Choosing Tooth Brush
================
Most of us hover over the shelves, picking up one brush then
another. After some minutes we make a purchase, seemingly at random.
When new patients are asked how they select a toothbrush, they usually
say, ‘Oh, I choose any brush really, one that looks nice in its
wrapper.’ A toothbrush is an important factor in preventing dental
disease, especially gum problems. Therefore the purchaser should be
quite specific when going into the shop. The dentist will tell you
which brush is suitable for you. Write it down and ask for it. Do not
be
fooled off with something else ‘almost the same’ or try somewhere
else!
Expensive brushes are usually not satisfactory. These are probably
hand-made (as if that made them better) and have natural bristles (hog
bristles) or sometimes-softer badger hair. None of these is
satisfactory. Natural bristle was believed by many (dentists, too) to
be better, but this is erroneous. Natural bristles have variable
textures and the filaments are hollow and absorbent and rapidly become
soggy and infected. Nylon can be made exactly to specification and,
because of mass production methods; good brushes can be made much
cheaper.
As has been shown already, both dental caries and periodontal
disease are the result of bacterial action, in the plaque, which
collects on the teeth and gums.
Brush heads should be small enough to reach all parts of the mouth and should have a flat brushing surface with a straight handle. The medium or medium soft nylon bristles (never hard) should be set close together - what is called multi-tufted. Brushes of any kind should not be expected to last very long and one should probably buy about four brushes per year. It is a sad fact that brush sales average about one brush per person per year with maximum sales during the summer holidays just before people go on vacation. Children need their brushes renewed more often as they tend to mishandle them. If an adult finds that brushes wear and splay out very quickly it is probably a sign that brushing is not being done correctly-probably force rather than care is being used. But some people are proud of wearing out their brushes: they feel they are doing a good scrubbing job!
Choosing
a Toothbrush
Automatic (electric) Toothbrushes
Many of the automatic toothbrushes produces a few years ago have now disappeared and there is no longer a great choice. The improved automatic brushes, which are still available, can be effective:
1. For handicapped people, especially arthritics.
2. For those who cannot master the technique of conventional brushing.
3. For those in a hurry and perhaps for those who are lazy.
4. For children who will often use the automatic brush more readily because of its novelty.
Nearly all-automatic brushes have battery-driven motors and it is important to make sure that the battery is not in a run-down state, otherwise there will be too little torque (driving action) on the brush. Most of these brushes have rechargeable cells and they should be kept always at peak charge. People who can brush effectively with the usual brush will not need an automatic brush. It is still necessary to be taught how to use the latter; it will not go anywhere in the mouth unless it is directed. But the automatic brush does have the advantage of speed.
Brush heads should be small enough to reach all parts of the mouth
and should have a flat brushing surface with a straight handle. The
medium or medium soft nylon bristles (never hard) should be set close
together - what is called multi-tufted. Brushes of any kind should
not be expected to last very long and
one should probably buy about four brushes per year. It is a sad
fact that brush sales average about one brush per person per year with
maximum sales during the summer holidays just before people go on
vacation. Children need their brushes renewed more often as they tend
to mishandle them. If an adult finds that brushes wear and splay out
very quickly it is probably a sign that brushing is not being done
correctly-probably force rather than care is being used. But some
people are proud of wearing out their brushes: they feel they are doing a
good scrubbing job!
Size. The best toothbrush head for you should allow you easy access to all surfaces of your teeth. For most adults, a toothbrush head a half-inch wide and one-inch tall will be the easiest to use and the most effective. Though there are larger toothbrush heads available, you may find that it is difficult to maneuver them to clean certain hard-to-reach areas, such as the sides and backs of your molars. The toothbrush should have a long enough handle so you can comfortably hold it in your hand.
Bristle variety. If you go to the drug store to purchase a manual toothbrush or a replacement head for your electric toothbrush, you will be able to select a toothbrush with soft, medium, or hard nylon bristles. For the vast majority of people, a soft-bristled toothbrush will be the most comfortable and safest choice. Depending on how vigorously you brush your teeth and the strength of your teeth, medium- and hard-bristled brushes could actually damage the gums, root surface, and protective tooth enamel. For even more tooth protection when you brush, be sure the bristles on the toothbrush you select have rounded tips.
