The Role of Toothbrushing in the Prevention and Treatment of Periodontal Disease: Personal Experience of Both Clinical and Experimental Observation for More than Thirty Years

Abstract

There have been dramatic developments in the theory and therapy of periodontal disease in the last few decades. This paper focuses on the role of toothbrushing in the treatment and prevention of periodontal disease, based on the author's personal experience gained from both clinical and experimental observations for more than 30 years. Even in the recent past, periodontal disease was considered to be untreatable because of various misconceptions regarding its etiology. Attention was concentrated mainly on systemic factors. As a result, periodontallyinvolved teeth were extracted mostly due to lack of technical know-how. The author devoted his primary investigative efforts to systemic factors and found that those were only minimally significant. Later, after using wild and captive monkeys to make extensive experimental studies on local factors, he was convinced that food habit (hard, fibrous, or soft) contributes directly to the etiology of periodontal disease which is restricted in the oral environment itself. Today it is well-established that accumulation of bacterial plaque on the tooth surface is the most important single factor responsible for periodontal disease, and systemic influence can merely modify the condition. Therefore, the accumulated plaque should be mechanically removed by toothbrushing. The essence of mechanical toothbrushing is not only to remove the plaque but also to compensate for the mechanical stimulation of the gingiva (gingival massage), which is lacking with modern soft food. This lecture reviews the effect of methodical toothbrushing obtained from both clinical and experimental studies in animals.