Brushing with a manual toothbrush does not appear to result in optimal oral hygiene even with daily use. A systemic study was conducted recently to determine the average amount of plaque removed during hand brushing. The study showed that plaque reduction after a single manual brushing exercise was approximately 42 percent. The study analyzed various toothbrush bristle designs and found that the most frequently recommended toothbrush configuration with a "flat-trim" bristle design removed less plaque than a toothbrush with multi-level bristles, which was shown to remove 61 percent of plaque. The amount of time spent brushing was also found to be a factor in the effectiveness of plaque removal. Plaque was reduced by 27 percent after one minute of brushing. With two minutes of brushing, plaque reduction increased to 41 percent. The bottom line is...regular maintenance visits are vitally important to remove the plaque that leads to decay and eventually to periodontal disease. If periodontal disease is already present, recall maintenance visits after initial periodontal therapy are just as important to oral health.