Lecture Notes: Oral Infection Control - Toothbrushes and Toothbrushing

Learning Objectives

• Identify the characteristics of an effective toothbrush.
• Differentiate between manual toothbrushing methods, including limitations and benefits.
• Describe motions of action for powered toothbrushes.
• Identify the basis for power toothbrush selection.
• Describe tongue cleaning and its effects on reducing dental biofilm.
• Identify negative effects of improper toothbrushing on hard and soft tissue.

Historical Background

• Chew Sticks (3500 BC): Primitive toothbrushes made from twigs or roots.
• First Toothbrushes (1000 AD): Made from hog or horse hair.
• Pierre Fitchard (1728): Proposed using sponges and herb roots instead of horse hair.
• 19th Century: Patents for toothbrushes made of gold, ivory, and ebony.
• 1919: AAP specifications for toothbrushes.
• 1938: Introduction of synthetic nylon bristles.

Characteristics of an Effective Manual Toothbrush

• Conforms to individual patient requirements in size, shape, and texture.
• Easily manipulated, easily cleaned, durable, and inexpensive.
• Soft bristles with rounded ends.
• Designed for utility, efficiency, and cleanliness.

Parts of a Toothbrush

• Head: Contains bristles.
• Shank: Connects head to handle.
• Toe: End farthest from handle.
• Heel: Bottom of bristles.
• Brushing Plane: Arrangement of bristles, typically 3 rows by 5-12 columns.

Composition and Design

• Made of plastic or polymer.
• Must be durable, easy to clean, visually appealing, and light-weight.
• Handle design varies (twist, curve, angle) for better maneuverability.
• Brush head designs vary in size and shape.

Types of Bristles

• Made of nylon filaments.
• Stiffness depends on diameter and length.
• Soft or sensitive bristles recommended to prevent damage.

Influencing Factors for Toothbrush Selection

• Patient ability and manual dexterity.
• Age and type of dentition.
• Gingival health and anatomical configurations.
• Patient preferences and compliance.
• Affordability, especially for powered toothbrushes.

Guidelines for Manual Toothbrushing

• Proper grasp: Light, controlled, palm grasp with thumb on shank.
• Brushing sequence: Consistent pattern to cover all areas.
• Duration: At least 2 minutes, use of timers or songs.
• Frequency: At least twice a day, morning and night.
• Pressure: Avoid excessive force.

Toothbrushing Methods

• Bass/Modified Bass Method: Focus on gingival margin and sulcular area.
• Stillman/Modified Stillman Method: Focus on cervical areas with rolling stroke.
• Roll or Rolling Stroke Method: Removes biofilm without sulcus focus.
• Charters Method: Effective for ortho patients, angling towards brackets.
• Horizontal Method: Not recommended due to potential damage.
• Fones Method: Circular method recommended for children.
• Leonard Method: Vertical method, limited plaque removal.

Power Toothbrushes

• More effective at biofilm removal.
• Good for patients with poor brushing habits or limited dexterity.
• Method: Hold bristles at 45-degree angle and let toothbrush do the work.
• Consider timer and head design preferences.

Supplemental Brushing

• Occlusal Brushing: Important for groove and pit cleaning.
• Tongue Cleaning: Reduces bacterial load, prevents halitosis.

Special Concerns and Adverse Effects

• Special care for patients with oral lesions, post-surgery, or blood disorders.
• Adverse effects include gingival abrasion, dental abrasion, and bacteremia.

Care of Toothbrushes

• Replace every 2-3 months or when bristles are frayed.
• Clean and let air dry between uses.
• Store upright and not in contact with other toothbrushes.

Documentation

• Record recommendations and patient oral hygiene instructions.
• Include methods taught and any supplemental aids advised.

These notes provide a comprehensive study guide on oral infection control and the importance of proper toothbrushing techniques and tools.