Battle of the Brushes: Manual VS Electric

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We all know that prevention is better than treatment when it comes to your teeth. Wanting the finest for our teeth, we search for the best gadgets to aid us in making sure our pearly whites are nice and healthy. The most often used tool, and thus your tooth’s best friend, is the handy dandy toothbrush. But when it comes time to select your toothbrush of choice, the wide array of choices sitting on the shelf or available on the net can be very, very overwhelming. Looking at the dilemma from the macro-level, I think the most common fork in the road occurs where we have to choose between a manual toothbrush and an electric toothbrush. Here, I will review the pros and cons of both options, and then talk about which one I myself choose to use, and why.

WHO COULD BENEFIT FROM AN ELECTRIC TOOTHBRUSH?

When patients come to me and ask if they need an electric toothbrush, many of them are surprised when I tell them that the answer is no. There are a few groups of people who could benefit from an electric toothbrush, but it is not necessary for everyone to have in order to maintain good oral health. Electric toothbrushes greatly benefit people with Parkinson’s Disease, Rheumatoid Arthritis, or other such conditions that could impair one’s ability to hold and maneuver a toothbrush. Spinning and vibrating (and whirling and twirling) bristles are really great at restoring one’s manual dexterity when it has been lost. However, if you do not have any existing conditions that impair movement, then there is likely no need for an electric toothbrush at all.

The Debtist

AN ELECTRIC TOOTHBRUSH DOES HAVE ITS LIMITATIONS

An electric toothbrush is useful because you’ve got this machine that moves in certain directions to remove the sticky plaque building up on your teeth, but it does have its limitations. Usually, the direction that a toothbrush head spins or vibrates is singular. With manual toothbrushes, you can vary the direction of your brushing at any time, which can be more effective. For example, if your teeth are slightly crooked, an electric toothbrush that only spins in a clockwise direction may miss a particular spot that a manual toothbrush can reach by moving side to side, or up and down. Depending on where the tight corners in your particular dentition are, you can alter the same toothbrush to move different ways in order to reach very difficult areas. Also, the electric brushes are very strong, which some people are not aware of. Using them requires an even softer hand than using a manual brush. Even though the intentions are good, pushing down on an electric toothbrush can cause too much trauma on the gums, causing gum recession. We like gums as much as teeth, so this is no good. Therefore, using an electric toothbrush may seem easier, but easier does not always mean better.

THE TRUTH: MOST PEOPLE WOULD DO JUST FINE WITH A MANUAL TOOTHBRUSH

The truth of the matter is, most people would do just fine with a manual toothbrush. I understand that it takes some time (and practice) to learn how to use a manual toothbrush, but the same is true of anything else in your life. Once mastered, the chore becomes a habit, and habits are subconscious and therefore become easy. If you can put in the time and effort to learn how to use a toothbrush effectively, then a manual toothbrush would work equally as well as an electric toothbrush! But, if you do not want to put in the effort to learn how to properly yield a manual toothbrush, then yes, you can buy a gadget and it can do the work for you. It makes sense that the results of inefficient manual toothbrush techniques will be subpar with the results of a vibrating electric device. However, what most people do not understand is that learning how to brush really well can yield results that are as good, and sometimes even better, than your new gadget.

WHY I CHOOSE TO USE A MANUAL TOOTHBRUSH

On that note, most patients are surprised to learn that I myself choose to use solely manual toothbrushes. There are many reasons why I opt for the manual brushes. As an advocate of slower-living, a lover of nature and sustainable products, and a fan-girl of the lost art of doing things for ourselves, I am partial towards tooth brushing by hand. Manual toothbrushes give us sustainable product options that are more eco-friendly than their plastic vibrating counterparts. We have manual brushes on the market that are biodegradable, recyclable, or recycled themselves. It allows me to pick a product that is in line with my values and my intention of creating less waste. Additionally, I have more control with a manual toothbrush. I can move the bristles in directions that are good for my particular dentition and I can alter the pressures that I place on my gums a bit easier. And lastly, I find them to be much more cost-effective. My persona as the Debtist easily explains why cost-efficiency is important for me. From a dentist’s perspective, I understand that we can do just as well with a manual as we can with an electric one.

