Reports & Studies

Medium bristles – are they really a problem?

PD Dr Kristina Bertl, PhD MSc MBA

The discussion on soft, medium or hard bristled toothbrushes is not a new one, and yet new literature on the subject is appearing all the time, so it is something we are keen to address.

Medium bristles
Medium bristles – are they really a problem?

Gingival recessions either occur in periodontitis patients or in patients with excessive and/or incorrect brushing technique. Small injuries, irritations and lesions on the gingiva are potential ‘precursors’ for the emergence of gingival recessions. This was also the subject of a recently published study which looked at this “old” topic once again, and compared soft- and medium toothbrushes in a randomised, controlled clinical study (Romitti 2022).

Specifically, 20 participants were recruited who each used a toothbrush with either soft or medium bristles for a period of 3 months. The aim of the study was to investigate whether gingival lesions occur as a precursor of possible gingival recessions more or less often, depending on bristle stiffness.

In total, 65 percent of study participants had a gingival lesion at least once during the course of the study. In 40 percent of study participants, this gingival lesion occurred without exception while using a toothbrush with medium bristles. This was also clearly reflected in the statistical analysis, which demonstrated a significantly increased risk (3.6 times) of a gingival lesion when using a toothbrush with medium bristles. Additionally, almost 60 percent of participants stated that they noticed pain and bleeding gums after brushing with a medium-bristled toothbrush.

This study therefore underlines the significance of our recommendation with regard to using soft-bristled toothbrushes.


  1. Romitti D, Fagundes AV, Angst PDM, Gomes MS, Gomes SC, Oppermann RV. The use of medium bristle toothbrushes is associated with the incidence of gingival fissures. Clin Oral Investig (2022) Feb;26(2):1657-1666. doi: 10.1007/s00784-021-04138-6.