The Toothbrush—Extraordinary Ordinary Things

Do you remember when you were a child, every evening your parents would say: “Don’t forget to brush your teeth before you go to bed!” Or the slogan of oral hygiene professionals, “Brush your teeth twice a day; see your dentist twice a year!”

Both slogans are still current today, as is the trusty toothbrush needed to execute the admonitions. The fact is, the humble toothbrush is a virtually indispensable feature of our everyday life; however, the toothbrush isn’t really all that humble. The designs and materials used in its various manifestations are the result of decades of careful scientific investigations. And development continues apace. Today if we so fancy, we can even choose computerized versions of the toothbrush that link to the internet to provide aspects of oral hygiene previously never even imagined.

Given its ubiquity, hygiene, and social importance, the toothbrush unquestionably deserves a place of honor on the list of what I like to call “extraordinary ordinary things.”

What Is a Toothbrush?

As a technical definition, a toothbrush may be described as an oral hygiene instrument used to clean the teeth and gums. However, mankind had been using precursors of the toothbrush long before anyone thought of it as a tool of oral hygiene (prevention of tooth decay and gum disease). The evidence suggests prehistoric peoples largely didn’t suffer from cavities or gum infections; nevertheless, they brushed their teeth. Dental diseases seem to have appeared with the rise of early civilizations, e.g. ancient Greeks, Romans, etc., who also brushed their teeth. But why?

Since neither group had any real understanding of the source of dental problems, speculation has it that they used what would now be considered oral hygiene devices (toothbrush, toothpick) largely to dislodge food caught between the teeth during eating, and to keep the teeth from developing unsightly stains (toothpowder, toothpaste).

Various devices formerly used for teeth cleaning included tree twigs, bird feathers, animal bones, and porcupine quills.

The direct predecessor of the toothbrush is the chew stick. A chew stick is a twig with a frayed end used to brush the teeth and a sharp end used as a toothpick. Chew sticks are still used in many parts of the world today, although now with some knowledge of their beneficial effect on preserving oral hygiene.

The earliest chew sticks were discovered in Sumer Mesopotamia in 3,500 BCE, in an Egyptian tomb dating from 3,000 BCE, and mentioned in Chinese records dating from 1,600 BCE. Toothpick-like twigs have also been discovered in China in tombs of the Qin Dynasty (221–210 BCE). Thousands of years later, chew sticks remain common in Africa and in parts of the rural southern United States. The miswak, a type of chew stick, plays an especially important role in the Islamic world, where it has been used since the 7th century to clean the teeth before prayers, i.e. five times a day.

The modern toothbrush, i.e. with clustered bristles at one end attached to a long handle, made its appearance in the 15th century in China. The very early toothbrushes were made of boar hair bristles on a bamboo handle. These were later abandoned because the hard boar bristles caused bleeding of the gums. The successors featured softer horse hair bristles.

In 1728, Pierre Fauchard, generally considered a “father of modern dentistry,” challenged the whole concept of brushing. In his book Le Chirurgien Dentiste (The Surgical Dentist), this French physician recommended cleaning the teeth with a toothpick or with a sponge soaked in a mixture of water and brandy. In 1819 American physician Levi Spear Parmley published his book A Practical Guide to the Management of Teeth, which brought brushing back to the fore. Dr. Parmley also recommended cleaning the teeth with a piece of waxed silk. In 1845, the American Journal of Dental Science recommended that in addition to brushing, teeth should be cleaned with floss silk two or three times a day as part of a total dental hygiene program. Fluoride, still the subject of controversy, was first added to toothpastes in 1914.

William Addis (United Kingdom) is believed to have conceived the first mass-produced toothbrush while languishing in prison, having been convicted in 1770 of causing a riot. While incarcerated, he concluded that cleaning teeth by applying soot and salt with a rag, which was common at the time, was ineffective. To remedy the situation, he surreptitiously saved a small bone from a meal. He then drilled small holes into the bone and tied in some bristle tufts he had obtained from one of the guards. Finally, he passed the tufts through the holes and sealed the holes with glue. After his release, in 1780 he began manufacturing his new-concept toothbrush, with great success. When he died in 1808, Addis left the thriving business to his eldest son, which remained within the family until 1996.

By 1840 toothbrushes were being mass-produced not only in Britain, but also France, Germany, and Japan. And market differentiation had already begun, with pig bristles being used for cheaper models and badger hair for the more expensive ones.

The first actual patent for a toothbrush was granted to H.N. Wadsworth in 1857 in the United States. Wadsworth’s improved design featured a bone handle with Siberian boar hair bristles. Somewhat surprisingly, mass production of toothbrushes did not begin in the U.S. until 1885, nearly 30 years later.

