These findings were not advanced much in the second review. Another systematic review for powered toothbrushes proposed the necessity of methodological homogeneity in future studies in this field to enable quantitative comparison of results [25]. To identify the most effective methods of tooth brushing in children, Muller-Bolla and Courson [26] carried out a systematic review to evaluate the children’s ability to remove dental plaque. The horizontal technique was found to be the most effective up to 6–7 years of age [27], [28] and [29]. Advantages of the horizontal Scrub are that it is easy to learn and practice and is effective at plaque removal [30] and [31]. However, this

tooth brushing method p38 MAPK signaling is less effective for cleaning in the proximal and gingival sulci of permanent teeth and may results in gingival recession and tooth abrasion [32]. For older children, there was no statistical difference between the Bass and Fones techniques. Bergstrom et al. suggested that the horizontal technique should be advised in younger children. For adults, the modified Bass technique is often recommended by dentists and in textbooks and used in clinical studies [33], [34] and [35]. However, the Fones technique is often Saracatinib molecular weight recommended in patient brochures in Germany, and its efficiency recently was proved by Harnacke et al. [36]. In general, these brochures, recommendations and instructions of tooth brushing

technique are very helpful

for improving oral hygiene. However, for serious improvement in a patient’s oral hygiene, the dentist should first evaluate the patient’s hand-skill motion before giving instructions. Each individual has poor (or weak) or favorite (or strong) hand-skill motion for each of MycoClean Mycoplasma Removal Kit the brushing techniques. From this point of view, toothbrushing technique is still an open question. As for the effectiveness of tooth brushing instruction along with practicing a particular tooth brushing method, Slot et al. [9] summarized in their systematic review that tooth brushing practice reduces plaque from baseline plaque scores by 42% on average, with a variation of 30–53%, dependent on the plaque index used. In addition, they suggested that bristle tuft arrangement (flat-trim, multilevel, angled) and brushing duration were factors that contribute to the variation in observed efficacy. Recently, several studies have tried to evaluate brushing techniques in terms of brushing motion, brushing action or both [33], [37], [38], [39] and [40]. One study developed and evaluated the efficiency of a smart digital toothbrush monitoring and training system in terms of correct brushing motion and grip axis orientation in the at-home environment [41]. Their analyzing software allowed calibration of all parameters individually. Hence, movements of the toothbrush during different brushing techniques could be characterized.