Manual versus powered toothbrushing for oral health

Assessment of Nursing Staff's Knowledge, Attitude and Practice Regarding Oral Hygiene Care in Intensive Care Unit Patients: A Multicenter Cross-sectional Study

Background

Oral care is one of the fundamental nursing care procedures used to decrease oral colonization, dental plaque, respiratory infections, patient stay, and cost. The importance of good oral hygiene for patients in intensive care units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear. Therefore, the aim of this study was to assess the knowledge, attitude, and practice of nursing professionals regarding oral healthcare in ICUs among various medical institutes across India.

Materials and methods

A questionnaire-based multicentric cross-sectional survey was conducted among registered nursing professionals employed at ICUs of three government tertiary healthcare centers (THC) of India: THC-I, THC-II, and THC-III located in the eastern and northern parts of India between February 2022 and July 2022.

Results

A total of 150 nurses completed the questionnaire form (response rate: 62.5%) comprised of 49 (32.7%) males and 101 (67.3%) females with a mean age of 35.69 ± 7.7 years. Nursing officers' knowledge surpassed that of staff nurses regarding the duration of toothbrushing (p = 0.033). Among interinstitutional comparisons, THC-I nurses showed the greatest knowledge regarding the duration of toothbrushing and the mechanism of preventing saliva accumulation to reduce microbial growth (p = 0.013 and p = 0.003, respectively). Based on total work experience, participants were segregated into three groups: Group I (<7 years), group II (7.1-13.9 years), and group III (>14 years). Group II surpassed the knowledge of denture removal during sleep, cleaning after every meal, and storing in personalized air-tight containers (p = 0.001 and p = 0.036, respectively). The majority from group II recommended plain saline as the material for oral hygiene maintenance in ICU patients (p = 0.008). Group III predominantly practiced the ideal handwashing technique pre- and post-patient contact which was statistically significant (p = 0.001).

Conclusion

This study observed that a knowledge gap exists among the nurses of the three institutes across India pertaining to the oral hygiene care of ICU patients. Nurse's education and implementation of the proper oral hygiene measures for intubated patients in ICU setup is an essential need.

How to cite this article

Kumar S, Singh B, Mahuli AV, Kumar S, Singh A, Jha AK. Assessment of Nursing Staff's Knowledge, Attitude and Practice Regarding Oral Hygiene Care in Intensive Care Unit Patients: A Multicenter Cross-sectional Study. Indian J Crit Care Med 2024;28(1):48-57.

Long-term comparison of the efficacy of manual versus powered tooth brushing in adolescent orthodontic patients: a single-centre, parallel design randomized clinical trial

BACKGROUND AND OBJECTIVES

To-date, there is no evidence comparing the long-term efficacy of powered and manual toothbrushes in adolescents undergoing fixed appliance treatment. The trial compared the efficacy of manual versus powered toothbrush in controlling plaque and gingival health in patients undergoing fixed treatment in respect of both the short- and long-term.

TRIAL DESIGN

This was a randomized, parallel, controlled single-blind clinical trial, undertaken in a hospital setting, for which the consolidated standards of reporting trials guidelines were followed.

METHODS

Ninety-two adolescent participants planned to undergo fixed appliance therapy, were randomly assigned to either a manual or powered toothbrush, with allocation concealment. The outcome measures were plaque and gingival indices and bleeding on probing, assessed at baseline (prior to fixed appliance), one-, six- and 12-months.

RESULTS

The final sample included 84 participants, aged 12-18 (M=14.1, SD=1.93) years, with 40 (47%) were using a manual and 44 (52%) a powered toothbrush. The intervention (powered vs. manual toothbrush) itself appeared insignificant with regards to the gingival index (GI) (95%CI -0.1 - 0.03; P=0.26), plaque index (PI) (95%CI -0.13 - 0.14; P=0.93) and bleeding on probing (BoP) (95%CI -0.03 - 0.03; P=0.98) at any of the time points assessed. However, periodontal health indicators and plaque control significantly worsened (p<0.01), over the 12-month follow-up period, following placement of the fixed appliances placement.

CONCLUSION

Whilst no differences were found between manual and powered toothbrushes in controlling plaque and gingival health, in participants undergoing fixed orthodontic treatment, both were suboptimal and highlighted the need for greater patient support and monitoring.

TRIAL REGISTRATION DETAILS

https://doi.org/10.1186/ISRCTN74268923 Trial funding: Colgate-Palmolive (USA).

Does education in special care dentistry increase people's confidence to manage the care of a more diverse population?

Education in Special Care Dentistry (SCD) at undergraduate and postgraduate levels is often limited when compared with other dental specialities, even though dental professionals encounter people with Special Healthcare Needs (SHCNs) on a very regular basis. This literature review examined whether education at undergraduate and postgraduate level increases dental students' and professionals' confidence in managing a patient with SHCN. It also appraised whether there was a correlation between increased practitioner confidence and increased quality of care for people with SHCN. This review also examined educational efforts worldwide, and whether there is an increased emphasis on providing education in SCD to dental students. It was found that those who received high-quality practical and theoretical education on how to properly manage patients with SHCN reported having higher levels of confidence than those who did not. People also reported being far more likely to employ the proper behavior management techniques and were more likely to treat people with SHCN regularly. There has been an increased emphasis on providing education in SCD worldwide in recent years, but a number of barriers still exist to providing complete education in the area.

Oral Health Factors Related to Rapid Oral Health Deterioration among Older Adults: A Narrative Review

Older adults who face systemic health issues and lack adequate social support are at risk for oral health deterioration. How rapidly such changes take place depends on the severity of their medical condition and their ability to access oral health services in a timely manner. The management of dental caries and periodontal disease in this cohort is made complex by the interaction of local and host factors such as the presence of dry mouth, involvement of root surfaces, and altered wound healing. in addition to enhanced maintenance needs to avoid recurrence or progression. Tooth replacement can be beneficial in restoring oral function, allowing patients to enjoy a healthy and nutritious diet but requires careful consideration to avoid further damage to remaining dental units. Establishing a dental home for the older adult can facilitate routine surveillance, disease prevention, and patient/caregiver education to achieve oral health goals commensurate with overall health. This narrative review details oral health factors that are related to rapid oral health deterioration among older adults.

[The contribution of the combined use of an electric toothbrush and specialized toothpaste for electric brushes to the dental health of young people aged 18-25 years]

THE AIM OF THE STUDY

Was to assess the impact of two toothpastes marked as «Whitening» and two electric toothbrushes on the dental health values of young adults aged 18-25 years.

MATERIAL AND METHODS

The study comprised 139 young adults 18-25 years old participated to assess the improvement of dental index score in dynamic observation. The study groups were formed by random sampling.

RESULTS

The effectiveness of two types of electric toothbrushes in combination with two different toothpastes has been studied. Significant improvement of oral health indices in 3 months of investigation was found in the study group with sonic electric brush and toothpaste specially designed for use with electric toothbrushes (p<0.01).

CONCLUSION

The study showed the benefit of combined use of sonic electric brush and low abrasive toothpaste containing bromelain, xylite, calcium glycerophosphate and magnesium chloride for dental health of young adults aged 18-25 years.

