Toothbrushes (2024)

Key Points

  • Caregivers should begin brushing teeth as soon as they begin to erupt. They should continue to assist or supervise until the child is able to spit out excess toothpaste after brushing.
  • The consensus recommendation is for people to brush their teeth for two minutes twice a day with a toothbrush that has soft bristles.
  • Replace toothbrushes every three to four months or more often if the bristles are visibly matted or frayed.
  • Either manual or powered toothbrushes can be used effectively.
  • A product earns the ADA Seal of Acceptanceby providing scientific evidence that demonstrates safety and efficacy, which the ADA Council on Scientific Affairs carefully evaluates according to objective requirements.

When to Start Brushing

As soon as primary teeth start to erupt, which may be as early as 6 months of age, they are at risk of tooth decay. Therefore, the American Dental Association and the American Academy of Pediatric Dentistry agree that brushing should begin as soon as the first tooth erupts.1, 2

Caregivers should follow instructions from their child’s dentist. Generally, caregivers should brush an infant’s teeth twice a day, using a child-sized toothbrush. The toothbrush should have soft bristles and a head small enough to easily maneuver inside the child’s mouth, reaching all tooth surfaces.2 As children become more coordinated with age, they should be able to brush their own teeth under adult supervision, continuing to use a child-sized toothbrush with a small head and soft bristles.

Children younger than 3 years should use a smear of fluoridated toothpaste about the size of a grain of rice. Once children are 3 years or older, they can use a pea-sized drop of fluoridated toothpaste. Children should be assisted by or supervised by an adult and should be instructed to spit the excess toothpaste out after brushing.1

Toothbrushing Methods

The American Dental Association recommends brushing teeth twice a day for two minutes using a fluoride toothpaste. Brushing for two minutes has been shown to achieve clinically significant plaque removal3 and use of a toothpaste containing fluoride enhances fluoride concentration levels in biofilm fluid and saliva, and is associated with decreased risk of caries and remineralization of teeth.4

There are a number of techniques for brushing teeth; any of which may have advantages depending on a patient’s particular needs.5 In general, the American Dental Association suggests that people place the toothbrush against the gumline at a 45-degree angle to remove plaque from above and just below the gingival margin, and move the toothbrush gently back and forth in short strokes.6 To clean the inside surfaces of the front teeth, they should tilt the brush vertically and make several up-and-down strokes.

Regardless of the technique used, brushing should touch upon all surfaces—inner, outer and chewing. Also, when brushing, the ADA recommends that people use a soft-bristled toothbrush and apply gentle pressure, both of which may help reduce the risk of gingival injury.7, 8

Toothbrush Care

Toothbrushes (1)

SEM images comparing new and used toothbrush bristles (Used with permission from Applied Science Accessed April 25, 2016).

Here are some toothbrush care tips to share with your patients:

  • Toothbrushes should not be shared. Sharing a toothbrush could result in an exchange of bodily fluids and microorganisms between people.9
  • Rinse the toothbrush thoroughly after each use to remove any remaining paste and debris.9
  • Store toothbrushes in an upright position after use and allow them to air dry. Storing a moist toothbrush in a closed container promotes microbial growth more so than leaving it exposed to the open air.10
  • Toothbrushes should be replaced approximately every three to four months or more often if the bristles become matted or frayed. The effectiveness of the brush decreases as the bristles become worn.11

Toothbrushes have been shown to harbor bacteria (including fecal coliform bacteria that can be released into the air when the toilet is flushed or can be spread to the toothbrush when the owner touches a contaminated surface before handling his or her brush).12 While toothbrushes have been shown to harbor bacteria, there is no evidence that these bacteria cause adverse health effects. Nonetheless, some patients may be interested in sanitizing their toothbrushes. While there is little data in the literature regarding toothbrush sanitizing, one study indicates that soaking a toothbrush in 3 percent hydrogen peroxide or Listerine mouthwash greatly reduces (i.e., 85 percent) bacterial load.13 Microwaving or putting toothbrushes in the dishwasher is not recommended as such high heat may damage the brush. Toothbrush sanitizer devices are available. Patients should look for a device that has been cleared by the U.S. Food and Drug Administration (FDA).

