This document is a dental pharmacy assignment submitted by a student, Md. Waliullah Wali, to his lecturer at Southeast University. It discusses various topics related to dental pharmacy including the anatomy of teeth, common dental problems, and medications used in dentistry. The medications section covers 10 categories of drugs including anesthetics, analgesics, mouthwashes, antibiotics, antifungals, antiseptics, muscle relaxants, artificial saliva, and fluoride supplements. For each category, examples of drugs are provided along with their indications, dosages, and potential complications. The document concludes with sections on dental prophylactic preparations including mouthwashes and toothpastes, and recommendations for proper teeth brushing technique.
1. Southeast University
Department of Pharmacy
Assignment on: Dental Pharmacy (Drugs used in dental cares and complications, Dental
prophylactic preparations)
Submitted to:
Md. ShahidSarwar
Lecturer
Hospital & Community Pharmacy
Department of Pharmacy
Southeast university
Submitted by:
Md. WaliullahWali
Id. 2010000300031
Batch- 15th(B)
Department of Pharmacy
Southeast University
Date: 30 October 2013
2. Table of Contents
Tooth ............................................................................................................................................................................. 3
Human Teeth Anatomy................................................................................................................................................. 4
Typesof Teeth .............................................................................................................................................................. 5
Functions of teeth ......................................................................................................................................................... 6
Common Dental Problems ............................................................................................................................................ 6
Medications Used in Dentistry ..................................................................................................................................... 8
Medication in dentistry................................................................................................................................................. 8
I. Anesthetics............................................................................................................................................................. 9
II. Analgesics/pain killers......................................................................................................................................... 10
A. Paracetamol/ Acetaminophen .................................................................................................................. 10
B. Non-steroidal anti-inflammatory drug (NSAIDs)[8] .................................................................................... 10
C. Corticosteroids ointment ........................................................................................................................... 11
III. Mouth washes ................................................................................................................................................... 11
IV. Antibiotics .......................................................................................................................................................... 12
V. Antifungal ........................................................................................................................................................... 13
VI. Antiseptics ......................................................................................................................................................... 13
VII. Dry Mouth Drugs .............................................................................................................................................. 13
VIII. Muscle Relaxants ............................................................................................................................................. 13
IX. Drugs to Control Plaque and Gingivitis .............................................................................................................. 14
X. Other dental medications .................................................................................................................................. 14
Fluorides ............................................................................................................................................................. 14
Benzodiazepines ................................................................................................................................................. 14
Saliva substitutes ................................................................................................................................................ 14
Dental Prophylactic Preparations ............................................................................................................................... 15
Mouthwash ................................................................................................................................................................. 15
Toothpaste .................................................................................................................................................................. 17
Recommendations ...................................................................................................................................................... 19
Teeth Brushing Technique .......................................................................................................................................... 19
References .................................................................................................................................................................. 20
2
3. Tooth
A tooth (plural teeth) is a small, calcified, whitish structure found in the jaws (or mouths) of many
vertebrates and used to break down food. Some animals, particularly carnivores, also use teeth for
hunting or for defensive purposes. The roots of teeth are covered by gums. Teeth are not made of
bone, but rather of multiple tissues of varying density and hardness.[1]
Figure 1: Teeth of humans
Teeth of humans are small, calcified, hard, whitish structures found in the mouth. They function in
mechanically breaking down items of food by cutting and crushing them in preparation for
swallowing and digestion. The roots of teeth are embedded in the maxilla (upper jaw) or the
mandible (lower jaw) and are covered by gums. Teeth are made of multiple tissues of varying
density and hardness. [1]
Figure 2:Longitudinal section of tooth
Teeth are among the most distinctive (and long-lasting) features of mammal species. In human the
first set (also called the "baby", "milk", "primary", and "deciduous" set) normally starts to appear at
about six months of age, although some babies are born with one or more visible teeth, known as
neonatal teeth. Normal tooth eruption at about six months is known as teething and can
bepainful.[2]
3
4. Human Teeth Anatomy
Figure 3:Human Teeth Anatomy
The teeth are the hardest substances in the human body. Besides being essential for chewing, the
teeth play an important role in speech. Parts of the teeth include:
1. Enamel: The hardest, white outer part of the tooth. Enamel is mostly made of calcium
phosphate, a rock-hard mineral.
