July/Aug 2011
Volume 7, Issue 4

Toothbrushing: Reviewing the Basics

Good oral health depends on a good oral hygiene foundation.

Oral hygiene habits become routine early, and once established, may not change unless one becomes aware of new clinical studies, revised recommendations, or improved products. Although there are many adjunctive oral hygiene methods, the mechanical removal of sticky plaque through toothbrushing is one of the foundations of oral health, and reviewing even this basic routine may help to strengthen oral health. Current recommended techniques for adults are1-4:

  • Brush twice a day.
  • Use a systematic approach, covering each quadrant completely. Brush teeth in the same order: for example, begin with the outer surface, then inside, and then the top.
  • Place the bristles at a 45º angle against teeth and gums and brush gently in small back-and-forth movements.
  • Avoid brushing with a heavy, horizontal motion. Aggressive brushing and/or using a hard-bristled toothbrush have both been associated with tooth abrasion.
  • Avoid toothbrushing soon after ingesting acidic foods or drinks.
  • Toothbrush size and design should be based on handling ease and comfortable fit in the mouth.
  • Use a timer to measure accurately the amount of time on toothbrushing, rather than estimating.

Recommended Toothbrush Care

Proper care of the toothbrush is also critical to effective oral hygiene. Patients should follow these instructions for caring for their toothbrush:

  • Thoroughly rinse the toothbrush with running water.
  • Do not share toothbrushes; keep them separated in holders.
  • Store in an upright position and air dry. Putting toothbrushes in cases or otherwise covering the bristles creates a moist environment that can promote the growth of microorganisms.
  • Replace toothbrushes (or the head of an electric toothbrush) every 3 to 4 months or when the bristles become frayed or splayed. Worn bristles have been associated with tooth wear.

According to the American Dental Association, there is no clinical evidence of the benefit of additional cleaning methods for toothbrushes (such as storing in a mouthrinse or using a toothbrush sanitizer).4

Oral Care Starts Early

Dental visits should start by a child’s first birthday,5 and a pediatric dentist should be consulted about oral healthcare methods based on a child’s tooth position and gum condition.6 Toothbrushing can begin at about age 24 months; and once they can brush their teeth themselves, children should still be helped by an adult until they are 6 to 8 years old5,6 (and supervised until they are about 10 to 11 years of age).6

General recommendations for children are5-7:

  • Use a soft wet toothbrush without toothpaste, until the pediatric dentist says the child is old enough to use toothpaste. Then, use only a small amount (no larger than the size of a pea) and supervise the child to prevent swallowing.
  • Bristles should be made of soft nylon and have rounded ends.
  • Gently brush in a circular motion, only a small group at a time.
  • Brush twice a day for 3 to 4 minutes each time.
  • Choose the appropriate size toothbrush that can be easily grasped and fits the child’s mouth comfortably.
  • Use a children’s toothbrushing timer to ensure sufficient time and amuse the child, encouraging the healthy habit by making it a fun activity.
  • Replace the toothbrush every 2 to 3 months, depending on wear.

In one-on-one interviews with the parents of young children regarding oral healthcare, few participants said that maintaining a twice-daily toothbrushing routine was easy. Those that did keep a regular schedule were more likely to use the approach of “making it fun, or personal reminders” for the child.7


1. Cleaning your teeth and gums. American Dental Association website. Available at: http://www.ada.org/2624.aspx. Accessed May 11, 2011.

2. Proper brushing. American Dental Hygienists’ Association website. Available at: http://www.adha.org/oralhealth/brushing.htm. Accessed May 3, 2011.

3. Moffitt AR. Tooth wear and erosion. Inside Dentistry. 2008;4(1):92-93.

4. Statement on toothbrush care: cleaning, storage and replacement. American Dental Association website. Available at: http://www.ada.org/1887.aspx. Accessed April 27, 2011.

5. Cavity prevention tips from the American Dental Asso-
ciation. American Dental Association website. Available at: http://www.ada.org/sections/newsAndEvents/pdfs/cavity_prevention_tips.pdf. Accessed April 29, 2011.

6. Tooth brushing. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site675/mainpageS675P0.html. Accessed May 5, 2011.

7. Huebner CE. Parent-child tooth brushing. Northwest Public Health. Fall/Winter 2010:20-21.

8. Waste reduction fast facts: plastic. Portland, Oregon Metro Regional Government website. Available at: http://www.oregonmetro.gov/index.cfm/go/. Accessed May 10, 2011.

9. Danigelis A. Paste-free toothbrush cleans with solar power. Discovery News. August 23, 2010. Available at: http://news.discovery.com/tech/paste-free-toothbrush-cleans-with-solar-power.html. Accessed May 10, 2011.

10. Feldman L. Garbage mogul makes millions from trash. Fortune Small Business. March 29, 2011. Available at: http://money.cnn.com/2009/03/24/smallbusiness/trash_talker_terracycle.fsb/index.htm. Accessed May 9, 2011.

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