How to choose a toothbrush

Soft bristles

The ADA recommends soft bristles because they minimize the risk of gum abrasion, noting that medium bristles remove biofilm well but carry more risk. ADA MouthHealthy says firmer bristles can harm gums and enamel and to brush gently, just enough to clean plaque off your teeth, and let fluoride toothpaste do the rest. Cleveland Clinic likewise says to choose soft or sensitive bristles because hard bristles can wear away enamel and gum tissue.

Manual or electric?

Both work. The ADA says both manual and powered brushes remove plaque effectively, and that powered brushes can help people with limited dexterity, such as older adults, people with disabilities, children or people with braces. Healthline reports a review in which electric brushes generally removed more plaque and gingivitis, with plaque falling by about 21 percent and gingivitis by about 11 percent after three months, and oscillating brushes appearing to outperform vibrating ones, though two studies in seniors found no significant difference. Cleveland Clinic's expert recommends electric toothbrushes, citing better plaque removal especially on molars, and says there is no recent evidence that either of the two main brand types is better. Healthline concludes the best toothbrush is the one you will use consistently.

Head size, bristle pattern and the ADA Seal

The ADA suggests a head size that fits the mouth, and says one systematic review found multi-level or angled bristles outperformed flat-trimmed bristles for plaque removal. A toothbrush earns the ADA Seal by showing evidence of safety and efficacy in plaque removal and gingivitis reduction, and ADA MouthHealthy says the Seal means the bristles stay in and the handle stays strong. Look for it on the box.

How often to replace a toothbrush

The ADA and ADA MouthHealthy say every three to four months, or sooner if the bristles are matted or frayed, because worn bristles clean less effectively. Healthline adds sooner after an illness. For electric brushes you often only need to replace the head.

How to clean a toothbrush

ADA MouthHealthy says to rinse with tap water after brushing to remove toothpaste and debris, stand it upright, let it air dry and keep brushes apart so they do not cross-contaminate. It says not to routinely cover brushes or keep them in closed containers, since moisture there encourages bacteria more than open air does, and not to share toothbrushes, especially if someone has a cold, flu or a weakened immune system.

How to disinfect or sanitize a toothbrush

The ADA says toothbrushes can harbor bacteria but there is no evidence this causes health problems, so sanitizing is optional. It says one study found that soaking in 3 percent hydrogen peroxide or Listerine reduced bacterial load by about 85 percent, and that you should avoid microwaving or dishwashing brushes, since heat can damage them. If you use a sanitizer device, choose one cleared by the FDA. The sources we read do not describe specific steps for cleaning an electric toothbrush body or handle beyond rinsing, so follow the maker's instructions.

Taking a toothbrush on a plane or traveling

ADA MouthHealthy's toothbrush page does not address travel, and the sources we read do not say anything about electric toothbrushes on planes. Check the airline's and airport's rules, and let a travel brush air dry and not be sealed while damp, as the storage advice above suggests.

How to brush

The ADA suggests brushing twice daily for two minutes with fluoride toothpaste, placing the brush at a 45-degree angle to the gum line and using short, gentle strokes. Cleveland Clinic says to clean every surface, including the tongue side of the teeth and the roof of the mouth, and warns against scrubbing. For children, the ADA says brushing should start when the first tooth appears, using a small, soft child-sized brush, with an adult supervising until the child can spit.

Frequently asked questions