Tooth Brushing

Tooth Brushing

Reviewed By:
Andrew M. Sicklick, D.D.S.

Summary

Brushing plays a crucial role in removing the bacteria that causes both tooth decay and gum disease. Experts recommend that people brush their teeth at least twice daily in addition to flossing and having their teeth professionally cleaned at least twice a year.

Experts generally recommend that patients use a soft-bristled brush, because it is gentler on the gums. Using a fluoride toothpaste makes the structure of the teeth less vulnerable to decay and aids in remineralization, the process in which early tooth decay may be repaired.

When brushing, a pea-sized amount of toothpaste should be sufficient to clean the teeth. Place the brush at a 45-degree angle to the teeth. This helps the bristles to reach the space between the teeth and gums.

Experts differ about the best motion to use when brushing. Regardless of which technique is used, it is important not to scrub too hard, because this can cause the gums to recede and expose the tender root surface.

It is important to clean all areas of the teeth – including the top and bottom of both the outside and inside of the teeth, and the chewing surfaces on the back teeth, where food can easily become stuck in crevices. Brushing the tongue can help remove bacteria that causes bad breath (halitosis).

Experts recommend brushing at least twice daily, and for at least three minutes per session. In addition, patients are urged to follow other brushing-related tips, including:

  • Do not share toothbrushes
  • Use a fluoride toothpaste
  • Consider purchasing a powered toothbrush
  • Floss regularly

About brushing

Brushing plays a crucial role in removing plaque from the teeth and helps to prevent both tooth decay and gum disease. Experts recommend that people brush their teeth at least twice daily in addition to having their teeth professionally cleaned at a dentist’s office twice yearly.

The main benefit of regular brushing is plaque removal. Plaque is a sticky film made up of bacteria, food particles and other substances that cling to teeth and cause tooth decay and gum disease. Brushing and flossing can significantly reduce the amount of plaque on a person’s teeth. However, it is important to brush and floss regularly. Studies show that plaque regrows on teeth just three to four hours after brushing.

Experts generally recommend that patients use a soft-bristled brush, because soft bristles are gentler on the gums. Choose a brush that is of a size and shape that feels comfortable inside the mouth and that provides the ability to reach all areas easily. The bristles should be made of nylon, as natural bristles tend to be more porous and to hold bacteria.

When brushing, always use toothpaste, also known as dentifrice. Brushing with a toothpaste containing fluoride makes the structure of the teeth less vulnerable to decay and aids in remineralization, the process in which early tooth decay is repaired before it becomes visible to dentists. Brushing with toothpaste also helps to remove stains and whiten teeth, and helps combat bad breath (halitosis).

Purchase products that are approved by the American Dental Association (ADA). These products have the ADA seal on them. Products that lack this seal may not meet the standards and regulations of the ADA.

Proper cleaning, storage and replacement of toothbrushes is essential to ensuring that brushing is effective. Toothbrushes should be replaced every three to four months or sooner if the bristles become worn, according to the ADA. A toothbrush is worn when the bristles begin to spread and fan out toward either side of the brush. Worn toothbrushes do not clean as effectively as a newer brush. Children’s brushes often have to be replaced more frequently than adult brushes.

How to brush

Rinsing the mouth with an antibacterial mouth rinse prior to brushing may reduce the amount of bacteria that builds up on a toothbrush, according to the American Dental Association (ADA).

When brushing, a pea-sized amount of toothpaste should be sufficient to get the teeth clean, as the paste foams when the teeth are brushed. Experts recommend that only water be used to cleanse a child’s teeth until at least 6 months of age. For children under the age of 6 years, use a small amount of toothpaste when brushing the teeth. Too much toothpaste can put the child at the risk of developing white and brown spots on the teeth (fluorosis). Squeeze the paste onto the top half of the brush’s bristles.

Place the brush at a 45-degree angle to the teeth. This helps the bristles to reach the space between the teeth and gums. Experts differ about the best motion to use when brushing. Some advocate short back-and-forth motions, whereas others advise patients to brush up and down. Still others advise patients to brush in a circular motion. Regardless of which technique is used, it is important not to scrub too hard, as this can cause the gums to recede and expose the tender root surface.

