Toothbrushes
		From tooth-stick to modern toothbrush industry Dental care has far-reaching economic significance Proper and regular dental care is an important contribution to oral health. And using the right brush is an important economic factor. Statistics collected in recent years prove that caries in children and adolescents has been more than halved since 1973. According to calculations made by the Ministry of Health, improved oral hygiene has saved millions of marks in visits to the dentist. However, although through the joint efforts of dentist, the Work Group for Dental Care in Youth and the manufacturers of toothbrushes and tooth pastes, the improvement in oral health is palpable, approximately DM 180 billion is still being spent on dental treatment in Germany each year, against DM 85,96 billion in 1980. This considerable cost factor justifies sustained efforts by the toothbrush industry and the dentist's organisations to continue to impress on the population the importance of regular dental care and hygiene. Statistically, Germany has a per capita consumption of 2,2 toothbrushes per annum and with respect to oral hygiene in effect is therefore still a " developing country". Dental experts point out that a toothbrush should be renewed every 2 to 3 months. Only this way can proper dental cleanliness be guaranteed. The toothbrush industry offers consumers a wide choice of different toothbrushes with a varying degree of hardness/softness. Cleaning the teeth is the best way to prevent caries and plaque developing. However far too little information is passed on to patients in Germany's dental practices on the subject of "Cleaning one´s teeth". In June this year, an article on this subject was published in "Stern", a leading German weekly magazine: " A study made by Peter Purcker, Senior Physician at the Parodontological Department of the University Clinic of Berlin, which measures the frequency and degree of dental disease among 45 to 54 year olds shows that by international comparison the Germans come off worse than Switzerland, Scandinavia and the USA. The reasons for this wretched state of affairs are evident: Too few doctors are interested in "basic" dental care. Of 31 German university dental clinics in Germany only 10 have departments of parodontolgy, and what the students haven't been taught at univeristy they are harldy likely to catch up on in training courses as practicing dentists." Although dental care has improved tremendously in Germany in recent years, which is also reflected in expanding production figures for toothbrushes, there is nevertheless one group of people who clean their teeth more regularly than others, as one experienced dentist told us: " People in love." Dental care mirrored in history A museum of the history of dental care has opened at the General Dentists Council Building in Cologne. The curator of the museum, Egon Peters, has devoted many years of his life to this subject, collecting exhibits for the museum to illustrate and document the "cultural history of dental care." He is also author of numerous expert publications on the subject from which we would like to quote in the following. What to modern mankind has become a daily ritual only after considerable educational effort, was so matter of fact to the ancient Eqyptians that they described the morning practice of cleaning their teeth with sodium bicarbonate as "The early meal." At that time it was also popular to use twigs to clean one´s teeth. These twigs, which were chewed until they became fibrous and flared, were called miswaks or siwaks in Islamic cultures. The use of such twigs is also mentioned in the Book of Laws by Manu ( 600 BC) and recommended in a well-known ancient Indian collection of medical knowledge (Susruta, approx. 400 AD). A mixture of honey, oil, powdered Bengali pepper, cinnamon, ginger and salt was used as a "toothpaste". In pre-Islamic times, twigs chewed until they became fibrous generally served the Arabs and the African natives as a means of cleaning their teeth. Later the method acquired religious significance when Mohammed declared that a prayer said after using the miswak was worth more than 75 ordinary prayers. The meaning of dental cleanliness was already recognized in those days, but with its appearance in the Koran it became a prime obligation. Twigs of the Arak tree ( Salvadora Perscia) or other aromatic woods were usually used as miswaks or siwaks. Research has shown that the twigs used in Nigeria have a fluoride content of 8 to 22 ppm ( 8 to 20 parts per thousand). It is interesting that in ancient times natural medicine already recognized the importance of fluoride for the teeth. There is evidence for the significnace of dental care in other early religions. Around 300 BC, in Greece, Dioccles recommended dipping ones finger in mint juice to clean the teeth after rising