Plaque (Bacteria in the mouth) is the major etiology for gum diseases and dental caries or tooth decay; therefore, daily plaque removal is critical to long-term success of all dental treatment. Carefully performed daily home plaque control, combined with frequent professionally delivered plaque removal, has been demonstrated to reduce plaque; thus decreasing the total number of harmful oral microorganisms. The daily use of a toothbrush and other oral hygiene aids is the most dependable way of achieving good oral health. Plaque control efforts must focus on improved brushing and cleaning the oral cavity that require mastering.

As bacterial growth takes place within hours of brushing all individuals should completely remove plaque from the teeth at least once every 24 hours.

Chemical inhibitors of plaque and calculus that are incorporated in mouthwashes or toothpastes also play important roles in plaque control. Fluorides are essential for control of tooth decay or dental caries. Many products are available as common adjunctive agents to mechanical techniques. These medicaments, as with any drug, should he recommended and prescribed according to the needs of individual patients.

Generally, toothbrushes vary in size and design as well as length, hardness, and arrangement of the bristles. When recommending a particular toothbrush, ease of use by the patient as well as the perception that the brush works well are important considerations.

Use of hard toothbrushes, vigorous horizontal brushing, and use of extremely abrasive dentifrices may lead to cervical abrasions of teeth and recession of gingiva.

Some novel toothbrush designs intended to make difficult-to-reach areas more accessible have been marketed. The cleaning efficiency of the toothbrush has been more attributed to individual brushing skill rather than toothbrush design. Thus practice and training is very essential to maintain a good oral hygiene.

Recommendations

1. Soft, nylon bristle toothbrushes clean effectively when used properly), remain effective for a reasonable time, and tend not to traumatize the gingiva or root surfaces.
2. Toothbrushes need to be replaced about every 3 months.
3. If you perceive a benefit from a particular brush design, then you should use it.

Typically, comparison studies of powered toothbrushes, manual toothbrushes, or other powered devices demonstrate slightly improved plaque removal in a short-term clinical trial. However, a distinct overall advantage for any one particular product has not been demonstrated.

Recommendations

1. Powered toothbrushes remove plaque as well as, if not slightly better than, manual toothbrushes. Patients who want to use powered toothbrushes should he encouraged to do so.
2. Patients need to be instructed in the proper use of powered devices.
3. Patients who are poor brushers, children, and caregivers may particularly benefit from using powered toothbrushes.

Toothpastes are made up of abrasives (e.g., silicon oxides, aluminium oxides, granular polyvinyl chlorides), water, humectants, soap or detergent, flavoring and sweetening agents, therapeutic agents (e.g., fluorides, pyrophosphates), coloring agents, and preservatives.

Recommendations

1. Dentifrices increase the effectiveness of brushing but should cause a minimum of abrasion to tooth surfaces.
2. Products containing fluorides and antimicrobial agents provide additional benefits for controlling caries and gingivitis.
3. Patients who form significant amounts of tartar/ calculus benefit from the use of a tartar control toothpastes.

Many methods for brushing the teeth have been described and promoted as being efficient and effective. The scrub technique is probably the simplest and most common method of brushing. The method most often recommended is the Bass technique.

1. Place the head of a soft brush parallel with the occlusal plane, with the brush head covering three to four teeth, beginning at the most distal tooth in the arch.
2. Place the bristles at the gum margin, pointing at a 45-degree angle to the long axis of the teeth.
3. Exert gentle vibratory pressure, using short, back and forth motions without dislodging the tips of the bristles. This motion forces the bristle ends into the gingival sulcus area as well as partly into the interproximal embrasures. The pressure should be firm enough to blanch the gingiva.
4. Complete several strokes in the same position. The repetitive motion cleans the tooth surfaces, concentrating on the apical third of the clinical crowns, the gingival sulci, and as far onto the proximal surfaces as the bristles can reach.
5. Lift the brush, move it to the adjacent teeth, and repeat the process for the next three or four teeth.
6. Continue around the arch, brushing about three teeth at a time. Then, use the same method to brush the lingual surfaces.
7. After completing the upper arch, move the brush to the lower arch, and brush in the same organized way to reach all the teeth.
8. If the brush is too large to reach the lingual surfaces of the anterior teeth, it should be turned vertically to press the end of the brush into the gingival sulcus area.
9. Brush the occlusal surfaces of three or four teeth at a time by pressing the bristles firmly into the pits and fissures and brushing with several short, back and forth strokes