Dentists Disagree On Proper Brushing Technique

Brushing teeth is an important part of patients' dental care routine for a healthy mouth and smile. Dentists, are you giving your patients good advice on how to brush teeth properly? It may surprise you but this supposedly simple advice has become inconsistent between many dentists and associations, research shows. 

The study, published in the British Dental Journal, looked at the brushing advice given by dental associations across 10 countries, toothpaste and toothbrush companies and in dental textbooks. They found a wide range of recommendations on what brushing method to use, how often to brush and for how long. The researchers found no clear consensus between the various sources, and a worrying lack of agreement between advice from dental associations compared with dental textbooks.

"The public needs to have sound information on the best method to brush their teeth," says Aubrey Sheiham, Emeritus Professor of Dental Public Health (UCL Epidemiology & Public Health) and senior author of the study. "If people hear one thing from a dental association, another from a toothbrush company and something else from their dentist, no wonder they are confused about how to brush. In this study we found an unacceptably inconsistent array of advice from different sources.

"Dental associations need to be consistent about what method to recommend, based on how effective the method is. Most worryingly, the methods recommended by dental associations are not the same as the best ones mentioned in dental textbooks. There is no evidence to suggest that complicated techniques are any better than a simple gentle scrub."

The most commonly-recommended technique involves gently jiggling the brush back and forth in small motions, with the intention of shaking loose any food particles, plaque and bacteria. However, no large-scale studies have ever shown this method to be any more effective than basic scrubbing.

"Brush gently with a simple horizontal scrubbing motion, with the brush at a forty-five degree angle to get to the dental plaque," Professor Sheiham advises. "To avoid brushing too hard, hold the brush with a pencil grip rather than a fist. This simple method is perfectly effective at keeping your gums healthy. There is little point in brushing after eating sweets or sugary drinks to prevent tooth decay. It takes bacteria from food about two minutes to start producing acid, so if you brush your teeth a few minutes after eating sugary foods, the acid will have damaged the enamel."

The conflicting messages given by different organizations highlight the need for research into how effective different brushing methods are. At present, the expert advice in the guidelines, recommend a simple scrubbing technique as it is easy to learn and there is no evidence to justify a more complicated method.

"The wide range of recommendations we found is likely due to the lack of strong evidence suggesting that one method is conclusively better than another," says lead author Dr John Wainwright, who carried out the study at UCL and is now a practicing dentist. "I advise my patients to focus their brushing on areas where plaque is most likely to collect - the biting surfaces and where the teeth and gums meet - and to use a gentle scrubbing motion. All too frequently I am asked why the method I am describing differs from how previous dentists have taught them in the past. What I feel we need is better research into what the easiest to learn, most effective and safest way to brush is. The current situation where not just individual dentists, but different dental organizations worldwide are all issuing different brushing guidelines isn't just confusing - it's undermining faith and trust in the profession as a whole. For something most people do twice a day, you would expect dentists to send a clearer, more unified message to their patients on how to brush their teeth."

The American Dental Associations Recommendation

The ADA recommends you:

Brush your teeth twice a day with a soft-bristled brush. The size and shape of your brush should fit your mouth allowing you to reach all areas easily.

Replace your toothbrush every three or four months or sooner if the bristles are frayed. A worn toothbrush wont do a good job of cleaning your teeth.

The proper brushing technique is to:

Place your toothbrush at a 45-degree angle to the gums.

Gently move the brush back and forth in short (tooth-wide) strokes.

Brush the outer surfaces, the inner surfaces, and the chewing surfaces of the teeth.

To clean the inside surfaces of the front teeth, tilt the brush vertically and make several up-and-down strokes.

Brush your tongue to remove bacteria and keep your breath fresh.

Brushing teeth is only a part of your patients complete dental care routine. You should also make sure to recommend to:

Clean between teeth daily with floss. Tooth decay-causing bacteria still linger between teeth where toothbrush bristles cant reach. This helps remove plaque and food particles from between the teeth and under the gum line

Eat a balanced diet and limit between-meal snacks.

Encourage them to visit their dentist regularly for professional cleanings and oral exams.

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