Hand Brushing

This has been the mainstay of plaque control for many years, and there are many designs of head shape and size. Can I refer you to ‘Rule of Thumb’ in the periodontal section of Turner’s Tips for advice about choosing the size of brush for different age groups.

There are other factors which affect the effectiveness of plaque control using hand brushes, and some of these will surprise you. I always found that demonstrating tooth brushing methods on models was just the start of the educational process.

The most important aspect is to ask your patient to bring their own toothbrush to the teaching session, without buying a new one. You can then assess both size, shape, and how worn it is. Most patients will be surprised when you tell them the average life expectancy of a brush is about 6 – 8 weeks. Next get them to show you how they brush ion their own mouths, and this is even more revealing. It is usual to find that patients start in one quadrant, then move to another without rhyme or reason, such that places are regularly missed and where periodontal disease may begin. So why does periodontal disease start interproximally? The answer is quite clear when watching patients brush. Mostly they use a backwards and forwards brushing stroke which inevitably missing cleaning thoroughly into the interproximal spaces.

Stage one is to teach a systematic approach working around the mouth in sequence. I found that the ideal was to say molars, then premolars/canine, then canine/incisors gave useful divisions of the mouth, each section of which needs the same time spent cleaning.

If you check carefully and ideally disclose teeth, then a right handed patient will brush the right side of their mouth more efficiently than the left because the brush is held in the same parasagittal plane as the line of the posterior dental arch.

On the left hand side you will find the buccal surfaces of molars less well cleaned, but the canine and first premolar cleaned very well.

Again the question is why? This is due to the way that brushes are naturally held across the line of the dental arch, where it is quite clear that posterior buccal surfaces will be missed.

The reason is related to the anatomy of the wrist!

Similarly, if you check inflammation and pocketing around maxillary lateral incisors, you will find more disease on the right than the left, because as the corner is turned it is difficult to brush palatally well. Another place that is poorly cleaned are right lingual and palatal surfaces. Again this is associated with movement limitations in the wrist. The answer is quite simple, teach your patient to change to using their left hand for these difficult places.

For a left handed patient, the reverse is true.

These limitations apply whether Bass, Stillman, or leave it to the patient brushing techniques are used. The method I devised over 30 years ago is shown in the video below, “How to Brush Your Teeth”