Toothbrushes | American Dental Association

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• 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 Acceptance by providing scientific evidence that demonstrates safety and efficacy, which the ADA Council on Scientific Affairs carefully evaluates according to objective requirements.

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

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}

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).

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

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 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 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.

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 manual or 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.

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.

Professional Resources:

• ADA Oral Health Topic: Home Oral Care

Patient Resources:

• Toothbrushes with the ADA Seal of Acceptance
• How to brush (PDF)
• MouthHealthy.org: Brushing Your Teeth
• Quick Facts: Toothbrushing

Last Updated: October 7, 2022

Prepared by:

Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC.

Disclaimer

Content on this Oral Health Topic page is for informational purposes only. Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment. ADA is not responsible for information on external websites linked to this resource.

Toothpastes | American Dental Association

• All toothpastes with the ADA Seal of Acceptance must contain fluoride.
• In addition to fluoride, toothpastes may contain other ingredients that improve oral health such as lessening tooth sensitivity, reducing gingivitis or tartar build-up, or preventing enamel erosion; or that cosmetically affect the mouth such as whitening teeth or improving bad breath.
• Flavoring agents that cause or contribute to tooth decay (e.g., sugar) may not be contained in any ADA-Accepted toothpaste.
• A product earns the ADA Seal of Acceptance by submitting data and publications to the ADA Council on Scientific Affairs to use in making a determination of whether the product meets the prespecified requirements for safety and efficacy.

,p>The U.S. Food and Drug Administration (FDA) monograph on over-the counter anticaries agents¹ provides a definition of toothpaste or “dentifrice,” as “An abrasive-containing dosage form (gel, paste, or powder) for delivering an anticaries drug to the teeth.” An anticaries drug is defined as “A drug that aids in the prevention and prophylactic treatment of dental cavities (decay, caries)” (see next section, “Ingredients”).

Toothpastes contain both active and inactive ingredients.

Toothpastes may contain a number of active ingredients to help improve oral health.² For example, fluoride actively helps prevent tooth decay by strengthening tooth enamel. Active ingredients may include:

• Anticaries agents: Fluoride-containing compounds in the form of sodium monofluorophosphate, sodium fluoride and stannous fluoride are used as anticaries agents in toothpastes. These are the only compounds to prevent caries compounds mentioned in the FDA monograph.¹ Fluoride strengthens teeth to help prevent tooth decay and remineralizes tooth enamel in the early stages of tooth decay.¹ It is a requirement that for a toothpaste to be ADA-Accepted it must contain fluoride.
• Desensitizing agents: Dentin hypersensitivity occurs in about 11.5% of patients which can be evaluated as sensitivity to touch, temperature, and air current.³ >A 2020 network meta-analysis by Martins et al.⁴ compared the various ingredients included in toothpaste formulations to reduce hypersensitivity and found differences among the compounds evaluated in terms of efficacy depending on type of stimulus tested. The following table uses the data from that analysis and present the interventions found to have large beneficial effects as mean difference in pain compared to fluoride. Only those formulations with moderate or higher certainty of the evidence are presented here; the table entries marked with an asterisk (*) had high levels of certainty.

Table. Efficacy of Dentin Hypersensitivity Interventions for Various Stimuli

Tactile Stimulus	Cold Stimulus	Air Stimulus
Potassium + stannous fluoride (3.49 [1.93,5.05])	Calcium sodium phosphosilicate (4.43 [0.38,8.49])	Potassium + hydroxyapatite (4.21 [0.57,7.85])
Potassium + hydroxyapatite (2.83 [0.34,5.31])		Potassium + stannous fluoride (3.94 [1.50,6.37])
CSP (2.45 [0.86,4.04])		Arginine (3.83 [2.50,5.16])
Stannous fluoride (2.31 [1.21,3.42])		Calcium sodium phosphosilicate* (3. 42 [1.71, 5.14])
Strontium (1.41 [0.55,2.76])		Stannous fluoride* (3.28 [1.78, 5.14)
Potassium (1.41 [0.55,2.27])

• Antimicrobial agents: Triclosan is FDA approved as an ingredient to prevent bacterial contamination in consumer products.⁵ While it has FDA approval when in combination with fluoride, as a drug that aids in the prevention of cavities, plaque, and gingivitis, as of 2019, toothpaste containing triclosan is no longer commercially available in the US.

