The toothbrush is the most common method for removing plaque from the oral cavity. A number of variables enter into the design and fabrication of toothbrushes. These include the bristle material; length, diameter, and the total number of fibers; length of brush head; an arrangement of bristle tufts; angulation of brush head to handle; and handle design. In addition, many features, neon colors or familiar cartoon caricatures, are also available. Brushes are classified as soft, medium, or hard based on the diameter of these bristles. The soft brush (0.16 to 0.22 mm ) is preferable for most uses in pediatric dentistry because of the decreased likelihood of gingival tissue trauma and increased interproximal cleaning ability. it is best to use a brush with a smaller head and a thicker handle than on the adult-size brush to aid in access to the oral cavity and facilitate the child's grip of the handle.
Several different types of toothbrushing techniques for children have been advocated over the years. The more predominant techniques are :
- Roll Method
The brush is placed in the vestibule, the bristle ends directed apically, with the sides of the bristles touching the gingival tissue. The patient exerts lateral pressure with the sides of the bristles, and the brush is moved occlusally. The brush is placed again high in the vestibule, and the rolling motion is repeated. The lingual surfaces are brushed in the same manner, with two teeth brushed simultaneously.
- Charters Method
The ends of the bristles are placed in contact with the enamel of the teeth and the gingiva, with the bristles, pointed at about a 45-degree angle toward the plane of occlusion. Lateral and downward pressure is then placed on the brush, and the brush is vibrated gently back and forth a millimeter or so.
- Horizontal Scrubbing Method.
The brush is placed horizontally on buccal and lingual surfaces and moved back and forth with a scrubbing motion.
- Bass method
It is one of the effective types of brushing technique. In this type, bristles are placed directly apically 45-degree angle to the tooth surface or place parallel to the tooth surface press the bristles slightly so that they enter the gumline vibrate the brush back and forth with the 10-15 strokes for each position and move next to the teeth.
- Fones/Circular Scrub Method
it is the simplest way for young children to brush. They have to place the toothbrush on teeth set and then activate the bristles by slightly pressing against the teeth 4-5 times on each set of the teeth and move to the next.
This technique is best suited for very young children or those who in general lack muscle dexterity.
- Modified Stillman Method.
The modified Stillman method combines a vibratory action of the bristles with a stroke movement of the brush in the long axis of the teeth. The brush is placed at the mucogingival line, with the bristles pointed away from the crown, and moved with a stroking motion along the gingiva and the tooth surface. The handle is rotated toward the crown and vibrated as the brush is moved.
Studies show that horizontal scrub technique removes as much or more plaque than the other techniques, regardless of how old the child is and whether the brushing is performed by the parent or the child. In addition, it is the technique most naturally adopted by children. Therefore, in most situations, the horizontal scrubbing method can be recommended for brushing children’s teeth. Regardless of the brushing method used, a systematic approach to brushing as advocated by Starkey should be employed.