1. In order to access the YouTube videos within this presentation, you must click on “Slide Show” in the top task bar, then click “From Beginning” on the far left corner of the task bar. Enjoy!

2. Toothbrushing By Pamela Larrabee RDH, BAS

3. History of Toothbrushes and Brushing Napoleon’s Toothbrush
In ancient times, people used chew sticks to brush their teeth. These chew sticks were wooden sticks that were frayed at one end. Sometimes you can see some of the cast members on Survivor using a chew stick to clean their teeth.
In the mid 1800’s, the first toothbrush was made, and then by the early 1900’s, toothbrushes were being produced.1
The recommendation for tooth brushing was to brush in the morning and after each meal. A person was to brush with a hard bristle brush with a heavy pressure against the gums and teeth.1

4. Characteristic of a Electric and Manual Toothbrush
Proper shape, size, texture, and weight
Easy to operate
Cost effective
Long battery life
2-minute timer
Pressure sensor
Replaceable heads
Easy to clean
Manual
Proper shape, size, texture, and weight
Inexpensive
Durable
Easy to use
Easy to clean
Easy to hold
Soft bristles
End-rounded bristles (Filaments)

5. Reasons Why You Would Recommend an Electric or Manual Toothbrush
The client may have a difficult time with dexterity because of arthritis, tremors, or Parkinson’s disease
Your client has braces. Using an electric toothbrush makes it easier to clean around the brackets to remove plaque (biofilm)
Your client might not be the best brusher. The electric toothbrush offers features, such as a small head, two-minute timer, or a sonic or spin action
Your client might have recession. Some electric toothbrushes are sensitive to excessive pressure from brushing, so they won’t allow your client to brush to hard
Manual
Your client has no dexterity issues
Your client might not like the vibration of the electric toothbrush
Your client’s home care is good—he/she brushes and flosses regularly
Your client doesn’t want to spend the money on an electric toothbrush
Your client has areas where he/she is just not getting with the electric toothbrush
Your client has had some type of periodontal surgery and needs to use special care when brushing

6. Toothbrushing Instructions
Brush for two minutes
Brush two to three times a day:
After breakfast
After lunch
Before bedtime
Use a soft bristle toothbrush
Brushing plane should be end-rounded to avoid trauma to the gums and teeth
Use a toothbrush that is the right size and fit
Use gentle pressure
Start in one quadrant of the mouth and work your way to the other quadrants, both facial, lingual, and the occlusal plane

7. Brushing Tecniques Bass (Sulcular) Stillman Charter Roll Stroke
Modified Bass, Stillman, and Charter
Fones

8. Bass (Sulcular)
The toothbrush is at a 45˚ angle towards the apex of the tooth and parallel to the occlusal plane (When brushing the lingual surface of the anterior teeth, turn the toothbrush so that it is perpendicular to the occlusal plane)
Gently place the bristles into the sulcus area covering about two teeth
Use approximately 10 vibratory strokes
Lift the brush and move on to the next two teeth
Repeat steps 1-4 until all teeth are brushed, both facial and lingual surfaces

9. Bass Technique

10. Stillman
The Stillman technique is for patients who have recessed areas.
The toothbrush is at a 45˚ angle towards the apex of the tooth and parallel to the occlusal plane (When brushing the lingual surface of the anterior teeth, turn the toothbrush so that it is perpendicular to the occlusal plane)
Gently place the bristles partially on the gums and partially on the cervical part of the tooth
Use approximately 10 vibratory strokes
Lift the brush and move on to the next two teeth
Repeat steps 1-4 until all teeth are brushed, both facial and lingual surfaces