Expert recommendation. To ensure your toothbrush has undergone rigorous quality control tests for cleaning effectiveness and safety, ask your dentist for a recommendation. Or look for manual or powered toothbrushes that have earned the American Dental Association (ADA) Seal of Approval.
General Tips for Choosing a Toothbrush
There are certain characteristics that you should look for in whatever toothbrush you choose, regardless of whether it is manual or powered.Size. The best toothbrush head for you should allow you easy access to all surfaces of your teeth. For most adults, a toothbrush head a half-inch wide and one-inch tall will be the easiest to use and the most effective. Though there are larger toothbrush heads available, you may find that it is difficult to maneuver them to clean certain hard-to-reach areas, such as the sides and backs of your molars. The toothbrush should have a long enough handle so you can comfortably hold it in your hand.
Bristle variety. If you go to the drug store to purchase a manual toothbrush or a replacement head for your electric toothbrush, you will be able to select a toothbrush with soft, medium, or hard nylon bristles. For the vast majority of people, a soft-bristled toothbrush will be the most comfortable and safest choice. Depending on how vigorously you brush your teeth and the strength of your teeth, medium- and hard-bristled brushes could actually damage the gums, root surface, and protective tooth enamel. For even more tooth protection when you brush, be sure the bristles on the toothbrush you select have rounded tips.
Expert recommendation. To ensure your toothbrush has undergone rigorous quality control tests for cleaning effectiveness and safety, ask your dentist for a recommendation. Or look for manual or powered toothbrushes that have earned the American Dental Association (ADA) Seal of Approval.
Automatic (electric) Toothbrushes
Many of the automatic toothbrushes produces a few years ago have now disappeared and there is no longer a great choice. The improved automatic brushes, which are still available, can be effective:
1. For handicapped people, especially arthritics.
2. For those who cannot master the technique of conventional brushing.
3. For those in a hurry and perhaps for those who are lazy.
4. For children who will often use the automatic brush more readily because of its novelty.
Nearly all-automatic brushes have battery-driven motors and it is important to make sure that the battery is not in a run-down state, otherwise there will be too little torque (driving action) on the brush. Most of these brushes have rechargeable cells and they should be kept always at peak charge. People who can brush effectively with the usual brush will not need an automatic brush. It is still necessary to be taught how to use the latter; it will not go anywhere in the mouth unless it is directed. But the automatic brush does have the advantage of speed.
Toothbrushes: Disposable or Electric?
As long as you clean your teeth regularly using proper brushing
technique, you should be able to reduce plaque build-up and keep your
gums healthy with either a manual or powered toothbrush. Here are some
things to keep in mind as you go about choosing the best toothbrush:
Cost. Although there are some more affordable powered toothbrush options being sold, electric toothbrushes cost many times more than manual toothbrushes. In addition to the initial expense of an electric toothbrush, you will need to replace the removable toothbrush head as often as you replace your manual toothbrush. Of course, if using an electric toothbrush helps you keep your teeth cleaner, you may make up for the expense with a reduction in dental bills.
Likability. When it comes down to it, the best toothbrush for you is going to be the one you're most likely to use -- and use well. Some people may not like the vibrating feeling of a powered toothbrush. Others might find an electric variety easier to use to clean all tooth surfaces. This may be especially true for people with conditions that limit mobility, such as painful arthritis. If you enjoy using your toothbrush, you're more likely to brush for the recommended length of time -- two minutes. Some powered varieties even have a built-in timer to let you know when you've devoted enough time to brushing.
Effectiveness. Numerous scientific studies have been conducted to investigate whether manual or powered toothbrushes are more effective at reducing gum disease and eliminating plaque. A review of nearly 30 studies comparing disposable and electric toothbrushes found that, overall, there was not a significant difference between electric and manual toothbrushes in their ability to remove plaque and prevent gum disease. But, evidence suggests that a certain type of powered toothbrush called a rotation oscillation toothbrush (the bristles go round and round and back and forth) is more effective than manual toothbrushes.
