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Brushing Techniques
The main objectives of tooth brushing include:
- To prevent plaque formation
- Plaque removal
- Cleaning the tongue
- Massage the gingival tissue
VARIOUS METHOD OF BRUSHING
THE BASS METHOD OR SULCUS CLEANING METHOD
It is the most accepted and effective method for the removal of dental plaque present adjacent to and underneath the gingival margin.
INDICATIONS :
- It is most adaptable for: Open interproximal areas. Cervical areas beneath the height of contour of enamel, Exposed root surfaces.
- It is recommended for patients with or without periodontal involvement.
TECHNIQUE :
- The bristles are placed at a 45º angle to the gingiva and moved in small circular motions.
- Strokes are repeated around 20 times,3 teeth at a time.
- On the lingual aspect of the anterior teeth, the brush is inserted vertically and the heel of the brush is pressed into the gingival sulci and proximal surfaces at a 45º angle.
- The bristles are then activated.
- Occlusal surfaces are cleaned by pressing the bristles firmly against pit and fissures and then activating the bristles.
ADVANTAGES :
- Effective method for removing plaque.
- Provides good gingival stimulation.
- Easy to learn.
DISADVANTAGES :
- Overzealous brushing may convert very short strokes into scrub technique of brushing and cause injury to the gingival margin.
- Time consuming.
- In certain patients dexterity requirement is too high.
MODIFIED BASS TECHNIQUE
TECHNIQUE :
- The head of the brush is kept parallel to the occlusal plane, with the brush head covering almost 3-4 teeth starting from the distal most teeth of the arch.
- The bristles are placed at the gingival margin at an angle of 45 degrees to the long axis ofthe tooth.
- Gentle vibratory pressure is given using short back and forth movement dislodging the tips of the bristles.
INDICATIONS :
- Intrasulcular cleaning
- Routine oral hygiene measure
ADVANTAGES :
- Good gingival stimulation
- Good interproximal &gingival cleaning
DISADVANTAGES :
- Moderate dexterity of wrist is required
Modified Bass technique is one of the most recommended type of brushing technique as evidence from studies have suggested a better plaque control and a significant reduction in gingival inflammation.
STILLMAN’S METHOD
TECHNIQUE :
- Like the Bass method the filaments are placed at a 45 degree angle to the tooth.
- Unlike the Bass method the filaments are placed half in the sulcus and half on the gingiva.
- The same stroke is used as on the Bass method.
CHATERS METHOD
TECHNIQUE :
- Bristles are placed at an angle of 45 degrees to the gingiva with the bristles directed coronally.
- Bristles are activated by mild vibratory strokes with the bristle end lying interproximally.
INDICATIONS :
- Open interdental spaces with missing papilla & exposed root surfaces
- FPD or orthodontic appliances
- Moderate gingival recession particularly interproximally
- Periodontal surgery
ADVANTAGES :
- Technique specifically indicated in patients with orthodontic and prosthodontic appliances.
- Effective plaque removal.
- Suitable after periodontal surgeries.
MODIFIED STILLMAN’S TECHNIQUE INDICATION
- Dental plaque removal from the cervical areas below the height of contour of enamel and from exposed proximal surface.
- Cleaning tooth surfaces and gingival massage.
- It is recommended for cleaning in areas with progressing gingival recession and root exposure to prevent abrasive tissue destruction.
- A soft toothbrush is indicated for this technique.
DISADVANTAGE :
- Time consuming.
- Improper brushing can damage the epithelial attachment.
TECHNIQUE :
- The bristles are pointed apically with an oblique angle to the long axis of the tooth.
- The bristles are positioned partly on the cervical aspect of tooth and partly on the adjacent gingiva.
- The bristles are activated with short back and forth motion and simultaneously in coronal direction.
- 20 strokes are applied and procedure is repeated systematically on adjacent teeth.
FONES METHOD OR CIRCULAR/SCRUB METHOD
INDICATION :
- Young children.
- Physically or emotionally handicapped individuals.
- Patients who lack dexterity.
TECHNIQUE :
- The child is asked to stretch his/her are such that they are parallel to the floor.
- The child is asked to draw big circles using whole arm in the air.
- The diameter of circles is reduced untill small circles are not formed in front of the mouth.
- The child is now ready to make circles on the teeth with the toothbrush, making sure that all teeth and gums are covered.
ADVANTAGE :
- It is easy to learn.
- Shorter time is required.
DISADVANTAGE :
- Possible trauma to gingiva.
- Interdental areas not properly cleaned.
- Detrimental for the adults especially who use the brush vigorously.
VERTICAL METHOD-LEONARD’S METHOD
- Vertical stroke is used.
- Maxillary and mandibular teeth are brushed separately.
ADVANTAGE :
- It is the most convenient and effective for small children with deciduous teeth.
TECHNIQUE :
- The bristles of the toothbrush are placed at 90° angle to the facial surface of teeth.
- With the teeth edge to edge, place the brush with filaments against the teeth at right angle to the long axis of teeth.
- Brush vigorously without great pressure with a stroke which is mostly up and down the tooth surfaces with a slight rotation or circular movements after striking the gingival margin with force.
- It is not intended that the upper and lower teeth shall be brushed in the same series of strokes. The teeth are placed edge to edge to keep the brush slipping over the occlusal or incisal surface.
THE ROLL TECHNIQUE
This method of brushing is also known as the Rolling Stroke method or ADA method or the Sweep method. It works fairly well for patients with anatomically normal gingival tissues.
INDICATIONS :
- Children.
- Adult patient with limited dexterity.
- Useful for preparatory lesson for modified Stillman’s technique since the initial brush placement is the same.
TECHNIQUE :
- The bristles are placed at a 45° angle.
- Toothbrush is rolled across the tooth surface towards the occlusal surface.
- This technique requires some flexibility around the wrist.
ADVANTAGE :
- Provide gingival massage and stimulation.
Hirsfield’s Brushing Technique
The technique is same as the Charter’s method except in the maxilla and mandible are kept occluded.The Hirschfeld’s technique is also a modification of the Fone’s technique where the circular motion is much smaller and concentrated over the gingival crevice.
ADVANTAGE :
- Provides additional stability and control to those who lack dexterity.
- Cheeks help in exerting pressure required to flex the bristles.
Smith-Bell(Physiologic) Brushing Technique
Also known as Physiologic technique of tooth-brushing because the brushing method is the same as that taken by the food during mastication.
TECHNIQUE :
- Bristles are placed at the height of the incisal edge or occlusal surfaces at an angle of 90ndegrees and moved in the gingival direction.
- Produces frictional action similar to that obtained from mastication of fibrous food.
- Suitable for patients having anatomically normal dentition.
ADVANTAGE :
- Stimulates gingiva and improves blood circulation in connective tissue.
