Powered versus manual toothbrushing for oral health

Cross-angled versus flat-trim bristle tuft configurations in manual toothbrushes: A systematic review

AIM

This systematic review synthesizes and evaluates the literature regarding the effect of manual toothbrushes (MTBs) with cross-angled bristle tufts (CA-TB) compared to flat-trim (FT-TB) configurations on plaque scores and parameters of gingival health in adult patients.

MATERIALS AND METHODS

PubMed-MEDLINE and Cochrane-CENTRAL databases were searched, from their insertion up to August 1st, 2023, to detect appropriate papers. Clinical trials involving adult patients without periodontitis who performed self-brushing were eligible for inclusion. Primary outcome parameters included plaque, bleeding, and gingival scores. Secondary outcomes encompassed signs of soft and hard tissue abnormalities. A descriptive analysis was conducted. When feasible, a meta-analysis was performed using either the 'fixed' or 'random effects' model, as appropriate.

RESULTS

Nine eligible papers were retrieved, presenting 20 comparisons. There was considerable heterogeneity in the clinical and methodological design aspects of the included studies. In the descriptive analysis, eight out of 12 comparisons demonstrated a difference in plaque removal performance in favour of the CA-TB. However, data regarding bleeding and gingival index scores were inconclusive. A meta-analysis was performed on plaque, bleeding, and gingival index scores, including different indices used for scoring. The meta-analysis of short-term studies showed a medium effect statistically significant difference in the reduction of plaque scores in favour of the CA-TB (SMD = 0.75; 95% CI (0.51; 0.99)), but this was not substantiated in longer-term studies (SMD = -0.06; 95% CI(-0.44; 0.31)). No adverse events were described in any group.

CONCLUSION

Within the limitations of the present study design, short-term evaluations, as assessed with various plaque indices, show a weak certainty in favour of the cross-angled toothbrush over the flat-trim toothbrush. However, based on longer-term evaluations, there is insufficient support due to the inconsistent outcomes of the analysis.

Comparison Between Powered and Manual Toothbrushes Effectiveness for Maintaining an Optimal Oral Health Status

This integrative literature review evaluates the effectiveness of power toothbrushes (PTBs) compared to manual toothbrushes (MTBs) across various populations, focusing on plaque removal, gingival health, calculus reduction, and stain removal. PTBs equipped with advanced technologies such as oscillating-rotating and high-frequency sonic mechanisms have been examined for their potential to enhance oral hygiene. Special attention is given to vulnerable groups, including the elderly and individuals with intellectual disabilities, to assess how PTBs meet their specific oral health needs. A comprehensive literature search was conducted in databases including PubMed, Cochrane Library, Embase, and Google Scholar using keywords such as "power toothbrush", "electric toothbrush", "manual toothbrush", "plaque removal", "gingivitis", "calculus", "dental stains", "oral hygiene", "elderly", and "intellectual disabilities". Studies published between 2000 and 2024 were selected based on their relevance to the PTB and MTB comparison, with an emphasis on outcomes related to oral hygiene efficacy. As this review is narrative rather than systematic, it focuses on synthesizing existing knowledge without applying strict inclusion or exclusion criteria. The results indicate that PTBs generally outperform MTBs in reducing plaque, gingivitis, and stains, though the benefits for special populations are less pronounced but still significant. However, practical issues such as user experience and mechanical reliability of PTBs warrant further investigation. In conclusion, this review enhances the understanding of PTB effectiveness, guides consumer choices, and informs future technological advancements in dental care practices.

Manual toothbrushes, self-toothbrushing, and replacement duration to remove dental plaque and improve gingival health: A scoping review from recent research

OBJECTIVE

To investigate characteristics of manual toothbrushes, self-toothbrushing methods, and replacement duration of manual toothbrushes that effectively remove dental plaque, reduce gingivitis, and promote gingival health.

STUDY DATA AND SOURCES

PubMed-MEDLINE, Scopus and Central Register Cochrane of Controlled trials (CENTRAL) were searched for randomized control trials (RCTs) from 01 January 2018 to 12 December 2023. Articles were subjected for including participants aged six years and older with a study duration of at least four weeks to investigate the efficacy of manual toothbrushes used self-toothbrushing. To investigate the appropriate time to replace manual toothbrushes, this study was focused on the physical properties of the bristles and changes in the microorganisms present in the bristles over time.

STUDY SELECTION

Of 1520 retrieved articles, 26 studies were included after screening. The total number of manual toothbrushes was 40 and 5 kinds of self-toothbrushing techniques were selected in the review. 4 studies investigated the changes the physical properties bristles of manual toothbrushes.

CONCLUSIONS

Among manual toothbrushes, the cross-angle and indicator bristles were found to significantly improve dental plaque index and gingival condition. Most toothbrushes with soft bristles had a trend of superior dental plaque removal and gingivitis improvement efficacy. Toothbrush with end-round shape bristles tip has tended to reduce the dental plaque and gingival index scores. Studies reported that brushing twice a day for at least two minutes using the Bass method had a positive effect on the dental plaque and gingival index. Further research is required to investigate the relationships between property physical bristle and clinical intraoral indices to clarify the replacement duration of manual toothbrushes.

CLINICAL SIGNIFICANCE

The findings of this study could guide people's daily self-brushing habits, thereby aiding the prevention of periodontal disease. Moreover, our findings suggest the need for strategic clinical trial designs to verify the ideal timing to replace manual toothbrushes.

Cleansing efficacy of the electric toothbrush Oral-B® iO™ compared to conventional oscillating-rotating technology: a randomized-controlled study

OBJECTIVES

This study aimed to compare the cleansing efficacy of the Oral-B® iO™ electric toothbrush incorporating oscillating-rotating technology with microvibrations - with a traditional oscillating-rotating toothbrush.

MATERIALS AND METHODS

Thirty adult participants were randomly assigned to use the iO™ electric toothbrush with the brush head iO™ Ultimate Clean or the traditional oscillating-rotating toothbrush Oral-B® Genius® with the Cross-Action brush head. Oral hygiene indices (Rustogi Modified Navy Plaque Index and Gingival Bleeding Index) were assessed before and after 28 days of home use of the assigned product. Participants were instructed to refrain from interdental hygiene during the study period. After a 2-week washout period, the clinical investigation was repeated in a crossover design.

RESULTS

All 30 participants completed the study with no dropouts. After 28 days of use, the iO™ showed statistically significantly lower plaque levels than the conventional oscillating-rotating toothbrush (25.09% vs. 30.60%, p = 0.029). This difference was particularly noticeable in marginal and approximal areas. There were no significant distinctions in gingival bleeding indices.

CONCLUSIONS

The Oral-B® iO™ electric toothbrush displayed enhanced plaque removal efficiency compared to a conventional oscillating-rotating technology.

CLINICAL RELEVANCE

This study highlights the potential benefits of advanced toothbrush technologies for plaque reduction and encourages further research.

Countering the Identified Barriers to Delivered Oral Care for Children With Special Healthcare Needs: A Narrative Review

Children with Special Health Care Needs (SHCNs) have poor oral health as a result of structural and systemic barriers. These children frequently have limited access to dental treatment, a higher prevalence and incidence of dental problems, and worse oral hygiene than the rest of the population. This review aims to offer an understanding of the existing oral care barriers of children with SHCNs. We reviewed the literature on children with SHCNs and their caregivers to identify the implications of the barriers faced by these individuals. Some of the perceived barriers to appropriate oral healthcare faced by these children include obstacles to adequate oral care and hygiene in the home, challenging behaviours, and limited preventive care and accessibility. We focussed on interventions and different management approaches to support the stakeholders responsible for these children. There is a need for strong communication as well as care coordination between caregivers, dentists, and other providers to achieve positive outcomes. The current dental healthcare system appears to desert the needed demands of this demographic.

The long-term effect on oral health and quality of life using a powered toothbrush in individuals with mild cognitive impairment. An intervention trial

BACKGROUND

The number of older individuals with mild cognitive impairment and neurocognitive diseases is increasing, which may rapidly deteriorate oral health and Quality of life. Therefore, removing dental biofilm is essential for maintaining good oral health. The present study aimed to investigate whether introducing a powered toothbrush reduces the presence of dental plaque, bleeding on probing, and periodontal pockets ≥4 mm, leading to maintained or improved oral health and improved Quality of life in a group of older individuals with mild cognitive impairment.

METHODS

Two hundred and thirteen individuals aged 55 or older living without official home care with a Mini-Mental State Examination (MMSE) score between 20 and 28 and a history of memory problems in the previous 6 months were recruited and screened for the study. The individuals received a powered toothbrush and thorough instructions on how to use it. Clinical oral examinations, Quality of life examinations, and MMSE tests were conducted at baseline, 6, 12, and 24 months. The intervention group was compared to control groups at baseline and 24-month examination. It was divided into an MMSE high group with a score of more than 26 and an MMSE low group with a score of 26 and lower or decreasing two steps or more for 12 months.