Other ingredients that toothpastes may include:

• Abrasive agents: Modified silica abrasives or enzymes help clean the teeth and may whiten teeth by physically removing surface stains. Examples include calcium carbonate, dehydrated silica gels, hydrated aluminum oxides, magnesium carbonate, phosphate salts and silicates.
• Detergents such as sodium lauryl sulfate, sodium N-lauryl sarcosinate are used for foaming action that may increase the solubility of plaque and accretions on teeth during brushing.
• Flavoring agents, and non-caloric sweeteners are common in toothpaste, though sugar or any other cariogenic ingredient is not permitted in any ADA-Accepted toothpaste. A 2018 systematic review and meta-analysis found that dentifrice flavoring did not increase toothpaste ingestion by children.⁶
• Humectants, such as glycerol, propylene glycol and sorbitol, minimize water loss in the toothpaste.
• Thickening agents or binders such as mineral or seaweed colloids, natural gums, or synthetic cellulose may be included in toothpaste formulations to stabilize the product.
• Peroxide: Hydrogen and carbamide peroxides to lighten intrinsic stains.

The Microbead-Free Waters Act of 2015 prohibits cosmetics and over-the-counter drugs from containing microbeads as of July 2019. ⁷

Toothpastes can contain ingredients that may rarely cause irritation or allergic reactions. Essential oils, including spearmint, peppermint and cinnamon, are the most common source of perioral contact dermatitis, stomatitis, or cheilitis.^{8, 9} These may not be explicitly mentioned on the packaging, but may instead be among unspecified “flavors.” Essential oils, fragrance mix,¹⁰ and menthol⁹ may induce allergic reactions or irritation to oral membranes. Other common ingredients of toothpastes that have been reported as allergens or contact irritants include citric acid (often listed as zinc or potassium citrate), sodium lauryl sulfate, propylene glycol, PEG-8, PEG-12, PEG-1450, cocamidopropyl betaine, parabens, and pyrophosphates.^9-13

Symptoms of contact dermatitis from toothpaste allergens can be difficult to differentiate from other sources of irritation and can include erythema, edema, desquamation and ulceration of the oral mucosa, gingiva, and/or tongue. ^{10, 12, 13}

Brushing with fluoride toothpaste has been shown to reduce caries incidence in children.¹⁴ The National Academies of Sciences, Engineering and Medicine Health and Medicine Division (HMD; formerly the Institute of Medicine, IOM) estimates the amount of fluoride that reduces caries to the greatest extent without causing adverse effects to be 0.05 mg/kg/day (range 0.02 to 0.10 mg/kg/day) for all children older than 6 months.¹⁵

Fluorosis may result from excess fluoride ingestion during the period in which permanent teeth are developing.¹⁶ Primarily a cosmetic concern, fluorosis can range from mild—in which white flecks or striations appear on the tooth—to severe—which may result in brown spots and/or pitting of the enamel.¹⁷

Studies demonstrate that the amount of toothpaste swallowed is directly associated with the age of the child, with younger children swallowing more than older children when the same amount of toothpaste was used. ¹⁸ And although a study published in 2019 suggested that children in the US commonly use more toothpaste than is recommended,¹⁹ a 2018 systematic review and meta-analysis found that the addition of flavoring to toothpaste did not increase ingestion of toothpaste by children.⁶

The ADA recommends that children use a smear of toothpaste (the size of a grain of rice) from the time the first tooth erupts until age 3 years. After that point, from 3 years to 6 years, children should use a pea-sized amount of paste. According to the ADA, these amounts help limit the exposure of children to fluoride from ingested dentifrice to levels below those suggested by the HMD (0.05 mg/kg/day).¹⁵ For example, if a child weighing 15 kg brushed twice per day, using a rice-sized smear of toothpaste (approximately 0.1 gram of toothpaste or 0.1 milligram of fluoride), swallowed the entire smear he or she would ingest 0.2 mg of fluoride, resulting in a dose of 0. 013 mg/kg. Under those same conditions, the Association estimates, a child using a pea-sized amount (approximately 0.25 g toothpaste or 0.25 mg fluoride) would ingest 0.5 mg fluoride, resulting in a dose of 0.033 mg/kg.²⁰

In addition to the appropriate amount of toothpaste to be used, the ADA recommends that caregivers supervise children during brushing to ensure that the children spit rather than swallow the paste.²⁰ Educating caregivers on these recommendations is essential as Zohoori et al. found that, on average, caregivers used up to twice the suggested amount of toothpaste.²¹

Although tooth enamel is the hardest substance in the body, the dentin that lies beneath it can become exposed—through, for example, enamel wear or gingival recession.

