Role of brushing technique and toothbrush design in plaque removal

Abstract – Twenty‐four adults participated in an intraindividual crossover experimental study to compare the plaque removing ability of straight multitufted and V‐shaped brushes. Twelve of the participants had loss of periodontal tissue resulting in open but healthy interdental areas while the other 12 displayed no periodontal breakdown. In part 1 the participants were asked to brush their teeth using their own brushing technique and length over two 12‐day periods during which time they, at random, used one brush for the first and the other brush for the second period. In part 2 the participants were professionally brushed by two dental assistants using four brushing techniques (The Bass, The Roll, The Circular Scrub and The Horizontal Scrub) randomly assigned to the four quadrants of the mouth. Cleaning was performed once a day for two 5‐day periods, during which time the participants refrained from brushing and interdental cleaning. Initial toothbrush assignment was randomized. At the beginning of the study and each test period no plaque or gingival inflammation was visible. At the end of each period the accumulated plaque was registered. The results showed that there was no difference between the two brushes tested in the unsupervised part. The plaque removing ability when using either of the brushes varied between participants. When professionally used the straight multitufted and V‐shaped toothbrushes did not show any difference in plaque removal on buccal and lingual surfaces. Interproximally the V‐shaped toothbrush was better at plaque removal than the straight one. However, plaque still remained after brushing with the V‐shaped toothbrush, which indicates that toothbrushing always must be supplemented with interdental aids and that the shape of brushes as well as the techniques used are of little importance. Interproximal areas with tissue breakdown and loss of interdental papillae accumulated more plaque than those with no periodontal tissue breakdown.