IDEAL TOOTH BRUSHING'

WILLIAM J. CHARTERS
Des Moines, Iowa
CONTENTS
I. Introduction ........................ xi
II. The method........................................................... xvi
III. The brush............................................................. xvii
IV. Concluding remarks........................................ xviii
I. INTRODUCTION

Of all the diseases by which mankind is afflicted, the most prevalent are
diseases of the teeth and gums. Pathological conditions have always been
present in the mouth, but unlike many other diseases, which have diminished
in severity in modern times, abnormal mouth conditions have been growing
steadily worse. I believe that more good can be accomplished by the den-
tist, in our day at least, in teaching patients how correctly to clean the oral
cavity, than by dietitians in trying to regulate the diet so that tooth brushes
will not be considered a necessity. One of these two systems must be
perfected, "with results," before the people will be relieved of many diseases
from which humanity is suffering.
It is not my intention to discourage the teaching of the use of proper diet,
but it is a much easier task to teach a correct method of brushing the teeth
than it is to wean the average person from his taste for jam and French
pastry. Therefore, let the dental profession take another step forward and
band together in the great cause of teaching real preventive dentistry,
so that patients will realize the necessity for dental examinations at in-
tervals of six months, and that, by faithfully brushing the teeth in the proper
manner, their mouths will be kept in practically perfect condition.
It has been said that "a clean tooth never decays." This sentence was
cut too short-there should have been added: "and stimulated gums never
have pyorrhea." People without dental decay are led to believe, after
hearing the phrase, "a clean tooth never decays," that they are free from
IRead at a meeting of the American Academy of Periodontology, in New York,
May 10, 1921.
xi

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 .ii AMERICAN ACADEMY OF PERIODONTOLOGY

mouth ills, when, if the truth were really known, they may be in a more
serious condition than they would be if dental decay were their only oral
abnormality. One of the most treacherous characteristics of pyorrhea is
the fact that, in 95 per cent or more of the cases, no pain is present,
with the result that first examinations often reveal unsuspectedly serious
conditions.
About eight years ago I began to develop a method of teaching my pa-
tients how to keep their mouths cleaner. This effort was prompted by the
fact that my patients would return in six months or a year with mouths
that were as unhealthy as when they were first examined, and my work
seemed to be in vain. I procured an artificial set of teeth, a tooth brush,
and some vaseline that I colored black. Then I plastered the inter-proxi-
mal spaces with the colored vaseline. By using the up-and-down brush-
ing motion, I found that it was impossible to remove the paste from between
the teeth. Then I tried another brushing method in vogue, the rotary
method, with results that were not as good as those of the first test. Finally,
it occurred to me that, to clean a surface, the cleansing instrument must
come into contact with that surface. Taking my brush I pushed the bris-
tles between the teeth and then gave the bristles a slight rotary or vibratory
motion. Very soon I was convinced that I was obtaining results.
In this last test I learned I could stimulate the gums with the sides of
the bristles. I also learned that the brush does not effectively remove
food film from the mouth without thorough rinsing. The next, and most
important step, was to try the method thoroughly on my own mouth.
When I pushed the bristles in between my teeth, I was immediately con-
vinced that my brush had touched parts of my gums that had never felt a
bristle before.
While brushing is effective as a cure, its greatest merit is its utility in
real prevention. Our patients will have greater respect for and confidence
in our work after we teach them that most all tooth surfaces can be cleaned
with a tooth brush, and that most of the brushing nowadays only hits
the high spots, where decay seldom starts. The attention of the patient
should be called to the fact that there are five surfaces to every tooth that
should be brushed, namely, mesial, distal, occlusal, buccal, and lingual.
The average person brushes only two surfaces, namely, buccal and lingual,
and firmly believes that he has done a perfect job, when in reality he
has not even started. I believe most people have learned incorrectly how
to brush their teeth through instruction from the platform and in tooth
brush drills, or by reading tooth-brush or tooth-paste advertisements.

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 il

-1
FIG. 1. 1.' I -. S.
Fic. 1. typec;.-- \ drawing that shows- that the aup/onlzoz/l Surfaces 111") lie Cleansed
when the bristles of the brnslh are iproperly lalttcel Lower. rA diawing thit indicates
the ditliculties the hcinner experiences in his effortL properly to place the bristles of the
brush between the teeth; a difficulty that can bc readily overcome by pralCtice.
FIG. S. A DRA\VJNG Q TnA SHOWS T1:E' CONlIIOXs REMAEINING AFI CO MPLE1 lION OF
O DL
A-NY 01F TIl GIG) 0)8 (10 IIRU lUNG 1111TI E I
The dark areas a.tround the gingAix a-epreent uindlisturbed p)oltiols of food dleri:s,
mucin film, etc.

