How to choose a toothbrush

Sukanya Sharma, New Delhi

ONCE a day, if not twice, at an hour when you aren’t necessarily at your best, a toothbrush does your sleepy bidding. In the few minutes that you give to this personal ritual, gums and teeth and tongue get a scrubbing.

For the intimate task that your toothbrush performs, as it traverses the recesses of your mouth, the fact is there is little that you know about it. 

Oral hygiene is an indicator of public health. So many diseases begin in the mouth and travel down from there. Having a good set of teeth is essential for being generally healthy. 

The World Health Organization (WHO) estimates that oral diseases affect nearly 3.5 billion people worldwide. There are 514 million children who suffer from caries of primary teeth across the globe.

Most people, in fact, don’t brush their teeth. They can’t  afford a toothbrush or toothpaste and settle instead for twigs or using charcoal dust which they rub in with their fingers.

 Getting people to brush is important. A giant business opportunity presents itself to brush makers. There is a case for making dental care products affordable.

But for those already using toothbrushes, selecting the right toothbrush is important. Currently, choices are made in blind faith. No questions are asked. All kinds of bristles in different formations are on offer. Some brands are better known than others, perhaps because of nifty marketing. Availability is also a factor — one tends to unquestioningly pick up what is being offered.

But is there more to toothbrushes than we care to know? Is there a science behind the way bristles cover a toothbrush head? Is the alignment of the handle important? Should the head be long or round or oval shaped?

Of the multiple types of brushes on offer, it is not known which combination of bristles is better for ferreting out particles of food or making tartar go away. Nor is toothbrush design public knowledge. So, how does one rate one over the other without trying them all — which, of course, is impractical.

Toothbrush manufacture is outsourced. Any entrepreneur could be into making toothbrushes. Ronnie Screwvalla used to make toothbrushes before he became a moghul of sorts in the Indian entertainment business. 

The brush you buy has no real pedigree. Nor is there the regulation to ensure it is of a proven medical standard before it enters your life and finds its way into your mouth.

According to American Dental Association (ADA) specifications, the brush head size for adults should be one inch long and half an inch wide, with two to four bristle rows, five to 12 tufts per row, and 80 to 85 bristles per tuft. The right size is simple to identify on your own — it should be big enough to clean every tooth’s surface without straining the jaw, and small enough to reach the back molars.

“Brush head designs vary from one country to another and there has been no conclusive research to indicate one as more superior than another as long as it cleans well and feels comfortable,” remarks Dr Puneet Kumar, a periodontist with a practice in New Delhi. 

For brush handles, grip is key. It should be comfortable to hold for a few minutes and ideally have rubber patches for better traction. For children, handles should be shorter and thicker, while adults can use longer ones. “A toothbrush with a secure grip and ergonomic handle is especially useful for those with limited dexterity, such as children or elderly individuals,” explains Dr Rajiv Balachandran, assistant professor of orthodontics at AIIMS, New Delhi.

The first toothbrush, closest to the one we use today, was invented by William Addis in England around 1780. The handle was carved from cattle bone and the brush was made from swine bristles. The invention of nylon by Du Pont helped it evolve into a truly modern and more hygienic form in 1938. A decade later came the first electric toothbrush. Nylon bristles are considered superior and are most common. 

 

CHOOSING RIGHT

There are three things to keep in mind when looking for the right toothbrush. Bristles (texture and design), brush head (size) and handle (grip). Bristle type plays the biggest role. Varieties range from soft, medium to hard. Most dentists lean towards soft or, sometimes, medium. The ADA recommends super soft or extra soft bristles (0.0075 mm). “Quite a few people ask for hard toothbrushes these days, but the majority of our customers admit they have been advised soft or medium,” says Rakesh Mittal, a chemist in south Delhi’s Green Park Market. An ideal toothbrush must have soft or medium-soft bristles for adequate cleaning and plaque removal while being gentle on the gums.