While electric toothbrushes do have their uses and are a huge help to those who need it, I believe we have gotten to a point where they may be a bit over-hyped (and possibly over-sold) for the sake of convenience. It’s an easy answer to the question, “How do I brush my teeth well?” Instead of teaching people to be better brushers, we are making them dependent on a tool to do the work for them, and the cost is more plastic being introduced into our environment at ever-increasing price as less and less people learn how to effectively brush. I tell patients all the time that we are responsible for our oral health, and we shouldn’t depend solely on spinning brush wheels. We need to take our oral health back into our own hands. Quite literally. And with that, the battle of the brushes continue.

Tooth Brushing Techniques With Bogobrush

This post is sponsored by Bogobrush, a source for ethically made, sustainable toothbrushes, with a one-for-one give-back program for low-income communities.

We all know that prevention is better than treatment when it comes to the dental office. There are many ways to prevent caries formation and periodontal disease, the most common of which are proper oral hygiene at home and consistent visits to the dentist for dental check-ups and cleanings. Off course, there are many tools one can use to implement oral hygiene at home. However, the tools are not as important as the methods with which we carry out our everyday oral hygiene. Hence, this short discussion on tooth brushing techniques.

People always see me at the dental office and ask me, “Hey Doc, do I need an electric toothbrush?” Well, that depends. Are you physically capable of brushing your teeth? If you are without Parkinson’s or Rheumatoid Arthritis, or other such conditions that could impair your ability to hold and maneuver a toothbrush, then I would venture that you do not need an electric toothbrush. Now, if the question you meant to ask was, “Could I benefit from an electric toothbrush?”, well, that depends too. If you put in the minimal time and effort to learn how to use a toothbrush effectively, then a manual toothbrush would work equally as well as an electric toothbrush. If you do not want to put in the effort to learn how to properly yield a manual toothbrush, then yes, you can buy a gadget that can do the work for you. It makes sense that the results of inefficient manual toothbrush techniques will be subpar with the results of a vibrating electric toothbrush. However, what most people do not understand is that the results of an efficient manual toothbrush can be as good, and sometimes even better, than your new gadget.

So, in an effort to save you some money, and to save the planet from unnecessary plastic devices, I am going to discuss tooth brushing techniques using my favorite, eco-friendly, socially-conscious Bogobrush.

How to hold your toothbrush.

Most people brush too hard. The point is not to be vigorous with brushing. I know that your intentions are good, and you are making all efforts to remove the plaque from your teeth as best as you can, but excessive forces while brushing can lead to recession of the gums, which can then unleash another set of problems such as teeth sensitivity. Dentists love gums as much as teeth, so we definitely do not want to do that! The root of the problem is usually in the way a person holds their toothbrush. Usually, I see people enclosing their entire fists around the handle, which increases the pressure they can exert on the gum tissue. Unfortunately, this is WAY too much pressure. You want to hold your toothbrush like a flute. Four fingers on the top and the thumb on the bottom. You will notice the vast difference in pressure, and your gums will be all the more happier about it.

Tooth Brushing Techniques

There are multiple tooth brushing techniques! Some are good, some not so good, and some are entirely bad. The methods that I will discuss today are the Bass Method, Stillman Method, and Charter’s Method, the names of which are completely unimportant, but the techniques of which are instrumental. All three methods can be modified, which will also be discussed here. Lastly, there are a few subpar methods called the Fones Method and the Roll-Stroke Brushing technique, which could be useful in teaching children elementary brushing techniques, however, they are not entirely effective in plaque removal and require graduation from once the individual is capable. But first…

How NOT to Brush Your Teeth: The Horizontal Method

A lot of people brush their teeth in horizontal fashion. Meaning they move the toothbrush left to right, from the posterior teeth to the anterior teeth, back and forth over and over again. Typically the toothbrush is pointed directly at the teeth, without ever touching the gums, which is the first negative part about this technique. Plaque will tend to accumulate near the gum line, so we definitely want to focus in this area. However, it’s just as bad if the horizontal method was carried out while pointing the toothbrush at the gums. This method is one of the leading causes of abrasion lesions. This means that the back and forth motion scrapes away at the gums and causes recession of the gum tissue. And as we said earlier, we want nice healthy gums to be covering the roots of our teeth. In the past, this is the tooth brushing method that was taught, so I hardly blame anyone who still believes that this is the optimal technique. But my dear friends, times have changed. Hand in hand with the idea of brushing your teeth as hard as you can, we now know that this is not the ideal way to brush teeth.

