A very essential tool

IT’S SIMPLE, effective – and very essential. “Toothbrushing stands as one of most straightforward yet highly effective preventive measure to reduce the burden of oral diseases, affecting nearly 3.5 billion individuals,” declares t he World Dental Federation ( FDI or Fédération Dentaire Internationale).

With more than one million members worldwide, t he FDI is the largest grouping of oral health care professionals, with 200 national dental associations and specialist groups in more than 130 countries.

While most people brush their teeth, the way to do it has been debated probably for as long as toothbrushes have existed.

The FDI now wants the doubts resolved and commissioned a special study to look into t he matter. Where evidence was insufficient, a consensus involving F DI scientific committees was reached to establish recommendations based on good practice and not just scientific evidence alone.

The results of the systematic review and the recommendations have now been published in FDI’s flag ship International Dental Journal. It encourages national dental associations to share the publication with members and provide clinicians with practical guidance for patients.

FDI is currently developing a chairside guide and a patient guideline that will offer comprehensive recommendations for toothbrushing and oral hygiene. These guidelines are designed to provide healthcare professionals with practical advice, enhancing their communication with patients and reinforcing personalized preventive measures.

The systematic review, published in the journal Science Direct, was co- authored by AnneMarie Glenny and Tanya Walsh of the Division of Dentistry, School of Medical Sciences, University of

Manchester, United Kingdom.

The study provides a professional consensus on toothbrushing methods and associated oral hygiene behaviors and develop evidence- informed recommendations.

Electronic searches of several databases including MEDLINE, Embase, Epistemonikos, and The Cochrane Library were undertaken from 2000 to May 2022. “Considered Judgement Forms” were developed detailing the underpinning evidence, the balance between benefits and harms, potential impact on the population, and the feasibility of implementation.

An online survey comprising 22 draft recommendations was distributed to international members of all FDI committees, including the FDI Council. Participants were asked to indicate to what level they agreed or disagreed with for each recommendation and to provide feedback. The Considered Judgement Forms were provided for reference.

Twenty- five participants from Asia, Europe, North and South America, Africa, and Australia provided feedback on the recommendations. More than 70 percent of respondents showed agreement with 21 of t he 22 draft recommendations. Final recommendations were drafted with associated strength of recommendation.

“Using robust methodology and an international professional consensus, a set of evidenceinformed recommendations was developed,” says Glenny, the study’s lead author. “These recommendations provide clinicians with practical guidance to facilitate communications with patients that may help to reinforce individual-level preventive strategies.”

While daily tooth brushing with fluoride- containing toothpaste is encouraged, “to our knowledge, there is no current professional consensus on recommendations for tooth brushing and associated oral hygiene behaviors for the general population or individuals with additional health care needs,” Glenny observes.

The guidance is sorely needed. The global burden of oral diseases represents a major public health concern. Using data f rom the Institute of Health Metrics and Evaluation’s global burden of disease model for oral diseases, the World Health Organization reports that around 3.5 billion people were affected by oral diseases in 2019.

Untreated tooth decay of permanent teeth was the most prevalent oral disorder, affecting almost 2 billion people worldwide, followed by severe gum disease, untreated caries or tooth decay of the primary teeth, and edentulism or total absence of teeth.

Inequalities in oral health persist, with the greatest burden borne by the most disadvantaged.

“The importance of attaining and maintaining good oral health cannot be overestimated,” Glenny says. “In addition to pain and infection, the consequences of poor oral health can include difficulties in eating and sleeping and time off work or school to attend appointments for dental treatment.”

The guidance has been taken forward in FDI visual and chairside guides for the purposes of dissemination to national dental associations, oral health professionals, and patients./