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Brushing and Flossing Teeth

“Individuals should use a fluoride dentifrice (toothpaste) daily to help prevent dental caries, and should brush and floss daily to prevent gingivitis.” – U.S. Surgeon General’s Report

  1. Why do we brush our teeth?
  2. What are the recommended techniques for brushing teeth?
  3. How can I be sure that I am cleaning my teeth properly?
  4. What helpful aids are there for cleaning between the teeth?
  5. Can brushing damage teeth?
  6. What is the ideal toothbrush?
  7. Are all toothbrushes made to the same design?
  8. What type of brush is suitable for children?
  9. How often should your toothbrush be changed?
  10. Should I share my toothbrush with another member of the family?
  11. Are electric toothbrushes recommended by dentists?

1. Why do we brush our teeth?

  • It is important to remove the dental plaque and food that stick to teeth, and cause decay and gum disease.
  • Brushing and flossing are the most effective ways of controlling plaque.
  • You need to be aware of the fact that plaque is being formed continuously.
  • Plaque formation and growth cannot be stopped. Plaque can only be controlled by regular daily removal.

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2. What are the recommended techniques for brushing teeth?

  • We recommend two methods for brushing teeth. They both use the same angled position of the brush:
    Place the brush at a 45-degree angle towards the junction of the tooth and the gum. This is the position for brushing the sides of the teeth.
  • One suggested method is to brush gently in a circular movement.
  • Another technique is known as the gentle scrub method.
    • The brush is moved backwards and forwards horizontally in very short strokes.
    • Each stroke is no more than the width of one tooth.
    • Brush all the tooth surfaces of all the teeth.
    • Brush behind the front teeth with an up and down movement using the end of the brush.
    • Brushing should be unhurried and thorough.
  • Partial dentures should be removed for the efficient brushing of the remaining teeth.
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Toothbrush position

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3. How can I be sure I am cleaning my teeth properly?

  • Disclosing tablets can be used after brushing to check that all the plaque has been removed.
    • These are brightly coloured tablets, which are chewed and then rinsed out.
    • If your teeth are not clean, a pink stain will show where more brushing is needed.
    • If your brushing has been thorough, little or no stained dental plaque will be seen.
    • The disclosing tablets are only used occasionally, to confirm how well the teeth are being cleaned.
    • Disclosing tablets are available in a few colours.
  • Teeth should be brushed at least twice a day, preferably after meals.
  • It is most important to brush your teeth before going to bed at night.
  • Brushing should not injure the gums and cause bleeding. If your gums bleed after gentle brushing you should see your dentist.
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After disclosing tablets
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After more brushing

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4. What helpful aids are there for cleaning between the teeth?

  • There are many dental hygiene products available for cleaning between the teeth. We describe and show them below.
  • It is most important to clean between the teeth to prevent decay and gum disease.
    • Plaque and food particles stick to the teeth in these areas.
    • Normal tooth brushing cannot reach these tooth surfaces.
    • Plaque can only be removed by daily brushing and interdental cleaning.
  • Flossing is the method of choice for cleaning between teeth.
  • Why it is important to use dental floss.
    • Dental Floss is the most efficient way to clean between teeth.
    • Different types of floss are available, such as regular floss, dental tape and super floss.
    • Floss is also available on a plastic holder, in the shape of a bow. The string of the bow is slipped between the teeth and makes flossing more manageable.


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    Dental tape
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    Floss holders
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    Regular floss
  • Here are a few tips for flossing as demonstrated below:
    • Use a 12-15inch (30-40cm) length of floss.
    • Wrap the floss around your middle fingers.
    • Hold the floss between the thumb and forefinger of each hand.
    • Leave about 2 inches (5cm) of floss between the hands.
    • The floss must be taut when it is used.
    • Gently guide the floss across the contact point between the teeth.
    • When the floss is in position between the teeth, rub it up and down a few times against each tooth surface, one after the other.
    • This is then repeated for all the teeth in the mouth.
    • Be careful not to cut your gums with the floss.
    • A sharp downward thrust of the floss will damage the gum and make it bleed.
    • Your dentist will be happy to show you how to floss, and choose which floss is best for you.
    • The floss holders shown above are easy to use, if you have difficulty using the conventional floss.


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    Floss on hands
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    Floss up
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    Floss down
  • Interdental (interproximal) brushes
    • These are triangular shaped small brushes, like little bottlebrushes.
    • They are very useful for cleaning between the teeth.
    • They fit onto a plastic handle, and are available in varying sizes.
    • Select the size of brush that is best suited to you.
    • Gently push the brush back and forth into the spaces between the teeth.
    • This interdental brush is best suited to teeth that have spaces between them, caused by gum recession.
    • Some degree of gum recession is seen in most mouths by middle age, and in those with gum disease, at any age.


