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A study of tooth brushing pattern and its effects on dental tissues in Obafemi Awolowo University students



Objective: To determine the tooth brushing patterns among Obafemi Awolowo University (OAU) students and the effects on dental tissues. Method: A convenient sampling technique was used to select 100 undergraduate students of the Obafemi Awolowo University. A self administered questionnaire designed to determine respondents' demographics and tooth brushing techniques was employed. Thereafter, dental examination was carried out on all respondents. Data was inputted and subjected to computer analysis using the Statistical package for social science version 17.0 (SPSS). Result: Majority (95%) of the respondents used toothbrush in cleaning their teeth while 7% combined toothbrush and chewing stick. Ninety nine percent of the respondents used toothpaste in cleaning their teeth, 72.7% of the respondents brushed their teeth once a day and 24.2% brushed twice a day. Fifty two percent of the respondents who brushed twice a day were females, while 48% were males. The pattern of tooth brushing was correct in 51.7% of the respondents as reported. Use of highly abrasive agents was also rare. Gingival recession was found in 31% of subjects (p=0.15) that employed hard texture toothbrush. The prevalence of non carious cervical lesion was 3% and these lesions were found in males only. Conclusion: The pattern of tooth brushing was correct in 51.7% of the respondents as reported. However the effect on dental tissues though present is not exaggerated when compared to other studies done in other parts of the world.
Objective: To determine the tooth brushing patterns among Obafemi Awolowo University
(OAU) students and the effects on dental tissues.
Method: A convenient sampling technique was used to select 100 undergraduate students
of the Obafemi Awolowo University. A self administered questionnaire designed to
determine respondents' demographics and tooth brushing techniques was employed.
Thereafter, dental examination was carried out on all respondents. Data was inputted and
subjected to computer analysis using the Statistical package for social science version 11.0
Result: Majority (95%) of the respondents used toothbrush in cleaning their teeth while 7%
combined toothbrush and chewing stick. Ninety nine percent of the respondents used
toothpaste in cleaning their teeth, 72.7% of the respondents brushed their teeth once a day
and 24.2% brushed twice a day. Fifty two percent of the respondents who brushed twice a
day were females, while 48% were males. The pattern of tooth brushing was correct in
51.7% of the respondents as reported. Use of highly abrasive agents was also rare. Gingival
recession was found in 31% of subjects (p=0.15) that employed hard texture toothbrush.
The prevalence of non carious cervical lesion was 3% and these lesions were found in males
Conclusion: The pattern of tooth brushing was correct in 51.7% of the respondents as
reported. However the effect on dental tissues though present is not exaggerated when
compared to other studies done in other parts of the world.
Key words: Tooth brushing pattern, dental tissue, gingival recession, non carious
cervical lesion
Tooth brushing is the act of using a brush of varying
design to brush the teeth and massage the gingivae
for cleanliness and oral health . Bacteria plaque is a
key player in the aetiology of dental caries, and
periodontal disease. Touching the social aspect of life,
proper tooth brushing reduces halitosis, and helps to
remove stains from tooth surfaces.
The toothbrush is an implement with bristles fixed to a
head at the end of a handle, used for cleaning the
teeth and massaging gingival tissues . Various
designs of the implement have emerged over time
with a bid to enhance functionality .
The American Dental Association recommends a soft-
bristle toothbrush for routine tooth brushing and that
a toothbrush should be changed at least once in three
month. Various patterns of tooth brushing techniques
have been reported. They include vertical, horizontal,
a combination of both vertical and horizontal or
rotational. Using an improper tooth brushing
technique with a hard-bristle toothbrush can be
detrimental to oral health. This could result in tooth
surface loss and gingival recession .
Tooth abrasion is the pathologic wearing of tooth
structure by an external mechanical source . It can
occur on any part of the tooth surface and structure.
Although clinically detectable, it may be symptomatic
or asymptomatic depending on the tooth structure
affected. Gingival recession on the other hand is
defined simply as the drawing back of gingivae from
the necks of the teeth, with exposure of root
surfaces . It may result from aggressive tooth
brushing, adult orthodontic movement of teeth,
sensitivity to detergent such as sodium lauryl
sulphate, bruxism, improper flossing and periodontal
disease . Its risk factors are; high level of dental
plaque and calculus, male gender, smoking duration,
toothbrushing frequency, traumatic toothbrushing
and high frenum . This study was designed to
determine the pattern of tooth brushing techniques
employed by selected undergraduates in Obafemi
Awolowo University (OAU) and also to determine the
effects of these brushing techniques and toothbrush
texture on dental tissues.
Materials and method
This study employed a descriptive design to evaluate
the pattern of tooth brushing and its effects on hard
dental tissues among undergraduates in Obafemi
Awolowo University (OAU) students. OAU, Ile-Ife is
located in south western Nigeria, comprises of
thirteen faculties. The study population comprised of
randomly selected undergraduates from all the
A convenient sampling technique was used to select
100 students with no consideration for gender.
Nig Dent J Vol. 21 No. 2 July - Dec. 2013
Ejemai AE, *Oginni FO, ** Oginni AO
* Department of Oral Maxillofacial Surgery,
** Department of Restorative Dentistry,
Faculty of Dentistry, Obafemi Awolowo University,
Ile Ife, Osun State Nigeria.
Correspondence: Oginni FO
A study of tooth brushing pattern and its effects on dental tissues in
Obafemi Awolowo University students
Having calibrated the examiner EE for reproducibility,
a structured self administered questionnaire was used
to col lect d ata from the r esp onden ts. The
questionnaire comprised of four sections:
Section A: Respondent's demographic data
Section B: The pattern of tooth brushing among OAU
Section C: Perception of the effects of tooth brushing
on dental tissues.
