Teaching toothbrushing with fluoride toothpaste – are we doing it well?


Toothbrushing at least twice a day with fluoride toothpaste is an effective way of reducing caries. This is confirmed by good systematic review evidence, so teaching patient effective toothbrushing with fluoride toothpaste is a key preventive strategy.  The aim of this qualitative study was to explore oral health professionals (OHPs) perspectives regarding their strategies, considerations and methods when teaching their patients the most effective way of toothbrushing with fluoride toothpaste.

Data was collected using focus groups. Sampling was purposive and included 23 OHPs (10 dental nurses, 4 dental hygienists and 9 dentists) from two regions of Sweden.  Open questions and patient vignettes were used and digital recordings taken and transposed.  Manifest and latent qualitative content analysis was used to analyse the data.

  • Three categories were identified
    • Strategies and intentions,
    • Providing oral hygiene information and instruction and
    • Barriers to optimal oral healthcare education.
  • Health promotion and seeing to the patients’ best interest were driving forces among the OHPs as well as personal success in their preventive work.
  • They focused on toothbrushing techniques more than on how to use F toothpaste.
  • Barriers to oral health information were cost to the patients and, to some extent, the opinion of the OHPs that some patients were impossible to motivate or that patients already know what to do.

The authors concluded

The OHPs described toothbrushing with fluoride toothpaste as very important, although the plaque removal perspective dominated. They did not focus on how to use fluoride toothpaste, because they believed that knowledge about and appropriate behaviour concerning fluoride toothpaste were already familiar to their patients.


Fluoride toothpaste has a high level of market penetration in a large number of countries and is considered to have played a significant role in the decreasing caries incidence. The fact that it is commonplace may have contributed to the findings expressed in the quote presented,

 I take it for granted … everybody’s heard it, lots of times……, 

However, despite the good evidence available for its use, this study does highlight gaps in knowledge regarding its use and suitability for various patient groups. It is also interesting that the focus of the OHPs was more on plaque control than the use of toothpaste, as in terms of caries reduction, the regular (twice daily) application of fluoride is probably more important.  This study is a small sample from just one country that highlights some interesting issues that may  be similar in other areas and with other groups of OHPs.


Int J Dent Hygiene Jensen O, Gabre P, Sköld UM, Birkhed D, Povlsen L. ‘I take for granted that patients know’ – oral health professionals’ strategies, considerations and methods when teaching patients how to use fluoride toothpaste.

Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VCC, Shi X. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD007868. DOI: 10.1002/14651858.CD007868.pub2.

Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002278. DOI: 10.1002/14651858.CD002278.






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