With the help of appropriate tooth brushing techniques, which serve to mechanically remove food residues and plaque (microbial plaque), the development of caries (tooth decay), gingivitis (inflammation of the gums) and periodontitis (inflammation of the periodontium) can be effectively prevented. Food residues, especially carbohydrates, which are left behind by inadequate toothbrushing technique, particularly in the interdental spaces (spaces between the teeth) or on the distal surfaces of the molars (behind the last molars), serve as a nutrient reservoir for cariogenic bacteria (germs that cause caries). In order to specifically combat the development of caries, these areas that are difficult to clean must therefore be targeted by an effective oral hygiene technique and cleaned regularly. Fluorides in toothpastes and mouth rinses improve the structure of the tooth enamel, making it more resistant to bacterial attack. If food residues, especially carbohydrates such as sugar, are left behind, they are metabolized by bacteria, thus promoting their growth. This microbial flora of the oral cavity organizes itself in the form of so-called plaque, the soft dental plaque. The longer plaque can remain undisturbed on the tooth surfaces, at the gum line or in the interdental spaces, the more organized the interplay between the different types of bacteria: after a few days, the mature plaque is a well-structured ecosystem. Their metabolic products cause inflammation of the gums: gingivitis develops. If the inflammation spreads to the periodontium in the presence of periodontopathogenic germs, periodontitis (inflammation of the periodontium) and bone loss are the result. For the reasons mentioned above, dental care is of fundamental importance from the eruption of the first milk teeth. While toddlers are taught to brush their teeth and the right time to do it as a daily ritual by their parents, children from the age of two to three can increasingly learn the systematic brushing technique through play until they are finally able to brush completely independently when they have mastered cursive writing – but only now – without having to be brushed again by their parents. In the course of adulthood, the toothbrushing technique must be adapted again and again to the individual circumstances or changes. The most important tool for an efficient brushing technique is the toothbrush. Its bristle field should be designed as a short head, and the rounded bristles should be arranged in closely spaced tufts (multi tufted). Scientifically, manual toothbrushes and electric toothbrushes are equally recognized. However, the following may speak in favor of using an electric toothbrush: tooth loss was on average one-fifth lower among users of electric toothbrushes than among those who used conventional brushes.Splitting is recommended to master the use of both conventional and electric brushes. Replacing the brush or electric brush head every six to eight weeks is advisable and, with proper toothbrushing technique, necessary. The following basic recommendations apply to the most favorable time for cleaning teeth:
- After meals
- Before going to bed
- After acidic foods and beverages wait at least 30 minutes before brushing teeth, because acids of any kind demineralize (decalcify) and thus soften the tooth structure. Through the action of saliva remineralization (re-storage of mineral substances) and hardness increase takes place, after which the enamel surface does not suffer abrasion when brushing.
Regardless of the toothbrush, the duration of brushing is critically important. Because the longer brushing, the more plaque can necessarily be removed. However, the average brushing time for children is well below one minute and thus deviates significantly from the two minutes recommended as a minimum and regardless of the type of toothbrush. Assuming a perfect brushing technique, not even half of the plaque can be reached in this too short time.
System
Even if the recommended brushing duration is adhered to, not all plaque retention sites (tooth surfaces to which bacterial plaque adheres) are necessarily covered by the brushing technique. This is only possible if brushing is based on a certain systematic approach. How this is structured is ultimately of secondary importance – the main thing is that the system covers all tooth surfaces. Small children are taught the KAI method as an introduction:
- K = the occlusal surfaces first, then
- A = the outer surfaces of the upper and lower teeth together, with closed rows of teeth in circular motions.
- I = the inner surfaces of the upper and lower rows of teeth individually.
For adults and also children who can switch to a more complex system, for example, the following procedure is suitable:
- In principle, start at the back right and follow the dental arch to work forward to the back left.
- Start with the outer surfaces of the upper row of teeth
- Continue with the outer surfaces of the lower row of teeth
- Now clean the distal surfaces of the upper and lower last molars (molars)
- Clean all inner surfaces of the upper row of teeth
- Clean all inner surfaces of the lower row of teeth
- Finish with the upper and lower occlusal surfaces (chewing surfaces)
The procedures
The various toothbrushing techniques are not equally recommended for everyone. Rather, they depend on factors such as age, motor dexterity and the individual dentition situation.
I. Horizontal method
The “scrubbing technique” is a successful introduction to dental hygiene for young children, as it is the only method that is appropriate for children’s movement patterns. From the age of four, the technique should be changed as motor dexterity increases. The bristles are positioned vertically on the outer surfaces of the closed rows of teeth or the chewing surfaces, and the brush is moved back and forth horizontally. Inner surfaces can only be cleaned very inadequately.
II. charters method (1929)
The bristle array is placed on the gingival margin (gum line) at a 45° angle with the bristles facing the occlusal surface. With a vibrating motion on the spot, the bristle ends are forced into the interdental spaces. The interdental spaces are cleaned well, but the method is difficult to learn. There may also be space problems in the tongue area. Like the modified Bass technique, the Charters method is suitable for periodontal disease (periodontal disease).
III. rotation method according to Fones (1934)
Here, too, the bristle field is placed vertically on the outer or inner surfaces of the teeth with the teeth closed, circular movements are performed. The chewing surfaces are cleaned by horizontal movements. The easy-to-learn method is suitable for children who are to be introduced to systematic brushing (KAI method).
VI. red-white method according to Leonard (1949)
The bristle field is placed vertically on the marginal gingiva (on the gingival margin: “red”). With a vertical rolling motion from the wrist, the brush is pulled toward the occlusal surface (toward “white”). For each rolling movement, the brush must be placed on the gumline again, cleaning one area several times. When changing from the upper jaw to the lower jaw, the direction of work must be changed, and the movement is more difficult in the lower jaw than on the upper row of teeth. This somewhat more complex, but easy to learn method is also suitable for children and also teenagers, who are introduced to the systematic approach to brushing teeth.
V. Bass technique (1954) / Modified Bass technique
The bristles are placed on the gingival margin at a 45° angle pointing toward the root of the tooth with light pressure. In small jarring movements, the brush is moved on the same spot. This is followed by a wiping motion towards the occlusal surface, which removes loosened plaque from the interdental spaces (spaces between the teeth). The process is repeated several times in the same place. The brush is then moved back into position following the course of the dental arch. The Bass technique is comparatively difficult to learn. There is a risk of falling back into the “scrubbing technique”. The method is suitable for motivated patients with gingival / periodontal problems (on the gums and periodontium), as gingival margin and interdental spaces are cleaned very well.
VI. modified Stillman technique
The bristle array is placed at an angle of 70-80° pointing toward the root of the tooth under pressure a few millimeters below the gingival margin. While maintaining the angle, i.e., without rolling the brush head, it is moved toward the occlusal surface with small circular movements. As with the red-white technique, a different working direction is required for the upper and lower teeth.This method cleans the interdental spaces (spaces between teeth) better than the previously mentioned techniques. It is suitable for patients with healthy periodontium (periodontium) and with recessions (exposed necks of teeth).
VII Jackson technique
In this technique, the brush head is positioned at an angle so that the bristles at the end of the brush head specifically push into the interdental spaces (spaces between teeth). The method should be seen as a complement to other techniques such as the modified Bass technique.
