Throughout the United States, it is widely understood that the path to good oral health involves brushing the teeth twice daily with a fluoride toothpaste and cleaning between the teeth once a day with floss or an interdental cleaner. This effective health plan has not always been so popular, however, and it was not until after World War II that people in the United States developed the oral hygiene habits that are recommended today. The first patent for a toothbrush was granted in 1857, to Washington D.C. dentist Dr. H. N. Wadsworth, but toothbrushes were not mass produced in the United States until 1885, and oral hygiene habits were not widely adopted until soldiers returning home from war brought their newfound hygiene habits with them; these soldiers brushed their teeth regularly in order to stay healthy and hearty enough to remain on the front lines and not get sidelined by painful tooth decay.
While the toothbrush itself did not become a common household item until the mid-20th century, people from various cultures have been keeping their mouths and teeth clean for centuries. Archaeologists have unearthed a long history of oral hygiene. Twigs with frayed ends, called chew sticks, were used to brush the teeth as early as 3500 BCE, in ancient Mesopotamia. Similar tools were also used in ancient Egypt, as early as 3000 BCE, and in China in 1600 BCE. In some developing areas, chew sticks remain popular. The first toothbrush with bristles is believed to have been developed in China during the Tang Dynasty (619-907). These early toothbrushes were made of hog bristles affixed to a handle of either bamboo or bone. Travelers brought these early toothbrushes from China into Europe, where toothbrushing was adopted in the 17th century, though Europeans preferred softer bristles made of horsehair. Toothbrushes were mass produced in the UK as early as 1780, and by 1840 they were being made throughout Europe, the UK, and Japan. Gradually, natural materials were replaced with synthetic ones, with handles made of celluloid, and then thermoplastic materials, and bristles made of nylon, and by 1954, a Swiss inventor had gone so far as to invent the first electric toothbrush.
Since their wider adoption in the 1940s, toothbrushes have been developed in many shapes, sizes, textures, and forms, with the goal of serving a wide array of people and needs. Some of these innovations are more successful than others. Electric toothbrushes, for example, which clean the teeth with a multi-directional rotating brush, have been shown to better clean harder-to-reach areas of the mouth and to remove a greater amount of plaque more efficiently than manual brushes. Electric toothbrushes may also be recommended for patients who brush incorrectly, as incorrect brushing can damage the delicate tissues of the gums. Dentists recommend brushing in a soft, circular motion with a soft-bristled brush and a nonabrasive fluoride toothpaste, while holding the brush gently against the teeth, and brushing in this manner for an adequate amount of time. Brushing too hard or in a rigid horizontal pattern can lead to gum recession and tissue damage, as well as leaving behind plaque at the gumline. Flossing, or using an interdental toothbrush, can help remove residual plaque, and regular dental checkups and professional cleanings are recommended to remove tartar and to assess the health of the gums and teeth.