The Influence of Coordinative Skills on the Oral Health of Children and Adolescents in Permanent Dentition

Removing dental plaque by using a toothbrush is the most important measure for oral hygiene. The aim of the present study was to estimate the impact of the coordination skills of children and adolescents on their oral health (plaque level, DMF/T: decayed, missing, filled teeth). Within a prospective cohort study, 996 children (10 to 18 years) were examined. The results of three coordination tests from the Motorik Modul (MoMo) were included to evaluate the coordination skills. Other parameters taken into account were age, sex, orthodontic treatment and socioeconomic status (SES). Univariate and various multivariate analyses were performed to evaluate relationships. Better results in precision coordination tests were significantly related to a better oral hygiene (backward balancing: logistic regression OR 0.86, 95%CI: 0.73−0.99, p = 0.051, proportional odds model OR 0.86, 95%CI: 0.75−0.99, p = 0.037; one-leg-stand: logistic regression OR 0.78, 95%CI: 0.63−0.96, p = 0.018, proportional odds model OR 0.77, 95%CI: 0.64−0.92, p = 0.003). Higher scores on one-leg-stand were significantly related to a lower caries prevalence (logistic regression OR 0.81, 95%CI: 0.66−0.99, p = 0.037; Poisson regression exp(ß) 0.82, 95%CI: 0.74−0.91, p < 0.001). Coordination test under a time constraint (jumping side-to-side) showed no significant relation. Oral hygiene was poorer in younger children, boys and low SES. Caries prevalence increased with low SES and increasing age. The present results suggest that oral health is influenced by coordinative skills.

How much do consumers consider sustainability when purchasing a toothbrush? A discrete choice experiment

Introduction A recent resurgence of sustainability in healthcare has resulted in huge progress towards more 'eco-aware' products and their incorporation into everyday life, with home oral hygiene products being not far behind. However, it is unclear which components of sustainability consumers value or how much they are willing to pay for these.Aim To use a discrete choice experiment (DCE) to evaluate preferences for attributes such as recyclable handle materials and recyclable packaging of low-cost disposable manual toothbrushes, along with the willingness to pay (WTP) for said attributes.Methods Design and implementation of the DCE were informed by best practice guidelines. A multi-method approach was used for attribute identification and refinement. Participants were recruited through an online survey platform. Conditional logistic regression model was used to estimate participant preferences for the attributes. WTP for attributes was estimated using the ratio of the coefficient of a given attribute level to the product cost coefficient.Results A total of 326 participants took part in the survey, of which 169 were women (52%). The median age was 35 years of age. The three most influential attributes were: bamboo handles (= 0.486 and WTP = £4.85 [€5.79]), recyclable plastic handles (= 0.338, WTP = £3.37 [€4.02]) and recyclable packaging (= 0.191,WTP = £2.32 [€2.77]).Conclusion Sustainable attributes dominated consumer preference when considering the purchase of a manual disposable toothbrush. This could perhaps be due to new environmental initiatives from influential oral hygiene companies or activism.

Impacts of the Triple bristles three-sided sonic powered toothbrush on tooth shade, plaque control and gingival health

OBJECTIVES

To evaluate the efficacy of the Triple bristles three-sided sonic powered toothbrush in plaque removal and its impact on tooth shade and gingival health, and to compare this with a conventional manual toothbrush.

METHODS

Fifty two participants (26 males and 26 females; mean age [SD] = 22.48 [1.52], SE = 0.210, 95% CI = 22.06-22.90) were recruited into this controlled within-subject, randomized, two-treatment, 1-month crossover and examiner-blinded observational study between October 2020 and January 2021 in the School of Dentistry, University of Jordan. Within each participant, the upper and lower jaws were randomized to receive a brushing protocol either with the Triple bristles three-sided sonic brush or with a soft manual standard toothbrush with flat trimmed bristles. Tooth shades were recorded for upper and lower anterior and premolar teeth. The Turesky-Modified Quigley-Hein Plaque Index (TMQHPI) and bleeding on probing (BOP) were evaluated at study baseline, 1 week and 1 month after applying the brushing protocol.

RESULTS

Both tested brushes were associated with significant reduction in plaque scores and BOP (p < 0.05). The Triple bristles brush was more effective in reduction in plaque and BOP in the lower jaw and among females than the manual brush (p < 0.05).

CONCLUSIONS

The Triple bristles brush was more superior for reduction in plaque and probing on bleeding in the lower jaw and among females.

Evaluation and Acceptance of an Electric Toothbrush Designed for Dependent Patients

INTRODUCTION

A key barrier to standardizing evidence-based oral health protocols for highly dependent patients is the lack of validated and accepted oral health products designed specifically for use by caregivers. This study compared preferences by users of a novel electric toothbrush and a manual toothbrush in a health care setting.

METHODS

We prospectively enrolled health care providers as volunteers. Volunteer brushers completed simulated tooth brushing sessions of mock-intubated and non-intubated volunteer brushees with both toothbrushes. Volunteers rated different domains of toothbrush preference in an anonymous, optional survey.

RESULTS

A total of 133 health care providers volunteered (123 brushers [providers brushing teeth] and 10 brushees [those having their teeth brushed]). The novel electric toothbrush received significantly higher positive ratings than the standard hospital-issue manual toothbrush in all domains that we surveyed: ease of use, thoroughness, safety, shape and size of the brush head, overall cleanliness, time requirements, and efficiency (p<0.001). Importantly, due to the integrated light and suction of this electric toothbrush, brushers completed more sessions without setting down the toothbrush with the electric toothbrush than with the manual toothbrush (75.4% vs 36.4%; p<0.001).

CONCLUSIONS

Integrating a lighted electric brush with suction into the caregiver's armamentarium as an evidence-based tool is warranted and should be evaluated in terms of patient outcomes.

The knowledge about periodontal health of northeastern Italian pharmacists: a cross-sectional survey

BACKGROUND

The aim of this study is to determine the knowledge of periodontal health and prevention of periodontal diseases of a pool of pharmacists working in Friuli Venezia Giulia.

METHODS

A 22 questions questionnaire about oral health was sent by mail to all the pharmacies working in Friuli Venezia Giulia and to the most known associations of pharmacists. The data were collected and analysed by Google Forms software.

RESULTS

164 questionnaires were analysed. 91% of the pharmacists assert to give advices about prevention and treatment of oral affection during professional practice but 97% never attended university courses about it. Only 21% took part in post graduate courses about oral health. Most of them have not enough notions about periodontal disease.

CONCLUSIONS

The findings from this study highlight that pharmacists have not enough knowledge about periodontal disease and its treatment but every day they provide advices about oral health. It would be appropriate a better organization of post-graduate courses about oral health and prevention of periodontal diseases.

The Effects of Oral Health Instruction, and the Use of a Battery-Operated Toothbrush on Oral Health of Persons with Serious Mental Illness: A Quasi-Experimental Study

People with a diagnosis of serious mental illness (SMI) have a greater incidence of poorer oral health as compared to the general population. The aim of this quasi-experimental study was to determine the effect that a combination of the use of a battery-operated toothbrush and a related educational intervention may have on the oral health of individuals with serious mental illness. Key findings include that the battery-operated toothbrush resulted in a significant improvement in the mean change in gingival index, a common indicator of oral health. The study also found that oral home care instructions, smoking and level of negative symptoms did not have an effect on the mean change in plaque or gingival indices. This project suggests that the implementation of a relatively simple, cost effective measures such as a battery-operated toothbrush may have a positive impact on the oral health in this population.

