An electric or a manual toothbrush?
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A husband and wife holding their hands and both probably acting as ‘moral props’ for each other, had travelled the distance from Tanga by bus to have their dental problems addressed as they entered the Dental Clinic.

There was rapport and mutual trust judged from their conversation. Men normally are chivalrous when it comes to displaying courtesy to women.

‘After you please’, usually is the phrase or mode of expression used by menfolk to allow ladies to come to the fore either when it comes to appetisers being served by the waiters in a cocktail party or when a door is opened for entering a restaurant room etc.

Before the husband could ask the wife to go in first on to the dental chair the wife said, “I know you always tell me to take a lead. However, this time I want to show you my streak of generosity. You can have your dental treatment before me I shall follow”.

The husband, momentarily startled, recovered quickly to say, “Darling, the Doctor has already treated me. I had come to see him in the third week of August. I had an OPG (Orthopantomogram) taken. He has that large x-ray picture with him.

The wife said, “I hope you are not making that up just to avoid going in first”. The Dental Surgeon (DS) extricated the husband by producing the OPG on which his name had been inscribed. She had a look at it and wondered why it was such a large x-ray picture.

Ds: “The OPG shows all teeth. In his case there was pain in the lower jaw on both sides. This was around the lower last molars. Both the third molars had been submerged and exposed (surrounded and covered by bone). Those have to be surgically removed. He, however had a filling in the upper left second molar. He needs to follow up.”

The wife finally settled down in the dental chair. Her Chief complaint was: hypersensitivity of her teeth. The DS placed the mirror and probe around her teeth. Upon probing there was sensitivity around the gum margins of teeth.

The dental checkup revealed alarming results. She had a total of 17 semi lunar depressions around the gum margins of her teeth. In terms of location-the canine, first premolar, second premolar and first molar on all sides were affected. The second upper molar on the left side was involved too. Out of these concavities six were minor cavities.

Ds: “The surfaces around the margins of gums have undergone considerable abrasion. What type of toothbrush do you use?” To this question the patient (P) nearly jumped up in glee. She said haughtily, “ I use an electric toothbrush. A friend of mine had recommended its use to me two years ago”.

Ds: “What about the bristles of the electric toothbrush– are they soft or hard?”

P: “It has hard bristles”.

The DS wanted her to demonstrate the bending of the bristles when the electric toothbrush was on. A model of upper and lower teeth with a tooth brush was handed over to the patient. She displayed the technique of brushing on the model by brushing across the long axis of all teeth and quite forcefully.

The DS took the model and toothbrush in his hand. He showed her the way to carry out the tooth brushing correctly. The bristles were held at an angle about 40 to 45 degrees to the long axis of teeth and brushed up and down and down and up gently but firmly allowing no scope for bristles to hit the surfaces of teeth horizontally.

The correct placement of bristles and their upward and downward movement also provided ‘massaging’ to the gums. The traumatisation of gums is thus avoided.

Ds: “The hefty and compulsive strokes of the bristles have resulted in ‘denuding’ the enamel. It has also caused injury to the gums causing their recession. The horizontal method over a span of time has resulted in concavities.

The electric toothbrush has to be led in a right direction. The momentum created by the electric power rotates the bristles alright but the movement of the bristles is horizontal. The rotating bristles ought to be placed onto the surfaces below the gum margins of lower teeth. Such a placement of bristles would clean the surfaces of teeth without impinging on the gums and injuring them. By the way is there anything wrong with your hand?”.

P: “Not at all. My hands are okay. No pain, nothing”.

Ds: “Since you are over indulgent when it comes to the use of the electric toothbrush you become oblivious of the correct placement of the bristles. Hence, the sensitivity caused by toothbrush abrasion”.

P: “What are you implying?”

DS: “There are patients with physical disabilities. Also there are those who have arthritis. This makes it difficult for them to brush their teeth. For them the use of electric toothbrush is obligatory.

It is my suggestion that you should revert to a manual type toothbrush. This will keep you fixed and focused when it comes to practicing the appropriate method of tooth brushing. Do you think you will be able to do that?”

P: “Doctor, I wish to confide to you that when I was small I used to brush my teeth with ‘Mswaki’ (a green turgid twig soaked in water overnight) till I was in standard seven. Subsequently I started using the toothbrush. The electric toothbrush came in much later. It is not going to require any effort on my part in going back to the manual toothbrush”.

DS “You will be pleased to note that those who dwell in villages in rural Tanzania still take recourse to ‘mswaki’ and they are better for it. There is no statistical difference of the DMF index (decayed, missing and filled teeth) between those who chose the mswaki or those who use the toothbrush”.

P: “In the meantime what do I do?”

DS: “Two things. First, use the toothbrush correctly. Second, use a toothpaste that contains strontium chloride or sodium fluoride. Do not expect these toothpastes to give you a dramatic curative effect. It takes time for the sensitive dentinal tubules of the dentine to be blocked out. Be patient and stick to a toothpaste that agrees with you. Do not keep on changing toothpastes”. P: “Cannot the concavities be filled up?”

Ds: “The concavities and the minor cavitation will be attended to subsequently. You need to start with the conservative approach and keep me informed over a period or 2 to 3 weeks after which the light cured composite fillings can be inserted after cavities around the gum margins are prepared”. The patient agreed to comply with the instructions of the DS. It is ten days now.

The ‘Strontium Chloride’ toothpaste has aided her to ward off her hypersensitivity. She says that she misses the ‘sound of hissing’ of the electric toothbrush. She is getting friendlier with the ‘muffled up’ toothbrush. Doing it manually with steady hands is helping her to brush more effectively.

_____________________

A 60-year-old mother-in-law of a person accompanying her to a dental clinic was completing two years of wearing the orthodontic braces. She was having the braces adjusted. As she sat in one of the waiting room chairs, a teenager next to her looked at the old lady in astonishment.

“Wow!” he said, “How long have you been coming here?”. In comparison, the patient in the narrative herein had one sitting that lasted just about 20 minutes. Her second sitting after two to three weeks specifically for placement of fillings would take approximately two hours.

There is a considerable difference between orthodontic treatment and conservative dental treatment.

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