic toothbrushes. Any electric toothbrush is technically a powered toothbrush. If the motion of the toothbrush is sufficiently rapid to produce a hum in the audible frequency range (20 Hz to 20,000 Hz), it can be classified as a sonic toothbrush. Any electric toothbrush with movement faster than this limit can be classified as an ultrasonic toothbrush. Certain ultrasonic toothbrushes, such as the Megasonex and the Ultreo, have both sonic and ultrasonic movements.

Interdental brush

Interdental Brushes TePe Interdental Brushes original.jpg
Interdental Brushes

An interdental or interproximal ("proxy") brush is a small brush, typically disposable, either supplied with a reusable angled plastic handle or an integral handle, used for cleaning between teeth and between the wires of dental braces and the teeth.

The use of interdental brushes in conjunction with tooth brushing has been shown to reduce both the amount of plaque and the incidence of gingivitis when compared to tooth brushing alone. [33] Although there is some evidence that after tooth brushing with a conventional tooth brush, interdental brushes remove more plaque than dental floss, [34] a systematic review reported insufficient evidence to determine such an association. [33]

The size of interdental brushes is standardized in ISO 16409. [35] [36] The brush size, [37] which is a number between 0 (small space between teeth) and 8 (large space), indicates the passage hole diameter. This corresponds to the space between two teeth that is just sufficient for the brush to go through without bending the wire. The color of the brushes differs between producers. The same is the case with respect to the wire diameter. [38]

Brush size according to ISO 16409 [35]
Brush size0 [39] 1 [40] 234567 [41] 8 [41]
Passage hole diameter in mm 0.60.7–0.80.9–1.01.1–1.21.3–1.51.6–1.81.9–2.32.4–2.8 2.8

End-tuft brush

The small round brush head comprises seven tufts of tightly packed soft nylon bristles, trimmed so the bristles in the center can reach deeper into small spaces. The brush handle is ergonomically designed for a firm grip, giving the control and precision necessary to clean where most other cleaning aids cannot reach. [42] These areas include the posterior of the wisdom teeth (third molars), orthodontic structures (braces), crowded teeth, and tooth surfaces that are next to missing teeth. It can also be used to clean areas around implants, bridges, dentures and other appliances. [43]

Chewable toothbrush

Chewable toothbrushes Chewabletoothbrush.jpg
Chewable toothbrushes

A chewable toothbrush is a miniature plastic moulded toothbrush which can be placed inside the mouth. While not commonly used, they are useful to travelers and are sometimes available from bathroom vending machines. They are available in different flavors such as mint or bubblegum and should be disposed of after use. Other types of disposable toothbrushes include those that contain a small breakable plastic ball of toothpaste on the bristles, which can be used without water. [44]

Musical Toothbrush

A musical toothbrush is a type of manual or powered toothbrush designed to make tooth brushing habit more interesting. It is more commonly introduced to children to gain their attention and positively influence their tooth brushing behavior. The music starts while child starts brushing, it continuously plays during the brushing and it ends when the child stops brushing. [45]

Tooth brushing

Hygiene and care

It is not recommended to share toothbrushes with others, since besides general hygienic concerns, there is a risk of transmitting diseases that are typically transmittable by blood, such as Hepatitis C. [46]

After use, it is advisable to rinse the toothbrush with water, shake it off and let the toothbrush dry.

Studies have shown that brushing to remove dental plaque more often than every 48 hours is enough to maintain gum and tooth health. Tooth brushing can remove plaque up to one millimeter below the gum line, and each person has a habitual brushing method, so more frequent brushing does not cover additional parts of the teeth or mouth. [47] Most dentists recommended patients brush twice a day in the hope that more frequent brushing would clean more areas of the mouth. [48] 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. [49]

Adversity of toothbrushes

Teeth can be damaged by several factors including poor oral hygiene, but also by wrong oral hygiene. Especially for sensitive teeth, damage to dentin and gums can be prevented by several measures [50] including a correct brushing technique.

It is beneficial, when using a straight bristled brush, not to scrub horizontally over the necks of teeth, not to press the brush too hard against the teeth, to choose a toothpaste that is not too abrasive, [51] and to wait at least 30 minutes after consumption of acidic food or drinks before brushing. [50] [52] Harder toothbrushes reduce plaque more efficiently but are more stressful to teeth and gum; using a medium to soft brush for a longer cleaning time was rated to be the best compromise between cleaning result and gum and tooth health. [53]

A study by University College London found that advice on brushing technique and frequency given by 10 national dental associations, toothpaste and toothbrush companies, and in dental textbooks was inconsistent. [54]

See also

Related Research Articles

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.

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.

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.

Dentures Prosthetic devices constructed to replace missing teeth

Dentures are prosthetic devices constructed to replace missing teeth, and are supported by the surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable. However, there are many denture designs, some which rely on bonding or clasping onto teeth or dental implants. There are two main categories of dentures, the distinction being whether they are used to replace missing teeth on the mandibular arch or on the maxillary arch.

An electric toothbrush is a toothbrush that makes rapid automatic bristle motions, either back-and-forth oscillation or rotation-oscillation, in order to clean teeth. Motions at sonic speeds or below are made by a motor. In the case of ultrasonic toothbrushes, ultrasonic motions are produced by a piezoelectric crystal. A modern electric toothbrush is usually powered by a rechargeable battery charged through inductive charging when the brush sits in the charging base between uses.

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.

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 brushing Manual abrasion of the surfaces of the teeth.

Tooth brushing is the act of scrubbing teeth with a toothbrush, usually equipped with toothpaste. Interdental cleaning 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.

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.

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.

Dental Public Health (DPH) is a para-clinical specialty of dentistry that deals with the prevention of oral disease and promotion of oral health. Dental public health is involved in the assessment of key dental health needs and coming up with effective solutions to improve the dental health of populations rather than individuals.

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.

Tongue cleaner

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. A 2006 Cochrane review found tentative evidence of decreased levels of odor molecules.

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.

Teeth-cleaning twig

A teeth-cleaning twig is a tool made from a twig from a tree. It can help to prevent tooth decay and gum 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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