Safety and plaque removal efficacy of a battery-operated power toothbrush and a manual toothbrush

PURPOSE

To compare the safety and plaque removal efficacy of a battery-operated power toothbrush and a reference adult manual toothbrush.

MATERIALS AND METHODS

This was a single-blind, randomized, split-mouth study. The power toothbrush studied was the Braun Oral-B Battery toothbrush (D4) and this was compared with a standard reference ADA manual toothbrush. The D4 toothbrush is derived from the Plaque Remover range of toothbrushes and has an oscillating/rotating action. At an initial visit, subjects (n = 48) were given a baseline examination of the oral hard and soft tissues and were instructed in the use of the D4. After one week during which subjects used the D4 at home, they returned to the test facility having abstained from oral hygiene for 23-25 hours. Two contralateral quadrants of the mouth were then randomly assigned to be cleaned with each toothbrush. Plaque assessments and hard and soft tissue examinations were made before and after brushing each quadrant for 15 seconds. Plaque was evaluated using the Rustogi modification of the Navy Plaque Index.

RESULTS

Plaque levels were significantly reduced for all sites, marginal sites and approximal sites by both toothbrushes (P < 0.0001), but the efficacy of the D4 was significantly greater than that of the ADA manual brush for all comparisons (P < 0.0001). The greatest difference between the two toothbrushes was at approximal sites where the D4 removed 19% more plaque than the manual toothbrush. For all sites, the D4 was 14% more effective, while at marginal sites the difference in favor of the D4 was 12%.

Clinical evaluation of the efficacy of a battery-powered toothbrush. results from two independent studies

PURPOSE

To compare the clinical efficacy with respect to plaque removal of a battery-operated power toothbrush (Dr. Johns Spin Brush Classic) with two manual toothbrushes, a standard ADA flat trim reference brush and the Oral-B CrossAction toothbrush.

MATERIALS AND METHODS

Efficacy was evaluated in two independent studies using a randomized, single-use, cross-over design. Healthy adult subjects from a general population brushed their teeth for a timed 1 min and plaque was scored before and after brushing was completed. In Study 1 (Spin Brush vs. ADA toothbrush), plaque was scored using the modified Quigley and Hein Plaque Index, while in Study 2 (Spin Brush vs. CrossAction) plaque was scored using the Modified Navy Plaque Index. In addition, a hard and soft tissue examination was carried out before and after brushing to allow evaluation of safety.

RESULTS

In Study 1, both the ADA toothbrush and the Spin Brush significantly reduced levels of whole mouth and approximal plaque (P < 0.0005); however, the Spin Brush was not significantly more effective than the manual brush. Relative plaque reduction for the whole mouth was 35.6 +/- 16.0% for the Spin Brush compared to 38.9 +/- 14.9% for the manual toothbrush (P < 0.047), and, for the approximal surfaces, 32.7 +/- 14.6% and 36.3 +/- 13.7%, respectively (P = 0.024). In Study 2, both toothbrushes significantly reduced plaque levels (P < 0.0001), but, as for Study 1, the CrossAction manual toothbrush was more effective than the Spin Brush. For whole mouth, marginal and approximal sites, respectively, the Spin Brush reduced plaque by 54.3%, 43.5% and 62.0%, compared with 58.6%, 47.5% and 67.1% for the CrossAction toothbrush. The difference in favor of the CrossAction brush was statistically significant (P < 0.0005) for all areas.

An evaluation of a commercial chewing gum in combination with normal toothbrushing for reducing dental plaque and gingivitis

New evidence suggests a beneficial outcome to chewing a sugarless gum as an added component to a regular, twice-daily toothbrushing regimen. Results of a 4-week study performed on 78 adults with preexisting gingivitis showed a significant reduction of dental plaque and gingivitis when the test group of 39 adults chewed 2 pieces of ARM & HAMMER Dental Care The Baking Soda Gum (AHDC)--a sugar-free chewing gum containing sorbitol, malitol, xylitol, and sodium bicarbonate--for 20 minutes twice a day in conjunction with once-daily toothbrushing for 60 seconds. The control group, also comprised of 39 adults, used breath mints (the study placebo) twice a day in conjunction with the same toothbrushing regimen. There were no statistically significant differences in plaque and gingivitis scores at the baseline examination. Using the Quigley-Hein Plaque Index, the test group experienced a 17% reduction in plaque over 4 weeks, while the control group reduced their plaque amounts by approximately 9% over the same period. Lobene's Mean Gingivitis Index scores were equally significant: a nearly 10% decline for the test group compared to almost 2% for the control group. This article describes the 4-week study and its promising results.

