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Proper Tooth-Brushing Technique According to Patient’s Age and Oral Status
Int J Clin Prev Dent 2020;16(4):149-153
Published online December 31, 2020;  https://doi.org/10.15236/ijcpd.2020.16.4.149
© 2020 International Journal of Clinical Preventive Dentistry.

Hye-Jeong Bok1, Cheon Hee Lee2

1Department of Dental Hygiene, Busan Women's College, Busan, 2Department of Dental Hygiene, Andong Science College, Andong, Korea
Correspondence to: Cheon Hee Lee
E-mail: arisu0515@hanmail.net
https://orcid.org/0000-0002-3203-8025
Received December 3, 2020; Revised December 17, 2020; Accepted December 26, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Tooth brushing is a basic technique to prevent major oral diseases (e.g., dental caries and periodontal disease). Several methods of tooth brushing technique devised by some dental scholars have been introduced. However, some guidelines to select the proper method are needed for an individual patient considering age and oral status. Methods such as rolling, Fones’, Bass, Stillman, Charters, Watanabe’s tooth-pick, and other modifications have been introduced. The rolling technique was recommended for general use, the Fones’ technique for preschool children, the Bass technique for the patient with gingivitis with gingival sulcus problem, the Stillman technique for widespread gingivitis, and the Charters technique for bridge wearer. Moreover, fixed-type orthodontic appliance wearer is recommended to use the mix-type methods as Bass, rolling, and Charters. Moreover, the Watanabe’s technique would be available for patients with a dental implant or periodontal problem. The denture wearer should clean the denture with a partial denture brush for a partial denture and a full denture brush for a full denture with the rolling method or its modification. The selection of the proper tooth brushing method suggested in this article would be one of the guidelines for clinical use of tooth brushing instruction for preventive measures.
Keywords : tooth brushing, oral status, simple plaque score, dental caries, periodontal diseases
Introduction

Tooth-brushing is the basic method for prevention of dental caries and periodontal disease, through eliminating dental plaque deposition at the tooth surface [1]. The aims of tooth- brushing has been known as 2 big things as removal of dental plaque from the tooth surface and gingival massage to promotion of the early inflammatory gingiva to enhance the blood circulation and increase the keratinization of the epithelial cells at the gingiva [2]. It has been introduced many methods of tooth-brushing technique as horizontal scrub, rolling, Bass, Stillman, Charters, Fones’, Watanabe’s method, etc., suggested several scholars who were interested in the preventive dentistry in clinical [3]. It would be different skill for technique and objectives for tooth-brushing goals. So it had better to choose the proper method for individual dental patient as different age group and oral state, by using the different type of tooth-brush and oral hygiene devices. Even though tooth- brushing is the fundamental and basic method of preventive dental measures, lots of dental professions didn’t know the exact method of each brushing method and the proper selection for individual patient. First of all, the training should be performed for tooth-brushing technique exactly frequent exercise would be needed to become habitual. This study could suggest the guide-line for selecting proper tooth-brushing method for individual [4].

Tooth-Brushing Method

1. Horizontal scrub method

It has been the most popular motion for tooth-brushing technique by uneducated people. It is a motion for scrub tooth-surface with horizontal movement as back and forth ward. It can be occurred the accumulation of micro-debris at the inter-dental area and happen the cervical abrasion or hyper sensitive dentin through the using this motion for a long time as 20 or 30 years (Figure 1).

Figure 1. Horizontal scrub method.

2. Rolling method

Rolling method of tooth-brushing is world-wide spread method recommending for general peoples who have not specific oral problems. It had been once recommended by World Health Organization as well as the Ministry of Health and Welfare in Korean government for general people. It has been suggested the movement of rolling through wrist the hand which had hold a tooth-brush. Sweep the tooth surface from up to down movement with rolling the hand-wrist in upper teeth, and from down to up in lower teeth. Insert the tooth-brush straight with obliquely at inner side of frontal teeth, both in upper and lower teeth, and sweep the brush from inside to outside and horizontal movement as back and forth for occlusal surface of posterior teeth, both upper and lower. Rolling technique is known as comparatively easy for learning and effective for removal of plaque even at proximal area (Figure 2).

