toothbrush a

Dr. Ibrahim Shaikh

1st Year MDS Periodontology

Seminar No. 2

CONTENTS :2

1. Introduction

2. History

3. Manual Toothbrushes

4. Toothbrushing Techniques

5. Power Toothbrushes

6. Toothbrushing for Special Conditions

7. Effects of Toothbrushing

8. Care of Toothbrushes

9. Modern toothbrushes

INTRODUCTION3

4

The toothbrush is the principal instrument in

general use for removal of dental biofilm and is

a necessary part of oral disease control.

Clinical Practice of The Dental Hygienist; Esther M. Wilkins

HISTORY5

Toothpicks as Toothbrushes6

3000 B.C - Mesopotamia


History of Periodontology ; Fermin carranza, Vincenzo Guerini

7

Omar Khayyam

(1025 – 1123)

William Shakespeare

(1564 – 1616)

Erasmus

(1466 – 1526)

Chewstick8

1600 B.C. – China

Religious ritual


Middle ages9

Tang Dynasty (619 - 907)

1223 – Dōgen Kigen

1498

1728 – Pierre Fauchard(Le Chirurgien Dentiste)


William Addis – The Inventor(1780)10


H. N. Wadsworth11

1857 – First person to patent the toothbrush

DuPont de Nemours12

24 FEB, 1938 – First nylon bristle toothbrush.


Electric Toothbrush13

The first electric

toothbrush, the

Broxodent, was

invented in

Switzerland in 1954


MANUAL TOOTHBRUSHES14

Toothbrush :15

According to American Dental Association Council on Dental Therapeutics

‘The toothbrush is designed primarily to promote cleanliness of teeth & oral

cavity.’

OBJECTIVES:

1. To clean teeth and interdental spaces of food remnants, debris & stains.

2. To prevent plaque formation.

3. To disturb and remove plaque.

4. To stimulate and massage gingival tissues.

5. To clean the tongue.

6. Halitosis control

7. Sanitation of oral cavity

Essentials of preventive & Community Dentistry; Soben Peter

Characteristics :16

1. Conforms to individual patient requirements in size, shape &

texture.

2. Easily & efficiently manipulated.

3. Impervious to moisture ; readily cleaned & aerated.

4. Durable & Inexpensive.

5. Has prime functional properties of flexibility, softness, & of

strength, rigidity & lightness of the handle.

6. Is designed for utility, efficiency & cleanliness.Clinical Practice of The Dental Hygienist; Esther M. Wilkins

Parts :17


ADA Specification :18

Brushing Surface:-

1 to 1.25 inches in length (25.4 to 31.8 mm

long)

5/16 to 3/8 inches in width (7.9 to 9.5 mm

wide)

2 to 4 rows of bristles

5 to 12 tufts per row Essentials of preventive & Community Dentistry; Soben Peter

Manufacturing :19

Handle

Durability

Moisture

Appearance

Cost

Maneuverability


20

Shape :

Grasp

Projections

Weight

Strength

† A Twist, curve, offset, or angle in the shank with or without thumb rests

may assist the patient in the adaptation of the brush to difficult-to-reach

areas.


Bristles & Filaments21


Factors Influencing Stiffness :22

1. Diameter

2. Length

3. Number

4. Angle


Brushing Plane23


Toothbrush Selection :24

Ability of the patient

Manual dexterity of the patient

Age of the patient

Size & Shape

Professional personnel


Soft Nylon Brush25

1. More effective in cleaning.

2. Less traumatic to the gingival tissue.

3. Can be directed into the sulcus & into interproximal areas.

4. Applicable around appliances.

5. Tooth abrasion &/or gingival recession can be prevented.

6. Effective use for sensitive gingiva.


TECHNIQUES26

Guidelines :27

A. Grasp of Brush :

Objectives –

1. Grasp & manipulate the brush for successful removal of

dental biofilm.

2. Control of brush during all movements.

3. Sensitivity to the amount of force applied.

4. Effective positioning.


Procedure –

1. Grasp handle in the palm of the hand with thumb against the

shank.

2. Position filaments in the proper direction for placement on the

teeth.

3. Adapt grasp for various positions of the brush head.

4. Apply appropriate pressure for the removal of the dental biofilm.

28


29

B. Sequence :


30

C. Amount –

The Count System :

1. Count 6 strokes in each area for modified Stillman or other

method in which a stroke is used.

2. Count slowly to 10 for each brush position while brush is

vibrated & filament ends are held in position for the Bass,

Charters, or other vibratory method.


31

The Clock System

1. Some patients brush thoroughly while watching a

clock or a egg timer.

Built-in timers

1. Signals may be set for 30seconds, one or two

minutes.


32

D. Frequency –

Emphasis in patient education is placed on complete

biofilm removal daily rather than the number of

brushings.

Atleast two brushings, are recommended for the control

of dental biofilm, oral sanitation & for halitosis control


Methods of Toothbrushing :33

1. Sulcular (Bass) Method & Modified Bass Method

2. The Stillman Method & Modified Stillman Method

3. Charters Method

4. Roll : Rolling Stroke Method

5. Circular : Fones

6. Vertical : Leonard

7. Physiologic : Smith

8. Horizontal

9. Scrub – brushClinical Practice of The Dental Hygienist; Esther M. Wilkins

Modified Bass & Bass Method :34

Indication

Limitation


Modified Stillman & Stillman

method 35

Indication

Limitations


Charter’s Method :36

Indication

Limitation


Rolling Method 37


Indication

Limitation

Circular : Fones Method38

Indication

Limitation


Vertical : Leonard Method39

Given by Hirschfeld

With teeth edge-to-edge, place the brush filaments against

the teeth at right angles to the long axes of the teeth.