The Role of Coconut Oil in Treating Patients Affected by Plaque-Induced Gingivitis: A Pilot Study

Objectives  The aim of the study was to evaluate the coconut oil pulling efficacy as adjuvant in reducing plaque formation and in treating plaque-induced gingivitis.

Materials and Methods  A sample of 20 patients was divided into two groups: a study and a control group. In the study group, coconut oil, in form of mouthwash, was administered to a sample of patients affected by gingivitis, aged between 18 and 35. The protocol established a daily application of the product for 30 days, where clinical parameters for plaque formation and gingivitis—plaque index (PI), bleeding index (BI)—will be evaluated during the recalls on a specific periodontal chart. The control group did not associate a coadjuvant to the normal daily oral health procedures and the same clinical parameters were evaluated at t0 and after 30 days (t1). The data were statistically analyzed using Student’s t -test, establishing the significance level as p < 0.05.

Results  PI and BI decreased in both groups, with a more relevant and significant drop in the study group, from a mean value of PI of 58.0 to 19.3 and a mean value of BI of 33.5 to 5.0. In the control group, the values decreased, respectively, from 53.9 to 29.1 for PI, and from 33.5 to 16.2. Furthermore, no significant side effect was reported during coconut oil pulling therapy.

Conclusions  The collected data showed significant and promising improvements in reducing plaque formation and gingivitis. However, further researches have to be performed to have more consistent and statistically significant data on larger samples and to fully understand the mechanisms of action and effectiveness.

Dental Plaque Removal by Ultrasonic Toothbrushes

With the variety of toothbrushes on the market, the question arises, which toothbrush is best suited to maintain oral health? This thematic review focuses first on plaque formation mechanisms and then on the plaque removal effectiveness of ultrasonic toothbrushes and their potential in preventing oral diseases like periodontitis, gingivitis, and caries. We overviewed the physical effects that occurred during brushing and tried to address the question of whether ultrasonic toothbrushes effectively reduced the microbial burden by increasing the hydrodynamic forces. The results of published studies show that electric toothbrushes, which combine ultrasonic and sonic (or acoustic and mechanic) actions, may have the most promising effect on good oral health. Existing ultrasonic/sonic toothbrush models do not significantly differ regarding the removal of dental biofilm and the reduction of gingival inflammation compared with other electrically powered toothbrushes, whereas the manual toothbrushes show a lower effectiveness.

Effectiveness and importance of powered tooth brushes in tooth movement

Introduction:

Effectiveness of vibratory stimulus from a commonly available battery-powered tooth brush in accelerating orthodontic tooth movement was tested by a randomized controlled split-mouth study.

Materials and Methods:

Twenty-three subjects with bimaxillary protrusion, requiring extraction of all first premolars and requiring maximum anchorage, were chosen. After initial leveling and aligning, miniscrews were placed between the first molar and the second premolar in the maxillary right and left quadrants and loaded with 150-g nickel–titanium closed-coil springs for individual canine retraction. Additional 5 min of vibratory stimulus thrice daily was applied on the experimental side. The mean treatment duration was 3 months.

Results:

There was no significant difference of means of the canine distal movement between the experimental and the control sides (P = 0.70).

Conclusion:

Application of vibratory stimulus with powered tooth brush during canine retraction was not seen to have an acceleratory effect on orthodontic tooth movement.

Detection of dental plaque with disclosing agents in the context of preventive oral hygiene training programs

No studies have evaluated the relationship between the detection points for dental bacterial plaque (DBP or biofilm) and gender, age, socioeconomic status, body mass index (BMI), and oral health, hence the need to investigate and clarify their possible association. This study aimed to map out the occurrence of DBP, investigate and evaluate the factors affecting its localization, and design preventive interventions. The research was conducted on 588 public school children aged 4–18 years in a provincial area of Greece. The subjects’ oral health status and anthropometric characteristics were examined by a dentist (A.F.) and a dietitian (E.P.), respectively. To identify DBP, chewable double-staining disclosing tablets were used. The results of the present study indicate the following: (1) Age and socioeconomic status seem to be associated with DBP development, particularly in the oral cavity. (2) Overweight schoolchildren show more DBP on the upper posterior occlusal and upper posterior buccal surfaces compared to normal-weight children. (3) Moderate caries disease is associated with DBP detection on almost all tooth surfaces and especially on the tongue and lower anterior labial surface. (4) Severe caries disease is most strongly associated with DBP in the upper posterior palatal, lower posterior buccal, and lower posterior lingual spaces, as well as on the tongue. (5) Sex is the only variable without a significant impact on DBP detection surfaces. In conclusion, DBP identification in specific areas of the mouth seems to be influenced by age, socioeconomic level, BMI, and oral health. Gender has no influence on DBP detection points. Disclosing agents can be used in oral health prevention programs, both for more effective guidance on the use of oral hygiene tools and for their evaluation.

WITHDRAWN: Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults

BACKGROUND

Effective oral hygiene is a crucial factor in maintaining good oral health, which is associated with overall health and health-related quality of life. Dental floss has been used for many years in conjunction with toothbrushing for removing dental plaque in between teeth, however, interdental brushes have been developed which many people find easier to use than floss, providing there is sufficient space between the teeth.

OBJECTIVES

To evaluate the effects of interdental brushing in addition to toothbrushing, as compared with toothbrushing alone or toothbrushing and flossing for the prevention and control of periodontal diseases, dental plaque and dental caries.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 7 March 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 2), MEDLINE via OVID (1946 to 7 March 2013), EMBASE via OVID (1980 to 7 March 2013), CINAHL via EBSCO (1980 to 7 March 2013), LILACS via BIREME (1982 to 7 March 2013), ZETOC Conference Proceedings (1980 to 7 March 2013) and Web of Science Conference Proceedings (1990 to 7 March 2013). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the metaRegister of Controlled Trials (http://www.controlled-trials.com/mrct/) for ongoing trials to 7 March 2013. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (including split-mouth design, cross-over and cluster-randomised trials) of dentate adult patients. The interventions were a combination of toothbrushing and any interdental brushing procedure compared with toothbrushing only or toothbrushing and flossing.

DATA COLLECTION AND ANALYSIS

At least two review authors assessed each of the included studies to confirm eligibility, assessed risk of bias and extracted data using a piloted data extraction form. We calculated standardised mean difference (SMD) and 95% confidence interval (CI) for continuous outcomes where different scales were used to assess an outcome. We attempted to extract data on adverse effects of interventions. Where data were missing or unclear we attempted to contact study authors to obtain further information.

