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 The Bass technique

 This brushing technique (Fig.11.2B) aims to clean the gingival crevices and to

this end the brush is held so that the bristle are about 45° to the axis o the

teeth! the end o the bristle "ointing into the gingival crevices (Fig!11.#). the

brush is "ressed to$ards the gingiva and are also orced bet$een the teeth. This

ma% be uncomortable i the tissues are in&amed and sensitive and thus $ill alert

"atients to this situation. 't has been sho$n to be a most eective method or

the removal o "laque! "articular% rom the gingival area o the tooth and

gingival crevices. Thereore! it can be recommended as the method o choice or

general use. 't must be carried out $ith a suitable sot toothbrush! i.e one $ith

sot! &exible! rounded bristles in its brushhead $hich can "enetrate into the

gingival crevice $ithout causing trauma.

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 There are no$ a larga number o toothbrushes on the maret o dierent si6es

and sha"es $ith bristles o various materials! textures! length and densit%.

0verhelmed b% available choices! the man in the street is as liel% to choose a

brush that matches his bathroom tiles as one that he thins $ill $or $ell. *ven

a dentist ma% $ell be conused on this issue since a great man% studies have

been carried out on the s"eci7cations o a satisactor% toothbrush (Frandsen

1892) $ith contradictor% results on almost ever% characteristic examined.

 The bristles o toothbrushes are usuall% arranged in about 4: tuts in # or 4 ro$s

(Fig. 11.4). ard brushes should never be recommended as the% can lacerate the

gingiva! encourage gingival recession and cause tooth abrasion! "articular% o

ex"osed root suraces. Furthermore! the bristle diameter o hard brushes is toolarge to "enetrate into gingival crevice. /ot toothbrushes should be recomended

or all "atient since the% minimi6e gingival and tooth abrasion and maximi6e the

e;cienc% o cleaning "rocedures "articular% around the gingival margin and into

the gingival crevice. Toothbrushes or children should be smaller and

should5relate to the mouth si6e at various ages. The bristles o children<s

toothbrushes should al$a%s be sot (:.1 mm=:.15 mm).

ertain basic requirements need to be meet>

1. The brush head should be small enough to be mani"ulated eectivel%

ever%$here in the mouth! %et not be so small that it has to be used $ith

extreme care in order to obtain com"lete coverage o the dentition.

lenght o about 2.5 cm is satisactor% or an adult> about 1.5 cm is suitable

or a child.2. The bristles should be o even lenght so that the% unction simultaneousl%.

convex or concave brush $ith bristles o dierent lenghts $ill not clean a

&at surace $ithout undue "ressure on some bristles. /hort bristles $ill ail

to reach interdental sites and ma% also be so rigid that the% in?ure the

tissues.#. The texture should allo$ eective use $ithout causing damage to either

sot or hard tissues. /tiness de"ends on $hether the brush is used $et or

dr%! and on the tem"erature o $ater. The bristles should be ca"able o

"enetrating into the gingival crevice $ithout causing trauma.

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4. The brush should be eas% to ee" clean. @ensel% "aced tuts tend to

retain debris and tooth"aste at the base o the bristle. -odern s%nthetic

7bre 7laments are much more h%gienic than natural bristle.5. The toothbrush handle must rest comortabl% and securel% in the hand. 't

should be broad and thic enough to allo$ a 7rm gri" and good control.

 The main requirements o a satisactor% toothbrush are best summari6ed as>

a. good cleaning abilit%b. minimal damage to sot and hard dental tissuesc. have a reasonable lies"an! i.e have good $ear characteristicsd. be h%gienice. be non=toxic

,ser "erormance is a huge variable and a balance must be achieved bet$een

this and the 7rst three requirements. o$ever! man% o the actors involved in

the brush head design can be de7ned reasonabl% "recisel%.

 The handle

 This is made o a variet% o materials such as acr%lic and "ol%"ro"%lene. 'ts

&exibilit%! si6e and sha"e must be convenient or manual use in the mouth but

details are more oten a matter o st%ling rather than utilit%.

 The toothbrush handle must rest comortabl% and securel% in the hand. 't should

be thic enough to allo$ a 7rm gri" and good control. s the stiness o the

handle is one o the actors aecting the orce a""lied to the teeth and gingiva

during use! toothbrushes are no$ also made $ith &exible (stress breaing)

handles (Ao et al 1885).