Brush vigorously with light pressure & mostly up and down

strokes with a slight rotation or circular motion after striking

the gingival margin with force.

Use enough pressure to force the filaments into the

embrasures, but not enough to damage the brush.

Detrimental Methods :40

A. Horizontal –

1. An unlimited sweep with a horizontal scrubbing

motion.

2. Can produce tooth abrasion.

3. Interproximal areas not touched.

41

B. Scrub-brush –

1. Consists of vigorously combined horizontal, vertical &

circular strokes, with some vibratory motions for certain

areas.

2. Can encourage gingival recession & tooth abrasion

POWER TOOTHBRUSHES42

Power Toothbrushes :43

The heads of these toothbrushes oscillate in a side to side motion or in

rotary motion. The frequency of the oscillations is around 40Hz in an

ordinary powered toothbrush.

ADVANTAGES

1. It increases patient motivation resulting in better patient compliance.

2. Increased accessibility in interproximal and lingual tooth surface

3. No specific brushing technique required

4. Uses less brushing force than manual toothbrushes

5. Brushing timer is incorporated in some brushes to help the patient in

brushing for the required duration.

Power v/s Manual :

McKendrick, A.J.W., et al. : A Two-year Comparison of Hand & Electric Toothbrushes, J.Periodontol. Res.,

3,224,1968

44

Biofilm removal & reduction of gingivitis¹

Current power brushes move in speeds & motions

that cannot be duplicated by manual brushes.

Safety of powerbrushes as compared to manual-

brushes has been well established.

Self-included timers.

Indications :45

1. Ineffective manual biofilm removal techniques

2. Reduce calculus & stain buildup

3. Undergoing orthodontic treatment

4. Aggressive brushers

5. Patients with disabilities or limited dexterity

6. Patients unable to brush

Brush Head Designs :46

Power Source :47

1. Direct

2. Replaceable Batteries

3. Rechargeable

4. Disposable

…In Areas For Special Attention

TOOTHBRUSHING…48

Facially Displaced Teeth :49

Lingually Placed Teeth :50

Overlapped Teeth or Wide

Embrasures:51

Distal Surfaces of Posterior

Teeth :52

Occlusal Brushing :53

Acute Oral Inflammatory/Traumatic

lesions :54

Brush all areas of mouth that are not affected

Rinse with warm, mild saline solution to

encourage healing & debris removal.

Resume regular biofilm control measures on the

affected area as soon as possible.

Following periodontal Surgery :55

Brush occlusal surfaces of the teeth & use light

strokes over the dressing.

Avoid direct vigorous brushing.

Brush over teeth & gingiva, not involved in

surgery.

ANUG :56

In acute stage oral tissues are sensitive to any

touch, toothbrushing is therefore neglected.

Soft brush recommended along with careful

brush placement.

Orthodontic Patients :57

EFFECTS OF

TOOTHBRUSHING58

The Gingiva :59

Trauma

Changes in the Gingival Contour

Gingival Recession

Dental abrasion60

Abrasion is the varying away of tooth structure.

Incorrect brushing especially with an abrasive

toothpaste is the most common cause.

Primarily on facial surfaces – canines, premolars

or any tooth in buccoversion or labioversion

Cervical areas – most abraded areas.

CARE OF TOOTHBRUSHES61

Brush Replacement :62

Frequent replacement recommended; every 3 months

Brushes need to be replaced before filaments become

splayed or frayed or lose resiliency.

Brush contamination occurs with use.

Patients who are debiliated, immunosuppresed, have a

known infection can be advised to disinfect their brushes or

use disposable brushes.

Cleaning Toothbrushes :63

Clean thoroughly after each use.

Hold brush under strong stream of warm water from faucet to force particles, dentrifice and bacteria from between the filaments.

Tap the handle on the edge of sink.

Use one toothbrush to clean another brush.

Rinse completely & tap out excess water.

Brush Storage :64

Open air – upright position, apart from contact with other

brushes.

Portable brush containers – with sufficient holes.

At least 6 feet away from the toilet.

NEWER ADVANCES65

Sonic Toothbrushes : 66

These types of toothbrushes produce high frequency

vibrations (1.6MHz)which leads to the phenomenon of

cavitation and acoustic microstreaming. This

phenomenon aids in stain removal as well as disruption

of the bacterial cell wall (bactericidal).

Philips Sonicare67

Ionic Toothbrushes : 68

Ionic toothbrushes change the surface charge of a tooth by

an influx of positively charged ions.

The plaque with a similar charge is thus repelled from the

tooth surface & is attracted by the negatively charged

brush.

Double-Headed Toothbrush69

Triple-Headed Toothbrush70

Ultra-Violet:71

CROSS-REFERENCES72

73

C.G.Daly, C.C.Chapple et al. To investigate the effect of

progressive toothbrush wear on plaque control. J Clin

Periodontol – 1996; 23: 45-49

Akshay Vibhute, K.L. Vandana. The effectiveness of

manual v/s powered tootthbrushes for plaque removal &

gingival health- A meta analysis. JISP – 2012, vol 16, issue

– 2

M.F. Timmerman et al. Comparitive analysis of high & low

brushing force in relation to efficacy and gingival abrasion.

J Clin Periodontol 2004, 31 : 620 - 624

References : 74



Essentials of preventive & Community Dentistry; Soben Peter

McKendrick, A.J.W., et al. : A Two-year Comparison of Hand & Electric Toothbrushes, J.Periodontol. Res., 3,224,1968

…For The Patience.

THANK YOU75

toothbrush a

Health & Medicine

dental hygienist esther

nylon bristle toothbrush

removal of dental biofilm

clean teeth

small holes

ibrahim shaikh

badger bristle

william addis of england