Section D: Findings on examination of the dental
tissues. (Appendix 1)
Sections A to C of the questionnaires were completed
by subjects and retrieved immediately, then dental
examination was carried under optimal illumination
by an Author (EE) and findings recorded in section D.
Gingival recession was scored as present whenever
the free gingival margin was apical to the cemento-
enamel junction and root surface was exposed. Non
Carious Cervical Lesion (NCCL) was said to be present
when there is a change in contour (loss of enamel
surface characteristics), when there is a defect or
there is pulp exposure or there is secondary dentine
exposure in the cervical margin of the tooth. (Using
the 'Smith and Knight Tooth Wear Index', with severity
not considered). The teeth were numbered using the
World Dental Federation (FDI) notation. Data was
inputted into a personal computer and subjected to
computer analysis using the Statistical package for
social science version 17.0 (SPSS). The results were
presented graphically and in tabular forms. Chi square
test was applied appropriately and statistical
significance was inferred at p<0.05.
One hundred subjects aged 16 to 29 years were
studied. A slight female preponderance was
observed (Table 1). Subjects' mean age (SD) was 21.9
(3.1) while their median age and modal ages were 22
and 18 years respectively. Close to half of
respondents (47%) were from the non-biological
sciences faculties while 35% were from biological
sciences and 18% from art based faculties.
Table 1: Socio-demographic characteristics
Of respondents
Age group Male Female Total
(Years) No(%) No(%) No(%)
16-20 7(7.0) 28.(28.0) 35(35.0)
21-25 28(28.0) 22(22.0) 50(50.0)
=25 12(12.0) 3(3.0) 15(15.0)
Total 47(47.0) 53(53.0) 100(100.0)
x = 18.4, df = 2, p = <0.001
Respondents were from 100 to 600 levels of studies
but majority were from the 200 and 300 levels and
the least representation was from the 600 level
(Figure 1).
The commonest single agent used was toothbrush
/toothpaste(toothbrush only) (85 %) while the
commonest combination was toothbrush/ toothpaste
and chewing stick (7%). Use of dental floss as a
cleaning aid was very unpopular (6.3%) (Table 2).
Table 2: Distribution and combination of tooth
cleaning material used by respondent
Tooth cleaning No. of (%)
materials respondent
Toothbrush 95 88.8
Chewing stick 7 6.5
Cotton wool 2 1.9
Others 3 2.8
Total 107 100.0
Tooth cleaning
materials as comb-
ined in use
Toothbrush only 85 85
Toothbrush and
chewing stick 7 7
Toothbrush and
others 3 3
Others 5 5
Total 100 100.0
Other aids used
Tooth paste 99 52.1
Tooth pick 46 24.2
Mouth wash 26 13.7
Dental floss 12 6.3
Abrasive powder 4 2.1
Charcoal 3 1.6
Total 190 100.0
NB: Totals exceeding 100 in table 2 above are due to use of
more than one material by some respondents.
Majority of respondents use smooth textured
toothpastes (78/99), while in the remainder, (21/99),
their toothpastes contained abrasives. Also, 73/99
respondents use a single brand of toothpaste (63
conventional and 10 herbal) while 12/26 respondents
employ various brands of conventional toothpastes
and 14/26 use conventional and herbal toothpastes
(Figure 2).
Most respondents (53.3%) used medium textured
toothbrushes and a significant majority (72.7%) brush
once a day while only 24.2% brush twice daily.
Frequency of tooth brushing and toothpaste
combinations did not differ significantly between
male and female respondents (Table 4).
Nig Dent J Vol. 21 No. 2 July - Dec. 2013 Ejemai, Oginni, Oginni
Effect of toothbrushing pattern on dental tissues
23 23
100 Leve l 200 Leve l 300 Level 400 Leve l 500 Level 600 Leve l
Perce ntages
Figure 1. Distribution of respondents by their levels
Majority of the respondents (62.9%) claimed to use
moderate force in brushing, only 3.1 % admitted to
using heavy force while 33% graded the force exerted
as light. The said force was assessed subjectively and
its measure depends on the respondent's perception
and personal grading. Since two respondents may
judge same force differently, this is a limitation of this
60.2% of respondents spend over 2 minutes in tooth
brushing. About half of them (52.1%) laid claim to
brushing their teeth correctly (up and down strokes).
Expectedly, majority of the respondents were right
handed (94.9%), and an almost equal proportion
engaged their right hands in tooth brushing. 23.2% of
respondents reported injury to their gum during tooth
brushing. This was occasional in majority of the
subjects (63.2%) and a frequent occurrence in only
one respondent (2.6%). 80.9% of patients did not
perceive that they had defects on their teeth, but
19.1% did. Most subjects (58.8%) did not know why
they had the defects, others attributed their perceived
defects to toothbrush pressure (29.4%).
A total of 3,099 teeth were examined in 100 subjects.
62% of respondents had all their teeth present and the
rest had varying numbers of missing teeth. Non
carious cervical lesion and gingival recession were
found in 3 and 16 subjects respectively. A total of 11
teeth had non carious cervical lesion (prevalence
=0.35%) while 62 teeth were affected by gingival
recession (prevalence =2.0%). All NCCL were located
in the mandibular left quadrant in right handed
Three am bi dextrou s i nd ividu al s iden ti fied
themselves as right handed in tooth brushing while
only one of them reported left handedness in tooth
brushing. Out of the 47 males and 53 females that
were examined, 11(23.4%) and 5(9.4%) had gingival
rec ession and/o r NCCL respectively. Si xteen
respondents used hard texture toothbrush, out of
which 5(31%) had gingival recession and/or NCCL and
8(15%) of the 53 respondents that used medium
texture toothbrush had gingival recession and/or
NCCL (Table 5).
