Efficacy of a sonic toothbrush on inflammation and probing depth in adult periodontitis

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.

Role(s) of cytokines in pulpitis: Latest evidence and therapeutic approaches

Pulpitis is known as a typical inflammation of dental pulp tissue, and microorganisms of the oral microbiome are involved in this opportunistic infection. Studies indicated that several factors related to host response have a crucial role in pulpitis. Among these factors, inflammatory mediators of the immune system such as cytokines and chemokines contribute to pulpal defense mechanisms. A wide range of cytokines have been observed in dental pulp and these small molecules are able to trigger inflammation and participate in immune cell trafficking, cell proliferation, inflammation, and tissue damage in pulp space. Therefore, the aim of this review was to describe the role of cytokines in the pathogenesis of pulpitis.

Effectiveness of a motionless ultrasonic toothbrush in reducing plaque and gingival inflammation in patients with fixed orthodontic appliances

OBJECTIVE

To compare the effectiveness of a motionless ultrasonic toothbrush to a manual toothbrush in reducing dental plaque, gingival inflammation, and mutans streptococci in patients with fixed orthodontic appliances.

MATERIALS AND METHODS

Twenty-five orthodontic patients were recruited to this crossover study. The patients were randomized into two groups starting with manual or motionless ultrasonic toothbrushes for 30 days. After a 30-day washout period, the patients switched to the other toothbrush type for 30 days. Plaque and gingival indices were evaluated by two calibrated-blinded examiners before and after each 30-day period of brushing. Salivary samples were also collected for quantification of mutans streptococci.

RESULTS

On the bracket side, the motionless ultrasonic toothbrush showed a significantly higher mean plaque index bracket score after 30-day usage than baseline (P = .049), while the manual toothbrush group showed no difference between the before and after brushing periods (P = .10). The changes in plaque index bracket score were significantly more favorable in the manual toothbrush group than in the ultrasonic toothbrush group (P = .04). In contrast, no difference was observed on the nonbracket side. There was no significant difference in the changes of gingival index or the numbers of mutans streptococci between the two groups.

CONCLUSION

Manual toothbrushing performed better than brushing with the motionless ultrasonic toothbrush in plaque removal on the bracket side in orthodontic patients. However, no difference was observed in terms of gingival status and the numbers of mutans streptococci.

Comparison of manual toothbrushes with different bristle designs in terms of cleaning efficacy and potential role on gingival recession

OBJECTIVE

The aim was to compare the efficacy of plaque control and potential effects on gingival recession of the toothbrushes with angled and straight bristles.

MATERIALS AND METHODS

A total of 40 healthy dental students (25 females and 15 males; age range: 23-25 years) participated and two study groups were constituted. Participants were randomly distributed into two groups to use either angled or standard design manual tooth brushes with soft bristles. Oral hygiene indicators and soft tissue levels were monitored for 6 months. Plaque index, gingival index (GI), probing depth, clinical attachment level, and bleeding on probing were measured at six sites. Vertical recession (VR) and horizontal recession (HR) were also recorded. All measurements were repeated at 3 and 6 months.

RESULTS

Plaque scores were reduced significantly at 6 months compared to baseline in both groups (P < 0.05 and P < 0.005 in criss-cross and standard design brushes, respectively). Mean GI scores of the criss-cross design were reduced significantly at 6 months (P < 0.05). Inter-group comparisons revealed that gingival recession (GR) values were not statistically significant (P > 0.05) at baseline, 3 and 6 months suggesting no pronounced impact of bristle design in terms of GR (VR = 0.596, HR = 0.572; VR = 0.884, HR = 0.572; VR = 0.884, HR = 0.572 in the groups).

CONCLUSIONS

Bristle design has little impact on plaque removal capacity of a toothbrush. Both designs are safe enough to prevent GR as long as soft bristle material is used.

Powered versus manual toothbrushing for oral health

BACKGROUND

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

OBJECTIVES

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

SEARCH METHODS

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

SELECTION CRITERIA

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

DATA COLLECTION AND ANALYSIS

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

MAIN RESULTS

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

AUTHORS' CONCLUSIONS

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

Comparison of sonic and ionic toothbrush in reduction in plaque and gingivitis

BACKGROUND

A paucity of conclusive research exists on the optimal design and mode of action of toothbrushes, leading to the introduction of new generation of toothbrushes. Sonic and ionic toothbrushes belong to this new generation of toothbrushes. The aim of the present study was to clinically assess and compare the efficacy of the sonic and ionic toothbrushes.

