The right toothbrush

The choice is confusing; the criteria for deciding are not. Three properties determine whether a toothbrush is suitable, and the price is not among them.

Soft bristles

Soft or medium — hard bristles have no place in daily oral hygiene. They do not clean better; they are stiffer, give way less and are more likely to injure gums and tooth necks. With inflamed gums, exposed tooth necks or after periodontal treatment, soft is the right choice.

The bristle ends should be rounded. That is standard with branded products, not always with very cheap brushes. Rounded ends slide off the gum; sharply cut ones stick into it.

Small head

A small brush head reaches more than a large one. The difficult places in the mouth are the rearmost teeth and the inner surfaces — both are narrow. A head that does not fit there cleans the easy surfaces very well and the difficult ones not at all.

Replace regularly

Every eight to twelve weeks, earlier if the bristles are visibly bent. Bent bristles lie flat and no longer reach into the niches; at the same time the edges scratch more. Many brushes have indicator bristles that fade — a usable, if rough, guide.

After a cold, a throat infection or a course of antibiotics, a change is worthwhile regardless of the age of the brush. And it belongs upright in the air, not in a closed cap: moisture in the dark is good for germs and bad for the bristles.

Electric or by hand?

The evidence is clearer than the subject appears to be in conversation: on average, electric toothbrushes remove more plaque and lead to less gum inflammation than manual toothbrushes. This is best established for brushes with a rotating-oscillating head.

The qualifier “on average” is the decisive restriction. Anyone who works carefully and systematically with a manual toothbrush achieves a very good result. Anyone who hurries the electric brush across the outer surfaces, a poor one. The device does not improve the technique; it makes a proper technique easier to carry out.

Rotating or sonic

• Rotating-oscillating: a small round head that turns back and forth. It is placed on tooth after tooth. Best studied.
• Sonic toothbrush: an elongated field that vibrates at high frequency. It is guided slowly along the row of teeth. Also effective; which of the two designs is superior cannot be clearly decided from the evidence.

“Ultrasonic toothbrushes” for home use are something different from the ultrasound device at the practice and of no particular benefit for home care.

For whom the difference is large

• People with limited fine motor skills — after a stroke, with arthrosis, with Parkinson's.
• Children and adolescents who do not yet brush systematically.
• Wearers of a fixed brace.
• Anyone who, despite good intentions, regularly presses too hard: the pressure control supplies the feedback your own sense of touch lacks.
• People needing care, whose teeth are brushed by a carer.

What a water flosser is good for

A water flosser rinses out food residues and can reduce the tendency of the gums to bleed. It does not loosen plaque — that is an adhering layer, not a crumb. It therefore does not replace an interdental brush or dental floss.

It is useful as an addition with fixed braces, with extensive bridges and for people who cannot manage dental floss. As the only interdental tool it is not enough.