There is at the moment agreement about the preference for using an electric toothbrush. We need to realize though that in order to maximize the effect of electric brushing, we need to apply a specific technique, which is way different than what we are used to while manually brushing. The biggest difference is that we should let the brush head do the job: we take care that the brush is properly positioned, and then we keep it there for some seconds in order to clean. We should avoid doing any kind of rotating or back and forth movement with our hand. Ideally we place the brush at 3 different locations on the outside and 3 on the inner side of every tooth. We should also pay attention to avoid having the brush hair touching the chewing surface while trying to clean the inner or the outer surface of the tooth. Otherwise the brush does not make contact with the part of the tooth adjacent to the gums that we need to keep clean for healthy gums.
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The brushing head should be placed more or less perpendicular to the surface to be cleaned. When brushing a rather curved tooth though, which is often the case when it bears a crown or when brushing dental implants, attention has to be paid at the position of the brush in relation to the rounding of the crown. In such a case the brush should be tilted appropriately to make contact with the neck of the crown right next to the gums.
It is also important to use the brush with little pressure in order not to have its hair bent.
This leads to more precision but it also allows the brush to rotate freely which then maximizes the cleansing effect. By using lots of pressure on the electric brush we reduce the efficacy of brushing!
When it gets to cleaning between teeth, the use of interproximal brushes has the preference. These are available in different shapes and sizes. The proper size (generally as thick as possible) and technique (multiple movements in different directions) make sure that the bacterial plaque gets removed. When treating pockets though, it is at least as important as removal of the dental plaque to massage the gums through intensive use of the interproximal brushes. This stimulates the healing process through reduction of swelling and tightening of the tissues.
When the pockets are located behind the last teeth, it is not possible to reduce the swelling and therefore the depth of the pocket by massaging the gums with interproximal brushes. In those cases, it is wordt trying to use some kind of ribbon to massage the gum. Traditionally patients have been using a piece of gauze folded in a way to create a band of about 1 cm width. Nowadays it is possible to buy also ribbons that are ready for use. The technique is simple:
the 2 ends of the ribbon are held between thumb and index of both hands, then it is placed behind the last tooth or in a big gap between teeth (often a place where a tooth has been lost in the past) to follow with 5 sawing movements in tight contact with the gum.