RESULTS

PI, BOP, and PPD≥4 mm improved continuously in both MMSE groups during the 24 months of the study. The values for QoL-AD deteriorated over time, while the oral health-related Quality of life did not show any statistically significant changes.

CONCLUSIONS

Introducing a powered toothbrush improved PI, BOP, and PPD≥4 mm over 24 months, even among individuals with low or declining MMSE scores. Improved oral health is associated with a preserved OHR-QoL.

The Effect of Different Electric Toothbrush Technologies on Interdental Plaque Removal: A Systematic Review with a Meta-Analysis

The removal of dental plaque from the gingival margins of the teeth is essential to maintaining periodontal health. Whilst it has been established that electric toothbrushes demonstrate a greater ability to remove plaque, no systematic review has specifically investigated which technology is better for removing plaque from the interdental tooth surfaces, where plaque control may be more difficult. Three databases were searched until October 2023: MEDLINE and DOSSS via EBSCOhost and Embase. Data extraction was carried out on studies which met the inclusion criteria, and a risk of bias assessment was completed. The study findings were combined via a narrative synthesis and a meta-analysis where appropriate. A total of 77 studies were found, out of which 14 were selected and included in the analysis. The mean difference in interproximal plaque reduction, measured using the Rustogi Modified Naval Plaque Index (RMNPI) at 8 weeks, was 0.09 (p < 0.00001) in favor of the oscillating-rotating toothbrush. At 6 and 12 weeks, the mean difference in plaque reduction (RMNPI) was 0.05 (p = 0.0008) and 0.04 (p = 0.0001) in favor of the oscillating-rotating toothbrush, respectively. The studies show a tendency for oscillating-rotating toothbrushes to remove more interproximal plaque than oscillating toothbrushes, especially in a short time (8 weeks).

Self-determined use of provided powered oral hygiene devices leads to improved gingival health after 1 year: a longitudinal clinical trial

PURPOSE

Our study aimed to evaluate the long-term concordance and acceptance when using powered devices for everyday oral hygiene routine and gingival health in patients showing papillary bleeding.

PATIENTS AND METHODS

Thirty-one participants were recruited at the dental clinic of the University Hospital of Cologne, Germany, over a 6-week duration. At baseline, a standard dental check-up was performed, including oral hygiene indices and documentation of oral hygiene devices used. The study consisted of two consecutive phases: the first (motivational trial) was designed to prove the effectiveness and safety of a microdroplet device and a powered toothbrush compared to dental floss and a manual toothbrush over a period of 4 weeks. The second (observational) phase began with all participants receiving the powered oral homecare devices. Participants were able to use their oral hygiene measures of choice over an unsupervised period of 1 year. All participants were then rescheduled for a routine dental check-up, where oral hygiene indices and oral hygiene devices used were reevaluated.

RESULTS

After 1 year, 93.3% of participants stated they performed interdental cleaning on a regular basis (baseline 60.0%). The percentage using a powered toothbrush increased from 41.9% (baseline) to 90.0% after 1 year. Oral hygiene parameters had improved after both the motivational trial and observational phases compared to baseline (papillary bleeding index p = .000; Rustogi Modified Navy Plaque Index p < .05; Quigley-Hein Index p = .000).

CONCLUSION

In the long term, participants preferred using powered oral hygiene devices over the gold standard dental floss and manual toothbrush. Improved oral hygiene parameters after 1 year may indicate implementation of newly acquired oral-hygiene skills during the 4-week instruction phase.

Manual vs. interactive power toothbrush on plaque removal and salivary Streptococcus mutans and Lactobacillus casei levels : Single-center, examiner-blinded, randomized clinical trial in orthodontic patients

INTRODUCTION

The purpose of this study was to compare efficacy of a manual and an interactive power toothbrush in orthodontic patients by assessing periodontal indexes and bacterial content of saliva samples.

METHODS

Forty patients (20 females, 20 males; age range 12-18 years) with fixed orthodontic appliances were included in the study. The patients were randomly divided into two groups in a 1:1 ratio using sealed envelopes: group 1: manual toothbrush (Oral‑B Ortho Brush, Procter&Gamble Company, Dublin, Ireland), group 2: interactive power toothbrush (Oral‑B Genius 8900, Procter&Gamble Company, Marktheidenfeld, Germany). All participants were given the same toothpaste (Colgate Triple Action, Colgate-Palmolive, New York, NY, USA). The brushing procedure for each patient was described in detail, both orally and visually, utilizing a video demonstration. Plaque and bleeding index scores were recorded for both the lower and upper arches at the beginning of the study (T0) and at weeks 6 (T1) and 12 (T2). In addition, the numbers of Streptococcus (S.) mutans, Lactobacillus (L.) casei, and Porphyromonas (P.) gingivalis bacteria were determined using a real-time polymerase chain reaction (PCR) analysis in saliva samples collected at T0, T1, and T2 times. Mann-Whitney U test and Student's t test were used to compare data between the groups, and one-way analysis of variance (ANOVA) and Friedman tests were used to compare data from different time intervals for each group.

RESULTS

Plaque index values were greater in group 1 at T1 and T2, although there was no difference between the groups at T0. The gingival index scores of both groups were similar at T0, T1, and T2. While group 2 had a larger number of salivary S. mutans at T0 and T2, there was no significant difference between the groups at T1. At all three time points, there was no significant difference in salivary L. casei levels between the groups.

CONCLUSIONS

Although the interactive power toothbrush was more effective at removing plaque than the manual toothbrush, the results of the gingival index did not reflect the plaque scores. The number of certain salivary bacteria and brush type did not appear to have a clear relationship.

Efficacy of an automatic electric toothbrush with nylon bristles in dental plaque removal: a cross-over randomized controlled trial

OBJECTIVES

The objective of this single-use, five-treatment, five-period, cross-over randomized controlled trial (RCT) was to compare the efficacy in dental plaque removal of a new Y-shaped automatic electric toothbrush (Y-brush) compared to a U-shaped automatic electric toothbrush (U-brush), a manual toothbrushing procedure (for 45 and 120 s), and no brushing (negative control).

MATERIALS AND METHODS

Eligible participants were volunteer students randomized to the treatments in the five periods of the study. The primary outcome measure was the reduction in full-mouth plaque score (FMPS) after brushing while the secondary outcome variable was a visual analogic scale (VAS) on subjective clean mouth sensation. Mixed models were performed for difference in FMPS and VAS.

RESULTS

After brushing procedures, manual toothbrushing (120 s) showed a statistically significant reduction in FMPS than Y-brush (difference 36.9; 95%CI 29.6 to 44.1, p < 0.0001), U-brush (difference 42.3; 95%CI 35.1 to 49.6, p < 0.0001), manual brushing (45 s) (difference 13.8; 95%CI 6.5 to 21.1, p < 0.0001), and No brushing (difference 46.6; 95%CI 39.3 to 53.9, p < 0.0001). Y-brush was significantly more effective than No brushing (difference 9.8; 95%CI 2.5 to 17.0, p = 0.0030), while there was no significant difference compared to U- brush. Similar results were obtained for the differences in the Clean Mouth VAS.

CONCLUSIONS

Y-brush was significantly more effective than no brushing (negative control) in removing dental plaque. When compared to manual toothbrushing for both 45 and 120 s, however, Y-brush was less effective in dental plaque removal.

CLINICAL RELEVANCE

Modified design of automatic toothbrushing devices could improve plaque reduction, especially in patients with intellectual disabilities or motor difficulties.

Cleaning performance of electric toothbrushes around brackets applying different brushing forces: an in-vitro study

Throughout treatment with fixed orthodontic appliances, effective plaque control is crucial to maintaining dental health. This in-vitro study evaluated the cleaning performance of eleven different brush heads of seven electric toothbrushes (oscillating-rotating and sonic motions) and varying brushing forces around orthodontic brackets. Six Mini Diamond® Twin brackets were placed on black-stained front teeth. Teeth were coated with white titanium oxide and brushed in a machine six times for one minute with two different brushing forces (1 N and 1.5 N). Eleven different brush heads were evaluated (either oscillating-rotating or sonic movements). The teeth were scanned and planimetrically evaluated after brushing. Three detailed plaque areas (DPAs) were created: proximal (< 1 mm to bracket), mid-tier (1-2 mm to bracket), and distant (> 2 mm to bracket). The proportion of contaminated proximal, mid-tier, and distant surfaces (white regions) in relation to the respective DPA was calculated. Independent of brushing forces, places with a higher distance (> 2 mm) to the orthodontic bracket had the least amount of residual contamination, followed by areas with a minor (1-2 mm) and proximal distance (< 1 mm). In all of the brushes tested and for both estimated brushing forces, the region with the highest residual contamination was the proximal area. The brush heads of the Paro® Sonic toothbrush left the least amount of residual contamination. The cleaning performance of electric toothbrushes around brackets on upper incisors varied across the brushes examined. The proximal area has the most residual contamination. Furthermore, 9 out of 11 toothbrushes cleaned more successfully with 1.5 N than with 1 N brushing force.

