Toothbrushing force in relation to plaque removal

Effect of a powered and a manual toothbrush in subjects susceptible to gingival recession: A 36-month randomized controlled clinical study

OBJECTIVE

The objective of this long-term clinical study was to evaluate the influence of a newly developed powered toothbrush (PT) on the size and number of pre-existing gingival recessions (GR) in comparison to a manual toothbrush (MT).

METHODS

This was a prospective, single-blind, parallel-group, randomized controlled clinical study. Participants without periodontitis, but with at least two teeth (index teeth) showing GR ≥2 mm were randomized to brush either twice daily with a MT or with a PT with a linear magnetic drive causing the round brush head to produce gentle micro vibrations along with oscillating-rotating movements. Primary outcome parameter was the mean change of GR at the index teeth over 36 months.

RESULTS

Totally 87 out of 92 participants completed the study (MT/PT: n = 42/n = 45). At the 36-month evaluation the mean (standard deviation) change of GR at index teeth differed significantly between MT 0.17 (0.77) and PT -0.10 (0.63) (p = 0.013). Furthermore, the amount of GR sites which improved ≥1 mm or remained stable during the study period did not differ between MT and PT, but the number of sites worsened ≥1 mm was significantly in favour for PT (MT 23 (25.5%) versus PT 10 (10.6%); p = 0.009). A binary logistic regression identified tooth type (OR = 2.991 for pre-/molar (1.096 [95% CI 1.002-8.933]; p = 0.050)) and manual brushing (OR = 3.341 (1.206 [95% CI 1291-8648]; p = 0.013)) as risk factors for recession impairment at the index teeth. There were no differences between groups for adverse events.

CONCLUSION

In a population with pre-existing gingival recessions and consequently a high risk of developing further recession the PT seems to be favourable with regard to further development of GR.

Orthodontists' instructions for oral hygiene in patients with removable and fixed orthodontic appliances

INTRODUCTION

The aim of this questionnaire-based survey was to evaluate information on frequencies, instructions and products relating to oral hygiene (OH) in orthodontic practices.

METHODS

Using a computer-generated randomization list, 1000 orthodontists were selected and sent a questionnaire. The size and number of inhabitants of the federal states of Germany were considered. The federal states with the highest return rate (Baden-Wuerttemberg [BW], Bavaria [B], Hesse [H], Lower Saxony [LS], Nordrhein-Westphalia [NRW]) were considered and differences between the 16 federal states were divided into North, South, East and Central Germany.

RESULTS

The response rate of the questionnaires was 52.4%. The majority (53.8%) worked in one practice alone. Most (59.1%) have been orthodontists for 5-25 years. For vestibular multibracket appliances (MBA) in BW, B, H and LS over 90% recommended interdental brushes (IDB). In NRW 91.4% recommend fluoride gel. In B and H more than 80% chose electric toothbrush (ETB), in BW, LS and NRW more than 80% manual toothbrush (MTB). For lingual MBA (LMBA) in BW, H, LS and NRW with approximately 50% each fluoride gel, IDB and MTB were chosen. In B fluoride gel, IDB and ETB. For removable apparatus (RA), five federal states recommended MTB (>80%) and ETB (BW, B, H > 80%; NRW > 70%; LS > 60%).

CONCLUSION

Electric toothbrushes are recommended for the use with all appliances, only with removable appliances manual toothbrushes are favoured. For vestibular MBA it is strongly advised to use IDB additionally.

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.

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.

Safety and Design Aspects of Powered Toothbrush-A Narrative Review

The powered toothbrush has become a modern dental tool that is available in the supermarket. Indeed, the design of the powered toothbrush, e.g., mechanical and electrical, would affect not only the efficacy but also the safety of the products. This narrative review attempted to view the powered toothbrush from design, safety, and application points with respect to tufts, filaments, handles, mechanics, motions, and materials interactions from various available sources. Different brands and models of powered toothbrushes have their own designs that might affect the clinical outcome. The rotational design was advocated to be clinically more effective than the manual one, some modern models might be designed with vibrational or oscillation (or mixed) tufts head that might be useful in patients with specific needs, such as having xerostomia or for the elderly. To conclude, tuft retention design is important in the powered toothbrush as it contributes significantly to safety as the fallen off tufts, filaments and metal parts might cause injury. Tests revealing the retention force of brush head plates and brush head bristles will be significant references for consumers to determine which design of powered toothbrushes is relatively safer.

Toss the Floss? Evidence-Based Oral Hygiene Recommendations for the Periodontal Patient in the Age of "Flossgate"

FOCUSED CLINICAL QUESTION

What are the key considerations for effective delivery of oral hygiene home care to best manage or prevent periodontal diseases?

BACKGROUND

Plaque control is critical for the management of periodontal diseases, but not all patients demonstrate the same risk for disease progression and challenges differ based upon clinical findings. This report seeks to present evidence-based oral hygiene recommendations for a variety of common periodontal diseases.

SUMMARY

Accurate diagnosis, risk assessment, and individualized delivery of oral hygiene instruction is necessary to ensure that patients can provide adequate home care to promote health and maintain the benefits of periodontal therapy.

CONCLUSIONS

Oral hygiene techniques and recommendations should vary based upon patients' clinical presentation and risk assessment. Utilization of evidence-based strategies to deliver personalized care will allow for optimal wellness for patients.

Comparison of Efficacy of Manual and Powered Toothbrushes in Plaque Control and Gingival Inflammation: A Clinical Study among the Population of East Indian Region

Aim and Objective:

To figure out, analyze and assess the effectiveness of powered toothbrush (Braun/Oral-B two-dimensional) and manual toothbrush (Oral-B40 Regular Advantage Plus) on supragingival plaque and gingival health.

Materials and Methods:

The efficacy of powered toothbrush to that of manual one was compared by using a randomized clinical trial over a 4 weeks period in controlling plaque and gingivitis using gingival index, plaque index (PI), and oral hygiene index. A total of 45 patients with age group from 19 to 23 years were included in the study. Collected data were analyzed, and different subgroups were compared using Student's t-test, Levene's test, and Chi-square test.