Good Brushing Techniques:

So how DO we want to brush our teeth? Below are three methods of teeth brushing. The three methods may seem very similar, and a mixture of these techniques may be used. The one unifying link between these brushing techniques that I think is an important take-away is the fact that the toothbrush is angled towards the gum line at a 45 degree angle, always!

The Bass Technique

This is my favorite brushing technique and it is actually one of the most effective because of its ability to remove plaque underneath your gum line, which then helps prevent periodontal infection.

Method: Point the toothbrush towards your gum line (where your tooth and your gums meet) at a 45 degree angle. Gently put enough pressure so that the bristles of the toothbrush enter the gingival sulcus, otherwise known as the space between the tooth and the gums. Create a vibrational movement using very very short back and forth strokes. You need to do 10-15 strokes per tooth (which is essentially what you pay an electric toothbrush to do for you). The important part is to do this vibrational motion without removing the bristles from the sulcus. After 10-15 strokes, you can move to the next tooth.

The Stillman Technique

Method: This is very similar to bass technique with a slight modification. You will still point the bristles at a 45 degree angle towards the gum and place similar pressure. As you vibrate the toothbrush using short strokes, you move the toothbrush towards the occlusal surface (otherwise known as the top of the tooth). So in essence, you start at the gum line and move towards the tops of your teeth, while moving in this vibrating motion!

The Charter’s Technique

Lastly, the Charter’s technique is used when there is an appliance in the mouth, such as braces!

Method: Think of the Charter’s technique as an inverted version of the Bass Technique. Instead of the toothbrush pointing at the gums, we want the toothbrush bristles to be pointing towards the occlusal surface of the tooth (or top of the tooth). The sides of the bristles should then be pushed up alongside the gums. The toothbrush should still be at a 45 degree angle. Vibrational movements are still used to remove the plaque.

Modified Versions of Techniques 1-3

The modified versions of all three techniques can be made, wherein one rolls the toothbrush towards the occlusal surface (or tops of the teeth) at the end of each vibrational sequence (Remember, 10-15 vibrational strokes per tooth!).

Brushing Techniques for the Young Learner

Fones Technique

This technique is one of the subpar techniques that can be used to LEARN how to brush, in a very elementary sense, but is not extremely efficient in removing plaque. We teach this technique to children who are just learning how to brush their teeth.

Method: This technique is known as the circular brushing method. A toothbrush is placed on a set of teeth and is moved in a circular fashion a few times, before moving to the next set of teeth. It is important to understand that this method is only meant to be used to introduce people to brushing techniques.

2. Roll Stroke Brushing Technique

Similar to the Fones Technique, this technique is also subpar, but is simple and requires little practice, so it is usually used as an introduction to tooth brushing.

Method: Place the toothbrush towards the gums and swipe towards the occlusal surface of the tooth (the top of the tooth). Continue this movement until all teeth have been brushed.

Common spots you don’t want to miss!

It’s easy to forget about the backs of your teeth, but those are equally important as well. The back of your front teeth are where plaque and calculus tend to accumulate for most people, mostly because this area is so easily forgotten. Brushing the backs of anterior teeth can be very difficult, so here are some images to show how you can achieve the 45 degree angle in such a funky spot. Uncomfortable at first, but like everything else, it’ll fall right into “normal” after a few practice runs. Disclaimer: you have to brush the backs of anterior teeth with an electric toothbrush too!

So there we have it! Tooth brushing techniques that will save you from needing an electric toothbrush, and the planet from unnecessary plastic.

To learn more about Bogobrush, check out a previous post here.

Fun Fact: On average, a person should be replacing their toothbrush every 3-4 months. Once the bristles are splayed out, they are less efficient at removing plaque. Conveniently, Bogobrush has a subscription option that will automatically send your next toothbrush at a monthly interval of your choosing. Bogobrush is currently offering TheDebtist readers their first subscription for free.

As always, thank you for supporting those that support TheDebtist.

Bogobrush: Raising social and environmental awareness, one toothbrush at a time.

This post is sponsored by Bogobrush, a source for ethically made, sustainable toothbrushes, with a one-for-one give-back program towards low-income communities, wherein a toothbrush is considered a commodity for the privileged.

In case I can convince you of the importance of choosing the right toothbrush for you and your loved ones, Bogobrush is offering The Debtist readers a special offer (full details below).

