The plaque removal effects of toothbrushes are continuously being investigated with clinical methods. Toothbrushes are also being modified continuously according to the results of these studies. You will find detailed information on this subject below.
The first toothbrush appeared in China in the 1600s and was first patented in the USA in 1857. There have been no major changes in toothbrushes since then. Changes in toothbrushes usually occur in size, shape, bristle arrangement and bristle hardness. The American Dental Association (ADA) has determined the dimensions of an acceptable toothbrush as follows. The brush surface should be 25.4-31.8 mm wide, with 2-4 rows of bristles and 5-12 tufts in each row. A toothbrush should be able to reach and clean all teeth and every surface. The type of toothbrush is a personal preference. Some toothbrush manufacturers claim that their brushes are better than others by making minor changes to their toothbrushes (brush head shape, bristle positioning, etc.). However, no particular type of brush has been shown to be clinically superior to others. The most important factors for a brush to be preferred are that it is easy for the patient to use and that it cleans well
The effectiveness of a brush or its injury to the gums is largely related to its use by the person. Two types of bristles are used in toothbrushes. Boar bristles and artificial bristles, usually made of nylon. Both types remove plaque. However; material homogeneity, uniformity of bristle size, elasticity, resistance to breakage are clearly superior to nylon bristles. Natural bristles are prone to contamination and breakage due to the channel in the middle and easily lose their elasticity. Today, natural bristle brushes have become almost non-existent. People who switch from natural bristle brushes to nylon bristle brushes should be warned about gum damage.
Toothbrushes with multiple bristle bundles contain more bristles and clean more effectively than toothbrushes with fewer bristles. Rounded-end bristles cause less damage to the gums than straight-cut bristles.
The question of the most appropriate bristle hardness has not yet been fully answered. Bristle hardness is proportional to its thick diameter and length. The diameter of the bristles generally used in toothbrushes is around 0.2 mm for soft bristles, around 0.3 mm for medium-hard bristles, and around 0.4 mm for hard bristles. The definition made by Bas (1948) for soft-bristled toothbrushes is generally accepted. Bas; recommends a brush with a straight handle, 0.2 mm diameter and 10.3 mm long nylon bristles, rounded bristle ends, three rows of bristle bundles, 6 bristle bundles arranged equally in each row, and 80-86 bristles in each bundle. For children, this brush should have a smaller head, thinner bristle diameter (0.1 mm) and shorter bristles (8.7 mm).
The ideas about the benefits of hard and soft bristle brushes are based on studies conducted under different conditions. These studies generally; difficult results; They are removable and conflicting works. Soft bristles are more flexible; they clean the tooth-gum junction and the gum groove better and enter the interdental areas better. In the use of hard bristles, more gum recession occurs. On the other hand, in this regard; the way the toothbrush is used and the abrasive feature of the toothpaste are more important than the hardness of the bristles. (ADA Report, 1970) Again, it is reported that the effect of the bristle hardness on the enamel stage is not in the foreground.
Brushing your teeth too hard can cause gum recession, wedge-shaped defects in the necks, and painful ulcers on the gums. The effectiveness of the brush to remove plaque gradually decreases as the bristles wear out. For these reasons, the toothbrush should be changed regularly. The brush should generally be changed every 3 months. This period may vary from person to person. For example, if all the bristles are flat after 1 week, the brushing is too hard and coarse. If the bristles are still flat after 6 months, it means that you are either brushing without too much pressure or not brushing every day. People generally tend to use a brush for as long as they can. For this reason, an indicator (such as a tuft of blue bristles that fade over time) that shows when it is time to change the brush is helpful. The characteristics of the brush handle are a personal matter. The brush handle should fit the hand and can be straight or angled. Straight handles are more common. Manufacturers report that brushes with a certain angle between the handle and the head fit the lingual surfaces of the molars more easily. The validity of this has not been established clinically. For many patients, Short-beveled, straight-set, rounded-bristled, soft and medium-hard bristled, three- or four-row tufted brushes are recommended. If a patient finds a particular brush shape beneficial and enjoys using it, the use of that brush should be encouraged. Here, attention should be paid to the fact that such a brush complies with the general principles mentioned and that the patient can remove plaque when it becomes stained. The plaque removal effects of toothbrushes are constantly being modified by clinical methods. It is the duty of the doctor to follow the results of the studies on toothbrushes, which have a high market share, to evaluate them correctly and to recommend a toothbrush by combining them with the patient's tendencies.
The electric toothbrush first appeared in 1939. The movements of the brush heads are very diverse. Forward-backward, circular, elliptical, etc. What is important here is that the patient places the brush on the tooth-gum correctly and uses it. Therefore, a patient who uses a normal toothbrush correctly will also use an electric toothbrush correctly. Some people may be recommended an electric toothbrush. In this context; those with poor manual dexterity, young children, disabled people, those with orthodontic appliances and those who prefer to use an electric toothbrush. Electric toothbrushes are not more effective than normal toothbrushes. There are many studies on the superiority of both types in this regard. In general, we can say the following: If a doctor has observed that an electric toothbrush is more beneficial to a patient, he can recommend it.
Bacterial plaque can only be cleaned with a toothbrush. However, it is not possible to completely clean the bacterial plaque in the interdental areas even with the best brushing method. Therefore, the best assistants of toothbrushes for interdental areas are dental floss and interdental brushes.
As a result; there is no toothbrush that has been proven to be unquestionably prominent and has been accepted to be significantly more effective in removing plaque than others. Individuals' requests regarding toothbrushes are very different. Each physician should make their toothbrush recommendations after evaluating the patient's oral structure, gum condition and manual dexterity. In general, the features of the brush that can be recommended are as follows: A normal, non-electric toothbrush with four rows of bristles, very soft nylon bristles. Such a brush is suitable for many patients, but patients with different needs should not be forgotten.