MATERIALS AND METHODS

A single blind study, using a split-mouth method, was conducted for 45 days on a total of 22 (11 males and 11 females) student volunteers, with age of 17 to 21 years. Plaque, gingival, and bleeding indices were recorded after every 15 days.

RESULTS

Both the toothbrushes showed significant reduction in all three parameters. However, the sonic toothbrush proved to be more effective than the ionic toothbrush on the percentage basis, the difference in parameters was statistically nonsignificant.

CONCLUSION

It may be concluded from the present study that though the sonic toothbrush was insignificantly superior to the ionic toothbrush, both the toothbrushes are clinically effective in removing plaque and improving the gingival conditions.

Comparison of manual versus sonic and ultrasonic toothbrushes: a review

PURPOSE

This review of the literature intends to evaluate the effect of brushes with high frequency motion when compared with manual toothbrushes regarding the indices of plaque and gingival bleeding.

METHODS

Patients presenting gingivitis and/or chronic periodontitis were evaluated in addition to patients having osseointegrated implants and fixed orthodontic appliances. Pertinent literature was reviewed to select articles according to previously defined inclusion criteria.

RESULTS

In the assessed studies results showed significant decreases in plaque and gingival indices by utilization of both types of brushes. However, in the selected studies where sonic brushes were tested in orthodontic and dental implant patients there was a more significant decrease in the indices. Furthermore, there was no indication of gingival recession attributed to product use.

CONCLUSION

Future studies with a more homogeneous methodology and better experiment designs will be needed.

Evaluation of the Benefits of Using a Power Toothbrush During the Initial Phase of Periodontal Therapy

BACKGROUND

Studies evaluating the efficacy of oral hygiene procedures typically focus on prevention or maintenance after periodontal therapy. Little is known about the specific benefit of a power toothbrush during therapy. The objective of this study was to evaluate the clinical efficacy of power toothbrushing compared to manual toothbrushing in patients undergoing the initial phase of periodontal therapy.

METHODS

This was an examiner-masked, randomized, two-arm parallel study involving 70 adults (range, 23 to 81 years) with untreated periodontitis. After an initial supragingival debridement, subjects were assigned to toothbrushing with a manual (group M) or power (group P) toothbrush. Subjects returned for evaluation after 7, 14, and 28 days.

RESULTS

At day 28, the mean plaque index (PI) was significantly lower for subjects in group P than for those in group M (P = 0.006). The mean number of sites with PI >1 at days 14 and 28 and the mean number of sites with bleeding on probing at days 14 and 28 also were significantly lower in these subjects (P = 0.018 and P = 0.005, respectively, and P = 0.017 and P = 0.034, respectively). Differences in the mean gingival index, the number of sites with a gingival index >1, mean recession, mean probing depth, and the number of pockets >4 mm were not significant.

CONCLUSION

Subjects using a power toothbrush during initial treatment reduced supragingival plaque to lower levels and showed significantly less bleeding on probing than subjects using a manual brush.

Quality of trials in a systematic review of powered toothbrushes: suggestions for future clinical trials

BACKGROUND

This study aimed to assess the quality of reports of randomized controlled trials (RCTs) comparing manual and powered toothbrushes and provide advice on how future trials might be improved.

METHODS

Studies were identified in the Cochrane systematic review of RCTs comparing powered versus manual toothbrushes. Reports were assessed against predefined criteria on the design of the studies to determine the effectiveness of the brushes in everyday home use and on their methodological quality.

RESULTS

Only 42 of 297 identified studies satisfied the inclusion criteria and were eligible for inclusion in the review. Many studies were excluded for more than one reason. Fifteen studies employed split-mouth designs that may have changed toothbrushing behavior. Of 42 included RCTs, the generation of randomization sequence was adequate in 15 trials and concealment of allocation was adequate in 16 trials. Intention-to-treat analysis was reported in only five studies. Plaque data were reported using 10 different indices and gingivitis with nine indices. Only 12 trials lasted 3 months or longer, and there were no data on the benefits of powered toothbrushes for periodontal attachment.

