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Year : 2006  |  Volume : 17  |  Issue : 4  |  Page : 167-170
Toothbrush selection : A dilemma?

1 Department of Periodontics, Manipal College of Dental Sciences, Karnataka, India
2 Department of Physics, Manipal Institute of Technology, MAHE, Manipal, Karnataka, India

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The toothbrush is a fundamental tool used for accomplishing plaque control. Various types of toothbrushes available in the market keep the buyer in a state of dilemma as to which one to choose, due to lack of information about the "quality" of it. This study has been designed to understand whether all the products available in the market adhere to the specifications laid down by the ADA, which is universally accepted in standardization of a tooth brush. 95% of the brushes surveyed contain less number of bristles per tuft than specified and a large percentage deviate from the standard prescribed value for their bristle diameter and other dimensions. Few brushes labeled as "Soft" were "Medium" and labeled "Medium" were "Hard". The study will bring to light the quality of toothbrushes available in India for a rationalised selection of appropriate toothbrush by the community at large.

Keywords: ADA specification, Toothbrush evaluation, Rationale

How to cite this article:
Sasan D, Thomas B, Bhat MK, Aithal K S, Ramesh P R. Toothbrush selection : A dilemma?. Indian J Dent Res 2006;17:167-70

How to cite this URL:
Sasan D, Thomas B, Bhat MK, Aithal K S, Ramesh P R. Toothbrush selection : A dilemma?. Indian J Dent Res [serial online] 2006 [cited 2019 Sep 19];17:167-70. Available from:

   Introduction Top

The toothbrush is a fundamental tool used for accomplishing the goals of plaque control. It is the most common device used for maintaining good oral hygiene [1]. From relying on nature for bristles to the era of manufactured nylon bristles and from the concept of a common brush for the whole family to stressing on more than one brush per individual, toothbrushes have gone major metamorphosis [2].

Today, the market is flooded with various brands of toothbrushes, some with more attractive packaging and the others with effective advertising, stating the size, shape, pliability, colour, and other physical features, each claiming superiority of it over the other. This makes it very difficult for the consumer to select a suitable toothbrush of specific clinical use. Thus, it is necessary to provide guidelines to both toothbrush manufacturers as well as the consumer. This helps to remind the manufacturers to produce quality products and consumers about the selection of a proper toothbrush for maintaining their dental hygiene, especially plaque control.

Toothbrushes vary in size, design, length, hardness, and arrangement of bristles. Today, toothbrush design has been studied, yet there is no convincing evidence to support the idea that which type is better than the other in terms of its efficacy in plaque removal [1].
"An ideal toothbrush may be defined as the one which removes plaque effectively"[1]

ADA has clearly stated their position and concluded that the method and toothbrush choice depends on patient oral health, manual dexterity, personal preference, the ability and their desire to learn and follow the prescribed procedures.[3],[4]

The specifications given by ADA are as follows [4]:

Brushing surface = 1-1.25 inches long (25.4 35.8 mm)

5/16 - 3/8 inches wide (7.9-9.5mm)

2 - 4 rows of bristles

5 -12 tufts per row


Diameter ofcommonly used bristles are [4]:

Soft = 0.007 inch (0.2mm)

Medium = 0.012 inch (0.3mm)

Hard = 0.014 inch (0.4mm)

The objective of this study was to evaluate the claimed specifications of toothbrushes (30 brands) available in the Indian market and compare with the specification stated by ADA.

   Materials and methods Top

Materials used were

  • 30 brands of toothbrushes available in the Indian market
  • Vernier callipers
  • Traveling microscope
  • Optical flats, monochromatic source of light.

All toothbrushes in this study group were randomly coded as type 1,2……..30.


Each toothbrush was evaluated for

  • Length of the head (Brushing surface)
  • Width of the head (using vernier calliper) : 3 trials each
  • No.of tufts per row
  • No.of bristles per tuft
  • Diameter of bristles (by optical interference method - 3 trials each) [5]

The length and width of the head (brushing surface) was found using a vernier callipers. The diameter or bristle thickness was determined using a traveling microscope by optical interference technique. Each bristle was cut from a tuft and placed between two optical flats, illuminated using a monochromatic light (λ=589.3nm)

Principle of optical technique is interference of light waves in a wedge shaped air film. The optical way diagram of the setup is as shown in [Figure - 1].

