Prebrushing rinse with water on plaque removal: a split-mouth design

Development of Tooth Brushing Recommendations Through Professional Consensus

INTRODUCTION

Despite being a largely preventable disease, untreated caries of permanent teeth is estimated to affect almost 2 billion people worldwide, which is followed by severe periodontal disease. The aim of this work was to provide a professional consensus on tooth brushing methods and associated oral hygiene behaviours and develop evidence-informed recommendations.

METHODS

An initial scoping search was undertaken to identify systematic reviews of relevance and key questions. This was followed by comprehensive evidence mapping of the literature focussing on systematic reviews and clinical guidelines. Electronic searches of several databases including MEDLINE (via Ovid), Embase (via Ovid), Epistemonikos, and The Cochrane Library were undertaken from 2000 to May 2022, alongside a guideline repository search. Considered Judgement Forms were developed detailing the underpinning evidence, balance between benefits and harms, potential impact on the population, and feasibility of implementation. An online survey comprising 22 draft recommendations was distributed to international members of all FDI committees, including the FDI Council. Participants were asked to indicate to what level they agreed or disagreed with for each recommendation and to provide feedback. The Considered Judgement Forms were provided for reference.

RESULTS

Three hundred ten records were identified and mapped to different aspects of tooth brushing methods and associated behaviours. Research literature informed 7 Considered Judgement Forms comprising 12 questions with draft recommendations. Twenty-five participants from Asia, Europe, North and South America, Africa, and Australia provided feedback on the recommendations. More than 70% of respondents showed agreement with 21 of the 22 draft recommendations. Final recommendations were drafted with associated strength of recommendation.

CONCLUSION

Using a robust methodology and an international professional consensus, a set of evidence-informed recommendations was developed. These recommendations provide clinicians with practical guidance to facilitate communications with patients that may help to reinforce individual-level preventive strategies.

Dental Health Benefits of Swimming in Chlorinated Water

Poor oral health is an important concern for athletes, as it can affect both general health and athletic performance. The aim of this study is to investigate the effects of activity in chlorinated water on oral health in elite swimmers compared to non-swimming athletes. This cross-sectional study included 101 swimmers and 100 other athletes aged 13-26 years with a minimum training intensity of five hours per week (for at least the preceding two years). Oral health was assessed using the approximal plaque index (API) and the decayed/missing/filled teeth (DMFT) index. A DIAGNOcam was used to detect caries. Results show that swimmers were younger (15 years vs. 18 years), were more likely to be female (54% vs. 17%), and had a lower body mass index (20.1 kg/m2 vs. 21.9 kg/m2) and a lower juice consumption (9% vs. 24%). Non-swimmers had significantly more decayed, missing, or filled teeth due to caries and plaque. In conclusion, by comparing elite swimmers and athletes competing in different sports, we have shown that competitive swimmers have a lower incidence of dental caries and plaque. Further research is needed to test our findings and to understand this relationship in greater detail.

Mechanical plaque removal in step-1 of care

Maintaining a regular oral hygiene routine is essential for taking care of our mouths, ensuring healthy teeth, and achieving fresh breath. Patient education on oral hygiene is an important component of their overall treatment. Firstly, patients should be informed about the direct connection between bacteria in dental plaque and oral diseases. It is important for patients to understand that these conditions can be treated, but the success of treatment greatly depends on their level of oral hygiene. This journey begins by selecting the appropriate toothbrush and mastering the correct brushing technique to effectively remove dental plaque while avoiding any potential damage to the gums. In addition to toothbrushes, there are other devices available for comprehensive dental cleaning, such as floss, interdental sticks, interdental brushes, and oral irrigators. These aids are particularly beneficial for eliminating dental plaque from hard-to-reach areas. Moreover, tongue brushing or tongue scraping can effectively reduce breath odor and tongue coating. Currently, self-care recommendations for dental implants are primarily based on existing knowledge regarding natural teeth cleaning. Evidence-based recommendations are derived from comprehensive systematic evaluation of various oral hygiene aids.

Can Desensitizing Toothpastes Also Have an Effect on Gingival Inflammation? A Double-Blind, Three-Treatment Crossover Clinical Trial