Manual Toothbrushes

A myriad of toothbrush head design options are available.14 One systematic review found that toothbrushes with either multi-level bristles or angled bristles perform better than the conventional flat-trimmed bristles in removing plaque.15 Although toothbrushes with medium bristles have been shown to be effective at biofilm removal, the ADA recommends use of a toothbrush with soft bristles because they minimize the risk of gingival abrasion.8

The ADA Seal Category section on ADA.org provides a list of manual toothbrushes that currently have the ADA Seal of Acceptance. The Seal of Acceptance indicates that the toothbrush is both safe and efficacious for the removal of plaque and reduction of gingivitis. In addition, ANSI/ADA standards are used for testing the safety of manual toothbrushes.16

If a toothbrush differs significantly from previously accepted toothbrushes, the Council may request clinical studies to demonstrate that the toothbrush could be used without supervision by an average adult to achieve a significant decrease in mild gum disease and plaque over a 30-day period.16

Powered Toothbrushes

Both manual and powered toothbrushes are effective at removing plaque.15, 17 While the powered toothbrushes can be more expensive than most manual toothbrushes, some people prefer the powered version. People who have dexterity problems—like the elderly, people with disabilities, or children—or those who have dental appliances, like braces, may find a powered toothbrush easier to use.

The ADA Seal Category section on ADA.org provides a list of powered toothbrushesthat currently have the ADA Seal of Acceptance. The Seal of Acceptance indicates that the toothbrush is both safe and efficacious for the removal of plaque and reduction of gingivitis. In addition, ANSI/ADA standards are used for testing the safety of powered toothbrushes.18

A variety of powered toothbrushes that use a different types of head movement (e.g., side-to-side, counter oscillation, rotation oscillation, circular, ultrasonic) are available.

ADA Seal of Acceptance

Look for the ADA Seal—your assurance that the product has been objectively evaluated for safety and efficacy by an independent body of scientific experts, the ADA Council on Scientific Affairs. The ADA Seal Category section on ADA.org provides a list of manual and powered toothbrushes that currently have the ADA Seal of Acceptance. A manualor powered toothbrush earns the ADA Seal for toothbrushes when the manufacturer provides scientific evidence demonstrating safety and efficacy in the removal of plaque and reduction of gingivitis. Toothbrushes with the ADA Seal have had data reviewed by the ADA Council on Scientific Affairs and have met the recommendations for both manual and powered toothbrushes.

ANSI/ADA standards are used for testing the safety of manual16 toothbrushes. To qualify for the Seal of Acceptance, the manufacturer of a manual toothbrush must provide evidence that:

  • All toothbrush components are safe for use in the mouth
  • Bristles are free of sharp or jagged edges and endpoints
  • Handle material demonstrates durability under normal use
  • Bristles won’t fall out with normal use.
  • The toothbrush can be used without supervision by the average adult to provide a significant decrease in mild gum disease and plaque

If a toothbrush differs significantly from previously accepted toothbrushes, the Council may request clinical studies to demonstrate that the toothbrush could be used without supervision by an average adult to achieve a significant decrease in mild gum disease and plaque over a 30-day period.

To earn the Seal, a powered toothbrush goes through tests based on the ANSI/ADA standards for testing powered toothbrushes.18 These tests evaluate qualities like electrical safety, tuft retention, mechanical strength and chemical resistance. The Seal program also requires powered toothbrushes to complete a clinical study demonstrating that they are safe for use on oral hard and soft tissues as well as restorations and that they meet the requirements of a safety laboratory such as Underwriters Laboratories, Inc.