Results:

In both groups whether using powered or manual toothbrush, there was marked decrease in PI scores and gingival health improvement. However, there was better reduction in PI scores and improvement in gingival health in powered toothbrush group.

Conclusion:

All individuals with both groups showed reduction in PI and hygiene index, but when it was assessed on the 4^th week, individuals using powered toothbrush showed better results when compared to the individuals using manual toothbrush.

Gingival Margin Stability After Mucogingival Plastic Surgery. The Effect of Manual Versus Powered Toothbrushing: A Randomized Clinical Trial

BACKGROUND

Oscillating-rotating power toothbrushes have been proven to be clinically efficacious. To the best of the authors' knowledge, a clinical evaluation of the safety of these toothbrushes after surgical root coverage procedures has not been published. The aim of this study is to evaluate the gingival margin (GM) stability with the use of an oscillating-rotating toothbrush compared with a manual toothbrush.

METHODS

Sixty healthy individuals with at least one Miller Class I or II gingival recession underwent a surgical root coverage procedure. Soft-bristle manual and powered toothbrushes were given to participants randomly assigned to control and test groups, respectively. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), and recession depth (RD) were recorded at baseline and 1, 3, and 6 months after completion of the surgical procedure. Data analyses were performed using linear random-intercept models to take into account within-participant correlations over time. Temporal trend differences across treatments by including treatment-time interaction terms were then tested using a global Wald test.

RESULTS

Use of a powered toothbrush resulted in a significantly greater reduction of recorded periodontal clinical indices compared with a manual device (FMPS, P = 0.05; FMBS, P = 0.005; RD, P = 0.004). No significant differences were noticed between the two experimental groups both for PD (P = 0.03) and clinical attachment level (P = 0.11). Complete root coverage was significantly higher in participants who used the powered toothbrush compared with the manual toothbrush at 6 months (control, 66.67%; test, 96.67%; P = 0.002).

CONCLUSION

Use of an oscillating-rotating powered toothbrush with a soft-bristle head resulted in higher GM stability after root coverage procedures compared with the use of a manual soft-bristled toothbrush.

Influence of Bristle Stiffness of Manual Toothbrushes on Eroded and Sound Human Dentin--An In Vitro Study

Aim

The aim of this study was to determine the influence of manual toothbrushes with different bristle stiffness on the abrasivity on eroded and sound human dentin.

Materials and Methods

Dentin specimens were made from impacted third molars and attributed to three groups: erosion-abrasion (EA), abrasion (A) and erosion (E). The specimens from EA and E were treated with 1% citric acid (pH 2.3) for 1 min rinsed, and neutralized with artificial saliva for 15 min. This cycle was repeated five times. Thereafter, specimens from EA and A were treated with three toothbrushes types with different bristle stiffness (soft, medium, and hard) in a custom-made toothbrushing machine. The brushing was performed at a load of 3 N with a toothpaste slurry for 630 s. This procedure was repeated five times, in group EA after each erosion cycle. EA and A groups passed through five cycles with a total of 6300 strokes. The abrasivity was analyzed by contact-free profilometry. Kruskal-Wallis and Mann-Whitney U tests were performed for statistical analysis.

Results

With respect to bristle stiffness there was no statistically significant difference in dentin loss within the EA group. In group A, a statistically significantly higher dentin loss was found for the soft in comparison to the hard bristles. No statistically significant differences were measured between soft/medium and medium/hard toothbrushes. The amount of dentin loss from specimens in the EA group was significantly higher than in the A group.

Conclusions

Within the limitations of this study, the dentin loss in the Abrasion group was higher with soft bristles than with hard ones. This result might have an influence on the toothbrush recommendations for patients with non-carious cervical lesions.

The effect of oral care on intracranial pressure in critically ill adults

A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960s when ICP monitoring was first introduced in the clinical setting. Until recently, few studies have specifically examined the effect of oral care on ICP, and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP. The purpose of this study was to describe the relationship between routine oral care interventions and the changes in ICP specifically focusing on the effect of intensity and duration of this intervention. Twenty-three patients with a clinical condition requiring ICP monitoring were enrolled over a 12-month period. Oral care provided by neuroscience intensive care nurses was observed and videotaped. Characteristics of the intervention were documented including products used, patient positioning, and duration of the intervention. A 1-5 subjective scale was used to score intensity of oral care. Wrist actigraphy data were collected from the nurses to provide an objective measure of intensity. Patient physiologic data were collected at 12-second epochs 5 minutes before, during, and 5 minutes after oral care. The mixed-effect repeated measures analysis of variance model indicated that there was a statistically significant increase in ICP in response to oral care (p = .0031). There was, however, no clinically significant effect on ICP. This study provides evidence that oral care is safe to perform in patients in the absence of preexisting elevated ICP.

Efficacy of homecare regimens for mechanical plaque removal in managing gingivitis a meta review

FOCUSED QUESTION

Based on evidence as presented in systematic reviews what is the efficacy and safety of available homecare toothbrush regimens for mechanical plaque removal on plaque and gingivitis in adults?

MATERIAL & METHODS

Three Internet sources were used (up to and including August 2014) to search for appropriate papers that satisfied the study purpose. Plaque scores and gingivitis scores were considered to be the primary parameter of interest. Safety was considered an important facet in relation to efficacy. Data and conclusions as presented in the selected papers were extracted. The potential risk of bias was estimated and the emerging evidence was graded.

RESULTS

Independent screening of 176 unique reviews resulted in 10 published and eligible systematic reviews. They were categorized into one review evaluating the effect of an oral hygiene instruction with a toothbrush on plaque and gingivitis scores, five evaluating the efficacy of manual and power toothbrushes and three reviews evaluating toothbrush safety and one evaluating toothbrush contamination.

