The objectives of toothbrushing are to (1) remove plaque and disrupt reformation of it; (2) clean teeth of food, debris, and stain; (3) stimulate the gingival tissues (gums); and (4) apply dentifrice (toothpaste) with specific ingredients to address caries (cavities), periodontal (gum) disease or sensitivity.
Although a variety of toothbrushing methods have been developed, the Modified Bass technique is recommended at O’Malley Dental as it is most effective at cleaning the facial (cheek-side) and lingual (tongue-side) of the teeth. Also, only the Modified Bass technique is effective in cleaning the gingival sulcus, the space between the gums and tooth where the gum tissue attaches to the tooth. No brushing technique effectively cleans the interproximal surfaces of the teeth (the surfaces “in-between” the teeth). These surfaces must be cleaned with dental floss.
A second method recommended at O’Malley Dental is that of a gentle, circular motion of the brush and bristles, essentially massaging the gums and removing debris from the teeth. This is typically not as effective as the Modified Bass technique, however.
In brushing the facial (cheek-side) and lingual (tongue-side) surfaces of the teeth, the following method should be employed:
- The toothbrush is positioned in the gingival sulcus at a 45-degree angle to the tooth apex (tip of the root).
- The bristles are then gently pressed against the teeth and gums to enter the sulcus. A vibratory action, described as a back-and-forth horizontal jiggle, causes a pulsing of the bristles to clean the sulcus and spread the bristles out over the tooth surface.
- A rotational sweeping motion away from the gums then removes debris from the teeth. (On the bottom arch, rotate the bristles up. On the top arch, rotate the bristles down).
- The press, “jiggle,” and roll action is repeated at least five times before proceeding to the next site.
The occlusal (chewing) surfaces may be cleaned by either: (1) short vibratory strokes, with pressure being maintained to accomplish as deep a penetration of the pits and fissures (crevices in the teeth) as possible; or (2) a rapid back-and-forth vibrating motion to force the bristles into the pits and fissures as much as possible, followed by a sweeping motion to expel the dislodged debris. Long, sweeping, horizontal strokes are not recommended, because the toothbrush bristles have minimum contact in the deeper and more critical fissures. The pits and fissures are typically too narrow for bristle penetration and, regardless of technique, are inaccessible for adequate cleaning. This helps explain why more than 60% of all carious lesions (cavities) in the mouth are found on the occlusal surface, even though most individuals attempt to brush this surface.
Access to the lingual (tongue side) surfaces of the mandible (bottom jaw) and maxilla (top jaw) is difficult. To clean these areas hold the toothbrush vertically out in front of you (bristles up and handle down) with the bristles facing away from you. Grab the handle with a “thumbs-up” grip, wrapping your fingers around the handle and positioning your thumb directly behind the bristles. To clean the maxillary (top arch) lingual (tongue side) surfaces, keep the brush in the same “thumbs-up” orientation and place the bristles against the back of the teeth at the gumline and draw the brush down and forward. Repeat this at least 5 times. To clean the mandibular (bottom arch) lingual (tongue side) surfaces, rotate your wrist so the brush is oriented in a “thumbs-down” position, and place the bristles against the back of the teeth at the gumline and draw the brush up and forward. Repeat this at least 5 times.
Time and Frequency
O’Malley Dental recommends patients brush at least twice daily (morning and night), but preferably 3 times a day, after each meal. Patients should brush for at least 2 to 3 minutes (Sing the ABC’s song twice in your head). Because few individuals completely remove all plaque (deposits on the teeth from food, bacteria, etc.), daily brushing is still extremely important to maximize sulcular (the space between the gums and tooth where the gum tissue attaches to the tooth) cleaning as a periodontal (gum and bone) disease control measure. This also provides an opportunity to use fluoride dentifrices (toothpastes) more often in preventing cavities. Where periodontal pockets exist (in patients with periodontal disease), even more frequent oral hygiene procedures are indicated.
A routine brushing pattern should be established to avoid exclusion of any area.
Children – One systematic pattern is to teach children to begin by cleaning the occlusal (chewing) surfaces of the maxillary (top) arch, starting with the molars on the top right and continuing all the way around the arch. For children, it is most important to brush the pit and fissures. This should then be repeated for the facial (cheek-side) and lingual (tongue-side) surfaces. Then repeat all of the above steps on the mandibular (lower) arch. The use of a three-dimensional brush can be recommended as long as children are not able to brush the more difficult buccal and lingual surfaces. Such toothbrushes that hug the teeth and clean the buccal, lingual, and occlusal surfaces simultaneously are easier for children to use, as the brush guides itself from tooth to tooth. Studies show that children favor such toothbrushes.
Adults – Adult patients are taught to begin with the most posterior (back) tooth on the top right brushing the occlusal and incisal surfaces around the top arch until the last molar on the top left has been reached. The lower arch is then brushed in a similar manner. This is then followed by the Modified Bass technique to clean the facial and lingual surfaces.