Figure 2. Rolling method.

3. Bass technique

Bass technique of tooth-brushing has been recommended for periodontal problem dental patient, even though it had been some difficult to perform. It needed for soft and 1 or 2 lane tooth-brush to vibrate shortly and lightly with holding tooth-brush handle with lightly. Short and light vibration would be needed inserting one lane of tooth-brush into the gingival sulcus or periodontal pocket which had been some inflammatory tissues. Vibratory action could induce the plaque removal and gingival massage effect at the gingival sulcus, in order to subsid the gingivitis. Recent years, the modification of Bass method as adding the rolling motion together to Bass method has been recommended for subsid gingivitis as well as plaque removal effectively (Figure 3) [5].

Figure 3. Bass method.

4. Stillman method

Stillman method would be applied for gingival inflam-mation area with relatively wide spread. Short zig-zag movement with soft bristled and 3 or 4 lane tooth-brush holding with lightly, from up to down ward sweep with short vibration on the gingiva at the upper jaw and from down to up at the lower jaw. Gingival massage effect would be great to increase the blood circulation on the inflammatory gingival area. Also modification would be performed by adding the rolling motion after zig-zag vibration at gingiva (Figure 4).

Figure 4. Fones’ method.

5. Fones’ method

Dr. Fones was a pediatric dentist and try to supply the proper and easy method for tooth-brushing for preschool child as sweeping with small sized kids tooth-brush with motion as drawing continues circle on the teeth with closing the mouth slightly. It could be easier to change the rolling method after school aging than in horizontal scrub method. Horizontal scrub action would be accomplished on brushing on occlusal site and lingual site (Figure 5) [6].

Figure 5. Stillman method.

6. Charters method

This method of tooth-brushing is emphasize to clean the interdental area especially. Insert tooth-brush tip with perpendicular direction to longitudinal tooth axis at the proximal area or revers 45 degrees from the gingiva to tooth direction. And then, short vibration would be needed focusing on the proximal area. But, this method is a little bit hard to perform at lingual side of the tooth surface. This method is effective for bridge wearer and well done at the bottom of the artificial tooth on bridge area. Of course, it could be applied as modified method by adding the rolling motion (Figure 6) [7].

Figure 6. Charters method.

7. Watanabe’s, tooth-pick method

Dr. Watanabe has suggested that plaque removal and gingival massage would be very important for periodontal problem patient or dental implant patient, and they should eliminate the plaque through the tooth-brushing movement of pushing action from buccal side to lingual side with short vibration, so we call as tooth-pick method. It might be some hard for patient to perform by oneself at the first without professional person aid., and it needed some trainings from the dental professions (Figure 7).

Figure 7. Watanabe’s, tooth-pick method.
Clinical Application of Proper Method for Each Patient

1. General dental patients

For the general dental patients age from over 7, and without any special problems or wearing the special dental appliance, rolling method is recommended to perform and to be habitual use (Table 1).

Table 1 . Recommend tooth-brushing method according to patient age or oral status

Patient stateCharacteristicRecommended methodSiteDevice tooth-brushEffect
GeneralNo specific problems over age 7RollingHorizontal scrubSweep in to outBuccal/LingualOcclusalInn.Front.TeethMedium hardnessPlaq.RemG. MassaPrev Calc
PreschoolUnder age 6Fones’ (circular)Horizontal scrubLab/BuccalOcc/LingualSmal. sizeEasyHabit Ch
Perio. ProblemLocal.Gingivi Perio pocketM. BassGingival sulcus2-lane brushSulcus cl.Ging.Ma.
GingivitisWide gingivitisM. StillmansGingivalSoft bruGing. Ma
Hypersen.Premolar. CanRollingCervical abrasi.Soft desDesensit.
Bridge wearerInterdentalPontic bottomM. ChartersBr.tip -45 dege.Bucc to LingualZig-zag B.Super fl.Prox. ClePontic. C
Fixed Orthodo. applianceBracket siteGingival siteProximalLingualHoriz.+ChartersBassInterd. BrushRollingLabial/BuccalLabial/BuccalInterdent.areaLingualConcave head.Wat. PikBracket cleaningGing.ma.Prox. Cle
Implant.InterdentalWatanabe, T.PikProximal2lane BrPeriimpl.
Denture wearerPartial dentureFull dentureModif. RollingPartial dentureFull denturePart.BruFull. BruDentureCleaner