CONCLUSION

Tooth brushing is effective in reducing levels of dental plaque. With respect to gingivitis power toothbrushes have a benefit over manual toothbrushes. The greatest body of evidence was available for oscillating-rotating brushes. Tooth brushing generally can be considered safe for the teeth and their investing tissues.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Resistance of dentin coating materials against abrasion by toothbrush

Thin-film coating of root dentin surface by all-in-one adhesives has been shown to be an effective option to prevent root surface caries. The purpose of this study was to investigate the wear resistance against toothbrush abrasion of two all-in-one coating materials; Shield Force (SF) and Hybrid Coat (HC). Bovine dentin surfaces were covered with one of the coating materials; SF or HC. After storage in water for 24 h, the testing surface was subjected to the toothbrush abrasion test up to 50,000 cycles either in water or toothpaste slurry. The remaining thickness of the coating material was measured using SEM. Toothpaste slurry significantly increased rate of tooth brush abrasion of the coating materials. While SF and HC wore at a similar pace under toothbrush abrasion, SF had a thicker coat and could protect dentin longer, up to 50,000 cycles.

Analysis of tooth brushing cycles

OBJECTIVE

The aim of this study was to demonstrate the effectiveness of an analysis of tooth brushing cycles using a system that measures tooth brushing motion and brushing force with an accelerometer and strain tension gage attached to a toothbrush.

BACKGROUND

Mechanical plaque removal with a manual toothbrush remains the primary method of maintaining good oral hygiene for the majority of the population. Because toothbrush motion has not been fully understood, it should be clarified by analysis of tooth brushing cycles.

METHODS

Twenty healthy female dental hygienists participated in this study. Their tooth brushing motions were measured and analyzed using an American Dental Association-approved manual toothbrush to which a three-dimensional (3-D) accelerometer and strain tension gage were attached. 3-D motion and brushing force on the labial surface of the mandibular right central incisor and the lingual surface of the mandibular left first molar were measured, analyzed, and compared. Multilevel linear model analysis was applied to estimate variables and compare motion and forces related to the two tooth surfaces.

RESULTS

The analysis of tooth brushing cycles was feasible, and significant differences were detected for durations and 3-D ranges of toothbrush motion as well as brushing force between the two tooth surfaces.

CONCLUSION

The analysis used in this study demonstrated an ability to detect characteristics of tooth brushing motion, showing tooth brushing motion to change depending on the brushed location. These results also suggest that more detailed instructions might be required according to patient's oral condition.

Scaffold-free microtissues: differences from monolayer cultures and their potential in bone tissue engineering

OBJECTIVES

Cell-based therapies for bone augmentation after tooth loss and for the treatment of periodontal defects improve healing defects. Usually, osteogenic cells or stem cells are cultivated in 2D primary cultures, before they are combined with scaffold materials, even though this means a loss of the endogenous 3D microenvironment for the cells. Moreover, the use of single-cell suspensions for the inoculation of scaffolds or for the direct application into an area of interest has the disadvantages of low initial cell numbers and susceptibility to unwanted cellular distribution, respectively.

MATERIALS AND METHODS

We addressed the question whether an alternative to monolayer cultures, namely 3D microtissues, has the potential to improve osteogenic tissue engineering and its clinical outcome.

RESULTS

By contrast, to monolayer cultures, osteogenic differentiation of 3D microtissues is enhanced by mimicking in vivo conditions. It seems that the osteogenic differentiation in microtissues is enhanced by strong integrin-extracellular matrix interaction and by stronger autocrine BMP2 signaling. Moreover, microtissues are less prone to wash out by body fluids and allow the precise administration of large cell numbers.

CONCLUSION

Microtissue cultures have closer characteristics with cells in vivo and their enhanced osteogenic differentiation makes scaffold-free microtissues a promising concept in osteogenic tissue engineering.

CLINICAL RELEVANCE

Microtissues are particularly suitable for tissue engineering because they improve seeding efficiency of biomaterials by increasing the cell load of a scaffold. This results in accelerated osteogenic tissue formation and could contribute to earlier implant stability in mandibular bone augmentation.

Brushing force of manual and sonic toothbrushes affects dental hard tissue abrasion

OBJECTIVES

This study aimed to determine the brushing forces applied during in vivo toothbrushing with manual and sonic toothbrushes and to analyse the effect of these brushing forces on abrasion of sound and eroded enamel and dentin in vitro.

MATERIALS AND METHODS

Brushing forces of a manual and two sonic toothbrushes (low and high frequency mode) were measured in 27 adults before and after instruction of the respective brushing technique and statistically analysed by repeated measures analysis of variance (ANOVA). In the in vitro experiment, sound and eroded enamel and dentin specimens (each subgroup n = 12) were brushed in an automatic brushing machine with the respective brushing forces using a fluoridated toothpaste slurry. Abrasion was determined by profilometry and statistically analysed by one-way ANOVA.

RESULTS

Average brushing force of the manual toothbrush (1.6 ± 0.3 N) was significantly higher than for the sonic toothbrushes (0.9 ± 0.2 N), which were not significantly different from each other. Brushing force prior and after instruction of the brushing technique was not significantly different. The manual toothbrush caused highest abrasion of sound and eroded dentin, but lowest on sound enamel. No significant differences were detected on eroded enamel.

CONCLUSION

Brushing forces of manual and sonic toothbrushes are different and affect their abrasive capacity.

CLINICAL SIGNIFICANCE

Patients with severe tooth wear and exposed and/or eroded dentin surfaces should use sonic toothbrushes to reduce abrasion, while patients without tooth wear or with erosive lesions confining only to enamel do not benefit from sonic toothbrushes with regard to abrasion.

Scaffold-free microtissues: differences from monolayer cultures and their potential in bone tissue engineering

Objectives

The paper’s aim is to review dentin hypersensitivity (DHS), discussing pain mechanisms and aetiology.

Materials and methods

Literature was reviewed using search engines with MESH terms, DH pain mechanisms and aetiology (including abrasion, erosion and periodontal disease).

Results

The many hypotheses proposed for DHS attest to our lack of knowledge in understanding neurophysiologic mechanisms, the most widely accepted being the hydrodynamic theory. Dentin tubules must be patent from the oral environment to the pulp. Dentin exposure, usually at the cervical margin, is due to a variety of processes involving gingival recession or loss of enamel, predisposing factors being periodontal disease and treatment, limited alveolar bone, thin biotype, erosion and abrasion.

Conclusions

The current pain mechanism of DHS is thought to be the hydrodynamic theory. The initiation and progression of DHS are influenced by characteristics of the teeth and periodontium as well as the oral environment and external influences. Risk factors are numerous often acting synergistically and always influenced by individual susceptibility.

