Abstract
Professional recommendations for individual oral hygiene mostly include tooth brushing at least twice daily for 2–3 min with gentle force using the Bass technique or modifications of it. This study evaluated whether habitual tooth brushing actually meets these standards. Uninstructed adults (n = 103; mean age 31 ± 6 years; 61 female, 42 male) with habitual manual tooth brushing were given a self-administered questionnaire about the frequency of brushing and a computer system recorded their brushing technique, duration and force. The majority (79.6%) of participants brushed twice daily. The mean brushing duration was 96.6 ± 36.0 s, the mean brushing force was 2.3 ± 0.7 N (max. 4.1 N), and no significant differences were found for quadrants. Most subjects (73.8%) brushed with circling, 8.7% with horizontal/scrubbing, 13.6% with horizontal/circling and 3.9% with vertical/sweeping movements. Modified Bass technique was not observed. When appropriate brushing habits were defined as brushing at least twice daily for 120 s with a brushing force of less than 3 N and with circling or vertical sweeping movements, only 25.2% of the participants fulfilled all criteria, emphasising the ongoing need for oral hygiene education.


Similar content being viewed by others
References
Addy M, Shellis RP (2006) Interaction between attrition,abrasion and erosion in tooth wear. Monogr Oral Sci 20:17–31
American Dental Association. Oral Health Topics A-Z. Cleaning Your Teeth and Gums (Oral Hygiene). http://www.ada.org/public/topics/cleaning.asp
Bartlett DW, Shah P (2006) A critical review of non-carious cervical (wear) lesions and the role of abfraction, erosion, and abrasion. J Dent Res 85:306–312
Benz C, Schwarz P, Sonnabend E (1987) Various physical parameters of toothbrushing and their relation to the appearance of non-inflammatory gingival recession. Das Deutsche Zahnärzteblatt 96:930–935
Bernhardt O, Gesch D, Schwahn C, Mack F, Meyer G, John U, Kocher T (2006) Epidemiological evaluation of the multifactorial aetiology of abfractions. J Oral Rehabil 33:17–25
Boyd RL, McLey L, Zahradnik R (1997) Clinical and laboratory evaluation of powered electric toothbrushes: in vivo determination of average force for use of manual and powered toothbrushes. J Clin Dent 8:72–75
Deery C, Heanue M, Deacon S, Robinson PG, Walmsley AD, Worthington H, Shaw W, Glenny AM (2004) The effectiveness of manual versus powered toothbrushes for dental health: a systematic review. J Dent 32:197–211
Fraleigh CM, Mc Elhaney JH, Heiser RA (1967) Toothbrushing force study. J Dent Res 46:209–214
Jepsen S (1998) The role of manual toothbrushes in effective plaque control: Advantage and limitations. In: Lang NP, Attström R, Löe H (eds) Quintessence Publishing Co, Inc, Chicago, Berlin, London, pp 121–137
Lussi A, Jaeggi T (2008) Erosion—diagnosis and risk factors. Clin Oral Invest 12(Suppl 1):S5–S13
Macgregor ID, Rugg-Gunn AJ (1985) Toothbrushing duration in 60 uninstructed young adults. Community Dent Oral Epidemiol 13:121–122
Macgregor ID, Rugg-Gunn AJ (1986) Effect of filming on toothbrushing performance in uninstructed adults in north-east England. Community Dent Oral Epidemiol 14:320–322
Mentes A, Atukeren J (2002) A study of manual toothbrushing skills in children aged 3 to 11 years. J Clin Pediatr Dent 27:91–94
Micheelis W, Schiffner U (2006) Vierte deutschen Mundgesundheitsstudie (DMS IV). Deutscher Zahnärzte, Köln
Mierau H-D, Haubitz I, Völk W (1989) Gewohnheitsmuster beim Gebrauch der Handzahnbürste. Dtsch Zahnärztl Z 44:836–841
Mierau H-D, Spindler T (1984) Beitrag zur Ätiologie der Gingivarezessionen. Dtsch Zahnärztl Z 39:634–639
Oginni AO, Olusile AO, Udoye CI (2003) Non-carious cervical lesions in a Nigerian population: abrasion or abfraction? Int Dent J 53:275–279
Paloheimo L, Ainamo J, Niemi ML, Viikinkoski M (1987) Prevalence of and factors related to gingival recession in Finnish 15- to 20-year old subjects. Community Dent Health 4:425–436
Rajapakse PS, McCracken GI, Gwynnett E, Steen ND, Guentsch A, Haesmann PA (2007) Does tooth brushing influence the development and progression of non-inflammatory gingival recession? A systematic review. J Clin Periodontol 34:1046–1061
Rugg-Gunn AJ, Macgregor ID (1978) A survey of toothbrushing behaviour in children and young adults. J Periodontal Res 13:383–389
Saxer UP, Emling R, Yankell SL (1983) Actual versus estimated tooth brushing time and toothpaste used. Caries Res (Abstr ) 17:179–180
Tezel A, Canakci V, Cicek Y, Demir T (2001) Evaluation of gingival recession in left- and right-handed adults. Int J Neurosci 110:135–146
Van der Weijden F, Danser MM (2000) Toothbrushes: benefits versus effects on hard and soft tissues. In: Addy M, Embery G, Edgar WM, Orchardson R (eds) Tooth wear and sensitivity. Dunitz, M., London, p 217–236
Van der Weijden GA, Hioe KP (2005) A systematic review of the effectiveness of self-performed mechanical plaque removal in adults with gingivitis using a manual toothbrush. J Clin Periodontol 32:214–228
Van der Weijden GA, Timmerman MF, Danser MM, Van der Velden U (1998) Relationship between the plaque removal efficacy of a manual toothbrush and brushing force. J Clin Periodontol 25:413–416
Van der Weijden GA, Timmerman MF, Nijboer A, Lie MA, Van der Velden U (1993) A comparative study of electric toothbrushes for the effectiveness of plaque removal in relation to toothbrushing duration. Timerstudy. J Clin Periodontol 20:476–481
Van der Weijden GA, Timmerman MF, Reijerse E, Snoek CM, Van der Velden U (1996) Toothbrushing force in relation to plaque removal. J Clin Periodontol 23:724–729
Völk W, Mierau H-D, Biehl P, Dornheim G, Reithmayer C (1987) Beitrag zur Ätiologie der keilförmigen Defekte. Dtsch Zahnärztl Z 42:499–504
Acknowledgement
We deeply thank H. Weigand, Institute of Physical Chemistry, University of Giessen, Germany for constructing the video system and the device for measuring brushing force, as well as for programming the software.
The study was supported by grant of the Deutsche Forschungsgemeinschaft KL 410/6-2
Conflict of interest statement
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ganss, C., Schlueter, N., Preiss, S. et al. Tooth brushing habits in uninstructed adults—frequency, technique, duration and force. Clin Oral Invest 13, 203–208 (2009). https://doi.org/10.1007/s00784-008-0230-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00784-008-0230-8