Efficacy of an Electric Toothbrush With Monitor in Dental Plaque Removal: A Crossover Randomized Controlled Trial

BACKGROUND AND PURPOSE

Plaque control is very important in the treatment of periodontitis. However, plaque is difficult to remove because one cannot see one's own oral cavity. The purpose of this study was to verify the plaque removal effect of a prototype device that has a built-in image sensor in the head of an electric toothbrush, enabling the user to brush while checking the condition of the tooth surface on a monitor in real time and to assess their sense of use.

MATERIALS AND METHODS

The subjects were 10 fifth-year students from the Graduate School of Dental Science, Fukuoka Dental College, Fukuoka, Japan. The subjects were divided into those who used electric toothbrushes while having the condition of the tooth surface checked with a monitor (monitor group) and those without a monitor (non-monitor group). O'Leary plaque control records before and after brushing and the brushing time were measured, and questionnaires were given to the subjects after brushing. Scaling and professional tooth cleaning were performed after completing the questionnaire. One week later, subjects were switched to the opposite group and had the same measurements and questionnaires. The Wilcoxon signed-rank test was used to compare both groups before and after the examination at a 5% significance level.

RESULTS

The monitor group had significantly better plaque removal than the non-monitor group. In addition, the monitor group spent significantly more time brushing than the control group.

CONCLUSION

Brushing while monitoring oral conditions in real time using an electric toothbrush with a built-in image sensor showed that significantly better plaque removal can be achieved with a longer brushing time.

A Meta-analysis Comparing Toothbrush Technologies on Gingivitis and Plaque

BACKGROUND

Research continues to show an association between oral health and systemic health, further stressing the importance of effective daily plaque removal via toothbrushing to maintain periodontal health and overall well-being. This investigation was undertaken to compare the efficacy of oscillating-rotating, sonic, and manual toothbrushes in reducing gingivitis and plaque in randomised controlled trials (RCTs) with up to 6 months' follow-up.

METHODS

This meta-analysis was conducted from a single database (Procter & Gamble Oral Care Clinical Archive) including RCTs from 2007 to 2022. Three authors independently assessed study eligibility. Disagreements concerning selected studies were resolved by discussion with an expert colleague. Direct and indirect treatment comparisons along with transition rates to gingival health were calculated using participant-level data. Transition-to-health time was calculated using data from all time points. Subregion analyses evaluated number of bleeding sites and plaque reduction.

RESULTS

This meta-analysis included 21 gingivitis RCTs and 25 plaque RCTs. Relative to manual and sonic brushes, oscillating-rotating brushes had a higher percentage of participants who transitioned to gingival health (72% vs 21% and 54%; P < .001). Compared with manual and sonic brushes, respectively, oscillating-rotating brushes demonstrated greater bleeding site reductions (by 52% and 29%; P < .001) and superior plaque reductions (by 19% and 5%; P < .001). Oscillating-rotating brushes provided faster transitions to health than sonic brushes and showed greater efficacy across subregions. The most advanced oscillating-rotating brush demonstrated statistically significantly greater efficacy compared with traditional oscillating-rotating, manual, and sonic brushes when analysed separately. Risk of bias was deemed low for all studies.

CONCLUSIONS

Oscillating-rotating toothbrushes offer superior results for transition to health, gingivitis, and plaque reduction compared with manual and sonic brushes. The most advanced oscillating-rotating model offers enhanced efficacy vs traditional models.

Antimicrobial effect of probiotic bacteriocins on Streptococcus mutans biofilm in a dynamic oral flow chamber model - an in vitro study

Aim

To determine the antimicrobial activity of the bacteriocin-producing probiotic strains Streptococcus salivarius K12 and Streptococcus salivarius M18 alone or in combination against caries-associated Streptococcus mutans.

Methods

Antimicrobial activity of S. salivarius K12 and/or S. salivarius M18 against S. mutans ATCC 25175 growth and biofilm formation on hydroxyapatite (HA) discs was determined in a flow chamber model by recording the colony forming units (CFU/ml) after 48 h of co-cultivation. The biofilm was analyzed by scanning electron microscopy (SEM) and by confocal laser scanning microscopy (CLSM). Additionally, the simultaneous antagonism assay was used to assess the inhibitory effect of S. salivarius K12 and/or S. salivarius M18 against S. mutans ATCC 25175 and 21 clinical isolates of S. mutans.

Results

Co-cultivation of S. mutans and S. salivarius K12 and/or S. salivarius M18 led to the inhibition of S. mutans viability, thereby, preventing its biofilm formation on HA discs. Furthermore, S. salivarius K12 and S. salivarius M18 exhibited antimicrobial activity against most clinical isolates of S. mutans.

Conclusion

The in vitro flow chamber system used in this study allows the simulation of time-dependent administration of S. salivarius probiotic strains, either alone or in combination, to investigate the prevention of S. mutans biofilm formation in a standardized model.

Results of objective brushing data recorded from a powered toothbrush used by elderly individuals with mild cognitive impairment related to values for oral health

OBJECTIVES

The study aimed to investigate how the objective use of a powered toothbrush in frequency and duration affects plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm in elderly individuals with MCI. A second aim was to compare the objective results with the participants' self-estimated brush use.

MATERIALS AND METHODS

Objective brush usage data was extracted from the participants' powered toothbrushes and related to the oral health variables plaque index, bleeding on probing, and periodontal pocket depth ≥ 4 mm. Furthermore, the objective usage data was compared with the participants' self-reported brush usage reported in a questionnaire at baseline and 6- and 12-month examination.

RESULTS

Out of a screened sample of 213 individuals, 170 fulfilled the 12-month visit. The principal findings are that despite the objective values registered for frequency and duration being lower than the recommended and less than the instructed, using powered toothbrushes after instruction and information led to improved values for PI, BOP, and PPD ≥ 4 mm in the group of elderly with MIC.

CONCLUSIONS

Despite lower brush frequency and duration than the generally recommended, using a powered toothbrush improved oral health. The objective brush data recorded from the powered toothbrush correlates poorly with the self-estimated brush use.

CLINICAL RELEVANCE

Using objective brush data can become one of the factors in the collaboration to preserve and improve oral health in older people with mild cognitive impairment.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05941611, retrospectively registered 11/07/2023.

Optimizing Parent Training to Improve Oral Health Behavior and Outcomes in Underserved Children with Autism Spectrum Disorder

A randomized controlled trial established initial efficacy of a novel parent training (PT) intervention for improving oral hygiene and oral health in underserved children with ASD (Fenning et al., 2022), a population at risk for unmet dental needs. The present study describes our emic approach to PT development alongside treatment outcome data examining feasibility, acceptability, and engagement. Families with Medicaid-eligible children with ASD ages 3 to 13 years (85% male, 62% with intellectual disability) were assigned to receive PT (n = 60) or a psychoeducational toolkit (n = 59). Results indicate strong retention, fidelity, and adherence, with quantitative and qualitative metrics revealing high treatment satisfaction and utilization. Discussion focuses on implications for individualizing treatment to optimize engagement of underrepresented families.

Effect of a multichannel oral irrigator on periodontal health and the oral microbiome

Oral biofilms or dental plaques are one of the major etiological factors for diverse oral diseases. We aimed to evaluate the effect of a multichannel oral irrigator (MCOI) on periodontal health in 29 participants randomly divided into two groups: the MCOI group and the control group. To evaluate the effect of the MCOI on periodontal health, the modified Quigley Hein Plaque Index (PI), Mühlemann-Son Sulcus Bleeding Index (SBI), bleeding on probing (BOP), and swelling were evaluated and compared before and after MCOI use for 3 days. Although PI and SBI showed statistically significant increases in the control group, the MCOI group showed no significant changes in either parameter. Moreover, the percentage of BOP was significantly lower in the MCOI group. Saliva samples were analyzed by 16s rRNA amplicon sequencing to investigate changes in the oral microbiome. Sequencing results showed that Porphyromonas spp. were significantly increased in the control group, whereas no significant change was detected in the MCOI group. Using the MCOI, enriched populations and functional pathways were detected in pioneer species comprising non-mutans streptococci. These findings provide evidence of the effectiveness of the MCOI in maintaining periodontal health and a healthy microbial ecology in the oral cavity.

Mirror, mirror on the wall-is toothbrushing instruction via a three-dimensional motion-tracked system the fairest of them all?

AIMS

To assess the efficacy of a smart toothbrush and mirror (STM) system which provided computer-assisted toothbrushing instruction versus conventional verbal toothbrushing instruction (TBI) amongst a group of 6-12-year-old children.

DESIGN

This randomised controlled trial comprised South Korean school children who were randomly allocated to one of two arms - the STM (n = 21) or the conventional TBI arm (n = 21). The STM system used identical brushes as the TBI group, but with the brush employing three-dimensional motion tracking systems alongside a mirror with an inbuilt computer to guide the user. Modified Quigley-Hein plaque indexes were taken at baseline, immediately after STM/TBI, and then at 1 week and 1 month.

RESULTS

Overall, there was a statistically significant reduction in the average whole-mouth plaque scores for both groups, 40.50% and 40.57% for the STM group and TBI group respectively. There was no statistical significance that either arm was more effective in reducing plaque scores than the other. Both groups demonstrated time to be a statistically significant factor in reducing plaque indices.

