Brushing our teeth – we all do it, once in the morning, once before bedtime, and we all think we know the best technique.
However, it would seem that after all we don’t and, more worryingly, neither do our dentists, the people who make our toothbrushes, nor even Her Majesty’s Government.
A new study, by dental experts at University College London, has condemned “unacceptably inconsistent” advice from national dental associations, manufacturers and dentists themselves on the simple matter of brushing teeth.
Across 10 countries, researchers identified no fewer than six basic methods of brushing, and a bewildering variety of advice on the most important aspects of dental hygiene: how often to brush, how long to brush for, technique, and the vexed question of to rinse or not to rinse.
The authors said there appeared to be “no consensus among professional bodies on the best method of toothbrushing for the general population or for people of different ages or with particular dental conditions”.
“Such diversity in recommendations should be of serious concern to the dental profession,” the study, published in the British Dental Journal, concludes.
Dr Nigel Carter, chief executive of the British Dental Health Foundation, who helped write the Government’s official guidance on oral health, admitted that experts “struggle” over toothbrushing recommendations.
“When you actually look at the science there is no clear evidence around what method might be best, and the recommendations on toothbrushing intervals also vary hugely around the world,” he said.
In the UK for instance, widely followed advice says to brush for two minutes twice a day. But many countries recommend three minutes, while most South American countries advise brushing for one minute, three times a day.
“I think the toothbrush manufacturers have been guilty of not doing as much research as they might and in the scientific community it’s probably not seen as a sexy area of research,” said Dr Carter. “Hopefully what [the UCL study] will do will focus some scientists on doing some more robust research on both the various techniques of brushing and the brushing intervals.”
The most-commonly recommended method is known as the modified bass – which involves horizontal brush movements, accompanied by vertical and sweeping motions to create circles. However, no large studies have been carried out to determine whether it is really more effective than other simpler methods – including the most basic scrub technique taught to children.
Dr John Wainwright, the study’s lead author and a practising dentist, said that “all too frequently” he encountered patients concerned that his recommendations differed to what previous dentists had told them.
“What I feel we need is better research into what the easiest to learn, most effective and safest way to brush is,” he said. “The current situation where not just individual dentists, but different dental organisations worldwide are all issuing different brushing guidelines isn't just confusing – it's undermining faith and trust in the profession as a whole. For something most people do twice a day, you would expect dentists to send a clearer, more unified message to their patients on how to brush their teeth.”
There is no consensus over the very best way to brush, but UCL’s Professor Aubrey Sheiham recommends:
- Brush gently with a simple horizontal scrubbing motion
- Avoid brushing too hard, hold the brush with a pencil grip, not a fist
- The British Dental Association (BDA) add that brushing should take two minutes, twice a day
- BDA experts also recommend spitting, not rinsing, after brushing.