A graphic display for the presentation of site-wise odds ratios for score transitions to augment the traditional findings from clinical studies employing dental indexes

Many of the parameters used in clinical dental research involve the assessment of a condition at each of a number of sites within the mouth. Traditionally, such measurements are averaged over all sites within the mouth (or over all sites of a specified type) for each study participant before statistical analysis. However, a consideration of the original, site-wise scores may provide some additional insights into the performance of therapeutic modalities that might not be made evident through an application of the traditional, means-based approach. A method based on the calculation of site-wise odds ratios of certain types of baseline-to-final examination score transitions was applied to the modified gingival index data from two clinical studies performed to investigate the effect of the daily chewing of a commercially available chewing gum relative to a mint control. A graphical display of these site-specific findings was prepared, which indicated that the chewing gum regimen tended to be associated with a higher frequency of occurrence of favorable score transitions than was the mint control at several measurement sites throughout the mouth.

Comparative efficacy of an antiseptic mouthrinse and an antiplaque/antigingivitis dentifrice

BACKGROUND

The efficacy of an essential oil-containing antiseptic mouthrinse (Listerine Antiseptic, Pfizer) and an antiplaque/antigingivitis dentifrice (Colgate Total, Colgate-Palmolive) has been demonstrated in numerous double-blind clinical studies. This study was conducted to determine their comparative efficacy.

METHODS

Three hundred sixteen subjects with mild-to-moderate gingival inflammation and plaque received a dental prophylaxis and began their randomly assigned brushing and rinsing regimen in an unsupervised setting. Subjects brushed for one minute and rinsed with 20 milliliters for 30 seconds twice daily for six months. The three groups were L (control toothpaste/Listerine rinse), T (Colgate Total toothpaste/control rinse) and P (control toothpaste/control rinse).

RESULTS

Subjects in the L and T groups demonstrated statistically significantly lower (P < .001) Modified Gingival Index, or MGI; Bleeding Index, or BI; and Plaque Index, or PI, at both three and six months than subjects in the P group. The magnitude of reduction for the L group was 22.9 percent, 70 percent and 56.1 percent, respectively, and for the T group, 20.8 percent, 58 percent and 22.1 percent, respectively. Subjects in the L group were not different from subjects in the T group in regard to visual signs of gingivitis (MGI), but were more effective (P < .001) than subjects in the T group in experiencing reduced BI and PI. No product-related adverse events were reported.

CONCLUSION

Although the Listerine Antiseptic and Colgate Total antiplaque/antigingivitis products produced similar, clinically significant reductions in gingivitis (as measured by MGI and BI), Listerine, when used in conjunction with a fluoride dentifrice and usual oral hygiene, provided a greater benefit in reducing plaque.

CLINICAL IMPLICATIONS

When considering an antiplaque/antigingivitis product to recommend to patients, clinicians should consider Listerine Antiseptic, in conjunction with usual oral hygiene, if more rigorous plaque control is desired.

Clinical effectiveness of essential oil-containing dentifrices in controlling oral malodor

PURPOSE

To assess the efficacy of two essential oil-containing dentifrices in the reduction of human intrinsic oral malodor ("morning bad breath").

MATERIALS AND METHODS

Two clinical trials were conducted which used observer-blind, negative control, parallel designs. To insure a homogeneous test population with similar oral odor characteristics, subjects followed instructions that included toothbrushing with a standard ADA-accepted fluoride dentifrice the night before. On odor evaluation days, subjects refrained from all oral hygiene procedures and from eating or drinking any food or beverage or smoking prior to and during the odor evaluations. Eighty healthy adult subjects in the first trial and 90 in the second trial with qualifying baseline levels of oral malodor participated. Odor ratings of each subject's breath were made by 4-5 trained judges using a nine point hedonic scale, i.e., 1 = most pleasant, 5 = neutral, 9 = most unpleasant. Qualifying subjects were randomly assigned one of two essential oil dentifrices or a negative control dentifrice. Subjects brushed with their assigned dentifrice for 60 s, rinsed with 20 ml of water for 10 s, and received post-treatment hedonic odor ratings at 30, 60, 90, 120, 180, and 240 min. Data were analyzed using an ANCOVA to adjust for baseline scores.