2. Dentin: A layer underlying the enamel. Dentin is made of living cells, which secrete a hard
mineral substance.
3. Pulp: The softer, living inner structure of teeth. Blood vessels and nerves run through the
pulp of the teeth.
4. Cementum: A layer of connective tissue that binds the roots of the teeth firmly to the gums
and jawbone.
5. Periodontal ligament: Tissue that helps hold the teeth tightly against the jaw.
6. A normal adult mouth has 32 teeth, which (except for wisdom teeth) have erupted by about
age 13:
7. Incisors (8 total): The middlemost four teeth on the upper and lower jaws.
8. Canines (4 total): The pointed teeth just outside the incisors.
9. Premolars (8 total): Teeth between the canines and molars.
10. Molars (8 total): Flat teeth in the rear of the mouth, best at grinding food.
11. Wisdom teeth or third molars (4 total): These teeth erupt at around age 18, but are often
surgically removed to prevent displacement of other teeth.
The crown of each tooth projects into the mouth. The root of each tooth descends below the gum
line, into the jaw.[3]
4
5. Typesof Teeth
There are 32 permanent teeth including four different tooth types in the mouth.
Figure 4: Types of tooth
1. Incisors
The incisors at the front of the mouth have a sharp biting surface and are used for cutting or
shearing food into small chewable pieces. There are eight incisors in both primary and permanent
dentitions.
2. Canines
The canines are situated at the 'corners' of the dental arches. They have a sharp, pointed biting
surface. Their function is to grip and tear food. There are four canine teeth in both primary and
permanent dentitions.
3. Premolars
The premolars, unlike the incisors and canines, have a flat biting surface. Their function is to tear
and crush food. They are unique to the permanent dentition which has eight premolars.
4. Molars
The molars are the largest of the teeth. They have a large flat biting surface. The function of the molars is to
chew, crush and grind food. There are eight molars in the primary dentition and twelve in the permanent
dentition.[4]
5
6. Functions of teeth
1. Food needs to be broken down and chewed before entering the digestive system so that our
body can easily absorb nutrients from them.
2. Teeth can help us pronounce accurately.
3. Teeth can help us look better by giving us a good profile. Deciduous teeth can reserve spaces
for permanent teeth. Once the permanent teeth start to erupt, the deciduous teeth will fall
out and give room for permanent teeth.[5]
Common Dental Problems
Dental problems are never any fun, but the good news is that most of them can be easily prevented.
Brushing twice a day, flossing daily, eating properly and regular dental checkups are essential in
preventing dental problems. Educating yourself about common dental problems and their causes
can also go a long way in prevention.[6]
1. Bad Breath
Bad breath, also called halitosis, can be downright embarrassing. According to dental studies, about
85% of people with persistent bad breath have a dental condition that is to blame. Gum disease,
cavities, oral cancer, dry mouth and bacteria on the tongue are some of the dental problems that can
cause bad breath. Using mouthwash to cover up bad breath when a dental problem is present will
only mask the odor and not cure it. If you suffer from chronic bad breath, visit your dentist to rule
out any of these problems.
2. Tooth Decay
Did you know tooth decay, also known as cavities, is the second most prevalent disease in the
United States (the common cold is first). Tooth decay occurs when plague, the sticky substance that
forms on teeth, combines with the sugars and / or starches of the food we eat. This combination
produces acids that attack tooth enamel. The best way to prevent tooth decay is by brushing twice a
day, flossing daily and going to your regular dental check ups. Eating healthy foods and avoiding
snacks and drinks that are high in sugar are also ways to prevent decay.
3. Gum (Periodontal) Disease
Studies have shown that periodontal disease, also known as gum disease, is linked to heart attacks
and strokes. Gum disease is an infection in the gums surrounding the teeth. Gum disease is also one
of the main causes of tooth loss among adults. There are two major stages of gum disease: gingivitis
and periodontitis. Regular dental check ups along with brushing at least twice a day and flossing
daily play an important role in preventing gum disease.
6
7. 4. Oral Cancer
Oral cancer is a serious and deadly disease that affects millions of people. In fact, the Oral Cancer
Foundation estimates that someone in the United States dies every hour of every day from oral
cancer. Over 300,000 new cases of oral cancer are diagnosed every year, worldwide. This serious
dental disease, which pertains to the mouth, lips or throat, is often highly curable if diagnosed and
treated in the early stages.