Clinical relevance

Whilst the pain mechanism of DHS is not well understood, clinicians need to be mindful of the aetiology and risk factors in order to manage patients’ pain and expectations and prevent further dentin exposure with subsequent sensitivity.

A graphic tool to help consumers determine when to replace a toothbrush: a cohort study

OBJECTIVES

The aim of this study was to create and validate a drawing to help adults establish when to replace a manual toothbrush.

METHODS

This cohort study had two phases. Phase I (3 months, 50 subjects) aimed to create a drawing of average wear in a toothbrush based on a wear index (WI) of 68% for the tested toothbrush. This was validated in Phase II (3 months, 30 participants). Pictures of worn brushing surfaces were generated using an image acquisition system. Images in each study phase were superimposed to provide a single reference outline to indicate when a toothbrush should be replaced. Residual plaque index values for identical brushing protocols were recorded using new and worn toothbrushes in Phase I and compared using Student's paired t-test. Student's t-test was used to compare duration of tooth-brushing and WI values in both phases.

RESULTS

After brushing according to a uniform protocol, the residual plaque index at baseline was significantly lower than that at the last use of the toothbrush (P < 0.01). The drawings generated in Phases I and II were similar in terms of WI (P = 0.33) and period of use (P = 0.12).

CONCLUSIONS

This simple drawing may help adults establish when they should replace a toothbrush.

Boundary lubrication by brushed salivary conditioning films and their degree of glycosylation

Objectives

Toothbrushing, though aimed at biofilm removal, also affects the lubricative function of adsorbed salivary conditioning films (SCFs). Different modes of brushing (manual, powered, rotary–oscillatory or sonically driven) influence the SCF in different ways. Our objectives were to compare boundary lubrication of SCFs after different modes of brushing and to explain their lubrication on the basis of their roughness, dehydrated layer thickness, and degree of glycosylation. A pilot study was performed to relate in vitro lubrication with mouthfeel in human volunteers.

Materials and methods

Coefficient of friction (COF) on 16-h-old SCFs after manual, rotary–oscillatory, and sonically driven brushing was measured using colloidal probe atomic force microscopy (AFM). AFM was also used to assess the roughness of SCFs prior to and after brushing. Dehydrated layer thicknesses and glycosylation of the SCFs were determined using X-ray photoelectron spectroscopy. Mouthfeel after manual and both modes of powered brushing were evaluated employing a split-mouth design.

Results

Compared with unbrushed and manually or sonically driven brushed SCFs, powered rotary–oscillatory brushing leads to deglycosylation of the SCF, loss of thickness, and a rougher film. Concurrently, the COF of a powered rotary–oscillatory brushed SCF increased. Volunteers reported a slightly preferred mouthfeel after sonic brushing as compared to powered rotating–oscillating brushing.

Conclusion

Deglycosylation and roughness increase the COF on SCFs.

Clinical relevance

Powered rotary–oscillatory brushing can deglycosylate a SCF, leading to a rougher film surface as compared with manual and sonic brushing, decreasing the lubricative function of the SCF. This is consistent with clinical mouthfeel evaluation after different modes of brushing.

Safety of oscillating-rotating powered brushes compared to manual toothbrushes: a systematic review

BACKGROUND

Oscillating-rotating power toothbrushes have been proven clinically efficacious. To our knowledge, a comprehensive review of all clinical and laboratory investigations solely comparing the safety of these toothbrushes to the standard of care (i.e., manual toothbrushes) has not been published. The aim of this systematic review is to examine the literature concerning the relative soft and/or hard tissue safety outcomes with the use of oscillating-rotating toothbrushes compared to manual toothbrushes.

METHODS

With the use of electronic databases of the National Library of Medicine (PubMed-MEDLINE), the Cochrane Central Register of Controlled Trials (Cochrane-CENTRAL), and the Excerpta Medical Database (EMBASE), a search of in vivo and in vitro trials through May 2010 was conducted to identify appropriate studies that evaluated the effects of an oscillating-rotating power toothbrush compared to a manual toothbrush with respect to soft and/or hard tissue safety. Eligible trials incorporated a safety evaluation as a primary or secondary outcome parameter (i.e., gingival recession, observed/reported adverse events, and hard tissue effects) or used a surrogate parameter (i.e., stained gingival abrasion and brushing force) to assess safety. Data extraction for the primary- and surrogate-measure safety studies, which included mean values and SDs when available, and a meta-analysis of the gingival recession data were performed.

RESULTS

Independent screening of the titles and abstracts of 697 PubMed-MEDLINE, 436 Cochrane-CENTRAL, and 664 EMBASE papers resulted in 35 publications that met the eligibility criteria. The mean change in gingival recession was not significantly different among toothbrush groups in the two selected trials with safety as a primary outcome (weighted mean difference: 0.03). A meta-analysis of the five trials that evaluated safety with a surrogate parameter was not possible; however, there were no significant between-group differences at the study end in any trial. A descriptive analysis of the 24 selected studies assessing safety as a secondary outcome revealed few brushing-related adverse events. The heterogeneity in objectives and methodology of the four in vitro trials that met the eligibility criteria precluded generalization of the results.

CONCLUSION

A large body of published research in the preceding 2 decades has consistently shown oscillating-rotating toothbrushes to be safe compared to manual toothbrushes, demonstrating that these power toothbrushes do not pose a clinically relevant concern to hard or soft tissues.

Tooth brushing habits in uninstructed adults--frequency, technique, duration and force

Professional recommendations for individual oral hygiene mostly include tooth brushing at least twice daily for 2-3 min with gentle force using the Bass technique or modifications of it. This study evaluated whether habitual tooth brushing actually meets these standards. Uninstructed adults (n = 103; mean age 31 +/- 6 years; 61 female, 42 male) with habitual manual tooth brushing were given a self-administered questionnaire about the frequency of brushing and a computer system recorded their brushing technique, duration and force. The majority (79.6%) of participants brushed twice daily. The mean brushing duration was 96.6 +/- 36.0 s, the mean brushing force was 2.3 +/- 0.7 N (max. 4.1 N), and no significant differences were found for quadrants. Most subjects (73.8%) brushed with circling, 8.7% with horizontal/scrubbing, 13.6% with horizontal/circling and 3.9% with vertical/sweeping movements. Modified Bass technique was not observed. When appropriate brushing habits were defined as brushing at least twice daily for 120 s with a brushing force of less than 3 N and with circling or vertical sweeping movements, only 25.2% of the participants fulfilled all criteria, emphasising the ongoing need for oral hygiene education.