FTi. 2. Fic. 3.
FIG. 2. A DRAWING rncrIIr SSrowS 'I OLD L'l 51A)-DowN A501) RO TRY AII'\lIT ODS or)
I l; TI1 Il-
Iliz-asIINI
Note the existence of uncleansed areas between the contact points and thC golmS.
FinG. 3. A DRAWING THAT SnIOwS TIE, BIcCCAi SN])
LNsINGUAL o110. 01 1I11 11I'TTI
IT
W is TilJ TETIH ARE BRUL5IIi) BAY THIE' TIELO AL
MroD
xiii

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xiv AMERICAN ACADEMY OF PERIODONTOLOGY

Removing sensitive conditions from exposed roots is easily accomplished

by the method of brushing I have suggested and this is one of the very
difficult conditions we have to contend with. The most sensitive tooth
surfaces can be desensitized in a few minutes; and in an hour's time, the
same sensitive condition may return and continue to return after each
brushing for a few days. In three or four weeks' time, however, most of
the bacteria will have been eliminated, the resistance of the remaining
bacteria is lowered, the fermentation acid is less abundant, and the dentine,
which at the start was hypersensitive, is insensitive to the touch of a steel
instrument. I have cured many such cases with no other instrument than
a tooth brush.
I have had cases of muscular rheumatism that were cured by brushing
only, and there are cases on record where eczema has been made to clear
up, and many cases of initial pyorrhea have been eliminated. That tired
and "no-pep" feeling is the most easily handled of all other conditions. I
find cases can be treated effectively in two weeks.
Several years ago Madam Montessori originated a method whereby small
children could be taught to feed themselves, sew, and in fact do everything
mechanically correct. She made a wonderful success of this method, and
many of her theories are being used in educating the small child today.
If children can be taught to do these things correctly, they can be taught
to brush their teeth correctly. I ask you to give this method a fair trial,
using normal children for your subjects. You will find that in most
cases they respond and learn the method much more readily than adults.
Some will say, perhaps, that they are afraid this method will cause undue
recession of the gums. In answer to this I want to say that I have examined
the mouths of hundreds of children and have never yet seen such a case
following the use of the method. You cannot drive the tissue from the
palms of your hands, or the soles of your feet. Nature cares for this and
builds up a resistance in the tissue to withstand any pressure applied.
The rotary method is half way between the horizontal motion and the
up-and-down motion, and to your surprise I make the statement that the
horizontal motion is more effective than the up-and-down motion. Tests
on artificial teeth have proved this. In orthodontic cases, which are in
process of correction, a mechanical appliance is used. Can you imagine
it possible to stimulate the gum margin, and clean the teeth under such
appliances, with the up-and-down or the rotary method of brushing?
Children undergoing orthodontic treatment have a fine opportunity to
learn the home care of the teeth, for they make many visits to dental
offices before their cases are completed. If the method I am presenting

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 PROCEEDINGS OF l)EN rAL SOCIETIES xv

/;

FIG. 4. Fic. 5.
FIeG. 4. A DR AWINGa TiAT SHOWS A-N OiL METI- 01) BRUSIIING
1I THY TI 1- in1
The bristles merely cleanse the most prominent )ortions of the teeth, which umoro1sllv1
are clean areas.
Fic. 5. A DRAWINcG THXT SHOS\WS A PP XURE OF TIn-E IJDFXL AILETHOD OF BRUSzIiaNG
THE T.snI
The bristles are pushed into, and moxed about in, the fissures and sulci

FIG. 6. FIG. 7.
Fic. 6. A DRAING T'InT SnIowsIS .N INCO1ZRRCT MAr-T1101) OF BRUSHIN-G OCCeU S.
SREF ACLS
The bristles touch only the high points and glide over the fi;sures and sulci
FIG. 7. A DRAWING TiIT' SHOWS THE CORRECT MIETlOD OF P WING THE T 13R5SIn IN
ORDER TO REAxCn THE SEEIfINGIvL I N A CC ESSIBLE D ISTAL Sv RE AC I S OF THE MOLA
NI R S