References

  1. American Dental Association Council on Scientific Affairs. Fluoride toothpaste use for young children. J Am Dent Assoc 2014;145(2):190-1.
  2. American Academy of Pediatric Dentistry. Guideline on Infant Oral Health Care. Ped Dent 2011;33(6):124-8.
  3. Creeth J, Gallagher A, Sowinski J, al. E. The effect of brushing time and dentifrice on dental plaque removal in vivo. J Dent Hyg 2009;83(3):111-16.
  4. Newby EE, Martinez-Mier EA, Zero DT, et al. A randomised clinical study to evaluate the effect of brushing duration on fluoride levels in dental biofilm fluid and saliva in children aged 4-5 years. Int Dent J 2013;63 Suppl 2:39-47.
  5. Darby ML, Walsh MM. Dental Hygiene: Theory and Practice. St. Louis: Saunders; 2010.
  6. For the dental patient ... methamphetamine use and oral health. J Am Dent Assoc 2005;136(10):1491.
  7. Cifcibasi E, Koyuncuoglu CZ, Baser U, et al. Comparison of manual toothbrushes with different bristle designs in terms of cleaning efficacy and potential role on gingival recession. Eur J Dent 2014;8(3):395-401.
  8. Zanatta FB, Bergoli AD, Werle SB, Antoniazzi RP. Biofilm removal and gingival abrasion with medium and soft toothbrushes. Oral Health Prev Dent 2011;9(2):177-83.
  9. Bunetel L, Tricot-Doleux S, Agnani G, Bonnaure-Mallet M. In vitro evaluation of the retention of three species of pathogenic microorganisms by three different types of toothbrush. Oral Microbiol Immunol 2000;15(5):313-6.
  10. Frazelle MR, Munro CL. Toothbrush contamination: a review of the literature. Nurs Res Pract 2012;2012:420630.
  11. Cooper AM, O'Malley LA, Elison SN, et al. Primary school-based behavioural interventions for preventing caries. Cochrane Database Syst Rev 2013(5):Cd009378.
  12. Alber L. Dissertation: An Epidemiological Survey of Toothbrush Contamination in Communal Bathrooms at Quinnipiac University; 2015.
  13. Beneduce C, Baxter KA, Bowman J, Haines M, Andreana S. Germicidal activity of antimicrobials and VIOlight Personal Travel Toothbrush sanitizer: an in vitro study. J Dent 2010;38(8):621-5.
  14. Voelker MA, Bayne SC, Liu Y, Walker MP. Catalogue of tooth brush head designs. J Dent Hyg 2013;87(3):118-33.
  15. Slot DE, Wiggelinkhuizen L, Rosema NA, Van der Weijden GA. The efficacy of manual toothbrushes following a brushing exercise: a systematic review. Int J Dent Hyg 2012;10(3):187-97.
  16. American National Standards Institute/American Dental Association. Standard No. 119 Manual Toothbrushes. Chicago, IL: American Dental Association; 2015.
  17. Rosema N, Slot DE, van Palenstein Helderman WH, Wiggelinkhuizen L, Van der Weijden GA. The efficacy of powered toothbrushes following a brushing exercise: a systematic review. Int J Dent Hyg 2016;14(1):29-41.
  18. American National Standards Institute/American Dental Association. Standard No. 120 Powered Toothbrushes. Chicago, IL: American Dental Association; 2009.

ADA Resources

Professional Resources:

Patient Resources:

Last Updated: October 7, 2022

Prepared by:

Research Services and Scientific Information, ADA Library & Archives.

Toothbrushes (2024)

FAQs

What is the best type of toothbrush? ›

The answer to this question is always soft-bristled. There's no opinion or taste involved here… it's just a simple fact. You may think that hard bristles would be more effective at scraping plaque off, but the problem is that hard bristles are a little too abrasive.

What do dentists recommend for toothbrush? ›

Although toothbrushes with medium bristles have been shown to be effective at biofilm removal, the ADA recommends use of a toothbrush with soft bristles because they minimize the risk of gingival abrasion.

How often should you change your toothbrush? ›

“The average person should be swapping out for a new toothbrush every three to four months,” explains Dr. Sienna Palmer, DDS, dentist at Meridien Dental in Santa Monica, CA. “This is recommended to ensure that the bristles are still effective and bacteria accumulation on the toothbrush is minimal.”

Are Oral-B toothbrushes better? ›

Oral-B electric toothbrushes are dentist-inspired and clinically proven to deliver a superior clean compared to a regular manual toothbrush. Their secret: the oscillating/rotating/pulsating power Oral-B is known for today.