The Relative Dentin Abrasivity (RDA) is a standardized scale developed by the ADA, governmental agencies and other stakeholders to quantify the abrasivity of dentifrices.²² It assigns dentifrices an abrasivity value, relative to a standard reference abrasive that is arbitrarily given an RDA value of 100. ^{22, 23} All dentifrices at or below 2.5 times the reference value, or 250 RDA, are considered safe and effective.²⁴ Clinical evidence suggests lifelong use of proper brushing technique with a toothbrush and toothpaste at an RDA of 250 or less produces limited wear to dentin and virtually no wear to enamel.²⁵

Relative dentin abrasivity is used by industry, researchers, or standards organizations to develop new products or to conduct quality control.²³ It should not be used to rank the safety of dentifrices. However, RDA values below 250 cannot be used quantitatively to rank safety of toothpastes as these values do not correspond to potential clinical changes to enamel.^{22, 23}

The RDA testing method and the upper limit of 250 has been adopted by the American National Standards Institute/American Dental Association (ANSI/ADA) and is included in the manufacturing standards outlined in ANSI/ADA Standard No. 130:2020 on toothpastes. ²⁶

All dentifrices with the ADA Seal of Acceptance must have an RDA of 250 or less.

To earn the Seal, fluoride toothpastes must meet the ADA’s Council on Scientific Affairs requirements for safety and efficacy in reducing tooth decay. The ADA Council on Scientific Affairs carefully evaluates the evidence according to the requirements from the ANSI/ADA specification on toothpaste,²⁶ as well as additional laboratory studies including:

• the amount of available fluoride;
• fluoride release in one minute;
• fluoride absorption in normal and weakened tooth enamel.

Although the U.S. Food and Drug Administration monograph²⁷ stipulates that manufacturers of fluoride-containing toothpaste meet certain requirements for the product’s active ingredients, product indications, claims and other qualifications, the FDA does not test toothpastes to verify compliance. Toothpastes with the ADA Seal of Acceptance have provided the ADA CSA with data that can be evaluated to determine whether the product is in compliance with the FDA monograph and ADA Seal requirements.