CONCLUSION

There is no conclusive evidence that the STM system offers any benefits in terms of plaque control over conventional TBI in this study.

The efficacy of manual toothbrushes in patients with fixed orthodontic appliances: a randomized clinical trial

OBJECTIVE

This study aims to evaluate three types of manual toothbrushes [Cross action (CA), Flat trim (FT), and orthodontic type (OT)] in terms of efficacy in plaque removal in patients undergoing fixed orthodontic treatment.

BACKGROUND

Manual toothbrushes are an essential part of oral hygiene for primary prevention. Plaque control, however, can be influenced by a number of individual and material-related factors. Individual factors include the presence of fixed orthodontic appliances on tooth surfaces, such as brackets and bands, which create difficulties with oral hygiene and lead to plaque formation. The evidence for the effectiveness of advanced bristle designs (multilevel, criss-cross) of the manual toothbrush alone in removing plaque in patients undergoing orthodontic therapy is limited.

METHODS

The experiment followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. This was a three treatment, three-period crossover clinical trial with a single brushing exercise. Thirty subjects were randomized to one of the three treatment sequences of different bristle designs: (CA, FT, and OT). The primary outcome measure was the difference in the plaque scores (baseline minus post-brushing) at each study period, as determined by the Turesky-Modified Quigley-Hein Plaque Index.

RESULTS

Of the thirty-four subjects enrolled in the study, thirty of the subjects met the inclusion criteria and completed all three periods of the study. The mean age was 19.5 ± 1.52 years, with a range of 18-23 years. The differences between treatments in plaque score reduction after brushing were statistically significant (p-value < .001). The treatment differences were statistically significant (p-value < .001) favoring the FT toothbrush over the OT and CA types of toothbrush designs. On the contrary, the difference between the OT and CA types was not statistically significant.

CONCLUSIONS

Plaque was significantly removed by the conventional FT toothbrush after a single brushing compared to the OT and CA types.

The Efficacy of the Three Types of Plaque Control Methods During Fixed Orthodontic Treatment: A Randomized Controlled Trial

BACKGROUND

When intraoral orthodontic devices are used, it becomes significantly more difficult to remove plaque effectively. Dentists and orthodontic specialists can come up with more effective preventive strategies while patients are undergoing fixed orthodontic work if they have a deeper understanding of the present scenario. In addition, individuals will become more aware of the importance of good dental hygiene habits as a result of this.

OBJECTIVE

To assess and compare the effectiveness of a manual toothbrush, machine-driven toothbrush, and conventional mechanical toothbrush coupled with mouth rinse in removing plaque and maintaining gingival health in patients undergoing fixed orthodontic treatment.

METHODS AND MATERIALS

In this research, a total of 222 individuals who met the eligibility and exclusion requirements were randomly selected and offered their written consent. There were a total of 74 participants for each of the three different categories. Category A used a physically driven toothbrush. Category B used a motorized toothbrush. Category C used a physically driven toothbrush together with mouthwash containing 0.2% chlorhexidine gluconate. All study participants were assessed at baseline, one-month follow-up, and two-month follow-up to document the preliminary information, including that of the modified papillary bleeding index (MPBI) by Muhlemann, plaque index (PI) introduced by Silness and Loe, and gingival index (GI) introduced by Loe and Silness.

RESULTS

In this study, the mean PI scores at the one-month and two-month follow-ups were minimum in Category C, while it was maximum in Category A at the two-month follow-up. The mean GI scores at the two-month follow-up were minimum in Category C, while it was maximum in Category A at the two-month follow-up. The mean MPBI scores at the two-month follow-up were minimum in Category C, while it was maximum in Category A. It was observed that participants in this trial who only used a typical mechanical brush experienced an increase in PI and GI scores after one and two months of follow-up. At the one-month and two-month follow-ups, it was noted that the values of PI, GI, and MPBI significantly decreased in the study participants using automated toothbrushes as well as in study participants using manual toothbrushes in conjunction with chlorhexidine mouthwash as compared to baseline values. However, when the three categories were compared, it was found that the research participants utilizing both a manual toothbrush and 0.2% chlorhexidine experienced the highest decreases in PI, GI, and MPBI values.

CONCLUSION

The reduction in the scores of PI, GI, and MPBI was maximum in orthodontic patients after two months when they apply manual toothbrushing along with 0.2% chlorhexidine.

Use of a powered toothbrush to improve oral health in individuals with mild cognitive impairment

OBJECTIVES

The aim of the study is to investigate whether the use of a powered toothbrush could maintain oral health by reducing the dental plaque (PI), bleeding on probing (BOP), and periodontal pocket depth (PPD) ≥4 mm in a group of individuals with MCI and also if changes in oral health affect various aspects of quality of life.

BACKGROUND

People with cognitive impairment tend to have poor oral hygiene and poorer Quality of life. In the present study, the participants were asked to use a powered toothbrush for at least 2 min morning and evening and no restrictions were given against the use of other oral care products. The participant survey conducted at each examination demonstrated that 61.2% of participants at baseline claimed to have experience of using a powered toothbrush, 95.4% at 6 months and 95% after 12 months. At the same time, the use of manual toothbrushes dropped from 73.3% to 44.7% from baseline to the 12-month check-up. This shows that several participants continue to use the manual toothbrush in parallel with the powered toothbrush, but that there is a shift towards increased use of the powered toothbrush. Removal of dental biofilm is essential for maintaining good oral health. We investigated whether using a powered toothbrush reduces the presence of dental plaque, bleeding on probing and periodontal pockets ≥4 mm in a group of older individuals with mild cognitive impairment.

MATERIALS AND METHODS

Two hundred and thirteen individuals with the mean age of 75.3 years living without official home care and with a Mini-Mental State Examination (MMSE) score between 20 and 28 and a history of memory problems in the previous six months were recruited from the Swedish site of a multicenter project, Support Monitoring And Reminder Technology for Mild Dementia (SMART4MD) and screened for the study. The individuals received a powered toothbrush and thorough instructions on how to use it. Clinical oral examinations and MMSE tests were conducted at baseline, 6 and 12 months.

RESULTS

One hundred seventy participants, 36.5% women and 63.5% men, completed a 12-month follow-up. The use of a powered toothbrush resulted, for the entire group, in a significant decrease in plaque index from 41% at baseline to 31.5% after 12 months (P < .000). Within the same time frame, the values for bleeding on probing changed from 15.1% to 9.9% (P < .000) and the percentage of probing pocket depths ≥4 mm from 11.5% to 8.2% (P < .004). The observed improvements in the Oral Health Impact Profile 14 correlate with the clinical improvements of oral health.

CONCLUSION

The use of a powered toothbrush was associated with a reduction of PI, BOP and PPD over 12 months even among individuals with low or declining MMSE score. An adequately used powered toothbrush maintain factors that affect oral health and oral health-related Quality of Life in people with mild cognitive impairment.

Safety and Efficacy of Plaque Removal Using Manual and Powered Toothbrush in Cerebral Palsy Children by Parents/Caregivers: A Randomized Control Crossover Trial

Aim

The aim of our study was to check the safety and efficacy of plaque removal using manual and powered toothbrush in cerebral palsy children by parents/caregivers.

Materials and methods

This was a single blinded, crossover randomized control trial conducted on 60 cerebral palsy children between the age of 6 to 14 years. They were randomly divided using a flip coin method into two groups: group A-manual toothbrush and group B-powered toothbrush. The plaque index (PI), gingival index (GI), and gingival abrasion (GA) score were measured at baseline, then at an interval of 3, 6, 9, and 12 weeks. This was followed by a crossover between two groups with a washout period of 1 week.

Results

Both manual and powered toothbrush showed a significant reduction in plaque and gingival score before and after crossover when compared to baseline (p < 0.05). The GA score was reduced to 100% in both groups. However, there was no statistically significant difference between both the groups before and after the crossover. Also, through the questionnaire it was observed that both child (86.6%) and parent (70%) showed positive feedback towards powered toothbrush.

Conclusion

It can be concluded from the present study that the efficacy of a powered toothbrush is comparable to that of a manual toothbrush. Parents and caregivers, on the contrary, displayed a favorable attitude towards the use of powered toothbrushes due to their ease of use.

Clinical relevance

Cerebral palsy is one of the most common neurological disorders among children. It is associated with poor motor skills and manual dexterity that hampers their ability to brush and thus leads to poor oral hygiene. A powered toothbrush seems more appealing and is specially designed for patients with poor neuromotor coordination.

How to cite this article

Deshpande AN, Naik K, Deshpande N, et al. Safety and Efficacy of Plaque Removal using Manual and Powered Toothbrush in Cerebral Palsy Children by Parents/Caregivers: A Randomized Control Crossover Trial. Int J Clin Pediatr Dent 2023;16(2):344-349.