5. Mouth Sores
There are several different types of mouth sores and they can be pesky and bothersome. Unless a
mouth sore lasts more than two weeks, it is usually nothing to worry about and will disappear on its
own. Common mouth sores are canker sores, fever blisters, cold sores, ulcers and thrush.
6. Tooth Erosion
Tooth erosion is the loss of tooth structure and is caused by acid attacking the enamel. Tooth
erosion signs and symptoms can range from sensitivity to more severe problems such as cracking.
Tooth erosion is more common than people might think, but it can also be easily prevented.
7. Tooth Sensitivity
Tooth sensitivity is a common problem that affects millions of people. Basically, tooth sensitivity
means experiencing pain or discomfort to your teeth from sweets, cold air, hot drinks, cold drinks
or ice cream. Some people with sensitive teeth even experience discomfort from brushing and
flossing. The good news is that sensitive teeth can be treated.
8. Toothaches and Dental Emergencies
I can't think of much worse than suffering from a toothache. While many toothaches and dental
emergencies can be easily avoided just by regular visits to the dentist, we all know that accidents
can and do happen. Having a dental emergency can be very painful and scary. Fortunately, you can
do several things until you are able to see your dentist.
9. Unattractive Smile
While an unattractive smile is not technically a "dental problem," it is considered a dental problem
by people who are unhappy with their smile and it's also a major reason that many patients seek
dental treatment. An unattractive smile can really lower a person's self-esteem. Luckily, with
today's technologies and developments, anyone can have a beautiful smile. Whether it's teeth
whitening, dental implants, orthodontics or other cosmetic dental work, chances are that your
dentist can give you the smile of your dreams.[6]
7
8. Medications Used in Dentistry
There are a number of different drugs, your dentist may prescribe, depending on teeth condition.
A description of the most commonly used drugs in dental care is described below. The dose of the
drugs and instructions on how to take them will differ from patient to patient, depending on what
the drug is being used for, patient's age, weight, and other considerations.[7]
It is important to always communicate all dental signs and symptoms to your dentist, so that
appropriate management and choice of medications can be made.
Medications UsedTo control pain (Anethetics, Analgesics, NSAID)
To control plaque and gingivitis(Mouth washe)
To prevent or treat infections (Antibiotics)
Antifungals (Candida)
To prevent tooth decay (Flouride)
To relieve anxiety (Muscle relaxant)
To treat xerostomia (Artificial saliva)
Medication in dentistry
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
Anesthetics
Pain killers
Mouth washe
Antibiotics
Antifungals
Antiseptics
Muscle relaxant
Artificial Saliva
Fluoride supplements
8
9. I. Anesthetics
Anesthetics areLocal anesthesia
General anesthesia
Nitrous oxide
Consiouse sedation: intravenous sedation by Diazepam[7]
Anesthetics Found in the form of
Spray
Gel (intraoral)
Ointments (extraoral)
Solutions
Brand name products
Chloraseptic
Orajel
Xylocaine
Used by the patient
To relieve pain or irritation caused by-
Complications
1. Complications associated with absorption of the anesthetic solution
1.1. Systemic drug reactions due to the local anesthetic agent:
Toxicity
Allergy
Anaphylactic reactions
Idiosyncrasy
1.2. Local reactions:
Infections due to contaminated solutions
9
10. Local tissue irritation
2. Complications associated with needle insertionPain
Edema
Infection
Muscle trismus
Broken needles
Hematoma formation
Sloughing and ulceration
Bizarre Neurological symptoms[8]
II. Analgesics/pain killers
A. Paracetamol/ Acetaminophen
Brand name products
Tylenol
Fevadol
Panadol
Napa
Indications:
Mild toothache
After tooth extraction
Teething
mild to moderate pain
Figure 5: Teething
Dose
Adults:.5–1 g every 4–6 hours.
6–12 yars: 250–500 mg every 4–6 hours.
1–5 year: 120–250 mg every 4–6 hours.[8]
Contraindication
Renal failure, papillary and tubular necrosis.
Asthma,
Liver failure
Complications
feeling dizzy
nausea
sleepiness
B. Non-steroidal anti-inflammatory drug (NSAIDs)[8]
10
11. Indications
Tooth ache
Abscess
Acute pain
Examples
– COX1 and COX-2 : Ibuprofen, ketorolac, flurbiprofen, ketoprofen, diclofenac, aspirin and
– COX-2 : celecoxib ,rofecoxib, and Nimesulide
Dose – 100 mg twice a day.