In 1892, Dr. Washington Sheffield (New London, Connecticut) conceived of facilitating the use of toothpaste in a convenient collapsible tube rather than in pots and other more cumbersome containers.

During the early 1900s, celluloid gradually replaced bone for toothbrush handles, and natural animal bristles were replaced by artificial (synthetic) fibers, usually nylon. The first nylon bristle toothbrush made with nylon yarn went on sale February 1938.

At this point, allow me to go off on a short tangent.

Some readers may be thinking that replacing natural bone and natural bristles with artificial ones was somehow reprehensible. I don’t share the pejorative distinction between “’natural” and “artificial.” If the definition of natural means what is found in nature, then things like beaver dams, bird nests, ant hills, beehives, etc. are artificial. They aren’t just there; they are constructed for a purpose. They would not exist unless these creatures set out to make them exist.

“Ah,” one might counter, “animals create these things on instinct. What mankind creates is done via intelligence.” I am not convinced that things done on instinct must necessarily be more salubrious than things done on purpose. Moreover, mankind is part of nature, so anything man creates by thinking is no more or less natural than things created by animals with no thought at all.

This is not to say that whatever mankind does is in our nature and therefore good and laudable. But only that the commonly practiced distinction between natural and artificial at its core is meaningless and should not be used as a basis for judging anything. 

Now back to our story.

In 1977, Johnson & Johnson (New Brunswick, New Jersey) introduced the Reach toothbrush, which differed from previous toothbrushes in three important ways: 1) it had an angled head, similar to dental instruments, making it easier to reach back teeth, 2) its bristles were packed more closely together to better remove more potentially cariogenic (cavity-causing) materials from the teeth, 3) it had two kinds of bristles, the outer bristles being longer and softer than the inner bristles.

Another significant advance came only a year later in 1978 when Dr. George C. Collis (Minneapolis, Minnesota) developed the Collis Curve toothbrush. In previous toothbrushes, including the Reach, however they were laid out, the bristles were always straight. On the Collis Curve toothbrush, the bristles were curved to better follow the curve of the teeth and better reach into sulcular areas, i.e. the spaces naturally found between a tooth and the gum tissue that surrounds it.

Patented in 1985, curved bristles allow for safe and more effective brushing of teeth and the gingival sulcus. Cleaning the gingival sulcus areas is also the reason most dentists also recommend flossing.

However, regular brushing is a two-way street because incorrect brushing can actually be detrimental to good oral health. For example, for sensitive teeth, incorrect brushing technique can damage the dentin (the tooth component just below the enamel) and the gums. This danger can be avoided by proper brushing technique, but it requires a conscious and sustained effort to do so.

In general, when using a straight bristled brush, it is preferable not to brush horizontally over the teeth, not to press the brush too hard against the teeth, and to choose toothpaste that is not too abrasive. And here’s a surprise. After consuming acidic food or drinks, it is preferable to wait at least 30 minutes before brushing. The acid temporarily weakens the enamel, so brushing immediately could eventually do the enamel permanent harm. On the other hand, it is a good idea to immediately rinse out your mouth with a glass of water while waiting to brush.

Enter the High-tech Toothbrush

The first electric toothbrush, the Broxodent, was invented in Switzerland in 1954. Its introduction was not just to reduce the tedium of manual brushing, but because motorized brushing seems to do a better job. Compared to manual side-to-side brushing, multi-directional power brushing appears to reduce the incidence of gingivitis and plaque. Additionally, for some people electric brushing is more comfortable.

As advancing technology frequently does, advancing toothbrush technology has spawned a number of distinct categories of the instrument, each with specialist characteristics and covering a wide range of prices. These include:

  • Standard Toothbrush. This is the “humble” inexpensive manual instrument with bristles at one end and a handle at the other sold in supermarkets, drugstores, airports, train stations, etc. Their prices are rock-bottom. Only recently here in Belgium I saw a package of two toothbrushes for the equivalent of about $1, or just over 50 cents a piece.
  • Interdental or Interproximal (“proxy”) Toothbrush. The proxy (typically disposable) is a small brush used for cleaning between teeth and between the wires of dental braces and the teeth.
  • Sulcabrush. This class of toothbrush is specifically designed for cleaning along the gum line adjacent to the teeth. Its bristles shaped like an arrow tip make it ideal for difficult-to-reach areas such as between crowns, bridgework, and crowded teeth. They may also be used for cleaning around braces and other fixed orthodontic appliances.
  • End-tuft Toothbrush. This category of toothbrush features a small round brush head composed of seven tufts of tightly packed soft nylon bristles. The bristles are trimmed in such a way that the center can reach deep into small spaces. The rounded head is complemented by an ergonomically designed handle permitting the control and precision needed to clean where most other cleaning devices cannot easily reach such as behind the wisdom teeth (third molars), crowded teeth, tooth surfaces adjacent to missing teeth, around implants, bridges, dentures, and other dental appliances.
  • Disposable Toothbrush. A disposable toothbrush is designed for a single use and then thrown away. The chewable disposable toothbrush is a miniature plastic molded toothbrush that is placed directly inside the mouth. Available in different flavors, they are chewed to clean the teeth and disposed of after use. Another type of disposable toothbrush features a small breakable plastic ball of specially compounded toothpaste mounted on the bristles which can be used without water.
  • Ecological Toothbrush. People today are increasingly aware of the need to protect the environment. Because toothbrushes have traditionally been made from plastic and other non-biodegradable materials, some manufacturers have switched to using biodegradable materials and/or using replaceable heads. In order to avoid non-biodegradable materials, some manufacturers use wooden handles (often bamboo) and heads of bamboo viscose or pig bristles.

Computerized Toothbrush

Having a so-called life coach these days in certain circles is considered de rigueur. But not everyone can afford a life coach, or even want one. However, anyone who wants a tooth brushing coach can afford one because of the computer and the internet.

Unlike an electric toothbrush, which since its introduction in 1954 has been shown to improve oral health, a tooth brushing coach (my picturesque name for a “smart toothbrush”) actively engages you. That is, it not only helps you get the brushing head of the toothbrush into those hard-to-reach places in your mouth, it encourages you to do so. And to a certain degree even enjoy the effort.

Why does a smart toothbrush deserve to be compared to a coach? Among other things, it tracks and tells users just how much time they have been brushing. Knowing how much time they have already expended encourages people to continue and come closer the generally recommended brushing time of two minutes. “Gee, I have been brushing for only 30 seconds; I thought it was already more than a minute.”

Many smart toothbrushes also keep track of your brushing history and performance, giving you a better sense of what you may need to do to improve your brushing efficacy. For example, the toothbrush will tell you when you are applying too much or too little pressure, areas of the mouth that aren’t being sufficiently brushed, when you are not holding the brush at the most efficient angle, etc.

Moreover, many smart toothbrushes also feature games and rewards that encourage proper brushing. For adults, the rewards are usually a virtual trophy documenting that you have reached a particular brushing goal. For children, the smart toothbrush turns the act of brushing into a game, thereby converting the admonition “Don’t forget to brush your teeth” into an anticipated pleasure rather than a dreaded chore.

One such game encourages children to brush away colored dirt from a set of virtual teeth shown on a computer screen. As the child does so, he or she immediately sees the impact on the virtual teeth, which encourages them to do likewise for themselves.

Getting children into the habit of regularly brushing their teeth and brushing correctly can have significant consequences for their long-term oral health. Correctly brushing one’s teeth is a learned skill. Even if they are willing to brush, studies show that the average five-year-old child actually cleans only a quarter of his teeth, leaving three-quarters unprotected.

How does all this high-tech encouragement and record-keeping happen?

Basically, a smart toothbrush is equipped with sensors in the brush’s head. When the brush is in use, these sensors send data on the user’s brushing routine to an interactive app on a smartphone. The data is processed virtually instantaneously and reported to the user, who can then adjust their brushing routine in real time. Since the data is recorded, the user (perhaps together with their dentist) can also review the brushing routine over a long period of time to see if any fundamental changes may be required.

Throughout this series of blogs, I have been nominating various common items that I consider to be “extraordinary ordinary things,” then mustering facts and figures to support my choice. In the case of the toothbrush, apparently I didn’t need to bother.

The 2003 Lemelson-MIT Invention Index, a survey carried out by MIT (Massachusetts Institution of Technology) found that the toothbrush was held in considerably higher esteem that one might have expected. Respondents were asked to choose the one invention they felt they could not possibly live without. The choices were: automobile, cell phone, microwave oven, PC (personal computer), and the toothbrush. Some 34 percent of teenagers and 41 percent of adults placed the toothbrush in first position. The automobile came in a close second, with 31 percent for teenagers and 37 percent for adults. The PC was ranked in third position (teens at 16 percent, adults at 6 percent); the cell phone ranked in fourth position (teens at 10 percent, adults at 6 percent); and the microwave oven in fifth position (teens at 7 percent, adults at 6 percent).

If the results of the 2003 Lemelson-MIT Invention Index don’t qualify the humble toothbrush as an extraordinary ordinary thing, I don’t know what would. In fact, they seem to make it the extraordinary ordinary thing.