MAIN RESULTS

There were seven studies (total 354 participants analysed) included in this review. We assessed one study as being low, three studies as being high and three studies as being at unclear risk of bias. Studies only reported the clinical outcome gingivitis and plaque data, with no studies providing data on many of the outcomes: periodontitis, caries, halitosis and quality of life. Three studies reported that no adverse events were observed or reported during the study. Two other studies provided some data on adverse events but we were unable to pool the data due to lack of detail. Two studies did not report whether adverse events occurred.Interdental brushing in addition to toothbrushing, as compared with toothbrushing aloneOnly one high risk of bias study (62 participants in analysis) looked at this comparison and there was very low-quality evidence for a reduction in gingivitis (0 to 4 scale, mean in control): mean difference (MD) 0.53 (95% CI 0.23 to 0.83) and plaque (0 to 5 scale): MD 0.95 (95% CI 0.56 to 1.34) at one month, favouring of use of interdental brushes. This represents a 34% reduction in gingivitis and a 32% reduction in plaque.Interdental brushing in addition to toothbrushing, as compared with toothbrushing and flossingSeven studies provided data showing a reduction in gingivitis in favour of interdental brushing at one month: SMD -0.53 (95% CI -0.81 to -0.24, seven studies, 326 participants, low-quality evidence). This translates to a 52% reduction in gingivitis (Eastman Bleeding Index). Although a high effect size in the same direction was observed at three months (SMD -1.98, 95% CI -5.42 to 1.47, two studies, 107 participants, very low quality), the confidence interval was wide and did not exclude the possibility of no difference. There was insufficient evidence to claim a benefit for either interdental brushing or flossing for reducing plaque (SMD at one month 0.10, 95% CI -0.13 to 0.33, seven studies, 326 participants, low-quality evidence) and insufficient evidence at three months (SMD -2.14, 95% CI -5.25 to 0.97, two studies, 107 participants very low-quality evidence).

AUTHORS' CONCLUSIONS

Only one study looked at whether toothbrushing with interdental brushing was better than toothbrushing alone, and there was very low-quality evidence for a reduction in gingivitis and plaque at one month. There is also low-quality evidence from seven studies that interdental brushing reduces gingivitis when compared with flossing, but these results were only found at one month. There was insufficient evidence to determine whether interdental brushing reduced or increased levels of plaque when compared to flossing.

A randomized controlled trial of a power brush/irrigator/mouthrinse routine on plaque and gingivitis reduction in orthodontic patients

OBJECTIVES

To assess plaque and gingivitis reduction in orthodontic patients after 4 weeks' use of an oscillating-rotating power brush, irrigator, and mouthrinse.

MATERIALS AND METHODS

This was a randomized, examiner-blind, clinical trial comparing plaque and gingivitis outcomes for an experimental power brush/irrigator/mouthrinse oral hygiene routine vs a dental prophylaxis followed by regular manual brushing (positive control). Fifty-one participants with fixed orthodontic appliances in the upper and lower jaw and a minimum of 15 gingival bleeding sites were randomly assigned to experimental or positive control treatment. Both groups were instructed to use their products at least twice daily. At baseline, week 1, and week 4, plaque was evaluated using digital plaque imaging analysis and a conventional subjective index. Gingival inflammation and bleeding were also measured. Analysis of covariance was used to compare groups.

RESULTS

Fifty-one participants (mean age = 13.9 years) were randomized; 50 (25 per group) completed the study. At baseline, group means were not statistically different (P > .1) for gingival inflammation or bleeding. At week 4, the experimental and control groups had a 10.0% to 32.7% and 5.9% to 6.7% reduction vs baseline, respectively, in plaque (across both methods); 12.6% and 8.3% reduction, respectively, in gingival inflammation; and 50.6% and 37.8% reduction, respectively, in bleeding. At week 4, group differences favoring the experimental group were statistically significant (P < .05) for gingival inflammation, gingival bleeding, and plaque (by conventional and digital imaging indexes).

CONCLUSIONS

Use of a power brush/irrigator/mouthrinse resulted in statistically significantly greater plaque and gingivitis reductions than prophylaxis followed by manual brushing in patients with fixed appliances over 4 weeks.

A randomized clinical trial to evaluate the plaque removal efficacy of an oscillating-rotating toothbrush versus a sonic toothbrush in orthodontic patients using digital imaging analysis of the anterior dentition

OBJECTIVE

To compare the plaque removal efficacy of an oscillating-rotating electric toothbrush with an orthodontic brush head versus a sonic toothbrush in adolescent patients with fixed orthodontic appliances.

MATERIALS AND METHODS

This was a randomized, examiner-blind, replicate single-use, two-treatment, four-period, crossover study with a washout period between visits of approximately 24 hours. Forty-four adolescent patients with fixed orthodontic appliances in both arches were randomized based on a computer-generated randomization schedule to one of four toothbrush treatment sequences. The primary outcome was plaque score change from baseline, measured using digital plaque imaging analysis.

RESULTS

Baseline plaque levels for both brush treatments were high, covering more than 50% of the tooth area. Effective plaque removal was observed with both brush treatments (P < .001); however, the reduction in plaque with the oscillating-rotating toothbrush was statistically significantly greater (P = .017) compared with the sonic toothbrush.

CONCLUSIONS

The study provides evidence for more effective plaque-removing efficacy of the oscillating-rotating toothbrush versus the sonic toothbrush among orthodontic patients.

Effectiveness of plaque removal with an experimental chewable brush in children between age 9 and 13 years

AIM

To evaluate the effectiveness of plaque removal of an experimental chewable brush in comparison with a manual brush in children between age 9 and 13 years.

METHOD

This single blinded randomised controlled study included a total of 60 healthy children between age 9 and 13 years that fulfilled the selection criteria. Selected children were randomly assigned to manual toothbrush group (MT) and chewable toothbrush group (CT). Children were instructed to use the respective toothbrushes under supervision. Effectiveness of plaque removal was evaluated by recording Turesky's modification of Quigley-Hein index scores (TMQHI) before and after brushing on single use. Difference in the pre-brushing and post-brushing plaque scores between the groups were statistically compared by using Mann-Whitney U test.

RESULTS

TMQHI plaque scores of selected children for the MT and CT groups was found to be statistically similar before using the toothbrush (p = 0.072). Difference between overall plaque reduction scores were found to be 1.0 for MT and 1.13 for CT, which did not reveal statistical significance (p = 0.308). In order to evaluate efficiency of chewable toothbrush, TMQHI scores for buccal and lingual scores were analysed separately, and found no statistical significance in plaque removal on either surfaces (p = 0.944 for buccal, p = 0.080 for lingual).

CONCLUSIONS

Chewable toothbrush was found to be as effective in total plaque removal as manual tooth brushing in the children between age 9 and 13 years. The chewable brush may be an appropriate oral hygiene adjunct for school children spending a considerable amount of time out of home.

A comparative assessment of plaque removal and toothbrushing compliance between a manual and an interactive power toothbrush among adolescents: a single-center, single-blind randomized controlled trial

BACKGROUND

Many adolescents have poor plaque control and sub-optimal toothbrushing behavior. Therefore, we compared the efficacy of an interactive power toothbrush (IPT) to a manual toothbrush (MT) for reducing dental plaque and improving toothbrushing compliance.

METHODS

In this randomized, parallel single-blind clinical study, adolescents brushed twice daily with either a MT (Oral-B® Indicator soft manual toothbrush) or an IPT (Oral-B® ProfessionalCare 6000 with Bluetooth). Subjects brushed for 2 min, plus an additional 10 s for each 'Focus Care Area'. At screening and Week 2, afternoon pre-brushing plaque was assessed via the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI), and supervised brushing duration was measured.

RESULTS

Sixty subjects were randomized; 98% completed. At Week 2, the mean reduction in whole mouth plaque relative to baseline was 34% (p < 0.001) for the IPT versus 1.7% (p = 0.231) for the MT. For Focus Care Areas, the IPT yielded a 38.1% mean TMQHPI reduction (p < 0.001) versus 6.2% for the MT (p < 0.001). Mean brushing time versus baseline increased 34 s in the IPT group (p < 0.001) while remaining flat in the MT group (p = 1.0).

