Incomplete removal of plaque through improper brushing technique can not only leave teeth unhealthy, but the gums unhealthy as well. Arun Purohit has done a great job describing what is called the Modified Stillman Technique.
However, the Modified Stillman is designed specifically for people who have just underwent gum surgery, though many times dentists recommend this technique for people with actively inflamed gums.
The current recommendation for plaque removal using a toothbrush is actually what is called the Modified Bass Technique, since it has been shown in studies to be the most efficient and effective technique for plaque removal.
The original application of this technique was with a manual toothbrush, and slight adaptations need to be made when using electrical toothbrushes. I covered instructions for both manual Tooth brushing and brushing with an Electric Toothbrush in recent blog posts, but I will go on to describe them below. If you want to see my original posts, with all the extra pictures, I am including the How-to Brush links:
Manual Toothbrush Instructions.
My instructions for executing the Modified Bass Technique center around developing tactile feedback, so that you gain a better awareness of where you are brushing and in turn remove plaque better in all situations. Not everyone has the typical straight set of teeth that you see in the demonstrations, so feeling the bristles go where they should, will ensure you are doing a good job.
- Practice brushing in the beginning without toothpaste so that the sussing doesn’t interfere with you sensing where you put the bristles. This is ok because you will still remove the same amount of plaque, you just don’t get the benefit of fluoride. I find this is easiest to integrate, by practicing this way before breakfast every morning for a week or so and using your brush with toothpaste at night.
- I always say hold your toothbrush like you are shaking hands with it, but the screwdriver analogy works well too.
- Place the toothbrush bristles against the outside of your tooth so that the bristles point towards your gums at an angle (roughly a 45 degree angle). You should be able to feel the tips of the bristles gently against your gum line, and in-between your teeth. This is very important. Plaque forms first along the gum-line and between teeth, so this is where we want the focus of our cleaning to be, and we want to feel the bristles there. Consult the two pictures below that show proper adaptation.
- You are focusing on brushing just two or so teeth at a time, where the bristles are well adapted. Once you can feel that you have wiggled the bristles into position, begin brushing by making 10-20 small circles to clean that area. You then lift the brush and move to the next spot and repeat steps 2-4. Continue all the way around your top and bottom teeth on the tongue and cheek sides with this process before brushing the chewing surfaces.
- You may need to tilt the brush vertically, to achieve the same adaptation when you get around to the front teeth, and if you have crowded teeth you might need to tilt the brush in a funny direction as well; however, if you are focusing on the feeling of the bristles adapting as they should then you are doing great.
- When you brush the chewing surfaces, horizontal strokes are just fine.
- The whole process should take about 2 minutes, but you need to focus on quality over quantity.
Small Changes for Electrical Toothbrushes
- The location and feeling of where the toothbrush bristles should adapt is the same; however, you no longer are performing the major brushing motion.
- Instead of you making circular motions, you gently rock the toothbrush head back and forth to clean around the tooth (or set of teeth) covered by the bristles. You should feel the bristles go from being in-between one area to being in-between another area as you rock. This is best seen with the pictures below.
I would also stress that it is extremely important that you measure results and track your progress with brushing. As with anything you can only improve what you measure, that is why I put together a really simple Plaque Scoring Test you can do at home: http://www.freysmiles.com/blog/view/evaluate-your-oral-hygiene-skills-using-a-plaque-scoring-test