RESULTS

The essential oil dentifrices were significantly more effective (P < or = 0.033) than the control in reducing intrinsic oral malodor from 90 to 120 min.

The clinical effectiveness of a dentifrice containing triclosan and a copolymer for controlling breath odor measured organoleptically twelve hours after toothbrushing

The objective of this double-blind clinical study was to investigate the effectiveness of a dentifrice containing triclosan and a copolymer, Colgate Total Toothpaste, for controlling breath odor twelve hours after brushing the teeth compared to a placebo dentifrice which did not contain triclosan or a copolymer. Breath odor was evaluated by a panel of four expert judges using a nine-point hedonic scale. Following a baseline evaluation of breath odor, prospective study subjects who presented scores above the threshold value for unpleasant breath odor were stratified by score, and randomized into two treatment groups. Subjects were provided with a soft-bristled toothbrush, and brushed their teeth thoroughly in their regular and customary manner with their assigned dentifrice. Subjects refrained from dental hygiene, breath mints, or mouth rinses for the next twelve hours, after which they were once again evaluated for breath odor. Sixty-three (63) adult male and female subjects from the Mississauga, Ontario, Canada area participated in the study. At twelve hours after brushing their teeth, subjects in both dentifrice treatment groups presented mean breath odor scores which were statistically significantly lower than the mean scores observed at baseline. However, the difference between the mean twelve-hour breath odor scores differed significantly between the two dentifrices. The mean twelve-hour breath odor score for the Colgate Total Toothpaste group was 4.77, which is within the range of values corresponding to pleasant breath odor; the mean twelve-hour breath odor score for the placebo group was 6.05, which is above the value corresponding to unpleasant breath odor. Thus, the results of this double-blind clinical study support the conclusion that Colgate Total Toothpaste provides effective control of breath odor at twelve hours after brushing the teeth.

A short-term brushing model for assessing antiplaque/antigingivitis dentifrice effectiveness: a pilot study

This pilot clinical study was conducted to evaluate the utility of a short-term brushing model for assessing the inhibition of supragingival plaque and gingivitis by an essential oil-containing dentifrice formulation. Forty-two qualifying subjects entered and completed this double-blind, parallel group, controlled study. At baseline, subjects received an oral soft and hard tissue examination and were also scored for plaque, gingivitis and bleeding, both visually and invasively. Subjects received a supragingival prophylaxis and were randomly assigned to an experimental essential oil-containing dentifrice or its vehicle control. Subjects brushed unsupervised for one minute, twice daily for three weeks, after which all clinical examinations were repeated. All examinations were performed by a qualified and calibrated examiner. Analyses of covariance were used to compare inter-group means for each of the three outcome variables. Compared to its vehicle control, the experimental dentifrice produced statistically significant (p < 0.0001) reductions of 39.6% for plaque, 10.8% for gingivitis, and 65.4% for bleeding. No adverse events were observed or reported. The results of this pilot study suggest that three weeks of conventional use may be an adequate duration to demonstrate effectiveness of an essential oil-containing dentifrice. Confirmation of these results in a duplicate study is desirable to assess the reliability of the model. Furthermore, the utility of this model to determine the effects of formula modifications to the antiplaque and antigingivitis activity of active agents needs to be explored.

An advanced toothbrush with improved plaque removal efficacy

PURPOSE

To compare the plaque removal efficacy and safety of a new advanced manual toothbrush, the Oral-B CrossAction, with seven other toothbrushes.