CONCLUSIONS

Over 2 weeks, adolescents using an IPT experienced superior plaque reduction and increased overall brushing time versus those using a MT.

TRIAL REGISTRATION

This trial was retrospectively registered ( ISRCTN10112852 ) on the 18th, June 2018.

Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues

BACKGROUND

The number of older people with dementia and a natural dentition is growing. Recently, a systematic review concerning the oral health of older people with dementia with the focus on diseases of oral hard tissues was published.

OBJECTIVE

To provide a comprehensive literature overview following a systematic approach of the level of oral hygiene and oral health status in older people with dementia with focus on oral soft tissues.

METHODS

A literature search was conducted in the databases PubMed, CINAHL, and the Cochrane Library. The following search terms were used: dementia and oral health or stomatognathic disease. A critical appraisal of the included studies was performed with the Newcastle-Ottawa scale (NOS) and Delphi list.

RESULTS

The searches yielded 549 unique articles, of which 36 were included for critical appraisal and data extraction. The included studies suggest that older people with dementia had high scores for gingival bleeding, periodontitis, plaque, and assistance for oral care. In addition, candidiasis, stomatitis, and reduced salivary flow were frequently present in older people with dementia.

CONCLUSIONS

The studies included in the current systematic review suggest that older people with dementia have high levels of plaque and many oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, stomatitis, mucosal lesions, and reduced salivary flow.

SCIENTIFIC RATIONALE FOR STUDY

With the aging of the population, a higher prevalence of dementia and an increase in oral health problems can be expected. It is of interest to have an overview of the prevalence of oral problems in people with dementia.

PRINCIPAL FINDINGS

Older people with dementia have multiple oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, mucosal lesions, and reduced salivary flow.

PRACTICAL IMPLICATIONS

The oral health and hygiene of older people with dementia is not sufficient and could be improved with oral care education of formal and informal caregivers and regular professional dental care to people with dementia.

A randomized clinical trial comparing plaque removal efficacy of an oscillating-rotating power toothbrush to a manual toothbrush by multiple examiners

OBJECTIVE

To determine whether multiple examiners can demonstrate consistent plaque removal advantages for an oscillating-rotating power toothbrush versus a manual toothbrush.

METHODS

This was a replicate-use, single brushing, examiner-blind, randomized, two-treatment, four-period crossover clinical trial involving four examiners. Subjects were randomized to one of four treatment sequences involving two toothbrushes: an oscillating-rotating power toothbrush or a manual toothbrush. At each of the four visits, subjects arrived having abstained from oral hygiene for 24 h prior, and brushed with their assigned toothbrush and a marketed fluoride dentifrice under supervision unaided by a mirror. Plaque was assessed by each examiner using the Turesky-Modified Quigley-Hein Plaque Index at each study period before and after brushing. Data was analysed separately for each examiner using the analysis of covariance for crossover design.

RESULTS

Ninety-five subjects between the ages of 18 and 70 met the entrance criteria and were enrolled in the study. Eighty-seven subjects completed all four periods of the study. Both brushes delivered a significant plaque reduction when compared to baseline. Significant treatment differences were observed for all four examiners - ranging from 0.10 to 0.16 - in favor of the oscillating-rotating brush (P < 0.001). There were no adverse events reported or observed for either brush.

CONCLUSIONS

All four examiners demonstrated the power toothbrush removed significantly more plaque after a single brushing than the standard manual toothbrush. Both brushes were well tolerated.

Three-year randomized study of manual and power toothbrush effects on pre-existing gingival recession

AIM

To compare long-term effects of brushing with an oscillating-rotating power toothbrush or an ADA reference manual toothbrush on pre-existing gingival recession.

MATERIALS AND METHODS

In this controlled, prospective, single-blind, parallel-group study, healthy subjects with pre-existing recession were randomized and brushed with a power toothbrush (n = 55) or an ADA reference manual toothbrush (n = 54) for a 3-year study period. Subjects were required to brush their teeth twice daily for 2 min. using a standard fluoride toothpaste. During the study, subjects were assessed for clinical attachment loss and probing pocket depths to the nearest mm at six sites per tooth by the same calibrated examiner. Gingival recession was calculated at pre-existing sites as the difference between clinical attachment loss and probing pocket depths. Hard and soft oral tissues were examined to assess safety.

RESULTS

After 35 ± 2 months, mean gingival recession did not differ significantly between groups, but was significantly reduced from baseline (p < 0.001), from 2.35 ± 0.35 mm to 1.90 ± 0.58 mm in the power and from 2.26 ± 0.31 mm to 1.81 ± 0.66 mm in the manual group.

CONCLUSIONS

Gingival recession in subjects with pre-existing recession was significantly reduced after 3 years of brushing with either a power or manual toothbrush.

The INCENTIVE study: a mixed-methods evaluation of an innovation in commissioning and delivery of primary dental care compared with traditional dental contracting

Background

Over the past decade, commissioning of primary care dentistry has seen contract currency evolving from payment for units of dental activity (UDAs) towards blended contracts that include key performance indicators such as access, quality and improved health outcome.

Objectives

The aim of this study was to evaluate a blended/incentive-driven model of dental service provision. To (1) explore stakeholder perspectives of the new service delivery model; (2) assess the effectiveness of the new service delivery model in reducing the risk of and amount of dental disease and enhancing oral health-related quality of life (OHQoL) in patients; and (3) assess cost-effectiveness of the new service delivery model.

Methods

Using a mixed-methods approach, the study included three dental practices working under the blended/incentive-driven (incentive) contract and three working under the UDAs (traditional) contract. All were based in West Yorkshire. The qualitative study reports on the meaning of key aspects of the model for three stakeholder groups [lay people (patients and individuals without a dentist), commissioners and the primary care dental teams], with framework analysis of focus group and semistructured interview data. A non-randomised study compared clinical effectiveness and cost-effectiveness of treatment under the two contracts. The primary outcome was gingivitis, measured using bleeding on probing. Secondary outcomes included OHQoL and cost-effectiveness.

Results

Participants in the qualitative study associated the incentive contract with more access, greater use of skill mix and improved health outcomes. In the quantitative analyses, of 550 participants recruited, 291 attended baseline and follow-up. Given missing data and following quality assurance, 188 were included in the bleeding on probing analysis, 187 in the caries assessment and 210 in the economic analysis. The results were mixed. The primary outcome favoured the incentive practices, whereas the assessment of caries favoured the traditional practices. Incentive practices attracted a higher cost for the service commissioner, but were financially attractive for the dental provider at the practice level. Differences in generic health-related quality of life were negligible. Positive changes over time in OHQoL in both groups were statistically significant.

Limitations

The results of the quantitative analysis should be treated with caution given small sample numbers, reservations about the validity of pooling, differential dropout results and data quality issues.

Conclusions

A large proportion of people in this study who had access to a dentist did not follow up on oral care. These individuals are more likely to be younger males and have poorer oral health. Although access to dental services was increased, this did not appear to facilitate continued use of services.