• Get a Complete List of ADA Accepted Toothpastes

1. U.S. Food and Drug Administration. Part 355. Anticaries Drug Products for Over-the-Counter Human Use. 2017. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=355.50. Accessed July 6, 2021.
2. Croll TP, DiMarino J. A Review of Contemporary Dentifrices. 2014. https://www.dentalacademyofce.com/courses/2697/PDF/1409cei_Croll_premier_web.pdf. Accessed July 6, 2021.
3. Favaro Zeola L, Soares PV, Cunha-Cruz J. Prevalence of dentin hypersensitivity: Systematic review and meta-analysis. J Dent 2019;81:1-6.
4. Martins CC, Firmino RT, Riva JJ, et al. Desensitizing Toothpastes for Dentin Hypersensitivity: A Network Meta-analysis. J Dent Res 2020;99(5):514-22.
5. U.S. Food and Drug Administration. 5 Things to Know About Triclosan. https://www.fda.gov/consumers/consumer-updates/5-things-know-about-triclosan. Accessed July 8, 2021.
6. Vieira TI, Mangabeira A, Alexandria AK, et al. Does flavoured dentifrice increase fluoride intake compared with regular toothpaste in children? A systematic review and meta-analysis. Int J Paediatr Dent 2018;28(3):279-90.
7. U.S. Food and Drug Administration. The Microbead-Free Waters Act: FAQs. U.S. Food & Drug Administration 2015. https://www.fda.gov/Cosmetics/GuidanceRegulation/LawsRegulations/ucm531849.htm. Accessed July 6, 2021.
8. Zirwas MJ, Otto S. Toothpaste allergy diagnosis and management. J Clin Aesthet Dermatol 2010;3(5):42-7.
9. Moreau J, Kaplan B. Toothpaste-associated labial allergic contact dermatitis. Allergy 2013;68:598.
10. Stoopler ET. AAOM Clinical Practice Statement. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 2016;122(1):50-52.
11. Basch CH, Kernan WD. Ingredients in Children’s Fluoridated Toothpaste: A Literature Review. Global Journal of Health Science 2016;9(3):1.
12. Davies R, Scully C, Preston AJ. Dentifrices-an update. Med Oral Patol Oral Cir Bucal 2010;15(6):e976-82.
13. De Rossi SS, Greenberg MS. Intraoral contact allergy: a literature review and case reports. The Journal of the American Dental Association 1998;129(10):1435-41.
14. Centers for Disease Control and Prevention. Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. MMWR Morbidity and Mortality Weekly Report 2001;50(RR-14).
15. Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride: 8 Fluoride. Washington, DC: National Academies Press 1997. https://www.ncbi.nlm.nih.gov/books/NBK109832/. Accessed July 6, 2021.
16. Clark MB, Slayton RL. Fluoride use in caries prevention in the primary care setting. Pediatrics 2014;134(3):626-33.
17. Levy SM. An update on fluorides and fluorosis. J Can Dent Assoc 2003;69(5):286-91.
18. Ekambaram M, Itthagarun A, King NM. Ingestion of fluoride from dentifrices by young children and fluorosis of the teeth–a literature review. J Clin Pediatr Dent 2011;36(2):111-21.
19. Thornton-Evans G, Junger ML, Lin M, et al. Use of Toothpaste and Toothbrushing Patterns Among Children and Adolescents – United States, 2013-2016. MMWR Morb Mortal Wkly Rep 2019;68(4):87-90.
20. American Dental Association Council on Scientific Affairs. Fluoride Toothpaste Use for Young Children. J Am Dent Assoc 2014;145(2):190-91.
21. Zohoori FV, Duckworth RM, Omid N, W.T. OH, A. M. Fluoridated Toothpaste: Usage and Ingestion of Fluoride by 4- to 6-year-old Children in England. Eur J Oral Sci 2012;120:415-21.
22. Abrasivity of current dentifrices. Council on Dental Therapeutics. J Am Dent Assoc 1970;81(5):1177-8.
23. Gonzalez-Cabezas C, Hara AT, Hefferren J, Lippert F. Abrasivity testing of dentifrices – challenges and current state of the art. Monogr Oral Sci 2013;23:100-7.
24. St John S, White DJ. History of the Development of Abrasivity Limits for Dentifrices. J Clin Dent 2015;26(2):50-4.
25. Hunter ML, Addy M, Pickles MJ, Joiner A. The Role of Toothpastes and Toothbrushes in the Aetiology of Tooth Wear. Int Dent J 2002;52:399-405.
26. American National Standards Institute ADA. ANSI/ADA Standard No. 130 for Dentifrices. American National Standards Institute, American Dental Association. Chicago: American Dental Association. 2020.
27. U.S. Food & Drug Administration. Code of Federal Regulations (CFR) Title 21; 2006. p. 300-04.

• ADA Seal of Acceptance products: Toothpastes

Professional Resources

• ADA Guideline: Fluoride Toothpaste in Young Children for Caries Prevention Clinical Practice Guideline (2014)
• ADA Oral Health Topic: Fluoride: Topical and Systemic Supplements
• Search JADA for articles related to toothpaste
• ADA Library Services

Patient Resources

• ADA MouthHealthy: Toothpastes, Fluoride, Babies and Kids; Healthy Habits
• JADA “For the Patient” pages:
• Fluoride helps fight cavities (January 2021)
• Taking Care of Your Child’s Smile (May 2014)
• Sealing the Deal: Buying Products that have the ADA Seal of Acceptance (January 2013)

Topic last updated: July 8, 2021

Prepared by:

Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC.

Proper dental care | Kremlin Dental Blog

02/18/2018

How to brush your teeth correctly?

Since childhood, everyone knows the standard rule: teeth should be brushed twice a day, in the morning and in the evening, for at least 2-3 minutes. It does not matter which brush you use – manual or electric. Natalya Polovinkina, the leading periodontist at Kremlin Dentistry, advises clarifying the nuances of cleaning with the attending dentist: “The doctor will develop an individual technique for you based on the condition of your teeth and gums. General recommendations are simple: teeth are cleaned with sweeping movements in the direction from the gums to the edge of the tooth, trema and interdental spaces should be cleaned with dental floss or a special interdental brush. Do not disregard the gums and tongue: the gums should be gently massaged, and plaque should be cleaned from the tongue. You also need to rinse your mouth regularly. Rinses are indispensable for inflammation of the gums, for the prevention of periodontitis and gingivitis. To prevent the occurrence of caries, you can use a fluorine-containing agent if there are no contraindications to it.

