Electric or manual toothbrush? Choosing the right brush and brushing technique

What does the evidence say?

The summary of many studies comparing electric and manual brushes: electric brushes give a small but consistent advantage over manual ones in plaque and gingivitis at 3 months. The difference comes less from the brush's "power" than from the standardised motion and helpers such as timers and pressure alerts. A manual brush used with good technique is also sufficient to keep the gums healthy; what really matters is technique, time and regularity.

Who benefits most from an electric brush?

• People with limited hand or shoulder movement, older people
• Those wearing braces or implant-supported prostheses
• Hard brushers with gum recession (models with a pressure sensor)
• Those who struggle to reach 2 minutes (timer)
• Children brushed with a parent's help

Choosing a brush

• Bristle stiffness: Soft. Hard bristles do not clean plaque better; they wear enamel and gums.
• Head size: Small; it must reach behind the last teeth.
• Replacement: Every 3 months or when the bristles splay; after an illness.
• Electric type: Oscillating-rotating (round head) and sonic types are both effective; ergonomics and price decide. Cheap "battery vibrating" models do not count as real electric brushes.

Correct technique (manual)

1. Place the brush at 45° to the gum margin.
2. Brush a 2–3-tooth section for 10–15 seconds with short, small vibrating strokes, then sweep from gum to tooth.
3. Outer surfaces, inner surfaces, chewing surfaces — in turn for each jaw; 2 minutes in all.
4. Hold the brush vertically for the inside of the front teeth.
5. Brush the tongue or use a tongue cleaner.

With an electric brush: Don't scrub; hold it on each tooth for 2–3 seconds and move on. If the pressure light comes on, ease off.

Common mistakes

• A horizontal, hard "sawing" motion — gum recession and cervical notches
• Finishing in 30–45 seconds (which the average person does)
• Brushing straight after acidic drinks and fruit — wait 30 minutes
• Rinsing with lots of water after brushing — reduces the effect of the fluoride in the paste; spitting without rinsing is better
• Skipping the spaces between the teeth — the brush cannot get in; floss or an interdental brush is essential. See How to floss

Toothpaste and fluoride

For adults, a pea-sized amount of paste containing 1,350–1,500 ppm fluoride. For children, a rice-grain smear under 3 and pea size from 3 to 6, under parental supervision. Whitening pastes can be abrasive; ask your dentist if you have sensitivity. More: How to teach a child to brush

When to brush

In the morning after (or before) breakfast and at night before bed; the night-time brush matters most because saliva falls during sleep. Brushing after lunch adds benefit but is not essential; sugar-free gum helps.