The measurement of enamel wear by four toothpastes

OBJECTIVES

To determine the enamel abrasivity of three whitening toothpastes and a silica toothpaste and to measure the brushing forces used.

METHODS

Polished human enamel blocks were indented with a Knoop diamond and attached to dentures of adult volunteers. The blocks were brushed ex vivo, twice per day with either a whitening toothpaste containing Perlite (White System), a commercial whitening toothpaste (A and B) or a silica toothpaste. After four and twelve-weeks, one block per subject was removed and the Knoop indent remeasured. From the changes in the indent length, the amount of enamel wear was calculated.

RESULTS

The mean enamel wear (sd) for White System, silica toothpaste, whitening toothpaste A and B after four-weeks was 0.14 (0.15), 0.09 (0.16), 0.14 (0.12) and 0.89 (0.93) and after twelve-weeks was 0.24 (0.21), 0.37 (0.73), 0.36 (0.52) and 1.04 (0.98) microm respectively. After four-weeks, the differences in enamel wear between whitening toothpaste B and all other toothpastes were of statistical significance (p < 0.003), but not after twelve-weeks. The mean ex vivo normal brushing force (sd) was 2.67 (1.33) N.

CONCLUSIONS

All three whitening toothpastes did not give significantly more enamel wear than a silica toothpaste after twelve-weeks in situ with ex vivo brushing.

The Additional Effect of a Dentifrice on the Instant Efficacy of Toothbrushing: A Crossover Study

BACKGROUND

Inconclusive evidence exists in the literature with regard to the additional (beneficial) mechanical effect of a dentifrice on plaque removal. A previous split-mouth study found that a dentifrice did not contribute to plaque removal. Because of limitations of the split-mouth model, a crossover design was used to evaluate whether a commercially available dentifrice had an additional effect on mechanical plaque removal during manual toothbrushing.

METHODS

Thirty-six subjects were given a manual toothbrush and a standard dentifrice. After a 48-hour plaque accumulation, subjects brushed under supervision with or without a dentifrice (total time of 2 minutes) in a 2 x 2 crossover design.

RESULTS

Plaque reductions were 50% with and 56% without the use of dentifrice. This 6% difference was statistically significant (P = 0.034). Explorative analysis showed that brushing without a dentifrice was more effective in removing plaque on the approximal surfaces.

CONCLUSIONS

The use of a dentifrice did not contribute to mechanical plaque removal during manual toothbrushing. It seemed that the mechanical action provided by the toothbrush was the main factor in the plaque-removing process.

Additional Effect of Dentifrices on the Instant Efficacy of Toothbrushing

BACKGROUND

Inconclusive evidence exists in the literature with regard to the additional effect of the use of dentifrice on plaque removal. The present study was undertaken to test whether the use of dentifrice during toothbrushing contributes to the instant cleaning efficacy of the brushing procedure.

METHODS

Three groups of patients, 40 subjects each, were randomly assigned to one of three dentifrices that differed with respect to the relative dentin abrasivity (RDA) value. After a 48-hour plaque accumulation, subjects brushed under supervision in a split-mouth order with or without the use of dentifrice (total time=2 minutes).

RESULTS

Plaque reductions varied between 51% and 58% for the three dentifrices. The overall analysis showed a mean difference of 3% in plaque reduction in favor of brushing without dentifrice (P=0.017). The type of dentifrice did not influence this observed difference (P=0.506). Also, the order of the brushing procedure (starting the brushing procedure with or without dentifrice) had no interaction with the effect of dentifrice on the brushing (P=0.187).

CONCLUSIONS

The use of dentifrice does not contribute to the instant mechanical plaque removal during manual toothbrushing. A higher dentifrice abrasivity does not seem to contribute to increased plaque removal with a manual toothbrush. It appears that the mechanical action provided by the use of a toothbrush is the main factor in the plaque-removing process.

Profilometric and Microradiographic Studies on the Effects of Toothpaste and Acidic Gel Abrasivity on Sound and Demineralized Bovine Dental Enamel

The objective of this study was to assess the abrasive effects of toothpastes and acidic F gels on sound and demineralized enamel. Pairs of enamel specimens were cut from bovine incisors, embedded in epoxy resin and polished. An artificial subsurface lesion of 80-90 microm depth was created in one specimen from each pair. The samples were covered with adhesive tape, thereby exposing the enamel for abrasivity testing. All samples were divided into six groups of 15 and brushed with a slurry (1:3) of F gel or toothpaste and human saliva. Brushing with water (control) or with slurry was carried out (16,000 strokes) using a medium toothbrush (load 275 g) mounted in a brushing machine. Abrasion was evaluated using laser profilometry, and was about 50% less on sound than on demineralized enamel (p < 0.001). In the latter, brushing with water (0.09 +/- 0.03 microm) or with fluoride-free gel (0.08 +/- 0.03 microm) resulted in negligible wear. With a medium-abrasive paste (1.76 +/- 0.85 microm) and an acidic F gel (2.48 +/- 0.72 microm), brushing abrasion was significantly greater (p < 0.001) than with a low-abrasive paste (0.84 +/- 0.38 microm). The greatest wear (16.6 +/- 10.8 microm) was observed with high-abrasive paste (p < 0.001), and here transversal microradiography revealed a complete loss of the pseudointact surface after brushing. In vitro formed caries-like lesions can be abraded (by toothbrushing) more easily than sound enamel; hence, initial white spot lesions should preferably be brushed with oral hygiene products of low abrasivity.

The measurement in vitro of enamel and dentine wear by toothpastes of different abrasivity

OBJECTIVES

To investigate the in vitro enamel and dentine wear by toothpastes with a range of Relative Dentine Abrasivity (RDA) and Relative Enamel Abrasivity (REA) values.