Future work

Further research is required to understand how best to promote and encourage appropriate dental service attendance, especially among those with a high level of need, to avoid increasing health inequalities, and to assess the financial impact of the contract. For dental practitioners, there are challenges around perceptions about preventative dentistry and use of the risk assessments and care pathways. Changes in skill mix pose further challenges.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Reporting of sources of funding in systematic reviews in periodontology and implant dentistry

Industry-supported clinical trials may present better outcomes than those supported by other sources. The aim of this paper was to assess whether systematic reviews (SRs) published in periodontology and implant dentistry report and discuss the influence of funding sources on study results. Two reviewers conducted a comprehensive search in PubMed and the Cochrane Database of Systematic Reviews independently and in duplicate to identify SRs published up to 11 November 2012. Speciality dental journals and the reference lists of included SRs were also scrutinised. Information on the reporting and discussion of funding sources of primary studies included in the SRs was extracted independently and in duplicate. Any disagreement regarding SR selection or data extraction was discussed until consensus was achieved. Of 146 SRs included in the assessment, only 45 (31%) reported the funding sources of primary studies. Fourteen (10%) SRs discussed the potential influence of funding sources on study results, that is, sponsorship bias. Funding sources are inadequately reported and discussed in SRs in periodontology and implant dentistry. Assessment, reporting, and critical appraisal of potential sponsorship bias of meta-analytic estimates are paramount to provide proper guidance for clinical treatments.

Comparison of Effectiveness of Manual Orthodontic, Powered and Sonic Toothbrushes on Oral Hygiene of Fixed Orthodontic Patients

Introduction: Maintenance of good oral hygiene is important for patients undergoing fixed orthodontic treatment.

Aim: The aim of this study was to evaluate the effectiveness of a manual orthodontic toothbrush, powered toothbrush with oscillating head and sonic toothbrush in controlling plaque, gingivitis and interdental bleeding in patients undergoing fixed orthodontic treatment, and to compare their relative efficacy.

Materials and methods: Sixty subjects, who were to receive orthodontic treatment with both upper and lower fixed appliances, were randomly divided into three study groups, with 20 patients in each group. Groups I to III were given manual orthodontic, powered and sonic toothbrushes, respectively. Plaque index (PI), gingival index (GI) and interdental bleeding index were scored to assess the level of plaque accumulation, gingival health and interdental bleeding at baseline; 4 and 8 weeks recall visits after fixed appliance bonding. Paired t-tests and one-way analysis of variance (ANOVA) tests were used for intragroup and intergroup comparisons. The level of statistical significance was set at p < 0.05.

Results: This study showed that a significant reduction in all the three indices scores was found from baseline to 4 and 8 weeks in group III. On intergroup comparison, no statistically significant differences were detected between the three groups for any of the parameters assessed.

Conclusion: On intragroup comparison, sonic brushes performed superiorly in reducing gingivitis, plaque and interdental bleeding as compared to the manual orthodontic and powered brushes. On intergroup comparison, the relative comparative effectiveness was found to be similar for all the three brushes.

How to cite this article: Sharma R, Trehan M, Sharma S, Jharwal V, Rathore N. Comparison of Effectiveness of Manual Orthodontic, Powered and Sonic Toothbrushes on Oral Hygiene of Fixed Orthodontic Patients. Int J Clin Pediatr Dent 2015;8(3):181-189.

Comparative study of oral health among trisomy 21 children living in Riyadh, Saudi Arabia: Part 2, gingival condition

BACKGROUND

Trisomy 21 (T21) is a congenital disorder characterized by triplication of Chromosome 21 components. Patients with T21 have an increased risk of acquiring periodontal disease due to their inability to maintain good oral hygiene. Consequently, it is important to determine an approach for disease prevention in this population.

AIM

The purpose of the study was to assess the periodontal health, through the prevalence of gingivitis and plaque, among children with T21 living in Riyadh, Saudi Arabia.

SUBJECTS AND METHOD

This study included 93 children with T21 and 99 age- and gender-matched children without T21 between the ages of 7 and 15 years. Parents were informed about the study and provided informed consent. Trained examiners using standardized tools assessed the prevalence rates of gingivitis and plaque in all children.

RESULTS

Gingivitis prevalence was elevated among T21 children (46.9%) compared to controls (34%) in all arch sextants except the mandibular middle (P < 0.01). Comparing the two groups, the prevalence of plaque was higher in the maxillary right sextant of the T21 group and the mandibular middle sextant of the control group (P < 0.05).

CONCLUSION

T21 children have significantly elevated plaque levels, resulting in greater prevalence of gingivitis, compared to healthy children. Preventive measure, such as oral health awareness programs, should be delivered early to parents and continued at school to encourage and motivate children.

Gingival abrasion and recession in manual and oscillating-rotating power brush users

OBJECTIVE

To assess gingival recession (GR) in manual and power toothbrush users and evaluate the relationship between GR and gingival abrasion scores (GA).

METHODS

This was an observational (cross-sectional), single-centre, examiner-blind study involving a single-brushing exercise, with 181 young adult participants: 90 manual brush users and 91 oscillating-rotating power brush users. Participants were assessed for GR and GA as primary response variables. Secondary response variables were the level of gingival inflammation, plaque score reduction and brushing duration. Pearson correlation was used to describe the relationship between number of recession sites and number of abrasions. Prebrushing (baseline) and post-brushing GA and plaque scores were assessed and differences analysed using paired tests. Two-sample t-test was used to analyse group differences; ancova was used for analyses of post-brushing changes with baseline as covariate.

RESULTS

Overall, 97.8% of the study population had at least one site of ≥1 mm of gingival recession. For the manual group, this percentage was 98.9%, and for the power group, this percentage was 96.7% (P = 0.621). Post-brushing, the power group showed a significantly smaller GA increase than the manual group (P = 0.004); however, there was no significant correlation between number of recession sites and number of abrasions for either group (P ≥ 0.327).

CONCLUSIONS

Little gingival recession was observed in either toothbrush user group; the observed GR levels were comparable. Lower post-brushing gingival abrasion levels were seen in the power group. There was no correlation between gingival abrasion as a result of brushing and the observed gingival recession following use of either toothbrush.

At-home oral care for adults with developmental disabilities: a survey of caregivers

BACKGROUND

Little is known about effective at-home oral care methods for people with developmental disabilities (DDs) who are unable to perform personal preventive practices themselves and rely on caregivers for assistance.

METHODS

A convenience sample of 808 caregivers (84.5 percent paid, 15.5 percent family members) who accompanied adults with DDs (20 years or older) to appointments at a specialized statewide dental care system completed computer-assisted personal interview surveys. The authors used these data to investigate caregivers' at-home oral care experiences and to explore differences between caregivers who were paid and those who were family members.

RESULTS

Caregivers reported that a high proportion (85 percent) of dentate adults with DDs received assistance with tooth cleaning. They also reported a high prevalence of dental problems, and low adherence to brushing (79 percent) and flossing (22 percent) recommendations. More caregivers reported that they felt confident assisting with brushing than with flossing (85 percent versus 54 percent). Family members and paid caregivers differed with respect to confidence and training.

CONCLUSIONS

At-home oral care, particularly flossing, presents substantial challenges for adults with DDs. Solutions must be tailored to address the different experiences and distinct needs of the family members and paid caregivers who assist these adults.

PRACTICAL IMPLICATIONS

Caregivers play an important role in providing at-home oral care, and they must be included in efforts to improve oral health outcomes for people with DDs.