Complications of NSAIDs
Dizziness
Feeling lightheaded
Problems with balance
Difficulty concentrating
Mild headaches[9]
C. Corticosteroids ointment
To relieve the discomfort and redness in [8]
1. The palat as in canker sore
2. The lip as in fever blister, angular chelitis
3. The cheak as in canker sore
Orabase
Oralone
III. Mouth washes
Chlorhexidine mouth wash
Wash to control plaque and gingivitis in the mouth
Antiseptic
Kill the bacteria that cause bad breath
Staining of the teeth
Fluoride mouth wash
Sensitive teeth
Used for patients with high caries activity
Figure 6: Mouth washes
Rinse for 2 minutes / 10 days
Complications
Staining of teeth and/or dental restorations
11
12. Taste disorder (dysgeusia)
Build-up of tartar on the teeth
Mouth and tongue irritation or numbness
Mucosal erosions
Retention of sodium
Swollen glands on the side of the face or neck
Sensitivity of tooth roots
Mouth ulcers
IV. Antibiotics
Tetracycline’s (the
class
of
drugs
including demeclocycline,
doxycycline,
minocycline, oxytetracycline, and tetracycline) and the drug triclosan (marketed as Irgasan DP300)
are also used in dentistry. These medications may be used either in combination with surgery and
other therapies, or alone, to reduce or temporarily eliminate bacteria associated with periodontal
disease, to suppress the destruction of the tooth's attachment to the bone or to reduce the pain and
irritation of canker sores. Dental antibiotics come in a variety of forms including gels, thread-like
fibers, microspheres (tiny round particles), and mouth rinses.[7]
Doxycycline (Vibramycin)
MOA: inhibit protein synthesis by preventing aminoacyl transfer RNA from entering the
acceptor sites on the ribosome
Dose: 100mg qd-bid x 7-14 days
Contraindications:
o Food
o pregnancy
Adverse events: GI
Drug interactions: anti-epileptics
Pregnancy category D
Bacteriostatic
Spectrum:
o Broad, Gram +, -, anaerobes, aerobes, and spirochetes
Resistance:
o Widespread, cross resistance
Photo Sensitivity
Complications of Antibiotics
Severe watery diarrhoea and abdominal cramps (signs of a serious bacterial infection of the
gut - Clostridium difficile infection).
Shortness of breath, hives, rash swelling of lips, face, or tongue, fainting
Vaginal itching or discharge (signs of vaginal thrush).
White patches on the tongue (signs of oral thrush) and bad taste in mouth.
Vomiting[10]
12
13. V. Antifungal
Antifungal are prescribed to treat oral thrush. The goal of treatment is to stop the spread of
the Candida fungus. Antifungal medicines are available in tablets, lozenges, or liquids that are
usually "swished" around in your mouth before being swallowed.[8]
Nystatin:
o MOA: inhibit cell wall synthesis
o Dose: 5 ml swish and swallow q 4 h x 10-14 d
o GI upset
o Drug interactions: minor
o Pregnancy category C
Clotrimazole (Mycelex), ketoconazole (Nizoral), fluconazole (Diflucan)
o MOA: inhibit cell wall synthesis
o Dose: 200-800 mg qd x up to 12 months
o GI upset
o Drug interactions: major p-450 enzyme inhibitor, interactions with many drugs
o Pregnancy category C
Complications of Antifungal
loss of appetite
vomiting
feeling sick for a long time
jaundice – yellowing of your skin or the whites of your eyes
unusually dark urine or pale faeces (stools)
unusual tiredness or weakness[11]
VI. Antiseptics
Dentist may recommend the use of an over-the-counter antiseptic mouth rinse product to reduce
plaque and gingivitis as well as kill germs, which may be the cause of bad breath.
