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Background information of procedure
Toothbrushing is the most common method used to remove plaque from
the easily accessible flat surfaces of the teeth, but not from the interdental

When toothbrushing is combined with the application of a fluoridated
toothpaste, the teeth and gums are cleaned free of plaque and the teeth are
protected from dental caries by the action of fluoride on the enamel.

Details of procedure
The aim of good toothbrushing is to remove plaque from the gingival
margins, and to protect the tooth surface with a layer of fluoride.
Many toothpastes are available to patients (fluoridated, tartar controlling,
desensitising, whitening, etc.), and the oral health team will advise the
most suitable in each case.

Similarly, many toothbrush designs are available – both manual and
electric – but, as a general rule, the head should be small to allow easy
manoeuvrability, and the bristles should be multitufted and made of
medium nylon. Even so, some patients brush with such force that they
actually saw into the necks of their teeth and produce abrasion cavities or
cause gingival recession.

• Identify those patients with regular residual plaque after
• Wet the patient’s own brush, apply a small amount of toothpaste
and allow the patient to brush his or her teeth in the usual way and
in the usual time
• Disclose the plaque to identify the areas of continued accumulation
• Develop a more thorough technique with the patient to remove all
the plaque
• This may involve a change of brush from manual to electric, or vice
versa, as well as a change of brushing technique by the patient
• Once an effective technique has been identified, a methodical
approach should be developed so that a routine brushing technique
is carried out every day
• This tends to be more effective if the more difficult areas are
tackled first, such as the lingual surfaces of the lower teeth
• The patient then brushes all the teeth in a systematic manner,
starting in the same place and ending in the same place each time.
• Advice can then be given on the frequency of brushing – usually
twice daily as a minimum, but some patients may continue with a
high sugar diet and need to brush after each meal
• Full dietary advice should also be discussed and ideally adjusted
where necessary
• Toothbrushes should be replaced once the bristles start to splay, as
they will not remove plaque effectively when worn down


Background information of procedure
The surfaces of the teeth that remain untouched by toothbrushing are the
contact points, or interdental areas. Plaque accumulates here just as easily
as on the flat surfaces of the teeth, and even more so when restorations
extend into the interdental areas as, microscopically, they provide more
potential for stagnation areas to occur.
Although toothbrushes are too large to clean interdentally, other oral
health products have been designed to do so:
• Tape or floss
• Manual interdental brushes (see Figure 2.4)
• Dental woodsticks
• Some electric toothbrush heads
• Some mouthwashes