Toothbrush dilemma

To Your Health

Dental plaque is the primary cause of gingivitis (gum inflammation) and can lead to periodontitis, a more serious form of gum disease. The buildup of plaque can also lead to tooth decay. Both gum disease and tooth decay are the primary reasons for tooth loss. As dental professionals, we are often asked, “What is the best toothbrush for me to use?” The market is saturated with a plethora of options and choosing the right one may seem daunting—from manual brushes with different bristle arrangements to powered toothbrushes with variations in oscillation or ultrasonic vibration, etc. While manual and powered brushes are both effective at removing plaque, you might want to consider the following the next time you are standing in the oral health aisle.

Manual toothbrushes

Studies have shown that toothbrushes with either multi-level bristles or angled bristles perform better than the conventional flat-trimmed bristles in removing plaque. Another recommendation is using a toothbrush with soft bristles, which will minimize the risk of gum abrasion leading to recession and root sensitivity. Implementing proper technique, which includes angling the toothbrush at 45 degrees and focused attention on each tooth with a gentle sweeping motion, can improve plaque removal and protect gums from trauma.

In addition, looking for a manual toothbrush with the American Dental Association (ADA) seal is recommended since in order to gain the ADA Seal of Acceptance, the toothbrush must demonstrate that it is both safe and efficacious for the removal of plaque and reduction of gingivitis.

Powered toothbrushes

A review of 56 studies showed powered toothbrushes had significantly more plaque reduction when compared with a manual toothbrush. Specifically, there was an 11 percent reduction in plaque at one to three months of use, and a 21 percent reduction in plaque when assessed after three months of use. While more expensive than manual toothbrushes, powered brushes are especially useful for people who have dexterity challenges which affect the ability to meticulously clean each tooth with a manual toothbrush. While beneficial for all, those who may particularly benefit are people with arthritis, carpel tunnel and prior stroke or other conditions that affect grip or fine motor skills.

There are a variety of powered toothbrushes ranging in price and different types of head movement (e.g., side-to-side, counter oscillation, rotation oscillation, circular, ultrasonic). Many newer models can link to phone apps to determine appropriate time spent in each section of the mouth and warn if pressure applied is too forceful. Powered toothbrushes do cost more but may be worth the investment in your oral health as they have consistently been shown to be superior to manual toothbrushes in the removal of plaque and reduction of gum inflammation.

Proper oral hygiene

Regardless of the brush selected, brushing should contact all surfaces of the tooth: inner, outer and chewing surfaces for two minutes twice a day. Remember to floss at least once a day and be sure to replace manual toothbrushes or power brushheads every three to four months or more often if the bristles are visibly matted or frayed. Proper oral home care partnered with your dental professional can help you maintain a long lasting and healthy smile.

Dr. Aaron Hayes has been practicing dentistry since 2008. He can be reached at 757-873-3001 or on the practice’s website at

About Aaron J. Hayes, DDS 3 Articles
Dr. Aaron Hayes has been practicing dentistry since 2008. He is co-owner of City Center Dental Care and can be reached at 757-873-3001 or on the practice's website at

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