Safety. Although all toothbrushes with an ADA Seal of Approval have been tested for safety, there may be certain individuals for whom a particular type of toothbrush is safer. If you tend to brush too vigorously, which can damage your gums and teeth, a powered toothbrush may make it easier for you to be gentle on your gums and teeth and get them clean at the same time. Some studies suggest that using a powered toothbrush may increase the amount of bacteria in the bloodstream more than a manual toothbrush. This does not pose a risk for healthy people with normal immune systems and healthy hearts. But it could increase the likelihood that people with certain heart conditions could acquire a potentially dangerous infection in the heart. Further investigation is needed to determine whether this should be a cause for concern.
Cost. Although there are some more affordable powered toothbrush options being sold, electric toothbrushes cost many times more than manual toothbrushes. In addition to the initial expense of an electric toothbrush, you will need to replace the removable toothbrush head as often as you replace your manual toothbrush. Of course, if using an electric toothbrush helps you keep your teeth cleaner, you may make up for the expense with a reduction in dental bills.
Likability. When it comes down to it, the best toothbrush for you is going to be the one you're most likely to use -- and use well. Some people may not like the vibrating feeling of a powered toothbrush. Others might find an electric variety easier to use to clean all tooth surfaces. This may be especially true for people with conditions that limit mobility, such as painful arthritis. If you enjoy using your toothbrush, you're more likely to brush for the recommended length of time -- two minutes. Some powered varieties even have a built-in timer to let you know when you've devoted enough time to brushing.
Effectiveness. Numerous scientific studies have been conducted to investigate whether manual or powered toothbrushes are more effective at reducing gum disease and eliminating plaque. A review of nearly 30 studies comparing disposable and electric toothbrushes found that, overall, there was not a significant difference between electric and manual toothbrushes in their ability to remove plaque and prevent gum disease. But, evidence suggests that a certain type of powered toothbrush called a rotation oscillation toothbrush (the bristles go round and round and back and forth) is more effective than manual toothbrushes.
Safety. Although all toothbrushes with an ADA Seal of Approval have been tested for safety, there may be certain individuals for whom a particular type of toothbrush is safer. If you tend to brush too vigorously, which can damage your gums and teeth, a powered toothbrush may make it easier for you to be gentle on your gums and teeth and get them clean at the same time. Some studies suggest that using a powered toothbrush may increase the amount of bacteria in the bloodstream more than a manual toothbrush. This does not pose a risk for healthy people with normal immune systems and healthy hearts. But it could increase the likelihood that people with certain heart conditions could acquire a potentially dangerous infection in the heart. Further investigation is needed to determine whether this should be a cause for concern.
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With
the popularity of fluoridated water in the West, and fluoride-enriched toothpaste in India, are we still
getting the benefits, if there ever was any, from fluoridation, or is it harmful?
Fluorination of communal water
supply has been around in the developed world for a while now and can still be one of the most
controversial and debated public health topics around the world. With Tasmania
first introducing fluoride into the city’s water in 1950, by 1977 two thirds of
Australia had done the same. With the major exception of Brisbane of course,
which is the only major city that rejects fluorination, resulting in a higher
occurrence of dental decay than the nearby fluorinated areas..
Anti-fluoride groups banter on that
there a links between fluoride and cancer, some saying calling it a mass
medication and the conspiracy theorists are paranoid the governments are
sedating us, However since the controlled amount of fluoride has been added to either
the community water as in the West, or to the toothpaste, as in India, there
have been many studies to no avail that there is any serious risk or link.
Dental fluorosis is a buildup of fluoride on tooth enamel, resulting in
discoloration if fluoride consumption is excessive; mostly likely caused by
regular ingestion of fluoride toothpaste and more commonly occurs in children;
though this is more a cosmetic concern rather than a significant problem. With
the safe amount of fluoride found in your toothpaste and water it really isn’t
a problem and pregnant women should just be aware.
So really with the abundance of
scientific evidence supporting the notion that fluoridation offers both health
and cost benefits, especially because of the fact that fluoridated water or
toothpaste was responsible for a reduction of 60% and 25% of dental caries respectively in the 70s
and 80s, Health Authorities continue to insist on fluoridation as the
benefit far outweighs the risk.
We
at The TOOTH CENTRE support fluoridated toothpaste and recommend it to all adults and children above 5 years as well.
If you have any questions about
fluoride or its safety, feel free to
call our office and speak to our dentist. We will be delighted to hear from
you.