Table 3: Frequency of toothbrushing and toothpaste
Variables Gender
Males No(%) Females No (%)
Frequency of
Once a day 36(50%) 36(50%)
Twice a day 12(48%) 13(52%)
More than once a day 1 (50%) 1 (50%)
X =0.03, df = 2, p = 0.99
Table 4: Time spent in tooth brushing, brushing
technique and handedness
Time spent in brushing
(minutes) No(%)
Less than 2 minutes 39(39.8)
Between 2-3 minutes 38(38.8)
More than 3 minutes 21(21.4)
Total 98(100.0)
Toothbrush movement
Up and down strokes 74(51.7)
Side to side 53(37.1)
Circular 16(11.2)
Total 143(100.0)
Respondents’ handedness
Right handed 92(92.0)
Left handed 3(3.0)
Ambidextrous 5(5.0)
Total 100(100.0)
Hand used in brushing
Right hand 95(95.0)
Left hand 4(4.0)
Both hands 1(1.0)
Total 100(100)
NB: Two respondents did not indicate the time spent
in brushing hence total is 98. Combination of
movements engaged in tooth brushing accounted for
a total of 143 toothbrush movements recorded.
Nig Dent J Vol. 21 No. 2 July - Dec. 2013 Ejemai, Oginni, Oginni
Effect of toothbrushing pattern on dental tissues
Conventional Combination
Conventional &
Males Females
Figure 2. Distribution of toothpaste combination
used by respondents’ gender
Figure 3. Distribution of gingival recession and non
carious cervical lesion by tooth type
χ = 0.24 , df = 3, p= 0.97
No f teh affeceo ettd
14 13 11 21 22 23 31 32 33 44 43 42 41
Gingival recession Cervical Abrasion
Table 5: Effects of tooth brushing practices on dental tissues
Variables Gingival recession NCCL GR and or NCCL
Yes NO Yes NO Yes No
Brushing techniques NO(%) NO(%) NO(%) NO(%) NO(%) NO(%)
Side to side only 1(7.0) 13(93.0) 1(7.1) 13(93.0) 1(7.0) 13(93.0)
Up and down only 8(22.2) 28(77.8) 1(2.8) 35(97.2) 8(22.2) 28(77.8)
Circular/ round only 1 (17.0) 6 (83.0) 1 (14.0) 6 (86.0) 1(17.0) 6(83.0)
Combination of more-
than one technique 6 (16.0) 32 (84.0) 0 (0.0) 38 (100.0) 6(16.0) 32(84.0)
χ= 1.7 df= 3 p= 0.6 χ= 4.8 df= 3 p=0.2
Toothbrush texture
Soft 2 (8.3) 22(91.7) 0 (0.0) 24(100.0) 2(8.3) 22(91.7)
Medium 8 (15.0) 45 (85.0) 1 (1.9) 52(97.1) 8(15.0) 45(85.0)
Hard 5 (31.0) 11 (69.0) 2(12.5) 14(87.5) 5(31.0) 11(69.0)
Not sure 1 (17.0) 5 (83.0) 0 (0.0) 6 (100.0) 1(17.0) 5(83.0)
χ= 3.8 df= 3 p= 0.2 χ=6.06 df= 3 p= 0.1 p=0.28
force on brushing
Light 5 (15.6) 27(84.4) 1 (3.0) 31 (97.0) 5(15.6) 27(84.4)
Moderate 10 (16.0) 51 (84.0) 2 (3.0) 59 (97.0) 10(16.0) 51(84.0)
Heavy 0 (0.0) 3 (100.0) 0 (0.0) 3 (100.0) 0 (0.0) 3 (100.0)
I don't know 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0)
p=0.81 p=0.99 p=0.86
hand often used in
Right 14(15.2) 81(84.8) 3 (3.3) 89(96.7) 14(15.2) 81(84.8)
Left 2 (50.0) 2 (50.0) 0 (0.0) 4 (100.0) 2(50.0) 2(50.0)
Interchanging both 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0)
P=0.17 P=0.92 p=0.16
Male 11(23.4) 36(77.6) 3 (6.4) 44(93.6) 11(23.4) 36(77.6)
Female 5 (9.4) 48(90.6) 0 (0.0) 53 (100.0) 5(9.4) 48(90.6)
χ=3.6 p=0.057 P=0.062 p=0.14
Toothpaste texture
Smooth 13(16.7) 65(83.3) 2 (2.6) 76(97.4) 13(16.7) 65(83.3)
Smooth with small granules 2 (1.0) 18 (99.0) 1 (5.0) 19 (95.0) 2(1.0) 18(99.0)
Smooth with big granules 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0)
p=0.69 p=0.84 p=0.7
Frequency brushing
Once a day 13(18.1) 59(81.9) 1(1.4) 71(98.6) 13(18.1) 59(81.9)
Twice a day 2(8.3) 22(91.7%) 1(4.2%) 23(95.8) 2(8.3) 22(91.7)
More than twice a day 1(50.0) 1(50.0) 1(50.0) 1(50.0) 1(50.0) 1(50.0)
Others 0 (0.0) 1 (100.0 0 (0.0) 1 (100.0 0 (0.0) 1 (100.0
P=0.37 p=0.001 p=0.40
Duration of toothbrushing
Less than 2 minutes 4(10.3) 35(89.7) 0(0.0) 39(100.0) 4(10.3) 35(89.7)
Between 2-3 minutes 8(21.1) 30(78.9) 2(5.3) 36(94.7) 8(21.1) 30(78.9)
More than 3 minutes 4(19.0) 17(81.0) 1(4.8) 20(85.2) 4(19.0) 17(81.0)
P=0.41 P=0.36 p=0.50
Perceived tooth surface loss
Yes 2(11.8) 15(88.2) 0 (0.0) 17(100.0) 2(11.8) 15(88.2)
No 13(18.1) 59(81.9) 3(4.2) 69(95.8) 13(18.1) 59(81.9)
P=0.42 p=0.53 p=0.42
Nig Dent J Vol. 21 No. 2 July - Dec. 2013 Ejemai, Oginni, Oginni
Effect of toothbrushing pattern on dntal tissues
Historically, diverse methods and aids have been
employed in maintaining oral health. The relationship
between tooth surface integrity and methods of teeth
cleaning have been reported in scientific literature.