Background: Many desensitizing toothpastes exist commercially; however, few clinical trials have investigated their anti-inflammatory effects. This study aimed to evaluate the anti-inflammatory effect and patient appreciation of two toothpastes containing desensitizing agents: (1) a zinc-carbonate-hydroxyapatite nanoparticle (CHA) and (2) a calcium sodium phosphosilicate bioactive glass (CSPS). Methods: CHA and CSPS were compared with an anti-inflammatory and antibacterial herbal based toothpaste (HB). The aims were accomplished by comparing the following outcomes: (1) the reduction in plaque and bleeding score (Full Mouth Plaque Score (FMPS) and Full Mouth Bleeding Score (FMBS), respectively); (2) the antibacterial activity (AbA) of the toothpaste by saliva samples; (3) the patient appreciation score (Visual Analogue Scale; VAS). Clinical parameters were assessed at baseline and 14 days post-treatment. Results: The final sample consisted of 25 subjects, aged between 20 and 58 years. Although no differences in FMPS were reported (p > 0.05), both desensitizing toothpastes showed an improvement in FMBS. CSPS and HB recorded more AbA compared to CHA (p < 0.05). Moreover, HB resulted in a higher VAS score than both desensitizing toothpastes (p < 0.05). Conclusion: In conclusion, only CSPS displayed a similar anti-inflammatory effect compared to HB. Despite the low VAS score, CSPS could be considered as a valid and effective toothpaste in subjects with both dentin hypersensitivity and inflamed gums, highlighting its utility in clinical practice.

Plaque control and reduction of gingivitis: The evidence for dentifrices

This paper focuses on plaque control and the management of gingivitis in adults and summarizes the evidence of commercially available dentifrices as gathered from existing systematic reviews. Three internet sources were used to search for appropriate papers (up to and including February 2017). The search strategy was designed to include any systematic review published on dentifrices that also included an evaluation of plaque and gingivitis scores. Characteristics of the individual reviews, such as methodological aspects, quantitative data and conclusions, were extracted. The potential risk of bias was estimated and the acquired evidence was graded. Independent screening of 205 unique reviews resulted in 10 published and eligible systematic reviews. One publication evaluated the mechanical contribution of dentifrice to plaque removal. Eight papers were identified that evaluated the efficacy of a proposed single active ingredients, of which two reviewed more than one potentially active ingredient. One study compared two active ingredients. This meta-review appraised the current state of evidence and found that toothbrushing with a standard fluoride dentifrice does not provide an added effect for the mechanical removal of dental plaque. Evidence suggests that compared with a standard dentifrice, those containing triclosan or stannous fluoride have benefits with respect to gingival health and control of dental plaque.

Dry brushing: Does it improve plaque removal? A secondary analysis

OBJECTIVE

This article is a secondary analysis comparing the effects on plaque removal of brushing with a dry toothbrush and brushing with a prewetted toothbrush.

METHODS

The participants had been included in two previous experiments involving single-brushing exercises. The 46 non-dental participants were systemically healthy and ≥18 years of age. In the first experiment, the control intervention was brushing with a prewetted toothbrush, while during the second experiment it was brushing with a dry toothbrush. Both experiments scored plaque before and after the brushing exercises and assessed participants' perception. The data of these two previous experiments were compared in this secondary analysis.

RESULTS

Plaque score reduction following brushing with a dry toothbrush was 58%, while with a prewetted toothbrush, it was 57%. The mean plaque index score reduction of 0.08 between a dry and a prewetted toothbrush was not significant (P = .096). Prewetting the participants' toothbrush had no influence on the perception of toothbrush filament stiffness (P = .410) nor on the perception of cleaning capability (P = .449). In both experiments, brushing without dentifrice was judged to be unpleasant.

CONCLUSION

On average, following a 2-minute brushing exercise, plaque scored were reduced by 57% or more. Dry brushing did not contribute significantly to toothbrush efficacy. The participants did not find that prewetting a toothbrush influenced the cleaning capability and filament stiffness.

A specific brushing sequence and plaque removal efficacy: a randomized split-mouth design

AIM

It has been propagated by the dental care professionals to start toothbrushing the lingual aspect of teeth first. In general, it is assumed that these surfaces of teeth are more difficult to clean. The evidence to support this recommendation is sparse.

METHOD

In this randomized controlled clinical trial using a split-mouth design, 46 students were included. Before the visit, the participants were requested to refrain from any oral hygiene procedure for 48 h. First, the plaque index (PI) score was assessed full mouth. Two randomly chosen contra-lateral quadrants were used to start brushing from the lingual aspect first. The opposing two quadrants were used to start brushing from the buccal aspect. After the brushing exercise was completed, full-mouth PI was scored again. Subanalyses were performed for the buccal, lingual and approximal surfaces.

RESULTS

At baseline, there was no statistically significant difference between the two sets of contra-lateral quadrants (P = 0.770). Starting at the lingual aspect of the lower jaw resulted in a 55% reduction of plaque scores in comparison with 58% when the brushing exercise was started buccally. [Correction added on 16 January 2017, after first online publication: In the preceding sentence, the percentage reduction of plaque scores when the brushing exercise was started buccally, was previously wrong and has been corrected to 58% throughout this article.] The difference in mean plaque scores between brushing orders was 0.04, which was not significant (P = 0.219). None of the subanalyses revealed any significant differences for the isolated surfaces.

CONCLUSION

Using a manual toothbrush reduced the plaque scores between 55 and 58% with no difference between brushing from either the lingual or buccal aspect first. Within the limitations of this study, a recommendation to start toothbrushing the lingual aspect is not supported by the outcome in this young student population.