There are many folks out there who believe that a dentist’s main purpose is to sell treatment. Numerous patients have voiced to me some past experience or other with dentists who tried to sell them whiter teeth and nicer smiles for the sake of esthetics. So while this may be true for some, it isn’t how I operate or how I practice my work. I would say I fall heavily towards the more conservative side of practicing dentistry. A majority of my time is spent trying to teach patients how to prevent the need for dental treatment, via proper oral hygiene techniques at home and frequent follow ups and dental visits. I like seeing my patients twice a year, if not only to hear how their children are doing at school or how their holidays went. I prefer to think that they enjoy doing the same with me. In general, I am pretty hesitant on agreeing to cosmetic treatment, especially so with treatments such as veneers. When patient’s come to me wanting such treatment, I kindly voice the truth, which is the fact that nothing will ever be as strong (or beautiful) as your natural dentition. Removing tooth structure will always weaken the tooth. Enamel is the hardest part of your body, stronger even than bone. A veneer will possibly pop-off, since it is only bonded to your tooth on the facial aspect, and preparing the teeth for a veneer could cause sensitivity. If the patient is young, in their twenties or thirties, they must consider the likelihood that they will have to replace these veneers 3-4 times throughout the rest of their life. Quite a costly price for a cosmetic fix. Off course, if the patient insists, then autonomy prevails, and I will succumb to what will make them happy, but only after failing to convince them otherwise. To each their own. Some would consider my method a bad business move (because it is), but I didn’t enter the profession for money, so I don’t really have a motive to promote such options.

A majority of my time is spent trying to achieve a patient’s goal via the most conservative path possible. My favorite word during diagnosis is to “observe”. More often than not, the patient will be happiest to. My focus at work revolves around prevention. I would rather teach prevention of caries and other dental problems so that my patients return every six months needing nothing but a cleaning. Easier for me, easier for them. It saves them money, and saves me time, which could be used teaching even more patients the power of prevention. And so the cycle continues.

When I first entered dentistry, I knew that my model would revolve around teaching. I tutored for ten years prior to dental school, and it has undoubtedly shaped my world view about learning. I paid a lot of money going to dental school to learn about dental health care, so that others wouldn’t have to pay a lot of money to care for their teeth. As I volunteered in multiple third world countries, and farming communities within our own state, I learned that empowering is more important than giving. That equipping with knowledge is more important than aiding. It is the idea that it is better to teach a child at an early age how to brush their teeth properly thus empowering them with a life-long skill to improve their health, rather than aid an adult in extracting all their decayed teeth and replacing them with a denture. This is what it means to have TRUE impact that will change communities, even after you are gone and no longer around. I refuse to be a part of cycle that creates further dependency, but rather, prefer to create groups of people who are self-sufficient and independent.

With all of this in mind, there is one thing I sell on the daily. Toothbrushes. And with this came multiple considerations that I felt did not align with my truest of values. Specifically, toothbrushes are created from plastic (most times), which are carelessly disposed of without a thought in the world.

Did you know that 450 million toothbrushes end up in US landfills every year?

Additionally, toothbrushes are usually packaged in clear plastic, but don’t ask me why. And then there is the issue of having multiple toothbrush companies, claiming that they can outdo all other toothbrushes. There are toothbrushes with hard bristles, medium bristles, soft bristles, even extra-soft bristles. There are toothbrushes with different handles, with grips claiming to improve ergonomics, with handles that are bent, handles that are straight. There are electric toothbrushes that move in circular motions, toothbrushes that vibrate left and right, toothbrushes that light up when you’ve brushed for the appropriate amount of time. Worse, there are advertisements, companies, and, let’s face it, some dentists, who sell these different types. I am here to say that while these toothbrushes could aid some groups of people, particularly those with arthritis, or Parkinson’s disease, or anyone else who has difficulty with holding and maneuvering a regular toothbrush, the efficiency of brushing teeth lies mostly in your technique, rather than the toothbrush itself. Sure, a change in toothbrush can get you closer towards increased plaque removal, but so could improving your brushing habits and methods. What if one increases plaque removal by practicing the proper technique? Then we could focus on buying a toothbrush based on other characteristics. Such as sustainability. Such as responsible and local manufacturing. Such as toothbrushes that give back to low-income communities.