Knowing the role of supragingival plaque in the initiation of periodontal disease and insufficient
control of the plate, the use of antiseptics is warranted. This anti-plaque derived from different
chemical classes and has different mechanisms of action.[8]
VII. Dry Mouth Drugs
Pilocarpine, marketed as Salagan, may be prescribed by your dentist if you have been diagnosed
with dry mouth. The drug stimulates saliva production. [8]
VIII. Muscle Relaxants
Muscle Relaxants may be prescribed to reduce your stress to help you stopgrinding your teeth and
to treat temporomandibular joint disorders.E.g. Valium in low dose. [8]
13
14. IX. Drugs to Control Plaque and Gingivitis
Chlorhexidine is an antibiotic drug used to control plaque and gingivitis in the mouth or in
periodontal pockets (the space between your gum and tooth). The medication is available as a
mouth rinse and as a gelatin-filled chip that is placed in the deep gum pockets next to your teeth
after root planing. The drug in the gelatin-filled chip is released slowly over about seven days.
Dental products containing this antibacterial are marketed under various prescription-only brand
names, such asPeridex, PerioChip, and PerioGard, as well as other over-the-counter trade names.
Complications: Chlorhexidine may cause an increase in tartar on your teeth. It may also cause
staining of the tooth, tooth filling, and dentures or other mouth appliances. Brushing with a tartarcontrol toothpaste and flossing your teeth daily may help reduce this tartar build-up and staining.
In addition, you should visit your dentist at least every six months to have your teeth cleaned and
your gums examined. Be sure to tell your dentist if you have ever had any unusual or allergic
reaction to this medicine or to skin disinfectants containing chlorhexidine. [8]
X. Other dental medications
Fluorides
Fluoride which is available in most over-the-counter toothpastes, is used to prevent tooth decay.
Prescription strength fluoride is also available if prescribed by a physician. [8]
Types of Fluorides
F tooth paste
F varnish
F mouth rinse
F tablets
Benzodiazepines
Benzodiazepines such as diazepam (Valium) is used for the management of anxiety disorders or for
the short-term relief of the symptoms of anxiety. It works by relaxing the patient during dental
procedures such as temporomandibular joint disorders.
Saliva substitutes
Saliva substitutes such as Moi-Stir, Mouth Kote, Optimoist, Saliva Substitute, Salivar and Xero-Lube
are used for treating dry mouth, an occasional complication of autoimmune diseases or occasionally
unassociated with other diseases. They usually come as sprays and are used as needed. [3]
14
15. Dental Prophylactic Preparations
Prophylactic means a medicine which preserves or defends against disease or any device or
mechanism intended to prevent harmful consequences.[12]
Mouthwash
Mouthwash or mouth rinse is a chemotherapeutic agent used as an effective home care system by
the patient to enhance oral hygiene. Some manufacturers of mouthwash claim that antiseptic and
anti-plaque mouth rinse kill the bacterial plaque causing cavities, gingivitis, and bad breath. Anticavity mouth rinse uses fluoride to protect against tooth decay. It is, however, generally agreed that
the use of mouthwash does not eliminate the need for both brushing and flossing. As per the
American Dental Association, regular brushing and proper flossing are enough in most cases
although the ADA has placed its Seal of Approval on many mouthwashes that do not contain alcohol.
Mouthwash is a liquid solution that is swished around inside the mouth to cover the teeth, gums
and tongue, and then is spit out. Some types of mouthwashes help to temporarily mask bad breath
(halitosis) as well as rinse the area of debris and bacteria. Others are intended to coat the teeth with
fluoride to strengthen them and help prevent decay. Mouthwash may be available in over-thecounter or prescription forms. [13]
Figure 7: Mouthwash
Contents
Sorbite, silicon dioxide, polyethyleneglycol, demineralised water, sodium lauryl sarcosinate,
flavoring material, sodium monofluorophosphate (fluoride weight fraction 0,1%), papain, sodium
carboxy-methylcellulose, stevioside, calcium glycerophosphate, tea tree oil, methyl paraben, propyl
paraben, disodium salt EDTA, CI 19140, CI 42090. [13]
15
16. The Manufacturing Process
Weighing and mixing
Figure 8: Manufacturing Process
1. After transporting the raw materials into the factory, the ingredients are both manually and
mechanically weighed. This ensures accuracy in the ingredients' proportions. Then the ingredients
are mixed together. Usually, the glycerin-water mixture is done first.
2 .All the ingredients are mixed together in the mixing vat. The temperature and humidity of vat are
watched closely. This is important to ensuring that the mix comes together correctly. A commonly
used vat in the toothpaste industry mixes a batch that is the equivalent of 10,000 four-ounce (118
ml) tubes.