Diseases of the mouth

Oral pathologic abnormality is common and can be potentially serious. There are many diseases of the mouth that medical personnel must be able to diagnose and initiate management. The most prevalent lesions can be categorized as infectious, inflammatory, and common benign and malignant lesions. This article discusses prevalence, cause, diagnosis, and management of lesions such as stomatitis, candidiasis, caries, oral cancers, and bony tori.

Oral healthcare education of future nursing personnel and auxiliary nurses

OBJECTIVE

To investigate the oral healthcare training in the education of auxiliary nurses in Norway.

BACKGROUND

Many elderly residents need assistance in every aspect of daily living, including help with oral care. Auxiliary nurses are the professional group who most often provide this help.

MATERIALS AND METHODS

An e-mail administered questionnaire was sent to all 164 high schools in Norway offering basic education for auxiliary nurse.

RESULTS

Of the 114 high schools responding to the survey (69.5% response rate), 83.3% reported mandatory courses, 49.1% offered three or more hours of teaching in oral health care. 89.5% offered both lectures and practical training, 93.9% had training in tooth cleaning, 37.7% lectured about different dental restorations, 50% lectured on ergonomic working positions, 12.3% on the working lights, 16.7% on inspection techniques, 25.4% on interdental brushes and 6.1% on electrical powered toothbrushes. Additionally, 45.6% assessed that their students are prepared for later work with oral health care. More lessons led to better quality of education.

CONCLUSION

Almost all of the high schools had mandatory education in oral care in the auxiliary nurse programme. Increasing the number of lessons may improve the quality of knowledge, but the teaching programmes for a number of topics seem insufficient. There is a need to strengthen the position of oral health in the education of auxiliary nurses. To meet the future challenges in oral health, international or national expert-developed guidelines for oral care training programmes would be useful for the education of auxiliary nurses.

Powered versus manual toothbrushing for oral health

BACKGROUND

Removing dental plaque may play a key role maintaining oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this. This is an update of a Cochrane review first published in 2003, and previously updated in 2005.

OBJECTIVES

To compare manual and powered toothbrushes in everyday use, by people of any age, in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 23 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE via OVID (1946 to 23 January 2014), EMBASE via OVID (1980 to 23 January 2014) and CINAHL via EBSCO (1980 to 23 January 2014). We searched the US National Institutes of Health Trials Register and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials of at least four weeks of unsupervised powered toothbrushing versus manual toothbrushing for oral health in children and adults.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by The Cochrane Collaboration. Random-effects models were used provided there were four or more studies included in the meta-analysis, otherwise fixed-effect models were used. Data were classed as short term (one to three months) and long term (greater than three months).

MAIN RESULTS

Fifty-six trials met the inclusion criteria; 51 trials involving 4624 participants provided data for meta-analysis. Five trials were at low risk of bias, five at high and 46 at unclear risk of bias.There is moderate quality evidence that powered toothbrushes provide a statistically significant benefit compared with manual toothbrushes with regard to the reduction of plaque in both the short term (standardised mean difference (SMD) -0.50 (95% confidence interval (CI) -0.70 to -0.31); 40 trials, n = 2871) and long term (SMD -0.47 (95% CI -0.82 to -0.11; 14 trials, n = 978). These results correspond to an 11% reduction in plaque for the Quigley Hein index (Turesky) in the short term and 21% reduction long term. Both meta-analyses showed high levels of heterogeneity (I(2) = 83% and 86% respectively) that was not explained by the different powered toothbrush type subgroups.With regard to gingivitis, there is moderate quality evidence that powered toothbrushes again provide a statistically significant benefit when compared with manual toothbrushes both in the short term (SMD -0.43 (95% CI -0.60 to -0.25); 44 trials, n = 3345) and long term (SMD -0.21 (95% CI -0.31 to -0.12); 16 trials, n = 1645). This corresponds to a 6% and 11% reduction in gingivitis for the Löe and Silness index respectively. Both meta-analyses showed high levels of heterogeneity (I(2) = 82% and 51% respectively) that was not explained by the different powered toothbrush type subgroups.The number of trials for each type of powered toothbrush varied: side to side (10 trials), counter oscillation (five trials), rotation oscillation (27 trials), circular (two trials), ultrasonic (seven trials), ionic (four trials) and unknown (five trials). The greatest body of evidence was for rotation oscillation brushes which demonstrated a statistically significant reduction in plaque and gingivitis at both time points.

AUTHORS' CONCLUSIONS

Powered toothbrushes reduce plaque and gingivitis more than manual toothbrushing in the short and long term. The clinical importance of these findings remains unclear. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and only temporary.

Minimal intervention dentistry II: part 2. Management of caries and periodontal risks in general dental practice

The long-term clinical management of caries and periodontal diseases requires a double approach, one that is concerned with both treatment and prevention. Dentists should recognise the risk factors and their likely triggers to be able to implement the right strategy as early as the diagnostic phase. This comprehensive assessment can easily be done in general practice. All it takes is to combine the patient's general information with the systemic and behavioural factors, and the clinical observations with the local factors. The resulting patient profile can thus effectively support treatment by providing the necessary explanations, advice or prescriptions in relation with the clinical procedures. The modifiable risk factors need to be monitored and the behaviours changed to stabilise or limit disease progression. The practitioner's active approach is meant to meet the patient's demand for preventive counselling.

Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults

BACKGROUND

Effective oral hygiene is a crucial factor in maintaining good oral health, which is associated with overall health and health-related quality of life. Dental floss has been used for many years in conjunction with toothbrushing for removing dental plaque in between teeth, however, interdental brushes have been developed which many people find easier to use than floss, providing there is sufficient space between the teeth.

OBJECTIVES

To evaluate the effects of interdental brushing in addition to toothbrushing, as compared with toothbrushing alone or toothbrushing and flossing for the prevention and control of periodontal diseases, dental plaque and dental caries.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 7 March 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 2), MEDLINE via OVID (1946 to 7 March 2013), EMBASE via OVID (1980 to 7 March 2013), CINAHL via EBSCO (1980 to 7 March 2013), LILACS via BIREME (1982 to 7 March 2013), ZETOC Conference Proceedings (1980 to 7 March 2013) and Web of Science Conference Proceedings (1990 to 7 March 2013). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the metaRegister of Controlled Trials (http://www.controlled-trials.com/mrct/) for ongoing trials to 7 March 2013. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (including split-mouth design, cross-over and cluster-randomised trials) of dentate adult patients. The interventions were a combination of toothbrushing and any interdental brushing procedure compared with toothbrushing only or toothbrushing and flossing.

DATA COLLECTION AND ANALYSIS

At least two review authors assessed each of the included studies to confirm eligibility, assessed risk of bias and extracted data using a piloted data extraction form. We calculated standardised mean difference (SMD) and 95% confidence interval (CI) for continuous outcomes where different scales were used to assess an outcome. We attempted to extract data on adverse effects of interventions. Where data were missing or unclear we attempted to contact study authors to obtain further information.

