MANY OF my patients ask me, “Doc, which is the best toothbrush? or, “How often should I change my toothbrush?”

Now, some dentists recommend a rectangular-shaped soft nylon brush without fancy curves and tufts. But actually, this is too vague for most people.  The best toothbrush is one with a small head and soft bristles. These bristles should be all of the same height and have round ends.
The advantages of a soft brush are that it can be used on the gum as well as the teeth and tongue with less risk of abrasion. In any event, plaque is like jelly, and does not require a hard brush to remove it.
How often should one change one’s toothbrush? Well, the direction of the bristles is what decides when it’s time to change. The bristles should point straight up; as soon as they start to curve outwards, the brush becomes practically useless. To be functionally effective, a toothbrush must have its bristles straight, and also at right angle to its head.
You may be wondering why, then, do manufacturers make hard toothbrushes.  The answer is that hard-bristle toothbrushes are for dentures and bridges; not natural teeth.  One way for you to evaluate which brush is best for you, is to prove whether or not you require a prophylactic cleaning from your dentist. Run your tongue over your teeth after brushing. If the teeth do not feel smooth and clean, you may want to see your dentist.
Plaque-disclosing tablets, available in my clinic, contain a vegetable dye that stains red any plaque that remains on the teeth after brushing and flossing. This is essentially a teaching device which tells you if you are brushing properly. The tablet is chewed and mixed with saliva, and then swished to bathe all the teeth with the solution. By disclosing the residual plaque to view, you can learn where better brushing and flossing are needed.
Disclosing tablets are not recommended for daily use, but only as an occasional checkup on the brushing efficiency. Since most brushing is deficient, anyway, the best advice is to take a little more time and work conscientiously at being more thorough.
If you brush more than once a day, it is a good idea to have two brushes. By alternating toothbrushes, the bristles have time to dry out and become firm again for reuse. Rechargeable battery-operated toothbrushes are recommended for handicapped persons who lack the manual dexterity required for hand brushing. Electric toothbrushes, though quite expensive, remove plaque effectively from exposed tooth surfaces, though the same results can be obtained from a hand brush, if you brush long enough.
Individuals who are too impatient for thorough manual brushing would benefit from one of the newer electric toothbrushes with programmed timers that tell you when to shift from one side of the mouth to another, over a period of two minutes. I have one of these, which I use occasionally, although I have more faith in the simple manual ones.
Following treatment for moderate to advanced periodontal disease, an electric toothbrush, with its high-speed oscillation, may be nearly as effective as brushing with both a conventional toothbrush and a small interproximal brush. However, the electric brush cannot completely remove plaque from the proximal surfaces, especially if the spaces between the teeth are filled with gum tissue. Interproximal plaque can be removed from these surfaces only by use of dental floss.
For a person with the average dexterity and no special dental problems, an electric brush may be just one more superfluous gadget. Brushing with toothpaste that combines a very mild abrasive and a safe detergent is the most effective way to clean teeth. However, the best toothpaste is the one that contains fluoride. You should not use so much paste that you foam at the mouth when you brush. A half-inch dollop of paste is more than sufficient. The addition of fluorides reduces dental decay and gum-line sensitivity. The fluoride can also repair early caries by promoting remineralization of enamel.
Some toothpastes, described as tooth whiteners, may contain harsher abrasives to remove tobacco stains. They are not intended for daily use, since the abrasive may wear away the tooth surface, especially at the gum-line, and produce areas of hypersensitivity.
Do not brush with table salt, which is excessively abrasive. Baking soda, a popular fad in the past, is not as effective as modern toothpastes. Unless one forms a great deal of tartar, tartar-reducing toothpastes have little advantage over regular pastes. The best guide is to choose fluoride toothpaste that has the approval of the American Dental Association, and suits your personal taste (and I am not saying this because I am a member of that Association, but because it has been proven by numerous studies).
The function of dental floss is to clean the side surfaces of incisors and cuspids( ‘eye teeth’) and the front and back surfaces of the bicuspids and molars that cannot be reached by the toothbrush. Dentists call these the proximal surfaces, meaning, the sides next to each other.
The floss is stretched taut between the fingers, which were placed inside and outside of the teeth. The floss is then gently slipped between the teeth. Excessive pressure that snaps the floss through the contact points of the teeth can injure the gum tissue, so it is important to ease rather than force the floss through. The floss should then be worked three or four times up and down in a scraping motion against the front and back tooth surfaces without rubbing against the gum as it passes from side to side. The floss should not be pulled back and forth like a shoeshine cloth. This “sawing” action can wear grooves into the roots. Flossing helps to prevent bad breath.
Flossing is a skill that does not come easily. It must be practiced until one’s fingers get a “feel” for where they are and what they are doing. Floss holders can be purchased to make it easier, but they are not necessary for anyone with normal dexterity. As long as you can hold a string taut between two fingers you can learn to floss. But even a skilled flosser has difficulty where contacts between the teeth are very tight or they are rough or sharp edges on fillings and tartar deposits that tear or fray the nylon. A trip to the dentist will be necessary to eliminate these problems by smoothing or replacing defective fillings and scaling the teeth.
For further information, feel free to e-mail me at bertrandstuart@gol.net.gy