Regular daily toothbrushing plays an important part in preventing periodontal disease and caries but is there consensus on how this should be carried out. The main aim of this study was to assess the methods of toothbrushing recommended for both adults and children by dental associations, toothpaste and toothbrush companies and professional dental sources such as in dental textbooks and by experts.

The websites of dental associations in Australia, Brazil, Canada, Denmark, Finland, Japan, Norway, Sweden, the UK and the USA were searched. Google translate was used to translate those in non-English speaking countries. Toothbrushing guidelines were sought from toothpaste and toothbrush company sources. Dental textbooks were also searched.

• 66 sources were located with 58 having usable data.
• Techniques
  • 19 – recommended the Modified Bass technique
  • 11 – recommended the Bass technique
  • 10 – the Fones technique
  • 5 – the Stillman technique.
  • None recommended the Charters technique.
• Frequency
  • 19 – sources did not provide information on brushing frequency
  • 42 – recommended twice daily brushing.
  • 3 – recommended 3 times a day
  • 25 – did not provide information on brushing duration
  • 26 – recommended 2 minutes
  • 12 – recommended 2-3 minutes
  • 2 – recommended 3 minutes
  • One source recommended brushing for more than 3 minutes.

The authors concluded

There was unacceptably very wide diversity in recommendations on toothbrushing techniques and on how often people should brush their teeth and for how long. Such diversity in recommendations should be of serious concern to the dental profession. There is an urgent need for research into the comparative effectiveness of brushing methods. Higher grades of evidence are required to inform professional bodies that develop guidelines.

Comment

While a broad search for relevant information has been conducted there is little detailed information on how the clinical trial literature has been searched. While the review might not have been exhaustive it has certainly created an impact in the media.  As is noted in the journal, there is good evidence that brushing with a fluoride toothpaste of at least 1000ppm fluoride twice a day helps reduce tooth decay (Marhino et al 2003; Walsh et al 2010). There is also evidence to show that a powered toothbrush reduces plaque and gingivitis more than manual toothbrushes, although the clinical importance is this is not known (Dental Elf 18^th June 2014).

That does mean that we still do not have high quality evidence about which brushing technique is best, or how long we should brush for or how often we should change our toothbrush. While the range of techniques recommended may cause confusion for patients it is not assisted by the wide range of toothbrush designs and toothpastes varieties on the market. The key aim of toothbrushing is to clean the teeth by removing plaque (and apply fluoride) and perhaps the focus should be on that rather than on which particular technique.

Links

WainwrightJ, Shieham A. An analysis of methods of toothbrushing recommended by dental associations, toothpaste and toothbrush companies and in dental texts. British Dental Journal 217, E5 (2014) Published online: 8 August 2014 | doi:10.1038/sj.bdj.2014.651

BBC News – Confusion over best way to brush teeth

Science daily – Best way to brush teeth? Even dentists, dental associations don’t agree

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.

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.

Dental Elf 18^th June 2014 – Powered toothbrushes reduced plaque and gingivitis more than manual toothbrushes.