METHODS

Human enamel/dentine (approximately 50:50) blocks (approximately 4 x 4 mm) were polished and the enamel indented with four Knoop indents. The step across the enamel-dentine junction was measured by interference microscopy. Specimens were brushed in vitro with toothpastes with a range of RDA/REA values using a flat trim toothbrush mounted in a Wira brushing machine for 360 s and a load of 375 g. After brushing the Knoop indent length and the enamel-dentine step were remeasured and the amount of wear to the enamel and dentine was calculated.

RESULTS

The mean enamel wear ranged from 0.05 to 0.40 microns, with the highest wear for the highest REA product. The mean dentine wear for all toothpaste products tested was positively correlated with RDA value (R2 = 0.897). The correlation was further improved if median wear values were used (R2 = 0.930).

CONCLUSIONS

This study has demonstrated a rapid technique for the simultaneous investigation of the abrasive wear of toothpaste on enamel and dentine. There was a good correlation between median dentine wear and RDA values.

Quality of bristle end-rounding on replaceable heads of powered toothbrushes

OBJECTIVES

The aim of this study was to evaluate the geometry and the quality of bristle tip-rounding using 14 different heads from powered toothbrushes.

MATERIAL AND METHODS

Six powered toothbrushes for children and eight for juveniles and adults were included. Five replaceable heads of each product were randomly selected. Of each sample, 35 bristles were used for examination. This resulted in 175 bristles from each product being evaluated. The quality of end-rounding was assessed by scanning electron microscopy at an original magnification x 80 in two categories of acceptable and five categories of unacceptable rounding according to Silverstone & Featherstone (1988).

RESULTS

The portion of acceptable end-rounding varied strongly between the products (18.9-94.3%). There were significant differences regarding the products for children (p<0.001) and for adults (p<0.001) with respect to end-rounding quality. Only one product achieved more than 90% and eight products had between 68% and 86% acceptable end-rounding. Two products for children and one for adults had less than 25% acceptable end-rounding.

CONCLUSION

A high standard of bristle tip-rounding is an important feature with respect to the safety of powered toothbrushes. Those products with a greater portion of unacceptably rounded bristles might cause more harm to oral soft tissues during use. The end-rounding quality of some of the products should be improved.

Manual versus powered toothbrushing for oral health

BACKGROUND

Removing dental plaque may play a key role maintaining oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this.

OBJECTIVES

To compare manual and powered toothbrushes in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group Trials Register (to 17/06/2004) and Central Register of Controlled Trials (The Cochrane Library Issue 2, 2004); MEDLINE (January 1966 to week 2 June 2004); EMBASE (January 1980 to week 2 2004) and CINAHL (January 1982 to week 2 June 2004). Manufacturers were contacted for additional data.

SELECTION CRITERIA

Trials were selected for the following criteria: design-random allocation of participants; participants - general public with uncompromised manual dexterity; intervention - unsupervised manual and powered toothbrushing for at least 4 weeks. Primary outcomes were the change in plaque and gingivitis over that period.

DATA COLLECTION AND ANALYSIS

Six authors independently extracted information. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using random-effects models. Potential sources of heterogeneity were examined, along with sensitivity analyses for quality and publication bias. For discussion purposes SMD was translated into percentage change.

MAIN RESULTS

Forty-two trials, involving 3855 participants, provided data. Brushes with a rotation oscillation action removed plaque and reduced gingivitis more effectively than manual brushes in the short term and reduced gingivitis scores in studies over 3 months. For plaque at 1 to 3 months the SMD was -0.43 (95% CI: -0.72 to -0.14), for gingivitis SMD -0.62 (95% CI: -0.90 to -0.34) representing an 11% difference on the Quigley Hein plaque index and a 6% reduction on the Loe and Silness gingival index. At over 3 months the SMD for plaque was -1.29 (95% CI: -2.67 to 0.08) and for gingivitis was -0.51 (-0.76 to -0.25) representing a 17% reduction on the Ainamo Bay bleeding on probing index. There was heterogeneity between the trials for the short-term follow up. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. There was no evidence of any publication bias. No other powered designs were as consistently superior to manual toothbrushes.Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and temporary.

AUTHORS' CONCLUSIONS

Powered toothbrushes with a rotation oscillation action reduce plaque and gingivitis more than manual toothbrushing. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.

Effects of post-surgical cleansing protocols on early plaque control in periodontal and/or periimplant wound healing

OBJECTIVE

The aim of this RCT was to evaluate early wound healing following specific post-surgical care protocols.

MATERIAL AND METHODS

Following periodontal flap surgery, 60 patients were randomly assigned to follow one of two post-surgical protocols. Subjects smoking >20 cigarettes per day were excluded. Patients following the control protocol rinsed twice daily for 1 min with 0.1% of chlorhexidine (CHX) for 4 weeks. In addition to CHX rinsing, patients assigned to the test protocol applied CHX locally using a special very soft surgical toothbrush (Chirugia) from days 3 to 14, and a soft toothbrush (Ultrasuave) from days 14 to 28, twice daily. Baseline measurements included gingival crevicular fluid (GCF) flow rate, probing depth, probing attachment level, presence of bleeding on probing and full-mouth plaque score. Measurements were repeated at 1, 2 and 4 weeks after surgery.

RESULTS

Both post-surgical protocols resulted in successful wound healing and optimal wound closure at 4 weeks. There were no statistical differences in the GCF flow rate between test and control protocols. There was a lower incidence of recession of > or =2 mm following the test protocol.

CONCLUSION

The use of specific post-surgical cleansing protocols including the introduction of mechanical cleansing at day 3, using local application of CHX in addition to daily rinsing with CHX may be recommended.

High and low brushing force in relation to efficacy and gingival abrasion

OBJECTIVES

Does a high brushing force induce more gingival abrasion than a low (regular) brushing force? Furthermore, what is the effect of a low or high force on the efficacy?

