Instead of telling patients
to “ease up on brushing
horsepower,” it’s important
to customize plaque/biofilm
removal instructions to make
sure the plaque/biofilm is
being adequately disrupted.
LYNNE SLIM, RDH, BSDH, MSDH, is an award-winning writer who has published extensively
in dental/dental hygiene journals. Lynne is
the CEO of Perio C Dent, a dental practice
management company that specializes in
the incorporation of conservative periodontal therapy into the hygiene department of
dental practices. Lynne is also the owner and
moderator of the periotherapist yahoo group:
www.yahoogroups.com/group/periotherapist. Lynne speaks on
the topic of conservative periodontal therapy and other dental
hygiene-related topics. She can be reached at firstname.lastname@example.org or www.periocdent.com.
B Y LYNNE SLIM, RDH, BSDH, MSDH
It’s been about five years since I last visited
family in northern England. So much has
changed since then, including the provision of dental hygiene services. My niece
Bethany and her boyfriend, Rik, are both
millennials, and they are always eager to
discuss their oral hygiene with me. They
are very particular about their self-care.
They love powered toothbrushes and Rik told
me his hygienist (pronounced hy-GEE-nist in
the UK) recommended a Philips Sonicare with small-
er brush head for hard-to-reach areas, but he uses Bethany’s
electric Oral-B when he spends the
night at her family home.
I asked them all kinds of questions about their hygiene visits and
always came away impressed with
their hygEEnist’s suggestions and
their overall commitment to good
oral health. “Bad British teeth” is
still the butt of jokes among those
who stereotype people but I know
through personal experience that
many Brits practice excellent oral
Powered toothbrushes offer
statistically significant benefits when compared to manual
toothbrushes. 1 Here are some comparison figures (based
on comparing mean scores for manual and powered tooth-
• A 2014 Cochrane Review showed an 11% reduction in
plaque/biofilm for the Quigley Hein index at one to three
months of use, and a 21% reduction in plaque when as-
sessed after three months of use.
• For gingivitis, there was a 6% reduction at one to three
months of use and an 11% reduction after three months
(Löe and Sillness index). 1
The evidence was considered to be of moderate quality.
The review included studies published from 1964 to 2011,
which compared powered to manual toothbrushes. Over
50% of the studies used a powered toothbrush with rotation
oscillation mode of action.
After manual toothbrushing, the overall plaque score reduction was estimated to be about 42% and was influenced
not only by duration of brushing but by bristle design. 3 A
manual toothbrush with a “flat-trim” bristle design removed less plaque than a toothbrush with multilevel and
angled bristles. 3
Brushing efficacy is more important than we sometimes
realize. Individualized instruction with disclosing agents
and a mirror can make a difference between a plaque
score of 27% after one minute of brushing compared to
41% after two minutes. 3 Application of additional hygiene
tools for interdental cleaning and an appropriate dentifrice with plaque/biofilm growth-inhibiting ingredients
are needed. 3
Many U.S. adult patients (even young adults) are presenting with noncarious cervical lesions (NCCLs), which
are controversial and not always well understood. 4 Many
of these NCCLs may have a multifactorial etiology and have been
called abfraction, abrasion, erosion, and corrosion. 4
In children and in young
adults, the erosive potential of
soft drink consumption, including energy drinks, is also a growing problem. In the case of dental
erosion, chemical, biological, and
behavioral factors need to be considered, and saliva is probably the
most important biological factor
affecting the progression of dental erosion. NCCLs (which are different from dental erosion) trap plaque/biofilm.
Instead of telling patients to “ease up on brushing horsepower,” it’s important to customize plaque/biofilm removal
instructions to make sure the plaque/biofilm is being adequately disrupted. Adults with NCCLs and clinical attachment loss are sometimes told by dentists and hygienists to
ease up on brushing. It’s often the wrong message.
DON’T EASE UP!