CONCLUSIONS

Some designs created an artificial research environment that may have undermined the findings. Authors of toothbrush trials should consider the Consolidated Standards of Reporting Trials statement. Greater standardization of the indices used is required. Trials of longer duration would enhance the evaluation of powered toothbrushes. Data on thresholds for clinically significant differences in plaque and gingivitis levels would help to determine whether oral hygiene aids provide important health benefits.

Sonic tooth brushing reduces gingival overgrowth in renal transplant recipients

Cyclosporine (CSA) is a commonly used immunosuppressive medication in pediatric transplantation. Drug-induced gingival overgrowth (DIGO) is a frequent side effect associated with CSA use and can impair the patient's ability to achieve good oral hygiene. This study tested the hypothesis that sonic tooth brushing and oral hygiene instruction can reduce the occurrence or severity of DIGO in CSA-treated pediatric renal transplant recipients. Twenty-three pediatric renal transplant patients with DIGO were randomly allocated to treatment or control groups. The treatment group received oral hygiene instruction and use of a sonic toothbrush, while the control group continued their usual home care with manual brushes. Dental impressions and photographs of all subjects were taken at baseline and every 3 months for a year. The casts and photographs were evaluated by a dental panel to compare the DIGO levels from baseline until the end of the study. After 12 months the control group had significantly more severe DIGO than did the sonic tooth brushing and oral hygiene instruction group (OR=4.5, 95%CI=1.2-16.0, P=0.03). Of the risk factors considered, only male gender was significantly associated with worse outcome (OR=6.1, 95%CI=2.3-16.1, P=0.03). The use of a powered toothbrush, together with oral hygiene instruction, may be an important component of health maintenance for pediatric transplant patients on CSA.

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.

A review of the clinical efficacy of the Oral-B oscillating/rotating power toothbrush and the Philips Sonicare toothbrush in normal subject populations

Plaque removal by a toothbrush results from a physical scrubbing of bristles on the tooth surface that removes adherent plaque bacteria. Because of the frequency of brush head motion, some power toothbrushes generally remove plaque more effectively than a manual brush. One power toothbrush, Philips Sonicare, claims also to remove plaque as a result of dynamic fluid activity. This effect has been shown in laboratory studies but clinical evidence is currently lacking. This review evaluated the data from well-controlled clinical studies carried out in normal subjects from a general population comparing the Sonicare toothbrushes with the Oral-B oscillating/rotating power toothbrush technology. It focuses on plaque removal from approximal surfaces where it is difficult for toothbrush bristles to reach, as it is here that any dynamic fluid effect should be most apparent. Results from the review found no evidence to support a greater efficacy for the Sonicare toothbrushes either generally or at approximal surfaces. Data revealed that the oscillating/rotating toothbrush was more effective than the Sonicare toothbrushes with respect to plaque removal. It is possible that factors associated with the clinical situation such as damping resulting from bristle contact with the tooth surface and the high viscosity of saliva and dentifrice may counteract dynamic fluid activity in vivo. This review indicates that dynamic fluid activity beyond the reach of bristles as demonstrated in the laboratory is yet unproven in the clinical situation.

The effectiveness of manual versus powered toothbrushes for dental health: a systematic review

OBJECTIVES

To compare manual and powered toothbrushes in everyday use, principally in relation to plaque removal and gingival health. Stain, calculus removal, dependability, adverse effects and cost were also considered.

METHOD

A systematic review was undertaken in collaboration with the Cochrane Oral Health Group. Five electronic databases were searched to identify randomised controlled trials comparing powered and manual toothbrushes. Trials of less than 28 days duration, or where toothbrushing was supervised, were excluded. Assessment of relevance, data extraction and validity assessment were all undertaken independently and in duplicate by two reviewers. Included studies were grouped according to the mode of action of the powered toothbrush. The primary outcomes were plaque and gingival health with data defined as either short-term (1-3 months) or long-term (greater than 3 months) duration were analysed. Powered brushes were categorised into six groups depending on mode of action. Numerical data extracted were checked by a third reviewer for accuracy and entered into RevMan (version 4.1).