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    Interdental brushes
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    Interdental brushing
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    Interdental brushing
  • End or single tuft toothbrushes
    • These are toothbrushes with only one tuft of bristles.
    • They are used where the normal, multi-tufted toothbrushes cannot reach.
    • These brushes are designed for brushing around crowns, bridges, displaced and rotated teeth.


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    End tuft brush
  • Interdental picks or sticks
    • These are specially designed soft wooden wedges for cleaning between teeth. They can be used after meals or at any time.
    • The end of the stick should be moistened and softened in the mouth before use.
    • Gently insert the stick between the teeth, with the flat edge facing the gum.
    • Then move it in and out gently to clean the teeth and massage the gums.
    • Food trapped between the teeth can be removed with these sticks.
    • They are effective for mouths where receding gums have left spaces between teeth.
    • The sticks should only be used where there is sufficient space to allow the free movement of the stick between the teeth. Do not force them into position.
    • They should not be used if they cause any bleeding.
    • They are not suitable for children.


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    Interdental sticks
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    Stick in use
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    Stick in use
  • Interdental rubber tip stimulators
    • These are pointed rubber tips that are fitted to a toothbrush handle.
    • They are used to stimulate and firm up the triangular soft gum between teeth.
    • Your dentist or periodontist will tell you if you need them.


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    Rubber tip stimulator
  • Pulsating water or medicament spraying devices
    • Irrigating devices provide a steady or pulsating stream of water under pressure through a nozzle. They are especially useful in mouths with fixed bridges, and for cleaning between teeth.
    • They should not be used as a substitute for toothbrushing.
    • Speak to your dentist before you buy one.

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5. Can brushing damage teeth?

  • Toothwear, the wearing away of the enamel and dentine, can be caused by brushing too vigorously, and by using a toothbrush with a very hard bristle.
    • This type of toothwear is called abrasion.
    • It usually takes place at the gum margin, where the enamel is thin, and is easily worn away.
    • Brushing across the teeth with long horizontal strokes is the main cause of abrasion. Gentle brushing is all that is necessary.
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See Toothwear

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6. What is the ideal toothbrush?

  • The ideal toothbrush should meet the following requirements:
    • It should have a head that is small enough, and correctly angled, to reach all the teeth.
    • The brush should be multi-tufted, and have a medium/soft texture.
    • Hard bristles can damage teeth and gums, and are not recommended.
    • The bristles should be made of nylon, and their ends need to be rounded.
    • Bristles made from synthetic rather than natural materials are preferable for hygienic reasons. Natural bristles may be porous and are likely to absorb bacteria.

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7. Are all toothbrushes made to the same design?

  • There is a large selection of toothbrushes:
    • Some have bristles arranged in patterns that reach the greatest possible area of tooth surface.
    • Others are designed for cleaning between the teeth, and along the gum margins.
    • Yet another design is made with a row of coloured bristles that fade with use, and thereby indicate that the brush needs replacing.
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Toothbrush bristles
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Various toothbrushes

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8. What type of toothbrush is suitable for children?

  • A toothbrush with a small head is recommended, so that children can use it easily, and it will not cause gagging when they brush their back teeth.
  • The handle should have the correct length and thickness. It must be easy to use and provide a firm grip.
  • Toothbrushes can easily be modified if difficulty is experienced with a regular brush.
  • Brushes for children often have handles and heads that are brightly coloured, and show cartoon characters. Brushing needs to be a fun experience!
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Toothbrushes for children
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Modified toothbrushes

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9. How often should your toothbrush be changed?

  • The toothbrush should be changed at the first sign of wear.
    • The bristles may become flattened and lose their shape.
    • Bristles wear differently from person to person depending on how the toothbrush is used.
    • Plaque removal becomes less efficient with an old worn toothbrush.
    • It is recommended that you to change your toothbrush every four to six months.

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10. Should I share my toothbrush with another member of the family?

  • Toothbrushes should not be shared as they can harbour infectious bacteria.
    • Using the same toothbrush can transmit hepatitis and other diseases.
    • Mothers should not share their toothbrushes with their children.
    • The initial immunity to infection that the child shares with the mother does not last indefinitely.
    • Toothbrushes should also be kept separately, as an added precaution.

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11. Are electric toothbrushes recommended by dentists?

  • Electric toothbrushes have proven to be very successful in maintaining good oral health, and removing plaque.
    • The action of the brush is more efficient than the manual brush for cleaning teeth.
    • Electric toothbrushes are recommended for the elderly and people with arthritis or other disabilities, who may find it difficult to manage with a manual toothbrush.
    • Children enjoy the fun of using an electric toothbrush. It will result in a more thorough cleaning of their teeth, particularly at an early age.
    • As they grow older it may be less important to use an electric toothbrush.
    • It is effective with fixed orthodontic appliances.
    • Remember that the cleaning of teeth will only be successful, if the motivation exists to have healthy teeth and gums.
    • Electric toothbrushes may provide interest and motivation for people who are reluctant to brush their teeth properly.
    • Consult your dentist and follow the manufacturer’s instructions.

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