March 1, 2019

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When patients ask me which toothbrush is best, my first response is, “the one you’re willing to use!”

Let’s talk first about the good, old-fashioned, manual toothbrush. If this is your go-to option, then make sure you are brushing with a soft bristle brush. This is so widely recommended that you would actually have to search pretty hard for a hard bristle tooth toothbrush. But just be sure. A hard bristle toothbrush can cause trauma to your gum tissue and promote recession over time. And recession in turn can lead to increased cold and hot sensitivity, and root caries. (Caries is the fancy word for the process that leads to cavities.) So do yourself and favor, and stick with a soft bristle brush.

With a manual toothbrush it is absolutely necessary to brush with proper form and for two minutes twice daily, as directed. There’s more to it then sawing back and forth like a lumberjack! In fact, the form you should be using won’t be the same for everyone. Let’s talk about the most important:

The Modified Bass form is the best option for most healthy individuals with little or no gingival recession. Angle your toothbrush at 45 degrees towards the gum tissue while keeping most of the bristles on the tooth. Then make very small vibratory strokes back and forth, slowly working your way from tooth to tooth. Occasionally ad a sweeping motion away from the gums back up the tooth. This method cleans the recesses between the teeth (called embrasures) very well, along with sweeping plaque away from the gum line and just below it to prevent gum disease. Make sure you are using gentle pressure, most people push too hard. Just be gentle and let your bristles do the work for you.

There are three or four other important brushing techniques, but I’ll cover those in detail in a different blog. The modified bass technique is actually trickier than it sounds, and it requires a good deal of patients. For those of you who feel like you either won’t or wouldn’t do a good job at it, consider getting an electric toothbrush.

Electric toothbrushes take most of the technique out of brushing by doing the small vibratory strokes and sweeps for you. You simply have to hold it in the right spot for them to get the job done. If you think you can do a better job with a manual toothbrush than an electric toothbrush, check out these videos and you might change your mind.


My homemade videos probably don’t do them justice, but I hope it convinced you that these electric models can do a better job than a manual toothbrush. Don’t get me wrong, many people have gotten the job done just fine for decades with regular toothbrushes, but I think many cases of caries and periodontitis could have been prevented with some extra help from one of these fantastic devices. Also, many of them have lights that indicate if you are brushing to hard, and timers to help you make it all the way to that two minute mark. And not all electric toothbrushes are created equal. These are two of the best, and I’ll break down the differences if you’re on the fence about which you’d like to buy.

Sonicare: This is the favorite of the hygienists and patients here at Cascade Dental. It is sleek, has fantastic cleaning power, and is shaped just like the regular toothbrush most people are used to. I only have one qualm with this device. The first time you use it, you might think your getting a brainwash too, since the vibrations transfer noise to to your ears at a decent level. But it doesn’t take too long to adjust to, and on most models you can vary the power level to accommodate sensitive ears. You might have noticed that it’s major competitor, Oral-B frequently advertises American Dental Association (ADA) approval while the Sonicare doesn’t. This simply is because the Sonicare company knows it has a top tier product and isn’t willing to pay for the the testing, approval, and endorsement of the ADA. I personally can guarantee its effectiveness because I’ve seen patients drastically improve their oral health after purchasing one.

Oral B: This is the model I use. I really like the rotating motion, and the scrubbing action doesn’t seem as noisy or intense as the Sonicare. The head is small and circular which is both a pro and a con. Just like the prophy cup your hygienist uses, it fits easily to clean every nook and cranny of each tooth, even the far side of back molars. However, because it is smaller, the user must be more careful to make sure the head comes into contact with every part of each tooth by rotating it through a range of motions. Another con is that it seems more messy to use than the Sonicare. Despite that, I still like it enough to keep using it personally.

I’ve learned over the years that most people don’t brush as well as they think. So to up your game, an electric toothbrush can help compensate for less than perfect form. I use one, and I do miss it when I’m traveling with just a manual toothbrush in my suitcase.

In conclusion, you can get the job done with a regular toothbrush, but the price of an electric toothbrush is a small investment that can really improve your oral health.

–Dr Joshua M. Rice DDS

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