An analysis of toothbrushing techniques

It is now universally accepted that regular tooth brushing to remove plaque is important in the prevention of dental decay and periodontal disease. But interestingly there remains to be a consensus on exactly which method of tooth brushing we should be employing and recommending to our patients. Evidence suggests that adherence to recommendations regarding tooth brushing tends to be poor (Watt and Marinho, 2005). Why exactly this is remains to be seen. This could be because instructions are too complicated, recommendations conflict with previous advice or simply, resistance to change.

There are six main manual tooth brushing techniques recommended. They vary in the age groups they are aimed at and in aspects of technique. The earliest tooth brushing technique described was by Fones in 1913 (Bhat et al 2003; O'Toole, 2013). This technique was recommended mainly for children. Then came the Bass technique, named after Charles C Bass (Bass, 1948). He would later be called ‘the father of preventive dentistry’ for his work on dental health. This technique was later adapted to the Modified Bass where bristles continue mainly in a horizontal position, but now also move in circular movements (Ganss et al, 2009). Similar to this is the Stillman technique that includes ‘vibratory’ movements before moving onto the next tooth (Stilman, 1932). The Scrub technique is the simplest of all and involves horizontal scrubbing at the gingival crevice before moving on to the occlusal and lingual surfaces (Phinney and Halstead, 2003). Charters (1928) suggested angling the brush head at 45° coronally to the margin rather than apically. A ‘vibratory’ and ‘slight rotary’ movement is then applied before moving to the next group of teeth. Finally is Hirschfield's technique that is an adaption of Fones' (O'Toole, 2013). In this technique, the circular movements are smaller and more concentrated over the gingival crevice.