While the aids employed in tooth cleaning can be said
to vary between socioeconomic classes, the
attendant effect(s) of such aids in Nigerian
undergraduates have not been reported to the best of
our knowledge.
One hundred subjects were selected by convenient
sampling and a slight female preponderance which
did not attain statistical significance was observed.
The peak age of subjects at 16-29 years is a clear
reflection of the pattern of the age of undergraduates
in Obafemi Awolowo University (one of the few
Universities that admit student less than 18 years in
Also, the greatest percentage of the respondents are
in 200 and 300 levels, accounting for about 23% each,
with only 2% in 600 levels. Again this is a true
reflection of the pattern of students' population and
length of courses offered on the campus. While most
courses span four years, very few last five or six years.
Minority of our respondents were art students and a
majority from the non biological based sciences. This
distribution cannot be related directly to the
proportion of student population on the campus but
can be attributed to chance as a convenient sampling
technique was used.
As expected in an academic community, 95% of the
respondents used toothbrush in cleaning their teeth.
85% used toothbrush alone, while 12% combined
toothbrush with other tooth cleaning materials, with
toothbrush and chewing stick being the commonest
combination, accounting for 7%. This is in agreement
with the findings of Umesi-Koleoso, et al who
reported 96.3% toothbrush use and 4% combination
with chewing stick in Lagos State Nigeria. These
finding continue to corroborate the fact that chewing
sticks; the traditional cleaning aid among most
Nigerians has not gone into extinction . Its use
among Nigerian u ndergraduates lends mu ch
credence to its existence in the present and younger
The use of toothpaste from this study is popular
among undergraduates as reported in 97% of
respondents. A few decades ago, there were very few
brands of toothpastes available on the Nigerian
market. Events around the importation of goods into
the country have since given rise to a multiplied
variety of brands. Classified broadly as conventional
and herbal toothpastes, majority of undergraduates
use single brands of conventional toothpaste but over
a quarter of them use combinations. Only 10% use
herbal toothpastes, which are available but not very
popular in the market.
Th is is p robab ly becau se the co nventi onal
toothpastes are more readily available in the market in
this environment while a number of respondents may
not have developed enough confidence in the newly
erupting brands of herbal toothpastes. Others
possibly believe that herbal toothpastes should be
applicable to a particular oral condition.
Out of those that used combination of toothpaste
brands, 14% combined both herbal and conventional
toothpastes, and 12% combined various conventional
toothpastes, with the remaining 1% making up for
those that did not respond to the question.
Herbal toothpastes are said to be made from natural
ingredients. There is absolutely no difference in
consistency of these toothpastes when compared
with the conventional toothpastes. They are however
different in their flavour.
It was also observed that more females (58%) combine
conventional toothpastes. This is probably because
females are more meticulous about their health and
may not want to dabble into new products (herbal
toothpastes) easily.
The presence of granules and abrasive components
was elicited among 21% of respondents. Some of the
respondents, (20.2%) classified their toothpaste as
having small granules, and only 1% said they use
toothpaste with granules classified as big. We believe
that with the availability of diverse toothpaste types,
more studies need to be conducted on toothpaste
combination use and its effect in a wider population
(possibly national).
The frequency of toothbrushing was predominantly
once a day (72.7%) and a minority brushed twice a day.
A slight female preponderance was observed among
the few who brush twice a day. Our finding is at
variance with the pattern in Scottish population
reported by Oliverira et al where 71% of respondents
brushed twice a day . A significant proportion of
respondents (61.5%) who brushed twice a day were
females but only 52% were females in our study. The
differences in proportion could be interpreted as an
expression of a better oral hygiene practise among
Scottish respondents than Nigerians. This appears to
be more in female Scottish respondents than the
female Nigerian undergraduates studied.
Unlike a 90% of the respondents used the horizontal
“scrub” method reported by Poyato-Ferrera, et al,
2003 , we found a 51.7% use of up and down stroke
and a 37.1% horizontal scrub technique. The difference
observed may be attributed to the educational status
and possible consequent better oral health awareness
in an academic environment, compared with an urban
Spanish population. aged 18-30 years.
About 53.5% of the respondents used medium texture
toothb rush, while 16.2% used hard textured
Most of the cases of gingival recession were
associated with the use of medium texture (15%) and
hard texture (31%) toothbrushes (p=0.15).
1.9% of respondents with non carious cervical lesion
used of medium texture toothbrush and 12.5% used
hard texture toothbrush. Despite the fact that
respondents' measure of force used was absolutely
subjective, and constitute a limitation, our finding is in
agreement with the study conducted by Brandini et
al, which concluded that the use of medium and hard
toothbrushes and greater force applied during tooth
brushing might contribute to the development and/or
aggravation of non carious cervical lesions .