RESULTS

The initial search identified 354 studies. Two hundred and fifteen full articles were obtained of which 29 trials fulfilled the inclusion criteria with results, which could be entered in the meta-analysis. Twenty-six trials (1786 participants) reported short-term and 10 trials (798 participants) long-term plaque scores. Twenty-nine trials (2236 participants) reported short-term and 10 trials (798 participants) long-term gingivitis scores. Powered brushes reduced plaque and gingivitis at least as effectively as manual brushing. Rotation oscillation powered brushes statistically significantly reduced plaque and gingivitis in both the short and long-term. For plaque at one to 3 months the standardised mean difference was -0.44 (95% CI: -0.66 to -0.21), for gingivitis SMD -0.45 (95% CI: -0.76, -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 3 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. 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.

CONCLUSION

In general there was no evidence of a statistically significant difference between powered and manual brushes. However, rotation oscillation powered brushes significantly reduce plaque and gingivitis in both the short and long-term. The clinical significance of this reduction is not known. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.

Does cavitation occur around powered toothbrushes?

AIMS/OBJECTIVES

The aim of this investigation was to determine if cavitational activity occurred around powered toothbrushes using a chemical dosimeter system based on terephthalic acid (TA).

MATERIAL AND METHODS

Five powered toothbrushes were used in this investigation: Braun Plaque Remover D8, Braun Oral-B 3D, Philips Jordan Sensiflex HX2520, Sonicare PS-1 and Sonicare Elite HX 7351/02. Each brush head was inserted into a conical flask containing 50 cm3 of aqueous TA solution. Brushes were operated for 10 and 20 min and a cuvette of the solution was placed in a fluorescence spectrometer (Perkin Elmer 3000). The fluorescence emitted at wavelength 425 nm, which is proportional to *OH radical concentration, was monitored.

RESULTS

Any cavitational activity that may have been produced by the powered toothbrushes was below the limit of detection of the system (<10(-8) M) for the timescales investigated.

CONCLUSIONS

This work has demonstrated that cavitational activity does not occur around powered toothbrushes. Operating the toothbrushes for periods up to 20 min resulted in no cavitational activity being detected.

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.

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.

Preventive strategies and supportive treatment

There is a preponderance of evidence in the literature that periodontal and other oral diseases, such as caries, can be treated and controlled by thorough mechanical plaque removal by the patient, the use of antimicrobial agents and antibiotics when necessary, and participation with the therapist in a well monitored, long-range program of supportive periodontal therapy. Recent evidence suggests that the control and prevention of oral disease, especially periodontitis, is especially important for patients with various systemic conditions that can be impacted by oral infections. It is far better for patients and therapists to practice primary and even secondary prevention with effective plaque control and regular, consistent supportive periodontal therapy, than having to rely on tertiary prevention for disease that has progressed to a level that requires costly treatment, is time-consuming and carries a greater risk of morbidity.

The efficacy of a counter-rotational powered toothbrush in the maintenance of endosseous dental implants

BACKGROUND

Although most patients with implants have lost their natural teeth because of poor oral hygiene, limited data exist to guide practitioners in their recommendations of home-care regimens for their patients' endosseous dental implants and maintenance of peri-implant soft-tissue health. The authors conducted a study to compare the home-care effectiveness of a counter-rotational powered tooth-brush with that of conventional home-care regimens.

METHODS

Before starting the six-year study, the authors trained 85 clinical investigators at 32 dental research centers across the United States in gathering periodontal data. Data for 2,966 implants were entered into a centralized database. Outcomes were derived from 24-month observations of a subset of the implants studied.

RESULTS

Repeated-measures analysis of the toothbrushing methods used on 2,966 implants showed that the counter-rotational powered toothbrush removed plaque significantly better than manual methods (P < .0001 Wald statistic) from all implant surfaces and at all recall intervals up to 24 months. Similar results were demonstrated for the gingival index.

CONCLUSIONS

The counter-rotational powered brush appears to be well-suited for home-care regimens aimed at maintaining optimal peri-implant soft-tissue health in patients with dental implants.

CLINICAL IMPLICATIONS

The importance of maintaining the health of the peri-implant tissues is well-recognized by the dental profession. The counter-rotational powered toothbrush is an effective tool in meeting the oral hygiene challenges associated with implant prosthesis maintenance.