Biomimetic Action of Zinc Hydroxyapatite on Remineralization of Enamel and Dentin: A Review

Biomimetic zinc-carbonate hydroxyapatite technology was developed to realize materials that mimic the natural hydroxyapatite of enamel and dentin and possess good activity in terms of affinity to adhere to these biological tissues. The chemical and physical characteristics of this active ingredient allows the hydroxyapatite itself to be particularly similar to dental hydroxyapatite, enhancing the bond between biomimetic hydroxyapatite and dental hydroxyapatite. The aim of this review is to assess the efficacy of this technology in terms of benefits for enamel and dentin and reduction of dental hypersensitivity.

MATERIALS AND METHODS

A literature search (Pubmed/MEDLINE and Scopus) of articles from 2003 to 2023 was conducted to analyze studies focused on the use of zinc-hydroxyapatite products. Duplicates were eliminated from the 5065 articles found, leaving 2076 articles. Of these, 30 articles were analyzed based on the use of products with zinc-carbonate hydroxyapatite in these studies.

RESULTS

30 articles were included. Most of the studies showed benefits in terms of remineralization and prevention of enamel demineralization in terms of occlusion of the dentinal tubules and reduction of dentinal hypersensitivity.

CONCLUSION

Oral care products such as toothpaste and mouthwash with biomimetic zinc-carbonate hydroxyapatite were shown to provide benefits according to the aims of this review.

Powered tooth brushes are beneficial for long-term oral health: Results from the Study of Health in Pomerania (SHIP-TREND)

AIM

To determine the long-term effects of the use of powered tooth brush (PTB) in comparison to manual tooth brush (MTB) on periodontitis severity, coronal caries experience, and the number of missing teeth using in a population-based cohort study.

MATERIALS AND METHODS

Using 7-year follow-up data of 2214 participants of the Study of Health in Pomerania (SHIP-TREND), comprehensively adjusted linear models using generalized least squares and ordinal regression models estimated the effects of PTB usage on dental outcomes in complete case and imputed data.

RESULTS

At follow-up, PTB users had lower medians for mean probing depth (PD; 2.21 mm) and mean clinical attachment levels (1.73 mm) than MTB users (2.30 and 1.96 mm, respectively). Adjusted models revealed the beneficial effects of PTB usage on follow-up levels of plaque, bleeding on probing, mean PD, percentage of sites with PDs ≥4 mm, mean clinical attachment levels (all, interdental, and non-interdental sites, respectively), and the number of missing teeth. For the number of missing teeth, the effects were more pronounced in participants aged ≥50 years. No significant effects of PTB usage on the number of decayed or filled surfaces (all and interdental sites) were found.

CONCLUSIONS

A recommendation of PTB usage in dental practice could contribute to the long-term promotion of oral health.

Expert consensus on clinical management for early childhood caries

Early childhood caries (ECC) is the most prevalent chronic oral disease and one of the worldwide public health problems of great urgency for children. ECC can affect children's teeth, dentition, craniomaxillofacial, and general health and development. Therefore, through dental caries etiologies and caries risk assessment, patient-centered, personalized planning and a combination of prevention and treatment should be implemented in the clinical management for ECC. Periodic and continuous cycle management can only be accomplished with the cooperation of medical staff, children, and their guardians. This expert consensus will expound the clinical management of ECC in the following aspects: caries risk assessment, early clinical prevention, treatment strategies, and postoperative management.

Oral Health Care of People with Down Syndrome in Germany

BACKGROUND

Due to a dearth of information on preventive and supportive oral care for people with Down Syndrome (PDS) in Germany, caregivers of PDS were surveyed on the topic.

METHODS

An anonymized questionnaire was sent to the 610 members of the German Down Syndrome Association. The study was approved by the ethics committee of Witten/Herdecke University (# 165/2017).

RESULTS

The parents/caregivers of 207 PDS responded. These PDS were between 1 and 55 years old (mean age 24.4 years) and included 111 males and 96 females. At their first dental appointment, 40.7% (n = 82) had been younger than three years. Although 78.3% (n = 162) tooth brushed twice daily, only 30.9% (n = 64) brushed for 2-3 min; 84.0% (n = 135) did not use other dental hygiene products apart from toothbrushes. Age-specific differences were found: Although only 30.8% (n = 12) of PDS < 18 years (n = 39) independently performed dental self-care; this was 67.3% (n = 113) for PDS ≥ 18 years (n = 168). A statistically significant (p < 0.001; Chi-Square-Test) difference in toothbrush preferences emerged: While PDS < 18 years mainly used manual toothbrushes, PDS ≥ 18 years preferred electric toothbrushes. In contrast to 72.6% of PDS ≥ 18 years, only 51.3% of PDS < 18 years accepted most types of toothpaste.

CONCLUSIONS

Age-dependent differences in tooth brushing behaviour became evident within the group of PDS in Germany. Hence, better age-specific, inter-professional dental prophylaxis concepts need to be developed and offered for all age groups of PDS. These concepts should include personalized check-up intervals and hands-on instruction in dental hygiene procedures by dental practitioners.

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.

Management of white spot lesions induced during orthodontic treatment with multibracket appliance: a national-based survey

OBJECTIVES

The study aimed to survey current strategies against enamel demineralization during multibracket therapy (MBT) and guide a prevention concept based on existing scientific evidence.

MATERIALS AND METHODS

The survey comprised questions on the prevention and management of white spot lesions (WSL). The questionnaire was sent via email to orthodontists working in practices and universities throughout Germany. The analysis involved descriptive statistics using the chi-square test (p < 0.05).

RESULTS

A prevention protocol was used before MBT by 80.6% of the participants. Less than a quarter of the participants regularly applied topical fluoride (gel or varnish) during MBT. According to the respondents' assessment, the prevalence of WSL during MBT is 11.6%, mainly observed in 12- to 15-year-old male patients. Orthodontists graduating after 2000 tended to recommend and apply fluoride-containing materials more often than their senior colleagues (p = 0.039). Participants from private practices applied fluoride varnish or gel more frequently than those from university clinics (p = 0.013). Fluoridation was the most common (70.7%) treatment for WSL after MBT, followed by resin infiltration (21.2%). The majority (80.9%) of the participants favor a guideline for preventing WSL.

CONCLUSIONS

WSL prevention during MBT is challenging. Males in puberty are predominantly affected. Younger orthodontists are more concerned about the prevention of WSL during MBT.

CLINICAL RELEVANCE

The non-negligible prevalence of individuals with WSL emphasizes the need for dental education and health care reform. This would help to implement standardized procedures and establish innovative applications.

Effects of Electric-Toothbrush Vibrations on the Expression of Collagen and Non-Collagen Proteins through the Focal Adhesion Kinase Signaling Pathway in Gingival Fibroblasts

Electric-toothbrush vibrations, which remove plaque, are transmitted to the gingival connective tissue via epithelial cells. Physical energy affects cell function; however, the effects of electric-toothbrush vibrations on gingival extracellular matrix (ECM) protein expression remain unknown. We aimed to examine the effects of these vibrations on the expression of ECM proteins—type I collagen (col I), type III collagen (col III), elastin, and fibronectin (FN)—using human gingival fibroblasts (HGnFs). HGnFs were seeded for 5 days in a six-well plate with a hydrophilic surface, exposed to electric-toothbrush vibrations, and cultured for 7 days. Subsequently, the mRNA and protein levels of col I, col III, elastin, and FN were examined. To investigate the role of focal adhesion kinase (FAK) signaling on ECM protein expression in vibration-stimulated cells, the cells were treated with siRNA against protein tyrosine kinase (PTK). Electric-toothbrush vibrations increased col I, col III, elastin, and FN expression; promoted collagen and non-collagen protein production; and enhanced FAK phosphorylation in HGnFs. Moreover, PTK2 siRNA completely blocked the effects of these vibrations on the expression of col I, col III and elastin mRNA. The results suggest that electric-toothbrush vibrations increase collagen, elastin, and FN production through the FAK-signaling pathway in fibroblasts.

On the Pathogenicity of the Oral Biofilm: A Critical Review from a Biological, Evolutionary, and Nutritional Point of View

Plaque control is one of the most recommended approaches in the prevention and therapy of caries and periodontal diseases. However, although most individuals in industrialized countries already perform daily oral hygiene, caries and periodontal diseases still are the most common diseases of mankind. This raises the question of whether plaque control is really a causative and effective approach to the prevention of these diseases. From an evolutionary, biological, and nutritional perspective, dental biofilms have to be considered a natural phenomenon, whereas several changes in human lifestyle factors during modern evolution are not “natural”. These lifestyle factors include the modern “Western diet” (rich in sugar and saturated fats and low in micronutrients), smoking, sedentary behavior, and continuous stress. This review hypothesizes that not plaque itself but rather these modern, unnatural lifestyle factors are the real causes of the high prevalence of caries and periodontal diseases besides several other non-communicable diseases. Accordingly, applying evolutionary and lifestyle medicine in dentistry would offer a causative approach against oral and common diseases, which would not be possible with oral hygiene approaches used on their own.

