Children under 6 years old require help from an adult when brushing their teeth. The MOI technique, using systematic movements suited to a child's abilities, should be introduced early. As children learn through imitation, they can watch adults brush and play with a children's toothbrush from a young age. Two to three year olds can brush the masticatory surfaces with horizontal movements and later learn circular and up-down motions. The appropriate brushing technique depends on a child's age, with scrubbing recommended for ages 9 and under and Bass for ages 10 to 15. Toothbrushes should be replaced every 8-10 weeks or sooner if bristles are bent.

1. Tooth brushing

2.  Small children do not yet have the manual
dexterity to clean their teeth themselves. Up
to the age of 6, an adult should therefore
always give the teeth a final brush after the
child has finished. However, children should
be introduced as early as possible to the MOI
(masticatory , outer surface, inner surface)
brushing technique which uses systematic
movements suited to the abilities of children.

3. M = Masticatory
surfaces: brush with
small horizontal
movements. Start at
the back and brush
slowly towards the
front
O= Outer surfaces:
clean them with
small circular
movements
I = Inner surfaces:
use small up and
down movements

4.  As small children learn a lot through imitation
it is a good idea to give your child a children's
toothbrush to play with at an early age and to
let him or her watch you while you brush your
teeth.The child's first attempts to imitate you
will be rather clumsy.

5.  But two- to three-year-olds can already clean
the masticatory surfaces with simple
horizontal (scrubbing) movements. After this
they learn the more difficult circular
movements for the outer surfaces and lastly
the small up and down movements for
cleaning the inside surfaces.

6.  TECHNIQUES FOR
Children up to 9 years:Scrub technique advised
· Normally the Scrubbing technique is advised for very
young children
· brush for at least 2 minutes
· always use tooth brush with soft bristles and fluoridated,
flavoured toothpaste
· a tooth brush with hard bristles can cause gingival
recession (i.e they will recede and move backward) and if used
with an abrasive toothpaste, can cause tooth abrasion(loss of
tooth substance)
Children 10-15 years: BassTechnique advised.
· Directly push the filaments toward roots of teeth at 45
degree angle, press lightly but not enough to bend filaments of
brush and gently, brush forward and backward in short vibratory
movement, attempting to press into gums margin
· brush for at least 3 minutes
· use soft toothbrush with fluoridated toothpaste
Adults: Soft or medium toothbrush & fluoridated paste. Several
techniques can be used

7.  · Modified bass technique: add circular
movement which will cover gum as well as tooth
surface. It massages the gums
· Roll technique: Position your tooth brush
as in bass technique , then roll downwards over
tooth surface, away from gum margins. Lift the
brush, position it and repeat.it is the most
commonly used method, it is an easy method
but it neglects the gum margins.

8.  Stillman technique: Position your tooth brush as
in bass technique, press the filaments of your
tooth brush till the gum blanches, turn your wrist
through an angle of 45 degree and proceed to
vibrate and roll against each tooth.Wrist
movement is required;it is an unpopular technique
because it is difficult. Also the gum margin is often
ignored
· Fones technique (circular method): Brush
is placed perpendicular to teeth. Large circular
motion of brush over clenched teeth to
simultaneously cover both upper and lower
teeth.A soft tooth brush is used.it was Previously
popular but is not advised nowadays as it has
proven to cause tooth abrasion

9.  Charter’s method: Brush is angled
45°downwards, with half the bristles of the
brush over the gum and half over the crown.
Vibratory movement along with a circular
motion is done.
· Modified Charter’s method:
Modification is to include occlusal surfaces(i.e
bittting surfaces). Both these are difficult to
learn, hence unpopular

10.  How often should a toothbrush be replaced?
 A toothbrush should be replaced as soon as the
bristles are bent or sticking out since in this state
they are no longer able to clean thoroughly and
can also injure the gums. A toothbrush should
generally be replaced every 8–10 weeks.
However, as small children often chew on
toothbrushes and the bristles start to stick out
much earlier, children's toothbrushes should be
replaced more often.