Non carious cervical lesion in this study was found in a
Nig Dent J Vol. 21 No. 2 July - Dec. 2013 Ejemai, Oginni, Oginni
Effect of toothbrushing pattern on dental tissues
total 11teeth out of all the teeth examined and has a
prevalence of 3%, with all the cases seen in the male
respondents. In a related study conducted by Smith
WA et al, on patients with mean age 40.6 years in
Trinidad, they recorded a prevalence of 62.2% .
Also, Brandini et al, recorded a prevalence of 53%,
among students (males aged 23.6±1.8yeras and
females aged 22.3±2.4years) with males accounting
for 80% . The age difference between our group and
Smith's may be enough reason for the disparity
observed. It is not unlikely that additional factors like
dietary and oral habits may have compounded the
picture. The age group studied in this study compares
quite favourably with Bradini's but our findings
contrast sharply. We opine that our group is probably
better enlightened in tooth brushing technique and
use of safe cleansing aids. The use of toothpicks in
about a quarter of our respondents shows a
substantial knowledge gap with regards to the use of
22.2% of respondents that used vertical brushing
technique (despite the use of smooth toothpaste) had
gingival recession. Hence the force exerted and
bristle strength may be implicated. Also, of the 3
respondents with non carious cervical lesion, 2 used
smooth toothpaste while 1 used smooth toothpaste
with small granules (p=0.602) while only 1 patient
each applied horizontal scrub technique, vertical and
circular motion in tooth brushing. This is at variance
with a study conducted by Bergstrom J. et al, in 1979
. They concluded that tooth brushing factors related to
the individual (brushing frequency and brushing
technique) exert a greater influence than material-
oriented tooth brushing factor such as dentifrice
abrasivity and bristle stiffness . We opine that our
sample size and age group studied may be
responsible for differences seen.
Less frequent tooth brushing means force over less
time and more time before damage manifests. It is
interesting to note that tooth surface loss was present
in the left quadrant only and in respondents that are
right handed. This is in line with the findings of Oginni
et al, which concluded that NCCL was commoner in
the left quadrant of right handed brushers, although
their result did not attain statistical significance .
The subject's perception of tooth surface loss was
correct only in 2 respondents. This was a very low
level of correctness. The need for routine dental check
up in detect ing, m anagi ng and preven ting
progression of these lesions is very important among
Conclusion and Recommendations
Most of the students studied have toothbrushing
patterns which conform with the recommended
standard by the American Dental Association (ADA),
while some engaged in tooth brushing practices
which greatly deviates from this recommended
standard. This pattern could be as a result of poor oral
health awareness imbibed from various family
Despite these varying patterns of tooth brushings, the
effects on dental tissues is not marked compared with
other studies conducted in other parts of the world,
with gingival recession having a prevalence of 16%
(affecting 2% of all the teeth examined) and non
carious cervical lesion as low as 3% (accounting for
0.35% of all the teeth examined).
A low prevalence at this age group might however give
way to a larger figure with time if bad brushing
techniques are sustained. Hence, these findings
notwithstanding, we advocate that effort should be
made to educate the students on proper brushing
te chniques pos si bl y a t the ori en ta ti on of
Aspects requiring improvement are frequency of tooth
brushing, discouraging the use of harmful cleansing
aids like abrasives, and enlightenment on the use of
dental floss instead of toothpicks. Availability of
convenient and affordable dental f loss must
accompany such enlightenment talks if knowledge
acquired will be put to proper use.
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Health Survey. Bri Med J 2010; 27: 340:c2451.
Nig Dent J Vol. 21 No. 2 July - Dec. 2013 Ejemai, Oginni, Oginni
Effect of toothbrushing pattern on dental tissues
Doi: 10.1136/bmj.c2451.
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Age............Years........ Sex: Male ( ) Female ( )
Department/Faculty………. / …………
Level ………………
1) What do you use in cleaning your teeth? (Tick all
applicable option or options).
Toothbrush ( ) Chewing stick ( ) Cotton wool ( )
Foam ( ) Finger ( ) Others ( )
2) What other aids do you or did you ever use in
cleaning your teeth? (Tick all applicable options).
Tooth pick ( ) Toothpaste ( ) Dental floss ( )
Mouthwash ( ) Dental probe ( ) Charcoal ( )
Abrasive powder ( ) Grinded broken plates
Others; specify…………………….
3) Wh at to ot hp as te do yo u us e? Giv e
4) Describe the texture of the toothpaste. Smooth
( ) smooth with small granules ( ) smooth with
big granules ( ) Others; specify…………………………..
5) What texture of tooth brush do you use? ( ) Soft
( ) Medium ( ) Hard ( ) Not sure / don't know
6) How often do you brush your teeth? ( ) Once a
day ( ) Twice a day ( )More than twice a day ( )
Alternate days Others (specify) ………………………
7) How long do you spend brushing your teeth at a
time? Less than 2 minutes ( ) Between 2 to 3
minutes ( ) More than 3 minutes ( )
Others (specify)……..........................
8) How do you move your tooth brush when
brushing? ( Pick more than one if appropriate) Up
and down ( ) Side to side ( ) Circularly/round ( )
Others; specify…………………………
9) Are you right handed ( ), left handed ( ) or
Ambidextrous (use both hands with equal ease
( )
10) Which hand do you use in brushing your t eeth ?
Right hand ( ) Left hand ( ) interchange both
hands ( )
11) Do you brush your teeth with force? ( ) Yes
( ) No
12) How would you grade the force you apply or
exert during tooth brushing.
Light ( ) Moderate ( ) Heavy ( ) I don't
know ( ).
13) Do you injure your gum when brushing? ( ) Yes
( ) No ( ) I don't think so
14) If yes, how often do you injure your gum? ( )
Always ( ) Occasionally ( ) Rarely
15) Have you noticed any groove or defect on the
front surface of your teeth near your gum?
