BRUSHING TECHNIQUES

Modified Bass Method:

• MECHANICAL PLAQUE REMOVAL BY THE INDIVIDUAL Includes :

-Tooth brushing.

-Flossing.

• TOOTH BRUSHING TYPES & TECHNIQUES :

Design variations in tooth brushes include:

-Dimensions of the head.

-The length.

-Diameter.

-Modulus of elasticity of the filaments & their numbers, distribution & angulations.

MODULUS OF ELASTICITY: is the mathematical description of an object or substance's tendency to be deformed elastically (i.e., non-permanently) when a force is applied to it.

• Current opinions favors a soft textured , nylon, multi-tufted brush with a short head. There is no clear-cut evidence that one particular type of tooth brush is superior to others with respect to plaque removal and prevention of gingivitis. *Frequent use of hard textured brush has been linked to gingival recession.

• Tooth brushing method: Are categorized according to the direction of brushing stroke.

1.Vertical.

2.Horizontal.

3.Roll technique.

4.Vibrating technique (Charters, Still man, Bass).

5.Circular technique.

6.Physiological technique.

7.Scrub brush method.

• Horizontal Scrub: Position of the bristles is 90 degree to tooth & horizontal strokes are done & it’s claimed that this technique achieves only supra gingival cleaning.
• Fones (Circular tech): Position of the bristles is 90 degree to tooth & brush is moved in large circles over teeth and gingiva. It also achieves supra gingival cleaning.

• STILL MAN: Bristles are positioned 45 degree to apex, part on the gingival margin & part on the cervix of tooth & brush is moved in a vibratory pulsing motion ,while in modified still man brush is swept occlusally ,thus cleaning supra gingival area.
• Charters method: Bristles are positioned 90 degree to tooth & brush is moved in a circular vibratory motion thus causing gingival stimulation & inter proximal cleaning. In modified Charter the brush is sweep occlusally & thus achieving supra gingival cleaning.

-          BASS METHOD: Bristles are positioned at 45 degree to the apex & vibratory horizontal motion is given thus achieving sub gingival cleaning & gingival stimulation, while in modified BASS method tooth brush is swept occlusally thus achieving supra gingival cleaning.

Bass method is the technique widely recommended by the dentist & hygienists

POWERED TOOTH BRUSHES

• There is evidence that suggest powered tooth brushes will improve plaque control in specific patient groups, those with orthodontic appliances; children & adolescents ;those with a physical or learning disability & Institutionalized patients who are dependent upon their care providers to brush their teeth.
• The brush heads are more compact than compared to the conventional tooth brush. Bristles are also arranged as more compact single tufts which facilitate inter proximal cleaning and brushing in less accessible areas of the mouth.

• The circular brush heads have oscillating, rotational, or counter rotational movements.
• Newer versions includes following features:

-An active brush tip to facilitate plaque control around posterior teeth.

-An orthodontic brush head for cleaning around the components of orthodontic appliances.

-Rotating or spiraling filaments for improved inter proximal cleaning.

 

A clicking mechanism to warn when a pre-determined brushing force has been reached.

-Timers, which usually indicate a brushing time of 2 minutes.

Cleaning between the teeth:

• The need for effective inter dental cleaning has led to the manufacture of various devices. This should be recommended in accordance with the individual dexterity & inter dental anatomy.
• WOOD POINTS(TOOTH PICKS):Triangular wood points are superior to  round or rectangular shaped ,but are effective only where sufficient inter dental space is available. But there is evidence that they should not be used

• DENTAL FLOSS: When tooth brushing is accompanied by flossing, more plaque tends to be removed from the proximal surface than by tooth brushing alone. There is little apparent difference in the cleaning ability of waxed & un waxed floss, nor is there any difference between dental tape and waxed or un waxed dental floss with regard to their effectiveness at reducing inter dental gingival bleeding.

• Interspace brush( single tufted tooth brush): This device was introduced to improve the access to tipped, rotated or displaced teeth & teeth effected by gingival recession. The interspace brush is of limited value on its own at cleaning proximal surfaces except for surfaces adjacent to an extraction space.

• INTERDENTAL  Brush (Bottle  brush):Open interdental brushes are cleaned more thoroughly by the inter dental brush which is manufactured in different shapes & sizes. The larger type is held by it’s wire handle while smaller versions are attachable to a metal or plastic handles. Studies comparing interdental brush with dental floss have shown it to be superior in cleaning large interdental space & suggest when used habitually supra gingival 

Proximal surfaces can be kept free of plaque & subgingival plaque to a depth of 2-2.5 mm below the gingival margin. However patients with gingivitis ,swollen papillae may initially limit the choice of interdental aid to dental floss. If however any proximal attachment loss has occurred, the gingival recession which will inevitably occur with the treatment, should , in  due course, allow interdental brushes to be used instead.