Please read this article in the Times of India for more information on the subject.
Fluoride Toothpaste – is Harmful For Children
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Times News Network
9-2-2
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Times News Network
9-2-2
NEW DELHI - If your toddler chews on the toothbrush, licks and
swallows toothpaste, make sure it is non-fluoridated. Fluoride ingested by
children less than four years old can be harmful.
Maulana Azad Medical College
(MAMC) dentist Dr Pankaj Goel told The Times of India, "Parents are not
aware about the difference between fluoridated and non-fluoridated
toothpaste. In fact, fluoride paste manufacturers often print on the packages
that it may not be suitable for children below four."
Goel said, fluoride toothpaste
when swallowed regularly and in considerable quantities may cause fluorosis
in children. "This disease is caused by excess fluoride and effects the
bones and teeth. In fact, we get to see quite a few people with stains on
their teeth caused by excess fluoride," he said.
Fluorosis makes bones brittle and
hampers the growth of a child. The bones may become crooked as well.
"When a child learns to spit out the toothpaste, he or she can easily
switch to a fluoride paste," said Dr Goel.
Max Health Care orthodontist Dr
Ajay Raj Bhagat said this quantity was very small and there was practically
no research evidence to show that ingested fluoride toothpaste had caused
fluorosis. "Yet, I seldom recommend a fluoride toothpaste for children
below four."
MAMC dental college principal Dr
Mahesh Verma said, Our medical literature says fluoride toothpaste must not
be given to a child below five years.
He said, "But throughout my
experience I am yet to come across a child who may have been harmed due to
such toothpastes. It is precaution that can be followed. But people should
also know that if a child does manage to swallow, no harm will be
caused."
FAQ
1. How does
Fluoride aid in prevention of dental caries?
1. Fluoride mainly has a topical effect
on enamel, rather than a systemic effect. It's role in prevention of dental
caries mainly occurs as a post-eruptive phenomenon rather than a pre-eruptive
one. It has the following effects:
· It inhibits demineralization of
enamel. It prevents mineral loss from crystal surface.
· It aids in remineralization of
enamel. However, for remineralization to occur, calcium and phosphate ions must
be present in the solution as well. The remineralized enamel is more acid
resistant than the original enamel since it contains fluoro-apatite rather than
carbonated apatite. This effect is evidenced even in the presence of very low
concentrations of fluoride (0.1 PPM).
· It interferes with glycolated
pathways of oral micro-organisms resulting in reduced acid production. In
addition it interferes with enzymatic processes involved in carbohydrate
metabolism resulting in reduced intra-cellular and extra-cellular
polysaccharide production (reduced plaque production)
· The greatest benefit of fluoride in
prevention of dental caries is achieved with life time exposure, and through
continuous low level presence along the enamel-plaque interface in the oral
environment.
2. What is
the best public measure to prevent dental caries, and how is it applied?
2. The best public measure to aid in
prevention of dental caries is the fluoridation of reticulated community water.
The use of fluoridated tooth pastes is also the most feasible way to aid in
prevention of dental caries. However, the effect of life time exposure to
fluoridated community water is greater in prevention of dental caries than this
achieved through the use of fluoridated tooth paste. Fluoridated community
water has an additive effect.
The ARCPOH guidelines regarding community water
fluoridation is that it is an effective and efficient, social equitable and
cost effective mean of prevention of dental caries. The guidelines recommend
the continuation of water fluoridation in communities which are already
benefiting from it and the extension of it to non-fluoridated communities. The
natural water in Australia contains 0.1-0.4 PPM. Fluoride is added to
reticulated community water to reach the level of 0.8 – 1 PPM. 70% of the
Australian population, particularly those in large urban communities, receives
fluoridated community water. Water fluoridation results in reduction of dental
caries by 20-40%. This percentage is comparatively lower than what was the case
when fluoride was firs introduced in western societies. This is because of the
increased availability of fluoride sources nowadays in western communities.
Discontinuation of water fluoridation results in reversal of those benefits. It
benefits both adults and children. It causes reduced incidence of root caries.
However, even with water fluoridation 20% of children in fluoridated
communities continue to show high caries activity. Therefore, topical fluoride
modalities still have a role in prevention of dental caries.
