The effect of brushing time and dentifrice on dental plaque removal in vivo.

PURPOSE Routine toothbrushing is the principal method by which individuals remove plaque and control plaque-related diseases, such as periodontitis and caries. Oral health care professionals generally recommend at least 2 minutes brushing with an appropriate technique, and yet the average brushing time in the general population is closer to 45 seconds. Our understanding of the relationship between brushing time and plaque removal, in an untutored general population using a conventional manual toothbrush and dentifrice, is limited. The role of dentifrice in plaque removal is also unclear. METHODS This study was undertaken to measure plaque removal during untutored brushing over timed periods between 30 and 180 seconds with 1.5 g dentifrice, using an Aquafresh Flex brush and Aquafresh Advanced dentifrice. Plaque removal after brushing without dentifrice was also determined (at the 60 second time point only). Forty-seven subjects participated in the study, in which plaque level was assessed using the Quigley-Hein (Turesky-modification) Index. RESULTS Plaque removal increased with brushing time across the range studied, tending towards a maximum at longer brushing times. At the extremes, brushing for 180 seconds removed 55% more plaque than brushing for 30 seconds. Brushing for 120 seconds removed 26% more plaque than brushing for 45 seconds. The use of dentifrice did not increase plaque removal during 60 seconds of brushing. CONCLUSIONS Oral health care professionals should reinforce efforts to persuade patients to brush for longer periods of time, as increasing brushing time to the consensus minimum of 2 minutes from a more typical 45 seconds increases plaque removal to an extent likely to provide clinically significant oral health benefits.