**4. Oral hygiene aids**

*"Correct and routine tooth brushing will soon iron out, so to speak, all the irregularities in, and restore normal colour and contour to, the gingivae … thus, since the toothbrush may also readily aid in the resolution of these incipient symptoms, its potentiality in their prevention is evident."*

*- Hirschfeld [4].*

Hirschfeld advocated tooth brushing to keep teeth and gums clean free from dental caries or periodontal diseases [24]. Cleaning of teeth and oral hygiene maintenance are carried out using toothbrushes and interdental cleaning aids. Commercially available varieties of dental products can be used to keep the mouth clean. Toothbrush with toothpaste is the most commonly employed teeth cleaning oral hygiene aid. American Dental Associations (ADA) advocates brushing of teeth twice daily, use of interdental cleaning aids regularly and oral rinse with mouthwashes every day to keep good oral health. Tooth brushing and interdental cleaning remain the mainstays of prevention of periodontal diseases. The primary approach requires individually tailored instruction for implementation of a systematic oral hygiene regimen [25].

Toothbrushes come in different designs and function.


#### **4.1 Manual toothbrush**

Manual tooth brush with toothpaste is commonly used all over the world to clean the teeth. Manual toothbrushes come in different sizes and design and basically classified according to the diameter of the bristles as soft, medium and hard.

Different brushing techniques are used to clean the teeth by different individuals. Tooth brushes can be used with horizontal scrub, vertical scrub, vibratory, sweeping, rotatory motion or combination of them. Various researchers have recommended different brushing techniques like Bass, Charter's, Stillman, Fone, Leonard, Hirchfeld's, Smith-Bell and many more. Modified Bass technique also called sulcus cleansing method is advised for healthy patients with no gingival disease. Fone's technique or circular method of brushing is advised for children

as it is easy to learn. Modified Stillman's method is recommended in patients with gingival recession for gingival massage. Charter's method is most useful in patients with fixed prosthesis or orthodontic appliances and post periodontal surgery.
