Oral Hygiene was practiced by the Sumerians of 3000 BCE, and elaborately decorated gold toothpicks found in the excavations at Ur in Mesopotamia suggest an interest in the cleanliness of the mouth. Mesopotamians wrote on the siwak, another version of the basic tooth stick which were made from porcupine quills, bird feathers or wooden thorns.
History Of Toothbrushes - Types of Oldage Toothbrushes
The Susruta Samhita contains numerous descriptions of severe periodontal disease with loose teeth and purulent discharge from the gingiva. In a later treatise, the Charaka Samhita, toothbrushing and oral hygiene are stressed – “The stick for brushing the teeth should be either an astringent or pungent or bitter. One of its ends should be chewed in the form of a brush. It should be used twice a day, taking care that the gums not be injured.”
The toothbrush first appeared around 3500 BC and was used by Egyptians and Babylonians. These were in the form of chewing sticks and were made from the branches of the Salvadora persica tree. Another very effective oral hygiene aid was boar bristles mounted on a bamboo stick. The Egyptians used tooth sticks for dental hygiene.
The Chinese were amongst the first people to use the chewstick as a toothpick and toothbrush to clean the teeth and massage the gingival tissues. Chewsticks were made of plant limbs or roots, with one end beaten into a soft fibrous condition and used for scrubbing and brushing the teeth. Chewsticks are still being used by some peoples and nations.
Chew Stick - Used as a toothbrush
The Romans were also very much interested in oral hygiene. The use of the toothbrush is mentioned in the writings of many of the Roman poets.
The toothbrush appeared about the year 1600 in China, was first patented in America in 1857 and has since undergone little changes. Chinese dentist would clean teeth with hairs of pigs and paste them on bamboo sticks or animal bones. Europeans would brush their teeth by dipping linen cloth or sponges dipped in sulfur oils and salt solutions and rubbing away all the tooth grime. William Addis became the first person to mass produce modern toothbrushes. He used cow hair drilled and tied on to cow bones. Later versions used horse hair instead of boar hair because it was softer.
During the World war moulds were created in the shape of brush handles and celluloid was poured in and cooled. Then in 1938, nylon bristles replaced animal hair. A company called DuPont de Nemours introduced the first toothbrushes with nylon bristles. The first such toothbrush was called Dr. West’s Miracle – Tuft Toothbrush.
Current Scenario -
American Dental Association has described an ideal toothbrush to be having – a brushing surface 1 to 1.25 inches long and 7.9 to 9.5 mm wide, 2 to 4 rows of bristles and 5 to 12 tufts per row.
Recently some novel designs intended to make toothbrushing easier have been described. One has curved bristles on both sides of the brush head and shorter bristles running down the centre. Another design has a U-shaped head with bristles that would reach all visible sides of a tooth at one time.
Bristles – Two kinds of bristle materials are used in toothbrushes – natural bristles from hogs and artificial bristles primarily made of nylon. Nylon bristles vastly predominate in the market and have clearly been shown to be more superior. Toothbrush bristles are grouped in tufts and are usually arranged in 3 to 4 rows. Rounded bristle ends cause fewer trauma to the gingiva (gums) than flat cut bristles with sharp ends. Diameters of commonly used bristles range from 0.007 inch for soft brushes to 0.012 inch for medium brushes to 0.014 inch for hard brushes. Soft bristles are more flexible, clean beneath the gingival margin when used with a sulcus brushing technique and reach further onto the proximal tooth surface.
Bass has recommended a straight handle and nylon bristles 0.007 inch in diameter and 0.406 inch long with rounded ends arranged in 3 rows of tufts, six evenly spaced tufts per row with 80 to 86 bristles per tuft. For children the brush is smaller, with thinner (0.005 inch or 0.1 mm.) and shorter (0.344 inch or 8.7 mm.) bristles.
Toothbrushes with wear reminders like a blue dye on some of the bristles are currently available as the dye fades with use and serve as a reminder to patients to replace their toothbrushes periodically.
The handle of a toothbrush could be straight or angled, thick or thin and should fit the palm of the hand. Variations include toothbrushes with modest angulation between the head and the handle or one with a double angulation of the neck of the handle. For most patients short headed brushes with straight cut, round ended, soft to medium nylon bristles arranged in three or four rows of tufts are recommended.
POWERED TOOTHBRUSHES –
Electrically powered toothbrushes were invented in 1939 in Switzerland, intended to make it easier for the patient to brush his teeth. Squibb and Dr. Scott were the pioneers of the electric toothbrush. Broxodent was the first electric toothbrush introduced for vigorous types of toothbrushers. The first powered toothbrush was designed to use back and forth motion. Other designs use a circular or elliptical motion and still others use a combination of motions. Further newer ones use reciprocating bristle tufts, some use low frequency acoustic energy to enhance cleaning ability. Powered toothbrushes that have shaped tips designed for interproximal cleaning are also available. Modern powered toothbrushes with additional features such as sonic technology to reach further onto proximal surfaces and timers to remind patients to brush longer are considered by some to be superior to manual brushes.
Oral B - Powered Toothbrushes
Powered toothbrushes have been shown to improve oral health for children and adolescents, children with physical and mental disabilities, hospitalized patients including older adults who need to have their teeth cleaned by others, patients with fixed orthodontic appliances, patients with rheumatoid arthritis, children who are well motivated brushers and patients with chronic gum disease.
Powered toothbrushes are generally not superior to manual ones. However they are atleast as good for plaque removal as manual ones. According to the oral hygiene principles first reported by Bass, the one brush that is most commonly recommended by dentists appears to be the four row, multitufted, soft, nylon, handheld toothbrush.
Conclusion – A manual toothbrush is almost equally effective as a powered toothbrush in removing dental plaque which is the root cause for all dental problems. Select a soft to medium toothbrush preferably to clean your teeth without damaging your gums. Any toothbrush you pick should be effective in removing dental plaque from all areas of the mouth and teeth and normally replace your toothbrush every 3 months.
- Carranza’s Clinical Periodontology – 9th Edition
- Evolution of toothbrush – Dr. M. Prakash, IDA Times, Mumbai, June 2008, Pg. 17.
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