-Soft, hard, or medium
A TOOTHBRUSH is merely a device intended to physically clean all the accessible plaque off the teeth and gums that the brush comes into contact with during normal use. Although no manual toothbrush can clean the faces between the teeth, or effectively go to any meaningful depth in the contact points between the teeth, or effectively go to any meaningful depth in the sulcus where the toxic stew may be, selecting the proper toothbrush is still critical. This is because the secret to oral health is the effective control of plaque.

A manual brush should always be soft, never hard or medium, as they can cause severe damage to teeth over time. Hard or medium toothbrushes are good for cleaning motor parts or boots. In dentistry, they serve well to sanitize acrylic, porcelain and metal parts of dentures. Such tough-bristle toothbrushes can cause immediate damage to the delicate soft tissues surrounding the teeth, leading to inflammation and a portal of entry for microorganisms. Oral surgeons and periodontists are kept continually busy extracting teeth and doing gum surgery to repair the damage done by hard and medium brushes, and I hope you can avoid this. In addition to never using a hard or medium brush, you should apply only gentle, light pressure when you brush with the recommended soft one, making sure that as you brush, no accessible areas are missed. Areas that are consistently overlooked often end up with disease, so take care to be thorough.

By the way, it is frequently more difficult to perform either tooth extractions or root canals on teeth that have been cut in half by toothbrush abrasion. This is because the teeth can be weaker and easier to break, or the canals have calcified due to persistent stimulation of the tooth’s root, making it virtually impossible to clean out the canal and save the tooth. Additionally, crowns (or caps) on teeth affected by toothbrush abrasion can end up looking too long when the crown has to cover the entire exposed root that was once covered by gum tissue. Sometimes cosmetic dental surgery is required to cover the exposed root structure before aesthetic crowns or other cosmetic procedures can be accomplished.

If the right technique is used, soft brushes can easily remove plaque, but no brush can remove hard deposits or stains safely without damage, and it is too risky to even try doing it yourself. This is a job for your dentist or dentex, because they are trained and equipped to do it the right way, without damaging your teeth or gum tissue.

Brushing safely and effectively isn’t difficult to do, and assuming you have chosen a manual (non-powdered) brush, please be certain that the brush is soft, with rounded bristle ends that are capable of cleaning not only above the gum line, but a little bit below it as well. In order to do the job thoroughly, proper brushing involves using a system as well as a technique, so I’ll tell you what I always instruct my patients to do. Begin tooth brushing on the cheek sides of the upper right back teeth, placing the brush at a 45 degree angle to the gum-line and gently brushing in a small back-and-forth motion, two to three teeth at a time, for approximately ten brushing strokes per area. Once this area has been brushed, move toward the front to the next two to three teeth. Continue the process of gently brushing the gum-tooth margin in small, gentle, back-and-forth strokes for at least ten brushing repetitions, or until the area feels adequately cleansed. Then, making sure to keep the bristles angled into the sulcus at a approximate 45-degree angle, continue brushing around the arch, two to three teeth at a time, until the entire outer surfaces of all the upper teeth have been brushed.

Continue the same process, brushing the tongue side of all the upper teeth systematically, two to three teeth at a time, with the brush angled into the sulcus, until the inner surfaces of all the upper teeth have been brushed. Brushing the inner surfaces of the upper and lower front teeth is sometimes accomplished more easily if the brush is used vertically, and gently moved left and right for ten repetitions, massaging the gum as you go. It’s easy to feel the progress of the toothbrush around the arch of the mouth, and being aware of how the brushing feels is important in order to make sure you don’t miss anything as you proceed.

Brushing the lower teeth is almost the same as brushing the upper teeth, except that the bristles are now angled downward at an approximate 45-degree angle in order to help cleanse the lower gum margins effectively. It is important to start on the outside surfaces of the back teeth, either right or left side, and brush two to three teeth at a time, for about ten back-and-forth repetitions before moving on to the next teeth. When all the outside surfaces of the lower teeth have been brushed, the lingual (inside) surfaces are the next to be systematically brushed until they have all been cleansed.

Are we done with brushing at this point? Not quite! It is important to brush the biting surfaces of all teeth, especially the back ones with the deep grooves, which can trap plaque that can, in turn, cause tooth decay (cavities), odor, and more gum disease.

Now, are we done brushing yet? No. But we’re almost there. To finish, use sideways motions to brush the gum margins at the back of your last teeth on the upper and lower arches, left and right. This step is best done when transitioning from brushing the outside surfaces of the teeth to brushing the inside surfaces, as you turn the corner around the last tooth and start brushing back in the other direction.

What type of brush does the best job? My personal manual toothbrush, the Radius, is an odd-looking but exceedingly effective toothbrush. Being right-handed or left-handed doesn’t matter here, since this particular Radius toothbrush (Radius has normal brushes as well) isn’t designed to be used alternatively by either hand. It has to be bought for one or the other, because it has a thumb-rest indentation built into the handle of the brush that automatically angles the bristles correctly when brushing at the gum-tooth margins. If you put the brush in the wrong hand, it simply doesn’t fit. I’m not saying that you must get a toothbrush like the one I have. Any Colgate toothbrush would do. And this is not about advertisement; it’s about my experience as a dentist for more than two decades.

The oval-shaped head of the brush is large enough to brush at least two to three teeth at one time, and the outside surfaces of the top and bottom teeth can be brushed at the same time if the upper and lower teeth are touching, or at least close together. I still brush, using the system I’ve described above, but since the brush is so big as well as angled, it makes brushing that much more effective, efficient, and quick when used properly. But, like I said, a soft manual brush made by a reputable company, and used according to the above instructions, will do a good job of helping you begin the process of cleaning your mouth.