MATERIALS AND METHODS

Seven independent, cross-over design clinical studies were conducted using the same examiner who was blind to the identity of the test products and treatment assignments. In each study, approximately 75 healthy adult subjects from a general population brushed with their randomly assigned toothbrush (CrossAction or comparison brush) at Visit 1 for 1 min without supervision or instruction in brushing technique. Subjects returned after a 1-week washout period and brushed with the alternate toothbrush (Visit 2). Plaque was evaluated before and after brushing using the Rustogi Modified Navy Plaque Index. Statistical analyses were conducted by an independent statistician who remained blind to the identity of all test products.

RESULTS

Each of the toothbrushes tested provided significant (P < or = 0.0001) reductions in plaque scores after a single brushing. In each of the studies, the CrossAction toothbrush removed significantly (P < or = 0.0001) greater amounts of whole mouth, gingival margin, and approximal plaque than the compared toothbrush. All toothbrushes were found to be safe, with no changes in oral tissues or restorations observed over the course of each study. The results from these studies were consistent, demonstrating that the CrossAction toothbrush significantly enhances the ability of subjects to remove more plaque during normal brushing compared to seven other toothbrushes.

A 3-month comparative investigation of the safety and efficacy of a new toothbrush: results from two independent clinical studies

PURPOSE

To compare the efficacy of a new toothbrush featuring a novel brush head design with those of two established toothbrushes by measuring plaque and gingivitis over a period of 12 weeks.

MATERIALS AND METHODS

The Oral-B CrossAction toothbrush was compared with the Dr. Best InterDent and Crest DeepSweep toothbrushes in two independent, parallel-group, examiner-blind clinical studies. Each study involved approximately 100 healthy individuals from a general population. At baseline, after 23-25 hrs of no oral hygiene, oral hard and soft tissues were examined and whole mouth, marginal and approximal plaque scores and whole mouth gingivitis scores were recorded. Subjects in the two studies were asked to use their assigned toothbrush twice a day. No instruction in brushing technique or brushing time was given. After a period of 6 weeks and finally after 12 weeks, subjects in the studies were reassessed for oral tissue status, and their plaque and gingival indices were rescored.

RESULTS

In each of the two studies, the tested toothbrushes significantly reduced levels of plaque and gingivitis. The CrossAction toothbrush was, however, more effective in reducing both plaque and gingivitis over 12 weeks, the differences in favor of the CrossAction being statistically significant. All the toothbrushes tested in this investigation were found to be safe with no evidence of hard or soft tissue trauma.

A comparison of the Braun Oral-B 3D plaque remover and the Sonicare plus electric toothbrush in removing naturally occurring extrinsic staining

PURPOSE

To compare the extrinsic stain-removing properties and the safety of the Braun Oral-B 3D Plaque Remover and the Sonicare Plus electric toothbrush.

MATERIALS AND METHODS

This randomized, parallel group, investigator-blinded study involved 67 subjects and was conducted over 6 weeks. After recruitment, the subjects received a baseline stain assessment (Lobene stain index) and a soft and hard tissue examination, and were then randomized to use either the Sonicare or the 3D device. All subjects were trained to use both devices, and instructed to brush twice daily with their assigned device for 2 min. The subjects' brushing technique was checked after 2 weeks. After a further 4 weeks, the subjects underwent a final stain assessment and soft and hard tissue examination. A questionnaire was also completed.

RESULTS

At 6 weeks, oral hard and soft tissue examinations revealed no abrasion or damage in either group. Both brushes produced significant (P < 0.001) reductions from baseline in total stain score, stain area and intensity, but group comparisons showed that these reductions were significantly (P < 0.001) greater for the 3D device.

Identification of bovine sperm specific polypeptides reactive with antisperm antibodies

The present study was taken to characterize molecular weights of sperm specific polypeptides antigenic to rabbits and calf with the aim to assess their immunoreactivity with IgG antibodies in sera from immuno-infertile cows. Seropositivity for antisperm IgG antibodies in 75 repeat breeder and 15 pregnant control cattle was tested by cellular ELISA using washed spermatozoa antigen from 4 bulls. Molecular weights of bovine sperm polypeptides antigenic to rabbit and calf were determined by 10% SDS-PAGE and Western blotting. Molecular weights of sperm peptides reactive with sera from immuno-infertile cows were also determined. Seropositivity of antisperm IgG antibodies for bull I, II, III and IV was 23.6, 14.6, 26.6 and 20%, respectively. A total of 16 polypeptides were discernible on gel. Out of these, 7 polypeptides were immunoreactive with sera from hyperimmunized rabbits as compared to 3 poly-peptides which reacted with sera from hyper-immunized calf. Only two polypeptides were reactive with sera from immuno-infertile cows. Variable number of sperm polypeptides and their immunoreactivity have been reported in different species. Antigenicity of different polypeptides in sperm needs further investigations.