For children, handles should be shorter and thicker with a secure grip

Dr Ritu Duggal, chief of the Centre for Dental Education and Research at AIIMS, New Delhi, breaks it down: “For infants (0-3 years), a finger slip toothbrush with rice-sized toothpaste is ideal. As children grow (3-9 years), a kid-sized toothbrush with soft bristles is recommended, using pea-sized toothpaste from the age of six onwards. Once children reach the age of 10, an adult-sized toothbrush is appropriate,” she explains. WebMD, a trusted online medical resource, suggests bristles should have rounded tips for better teeth protection.

“Between all designs — straight, criss-cross, zigzag, angulated — the angulated ones are considered best because they are both layered and at an angle so they can reach the hidden spots in between and scoop up the dirt. As far as the shape is concerned, dome shaped bristles are what I recommend,” says Dr Khursheed Tuli, a leading dental surgeon whose clinic is in south Delhi.

Another common dilemma is whether a manual toothbrush is better than an electric one. While the electric one is more expensive, it does have an edge, according to some dentists. For people with mobility issues due to an injured arm, a disability or a geriatric illness, it does help by facilitating movement. But, while a good quality manual toothbrush can cost between Rs 75 and Rs 100, an electric one is priced at Rs 500 upwards.

“The differences are mainly in user experience and brushing efficiency. While some features are genuinely beneficial like soft bristles, small head and ergonomic handles, others may appeal more to personal preferences than proven dental benefits. If used properly, the difference is insignificant,” says Dr Balachandran.

 

DENTAL TIPS 

The rising trend of dental caries amongst young children has been cause for concern in India and globally. Dental diseases that earlier manifested in older children are now apparent in children as young as three to five years old. 

“Avoiding sweet and sticky food, developing regular brushing habits at an early age and consulting a dentist as soon as signs of cavities appear, is important. For children who have had their primary teeth removed, following the suggested course of treatment to the dot is vital,” says Dr Roshni Lekhi, a dentist, when asked for advice she would like to give concerned parents.

The Indian Dental Association recommends supervision of the brushing process till the child is about seven years old. “Parents should brush their child’s teeth until they are around six years old to ensure it’s done effectively,” says Dr Duggal.

Making brushing a fun activity instead of a burden can help encourage positive hygiene habits. “If a parent brushes alongside, with some music and, if possible, uses an electric toothbrush that plays fun tunes for the two-minute brushing duration, it can make a difference,” says Dr Tuli.

After picking out the right toothbrush, the question is — are we brushing right? Different oral conditions require diverse brushing styles but the one that is most widely used and recommended remains the Modified Bass technique. Under this method, the brush should be held at a 45-degree angle to the gums, followed by a combination of small circular motions and short back and forth strokes. Focussing on outer, inner and chewing surfaces of all teeth is a must.

For children, the Fones technique is often suggested. As per this method, the tooth surface is cleaned using gentle, simple circular motions.

The ideal brushing duration is two minutes — a time frame that is unanimously agreed upon. “During the two minutes spent on brushing, 30 seconds should be devoted to each quadrant of your mouth. Avoid brushing too hard, as this can damage gums and enamel,” advises Dr Balachandran. The general recommendation is to change a used toothbrush every three months or when the bristles start to look frayed. 

Tips for inter-teeth hygiene include regular flossing, mouthwash and visits to the dentist. The importance of flossing should not be under-estimated. “While brushing and flossing each have their own role, it must be noted that floss focusses on interdental areas which are often neglected by patients and become the main cause of caries these days,” warns Dr Kumar. A routine check-up should be a priority every six months and should not be taken lightly. 

Brushing your teeth may seem like a mundane everyday task but doing it right can prevent the onset of serious oral diseases. An informed and scientific perspective helps people make healthier choices. “Beyond intricacies like brush types and styles of brushing, what is most important is consistency. Twice a day should be routine for all age groups. Consistency is key,” says Dr Tuli.