Brushing teeth twice daily is a widely accepted dictum among individuals who prioritize their oral hygiene. But there are times when people take the extra mile with their oral hygiene and over-excitedly tend to brush their teeth too hard with the intent of keeping their teeth clean and healthy. Brushing your teeth for too long, using too much force, or employing incorrect techniques can harm the teeth. Oblivious to some, compulsive or over-vigorous brushing can give rise to a range of oral health problems.

Deleterious effects of vigorous brushing 

1. Toothbrush Abrasion

Abrasion happens on:

• brushing too hard

• brushing too often

• brushing too fast

• brushing too long

• using a firm or hard-bristled toothbrush.

The vehement brushing of teeth can wear away the protective layer,  enamel, and eventually, the softer dentin and cementum structures. Abraded areas appear as worn, shiny, and often yellow or brown spots on the tooth near the gumline. Notching — a wedge or V-shaped indentation of the tooth along the gumline — is also a sign of abrasion.

2. Gum Recession

Continued overzealous and improper brushing may also cause your gums to recede exposing the roots of teeth. This endangers the cementum, which is a calcified tissue that covers the roots. Not only is exposed cementum easily worn away and notched, leading to sensitivity and pain but there is also a higher risk for decay.

3. Tooth sensitivity 

Receding gums and the loss of tooth enamel as a result of overbrushing-may subsequently cause teeth to feel more sensitive. Tooth sensitivity occurs as a result of exposed nerve endings in the inner dentin layer, secondary to the loss of the protective enamel layer. This is perceived as sharp, transient pain or discomfort when exposed to hot, cold, sweet, or sour stimuli or even while brushing the teeth.

What is the key practice that effectively removes plaque?

 Brushing teeth the right way requires mindfulness and changing hard brushing habits is definitely not difficult. The key to thoroughly cleaning teeth while minimizing the risk of abrasion and other damages related to over-brushing is to employ a proper brushing technique. 

Place the toothbrush at an angle of 45-degree angle along the gumline. This ensures the bristles can access the areas underneath the gums.

Gently move the brush back and forth over each tooth occasionally switching to a concentric circular motion. Brush 3-4 teeth at a time until all the teeth as well as all teeth surfaces are covered. Ensure that the lingual and palatal surfaces are also cleaned using the same technique in order to not miss out on any section. In the case of using an electric toothbrush, follow the same techniques while lightly gliding the toothbrush over your teeth taking care to not exert too much pressure. 

Ways to avoid the risks of overbrushing 

Implementing small changes in one’s oral health routine is all that is needed to avoid overbrushing.

1. Use a soft-bristled toothbrush

Soft-bristled toothbrush tends to cause less wear of teeth even with increasing brushing forces. They’re as effective as firm and medium brushes but are less likely to cause any damage. Especially when cleaning along the gum line, where gum recession from over-brushing is a risk. So a soft brush would be a better choice for over-enthusiastic brushes.

2. Time your brushing

Brushing teeth for longer won’t make them cleaner. The Indian Dental Association recommends brushing for a minimum of 2 minutes, twice a day. This is a very small investment for the part of the body which can never grow back once lost. Using a timer, if necessary, can assist in gaining control over prolonged brushing duration.

3. Use gentle strokes

Applying too much pressure against teeth and gums doesn’t remove more plaque or bacteria. This not only damages teeth but also necessitates frequent replacement of your toothbrush.  A light touch is all that’s needed, just enough to sense the brush gliding over the teeth and gums. 

Treatment

The type and severity of damage dictate the optimal treatment approach. 

1. Switching to a desensitizing toothpaste helps counteract tooth sensitivity experienced resulting from over-brushing. Additionally, hard brushers are advised to opt for a soft-bristled toothbrush to stop more wearing of tooth enamel.

2. Dental restoration with materials like composite or glass ionomer is suggested in severe cases where considerable tooth substance is lost. 

3. The use of a fluoride varnish to strengthen the teeth' surface.

4. Dental veneers 

5. Gum graft surgeries can replace the missing gum tissue and offer coverage to the exposed root surfaces. 

Conclusion 

While regular teeth brushing is indispensable for good oral health, it is equally important to steer clear of the trap of overbrushing. Although many individuals may believe that vigorous brushing removes more plaque, this common misconception can invite more harm. Overbrushing can be problematic if it is not nipped in the bud. The potential harm inflicted by overbrushing is twofold- it damages both teeth as well as gums. Preventing it largely comes down to reinforcing proper brushing habits.

REFERENCES 

1. Ledder RG, Latimer J, Forbes S, Penney JL, Sreenivasan PK, McBain AJ. Visualization and Quantification of the Oral Hygiene Effects of Brushing, Dentifrice Use, and Brush Wear Using a Tooth Brushing Simulator. Front Public Health. 2019 May 8;7:91. doi: 10.3389/fpubh.2019.00091. PMID: 31192180; PMCID: PMC6517784.

2. Hamza B, Tanner M, Körner P, Attin T, Wegehaupt FJ. Effect of toothbrush bristle stiffness and toothbrushing force on the abrasive dentine wear. Int J Dent Hyg. 2021 Nov;19(4):355-359. doi: 10.1111/idh.12536. Epub 2021 Jul 22. PMID: 34270163; PMCID: PMC8597153.

3. Gallagher, Andrew, Joseph Sowinski, James Bowman, Kathy Barrett, Shirley Lowe, Kartik Patel, Mary Lynn Bosma, and Jonathan E. Creeth. "The effect of brushing time and dentifrice on dental plaque removal in vivo." American Dental Hygienists' Association 83, no. 3 (2009): 111-116.

By Dr.Vineesha V