A comparison of two electric toothbrushes with respect to plaque removal and subject preference

PURPOSE

To compare the safety and plaque removal efficacy, and subject preference of two electric toothbrushes in a single-blind, randomized, split-mouth study.

MATERIALS AND METHODS

The devices studied were the Braun Oral-B 3D Plaque Remover and the sonicare electric toothbrush. The 3D toothbrush combines the clinically proven oscillating/rotating action of the D9 with a sonic frequency pulsating action in the direction of the long axis of the bristles, giving a three-dimensional cleaning action. At an initial visit, the subjects (n = 44) were given a baseline examination of the oral soft tissues and a full mouth prophylaxis and instructed in the use of the two products, which was followed by a 4-week training period. After 2 weeks of using each toothbrush on alternate days, brushing technique was checked. After a further 2 weeks, having abstained from oral hygiene for 48 hours, two contralateral quadrants of the mouth were randomly assigned to be cleaned by the subjects with each toothbrush. Plaque assessments and soft tissue examinations were made before and after brushing. Plaque was evaluated according to a refinement of the Modified Navy Plaque Index. At the end of the study, subjects completed a product evaluation questionnaire.

RESULTS

Plaque levels were significantly reduced by both toothbrushes (P = 0.001), but the efficacy of the 3D electric toothbrush was significantly greater than that of the sonicare toothbrush (P = 0.001) for all comparisons. Plaque reduction was particularly marked in the interproximal areas, reaching 87% with the 3D product, compared with 68% for sonicare (P = 0.001). In the responses to the questionnaire, the majority of subjects stated that they preferred the 3D toothbrush (88% vs 12%), mainly because of the smaller size of the brush, ease of control and overall maneuverability.

Iodine deficiency in district Kinnaur, Himachal Pradesh

The state of Himachal Pradesh is a known iodine deficiency endemic region since the last 40 years. The state government is supplying iodised salt to the district since 1970. No recent survey has been conducted on the prevalence of iodine deficiency from the district Kinnaur which is located at an average altitude of 10,000 feet above sea level. A total of 1094 children in the age group of 6-10 years were included in the study and clinically examined. The total goitre prevalence of 6.1% was found in the subjects studied. Urine samples were collected from 226 children and were analysed using standard laboratory procedures. It was found that the percentage of children with < 2 mcg/dl, 2-4.9 mcg/dl, 5-9.9 mcg/dl and 10 and above mcg/dl of urinary iodine excretion (UIE) level was 1.3, 5.8, 10.6 and 82.3 respectively. A total of 242 salt samples were collected and analysed using the standard iodometric titration method. Results showed that almost 90% of the families were consuming salt with an iodine content of 15 ppm and more which is the stipulated level of iodisation of salt. The findings of the study indicate that iodine nutrition is in the transition phase from iodine deficient to iodine sufficient. Findings revealed a need for further strengthening the monitoring of the quality of salt being distributed in Kinnaur to achieve elimination of iodine deficiency.

Isolation of Salmonella senftenberg bacteriophages

A total of 61 bacteriophages were isolated from 100 strains of Salmonella senftenberg. Six bacteriophages were selected for typing purposes which were specific for S. senftenberg. Five phages, SasL1 to SasL5 were morphologically similar; phage SasL6 was morphologically different from the others. These phages fall into two morphological groups none of which correspond to the known tailed enterobacterial phage species. Hence, two new phage species represented by SasL1 and SasL6 are proposed.

