CDHA Position Paper on Tooth Brushing

EXECUTIVE SUMMARY Purpose: Tooth brushing is the most commonly recommended and performed oral hygiene behaviour by North Americans and is done ubiquitously in developed nations. It is the primary mechanical means for removing dental plaque, thereby assisting in the prevention of oral diseases including gingivitis and dental caries. The aim of this paper is to report on an investigation of the current state of the science on tooth brushing for the control of plaque and periodontal diseases, particularly gingivitis, and in order to develop a Canadian Dental Hygienists Association (CDHA) position statement. Methods: Using previously published reviews and analyses as a departure point, a comprehensive review and analysis of the literature was conducted. The search was guided by the development of several PICO questions on tooth brushing and included the following databases: MedLine, CINAHL (Cumulative Index of Nursing a Allied Health Literature), and the Cochrane Controlled Trials Register. Salient websites were also examined. Subsequent to the review and analysis, input was solicited from recognized experts and researchers in relevant fields of inquiry. Results: A total of 238 papers were identified and retrieved in full text. Data on tooth-brushing frequency and duration, ideal bristle stiffness, and tooth-brushing method were found to be equivocal. Worn toothbrushes were not shown to be less effective than unworn brushes, and no ideal toothbrush replacement interval is evident. Re-chargeable power toothbrushes with an oscillating, rotating (with or without pulsating action) mode of action have been shown to be more effective in removing plaque and improving gingival outcomes than manual toothbrushes. Ideal tooth-brushing force has yet to be determined, but excessive force may be associated with gingival trauma. While gingival recession and hard-tissue cervical abrasion are recognized as having multi-factorial etiologies, tooth brushing is considered contributory. Toothbrushes have been shown to support a variety of micro-organisms, but research showing a relationship between a contaminated toothbrush and oral/systemic clinical manifestations is not evident. Conclusions: Seven recommendations were developed representing the current understanding surrounding toothbrush use, based on the best available evidence. While considerable research into tooth brushing has been conducted, it was found that there is a paucity of research on several aspects of tooth brushing; thus many firm conclusions could not made. This lack of conclusive data in several areas about tooth brushing limits dental hygienists’ ability to provide evidence-based recommendations for their clients. In these cases, dental hygienists will need to rely on their clinical experience along with the specific conditions of their clients. It is apparent that many opportunities exist for future dental hygiene research in several areas of tooth brushing. Canadian Dental Hygienists Association Position Statement