Toothbrush Selection Simplified

Brushing one's teeth is not a human instinct. It is a skill developed to defend against cariogenic agents which, if left undisturbed, will attack oral structures. Toothbrushes are invaluable in protecting against these threats, but, with a dizzying array of brushes on the market, it is not always clear which will provide the most benefit for a particular patient. And even when a patient selects a product that's an ideal match, the toothbrush may not perform effectively if it's not used properly.

For these reasons, it is vital to educate patients so they can make informed buying decisions and exercise proper brushing technique. In this Sunstar E-Brief, dental hygiene educator Caren M. Barnes, RDH, MS, of the University of Nebraska Medical Center's (UNMC) Department of Dental Hygiene, shares insights into the latest developments in toothbrush design. She also explains how to clear up any confusion patients may have about which features are right for them, and offers tips for dental hygienists to help patients get the most from brushing.

The first step is for clinicians to factor in data collected from the comprehensive dental hygiene patient assessment. This, Barnes says, will provide insight into a patient's self-care regimen. More importantly, it identifies products the patient currently uses, as well as how they are being used. At this point, the dental hygienist can identify the type of toothbrush that will provide the greatest benefit. Barnes suggests this approach is a marked improvement over the long-held practice of keeping one type and brand of toothbrush in the dental office to distribute to all patients, regardless of their oral hygiene status—a routine she says should be abandoned.

"Given the huge selection of oral hygiene products, dental hygienists can assist patients in the purchase process by writing the names and specific descriptive information about recommended products," she advises. "In essence, provide the patient with an oral hygiene prescription for those products, along with instructions for use." This will help avoid confusion when the patient faces the variety of oral hygiene products available in stores.

BRISTLES MAKE A DIFFERENCE

For decades, toothbrushes were manufactured only with a predictably straight, utilitarian design. Current models, however, are sophisticated dental tools built to meet highly personalized demands. The market offers an array of toothbrushes with various handle shapes, heads, tufts and bristles. One of the most recent trends in toothbrush design has been the introduction of tapered bristles, which are engineered to improve the effectiveness of cleaning and, by extension, enhance plaque removal. This feature was at the heart of a UNMC-based study that Barnes led comparing—under identical conditions—the efficacy of a toothbrush with soft, tapered bristles to one with soft, straight bristles.¹ The study results, published in the American Journal of Dentistry, demonstrated that tapered bristles provide superior cleaning ability.

According to Barnes, the study's most significant finding was that the soft, tapered bristles were better able to access the most difficult areas for patients to clean, including areas between the teeth, the gingival margin and subgingival areas. Toothbrush performance in these areas is vital, because an inability to clean interproximal spaces leads to interproximal caries, interproximal infection and inflammation of the gingiva.

Considering how toothbrushes vary in performance, patients should understand exactly the type of bristles built into the model they purchase. It is particularly important to point out that a toothbrush with soft bristles of varying heights doesn't necessarily mean that its bristles are tapered. Barnes suggests that patients look for packaging that clearly indicates the product features tapered bristles.

ADJUNCTS COMPLETE THE CARE

Although today's toothbrushes are engineered to be more effective than ever for disrupting biofilm and removing plaque, even the best toothbrush should not be considered the only tool needed for optimized oral care. Many patients still require oral hygiene adjuncts to complement toothbrushing and flossing, such as interproximal brushes and mouthrinses. Patients who have wide interproximal spaces for which dental floss would not be effective, for example, must use interproximal brushes wide enough to fill the interproximal space to remove dental plaque and biofilm. Mouthrinses may also be an advisable addition to brushing for patients with periodontal disease.

These aids are also important in the care of patients who lack the physical function to effectively use a toothbrush, and therefore cannot rely on brushing to remove plaque properly. The use of oral hygiene adjuncts may also be warranted for patients affected by specific physical or medical conditions, as noted in the comprehensive dental hygiene patient assessment.

PERSONALIZED PROGRAM

In tailoring a personalized care program, the most important thing a dental hygienist can do is base oral hygiene instructions and recommendations on individual patient needs. "It is also prudent to record the findings and recommendations in the patient's chart," notes Barnes. Clinicians should accept that some patients will refuse a recommendation for any care product other than what they already use. This, she says, should also be documented in the chart.

"These patients like the products they use—they're comfortable with them, and are not open to change," she explains. "In these cases, the best thing a dental hygienist can do is work with the products the patient will use, and provide appropriate instructions to remove the largest amount of dental plaque and biofilm possible." That's not to say that clinicians can't continue to delicately suggest that patients at least try the products that will likely benefit them most.

While advances in technology have improved the performance of today's toothbrushes, their effectiveness ultimately hinges on daily use and proper brushing technique. By helping patients choose the best brush for each individual, and educating them about effective self-care regimens—including brushing technique and adjunctive care products—dental hygienists can significantly contribute to their patients' oral health.

1. Barnes CM, Covey DA, Shi X, Yankell SL. Laboratory evaluations of a bi-level, extremely tapered bristled toothbrush and a conventional uniform bristled toothbrush. Am J Dent. 2009;22:84–88.

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