Do not move the brush more than half the length of a tooth, and only brush two to three teeth at a time before moving on. Clean the top and bottom of both the outside and inside of the teeth. When reaching behind the upper and lower front teeth, it helps to hold the brush vertically, use the bristle at the end of the brush and gently scrub.

The chewing surfaces on the back teeth also need to be cleaned because food can easily become stuck in crevices. Use a gentle back-and-forth motion when cleaning these teeth. Finally, brush the tongue to remove bacteria that can cause bad breath. Overall brushing time should take at least three minutes. It may help some patients to use a timer or to play a recording of a song that lasts that length of time.

Once brushing is completed, thoroughly rinse the brush under tap water. Store the brush in an upright position and allow it to air dry. It is important to keep stored brushes separate so that the bristles are not touching. This helps prevent contamination from one brush to another.

Whenever possible, it is best to avoid storing a brush in a closed container, which can promote the growth of microorganisms. There is no evidence that soaking a toothbrush in antibacterial solution or using a commercially available toothbrush sanitizer has any effect on oral health, according to the ADA.

In some cases, a person may have to brush the teeth of another. For example, children, the elderly and disabled people may need help brushing. Before brushing the teeth of children or the mentally disabled for the first time, try to reassure them that brushing is painless and explain each step of the process before performing it. Anxieties typically dissipate quickly as brushing becomes a predictable routine. Also, remind children and others not to swallow toothpaste.

When brushing the teeth of children, try to help them feel included in the process by allowing them to brush their own teeth first. Do not worry too much about technique when they are young – the important thing is to get them in the habit of brushing their teeth.  After a child has brushed, it is recommended for the adult to take the brush and complete the job using the proper technique.

Other brushing tips

Brushing is a major part of ensuring continued oral health. Other brushing-related tips that can help promote healthy teeth and gums include:

  • Brush teeth at least twice daily. Brushing after breakfast and before bed is the minimum standard. Also, brush after lunch and after eating sugary snacks when possible. Brushing may also be recommended after taking syrupy medications, such as certain cough and cold medications.
  • Do not share toothbrushes. This can result in the exchange of body fluids and microorganisms that trigger infections. People with compromised immune systems or carriers of infectious disease are especially urged to avoid this practice.
  • Use the right toothpaste. The brand or type of toothpaste (e.g., gel, paste, powder) does not matter as long as the paste contains fluoride. Certain types of toothpaste provide extra benefits. Patients with teeth sensitive to hot and cold may benefit from using a toothpaste designed to combat such sensitivity. Other types of toothpaste help control the buildup of soft calculus deposits (tartar) or promote extra whitening of the teeth.
  • Consider purchasing a powered toothbrush. Although manual toothbrushes do an excellent job of removing plaque, some people prefer powered brushes. These brushes may remove more plaque and stains than regular toothbrushes. Patients with certain disabilities might also find it easier to use a powered toothbrush.
  • Floss regularly. Using dental floss to clean between the teeth is just as important as brushing for removing the plaque and food particles that lead to tooth decay and gum diseases. Experts recommend flossing at least once daily, usually at night. Flossing twice daily may provide further benefits.

Questions for your doctor regarding brushing

Preparing questions in advance can help patients to have more meaningful discussions with their physicians or dentists regarding their conditions. Patients may wish to ask their doctor the following brushing-related questions:

  1. How often should I brush? More than twice daily?
  2. What brushing method do you suggest – up and down, side to side, back and forth?
  3. How will I know if I’m brushing correctly? Can you demonstrate for me?
  4. Are there certain areas that may be trouble spots and require extra brushing?
  5. Do you recommend using a powered toothbrush?
  6. What are the signs of fluorosis that I should watch for in my child?
  7. When should my child start brushing for himself/herself?
  8. How often should I change my toothbrush?
  9. Should I use a toothpaste with tartar control?
  10. How should I store my toothbrush?
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