May 2019 Volume LIV Number 3


Keep It Simple

Emphasizing effective toothbrushing technique and compliance can make all the difference in caries prevention.

March 2013 Volume XLVIX Number 2


The dental profession is ripe with innovation in all facets of practice. With advances in molecular genetics, engineering, management, research and education, there are many new ways to treat patients. While innovation is always welcome, it doesnt mean that the old ideas are useless. This is especially true in dental caries management and prevention. I am thrilled that so much is happening in the field of cariology and the caries management continuum. Advancement is underway in caries risk assessment, caries lesion detection, genetic predisposition technologies, and restorative techniques. Yet, the tenets of effective caries prevention remain diet, fluoride exposure and oral hygiene.


Although dental professionals continue to reinforce the message that caries development is affected by the frequency of fermentable carbohydrate consumption and not the quantity, this message often falls on deaf ears. This is not terribly surprising because this kind of behavior change is difficult to make, particularly for those who have never experienced the disease. The change in American dietary habits to consistent daily exposure to fermentable carbohydrates through grazing or snacking is one of the main reasons that the incidence and prevalence of early childhood caries and smooth surface caries lesions among adolescents are growing.

When it comes to fluoride, the fight is still being waged to ensure that community water supplies remain fluoridated, as there is a resurgence of anti-fluoride activists who object to every effort to sustain and, hopefully, increase one of the most well-documented and cost-effective public health efforts of recent times.

Dental professionals provide consistent education on the appropriate use of  fluoride during self-care, as well as professional application when warranted. Fluoride is also widely available in a variety of products, from toothpastes to mouth rinses. Yet, caries remains the most common disease of childhood.


Educating patients on the importance of brushing and flossing, in addition to effective technique, are stalwarts of standard oral health care. But is oral hygiene truly a priority at every dental appointment?

Patients and parents often ask me what the "best" toothbrush is. While I am knowledgeable about the major developments in manual and power toothbrushes, I almost always advise that the best toothbrush is the one that gets used. But what does "use" mean? When observing patients brushing their teeth (a necessary first exercise to improve success), few individuals demonstrate the necessary skill or even the required dexterity to effectively clean their teeth with a toothbrush. This is often the case when assessing a childs ability to independently brush his or her teeth. When I ask parents to demonstrate how they brush their childs teeth, they nearly always struggle even to properly position the child for brushing. Nonetheless, it is often easy to merely advise "dont forget to brush your childs teeth."

The desire and the ability to effectively brush a childs teeth are not genetically predetermined. They must be instilled into each patient individually. The first ever major campaign to promote two minutes of  toothbrushing twice a day directly to children is underway ( Created by the Ad Council in collaboration with several dental organizations, this simple but important message will reach millions of children and caregivers, hopefully raising their awareness about the importance of toothbrushing as a first and important step in disease prevention.



This Ad Council campaign provides dental professionals the chance to reaffirm our commitment to ensuring that parents brush their childrens teeth often and with effective technique. If  we, as oral health professionals, don’t seize the chance to be the "coach" for all of  our patients, we will miss an opportunity to improve the oral health of  all Americans.

When discussing patient motivation and compliance, I often use the analogy of a personal trainer. If you want to get into shape, hiring a personal trainer is a good start.

Without the help of an expert, you may injure yourself or not achieve the desired results. The same with patients— without a coach they may not achieve full compliance, which ultimately leads to the best long-term results. Just as only a small percentage of people maintain a routine exercise program, only a few will sustain adequate toothbrushing—both in quantity and quality.

So what should a toothbrushing personal trainer do? Set goals, develop a plan to reach those goals, and measure and document performance along the way. As challenges arise, the personal trainer intervenes and makes necessary corrections along the way. An individual member of the dental team—dental hygienist, dentist, dental assistant—should be designated as the personal trainer for each patient. An intake session should occur where abilities, schedules, and desires are identified. Clear documentation must be made as to how well patients or parents are able to brush their own or their childs teeth. A series of steps should then be implemented to move toward conditioning and training, so the identified goals can be achieved. The patient is informed that follow-up sessions will include evaluation of  their, hopefully, enhanced ability to perform. The goal is to enter into an eventual "cycle of  compliance" in which the visualization of  good results will lead to further improvement, new goal setting, and better oral health. Dental professionals must commit to helping patients achieve continuous improvement.

Toothbrushing is low-tech. Its not innovative, fancy, or sophisticated. But it can work. Imagine if a large community of oral health care providers unified around the twice a day, two-minute brushing message to affect behavior change for the long term.

Reprinted with permission. Berg. J. Keep it Simple, Dimensions of Dental Hygiene, February 2013; 11: 26-27.