Perio.probl: periodontal problem patient, Orthodo: orthodontics, Gingiv.: Gingivitis, Perio pocet: periodontal pocket, Horiz.: horizontal scrub, Interd. Br.: interdental brush, Inn. Front Tooth: inner site of frontal tooth, M: modification, Occ: occlusal surface, Br.tip: bristle tip, 45 dege.: 45 degrees, Interd.: interdental, Hardne.: hardness, Hypersen: hypersensitivity, Can: canine, Smal. Siz: small size, Bru: brush, Prox.B: proximal brush, Part.b: partial denture brush, Full Bru: full denture brush, Plaq. Rem: plaque removal, Prev. calc,: prevention of calculus deposit, Abrasi: Abrasion, Soft des.: soft brush, desensitization dentifrice, Desensit: desensitization effect, Habit Ch,: habit for child, Ging.Ma.: gingival massage, Prox cle: proximal cleansing, Periimpl: peri-implantitis.



2. Preschool age child

For preschool child, Fones’ technique is recommended for easy learning to use and changing it with rolling technique in the later (Table 1).

3. Gingivitis-gingival sulcus

Modified Bass technique would be available for gingivitis dental patient for cleansing in the gingival sulcus and gingival massage (Table 1).

4. Gingivitis-wide area with periodontitis

Modified Stillman’s method would be recommended with short and soft zig-zag vibration by moving the vibration from apical to coronal direction and then, the rolling movement would be added (Table 1).

5. Bridge wearer

At bridge portion, Charters method would be available to clean the inter-proximal and the bottom of the pontic area, as short vibratory action with inserting the bristle tip into the proximal or bottom of the pontic area by locating the head of tooth-brush with reverse 45 degrees from the long axis of the tooth (Table 1).

6. Fixed orthodontic appliance patient [8,9]

At first, horizontal scrub would be applied on the labial surface to clean upper and lower of the bracket, and then short vibration action would be applied at upper, lower and subgingival sulcus from 1 tooth by the other tooth, by use of concave form of the bristle head tooth-brush. Rolling motion would be done at lingual surface and back and forth stroke at the occlusal surface. It should be needed to use the interdental brush for cleaning the proximal area and around the bracket. Water pick is also recommended to use to clean the interdental area and around the bracket (Table 1).

7. Hypersensitive dentin [10]

Rolling technique should be educated for the hypersen-sitive dentine with cervical abrasion, owing to habits for tooth-brushing with horizontal scrub for a long time (Table 1).

8. Implant patient

Watanabe suggested tooth-pick method for implant patient as well as severe problem at the interdental area. Insert the brush tip into the proximal area of the implant tooth with perpendicular or reverse 45 degrees to the long axis of the tooth and push it with zig-zag vibration action from buccal to lingual direction, like using the tooth-pick. It could be hard to perform for lingual surface and rolling method would be recommended if it could be hard (Table 1).

9. Denture cleaning

Partial denture should be cleaned by use of partial denture brush and full denture for full denture brush, with holding the denture on the water base or towel. Brushing method would be a modification of rolling technique and specific cleansing at the specific part as like a clasp. Denture should be storage with in the water with denture cleaner tablet when sleeping at night time (Table 1).

Conclusion

Tooth-brushing is the basic and the nest way to prevent major oral diseases as dental caries and periodontal disease through the elimination of plaque deposition and gingival massage effect. It would be cleaver to select the proper technique of tooth-brushing method in consideration of patient age or oral state. This paper would be one the guide-lines to select the adequate method of tooth-brushing technique for each dental patient in clinical, in order to removal of the dental plaque and gingival massage effect effectively.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

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