( ) Yes ( ) No
16) If yes what is / are the cause(s)? …………………………..
SECTION D (Examination)
Teeth present
Teeth with gingival recession
Teeth with non carious cervical lesion
Other Remarks ………………………………………………………….
Nig Dent J Vol. 21 No. 2 July - Dec. 2013 Ejemai, Oginni, Oginni
Effect of toothbrushing pattern on dental tissues
... When used correctly, chewing sticks, a traditional cleaning aid in Nigeria [21] and other parts of the world [17] even among health care professionals [17] demonstrate beneficial effects on oral health. [22,23] Surprisingly, the frequency of chewing stick use among the residents in this study was higher than the 7% reported among 100 undergraduate students in the Nigerian study by Akhimie et al. [24] In their study, chewing stick was used in combination with toothbrush. The reason for the higher prevalence of chewing stick use among our study participants can be ascribed to their relatively older age since older persons may be more likely than younger persons to adhere to traditional practices. ...
... It would be interesting to assess their reasons for the choice of brushing techniques in future studies. On the other hand, the lower frequency of use of the horizontal (scrub) method by the doctors in our study (5.6%) compared to the higher frequency (37.1%) among the university undergraduates in Nigeria [24] may be attributed to the doctors' greater oral health knowledge and awareness of the association between the horizontal brushing method and gum recession and cervical abrasion. ...
... Our study found a higher frequency of persons who brushed twice daily compared to 24.2% of the university undergraduates in Nigeria. [24] On the contrary, it was lower than the 55.9% in an Indian study of dental professionals. [14] This poor oral hygiene practice will compromise effective plaque control and should be addressed among the resident doctors through proper oral health education. ...
Full-text available
Background: Oral health is important for well‑being and chronic disease prevention. Physician’s confidence and willingness to counsel patients on lifestyle practices is related to their personal behavior. Limited data exists regarding oral self‑care practices among physicians in developing countries, as the majority seeks oral health advice and care from doctors rather than dentists. Aim: To determine the oral self‑care practices, dental attendance, and self‑perceived oral health status of internal medicine residents in Nigeria. Methods: A cross‑sectional study was conducted among internal medicine resident doctors attending an update course using a self‑administered structured questionnaire, which included oral care practices. Data were analyzed with SPSS version 21.0, P < 0.05 was significant. Results: The response rate was 82.0%. Data from 109 residents from the 6 geopolitical zones in Nigeria were analyzed. The mean age of the residents was 33.1 (4.0) years. 39.8% brushed twice a day, 20.2% used dental floss regularly, 10.1% used the roll technique for brushing and 30.3% of the doctors had never been to a dentist. However, 61.1% felt dental visits should be undertaken every 6 months and 57.8% strongly agreed/agreed that the state of their oral health was excellent. There was no difference in the oral hygiene practices by gender, designation or geopolitical zone of the residency program apart from dental flossing (female > male, P = 0.002). A higher proportion of junior compared to senior residents strongly agreed/agreed and strongly disagreed/disagreed that their oral health status was excellent (P = 0.026). Conclusion: The oral self‑care practices of these doctors involved in managing patients with medical conditions linked to oral health is inadequate. There is a need for better education on oral self‑care among physicians. Key words Dental attendance, internal medicine, Nigeria, oral health, oral self‑care
... This study showed that a good number of the study population brush their teeth at least once daily with fluoridated toothpaste; this is similar to findings by Ejemai et al. 19 This may be attributed to adequate knowledge that translates to practise among the participants. However, the percentage of study participants brushing twice daily in this study was higher than that reported in the study by Ejemai et al. 19 Al-Qahtani et al showed that adequate knowledge of oral health care results in practise, and this in turn reduces the prevalence of oral health diseases. 20 The significant risk indicators of poor oral hygiene among the study participants were found to be age and last dental visit, suggesting a unique impact on the odds of poor oral hygiene status. ...
... Socioeconomic status and educational level have shown to be a determinant of good oral health. [26][27][28] This finding was also contrary to the finding by Ejemai et al 19 which reported a low percentage of participants using dental floss. This may be due to unavailability or lack of awareness regarding dental floss, its use, and significance. ...
Full-text available
Objective: This study determined the associations between dental caries, oral hygiene status and oral health care practices among first-year undergraduates in a private university in Nigeria. Methods: Secondary data was obtained from a cross-sectional study that recruited first-year undergraduates undertaking mandatory medical screening exercises. Data collection was through a self-administered questionnaire that assessed participants' sociodemographic characteristics and preventive oral health care measures. Oral examination for dental caries and oral hygiene status was done by qualified dentists. Data collected were analyzed using STATA version 13 for Mac Air. Pearson's Chisquare test was used to establish the associations between dental caries, oral hygiene, and preventive oral health care. Binary logistic regression was used to estimate the degree of association between the dependent and the independent variables.
... Dental plaque is nothing more than a bacterial biofilm that forms on the surface of teeth and is made up of a complex community of microbial species. 1 Bacterial plaque is the key player or etiology of periodontal disease. 2 Both commensal and pathogenic species can be found in the microbial community of dental plaque. 3 These bacteria are known to generate a substance that can start a chain of host reactions that, when unchecked, can both protect and destroy tissue. ...
... Improper/ aggressive toothbrushing technique with a hard-bristle toothbrush can be detrimental to oral health and lead to cervical abrasion and gingival recession. 2 Studies have proved that onset of disease progression can be prevented by regular plaque removal-primary prevention (Axelsson and Lindhe 1978, Garmyn et al. 1998). More amount of plaque is removed when brushing time is increased from 1-4 minutes (Huber et al. 1985). ...
