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Title: The comparison between the effectiveness of six different tooth brushing methods on removing dental
bacterial plaque
Authors: Saghazadeh M. Assistant Professor*, Ashayeri N. Pedodontist
Address: * Faculty of Dentistry, Tehran University of Medical Sciences
Statement of Problem: There are different tooth brushing methods for removing dental plaque from tooth
surfaces. The effectiveness of these methods, and the time needed for instruction, learning and using seem to
be different. Also, it is possible that the effectiveness of each method reduces with time, based on its difficulty
level and the reduction of the patient's attention in following the given instructions.
Purpose: The aim of this research was to compare the effectiveness of six different accepted tooth brushing
methods on total and specific teeth, as well as on special tooth surfaces. The research also compared the time
needed for instruction, learning and using the methods.
Materials and Methods: The study was designed as a single blind randomised controlled trial protocol to
compare the six accepted tooth brushing methods: Roll, Bass, Charters (C), Modified Stillman (MS), and
Modified Bass in two ways (MB1-MB2). 15 volunteers were selected from the basic science level dental
students at Tehran University of Medical Sciences. All the six methods were instructed to each volunteer,
using a randomly selected sequence. Each participant should, therefore, pass six consequent courses, by the
same sequences as follow:
1st Visit: After polishing the teeth, the participant was asked to abstain any kind of tooth cleaning. - 2nd visit
(48-72 hours later): O'Leary Plaque Index (PI) was recorded and then the randomised selected method was
instructed. Then, the participant brushed his/her teeth and PI was registered again. The time needed for
instruction and using the method was registered too. The participant was then asked to use this newly learned
tooth brushing method twice a day for 71 days. - 3rd visit (71 days later): PI was recorded. The teeth were
polished. The participant was asked to abstain any kind of tooth cleaning for 48-72 hours, as washout period
of the previous method and preparation period for the next method (2nd visit of the next course).
The final stage was comparing the results, in which the effectiveness of each method was evaluated based on
the mean percentage of plaque reduction after the first usage, and also the mean percentage of the plaque
remained after using the method for 71 days. The time needed for instruction, learning and using the
methods were also compared. The statistical analysis was done using the SPSS software and variance analysis
(randomised block design).
Results: Considering all the teeth and their total surfaces; after 1st usage, the methods of C and MB1 were
statistically more effective than the other methods. But the difference between these two methods was not
significant. Also after 71 days, the differences between all methods were not statistically significant. On the
posterior teeth, after 1st usage and also after 71 days, the method of C was significantly more effective than
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the others, with the exception of MB1 for which their differences were not significant. Also MB1 was
significantly more effective than the methods of Bass and Roll, but only after the 1st usage. On the anterior
teeth, after 1st usage, method of C was statistically more effective than the methods of Bass, MB2 and MS.
Also MB1 was significantly more effective than MB2 and MS. But after 71 days, the differences proved
insignificant. Considering the specific surfaces of the teeth; on the proximal surfaces, after the 1st usage of the
methods, the methods of C and MB1was significantly more effective than the others, except each other, which
their difference was not significant. But after 71days the method of C was statistically more effective only
than the methods of Bass, MB2 and MS, and the method of MB1was significantly more effective than MB2.
On the buccal and lingual surfaces the differences were not statistically significant at both stage of evaluation.
When statistically considering the time needed for instruction, learning and usage, the method of C needed
more time than Bass and Roll methods. In the same way, MB1 needed more time than Roll method. The most
time needed was related to MB2 which was more than the time needed for the methods of Bass, Roll and MS
(P<0.001 and B=0.05).
Conclusion: The tooth brushing methods of Charters and a kind of Modified Bass method (in which Bass
and Roll methods are used separately and consequently) were evaluated as the most effective methods.
Key words: Tooth brushing method; Roll; Bass; Modified Stillman; Charters; Modified Bass

Journal of Dentistry. Tehran University of Medical Sciences (Vol. 17; No2; 2004)

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1- Frandesn AM, Barbano JP, Suomi JD, Chang JJ, Burke AD. The effectiveness of the charters, Scrub and Roll
methods of tooth brushing by professionals in removing plaque. Scand J Dent Res 1976; 78: 459-63.
2- OLeary TJ. Oral Hygiene Agents and procedures. J. Periodontol 1970; 41: 625-29.
3- Hansen F, Gjermo P. The plaque- removing effect of four tooth brushing methods. Scand J Dent Res 1971; 79: 502506.
4- Frandsen AM, Barbano JP, Soumi JD, Chang JJ, Houston R. A Comparison of the effectiveness of the Charters,
scrub, and roll methods of tooth brushing in removing plaque. Scand J Dent Res 1972; 80: 267-71.
5- Gibson JA, Wade AB. Plaque removal by the Bass and roll brushing techniques. J Periodontol 1977; 48(8): 456-59.
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periodontal disease. Chicago. June 12-15,1977; P 324.
7- Bergenholtz A, Gostafsson LB, Seger lund N, Magberg C, Nygaard Ostby P. Role of brushing technique and toothbrush design in plaque removal. Scand J Dent Res 1984; 92: 344-51.
8- Wilkins EM. Clinical practice of the Dental Hygienist. 8th ed. Baltimore: Williams & Williams; 1999.
9- Charters WJ. Home care of the mouth, I. Proper home care of the mouth. J Periodontol 1948; 19: 136-37.
10- Danser MM, Timerman MF, Ijzerman Y, Bulthuis H, Vander Valden U, Vander Weijaden GA. Evaluation of the

37

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incidence of gingival abrasion as a result of tooth brushing. J Clin Periodontol 1998; 25: 701-706.
11- Jones SC. Tooth brushing and tooth brushing technique in primary preventive Dentistry. 2nd ed. Harris No, and
Christen AG. (Eds). Reston VA: Reston Publishing; 1987; 79-102.
12- Vander Weijden GA, Timmerman MF, Reijerse E, Snoek CM, Vander Velden U. Tooth brushing force in relation
to plaque removal. J Clin Periodontol 1996; 23: 724-29.
13- Sangnes G, Zachrisson B, Gjermo P. Effectiveness of vertical and horizontal brushing techniques in plaque
removal. J Dent Child 1972; 39: 94-97.

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14- Hard D. Oral prophylaxis. In: Bunting RW. Oral Hygiene. 3rd ed. Philadelphia: Lea & Febiger 1957; 280-283.
15- Tritten CB, Armitage GC. Comparison of a sonic and a manual tooth- brush for efficacy in supragingival plaque
removal and reduction of gingivitis. J Clin Periodontol 1996; 23: 641-48.

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