Lower Right Lingual Most Difficult Area to Clean

Several authors have reported that the area in the mouth most likely to be missed with toothbrushing is the lower rightlingual. This area is also reported to have the highest levels of plaque and gingivitis, compared to other areas of the mouth.

In a clinical practice, the hygienist noticed many patients with problems brushing the mandibular right lingual surfaces. These surfaces had more plaque and more inflammation than other areas of the mouth. It was decided to change
the pattern of toothbrushing to begin in this area. Ten patients with puffy, swollen lingual tissue were invited to participate in this Action Research Project. An intraoral camera was used to capture images of both the right and left
mandibular lingual tissues. These images were shared with the patient and the difference between the sides was discussed.  Following their routine prophylaxis, they were given a new toothbrush and instructed to brush the lower right inside surfaces first, before brushing the rest of the teeth. They were given a disposable mouth mirror and asked to evaluate the tissue for any changes after brushing this way for two weeks. The hygienist either telephoned or emailed, per patient request, after two weeks to see if any difference was noted.

Of the ten patients who participated in this study, six patients reported improvement in the tissue color and no bleeding upon brushing or flossing. Three patients didn’t notice any difference and one forgot the instructions and didn’t make any changes to the brushing pattern.

Rogers, C.: Would Starting Toothbrushing on the Lower Right Lingual Reduce Tissue Swelling from Inflammation? OHU Action Research 9A-13, 2014.