 The brush head (Fig. 11.4)

 The sha"e o the brush head ma% have a utilit% as"ect but is oten the result o

st%ling. 't should be small enough to be mani"ulated eectivel% ever%$here in

the mouth! %et not so small that it has to be used $ith extreme care to obtain

com"lete coverage o the dentition. lenght o about 2.5 cm is satisactor% or

an adult! about 1.5 cm is suitable or a child.

 The 7laments (bristles)

-aterial

 Toda% toothbrush bristles are either "ol%ester or n%lon. 'n 18#! @uCont created

n%lon and its 7rst a""lication $as the toothbrush bristle! graduall% re"lacing "ig

bristle. 'nitial%! %lon DD (*xon) $as used! but this $as re"laced 7rst b% n%lon

D1: and then n%lon D12 (T%nex). Col%ester and n%lon are "ol%mers $ith good

chemical resistance and are inert so that the% $ill "ass through the bod%

unchanged i s$allo$ed. %lon is said to $ear less ra"idl% than "ol%ester! andbecause o its antistatic "ro"erties! is more h%gienic.

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@iameter

 The diameter o the 7laments varies considerabl% rom :.:D4 mm to 1.524 mm

but those used or toothbrushes all into three categories>

1. sot :.15=:.1 mm (:.::D=:.::9 in).

2. -edium :.1=:.2# mm (:.::9=:.::8 in).#. ardEextra hard :.2#=:.2 mm (:.::8=:.:11 in).

Bristle stiness also de"ends u"on the lenght o the 7lament! its elasticit%!

$hethere the brush is used $et or dr%! and the tem"erature o the $ater. 'n

general! n%lon loses #: o stiness $hen $et. The bristles o children<s brushes should al$a%s be sot (:.1=:.15 mm). ard

brushes should never be recommended as the% can lacerate the gingiva!

encourage gingival recession and cause tooth abrasion. Furthermore! the bristle

diameter o hard bristles is too large to reach into the gingival crevice! sot

brushes i used "ro"erl% can clean eectivel% around the gingival margin and

into the crevice! and minimi6e gingival and tooth abrasion.Bristles should be o even lenght to that the% unction simultaneousl%. convex

or concave brush $ith bristles o dierent lenghts $ill not clean a &at surace

$ithout undue "ressure on some bristles. /hort bristles $ill ail to reach into

interdental sites and are also more rigid causing gingival and tooth abrasion.

Bristles in an adult toothbrush are usuall% about 1:=11 mm long (Fig. 11.4).

*nd sha"e To be as non=abrasive as "ossible! the end o the bristle should be round. 't is

essential that this a""lies to at least 8: o the bristles.

umber o tuts in the brush head This varies greatl%. Gisdom brushes use 42=45 and some larger american

brushes use D:. These are arranged in #=4 ro$s. (Fig. 11.4B).

 The densit% o the 7laments in the tut This varies $idel% but 1=2D 7laments "er tut a""ears to "rovide good $ear

"erormance. The brush should be eas% to ee" clean and densel% "aced tut

tend to retain debris and tooth"aste at the base o the bristle.

 Tut length This is usuall% about 1: mm (Fig.11.4). $ear "erormance deteriorates as tut

length increase.

0"timal "acing actor0"timal $ear "erormance is controlled b% "utting the right number o 7laments

in the tut hole to "roduce the correct "acing actor. This is the ratio o the

7lament cross=section area minus the anchor $ire area. The o"timal "acing

actor is :.D#=:.94. the chosen dimensions o the diameters o the tut=hole and

the 7lament are not arrived at arbitraril% but need to "roduce this "acing actor.

nchor $ire thicness The anchor $ire is the metal cli" $hich holds the tut o bristles in the tut hole

and this usuall% has a thicness o :.2:=:.#5 mm.

 Tut not retention

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ccording to the B/' standard! this must exceed 19 ne$tons. -an% euro"ean

manuactures do not use a minimum standard./ingle strand 7lament retention! according to the B/'! this must exceed 1 ne$ton

().

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 The electric toothbrush is no$ a $ell=acce"ted "art o the home care

armamentarium. There are number o designs available $ith dierent orms o

movement! arcuating! vibrating and reci"rocating. There have been man% studies com"aring the eectiveness o the hand and

automatic brush and the results indicate that the sub?ect<s control is more

im"ortant than the a""liance. These studies can be divided into t$o grou"s>

those $hich have sho$n no added bene7t o electric brushes over manual ones

in res"ect o "laque levels and gingival health (iemi 189I -urra% et al 188I

inamo et al 1881I Jan der Gei?den