vigorous brushing a cause for dental issues or not?

Question

My daughter is twelve years old. She is having frequent tooth problems. She brushes her teeth vigorously and most of the times she has gum pain too. One of the teeth from the lower jaw is decayed and I consulted a dentist in Whitby. The dentist suggested for root canal therapy ( http://www.appletondental.ca/services/dental-procedures/root-canal-treatment/ ). I think, over brushing may be a cause of her dental issues. Please share your views.

Answer 1

Can 'vigorous' brushing cause dental problems?

Short answer: Yes*

^{(* reviews tend to conclude that it's better to over-brush than under-brush)}

Longer answer:

In addition to the good answer by sergiouribe which lists factors relevant to detrimental tooth brushing, there are a few more things you mentioned which are worth dealing with as implicit questions.

Are her gum problems related to over-brushing?

most of the times she has gum pain too

Over-brushing can indeed cause gum problems. From a BDJ review:

Direct mechanical/physical influence or indirect factors resulting in gingival inflammation are key aetiological factors in gingival recession.

Vigorous tooth brushing or by brushing with a hard bristle toothbrush are common causes of recession and this is often seen in patents with good oral hygiene.

Tooth Decay

Back in 2003, a study on brushing force using electric toothbrushes made it to the general news, under the guise of (eg) "Brushing too hard 'damages teeth'. The news article has a couple of helpful comments on the matter:

"Despite this, anecdotal evidence within the dental profession suggests that the majority of the population still believe that the longer and the harder you brush, the better for your teeth it is.

"The way in which you brush your teeth is just as important, and this goes hand in glove with the time you spend brushing and the pressure you apply to them."

What should I do about this vigorous brushing?

If you haven't already, talk to your daughter about the reasoning behind tooth brushing and clear up potential misconceptions:

• harder isn't necessarily better
• longer isn't necessarily better

Giving some physical analogies may help. Instead of thinking of thinking of 'scrub' (like cleaning tile grout!), think more along the lines of 'massage' (with apologies to webMD for borrowing the image). That same article recommends circular motions for brushing, but apparently "wide diversity in recommendations on toothbrushing methods" is a problem as advice isn't clear.

Naturally it's important to be positive and encouraging in how this is phrased- you don't want your daughter to be put off brushing.

Slightly orthogonally, if she is rinsing or using mouthwash after brushing, it's better to do these either before brushing, or after a meal. This might be slightly confusing as there's plenty of mouthwash marketing showing using it after brushing! But the prevailing wisdom is that rinsing or mouthwashing "will wash away the concentrated fluoride in the toothpaste left on your teeth".

It is right to go for a root canal then if the problem is with brushing?

Since the dentist is a dental professional, that's their call. There is information on root canal procedures from NHS Choices though.

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Further Reading

• British Dental Journal - gingival recession review
• Tooth brushing force (and one of the many news articles it spawned)
• webMD "teeth brushing mistakes"
• NHS tooth cleaning guide (there is also info on tooth decay)

Answer 2

A detrimental effect of toothbrushing can be influenced by

1. use of an abrasive toothpaste
2. use of hard bristles toothbrush
3. use of excessive force during toothbrush
4. excessive number of toothbrushing per day
5. and any combination of the above

A recent review concludes:

The benefits of normal oral hygiene procedure exceed possible side effects by far, but excessive toothbrushing - especially of eroded teeth - might cause some harmful effects.

More information in The role of oral hygiene: does toothbrushing harm? Monogr Oral Sci. 2014;25:215-9. doi: 10.1159/000360379. Epub 2014 Jun 26

The usual reccomendation is to use regular fluoridated toothpaste with soft bristles toothbrush. To compensate the use of excessive force, the use of electric toothbrush could be reccomended (reference).

Answer 3

I am not a dentist; however, I have heard from my dentists that using a medium or hard bristled toothbrush has no positive effect but can actually wear away tooth enamel and cause a receding gumline. Switch to a soft bristle toothbrush if you haven't already.

In my childhood I preferred medium bristles because it felt like it was cleaning my teeth better - keep that in mind if your daughter complains. Make sure she knows the firmer bristles are not what do the cleaning, the toothpaste and its foaming and abrasives do.

Also, if she uses a sonic toothbrush than the effects with be magnified. You can try replacing the toothbrush with one that uses sound or change in vibration patterns to signal when it is time to change positions, such as the phillips DiamondClean. You can usually get them cheaper on Amazon or through your dentist.

One more thing - no amount of brushing some parts of your teeth will compensate for the parts that aren't brushed at all. Proper brushing technique is very hard to get used to, if it is even shown at all. Ask your dentist or dental hygienist to provide a thorough instruction.

Floss!

Best of luck :)