Enter Bogobrush! A toothbrush that is in harmony with many of my values, and one I would be happy to sell. Bogobrush was created with two things in mind: a product that was good for the planet, and for the people who live on it. The masterminds behind bogobrush are a brother sister duo from a small town in North Dakota, whose father was a dentist. The name BOGObrush comes from the idea of Buy One, Give One, a pillar of what Bogobrush is about. With each toothbrush you buy, another is given to someone in need through their partners. Created was a simple way to protect the planet, buy ethically-made, and give back.

Sustainable:

There are two toothbrush options:

Recycled Plastic: A toothbrush that can be recycled repeatedly, forever. We are taking plastics destined for the landfill and giving them a second chance at life. The toothbrushes are made from recycled plastic number 5, and can be placed in your recycle bin. To facilitate the process, please remove the non-recyclable bristles with small pliers.

Biodegradable: A composite material made from biodegradable plants, which can be composted at the end of its life. The current design is made from flax, but a new design is in the works for a plant-based material made from hemp! Recycling options include curbside or backyard. If you have a curbside compost bin, simply discard there. If not, you can toss the handle into your backyard compost pile. As organic matter, it will degrade into carbon monoxide, water, and humus (a soil nutrient). As with anything, it may take a few months or a few years to decompose, since the time of degradation depends on the health of the compost pile and is affected by factors such as humidity, temperature, and biodiversity. The bristles are not compostable so please pull them out using small pliers. However, if bristles do end up in the compost stream, they will break down into little pieces with time. Not the best solution, but a step towards the right direction.

Ethically Made:

Despite the higher cost of producing in the United States, these brushes are manufactured here, a sacrifice worth making. It allows for easier communication with the developers, facilitates site visits, and creates more personal relationships with those who source Bogobrush materials. The focus is to have transparency regarding the supply chain, with the knowledge of the who, what, where, and when of each part of the product, down to the bristles!

Giving back:

More than 80 million Americans lack access to adequate oral care.

This statistic can affect aspects in daily living that we take for granted, including education, work, and overall health. Imagine how much less access there is, to something as simple as a toothbrush, throughout the rest of the world. A toothbrush is a privilege, something I’ve learned throughout my journey volunteering in under-privileged communities. This is something we can change. The hope of creating a more balanced world was so important, that the name itself comes from the idea of buy one, give one.

Currently supporting:

Covenant Community Care: Detroit, MI. Serving the people of Metro Detroit through six health clinics across the city. They provide medical, dental, and behavioral health care to everyone regardless of their ability to pay.
Apple Tree Dental: Twin Cities, MN. Dedicated to providing complete dental care to people throughout Minnesota through its clinics and innovative mobile dental unites. They give away 20,000 toothbrushes annually.
Family Healthcare: Fargo, ND. Providing personal, high quality medical and dental care to anyone in the Fargo region, regardless of ability to pay. They also offer significant tools to aide healthful lifestyles.

Minimalist Design:

Admittedly, part of what initially grabbed my attention was the minimalist design. Here they are selling a toothbrush without the frills. Without the batteries, without the lights. A simple design that can be just as effective is always appreciated, in my book.

Option to purchase a stand, also in a minimalist form.

Subscription:

Most of my patients are surprised when I tell them that, ideally, we want the toothbrush to be replaced every 3-4 months. A frayed toothbrush has decreased efficiency with plaque removal, and depending on the method of use, a toothbrush can easily fray within a few months. Some tell me that they’ve had their toothbrush for over a year! With Bogobrush, you could subscribe so that a toothbrush is delivered to you every 2, 3, or 4 months. So you’ll never forget. You can also mediate how many shipments you receive. As incentive, the price of each toothbrush decreases with a subscription, in case all the other incentives above were not enough.

As even further incentive, Bogobrush is offering The Debtist readers their first subscription for free. Cancellation is allowed at any time, if you are not satisfied with the product. A link is placed on the sidebar, in case you are interested in making a change. You must subscribe via my personal link below or in the sidebar in order to receive the promotion. I hope you join me in the movement. If I am to support a product, I want it to be a product that will bring both social and environmental awareness into people’s everyday lives. A toothbrush is a product many of us use every day. And we have a choice.

Thank you for supporting the brands that harmonize with The Debtist’s internal values and external intentions. And thanks to Bogobrush for inspiring me to be a better dentist and a better teacher. Starting today, there will be a series on my blog regarding all things dental, to promote dental education, without the student loans.