- A brush with a small head suits most people. Australian and American bodies advise soft bristles; UK guidance says medium or soft.
- Manual and electric brushes both clean well when used properly. Electric brushes remove a little more plaque in trials, but how much that matters in the long term is unclear.
- An electric brush can help if you find a manual brush hard to hold or control, or if you wear braces.
- Replace your brush or brush head about every 3 months, or sooner if the bristles are splayed.
- Rinse it after use, store it upright to air dry, and do not share it.
The toothbrush aisle offers a lot of choice, but the NHS says cleaning your teeth thoroughly at least twice a day is more important than the type of brush. This guide sets out what health bodies say to look for. For technique, see how to brush your teeth, and for toothpaste, toothpaste explained.
What size head and which bristles?
A small head is the common advice. healthdirect Australia and the Better Health Channel (Victoria) advise a small head and soft bristles. The NHS says that for most adults, a brush with a small head and a compact, angled arrangement of long and short, round-ended bristles is fine.
Soft or medium bristles?
The sources differ slightly here.
- Soft: the American Dental Association recommends soft bristles for both manual and powered brushes. It says medium bristles do remove plaque (the sticky film of bacteria on teeth), but recommends soft because they lower the risk of damaging the gums. Its consumer site goes further, saying firm or even medium bristles may damage the gums and enamel. healthdirect, the Better Health Channel and the Australian Dental Association also advise soft bristles.
- Medium or soft: the NHS says medium or soft bristles are best for most people. The UK government's guidance for dental teams, Delivering Better Oral Health, says there is low-certainty evidence that medium and soft bristles are less likely to injure the gums than hard ones, and that for most people a small-headed brush with medium bristles is appropriate.
None of these sources recommends hard bristles. If your teeth are sensitive or your gums have shrunk back, see tooth sensitivity and receding gums.
Manual or electric?
Both can work well. The NHS says it does not matter which you use, as long as you clean all surfaces of your teeth with fluoride toothpaste, though some people find an electric brush makes thorough cleaning easier. The American Dental Association says both can clean teeth effectively and it comes down to preference.
The Australian Dental Association puts more weight on the research: it says electric brushes can remove more bacteria and reduce gum inflammation more than manual brushes, but that how well any brush cleans depends on how well you use it.
What the research shows
A Cochrane review (a large, independent summary of trials) pooled 56 trials with more than 5,000 people, up to January 2014. Compared with manual brushes, powered brushes reduced plaque by 11% after one to three months and 21% after more than three months. They reduced gingivitis (inflamed gums, the early stage of gum disease) by 6% and 11%. The evidence was of moderate quality and the benefit for long-term dental health was unclear. Few trials reported side effects, and those reported were localised and temporary.
Delivering Better Oral Health reads the evidence the same way: reviews consistently favour powered brushes, but the clinical importance is unclear. It adds that many people cannot afford a powered brush, that teeth can be cleaned effectively with either type, and that there is no evidence about which type better prevents decay.
Who might find an electric brush helpful?
The Australian Dental Association says your dentist may suggest one if you have trouble holding and controlling a manual brush, wear braces or have gum disease. The American Dental Association says people with dexterity problems or braces may find a powered brush easier, though it can cost more.
Types of electric brush
The American Dental Association lists several head movements, including side to side, rotating one way then the other (rotation oscillation), circular and ultrasonic. A 2010 Cochrane review of 17 trials found some evidence that rotation oscillation brushes reduce plaque and gingivitis more than side-to-side brushes in the short term, but the difference was small and of unclear importance, and there were too few trials to compare other types. Delivering Better Oral Health says the evidence is not enough to say that any type of powered brush is better than another.
Some electric brushes have a 2-minute timer, some signal every 30 seconds, and some have a pressure sensor that warns you when you press too hard (Australian Dental Association).
Brushes for children
The American Dental Association says to start brushing as soon as the first tooth appears, using a child-sized brush with soft bristles and a head small enough to reach every tooth surface. The NHS advises a small, soft brush that is right for your child's age, and says not to let children run around with a toothbrush in their mouth. For toothpaste amounts by age, see children's teeth.
Brushing with braces
The NHS says to brush with fluoride toothpaste in the morning, at night and after meals, and to use an interdental brush every day to clean between the teeth and under the brace. As above, an electric brush can help. See braces and aligners and cleaning between your teeth.