... 10 Here in this study, 96% patients were brushing once in a day, whereas 3% patients were brushing twice in a day and only 1% patient had no habit of brushing teeth while In the study of Ejemai 72% patients were brushing once in a day, whereas 25% were brushing twice in a day. 11 In present study, 53% patients were studied upto Higher secondary school whereas only 18% patients were graduated and 29% were illiterate. In study done by Toker et al and other study 60% patients were studied upto high school, whereas 40% were studied beyond high school. ...
Full-text available
Background: Periodontal disease, ever since the days of hippocrates has crippled the survival of human dentition. As a quiescent disease most of the time, periodontal disease presents mainly a chronic or asymptomatic chief complaint. In its most common form, periodontal disease generally is considered to be a painless process unless it reaches severe stages. For this reason, it often is overlooked by patients and dentists in early stages, especially when inflammation is not obvious. The aim of this study was to determine the most common chief complaints of chronic periodontitis patients to assess public awareness about this disease symptom, distribution of these chief complaints among males & females and their correlation with age and some of periodontal parameters. Methods: The data of patients include chief complaint of the patients, age-sex, patient’s education level, systemic and oral health status, smoking, tobacco and gutka chewing habits were collected. The examiner also collected information related to the toothbrushing frequency of each patient. Results: Total samples testing in the study were 100 (n=100). Out of which majority samples were female patients. Maximum samples were received from age group of 51-60 years. Major pre-disposing factor is Tobacco and Gutka Chewing. Majority of chief complaint was mobility of teeth. Conclusions: 51 years to 60 years of age group with higher number of females and tobacco chewer have higher incidence of periodontitis with major chief complaint of mobility of teeth. These patients are brushing once in a day.
... However, a study by Jiang 27 reported that there was no evidence to support the superiority of toothbrushing after breakfast over brushing before breakfast or the ideal time for optimal results. 27 It is not surprising that majority of the participants used toothbrush and fluoride toothpaste as cleaning aid, with some using chewing stick in addition, this finding is comparable to a previous study, 28 while very few used any type of toothpaste, which should be discouraged. Fluoride has been documented to improve oral health, by being incorporated into enamel during the time of brushing, 29 and is also taken up by oral soft tissues and plaque 30 hence boosting its protective effect on enamel. ...
Objective: This study was aimed at determining the oral self-care practices and dental service utilization among dental auxiliaries in teaching hospitals in Nigeria, and also to assess the dental utilization of their relatives. Methods: This was a descriptive, cross-sectional multicenter study conducted among dental auxiliaries from three teaching hospitals in Nigeria, namely; University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt, Rivers State, Lagos University Teaching Hospital (LUTH) Idi-araba, Lagos State and University College Hospital, (UCH) Ibadan, Oyo State Nigeria. Self-administered questionnaires were used to obtain information on participants’ sociodemography, oral hygiene practices and dental service utilization. The self-rated oral health status was used to assess their oral health behavior (frequency of brushing, regular check-up and fluoride application). Statistical analysis was done using the IBM SPSS version 20.0. Statistical significance level was considered at p ≤ 0.05. Results: A total of 101 participants were enrolled into the study, consisting of dental nurses (16[15.8%]), dental technicians (21[20.8%]), dental technologists (46[45.5%]) and dental therapists (18[17.8%]). The mean age of the participants was 35.12 ± 8.89 years. Female: Male ratio was 2.26: 1. Most (90.1%) of the study participants rated their oral hygiene as excellent. Slightly over half (57.4%) brushed twice daily; 25% of the dental nurses, 52.4% of the dental technicians, 58.7% of the dental technologists and 88.9% of the dental therapists, this was statistically significant (p=0.002). Frequency of dental check-up for six months among the participants was low (31.7%). Only 31 (30.7%) of the participants had scaling and polishing done in the last 6 months. More of the dental nurses (93.8%) and technicians (71.4%) had invited their relatives for scaling and polishing compared to the other dental auxiliaries (p=0.0019). Conclusion: Even though the dental therapists had better tooth brushing practices in this study, the oral hygiene practices and utilization of dental services by the dental auxiliaries were generally less than optimal. There was a disparity between the self-rated oral health status and oral health practices of the dental auxiliaries. There is need for better motivation of dental auxiliaries towards optimal oral hygiene behavior.
... The practice of once daily teeth brushing has a significant effect on influencing plaque formation. Studies have shown that the rate and severity of dental caries are more in patients who brush their teeth once daily as opposed to those who brush twice 25,26 daily. When you brush twice a day, the dental plaque can be removed earlier before it hardens on the teeth surface. ...
Full-text available
Dental caries; its sequelae and treatment among patients in a tertiary hospital in northwestern Nigeria: A retrospective study Background: Dental caries has been the most prevalent dental disease that affect human dentition. Lack of early visitation to the dentist and, awareness could lead to tooth mortality. This study aims to describe the pattern of dental caries, sequelae and, treatment among patients attending the dental clinic of Yariman Bakura Specialist Hospital Gusau (YBSH). Materials and method: This is a 4year retrospective study conducted at YBSH Gusau. After obtaining ethical approval from the Hospital's Research and Ethics committee, patients' case notes from 18 years who were treated for dental caries and sequelae were retrieved. Demographic variables, presenting complaints, the number of carious teeth, frequency of teeth brushing, history of dental visitation, diagnosis and, the treatment offered were also recorded. Data recorded were analyzed using SPSS version 25. Abstract Conclusion: Dental caries is a major public health problem that could lead to sequelae with life threatening consequences. Majority of those affected had not visited dentist before and could only afford tooth extraction as their preferred treatment option. Poor access to dental facilities and lack of awareness could have been the barrier to early presentation. Result: There were 100 (40.3%) males and 148 (59.7%) females in the age range of 18-78 years with a mean±SD of 36.4±12.3years. Toothache in 159 (64.1%) was the main presenting complaint and, 168 (67.7%) of the study population visited a dentist for the first time. The majority 212 (85.5%) of the patients brush their teeth once daily. Permanent mandibular first molar 103 (41.5%) was the highest tooth affected by caries and apical periodontitis 66 (26.6%) constitute the majority of diagnoses. Dental extraction 171 (69.0) was the most treatment done.