How to choose a toothbrush?

When choosing a brush, you need to pay attention to the stiffness of the bristles. It is important to observe the correct pressure when brushing your teeth with medium hard and hard brushes. Such bristles easily damage the enamel, which, unfortunately, cannot be restored. “There is no significant difference between a manual toothbrush and an electric toothbrush if you brush your teeth properly. An electric toothbrush is more convenient because there is practically no need to follow the method of brushing technique – you need to bring the brush to your teeth and lightly touch their surface, and water and air will do the rest, ”explains Kristina Shvetsova, doctor at Kremlin Dentistry.

A.Yu. Arkhipenko, director of the Kremlin Dentistry clinic, notes that electric toothbrushes are not suitable for everyone: “If a patient has pathological processes in the oral cavity – inflammation and bleeding of the gums, caries and its initial stages in the form of a chalk stain – an electric toothbrush will only aggravate position due to the intense action of the bristles on the enamel and mucous membrane. Before you buy such a brush, you need to cure all teeth and gum disease.

Yulia Barabanova, a children’s dentist at Kremlin Dentistry, speaks in favor of combining manual and electric toothbrushes: “Of course, children are more willing to brush their teeth with a bright, beautiful “motorized” brush. But at first, parents should make sure that the child does not overdo it with pressure. Show your child how to properly brush their teeth with a manual toothbrush and an electric toothbrush, and remember to alternate between them regularly.”

Does it matter what kind of toothpaste you brush your teeth with?

When choosing a toothpaste, we most often focus on its cost. There is a reason for this: cheap pastes, at best, will not affect the condition of your teeth in any way, and at worst, they will simply ruin the enamel. This applies equally to both domestic and imported pastes. Foreign companies often produce the same product of different quality: for example, in pastes for the local market, abrasive fillers are processed more carefully than in pastes for export.

Before buying a specialized (preventive, curative, whitening) toothpaste, you should consult your dentist. It will help you choose the brand and type of paste depending on the condition of your teeth and gums. For example, in patients with a tendency to caries, fluoride toothpaste is indicated; patients with sensitive enamel – low-abrasive paste.

Not every toothpaste sold in a supermarket will be suitable for solving a particular dental problem. Pharmacies and specialty stores offer a huge range of therapeutic toothpastes developed with the latest technology.

When choosing a paste, it is useful to pay attention to its composition. Residents of areas with fluoridated water are contraindicated in fluoride-containing toothpastes. It is also better to avoid pastes that contain sodium lauryl sulfate (SLS), triclosan, calcium carbonate.

Professional dental care

Even if you regularly brush your teeth, use floss and mouth rinses, dentists recommend professional cleaning at least once every six months to a year. It is convenient to combine a visit to a hygienist with a preventive examination, which also needs to be done twice a year. Occupational hygiene will help get rid of tartar, prevent diseases of the teeth and gums, and prevent the development of caries.

For high-risk patients – adolescents, pregnant women and patients with increased sensitivity of the teeth, in addition to hygienic cleaning, the attending physician will offer to remineralize the tooth enamel.

Teeth whitening: pros and cons

In dental care, teeth whitening is a great aesthetic addition. Doctors of “Kremlin Dentistry” carry out teeth whitening in Ryazan using cutting-edge technologies based on ZOOM 4 hydrogen peroxide – this technique is absolutely safe for tooth enamel. This whitening can be done both in the dentist’s office and at home – the difference will be in the cost and duration of the procedure. After any type of bleaching, you must follow the doctor’s recommendations, do not use coloring products (coffee, tea, red wine, etc. ) for several days and use strengthening toothpastes.

It should be noted that despite the safety of the procedure, bleaching is contraindicated for pregnant and lactating women, adolescents under 16 years of age; patients with allergies to hydrogen peroxide, as well as hypersensitivity or demineralization of teeth (fluorosis).

For patients with restored or restored dentition, whitening is performed followed by the replacement of crowns and veneers.

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How to properly care for your teeth at home

09.10.2018

Beautiful teeth are rightfully considered an indispensable attribute of a successful person. A beautiful smile, whiter teeth and their health largely depend on proper care and daily hygiene procedures.

Today, every person who cares about the condition of their teeth should use not only toothpaste and brush, but also other care products.