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xvi AMERICAN ACADEMY OF PERIODONTOLOGY

to you is ideal for such mouths, it certainly must be ideal for any other
condition, either normal or sub-normal.
Every local patient who presents his or her case for pyorrhea treatment
is required to take a two-weeks course in brushing before curetting is
started. A urine analysis is also made at the first sitting. If trouble is
located, the patient is informed of the condition and is told to visit the
family physician. The patient is also instructed to bring two tooth brushes,
which are re-shaped. One is returned to the patient for home work, and
the other is placed in a large test tube, which is labeled and dated, and is
kept in the office for brushing and demonstrating. Appointments are
made with the patients for every day, if possible, or at least every other
day. The nurse who gives the lessons consumes about ten minutes at a
brushing, and ten minutes in instructing the patients how to manipulate
the brush. Disclosing solution is used to show the patients the surfaces they
may be missing.
II. THE METHOD
Place the brush at right angles to the long axis of the teeth, the point of
the bristles in contact with the surfaces. Then gently force the bristles
between the teeth, being careful not to pierce the gum, that is, do not allow
the points of the bristles to rest on the gums. With the bristles between the
teeth, exert as much pressure as possible, giving the brush several slight
rotary or vibratory movements, causing the sides of the bristles to come
in contact with the gum margin, producing an ideal massage. Be careful
not to make this movement sufficiently extensive to remove the bristles
from the spaces between the teeth. After making three or four small
circles, remove and then replace. Make three or four applications in the
same place, so that the points of the bristles will strike the labial, buccal
and lingual surfaces; then slide them into the inter-proximal spaces. Move
the distance of one embrasure and repeat the same process, holding the
sides of the bristles firmly on the gum margin. The V-shape space between
the teeth assists in crowding the sides of the bristles against the gingiva.
However, when teeth are missing one must depend on his sense of touch
to maintain the proper pressure, with the sides of the bristles on the gum
margin.
Enter every embrasure from both the outer and inner surfaces, on both
the upper and lower teeth. Most of the third molars, which, because of
the close proximity of the ramus of the jaw and the soft tissues in that
region, cannot be approached at right angles, must receive more careful
attention. The brush should be tipped so that the bristle ends reach the

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 PROCEEDINGS OF DENTAL SOCIETIES ii
*

outer and inner sides. Third molars in proper alignment and occlusion can
be saved as long as any other teeth, if they are kept equally as clean. Last,
but very important, do not brush the chewing, occlusal, or grinding sur-
faces with a sliding or sweeping motion, but place the brush vertically
upon this surface, then gently, with a slight rotary movement, force the
bristles into the pits and fissures. Remove the brush and repeat the process
until the entire chewing or biting surface has been brushed.
After the teeth have been thoroughly brushed according to the foregoing
method, the next important point for consideration is proper rinsing of the
mouth. The brush can remove very little debris from the mouth. The
"food film" and saliva comprise a liquid that fills the fissures and embra-
sures. It is very important that the debris be washed out of the mouth.
After taking a mouth full of luke warm water, occlude the teeth and lips,
and force the water back and forth through the inter-proximal spaces
frequently with as much pressure as possible. Use an abundance of water
for this purpose. It is better to wash the bacteria out of the mouth than
to try to destroy them in the mouth with antiseptics.

III. THE BRUSH

The brush should be seven-eighths of an inch from heel to toe, and five-
sixteenths of an inch in width; the bristles, one-half an inch in length.
The tufts should be separated from each other by a space about the width
of the tuft. The top of the tufts should be saw-shaped. The handle of
the brush ought to be 7.5 inches in length, rigid, and preferably of bone.
The fine Russian bristle, by far the best, cannot be procured at present.
Therefore, we are forced to go to the other extreme and use a coarse bristle,
for this method, I must admit, is hard on bristles, especially in the hands of
the beginner.
One member of each of many families using this method of brushing their
teeth has been instructed in my office, or in another dental office, and in
return has been an efficient teacher in his home.
I think you will agree with me when I say that practical demonstration
in the mouths of dentists is the best way to make this method clear. Real
experience is the best teacher and makes most lasting impressions. Several
lessons will be necessary to teach the proper use of this method. After the
first lesson I am sure you will be convinced and brought to a realization of
the value of this method.

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 *

*ii AMERICAN ACADEMY OF PERIODONTOLOGY

IV. CONCLUDING REMARKS

After a few years of uphill work I organized the Des Moines Tooth-
Brush Clinic, which has given demonstrations at three national dental
conventions, and at several state meetings. If each district dental society
would organize a tooth-brush unit, we should be able to reach all the den-
tists in a comparatively short time. Would it not be worth the effort?
I am going to show here for your consideration some x-ray slides demon-
strating a phase of work in which I am intensely interested, that of deceit-
ful pyorrhea. In diagnosing mouth conditions, by exploration, I have
often found minute pockets extending deeply into the process between the
teeth, when the x-ray failed to reveal them. I believe these conditions could
have been prevented if the gum and process had been properly stimulated
by the ideal method of brushing that I advocate.
This method is not an experiment. I have been teaching it to my pa-
tients for years, and there is no other one thing in my practice that has given
me such lasting and genuine satisfaction. The pleasure of having my
patients come back, year after year, with clean teeth and beautiful, pink,
hard gums, is worth more to me than money. I earnestly advise that you
make the teaching of this method to your patients a part of the routine of
your practice.

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