Fig 1.1 Toothbrushing

A good cleaning regime, carried out on a daily basis, is important in preventing disease and bad breath, and maximising the lifespan of any fillings, crowns, bridges or implants you may have. Technique is very important to ensure no areas are missed. A bad technique will continue to miss certain areas every time, and lead to problems in those areas. Our dentists or hygienists would be happy to provide individual advice. Manual toothbrushes used well can be very efficient though nowadays, many people prefer electric brushes. If you are thinking of buying an electric toothbrush, we would strongly recommend one which is rechargeable and not run by small disposable batteries. Again, technique is important in providing the best results. We always have a supply of electric brushes to purchase at the practice.

Good tooth-brushing is not as straightforward as many would like to believe. It is often done ineffectively in some areas of the mouth which may not be visible, and many patients need some guidance to help in these areas. Another common fault is to be too vigorous which can damage the gums and teeth, cause recession, and cut grooves into the teeth. Vigorous brushing tends to also be ineffective at plaque removal. A good technique is gentle but thorough.

Tooth-brushing Technique

A good technique is to start at the outer surface of the top left back tooth, and clean this surface for 2 seconds be it by holding the electric brush in contact with it, ensuring an overlap of tooth and gum, or by jiggling a manual brush. Do not use big back and fore movements or up and down movements, we want small jiggling movements to encourage the bristles to go into all the crevices. After 2 seconds, move to the tooth in-front and repeat the same process and so on until reaching the back tooth on the top right. At some point, you will have to change from fore-hand to back-hand, make sure you do not miss out teeth when doing this. Change then to the inner surface (adjacent to the palate) of the back tooth and again spend 2 seconds cleaning each surface, until reaching the rear tooth on the other side.

Switch then to the lower teeth left back tooth and repeat the technique on the lower teeth. When cleaning inside at the bottom, make sure the brush pushes the tongue out of the way to ensure the brush gets to the tooth/gum junction rather than the tongue dictating where the toothbrush goes! Having spent about 4x 30 seconds brushing all the side surfaces, give the biting surfaces a good brush too. When there are spaces between teeth, eg after an extraction, make sure to angle to brush so as to clean the teeth the tooth surface next to the spaces.

Soft plaque which has been missed will harden to form calculus (tartar) which is unable to be removed by a toothbrush and needs professional removal.

Interdental Cleaning

Fig 1.2 Use of interdental
TePe brushes

Cleaning between the teeth with interdental brushes such as TePes or Curaprox, or floss is also important and should ideally be carried out daily. Straight brushes are best used towards the front of the mouth and the longer handled angled brushes for the side and reat teeth. They should always be carefully inserted at 90 degrees to the space, getting the wrong angle will cause them to buckle. Having the right sized brushes for the individual spaces is important, as is the technique, and we can help you with this. Brushes are now considered to be more effective than floss for most people.

Superfloss is generally used for cleaning beneath bridges where ordinary floss won’t go, though the interdental brushes are another option.

Personalized advice and detailed instruction sheets to take away and are available from the practice.

You may also like to read “Gum disease” or “Hygienist Care