The bristle is kept between two optically flat glass plates, which is illuminated by a monochromatic light (Sodium vapor lamp of wavelength 589.3 mm). This method is specifically recommended for measurement of small dimensions [5].

The incident light wave will undergo reflections inside the air film and thereby two coherent waves will be produced. These coherent waves will interfere and produce interference pattern of alternate bright and dark bands. Measuring the width of these bands, it is possible to determine the thickness of the bristle. [Figure 2]

The formula used is:

where β = Band width, average of 6 trials (average distance between consetive bright or dark bands), L = Distance between the bristle and the wedge (average of 2 trials), λ=wavelengths of the light used.

All measurements were done for 3 trials and the mean ± SD was calculated using the statistical package SPSS version 10.0.

   Results Top

Evaluation ofbristle diameter showed that only 6 out of 13 'Soff toothbrushes [Table - 1], 4 out of 11 Medium' toothbrushes [Table - 2], and 3 out of 6 'Hard' toothbrushes [Table - 3] were in accordance with theADA specifications.

On measuring the length and width of toothbrush head in the order of soft, medium, and hard variety, it was found that only 9 out of 30 brushes met the ADA specifications with regard to the length of toothbrush head. Whereas the width of only 1 brush was in accordance with ADA specifications [Table - 4].

No. of rows in 23 brushes, no. of tufts per row in 25 brushes, and no. of bristles per tuft in only one toothbrush, were in accordance with the ADA specifications [Table - 4].

   Discussion Top

This study was conducted to evaluate whether the various marketed toothbrushes fulfill the standards set by ADA, since these specifications are universally accepted for the standardization of a toothbrush (6).

The following details were observed

  • Certain toothbrushes marketed under "Soft" label exhibited dimensions which were of "Medium" toothbrushes and some "Medium" and "Hard" brushes did not meet the set specifications for their said categories.
  • Few brands failed to denote whether the toothbrushes are of"Soft", "Medium", or "Hard" variety.
  • The greatest disparity was seen with regard to the number of bristles per tuft. 95% of the surveyed brushes had far less bristles than the said specifications.
  • Since the efficacy of plaque removal has been emphasized more on the technique rather than the type of bristles, and as brushes with hard bristles may precipitate adverse changes associated with brushing, like, abrasion of tooth surface as well as traumatizing the gingival margin, the need of hard bristled toothbrushes in the market is questionable.
  • A significant number of these surveyed brushes did not meet the ADA specifications with regard to length and width of the head, all being larger than the norms. Thus the advantages of smaller heads for improved plaque removal especially in the second and third molar areas are minimized with a brush of a larger head.
  • Surprisingly none of the evaluated toothbrushes totally satisfied the specifications of ADA.

   Conclusion Top

The detailed evaluation of toothbrushes provided an insight into the deviation from the norm existing in the available toothbrushes. Majority of the manufacturers had not included specified number of bristles per tuft. Some of the manufacturers did not provide with proper type of bristles as per their labeling. By and large there has been a partial violation from ADA specification probably due to lack of implementation of strict quality control on the manufacturers of tooth brushes.

There is a wide array of brushes available in many colours, designs, packages, each claiming to be better than the other. Keeping in mind the main purpose of brushing, any toothbrush with a simple design following ADA specifications, that provides access to all areas of the mouth should be the suitable one, provided the patient uses proper brushing technique[6].

   References Top

1.Stallard RE: Textbook of preventive dentistry 227­231,1981.  Back to cited text no. 1    
2.Sebastian G: Mechanical removal and oral health, Periodontology2000 8:60-71,1995.  Back to cited text no. 2    
3.Wilkins EM: Clinical practice of dental hygienist, Lea and Febiger 4th Edn: 307-310,1983.  Back to cited text no. 3    
4.Carranza FA: Clinical periodontology: Saunders, 9th Edn: 651-654,2003.  Back to cited text no. 4    
5.Francis A, Harvey EW: Fundamentals of optics, McGraw Hill International Edition 4th Edn: 293-294, 1976.  Back to cited text no. 5    
6.Chong MP and Beech DR: Characteristics of tooth brushes, Aust Dental J 28:202-211,1983.  Back to cited text no. 6    

Correspondence Address:
Dhiraj Sasan
Department of Periodontics, Manipal College of Dental Sciences, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-9290.29869

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[Figure - 1]


[Table - 1], [Table - 2], [Table - 3], [Table - 4]

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