When to start taking care of your dental health

The correct beginning of this process should be carried out at the stage of pregnancy. The expectant mother often wants far from the most useful products, and after all, the laying of the teeth of the future baby occurs in the first months of pregnancy. Lack of protein in her diet can lead to the fact that the child will have a lot of dental problems.

The condition of the teeth is affected by diseases, medications, living conditions of a person. So, for example, if the content of fluoride salts in water is reduced, the teeth become gray, the neck of the tooth is damaged. Teeth brushing skills should be instilled in a child from childhood, showing a personal example. As early as two years old, a child can be given a toothbrush.

Care consists of two main components:

• daily hygiene activities at home;
• regular visits to the dentist.

Home Care

In this matter, the main rule is regularity. You should brush your teeth at least twice a day, ideally after every meal. The duration of the procedure is at least three minutes. During this time, you need to process all available surfaces in the mouth.

If conditions do not allow such a cleaning, you need to rinse your mouth with water.

How to brush your teeth properly

It is necessary to use three types of movements: vertical, horizontal and circular.

Start by brushing the teeth of the upper jaw, then on the lower, not forgetting to process the inner surface. Children need to clean with a special children’s paste. It is important to instill in children the habit of rinsing their mouth after each meal.

Gum care

Teeth need comprehensive care, including gum care. It is not difficult to keep them healthy – it is enough to perform massage and hygiene procedures. There are cases of increased sensitivity of the gums, to solve this problem it is useful to use traditional medicine recipes. For example, rinsing your teeth with a strong saline solution. After a while, discomfort will disappear, the enamel will strengthen, and a thin disinfectant layer will cover chips and cracks.

Toothbrush selection

The modern choice of brushes is simply huge. In order not to make a mistake, you need to be guided by simple rules:

• soft fibers are suitable only for sensitive enamel and children; for an adult, such a brush will not allow you to clean the surface of the teeth;
• bristles that are too hard can damage tooth enamel;
• do not use brushes made of natural fibers – this is unhygienic;
• give preference to fibers with rounded ends to reduce the risk of enamel injury and perform a quality gum massage;
• to massage the gums, the drag needs soft, elongated fibers on the outside;
• with densely spaced teeth that are most susceptible to caries, it is better to purchase a brush with fibers of different lengths, electric options with high speed rotation are suitable;
• universal option – sonic brushes that can clean surfaces in the most inaccessible areas;
• When brushing your teeth, do not forget to treat the surface of the tongue;
• change your toothbrush regularly – at least once a quarter;

Toothpaste selection

Pasta should be selected based on your needs. It is better to take the advice of a dentist.

• If you have bad breath, choose a refreshing one.
• If gums with increased bleeding – anti-inflammatory.
• With a yellowish tint of enamel – with a whitening effect.
• Well, if the paste contains fluorine. Such compounds act as strengthening enamel, reduce tooth sensitivity and inflammation of the gums, and whiten.
• Whitening toothpastes can be used, but not always, as they, along with an ugly plaque, also erase the enamel. Such funds contribute to the development of caries.
• Teeth may have a naturally yellowish enamel. Doctors believe that such enamel more successfully resists caries.
• If you want to have snow-white teeth, it is better to consult a dentist to find a suitable method for a particular case.

Flossing

It is difficult to clean the space between the teeth with just one brush. Floss comes to the rescue. The threads may contain fluorine, propolis, vitamins and mineral salts. The taste can be menthol, mint – the choice is quite large.

Tooth fresheners

An effective addition to toothpaste is a mouthwash.

These funds act as deodorants, contributing to high-quality cleaning of the teeth.

after cleaning, you can use gels – they are applied with a toothbrush for a while, and then washed off. It is advisable to use gels with gums prone to irritation.

If, with properly performed hygiene procedures, caries develops, you should consult a doctor. You may need to use a special toothpaste or undergo a course of physiotherapy to strengthen the enamel.

Specialist’s opinion

Lyubov Ivanovna Kopylova

dentist-therapist

Experience: more than 12 years

There are various ways and means to improve the quality of oral hygiene and increase efficiency. So, to clean the interdental spaces, you can additionally use special flexible brushes. The irrigator is excellent for caring for teeth after implantation, as well as for patients with signs of periodontal disease – a thin powerful jet of water washes gum pockets with high quality, while at the same time providing a massage effect.