Sonic and mechanical toothbrushes. An in vitro study showing altered microbial surface structures but lack of effect on viability

The purpose of the present study was to compare the in vitro effects of a mechanical and a sonic toothbrush on the viability of Actinomyces viscosus, the rationale being that induction of irreparable microbial damage resulting from aggressive mechanical action or sonic energy, may inhibit or disrupt the process of successional colonization. Cultures of A. viscosus were grown to a standardized optical density and subdivided into 3 treatment groups of 20 specimens each. Treatment groups consisted of an untreated control and exposure to a mechanical or sonic toothbrush for 15, 30, 45, and 60 s. Subsequent to the prescribed treatment, samples were taken from each specimen dish, subcultured, and the number of CFUs determined. Additional samples were obtained for negative staining and examination by electron microscopy. The mean number of CFUs for each treatment group at each treatment interval were statistically analyzed by ANOVA and multiple pairwise comparisons. Results showed a significant main effect for toothbrushes (p<0.0001) and exposure time (p<0.01), but only marginal significance for the interaction of toothbrush with exposure time (p<0.055). Post-hoc tests showed a significantly greater number of CFUs for the sonic toothbrush compared to both the untreated control and mechanical toothbrush groups. Electron microscopic examination revealed a decrease in aggregation tendency and loss of fimbriae in the sonic toothbrush group. Based on the lack of morphologic evidence that would indicate cell damage and the increase in CFUs over that of the control group, it appeared that neither the mechanical or sonic toothbrushes affected cell viability.

Effect of brushing with sonic and counterrotational toothbrushes on the bond strength of full veneer crowns

STATEMENT OF PROBLEM

Earlier studies on orthodontic brackets have shown a loss of bond strength after a sonic toothbrush was used.

PURPOSE

This in vitro study evaluated the difference in bond strength of single complete veneer crowns after being subjected to the equivalent of 2 years of brushing with sonic and counterrotational toothbrushes.

MATERIAL AND METHODS

Complete gold crowns were fabricated with a conventional indirect technique for 30 extracted, intact, prepared human premolar teeth. Castings were then luted to the teeth with glass ionomer cement. Teeth were randomly divided into 3 groups of 10 teeth each, 1 group to be brushed with Sonicare sonic toothbrush, 1 group to be brushed with Interplak counterrotational mechanical toothbrush, and 1 group as the control. Groups 1 and 2 were then brushed for the equivalent of 2 years per tooth. A uniform force of 50 g for the sonic toothbrush and 120 g for the counterrotational toothbrush was used. Control specimens were not brushed. Brush heads and sample teeth in contact with the toothbrush were kept moist at all times. Tensile dislodgment force was determined with an Instron universal testing machine.

RESULTS

The castings brushed with a sonic toothbrush required a mean of 43.22 kg (+/- 11.16) force to remove the crowns from the teeth, whereas the counterrotational group required a mean of 42.87 kg (+/- 10.42) and the control group a mean of 42.12 kg (+/- 6.61). Analysis of variance on the force data indicated no differences among the 3 groups in the force needed to remove the castings (F[2,24] = 0.031, P = .97).

CONCLUSION

This in vitro study demonstrated no significant differences between groups in the amount of tensile dislodgment force required to remove cemented full veneer crowns from prepared teeth after brushing for the equivalent of 2 years time with a sonic toothbrush or a counterrotational toothbrush.

Modern supragingival plaque control

Supragingival plaque control is essential for the maintenance of oral health. Despite the many chemotherapeutic agents available as mouthrinses and toothpastes, mechanical plaque removal is still the best method to achieve effective plaque control. This is due, in part, to the lack of development of oral antimicrobials with the effectiveness and substantivity of chlorhexidine gluconate but without its adverse effects of dental staining and calculus formation. The use of the numerous mechanical (manual and electric) oral hygiene devices extant and their effectiveness, however, are dependent upon patient dexterity and compliance and concomitant active professional treatment for the monitoring of home care, oral hygiene instruction and patient motivation. This paper evaluates the current methods available to reduce plaque and gingivitis with emphasis on their effectiveness at both supragingival plaque control and disease prevention. In addition, recent studies on the newer oscillating/rotating electric plaque removers and interdental cleaning devices will be discussed as related to their efficacy and compliance.