11. Stillman and Modified Stillman Technique

12. Charter
The Bristles (Filaments) are angled opposite of the Bass or Stillman techniques. This technique is for the facial and buccal surfaces of the teeth on both the upper and lower arch. This technique is used mainly for people with orthodontics or fixed bridges.
Angle the toothbrush towards the occlusal so that the bristles are
partially on the gum and cervical part of the tooth
Use back-and-forth vibratory strokes
Use about 10 vibratory strokes
Lift the brush and move on to the next two teeth
Repeat steps 1-4 until all four quadrants are brushed
image source:quizlet.com via Google
For lingual surfaces, use the Modified Bass or Stillman techniques

13. Charter Technique

14. Roll Stroke Technique
The roll technique is meant for children or in conjunction with the Bass, Stillman, and Charter techniques.
The toothbrush is angled apically and rolled towards the occlusal surface of the teeth
Repeat stroke about four or five times
Lift toothbrush and place it on the next two teeth and repeat the roll stroke
Continue steps 1-3 until both maxillary and mandibular teeth are cleaned on both the facial and lingual surfaces

15. Roll Technique .

16. Modified Bass, Stillman, and Charter
The Modified Bass, Stillman, and Charter techniques simply add the Roll technique to the existing Bass, Stillman, and Charter techniques, thus adding the term “Modified.”
Clean the cervical area and massage the gums with the preferred method of brushing
After you have cleaned the cervical area then roll the toothbrush downward
Lift toothbrush and repeat steps 1-2 until both the maxillary and mandibular arches are clean

17. Modified Bass

18. Fones
The Fones technique is good for young children who still have a primary dentition.
The Fones technique is appropriate for patients that lack the dexterity to use either the Modified Bass or Stillman techniques.
This technique involves a circular motion while using light pressure against the tooth surface.

19. Fones Technique

20. Brushing Occlusal Surface
Toothbrush should be parallel to the occlusal surface of the teeth
Place bristles so that they lie on the occlusal surface against the grooves of the teeth
There are two ways to clean the occlusal surface:
In a circular and vibratory motion, move the toothbrush back-and-forth against the occlusal surface
Move the toothbrush in a back-and-forth motion while applying firm pressure

21. Toothbrush Maintenance
Replace a toothbrush every three months
If the bristles (Filaments) are starting to show signs of wear, such as flaring out of the bristles, then replace the toothbrush sooner than three months
Replace your toothbrush if you have been sick; It’s best to use disposable toothbrushes while your sick
After use, rinse the toothbrush under warm water making sure any particles are removed from between the bristles
Store the toothbrush so that the head of the toothbrush is facing upwards and is exposed to open air

22. Electric Toothbrush There are four types of electric toothbrushes:
Battery operated
Disposable
Needs a power source
Rechargeable

23. Electric Toothbrush Heads
Brush Trims
Brush Shapes
Bilevel
Multilevel
Orthodontic
Regular
Teardrop
Rectangle
Round
Round angled
Photo source: Commons, Wikimedia via Google images

24. Electric Toothbrush Motions
Circular (one directional)
Oscillating and rotating (moves in two opposite directions, and in some cases, the bristles move in and out)
Side-to-side (a lateral movement)
Sonic (Uses sound waves to move the bristles in a side-to-side motion or an up and down movement
Ultrasonic (uses an ultrasonic frequency to move the bristles in a vibratory motion)

25. Electric Toothbrush Maintenance
Replace the toothbrush head every three months
If the bristles (Filaments) are starting to show signs of wear, such as flaring out of the bristles, then replace the toothbrush head sooner than three months
Replace your toothbrush head if you have been sick; It’s best to use disposable toothbrushes while your sick
After use, rinse the toothbrush under warm water making sure any particles are removed from between the bristles
Store the toothbrush so that the head of the toothbrush is facing upwards and is exposed to open air

26. Sources
Darby, M. L., & In Walsh, M. M. (2015). Toothbrushing In Dental hygiene: Theory and practice (4th ed., pp.  ). St. Louis, MO: Elsevier Saunders.
Wilkins, E. M., & Wyche, C. J. (2013). Oral Infection Control: Toothbrushes and Toothbrushing. In Clinical practice of the dental hygienist (11th ed., pp.  ). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.