Dental Advices Provided to you by: Brite Medical Center
As soon as primary teeth start to erupt, which may be as early as 6 months of age, they are at risk of tooth decay. Therefore, the American Dental Association and the American Academy of Pediatric Dentistry agree that brushing should begin as soon as the first tooth erupts.1, 2
Caregivers should follow instructions from their child’s dentist. Generally, caregivers should brush an infant’s teeth twice a day, using a child-sized toothbrush. The toothbrush should have soft bristles and a head small enough to easily maneuver inside the child’s mouth, reaching all tooth surfaces.2 As children become more coordinated with age, they should be able to brush their own teeth under adult supervision, continuing to use a child-sized toothbrush with a small head and soft bristles.
Children younger than 3 years should use a smear of fluoridated toothpaste about the size of a grain of rice. Once children are 3 years or older, they can use a pea-sized drop of fluoridated toothpaste. Children should be assisted by or supervised by an adult and should be instructed to spit the excess toothpaste out after brushing.1
The American Dental Association recommends brushing teeth twice a day for two minutes using a fluoride toothpaste. Brushing for two minutes has been shown to achieve clinically significant plaque removal3 and use of a toothpaste containing fluoride enhances fluoride concentration levels in biofilm fluid and saliva, and is associated with decreased risk of caries and remineralization of teeth.4
There are a number of techniques for brushing teeth; any of which may have advantages depending on a patient’s particular needs.5 In general, the American Dental Association suggests that people place the toothbrush against the gumline at a 45-degree angle to remove plaque from above and just below the gingival margin, and move the toothbrush gently back and forth in short strokes.6 To clean the inside surfaces of the front teeth, they should tilt the brush vertically and make several up-and-down strokes.
Regardless of the technique used, brushing should touch upon all surfaces—inner, outer and chewing. Also, when brushing, the ADA recommends that people use a soft-bristled toothbrush and apply gentle pressure, both of which may help reduce the risk of gingival injury.7, 8
SEM images comparing new and used toothbrush bristles (Used with permission from Applied Science Accessed April 25, 2016).
Here are some toothbrush care tips to share with your patients:
Toothbrushes have been shown to harbor bacteria (including fecal coliform bacteria that can be released into the air when the toilet is flushed or can be spread to the toothbrush when the owner touches a contaminated surface before handling his or her brush).12 While toothbrushes have been shown to harbor bacteria, there is no evidence that these bacteria cause adverse health effects. Nonetheless, some patients may be interested in sanitizing their toothbrushes. While there is little data in the literature regarding toothbrush sanitizing, one study indicates that soaking a toothbrush in 3 percent hydrogen peroxide or Listerine mouthwash greatly reduces (i.e., 85 percent) bacterial load.13 Microwaving or putting toothbrushes in the dishwasher is not recommended as such high heat may damage the brush. Toothbrush sanitizer devices are available. Patients should look for a device that has been cleared by the U.S. Food and Drug Administration (FDA).
A myriad of toothbrush head design options are available.14 One systematic review found that toothbrushes with either multi-level bristles or angled bristles perform better than the conventional flat-trimmed bristles in removing plaque.15 Although toothbrushes with medium bristles have been shown to be effective at biofilm removal, the ADA recommends use of a toothbrush with soft bristles because they minimize the risk of gingival abrasion.8
The ADA Seal Category section on ADA.org provides a list of manual toothbrushes that currently have the ADA Seal of Acceptance. The Seal of Acceptance indicates that the toothbrush is both safe and efficacious for the removal of plaque and reduction of gingivitis. In addition, ANSI/ADA standards are used for testing the safety of manual toothbrushes.16
If a toothbrush differs significantly from previously accepted toothbrushes, the Council may request clinical studies to demonstrate that the toothbrush could be used without supervision by an average adult to achieve a significant decrease in mild gum disease and plaque over a 30-day period.16
Both manual and powered toothbrushes are effective at removing plaque.15, 17 While the powered toothbrushes can be more expensive than most manual toothbrushes, some people prefer the powered version. People who have dexterity problems—like the elderly, people with disabilities, or children—or those who have dental appliances, like braces, may find a powered toothbrush easier to use.
The ADA Seal Category section on ADA.org provides a list of powered toothbrushes that currently have the ADA Seal of Acceptance. The Seal of Acceptance indicates that the toothbrush is both safe and efficacious for the removal of plaque and reduction of gingivitis. In addition, ANSI/ADA standards are used for testing the safety of powered toothbrushes.18
A variety of powered toothbrushes that use a different types of head movement (e.g., side-to-side, counter oscillation, rotation oscillation, circular, ultrasonic) are available.
Look for the ADA Seal—your assurance that the product has been objectively evaluated for safety and efficacy by an independent body of scientific experts, the ADA Council on Scientific Affairs. The ADA Seal Category section on ADA.org provides a list of manual and powered toothbrushes that currently have the ADA Seal of Acceptance. A manual or powered toothbrush earns the ADA Seal for toothbrushes when the manufacturer provides scientific evidence demonstrating safety and efficacy in the removal of plaque and reduction of gingivitis. Toothbrushes with the ADA Seal have had data reviewed by the ADA Council on Scientific Affairs and have met the recommendations for both manual and powered toothbrushes.
ANSI/ADA standards are used for testing the safety of manual16 toothbrushes. To qualify for the Seal of Acceptance, the manufacturer of a manual toothbrush must provide evidence that:
If a toothbrush differs significantly from previously accepted toothbrushes, the Council may request clinical studies to demonstrate that the toothbrush could be used without supervision by an average adult to achieve a significant decrease in mild gum disease and plaque over a 30-day period.
To earn the Seal, a powered toothbrush goes through tests based on the ANSI/ADA standards for testing powered toothbrushes.18 These tests evaluate qualities like electrical safety, tuft retention, mechanical strength and chemical resistance. The Seal program also requires powered toothbrushes to complete a clinical study demonstrating that they are safe for use on oral hard and soft tissues as well as restorations and that they meet the requirements of a safety laboratory such as Underwriters Laboratories, Inc.
Professional Resources:
Patient Resources:
Last Updated: October 7, 2022
Prepared by:
Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC.
Disclaimer
Content on this Oral Health Topic page is for informational purposes only. Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment. ADA is not responsible for information on external websites linked to this resource.
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