If brushing is difficult
Delivering Better Oral Health says adapted brushes, such as ones with special grip handles, can help people with limited hand movement or physical disabilities, and that some people with learning disabilities may benefit from a powered brush. It notes that some people find powered or three-headed brushes difficult or worrying to use, so they will not suit everyone, and that the evidence for three-headed manual brushes is of low to very low certainty. A dental team can advise. For help brushing someone else's teeth, see caring for someone else's teeth.
When to replace your brush
Replace your brush or brush head every 3 months (Australian Dental Association, healthdirect), or when it looks worn. The American Dental Association says every three to four months, or sooner if the bristles are matted or frayed, because a worn brush cleans less well. The Australian Dental Association adds that pressing too hard wears bristles out faster, and splayed bristles stop you cleaning your teeth well.
Keeping your toothbrush clean
The American Dental Association advises:
- Do not share a toothbrush, because it can pass on body fluids and germs.
- Rinse it thoroughly after each use.
- Store it upright and let it air dry. Keep it apart from other people's brushes, and do not routinely cover it or keep it in a closed container, because a moist, closed space helps bacteria grow more than open air does.
- Skip the microwave and dishwasher. High heat can damage the brush.
It says brushes do carry bacteria, but there is no evidence these cause health problems.
What does a seal of approval mean?
Some dental associations run schemes that assess products. The American Dental Association's Seal of Acceptance requires a manual brush to have safe components, bristles without sharp edges that do not fall out, a durable handle, and evidence that it significantly reduces plaque and mild gum disease. Powered brushes also go through electrical safety and clinical testing. The American Dental Association describes the Seal as a voluntary programme, so a product without one has not necessarily been tested and failed. The Australian Dental Association runs its own Seal of Approval, which it says verifies that over-the-counter products are safe, effective and consistent with their advertising claims.
Delivering Better Oral Health says bamboo brushes have a lower carbon footprint but need a lot of land and water to grow, and there is little evidence on how well they clean. Brush heads of any material contain nylon or metal and cannot currently be recycled; it suggests removing the head and recycling the handle where possible.
- Your gums bleed, look red or feel sore when you brush.
- You find it hard to hold a brush or reach all your teeth, and want advice on an electric or adapted brush.
- You wear braces or other dental appliances and are not sure how to clean around them.
- You are not sure which bristle firmness suits you, for example because your teeth are sensitive.
Frequently asked questions
Do I need an electric toothbrush?
No. The NHS says manual and electric brushes are equally good if you clean every surface with fluoride toothpaste. Trials show electric brushes remove slightly more plaque, and the Australian Dental Association says a dentist may recommend one if you have braces, gum disease or trouble controlling a manual brush.
Should I cover my toothbrush or keep it in a case?
Not routinely. The American Dental Association says a closed, moist container encourages bacteria to grow more than open air. Let it air dry upright.
Are bamboo toothbrushes better?
Not clearly. Delivering Better Oral Health says there is little evidence on how well they clean, and they have their own environmental costs.
Sources
- How to keep your teeth clean, NHS, accessed September 2026
- Children's teeth, NHS, accessed September 2026
- Braces and orthodontics, NHS, accessed September 2026
- Delivering better oral health, chapter 8: oral hygiene, Department of Health and Social Care and NHS England, accessed September 2026
- Dental care and teeth cleaning, healthdirect Australia, accessed September 2026
- Teeth and mouth care, Better Health Channel, accessed September 2026
- Brushing teeth, Australian Dental Association, accessed September 2026
- How to brush with an electric toothbrush, Australian Dental Association, accessed September 2026
- Seal of Approval, Australian Dental Association, accessed September 2026
- Toothbrushes, American Dental Association, accessed September 2026
- 10 things you didn't know about your toothbrush, American Dental Association (MouthHealthy), accessed September 2026
- ADA Seal of Acceptance, American Dental Association, accessed September 2026
- Whitening, American Dental Association (describes the Seal as voluntary), accessed September 2026
- Powered versus manual toothbrushing for oral health, Cochrane (Yaacob and others, 2014), accessed September 2026
- Different powered toothbrushes for plaque control and gingival health, Cochrane (Deacon and others, 2010), accessed September 2026
This article is general information about oral health. It is not a diagnosis or a substitute for advice from a dentist or doctor who knows your situation. If you have pain, swelling, bleeding that does not settle, or a problem that is getting worse, see a dental professional. In an emergency, contact your local emergency service.