Are sonic toothbrushes really better? ›

Studies have even shown that sonic toothbrushes still provide superior plaque removal even when they are held up to 4mm away from the tooth's surface! Obviously, users should brush in full contact with their teeth, but this is a testament to how effectively people can clean their teeth with this technology.

Do dentists recommend Oral-B or sonicare? ›

Sonicare's heads are large and flat compared to Oral-B's small round brushes, and they're long-lasting, according to Wellspring Dental dentist Mandy Nebel, who prefers Sonicare over other brands. This specific model — one of two from the brand accepted by the ADA — is a more entry-level Sonicare.

Which is better sonic or rotating toothbrushes? ›

Electric rotating-oscillating toothbrushes come with lower power than sonic toothbrushes, but due to the rotating head you can find them quite powerful in removing the plaque off your teeth. Sonic toothbrushes, on the other hand, are considered much more effective thanks to the high level of vibrations they provide.

Is Oral-B or Colgate better? ›

However, Oral-B has been termed as the besets amongst the best. With suitable fluoride concentration that helps prevent tooth decay, adequate Novamin and Triclosan levels that act as gum-protectors, anti-bacterial and helps fight sensitivity, Oral-B is an outstanding choice.

What toothpaste do dentists really use? ›

We recommend Crest Gum Detoxify Deep Clean Toothpaste as an excellent baseline toothpaste that can get you started on the right foot. It removes up to 96% of plaque bacteria along the gum line from gum problems such as gingivitis and tooth sensitivity.

Should I rinse after brushing? ›

Don't rinse with water straight after toothbrushing

After brushing, spit out any excess toothpaste. Don't rinse your mouth immediately after brushing, as it'll wash away the concentrated fluoride in the remaining toothpaste. Rinsing dilutes it and reduces its preventative effects.

Should I floss before or after I brush? ›

floss first because it will break up plaque between the teeth for the brush to remove.

How to sanitize a toothbrush? ›

You can also disinfect your toothbrush by swishing it in an antibacterial mouthwash for 30 seconds. If you don't have mouthwash, you can use 2 teaspoons of baking soda mixed into 1 cup of water instead. Soaking your toothbrush in white vinegar once a week may also help disinfect it.

What is the number 1 recommended toothbrush? ›

Philips and Oral-b ranked the highest in terms of brushing performance. Our product picks are editor-tested, expert-approved. We may earn a commission through links on our site.

What is the disadvantage of using an electric toothbrush? ›

The Cons of Electric Toothbrushes

Higher Cost- Battery-powered toothbrushes are more expensive than their traditional counterparts. They also require replacement heads, which can be quite pricey. Higher Risk of Damage- Because of their electronics, they are at a higher risk of damage if dropped or falling in the water.

Which Oral-B is most used by dentists? ›

The Oral-B iO Gentle Care Brush Head is also a great go-to when it comes ensuring a gentler clean for teeth and gums. From Oral-B, the #1 dentist-recommended toothbrush brand.

What type of brush is best for teeth? ›

The type of bristles that are right for you depends on your specific oral care needs and any issues you might be suffering from at the time. As a general rule, however, dentists recommend choosing a toothbrush with soft bristles, instead of one considered hard or even medium.

Is it better to have a soft or firm toothbrush? ›

Dental professionals recommend soft-bristle toothbrushes because too much pressure or overzealous brushing can negatively impact the enamel and gums. The American Dental Association (ADA) recommends soft-bristle toothbrushes with angled or multi-layer bristles to ensure an excellent clean without harming your teeth.

Is it better to have a soft or extra soft toothbrush? ›

Nearly all dentists recommend a soft bristle toothbrush. In fact, if you can pick a toothbrush with extra soft bristles, it is even more beneficial. This is because a brush with soft bristles won't harm your gums and cause bleeding or irritation.

Which is better ultrasonic or electric toothbrush? ›

While both the sonic and electric toothbrushes work well in comparison to the manual toothbrush, the sonic toothbrush is undeniably more efficient in cleaning your teeth. Electric toothbrushes typically have bristles that either scrub forward and backward or rotate in a mechanized motion.

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