Health promotion through structured oral hygiene and good tooth alignment

Aim

Periodontal diseases and caries are two of the most common forms of chronic degenerative diseases, with consequences not only for the oral cavity manifesting as tooth loss, orofacial pain and xerostomia, but also with effects on the cardiovascular system and, in the elderly, on the pneumonia rate. This can be prevented or controlled by structured oral hygiene.

Method

Based on a systematic literature search in PubMed, the possibilities for ensuring structured oral hygiene are analyzed.

Results and conclusion

Limiting the consumption of sugary meals and beverages, regular removal of food debris - supplemented by sugar-free chewing gum if desired - and preventing plaque formation by brushing with fluoridated toothpastes, using dental floss and interdental brushes after meals, serve to prevent or control gingivitis, periodontitis and caries. In the long term, the development of periodontitis-associated cardiovascular diseases and, in the elderly, the risk of pneumonia can probably be reduced. Antiseptic rinsing of the oral cavity is an important supplement to prevent periodontitis, especially in cases of limited ability to perform mechanical biofilm removal, but also for the prevention of respiratory infections. Proper functional tooth alignment is important for optimal mechanical cleaning to prevent plaque accumulation. If correction of misaligned teeth is possible with the use of removable aligners instead of fixed orthodontic appliances, these are to be preferred because of the better accessibility for mechanical hygiene measures.

Influence on the patient's oral hygiene depending on the treatment performed by either one or different pre-graduate practitioners - a randomized, controlled, clinical short-term trial

Objectives

Plaque control by improved domestic oral hygiene is essential in periodontal treatment. However, changing treatment providers may interfere with building a dentist-patient relationship and in turn affect treatment success. The aim of this randomized, controlled, prospective short-term study was to determine the influence of either one or four different pre-graduate practitioners on patients’ oral hygiene parameters during active periodontal therapy.

Material and Methods

A total of 55 patients with periodontitis were allocated to two groups. Within the group “continuous treatment” (CT, n = 27), each patient was treated by one individual practitioner over the treatment period. For patients of the group “discontinuous treatment” (DT, n = 28), treatment in each session was performed by a different practitioner. Periodontal parameters (BOP, PBI, and PCR) were assessed at two timepoints: T1 (baseline) and T2 (end of active therapy).

Results

With CT, the PBI improved in 93% of the patients, compared to 71% with DT (p = 0.048). T1-T2 intragroup analysis showed a statistically significant improvement of all observed clinical parameters with no differences in ∆PBI, ∆BOP, and ∆PCR. Spearman’s correlation analysis revealed a weak correlation between PCR and BOP of CT only.

Conclusions

In the present study, improvement of all parameters was comparable between the groups. PBI, as a parameter displaying patient’s domestic plaque control compliance, improved in more patients from CT than DT. This is possibly indicating an advantage of continuous treatment by one single practitioner.

Clinical relevance

Treatment by either a single practitioner or by multiple, constantly changing practitioners might influence patients’ compliance to modify their behaviour when medically necessary.

Efficacy of dental floss in the management of gingival health: a randomized controlled clinical trial

OBJECTIVES

This randomized controlled clinical trial evaluated the efficacy of dental floss as a supplement to toothbrushing in support of gingival health in adults.

MATERIALS AND METHODS

Seventy-five systemically healthy subjects, non-smokers, without loss of interproximal periodontal attachment and with more than 15% of the interproximal sites presenting with gingival bleeding were randomized into two groups either performing toothbrushing supplemented by dental floss (TB + DF) or toothbrushing (TB) alone. Over a 60-day period, participating subjects weekly received oral hygiene instruction and supervised personal and professional plaque removal by applying the devices assigned for the group. Study subjects were instructed to perform toothbrushing twice daily (group TB + DF and TB) and use dental floss once daily (group TB + DF). Gingival Index (GI) and Plaque Index (PlI) were evaluated at baseline, and at 30 and 60 days. Linear mixed models were used to compare PlI and GI intra- and intergroup means.

RESULTS

Interproximal gingival inflammation (GI = 2 and mean GI) was significantly reduced in both groups by day 30, reduction in inflammation being significantly greater in the TB + DF compared with the TB alone group. No further significant alterations were observed by day 60. Moreover, reduction in gingival inflammation (GI = 2) was greater in the anterior compared with the posterior dentition.

CONCLUSIONS

Interproximal gingival inflammation may be significantly reduced by toothbrushing alone, the effect being significantly enhanced when toothbrushing is combined with dental floss.

TRIAL REGISTRATION

The protocol registration was filed on May 9, 2018 (# 538,311,716.5.0000.5346) on ClinicalTrials.gov and after complete registration, a NCT number was generated (NCT04909840). Since the date in May 2018 when the protocol preregistration was filed, no change in methodology, primary outcome, and data analysis has occurred.

CLINICAL RELEVANCE

Optimized personal oral hygiene routines in individuals without loss clinical attachment interproximal should include dental floss as a supplement to toothbrushing in support of gingival health.

T-shaped toothbrush for plaque removal and gingival health in children: a randomized controlled trial

Background

To evaluate an experimental T-shaped toothbrush for plaque removal and gingival health when compared to a conventional toothbrush among children.

Methods

This single blind parallel randomized controlled trial was conducted on 8–10-year-old healthy schoolchildren with no history of recent antibiotic intake, proximal caries or more than 3 missing teeth per quadrant. A computer-generated randomization list allocated child to the 2 groups. Each child received detailed instructions for tooth brushing. Gingival health and plaque scores were recorded in school at baseline, 2 weeks, 1 month and 3 months in a portable dental chair by an examiner who was blind to the allocated toothbrush. A general feedback on the use of the T-shaped toothbrush was obtained at 3 months. Data was analyzed using two-way repeated measure ANOVA, Generalized estimating equation and Bonferroni test.

Results

A total of 195 eligible children were invited, 110 parents gave consent and 100 children completed the study; 50 in each group. There were statistically significant reductions in mean gingival and plaque scores at each visit when compared to baseline for both toothbrushes (p < 0.05). There were no statistically significant differences between scores for the two toothbrushes at each visit (p > 0.05). Majority of participants gave positive feedback regarding the T-shaped toothbrush.

Conclusions

Both toothbrushes had similar efficacy in removing plaque and improving gingival health among children. The T-shaped toothbrush is an alternative to the conventional toothbrush for oral hygiene in children.

Trial registration Retrospectively registered at ClinicalTrials.gov Registry—NCT03989479 18/06/2019.

Efficacy of a sonic toothbrush on plaque removal-A video-controlled explorative clinical trial

Clinical studies on the efficacy of sonic toothbrushes show inconsistent results, most studies have been conducted without sufficient supervision of appropriate toothbrush usage. Aims of the explorative clinical trial were therefore to investigate whether the usage of an activated sonic toothbrush reduces plaque more effectively than an inactivated one used as a manual toothbrush, and to which extent the correct use of such toothbrush plays a role in its efficacy. The clinical trial was designed as a video-controlled interventional study. Thirty participants (mean (±SD) age 22.9 (±2.5) years) were included, areas of interest were the buccal surfaces of the upper premolars and the first molar (partial mouth recording). Toothbrushing was performed without toothpaste in a single brushing exercise under four different conditions: switched off, habitually used as manual toothbrush, no instruction; switched on, habitually used as powered toothbrush, no instruction; switched off, used as manual toothbrush, instruction in the Modified Bass Technique; switched on, used as powered toothbrush, instruction in a specific technique for sonic toothbrushes. Brushing performance was controlled by videotaping, plaque was assessed at baseline (after 4 days without toothbrushing) using the Rustogi modified Navy-Plaque-Index and planimetry. Main study results were that plaque decreased distinctly after habitual brushing regardless of using the sonic brush in ON or OFF mode (p for all comparisons < 0.001). After instruction, participants were able to use the sonic brush in ON mode as intended, with only minor impact on efficacy. Using the toothbrush in OFF mode with the Modified Bass Technique was significantly less effective than all other conditions (p for all comparisons < 0.001). Under the conditions used, the sonic toothbrush was not more effective when switched on than when switched off, and there was no evidence that the correct use of the toothbrush was more effective than the habitual use.

Electric and Manual Oral Hygiene Routines Affect Plaque Index Score Differently

This cross-sectional study aimed to examine the oral hygiene behaviors in the general population and identify factors affecting oral hygiene behaviors and plaque removal efficacy. A survey was distributed to patients through 11 dental practices in Japan, and each patient’s plaque index score (PIS) was recorded. In total, 1184 patients participated (521 women and 660 men), with 84.04% using manual toothbrushes (MTBs) and 15.96% using electric toothbrushes (ETBs). ETB users had a significantly lower PIS compared to MTB users (p = 0.0017). In addition, a statistically significant difference in the PIS was detected in relation to the frequency of brushing per day (≥2 times) and time spent on brushing (≥1 min). Some MTB users spent less than 1 min brushing, while all ETB users spent at least 1 min brushing, and extended brushing periods significantly improved the PIS for the MTB users. MTB users tend to replace brush heads more frequently than ETB users, and the frequency of replacement affected the PIS significantly (p < 0.01) for the MTB users. The status of dental treatment (first visit, in treatment versus recall) also significantly affected the PIS (p < 0.01). The ETB was more effective than the MTB in terms of better plaque removal and reduced frequency of brush head replacement.