Adjuvant effect of DEAE-dextran and tetanus toxoid on whole cell heat inactivated phenol preserved typhoid vaccine

Active mouse protection test (AMPT) and enzyme linked immunosorbent assay (ELISA) were used to determine the immunogenicity of whole cell typhoid vaccine when administered in conjunction with either tetanus toxoid (TT) or DEAE-Dextran (DD). Immunization of mice with whole cell typhoid vaccine showed enhanced potency either when administered in conjunction with TT or DD and values were statistically significant (p < 0.05) in comparison to conventional or standard typhoid vaccines. For ELISA, the mice were immunized with 2 different schedules, one in which a single dose of 0.25 ml subcutaneously (s/c) was administered and in another two doses of 0.25 ml each s/c, 14 days apart. In case of single dose schedule of immunization D vaccine (Whole cell typhoid + 5 mg/ml DD) showed significant increase of immune response (3.201 log10) as compared to plain vaccine (2.550 log10). Two dose schedule further increased the titres to 3.856 log10. DD adjuvanted vaccine showed higher potency by AMPT as compared to the TT adjuvanted vaccine or plain vaccine. The present study clearly demonstrates that a single dose of 0.25 ml which is equivalent to half of the conventionally used single human dose of typhoid vaccine adjuvanted with DD can significantly improve the immunogenicity of the vaccine.

Development of a conjoint phage typing & biotyping schema for Salmonella enterica serovar Senftenberg (S. senftenberg) & the correlation of biotypes with phage types

A total of 287 strains of S. senftenberg received from various parts of India during 1969 to 1992 were phage typed using six lysogenic phages. The typability was 90.3 per cent and 14 different phage types could be defined excluding a small group of untypable strains. A biotyping scheme was developed utilising six characters and 13 biotypes could be defined. Stern's glycerol medium proved to be the best discriminatory medium. Diversity indeces of phage typing and biotyping schemes were 0.868 and 0.503 respectively. Better discrimination was obtained when phage types were subdivided into different biotypes with a diversity index of 0.931. The schemes were found stable, reproducible and epidemiologically useful.

Bacteriophage typing in Salmonella bareilly

A total of 675 strains of Salmonella bareilly received from different parts of India and France during 1959-92 were phage typed using six bacteriophages. Overall typability achieved was 90.8% with 23 distinct phage types excluding a group of untypable strains. Phage types have been defined in octal code. Simpson's coefficient was applied for diversity index having a value of 0.839. This system was found to be reproducible, stable and epidemiologically useful.

Transferable colicinogeny in Salmonella bareilly

Twenty eight (5.6%) of the 500 isolates of S. bareilly studied were found to be colicin producers. Of these 27 (96.4%) were Col V producers. None of these produced aerobactin and 18 (64.3%) were multidrug resistant. Among 23 (85.2%) strains both drug resistance as well as colicinogeny could be transferred by conjugation. This is the first time that the transferable colicinogeny has been demonstrated in S. bareilly.

Phase I clinical trials with three formulations of anti-human chorionic gonadotropin vaccine

Comparative phase I clinical trials were carried out in 5 centres with three formulations of beta-hCG-based vaccines inducing antibodies against human chorionic gonadotropin. The objectives of these trials were to determine their relative immunogenicity, duration, reversibility and safety. A total of 116 tubal ligated women volunteers were enrolled in the study and 101 subjects were followed-up for one year or more until the antibody titres declined to near zero levels. Every woman receiving the vaccine produced anti-hCG and anti-tetanus antibodies. Clinical examination carried out at intervals of 4-6 weeks revealed no abnormality. No serious side effects or adverse reactions were reported with any of the formulations during primary immunization with three monthly injections of the vaccine. Eleven women, however, demonstrated hypersensitivity to test dose at the time of the booster injection. The reaction was to tetanus toxoid; gonadotropin subunits conjugated to another carrier did not evoke any such reaction. Progesterone in bleeds taken at midluteal phase, as well as complete progesterone and estradiol done in two immunized women, indicated normal ovulatory cycles. Immunization with these formulations had no significant effect on haematological, clinical chemistry and other metabolic parameters. In summary, the results indicate that none of the three beta-hCG-based contraceptive vaccines had any adverse effects clinically, on endocrine status and metabolic parameters. Formulations A and B induced comparatively higher anti-hCG titres than M. Thus, further work can be undertaken to study the efficacy of these vaccines in humans for preventing pregnancy.