Tooth brushing abrasion is one factor in the multi-factorial process of tooth wear. While tooth brushing is considered to be of minor importance for abrasion of sound enamel and dentin [51], it was shown to be a significant risk factor for the etiology of erosive lesions [52], [53] and [54], especially on eroded enamel and dentin. Tooth-brushing abrasion is determined by the abrasive properties [55] and [56] and concentration [57] of the toothpaste, and is also modified by the kind of toothbrush [58] and the brushing learn more force [59] and [60]. Comparison of the brushing forces applied during in vivo tooth brushing with

manual and sonic toothbrushes and the average brushing force of manual toothbrushes (1.6 ± 0.3 N) was significantly higher than for sonic toothbrushes (0.9 ± 0.2 N) [54]. These different brushing forces affect the abrasive capacity of manual and sonic toothbrushes. Recent systematic reviews also suggest that power toothbrushes produce less clinically relevant damage potential to soft and hard tissues than manual toothbrushes [61] and [62].

Patients with clinically significant severe tooth wear and exposed JNJ26481585 or eroded dentin surfaces should use sonic toothbrushes to reduce abrasion, while patients without tooth wear or with erosive lesions confined to the enamel do not benefit from reduced abrasion from sonic toothbrushes [54]. Duration is one of the critical factors affecting the efficacy of tooth brushing for dental plaque removal [63]. It has been proposed that the main cause of insufficient oral hygiene in the general population is too short a brushing time [64]. However, changing this seems to be very difficult [65]. Reported tooth brushing durations for children and adults are shown in Table 2. Brushing’s major effect on plaque reduction is reached after 30–45 s of brushing per quadrant; accordingly, the commonly recommended tooth brushing times vary between 120 s (USA) and 180 s (Europe) [66]. Manual brushing for additional time did for not lead

to any significant improvement [66], and a brushing duration of more than 3 min is usually not achieved [67]. On the other hand, Schlueter et al. [41] reported that repeat motivation at each recall, using leaflets, instructions and demonstrations, were statistically effective in prolonging tooth brushing duration and improving tooth brushing technique. The gold standard for clinical research is a randomized controlled trial with large numbers of participants to test the efficacy and effectiveness of various types of clinical intervention. Indices for the clinical evaluation of dental plaque have been developed and are listed in Table 3. Each index has its own characteristics, and each study selects the index best suited for its purpose. However, this variety of indices makes it difficult to compare them directly for a systematic review.