Assessment of Oral Microbiome Changes in Healthy and COVID-19-Affected Pregnant Women: A Narrative Review

During pregnancy, there are several metabolic changes and an alteration in the composition of microorganisms that inhabit the oral cavity, with an increase in pathogenic bacteria that promote the onset of gingival diseases. This review is based on research in reference to the PICO model (Problem/Intervention/Comparison/Outcome), related to changes in the oral microbiome of pregnant women and possible oral consequences in patients with COVID-19. The results showed a growth of some pathogenic bacteria in pregnant women, including Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum, and the selective growth of the Prevotella intermedia, Porphyromonas gingivalis and Tannerella species, probably due to the fact that these bacteria use progesterone as a source of nutrition. These same bacteria are implicated in the development of periodontal disease. Periodontal pockets have bidirectional interactions between the oral cavity and the systemic circulatory system through the peripheral gingival blood vessels. The affinity of the SARS-CoV-2 virus to specific membrane receptors is now clear, and could involve the internal and external epithelial lining or the fibroblasts of the periodontal ligament. According to the results of the present review, the control of oral microbiome changes during pregnancy would be welcomed. The use of probiotics could help clinicians manage pregnant patients, reducing inflammatory indexes. Future studies should focus not only on changes in the level of the oral microbiome in pregnancy or the correlation between periodontal disease and COVID-19, but also on oral changes induced by both clinical situations.

Use of water and ethanol extracts from wine grape seed pomace to prepare an antioxidant toothpaste

BACKGROUND

Extracts of fresh wine grape seeds/skin or of grape pomace seeds were used to prepare antioxidant natural toothpastes.

RESULTS

Ethanol extracted twice more polyphenols than water; ultrasound did not provide any improvement in the extraction. The addition of freeze-dried ethanol extracts of seeds or skin, at 2% and 10%, to the commercial toothpaste significantly increased the polyphenol content, both from white grape seeds and skin and from red grape seed pomace. The evaluation of time stability (shelf life) revealed a decrease, after 4 months, of 3.9% and 9.4% in total polyphenol content, in 5% and 10% water extracts, but not for ethanol extracts. 1,1-Diphenyl-2-picrilhydrazil¹ antiradical activity was the highest in 10% of seed water extract toothpaste and, after 4 months, the activity was stable.

CONCLUSION

Ethanol and water are efficient and safe solvents to create natural toothpaste with grape or pomace seed extract with antioxidant activity. © 2021 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Development of a secondary school-based digital behaviour change intervention to improve tooth brushing

BACKGROUND

Dental caries in adolescents remains a significant public health problem with few oral health promotion interventions aimed at reducing dental caries in secondary school-aged students. Previous oral health and mobile health (mHealth) research has suggested the need for the development of a school-based behaviour change intervention incorporating a digital component. This study aimed to describe the development process of a behaviour change intervention to improve the oral health of students aged 11-16 years attending secondary schools in the UK.

METHODS

A six-step process was used to develop the complex intervention informed by behaviour change theory and involving students, young people, parents and teachers in the process. The steps were: (1) identifying the target behaviours, namely tooth brushing with a fluoride toothpaste (2) identifying the theoretical basis and developing the causal model (3) reviewing the relevant literature and developing the logic model (4) designing the intervention with young people, parents and school staff (5) specifying the intervention content and (6) translating this content into features of the intervention and piloting.

RESULTS

The resultant intervention included a quality-assured classroom-based session (CBS) (guided by a lesson plan and teaching resources), delivered by school teachers which was embedded within the school curriculum. This CBS was followed by a series of (Short Message Service) SMS texts delivered twice daily to student's mobile telephones with the content, duration and timing of the messages informed by involvement of students and young people.

CONCLUSIONS

An intervention to improve the oral health of secondary school students through improved tooth brushing was rigorously developed based on behaviour change theory and work with young people, parents and school staff. Further research is needed to evaluate the outcomes and processes involved following the delivery of this intervention. BRIGHT Trial Trial Registration ISRCTN12139369.

Nonrestorative Management of Dental Caries

The World Dental Federation (FDI) policy statement in 2016 advocated evidence-based caries-control measures for managing dental caries. The caries management philosophy has shifted from the traditional surgical manners to minimal intervention dentistry. Minimal intervention dentistry aims to extend the longevity of natural teeth. It places the nonrestorative approaches as a priority. The nonrestorative approaches for caries management aim to tackle the etiological factors of dental caries. Caries can be prevented or reversed by restricting the sugar intake and its frequency in the diet, improving oral hygiene practices, and using fluoride toothpaste. This article aims to present strategies for the nonrestorative management of dental caries, which are divided into four components to address the different etiological factors of dental caries. The first component is controlling dental plaque. Strategies for plaque control include oral hygiene instruction, motivational interviewing, mechanical plaque control, and chemical plaque control. The second component for nonrestorative management is reducing the risk of caries by identifying caries risk factors and protective factors, assessing personal caries risk, and customizing a treatment plan. Evidence-based measures for caries prevention include using fluoride, and dental sealants should be provided. The third component includes topical treatment to remineralise early carious lesions. The last component is long-term follow-up. Appropriate strategy adoption for the nonrestorative management of dental caries prolongs the life span of the teeth and sustains the good oral health of patients.

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.

Influence of brushing with natural dentifrices on color change: In vitro study

Background

To evaluate in vitro the influence of daily brushing with the use of natural toothpastes on the color change of enamel in bovine teeth.

Material and Methods

Four dentifrices were used, one conventional Colgate Total 12 - Clean Mint (G1), and three natural, Contented Toothpaste with Organic and Natural Ingredients (G2); Dental Toothpaste (G3) and Aliv-Gaia Toothpaste (G4). Eighty bovine teeth were distributed in four experimental groups with 20 teeth each (n = 20). The buccal enamel surface of the teeth was subjected to brushing, with the related dentifrices of each group, for 2.13 seconds three times a day, with an electric brush Oral B 5000 Professional Care. Before and after brushing, color measurement tests with a spectrophotometer were performed. The color variation was calculated using the formula ΔE = [(ΔL *) 2+ (Δa *) 2+ (Δb *)2] 1/2. The results obtained were tabulated and submitted to the Kruskal Wallis non-parametric test.

Results

The color change (ΔE) observed was 7.551 and p-value equal to 0.056, determining that there was no statistically significant difference between the groups. However, qualitative tests showed the clearing of all experimental groups, G3 with the greatest change, followed by G2, G1 and G4.

Conclusions

The evaluated dentifrices were not able to promote color change.

Key words:Dental enamel, plant extracts, saliva, artificial, dentifrices.

Improved Oral Health and Adaptation to Treatment in Dogs Using Manual or Ultrasonic Toothbrush or Textile of Nylon or Microfiber for Active Dental Home Care

Poor oral health is a common problem in dogs causing pain and impaired welfare. The gold standard to maintain good oral health and prevent periodontitis is daily tooth brushing. However, many dog owners find it difficult, and dogs often show aversive behavior. There are several different tools available, and in this intra-subject study, four different active dental home care treatment options were examined: manual and ultrasonic toothbrush, a nylon glove, and a microfiber finger cloth. The treatments were evaluated for efficacy against gingivitis, plaque, and calculus in beagle dogs. Each dog received two treatments on the buccal sides of the teeth once daily, either two types of toothbrushes (N = 10) or two types of textiles (N = 11), on separate sides of the mouth. The dogs' teeth were assessed before and after the five-week treatment period, with the assessor blinded by additional, similar dogs (N = 7). The study also assessed the dogs' stress levels during treatment using a fear, anxiety, stress (FAS) protocol. All four treatments improved dog oral health, reducing gingivitis and plaque. Furthermore, the amount of calculus also decreased in some individuals. Adaptation to dental care occurred in the dogs over time. This information can be used to encourage dog owners to brush their dogs' teeth.

Efficacy of sonic versus manual toothbrushing after professional mechanical plaque removal: A 6-month randomized clinical trial

Aim

The aim of this study was to compare the efficacy of two brushing methods (manual vs. sonic) in terms of plaque control after a session of professional mechanical plaque removal (PMPR).

Methods

Subjects with gingivitis underwent a session of PMPR and were randomly assigned to sonic (SB) or manual brushing (MB). Oral hygiene instructions were provided at baseline (BL), 2 (T0a), 4 (T0b) and 6 weeks (T1) and 6 months (T2). Plaque Index (PI), Gingival Index (GI) and bleeding on probing (BoP) were measured at BL, T1 and T2. The proportion of sites with PI, GI and BoP was modelled at site level using a negative binomial regression fitted via generalized linear mixed model accounting for intra‐patient correlation.