3. Assess the
effect of fluoridated tooth pastes in prevention of dental caries.
3. Fluoridated tooth paste causes a
reduction of dental caries in the population by about 25%. Its effect is mainly
related to smooth surfaces and interproximal surfaces. A tooth paste containing
low fluoride concentration such as 250 PPM is much less effective in reduction
of dental caries than the standard fluoridated tooth paste containing 1000-
1100 PPM. Brushing the teeth twice daily with fluoridated tooth paste reduces
dental caries in 80% of children and 60-70% of adults. Swishing and pumping the
paste between teeth enhances its effect on proximal surfaces. Tooth brushing
twice daily commenced before the age of 2 years old greatly decreased the
incidence of dental caries. Greater frequency of tooth brushing with
fluoridates tooth paste reduced dental caries much further.
Fluoridated
tooth pastes either contain NaF or sodium monofluorphosphate (0.76% MFP)
4. What are
the risks associated with the use of fluoridated tooth paste by children? And what
are the guidelines to minimize such a risk?
4. The greatest risk associated with
the use of fluoridated tooth pastes by children is ingestion of the tooth paste
which would result into increasing the chance of exceeding the limit of 0.1mg
F/kg of body weight or the daily limit of 2mg/day resulting in dental
fluorosis. Up to 30% of the used fluoridated tooth paste can be swallowed by
children. This is of particular concern for children under the age of 30 months
in fluoridated communities. Incidence of dental fluorosis should be of concern
to us since 33% of children show mild dental fluorosis. The most probable
causes of this increased incidence are the ingestion of fluoridated tooth
pastes and infant formulae manufactured in fluoridated communities which might
contain fluoride from0.9 to 2.8 PPM. The ARCPOH guidelines minimizes this risk
through the following recommendations:
· Teeth should be cleaned as soon as
they erupt twice daily by the parents. However, don’t' use a tooth paste till
the age of 17 months.
· From the age of 17 months to the age
of 5 years old (inclusive) clean teeth twice daily with a child formula
fluoridated tooth paste in fluoridated communities. Child formula tooth pastes
contain 250 – 400 – 500 PPM, in comparison with standard fluoridated tooth
pastes which contain 1000 – 1100 PPM. Parents should brush and floss their
children teeth up to the age of 8 years old. Parents should supervise any form
of brush play. They should use a small pea-sized amount of tooth paste smeared
across rather than along the brush head. Children should n spat the tooth
paste, not rinse, and not swallow it.
· From the age of 6 years old,
children should brush their teeth twice daily with the use of standard
fluoridated tooth paste. They should spat the tooth paste, not rinse and not
swallow the tooth paste.
· Those recommendations however can be
altered by professional guidance for children at higher risk of dental caries.
Alternation might be in the form of earlier use of standard fluoridated tooth
pastes, brushing more frequently, and earlier use of fluoridated tooth paste.
· There are high fluoride containing
tooth pastes, known as treatment pastes which contain 1500 -5000 PPM F. the
ARCPOH guidelines recommends that teenagers, adolescents and adults at high
risk of dental caries should be sought for professional recommended use of high
fluoride containing tooth pastes.
5. What is
the role of fluoridated mouth rinses in prevention of dental caries? And are
they suitable for children?
5. Fluoridated mouth rinses results
into the reduction of dental caries by 20-50%. It should not replace tooth
brushing with fluoridated tooth paste and it should be used in periods of the
day at which fluoridated tooth paste is not used if possible. There are two
main types of fluoridated mouth rinses:
· Daily rinses: 0.05% NaF mouth rinses
(containing 220-227 PPM F), and partially acidulated fluoride phosphate APF
consisting of a mixture of sodium fluoride, phosphoric acid, and sodium
phosphate monobasic mouth rinses (containing 200 PPM F)
· Weekly rinses: 0.2% NaF Mouth rinses
According to the ARCPOH regulations they should not be used by children
under the age of 6 years old. This is recommended to avoid their swallowing. It
is particularly indicated for children above the age of 6 years old who are at
high risk of developing dental caries, such as children undergoing orthodontic
treatment, children who receive irradiation therapy for cancer, and children
who are physically or mentally disabled to provide good level of oral hygiene.
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