Brushing your teeth might seem like a boring and time consuming task, but the importance of doing so should not be underestimated.
Brushing removes the food and plaque that builds up over the course of the day.
But, just how long and how often should you be brushing for?
Twice a day for 2 minutes.
This is the general advice given in some of the largest countries of the world.
Brushing for 2 minutes, twice a day with the correct brushing technique will in most instances ensure you have generally good oral health.
You should also clean the spaces between your teeth that a toothbrush cannot reach every day too. Some 40% of your tooth surface is missed with regular brushing.
Differing research and opinion
Globally the research and recommendations vary.
In 2014, UCL researchers, Dr John Wainwright and Prof Aubrey Sheiham, analysed 66 different sources of advice from around the world. Their findings were published in the British Dental Journal.
Most recommendations were for cleaning the teeth twice a day, but when it came to stating how long to brush, 26 sources advised brushing for 2 minutes, 12 for 2-3 minutes and 2 recommended 3 minutes of brushing.
In Korea for example, they are encouraged to brush 3 times a day for 3 minutes. Dentists and the Korean Dental Association call it the 3-3-3 approach (3 times a day for 3 minutes within 3 minutes of eating).
A 2017 study concluded that Korean adults who are encouraged to brush three times a day for at least three minutes had lower incidences of periodontal disease than Americans and Australians who are taught to brush twice a day.
How many times a day?
A number of research pieces including that by Menzies Health Institute Queensland and School of Dentistry and Oral Health has shown that brushing twice-daily is optimal for reducing risk of tooth decay, gum disease and recession.
Despite the fact that within the UK and the USA the general consensus and advice is for 2 minutes twice a day, research recently completed by YouGov found that 1 in 3 within the UK are brushing their teeth just once a day!
This is concerning, particularly when some 87 percent of those surveyed were more likely to brush in the morning, yet NHS information advises brushing before bed and another time in the day, not necessarily in the morning.
Dental professionals advised that brushing before bed is actually more important than in the morning. This is to remove the food and plaque that has built up during the day.
The reason it is so important to clean before bed is because your have less saliva and your tongue moves less overnight. During the day saliva provides a natural protection against bacteria causing tooth decay, and the movement of your tongue also helps remove bacteria and food naturally.
If recommendations were to change to follow the oral health pattern of Koreans, the routine would be after breakfast, lunch and dinner.
How long should I brush for?
Whilst 2 minutes twice a day is the recommendation as it encourages people to brush enough, this is not necessarily appropriate for everyone and there is the need to consider personal circumstances and lifestyles, no 2 people are necessarily the same.
Individuals with an increased risk of gum disease or tooth decay may be advised by dental professionals to brush for longer or take extra steps when brushing to ensure optimum dental health. Those with limited dexterity or control may also have extra recommendations from their dentist. It is about taking the time that is appropriate for you to get your teeth clean, be that 2 or 5 minutes.
The Journal of Dental Hygiene in 2009 published results of a study that confirmed that plaque removal increased with brushing time and that 2 minutes should be the minimum recommended time, but dental professionals should continue to coach the correct brushing technique.
Detailed analysis showed that brushing for 180 seconds (3 minutes) removed 55% more plaque than brushing for 30 seconds. Brushing for 120 seconds (2 minutes) removed 26% more plaque than brushing for 45 seconds.
Thus, there is evidence to suggest that actually brushing for longer than the 2 minutes advised by the ADA and NHS is beneficial. In the meantime, the two minute goal is ultimately a balance and aims to encourage us to meet a minimum standard.
What technique should I use?
There must be consideration for using the right brushing technique too. By applying the correct technique you improve your chances of effectively removing plaque and bacteria. See our post on how to brush your teeth properly for detailed instructions.
The ADA demonstrate what they consider to be the correct technique in the following video.
This correct brushing technique is something that Wainright and Sheihams research picked up on. They found that 6 different techniques were actually being offered and that the unacceptably large diversity in recommendations on what tooth brushing method to use should concern the dental profession.
In a BBC article Dr Nigel Carter, from the British Dental Health Foundation, said there was little evidence for recommending one brushing technique over another.
“Dentists generally feel it is better to take a person’s existing habits and modify them if necessary,” he explained.
“Even children have a preferred way of brushing their teeth, and dentists should point out the areas that are not being cleaned well, rather than teaching them a whole new technique.”