Results

Thirty‐two subjects were selected, 16 assigned to each group and 31 completed the study. PI, BoP and GI were comparable at BL. At T1, PI was successfully maintained at 6.21% for SB and 22.81% for MB, while at T2 reached 11.34% for SB and 28% for MB, favouring the SB group (p < 0.001). GI and BoP were significantly lower in the SB group at T1, with a BoP reduction for SB about 3 times higher than MB (p < 0.001). These parameters then levelled at T2 between the groups, with BOP reaching 0.14% versus 0.05% (p = 0.356) and GI 1.75% versus 3.52% (p = 0.020).

Conclusion

Sonic brushing seemed to maintain a lower PI score compared to a manual brush at 6 months. BoP and GI resulted comparable.

Bacteraemia of oral origin in children-A Systematic review and network meta-analysis

OBJECTIVES

To systematically review the prevalence of bacteraemia, triggered by dental intervention and home oral hygiene practices, in children. The network meta-analysis (NMA) quantitatively compared the risk of bacteraemia triggered by dental extractions and home and professional cleaning procedures.

MATERIALS AND METHODS

Clinical trials with the outcome "bacteraemia in children" were searched. The NMA was performed using the frequentist weighted least-squares approach comparing the odds ratios (OR) of different interventions.

RESULTS

Among 11 of 13 studies, dental treatment was performed under general anaesthesia. In 2,381 patients, bacteraemia occurred in 38.7%-56% patients following single-tooth extractions, in 22%-46% after manual toothbrushing (MTB), and in 26%-78% after power toothbrushing (PTB). When MTB was set as the reference (OR 1), rubber cup polishing showed a slightly higher risk (OR 1.26) of bacteraemia. PTB presented a higher risk (OR 1.79-2.27) than with single-tooth extractions (OR 1.55) but lower than that with multiple extractions (OR 2.55).

CONCLUSION

Daily use of MTB and routine professional cleaning were associated with the lowest risk of developing bacteraemia in children with gingivitis, almost as much as with a single-tooth extractions. Improved plaque control with PTB increased the risk of bacteraemia. There is limited evidence on gingivitis-free and systemically-diseased children.

Toothbrushing compliance tracking in a nursing home setting using telemonitoring-enabled powered toothbrushes

Introduction Nursing home residents with cognitive and physical disabilities often depend on assistance from caregivers to perform personal hygiene tasks including toothbrushing. Only a minority receives the care needed and toothbrushing compliance levels are not registered.Aims To describe toothbrushing compliance levels in a nursing home setting and investigate the relevance and practicality of using telemonitoring-enabled powered toothbrushes for automated compliance tracking. Furthermore, to investigate changes in plaque and bleeding scores.Materials and methods Nursing home residents were provided with powered toothbrushes and telemonitoring gateways. Toothbrushing frequency and duration were automatically recorded by the telemonitoring gateways, and an email report was sent once a week to the nursing home manager. Plaque index and bleeding index were assessed by dentists at baseline, at the end of the intervention and at three months post-intervention.Results Data from 20 participants for 100 days (3,920 measurements) were collected and used to evaluate toothbrushing compliance. A minority of toothbrushings (5%) were in compliance with the two-minute toothbrushing duration recommendation, while around 30% achieved the one-minute toothbrushing minimum duration recommendation. Around 25% of participants would get only one toothbrushing per day, while 40% would get none. Both plaque and bleeding scores improved significantly during the project, but all progress was lost three months after the project's end.Conclusions It is relevant and practical to monitor toothbrushing compliance in the nursing home setting using telemonitoring-enabled powered toothbrushes. Despite finding limited compliance levels, a significant improvement in the plaque and bleeding index was found after the intervention, which was lost again three months after the telemonitoring gateways had been removed.

Drivers, opportunities and best practice for sustainability in dentistry: A scoping review

OBJECTIVE

To undertake a comprehensive scoping review of the literature to address the research question 'What is the current state of environmental sustainability in general dental practice?' To provide an effective baseline of data that will consider the drivers, opportunities and recommendations for the implementation of sustainable practice.

DATA & SOURCES

The scoping review was conducted for all published literature in the English language that addresses this topic up to the 31st April 2021. The method of the PRISMA-ScR (PRISMA extension for Scoping Reviews was followed. 128 papers included in this scoping review consisted of: Commentary [Letters, editorials, communication and opinion] (n=39); Research (n=60); Literature reviews (n=25); Reports [Policy and legislation] (n=4). Each included record was analysed for emerging themes that were further classified according to their general relevance. The scoping review is considered over two manuscripts, with this second paper focusing on the opportunities, recommendations and best practice to develop and engage with sustainable practice.

CONCLUSIONS

Drivers, opportunities and recommendations for best practice to achieve environmentally sustainable goals in oral health care: The lack of public and professional awareness is the greatest driver to engage with a positive change of behaviour and attitudes. Awareness through education is key at all levels and this should be the bedrock of future strategies. Reduction in staff and patient commuter travel through a reduction of the incidence of preventable oral diseases, improved patient care logistics and IT. Reducing waste and increase recycling opportunities, especially for SUPs. Engagement with legislation and policy makers. Engagement with key stakeholders across the dental materials/products supply chain for the management of manufacturing, distribution, procurement, clinical use and waste management.

[Trends in dental and oral health status in Germany between 1997 and 2014]

Hintergrund

Zur Veränderung der oralen Krankheitslast in der deutschen Allgemeinbevölkerung über die letzten 20 Jahre gibt es bisher keine umfassende Darstellung.

Fragestellung

Wie haben sich die Prävalenzen der Karies, der Parodontitis und des Zahnverlustes und deren Determinanten von 1997 bis 2014 in Deutschland verändert?

Material und Methoden

Ausgewertet wurden Daten von 35- bis 44- und 65- bis 74-Jährigen der Deutschen Mundgesundheitsstudien (DMS) III, IV und V sowie von 25- bis 74-Jährigen der Studies of Health in Pomerania (SHIP‑0 und SHIP-Trend-0). Der Decayed, Missing, Filled Teeth Index (DMFT), die Anzahl füllungsfreier Zähne, der Community Periodontal Index (CPI) als auch Daten zur Zahnzahl und Zahnlosigkeit wurden herangezogen.

Ergebnisse

In beiden Studien waren bzgl. der Determinanten eine Zunahme der Probanden mit hoher Schulbildung, eine geringfügige Abnahme der Raucher sowie eine Verbesserung der Mundhygiene zu beobachten. Bei den 35- bis 44-Jährigen stieg die Anzahl gesunder Zähne von 11,9 in DMS III auf 16,8 in DMS V, während bei den Senioren die Anzahl gesunder Zähne um 5,9 anstieg. In SHIP wurde ein ähnlicher Trend beobachtet. Die Prävalenz des höchsten CPI-Grades 4 fiel in den DMS bei den 35- bis 44-Jährigen von 9,3 % auf 3,5 %; bei den Senioren lag der Wert 2014 wieder auf dem Niveau von 1997 (10,5 % und 9,8 %). Parallel dazu hat sich der Anteil der zahnlosen Senioren in beiden Studien halbiert. Die Zahnzahl nahm über alle Altersklassen hinweg zu.

Diskussion

DMS und SHIP zeigten über die Jahre konsistent eine Zunahme gesunder, füllungsfreier Zähne, eine geringfügige Reduktion der Probanden mit CPI-Grad 4 sowie mehr Zahnerhalt und weniger Zahnlosigkeit. Bedingt durch den höheren Zahnerhalt und die Alterung der Gesellschaft ist in Zukunft mit einer erhöhten parodontalen Behandlungslast zu rechnen.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03345-6) enthalten.

Effects of an oral hygiene regimen on progression of gingivitis/early periodontitis: A randomized controlled trial

BACKGROUND

Periodontal disease continues to be prevalent globally, but little clinical research has been undertaken to evaluate the long-term benefits of a daily oral hygiene regimen on progression of gingivitis/early periodontitis. The objective of this study was to evaluate the effects of an oral hygiene regimen (OHR) on the periodontal health of adults in good general health with established gingivitis and early periodontitis over 24 months.

METHODS

A randomized controlled trial was conducted in adults with established gingivitis, with isolated sites of probing pocket depth >4 mm. Study participants were randomized to the OHR (bioavailable stannous fluoride dentifrice, oscillating-rotating electric toothbrush, cetylpyridinium chloride rinse, and floss; P&G) or usual care products (sodium fluoride dentifrice and manual toothbrush; P&G) groups. At baseline and every 6 months, gingivitis and periodontal measures were assessed and a prophylaxis was conducted. The primary outcome was Gingival Bleeding Index-Bleeding Sites (GBI-BS). Analyses used ANCOVA at 5% significance levels.

RESULTS

A total of 107 individuals were enrolled; 87 completed the study. Mean GBI-BS, Modified Gingival Index, and Probing Pocket Depth (PPD) scores were significantly lower at each visit for the OHR versus usual care group by 28% to 39%, 12% to 18%, and 6% to 13%, respectively (p≤ 0.0009). The magnitude of reduction in median number of ≥2 mm PPD loss events for OHR versus the usual care group at 24 months was 74%.

CONCLUSION

Long-term use of the OHR produced significant periodontal health improvements versus the usual care products.