... This is similar to a study by Azodo et al among dental technologist and dental therapists in training which reported that 78.9% of the respondents used medium textured brush [28]. A study on the effect of toothbrushing patterns on dental tissues that was carried out amongst Obafemi Awolowo University students revealed that gingival recession was found in 31% of subjects that employed hard textured toothbrush [29]. ...
Full-text available
Aims: To evaluate the academic stress and oral hygiene practices among students in health-related profession such as medicine and surgery, nursing, dentistry and pharmacy Study design: This study was a cross sectional survey done among students in health-related professions Place and duration of study: Faculties of Medicine and Surgery, Dentistry, Pharmacy and Nursing in College of Health Sciences, University of Port Harcourt between August and September, 2021. Methodology: Four hundred and twenty-two participants in health-related professions (dentistry, pharmacy, medicine and surgery and nursing) in the penultimate and final year who gave their consents were recruited for the study (266 females, 156 males; age range= 17-37 years). Self-administered questionnaires were used to collect data on demographics, perception of course Original Research Article Omotunde and Dorcas; AJDS, 5(1): 1-11, 2022; Article no.AJDS.78617 2 stress and oral hygiene practices. Data was analyzed using IBM SPSS (statistical package for the social sciences) version 25. Results: Sample size was 422 and response rate was 100%. P value was set at <0.05. About two-third of participants reported a high academic stress and said they spend between 9 and 15 hours daily on academic work (p=0.02). Majority of the respondents cleaned their teeth with toothbrush and fluoridated toothpaste. 56.4% of the participants brush twice daily, 49.3% change their toothbrush every 3 months and 18.7% change their toothbrush when it lost its efficiency. 84.8% of the respondents were aware of interdental Conclusion: The oral hygiene practice among the undergraduates was fair despite their high academic demands. There is however, still the need to motivate them for improved oral hygiene practice.
... Brushing twice daily, (before going to bed and after breakfast) has been reported to enhance oral hygiene [28]. In this study, three-fifth (60.3%) brushed twice daily; more males, greater number of consultants and more participants in federal hospital. ...
Full-text available
Maintenance of good oral hygiene practice is the key to having a good oral health and invariably, an improved quality of life. Consecutive consenting medical practitioners attending the 2019 National Medical Association Annual General Meeting were recruited for this study. Data was analyzed using the Statistical Package for Social Sciences version 20.0 (IBM SPSS Statistics Armonk New York). One hundred and fifty-six participants were recruited. Ninety-four (60.3%) were male and 62(39.7%) females. Age ranged between 23 and 72 years with a mean age of 41.6±11.18 years. Almost all participants cleaned their teeth with toothbrush and fluoridated toothpaste. More males, more consultants and more participants in the federal hospital brushed their teeth twice daily and used medium bristled toothbrushes. Equal number of males and females used dental floss and interdental brushes. More consultants than all other cadre of participants and more participants in the federal hospital used dental floss (p=0.02). More participants in the federal hospital visited the dentist in the past (p=0.05); however, more males and more consultants did not have time to visit. Twice the participants with six to ten years of practice compared to those with more than fifteen years of practice did not access dental service because they felt they had no dental problem (p=0.248). The longer the year of medical practice, the better the oral hygiene practice. One out of every 5 participants regularly visit the dentists; a consultant will likely visit more regularly than other designated participants.
... A study of tooth brushing trends in 20 countries in Europe and North America from 1994 to 2010 revealed that a largely positive trend was brushing twice daily was observed across all the countries studied with the younger age groups showing more potential of oral hygiene improvement from oral health education (Honkala et al., 2015). Local studies on brushing techniques have been majorly descriptive, Oginni et al (2013) in a study amongst Obafemi Awolowo University Undergraduates, reported 73% of the respondents brush only once daily. The study further reported 52%, 37% and 11% of respondents used vertical (up and down), horizontal (side by side) and circular brushing techniques respectively. ...
Full-text available
The Modified Bass Technique (MBT) of tooth brushing is the most effective in plaque removal compared to some other reported techniques like Fones, Scrub, Charters and Stillman. We hypothesize that there will be a greater plaque reduction using the MBT as compared to the other reported techniques. The aim of this study therefore is to determine the effectiveness of the MBT compared to other tooth brushing techniques in plaque control. A 28 day clinical trial amongst 50 preclinical dental students was done. Participants were randomized into two groups, MBT group and other preferred tooth-brushing methods group. Data was collected using a self-administered semi-structured questionnaire on sociodemographic, oral health habits and knowledge on brushing techniques. The oral examinations were done by two calibrated examiners. Simplified Oral Hygiene Index (OHI-S), percentage plaque score and gingival bleeding score were recorded. The examiners and data analyst were blinded and data analysis was done using Paired T test with statistical significance of p< 0.05. Significant reduction was found in facial and interproximal plaque scores for both groups but more in the MBT group. There was significant reduction in gingival bleeding on probing in the MBT group after seven days while this was not significant in the other group (p>0.05). However, after 28 days, there was significant reduction in bleeding on probing in both groups. Within the limitations of this study, we found the Modified Bass Technique of tooth brushing to be more effective in plaque control compared to other brushing techniques..
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