METHODS

Thirty-five non-dental students were selected. All received an appointment prior to which they abstained from oral hygiene for at least 48 h. At baseline the teeth and surrounding tissues were disclosed using Mira-2-Tone disclosing solution. Next, the examiner (PAV) evaluated the number of sites with gingival abrasion and the amount of dental plaque (Quigley & Hein) at 6 surfaces of each tooth. In the absence of this examiner, the subject's teeth were brushed by a hygienist (MP) using the Braun/Oral-B-D17 oscillating rotating toothbrush. Brushing was performed in two randomly selected contra-lateral quadrants for 60 s with either a low force (+/-1.5 N) or high force (+/-3.5 N) and in the opposing quadrants for 60 s with the alternative force. Visual feedback was given to control force. The brush was moved from the distal tooth to the central incisor perpendicular to the tooth surface with an angle of approximately 10-15 degrees towards the gingival margin. Next, the number of sites with abrasion and the remaining plaque were assessed again.

RESULTS

The overall baseline gingival abrasion scores were 3.1 and 3.2 sites for high and low force, respectively, and increased to 5.0 and 5.9 sites respectively after brushing. There was no significant difference with respect to incidence of abrasion. At baseline, 48 h. plaque levels were 2.2. The reduction in plaque scores with the low force was 60% and with the high force 56%. This difference was significant.

CONCLUSION

With the oscillating rotating power toothbrush (Braun/Oral-B D17) the use of high force (+/-3.5 N) is less efficacious as compared to a regular low force (+/-1.5 N) while the incidence of gingival abrasion sites was comparable.

Can tooth brushing damage your health? Effects on oral and dental tissues

Circumstantial evidence based on anecdote, case reports, epidemiological data and studies in vitro and in situ implicate tooth brushing with toothpaste with tooth wear, gingival recession and dentine hypersensitivity. This review attempts to assess the clinical significance of the potential harm produced by this most common oral hygiene habit. The toothbrush alone appears to have no effect on enamel and very little on dentine. Most toothpaste also has very little effect on enamel and in normal use would not cause significant wear of dentine in a lifetime of use. Wear of enamel and dentine can be dramatically increased if tooth brushing follows an erosive challenge. Gingival recession has a multi-factorial aetiology and certain individuals and specific teeth may be predisposed to trauma from tooth brushing. Tooth brushing is known to cause gingival abrasions but how these relate to gingival recession is not known. The role of toothpaste in gingival abrasion and recession surprisingly has received little if any attention. Gingival recession most commonly exposes dentine and localises sites for dentine hypersensitivity. Some toothpaste products can expose dentinal tubules but erosion is probably the more dominant factor in dentine hypersensitivity. There is no evidence to indicate that electric and manual toothbrushes differ in effects on soft and hard tissues. It is only under, over or abusive use or when combined with erosion that significant harm may be thus caused. In normal use it must be concluded that the benefits of tooth brushing far out-way the potential harm.

A systematic review of powered vs manual toothbrushes in periodontal cause-related therapy

BACKGROUND

Power-driven toothbrushes (PDT) have been designed to improve the efficacy of oral hygiene. It is not clear how they compare in efficacy with manual toothbrushes in cause-related periodontal therapy.

OBJECTIVES

To evaluate the effectiveness of the use of a PDT as compared with a manual toothbrush (MT), in terms of gingival bleeding or inflammation resolution, in cause-related periodontal therapy.

MATERIAL AND METHODS

An electronic (MEDLINE and Cochrane Oral Health Group Specialised Trials Register) and a manual search were made to detect studies which permitted the evaluation of the efficacy of PDT in the reduction of gingival bleeding or inflammation, and their effect on other secondary variables. Only randomized studies in adults, published in English up to June 2001, which compared a PDT with an MT, and evaluated the evolution of gingival bleeding or inflammation were included. The selection of articles, extraction of data and assessment of validity were made independently by several reviewers.

RESULTS

Twenty-one studies were finally selected. The heterogeneity of the data prevented a quantitative analysis. A higher efficacy in the reduction of gingival bleeding or inflammation in the PDT patients was detected in 10 studies. This effect appears to be related to the capacity to reduce plaque, and is more evident in counter-rotational and oscillating-rotating brushes. No solid evidence was found for a higher efficacy of sonic brushes. In short-term studies with prophylaxis after initial examination, independently of the type of PDT tested, no significant differences were found.

CONCLUSION

The use of PDT, especially counter-rotational and oscillating-rotating brushes, can be beneficial in reducing the levels of gingival bleeding or inflammation. There is a need for methodological homogeneity in future studies in this field to enable quantitative analysis of their results.

Effect of brushing force and time on plaque removal using a powered toothbrush

OBJECTIVES

Primary objective - To determine the effect of varying brushing forces and brushing times upon the plaque-removing efficacy of a powered toothbrush. Secondary objective - to determine the optimum combination of brushing force and time for plaque removal.

MATERIAL AND METHODS

This randomised, single-blind, 16-cell, cross-over trial compared the efficacy of plaque removal of a powered toothbrush (PTB) used with four brushing forces (75, 150, 225 and 300 g) and over four brushing times (30, 60, 120 and 180 s). Twelve volunteers (18-30 years) were recruited and trained to use the Philips/Jordan Sensiflex 2000 PTB, which was modified so that specified forces and times could be recorded. Each subject was asked to abstain from all oral hygiene procedures for 24 hs prior to each brushing event, to allow plaque accumulation. Plaque was recorded using a modified Quigley & Hein index (PI) at six points per tooth before and after each episode of brushing, and the differences in the means (pre- to postbrushing) were compared. Three-way anova was undertaken to compare differences between plaque-removing efficacy for the 16 combinations of force and time. Subjects, brushing time and brushing force were used as fixed effects within the analysis.

RESULTS

All 12 subjects participating completed the 16 combinations of force and time over which plaque removal was assessed. Statistically significant differences in PI reductions were found between different brushing times and forces over all tooth surfaces (p<0.001). The interaction of varying brushing force and brushing time was significant for full mouth (FM) and interproximal (IP) sites (p<0.03). No statistical significance was demonstrated for smooth surface (SS) sites, nor was it detected for the interaction of subjects with brushing force or subjects with brushing time (p>0.05).

CONCLUSION

We conclude that brushing time and brushing force have significant effects upon the level of plaque removal by a PTB, and at 120 s brushing time the improvement in plaque removal with forces in excess of 150 g was negligible.

Manual versus powered toothbrushing for oral health

BACKGROUND

Specific oral bacteria, generically known as "dental plaque" are the primary cause of gingivitis (gum disease) and caries. The removal of dental plaque is thought to play a key role in the maintenance of oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this.

