The role of oral hygiene: does toothbrushing harm?

Although toothbrushing is considered a prerequisite for maintaining good oral health, it also has the potential to have an impact on tooth wear, particularly with regard to dental erosion. Experimental studies have demonstrated that tooth abrasion can be influenced by a number of factors, including not only the physical properties of the toothpaste and toothbrush used but also patient-related factors such as toothbrushing frequency and force of brushing. While abrasion resulting from routine oral hygiene can be considered as physiological wear over time, intensive brushing might further harm eroded surfaces by removing the demineralised enamel surface layer. The effects of brushing on eroded dentine are not fully elucidated, particular under in vivo conditions. However, there are indications that brushing after an acid impact causes less additional hard tissue loss in dentine than in enamel. Toothbrushing frequency and force as well as toothbrush hardness were shown to act as co-factors in the multifactorial aetiology of non-cervical carious lesions. In vitro studies showed that toothbrushing abrasion is primarily related to the abrasivity of the toothpaste, while the toothbrush acts as a carrier, only modifying the effects of the toothpaste. 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.