MAIN RESULTS

There were seven studies (total 354 participants analysed) included in this review. We assessed one study as being low, three studies as being high and three studies as being at unclear risk of bias. Studies only reported the clinical outcome gingivitis and plaque data, with no studies providing data on many of the outcomes: periodontitis, caries, halitosis and quality of life. Three studies reported that no adverse events were observed or reported during the study. Two other studies provided some data on adverse events but we were unable to pool the data due to lack of detail. Two studies did not report whether adverse events occurred. Interdental brushing in addition to toothbrushing, as compared with toothbrushing alone Only one high risk of bias study (62 participants in analysis) looked at this comparison and there was very low-quality evidence for a reduction in gingivitis (0 to 4 scale, mean in control): mean difference (MD) 0.53 (95% CI 0.23 to 0.83) and plaque (0 to 5 scale): MD 0.95 (95% CI 0.56 to 1.34) at one month, favouring of use of interdental brushes. This represents a 34% reduction in gingivitis and a 32% reduction in plaque. Interdental brushing in addition to toothbrushing, as compared with toothbrushing and flossing Seven studies provided data showing a reduction in gingivitis in favour of interdental brushing at one month: SMD -0.53 (95% CI -0.81 to -0.24, seven studies, 326 participants, low-quality evidence). This translates to a 52% reduction in gingivitis (Eastman Bleeding Index). Although a high effect size in the same direction was observed at three months (SMD -1.98, 95% CI -5.42 to 1.47, two studies, 107 participants, very low quality), the confidence interval was wide and did not exclude the possibility of no difference. There was insufficient evidence to claim a benefit for either interdental brushing or flossing for reducing plaque (SMD at one month 0.10, 95% CI -0.13 to 0.33, seven studies, 326 participants, low-quality evidence) and insufficient evidence at three months (SMD -2.14, 95% CI -5.25 to 0.97, two studies, 107 participants very low-quality evidence).

AUTHORS' CONCLUSIONS

Only one study looked at whether toothbrushing with interdental brushing was better than toothbrushing alone, and there was very low-quality evidence for a reduction in gingivitis and plaque at one month. There is also low-quality evidence from seven studies that interdental brushing reduces gingivitis when compared with flossing, but these results were only found at one month. There was insufficient evidence to determine whether interdental brushing reduced or increased levels of plaque when compared to flossing.

Oral health education and therapy reduces gingivitis during pregnancy

BACKGROUND

Pregnant women demonstrate increases in gingivitis despite similar plaque levels to non-pregnant counterparts.

AIM

To evaluate an intensive protocol aimed at reducing gingivitis in pregnant women and provide pilot data for large-scale randomized controlled trials investigating oral hygiene measures to reduce pregnancy gingivitis and alter maternity outcomes.

MATERIALS AND METHODS

One hundred and twenty participants between 16 and 24 weeks gestation with Gingival Index (GI) scores ≥2 at ≥50% of tooth sites were enrolled. Plaque index (PI), gingival inflammation (GI), probing depth (PD), and clinical attachment levels (CAL) were recorded at baseline and 8 weeks. Dental prophylaxis was performed at baseline and oral hygiene instructions at baseline, 4 and 8 weeks. Pregnancy outcomes were recorded at parturition. Mixed-model analysis of variance was used to compare clinical measurements at baseline and 8 weeks.

RESULTS

Statistically significant reductions in PI, GI, PD, and CAL occurred over the study period. Mean whole mouth PI and GI scores decreased approximately 50% and the percentage of sites with PI and GI ≥2 decreased from 40% to 17% and 53% to 21.8%, respectively. Mean decreases in whole mouth PD and CAL of 0.45 and 0.24 mm, respectively, were seen.

CONCLUSIONS

Intensive oral hygiene regimen decreased gingivitis in pregnant patients.

WITHDRAWN: Interspace/interdental brushes for oral hygiene in orthodontic patients with fixed appliances

This review has been withdrawn from publication because it is out of date. It is being updated and replaced by a new expanded Cochrane review entitled 'Interdental cleaning in patiens wih fixed orthodontic appliances' by HH Goh and B Doubleday. It will remain withdrawn when the new review is published.

The editorial group responsible for this previously published document have withdrawn it from publication.

Relationship between plaque score and video-monitored brushing performance after repeated instruction--a controlled, randomised clinical trial

OBJECTIVES

Aim of this prospective, randomised, controlled clinical trial was to use the modified bass technique (MBT) and a specific brushing sequence to investigate whether two types of instruction methods lead to differences in plaque reduction and whether plaque reduction is related to technique adoption.

METHODS

Ninety-eight participants were randomly assigned to three groups: (1) control, no instruction; (2) verbal instruction by means of a leaflet; and (3) verbal instruction supported by demonstration, no leaflet. Brushing performance was video monitored. Plaque score (Turesky modified QHI (T-QHI)) was measured at baseline, afterwards participants received instructions. After 2 weeks, T-QHI was measured for a second time, and participants were re-instructed. After another 2 weeks, T-QHI was measured for a third time.

RESULTS

At baseline, T-QHI did not differ between groups ((1) 1.99 ± 0.51, (2) 1.90 ± 0.51, (3) 1.93 ± 0.56). The second measurement revealed an improvement of T-QHI in the instructed groups and in the non-instructed control group ((1) 1.80 ± 0.47, (2) 1.58 ± 0.58, (3) 1.64 ± 0.58; n.s. between groups); in the intervention groups, remotivation achieved no further improvement ((1) 1.72 ± 0.48, (2) 1.52 ± 0.58, (3) 1.50 ± 0.69; n.s. between groups and compared to second measurement). Improvement of T-QHI was not related to proper performance of technique or brushing sequence. Those who fully adopted the brushing technique, the sequence or both did not have lower plaque scores.

CONCLUSION

Technical performance and effectiveness were not linked.

CLINICAL RELEVANCE

Within the study setting, the MBT was not effective in reducing plaque scores. The general recommendation of the MBT should be re-evaluated in further studies.

Electric versus manual tooth brushing among neuroscience ICU patients: is it safe?

BACKGROUND

Poor oral hygiene has been associated with ventilator-acquired pneumonia. Yet providing oral care for intubated patients is problematic. Furthermore, concerns that oral care could raise intracranial pressure (ICP) may cause nurses to use foam swabs to provide oral hygiene rather than tooth brushing as recommended by the American Association of Critical-Care Nurses. Evidence is needed to support the safety of toothbrushing during oral care. We therefore evaluated ICP and cerebral perfusion pressure (CPP) during oral care with a manual or electric toothbrush in intubated patients in a neuroscience intensive care unit (ICU).

METHODS

As part of a larger 2-year, prospective, randomized clinical trial, 47 adult neuroscience ICU patients with an ICP monitor received oral care with a manual or electric toothbrush. ICP and CPP were recorded before, during, and after oral care over the first 72 h of admission.

RESULTS

Groups did not differ significantly in age, gender, or severity of injury. Of 807 ICP and CPP measurements obtained before, during, and after oral care, there were no significant differences in ICP (P = 0.72) or CPP (P = 0.68) between toothbrush methods. Analysis of pooled data from both groups revealed a significant difference across the three time points (Wilks' lambda, 12.56; P < 0.001; partial η(2), 0.36). ICP increased significantly (mean difference, 1.7 mm Hg) from before to during oral care (P = 0.001) and decreased significantly (mean difference, 2.1 mm Hg) from during to after oral care (P < 0.001).

CONCLUSIONS

In the absence of preexisting intracranial hypertension during oral care, tooth brushing, regardless of method, was safely performed in intubated neuroscience ICU patients.