Filling the tubes
3. Before tubes are filled with toothpaste, the tube itself passes under a blower and a vacuum to
ensure cleanliness. Dust and particles are blown out in this step. The tube is capped, and the
opposite end is opened so the filling machine can load the paste.
16
17. 4. After the ingredients are mixed together, the tubes are filled by the filling machine. To make sure
the tube is aligned correctly, an optical device rotates the tube. Then the tube is filled by a
descending pump. After it is filled, the end is sealed (or crimped) closed. The tube also gets a code
stamped on it indicating where and when it was manufactured.
Packaging and shipment
5. After tubes are filled, they are inserted into open paperboard boxes. Some companies do this by
hand.
6. The boxes are cased and shipped to warehouses and stores.
Quality Control
Each batch of ingredients is tested for quality as it is brought into the factory. The testing lab also
checks samples of final product. [13]
Toothpaste
In our daily activities can not be separated from tooth brushing with a toothbrush and toothpaste.
Activities toothbrush should be done 2-3 times a day, mainly carried out after every meal. If ones
never once in a day does not brush his teeth, consequently the mouth feel uncomfortable and
awkward to talk to someone at close range because worry about bad breath. [14]
Figure 9: Toothpaste
When used for toothbrushes, toothpaste that both must satisfy the properties:
Can remove foreign particles, the remaining food on the teeth, plaque or tartar, and can clean
teeth.
It should not toxic, has a sense of fun and feel fresh after using the mouth. [14]
17
18. The raw material is composed of toothpaste
1. Polishing material (abrasive), is one of the most important ingredient to remove food particles
remaining on the teeth. Materials used include aluminum phosphate.
2. Foaming material, serves to assist the action polishing materials by wetting the teeth and food
particles left on the teeth and also serve as mucus emulsifier in the mouth. Materials used as
foaming agent is SLS (sodium lauryl sulfonate) by trade name texapon, FAME, etc.
3. Materials moistener (moisturizer), serves to prevent drying and hardening of the toothpaste.
Materials often used include glycerin, propylene glycol, etc..
4. Binder, serves to prevent separation of ingredients in toothpaste. Materials used include sodium
alginate.
5. Sweetening matter, serves to also write a sweet taste in toothpaste. Materials used include
saccharin.
6. Flavoring agent, serves to provide aroma and flavor in pasta and avoid feeling of nausea. In
addition, to increase the freshness of toothpaste. Materials used peppermint oil.
7. Preservative, serves to maintain the physical structure, chemical and biological toothpaste. This
material should not toxic. Preservative sodium benzoate used.
8. Fluoride materials, is one substance that serves for the growth and health of teeth, coating the
tooth structure and resistance to decomposition process and trigger mineralization. The flour give
the effect of detergents and chemical elements harden tooth enamel coating. Fluoride is widely used
is one of sodium fluoride (NaF). Provision of fluoride toothpaste is recommended for 0.05% 0.08%, due to excess of fluoride will cause damage to health. The authors recommend that in
making toothpaste without fluoride does not matter. [14]
Composition
1.
2.
3.
4.
5.
6.
7.
8.
9.
Aluminum phosphate maximum
Texapon 3%
Glycerin (15-20)%
Sodium alginate 25%
Saccharin taste
Peppermint oil to taste
Sodium benzoate 0.1%
Sodium fluoride
Sufficient water
Equipment needed: container and wood stirrer
18
19. Preparations
1.
2.
3.
4.
5.
6.
7.
8.
Sodium alginate + glycerin mix evenly
(1) + Texapon mix evenly
Water + Sodium benzoate stir
(3) is mixed into (2) stir + NaF
(4) + Sweeteners stir
(5) + Aluminum phosphate mix
(6) + Peppermint oil mix
Ready packaged
Recommendations
To keep your teeth healthy it is recommended to clean them not less than 2 times a day. Additional use of
elixir for the mouth cavity provides even better result. [7]
Reduce sugar intake.
Brushing twice a day.
Flossing once daily.
Use of mouthwash.
Healthy snack habit.
Proper brushing method
Teeth Brushing Technique
Proper brushing takes at least 2 min.
Use short gentle strokes.
Make a 45 degree angle between brush and tooth surface .
Clean the outer surface of upper teeth , then lower teeth .
Clean the chewing surface.
Make sure to brush your tongue .[7]
Figure 10:Proper Teeth Brushing Technique
19