in the morning. Rinsing out the mouth before and after meals is prescribed in the Indian Book of Laws by Manu and the ancient Indian Bower manuscripts decribe 6 recipes for mouth rinses ( 400 AD) The Aztecs also set great store by proper physical and oral hygiene: They cleaned their teeth with coal and salt and later rinsed their mouth out with urine. Using urine to rinse out the mouth was evidently not unusual in antiquity: In China, besides using pulverized horn, it was recommended that the night urine of young boys be used, and even Pierre Fauchard, the founder of modern scientific dentistry, writes in his famous work published in 1728: to prevent caries, the mouth should be rinsed with a few spoons of fresh urine in the morning and at night. However, he warns, as does Philip Pfaff, who was physician at the court of Frederick the Great, against using a toothbrush too frequently as this may damage the teeth and gums. Of course in the meantime it has been proven that using a brush to clean the teeth will not damage them. Toothpaste manufacturers have recognized that the use of abrasive components in the paste will damage the enamel of the tooth. Paintrushes as toothbrushes Toothbrushes were "invented" in 1498 in China, but they were paintbrush-shaped in imitation of the widespread toothstick. However, the plate-shaped toothbrush back as we know it today is already documented in a Chinese encyclopedia dating from 1609, a time when the paintbruh-shaped brush was still common in Europe. The plate-shaped brush didn't become established in Europe until the beginning of the 18th century. An early illustration of a toothbrush dates from the reign of Frederick the Great ( approx. 1730), but with its ornate handle and artistically crafted silver head is more like a piece of jewellery than a utensil. This is understandable because in the 18th century a brush was not considered to furnish such good results as the various other widepread remedies recommended such as powdered crab eyes, mother of pearl, horn and toads legs pickled in urine. The only dentist in the 18th century to set forth the importance of cleaning ones teeth once a day with a toothbrush was the Englishman Thomas Berdmore. While agreeing in an essay dated from 1771 with the general view that brushing ones teeth is harmful to the gums he does however reveal the real reason and that is that the gums only bleed if not looked after properly and recommends that children should start cleaning their teeth with a brush and water on a daily basis from the time they loose their milk teeth. He also recommends that adults whose gums bleed when cleaning their teeth should just continue doing so as brushing stimulates the gums and makes them firm again. A remarkable piece of knowledge for those days which still has validity today. Although his teachings on oral hygiene did not have much bearing on reality, Fauchard (1728) was right in claiming that sweets may damage the teeth and recommended rinsing out one´s mouth with warm water after eating them. It was not until 1801 that the German court physician Carl Schmidt strongly recommended brushing children's teeth - albeit before breakfast. Progressive for his day, Schmidt also rectified the widespread belief that brushing the teeth damaged the enamel, this only being possible he claimed by using aggressive powders. While a whole range of different toothbrush designs were available, some of which were designed to clean specific areas, were already available in 19th century France, in Germany brushes were still used sparingly, in spite of widespread vanity. It wasn't until the second half of the 19th century that brushes became common in Germany, too, although doctors and dentists still warned against their use. Instructions on how to brush the teeth can be found in textbooks of the time, where a rotational movement is recommended. The biggest variety of toothbrush shapes is not found until the 20th century and the creativity displayed by manufacturers and inventors in bringing forth such a multitude of different shaped brushes to ensure optimum dental care is remarkable. However, in spite of all attempts at modification the "normal" toothbrush with synthetic bristles and a small head has won through as a basic concept. Of course, other useful dental care aids are available today, e.g. interdental brushes, dental floss and electric toothbrushes, which feature a high technological standard. Manufacturers of special machines have successfully developed high-performance machines capable of making almost any toothbrush design, in which every individual bristle is perfectly rounded. These high performance machines inspire dental hygienists to bring forth new developments and to improve a product of tremendous economic and hygienic importance: the toothbrush.
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