OBJECTIVES

To compare manual and powered toothbrushes in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register (to 22/8/02); Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to week 5 2002); EMBASE (January 1980 to week 3 July 2002) and CINAHL (January 1982 to June 2002). Manufacturers of powered toothbrushes were contacted for additional published and unpublished trials.

SELECTION CRITERIA

Trials were selected if they met the following criteria: design-random allocation of participants; participants-general public with uncompromised manual dexterity; intervention- supervised manual and powered toothbrushing for at least four weeks; primary outcomes-the change in plaque and gingivitis over that period.

DATA COLLECTION AND ANALYSIS

Six reviewers independently extracted information in duplicate. Indices for plaque and gingivitis were expressed as standardised values for each study. The effect measure for each meta-analysis was the standardised mean difference (SMD) with the appropriate 95% confidence intervals (CI) using random effect models. Potential sources of heterogeneity were examined, along with sensitivity analyses for the items assessed for quality and publication bias.

MAIN RESULTS

Twenty-nine trials, involving 2,547 participants, provided data for the meta-analysis. Brushes that worked with a rotation oscillation action removed more plaque and reduced gingivitis more effectively than manual brushes in the short and long term. For plaque at one to three months the SMD was -0.44 (95% CI: -0.66 to -0.21), for gingivitis SMD -0.44 (95% CI: -0.72, -0.15). These represented an 11% reduction on the Quigley Hein plaque index and a 6% reduction on the Löe and Silness gingival index. At over three months the effects were SMD for plaque -1.15 (95% CI: -2.02,-0.29) and SMD for gingivitis -0.51 (95% CI: -0.76, -0.25). These represented a 7% reduction on the Quigley Hein Plaque Index and a 17% reduction on the Ainamo Bay Bleeding on Probing Gingival Index. The heterogeneity found in these meta-analyses for short term trials was caused by one trial that had exceptionally low standard deviations. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. There was no evidence of any publication bias. No other powered brush designs were consistently superior to manual toothbrushes. In these trials, data on cost, reliability and side effects were inconsistently reported. Those side effects that were reported on in the trials were localised and temporary.

REVIEWER'S CONCLUSIONS

Powered toothbrushes with a rotation oscillation action achieve a modest reduction in plaque and gingivitis compared to manual toothbrushing. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.

Antimicrobial effects of mechanical debridement

Self-performed plaque removal using manual or powered toothbrushes and interdental cleaning devices is improved in subjects that have received oral hygiene instructions. Personal oral hygiene coupled with regular professional supragingival debridement may further improve the level of plaque control but still fails to achieve a completely plaque-free dentition. Both patient-performed and professional supragingival plaque removal has an effect on subgingival microbiota that is limited to the marginal 3 mm of the periodontal pocket. At sites with 4 mm or more of probing depth, only subgingival scaling leads to a significant reduction of the bacterial load. The subgingival microflora can be further reduced by pocket elimination surgery. Due to the sequence of bacterial recolonization that occurs following mechanical debridement, the level of periodontal pathogens such as B. forsythus, P. gingivalis and T. denticola may be reduced for several months. Mechanical debridement also influences the patient's immune system response, resulting in antibody titers and avidity against periodontal pathogens. As a basis for the restoration and maintenance of periodontal health, repeated subgingival debridement, as performed in supportive periodontal therapy, can reduce the number and proportions of periodontopathogenic bacteria in subgingival plaque. However, intensive subgingival scaling and root planing should be avoided in sites that probe less than 3 mm, as this is likely to traumatize the periodontium and cause attachment loss.

Models for assessing powered toothbrushes

The continued development of the power toothbrush over the last 25 years has led to some present-day models that demonstrate increased efficacy in plaque removal compared with a manual brush. The wealth of clinical data that supports these claims has a reference to both in vitro and in vivo models. An overview of performance evidence compared with manual toothbrushes must also be considered from a research model view. The issue of power toothbrush safety in relation to soft tissue abrasion will offer an opportunity for the review of the scientific facts behind any fictitious "hype". Specific studies will provide clinical evidence on power toothbrush safety and performance. This paper will consider implications of the evidence for the use of powered toothbrushes in clinical practice and will emphasize the current consensus of clinical opinion in the light of scientific evidence.

Oscillating/rotating electric toothbrushes compared: plaque removal and gingival abrasion

OBJECTIVES

This study was designed to test the efficacy in plaque removal and the potential for gingival abrasion of 3 electric toothbrushes. The established Braun Oral-B 'Ultra' plaque remover (D9), the Philips/Jordan HP 735, and the newly designed Braun Oral-B 3D Plaque Remover (3D).

MATERIAL AND METHODS

This study was designed as a split-mouth, single blind, randomised clinical study consisting of 3 identical experiments with 3 combinations of toothbrushes (exp 1:3D-HP735, exp 2:D9-HP735, exp 3:D9-3D). 40 subjects were requested not to brush their teeth 48 h prior to each examination. At this visit, both the gums and teeth were disclosed for the assessment of baseline plaque and gingival abrasion. Abrasion sites were scored as small (< or = 5 mm) or large sites (> 5 mm). Plaque was assessed according to the Quigley & Hein index at 6 sites per tooth. The participants brushed 60 s with the 2 brushes, each brush in 2 randomly selected contra-lateral quadrants.

RESULTS

The increase in number of small abrasions after brushing (exp. 1) was 1.2 versus 1.7 for 3D and HP735, respectively (ns); In exp. 2 the increase was 0.9 for both D9 and HP735. In exp. 3 the increase was 0.4 sites for both D9 and 3D. Comparison of the 3D and HP735 showed a mean plaque reduction of 67% and 54%, respectively (p<0.05); when the D9 and HP735 were compared, a mean plaque reduction of 70% and 58%, respectively, was found (p<0.05); a mean plaque reduction of 74% was found in the comparison of D9 and 3D.

CONCLUSION

The results show that the potential gingival abrasion after brushing is comparable for all 3 electric toothbrushes. In addition the longer the subjects used the brushes the less abrasion occurred. Finally both 3D and D9 were more effective than the HP735 in removing plaque.