Additional Effect of Dentifrices on the Instant Efficacy of Toothbrushing

Clinical Assessment of Plaque Removal Using a Novel Dentifrice Containing Cellulose Microfibrils

Dentifrice performance in the removal of dental plaque is influenced by the interactions of dentifrice components with tooth surfaces. This randomized controlled clinical study assessed the effectiveness and safety of a novel fluoride dentifrice formulation that included a micro-fibrillated cellulose network with entangled microcrystalline cellulose and silica particles (ProtegeraTM), and compared this to a positive control fluoride dentifrice (Crest Cavity Protection™). Whole mouth dental plaque levels in 82 healthy adults were measured after the first supervised use, and following a week of twice daily use at home. Overall, the test dentifrice was at least three times and up to four times more effective in whole-mouth plaque reductions, with a 38.6% reduction on first use, a 30.9% reduction at day 7, and a 41.6% reduction from day 1 to day 7, compared to reductions of 12.0%, 9.6% and 11.6%, respectively for the positive control, and up to seven times more effective in lingual plaque reductions, than the reference dentifrice (p < 0.001), with a 27.7% reduction on first use, a 22.3% reduction at day 7, and a 31.0% reduction from day 1 to day 7, compared to reductions of 4.4%, 2.2%, and 4.5%, respectively, for the positive control. No safety issues arose from the use of the test dentifrice. These results indicate that including micro-fibrillated cellulose enhances plaque removal effectiveness, without causing adverse changes to oral soft tissues.

Effectiveness of Apple Cider Vinegar and Mechanical Removal on Dental Plaque and Gingival Inflammation of Children With Cerebral Palsy

Background

This study was designed to evaluate the effect of apple cider vinegar (ACV) 5% and mechanical plaque removal with a manual toothbrush on dental plaque and gingivitis. The objective was to study available, natural, and inexpensive ways to improve oral health status among the studied group.

Materials and methods

A randomized clinical trial was performed on 50 children with cerebral palsy aged from three to six years. Participants were divided into two groups (n=25, apple cider vinegar, manual brushing without toothpaste). Plaque accumulation and gingival status were evaluated using Turesky of the Quigley-Hein plaque index (TQHPI) and modified gingival index (MGI) seven times: pre-intervention baseline (T0), post-intervention at one month (T1), two months (T2), three months (T3), four months (T4), five months (T5), six months (T6).

Results

Plaque accumulation and gingivitis decreased significantly for the ACV group between T0 and T6 (p<0.05) and demonstrated significantly lower plaque accumulation and gingivitis compared to the manual brushing group (p<0.05) at T5 and T6. The manual brushing group showed decreasing in TQHPI between T0 and T3, then TQHPI increased significantly (p<0.05) at T4, T5, and T6.

Conclusions

To sum up, this in vitro study has demonstrated the possibility of using apple cider vinegar to reduce plaque and gingivitis. In addition, without additives, apple cider vinegar has both mechanical and chemical effects on dental plaque, and it may be a natural, available, inexpensive, and harmless substance that can improve the quality of oral care for difficult groups of children and people with special needs. Unlike toothbrushes, especially electric toothbrushes, they are effective, but they may be expensive and not available to all children.

Czech and Slovak Dental Students' Oral Health-Related Knowledge, Attitudes, and Behaviours (KAB): Multi-Country Cross-Sectional Study

Dentists play a key role in the primary prevention of oral diseases and related systemic complications; therefore, their views on behavioural interventions need to be aligned with the current agendas for oral health. Likewise, dental students' oral health-related knowledge, attitudes, and behaviours (KAB) are of practical importance, as they are the future opinion leaders for oral health in their respective communities. A cross-sectional survey-based study was designed to evaluate the oral health KAB of dental students in both the Czech Republic and Slovakia. The study utilized translated versions of the Hiroshima University Dental Behavioural Inventory (HU-DBI), and it aimed to recruit students from all Czech and Slovak dental schools. A total of 487 students were included in this study, out of which 372 (76.4%) were females, 271 (55.6%) were enrolled in preclinical years, 68 (14%) reported smoking tobacco at least once a week, and 430 (88.3%) reported problematic internet use. The mean HU-DBI score of Czech and Slovak dental students (8.18 ± 1.80) was comparable with the previously reported scores of dental students in Nordic and Western European countries. Czech students (9.34 ± 1.29) had a significantly higher score than their Slovak counterparts (7.56 ± 1.73). In both countries, preclinical students (8.04 vs. 8.35), the students who reported tobacco smoking (7.63 vs. 8.27), and those who reported problematic internet use (8.11 vs. 8.70) had significantly lower HU-DBI scores than their counterparts, respectively. In the Czech Republic, the significant increases in HU-DBI scores occurred after the first academic year when the students received preventive dentistry courses; therefore, one can put forward that early implementation of preventive elements in undergraduate dental curricula may yield better and more sustainable oral health gains for the students. Future research on Czech and Slovak dental curricula need to re-evaluate the oral hygiene and anti-smoking components and their impact on students' views and attitudes.

Is plaque regrowth inhibited by dentifrice?: A systematic review and meta-analysis with trial sequential analysis

Objectives

The aim of this systematic review was to establish in studies with human participants the effect of a regular fluoride dentifrice compared to water or saline on dental plaque inhibition.

Methods

MEDLINE‐PubMed, Cochrane‐CENTRAL, EMBASE and other electronic databases were searched, up to April 2018. The inclusion criteria were controlled clinical trials among participants aged ≥18 years with good general health. Papers that evaluated the effect of dentifrice slurry compared with water or saline on plaque regrowth during a 4‐day nonbrushing period were included. Data were extracted from the eligible studies, the risk of bias was assessed, and a meta‐analysis was performed where feasible.

Result

The search retrieved eight eligible publications including 25 comparisons. The estimated potential risk of bias was low for all studies. Based on three different indices, overall plaque regrowth was significantly (P < 0.01) inhibited for 0.25 or more by the use of a dentifrice slurry as compared to water. All subanalysis on specific dentifrice ingredients and the overall descriptive analysis supported these findings.

Conclusion

The results of this review demonstrate moderate‐quality evidence for a weak inhibitory effect on plaque regrowth in favour of the use of a dentifrice intended for daily use.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

AIM

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

METHOD

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

RESULTS

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

CONCLUSION

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

Does dentifrice use help to remove plaque? A systematic review

AIMS

The aim of this systematic review was to establish the efficacy of brushing with and without a dentifrice for dental plaque removal.

MATERIALS AND METHODS

MEDLINE-PubMed, Cochrane-CENTRAL, EMBASE and other electronic databases were searched. The inclusion criteria were randomized controlled trials and controlled clinical trials and subjects ≥18 years of age with good general health. Studies that evaluated the effect of toothbrushing with a dentifrice compared to brushing without a dentifrice were included. Data were extracted from the eligible studies, and a meta-analysis was performed where feasible.

RESULT

The search was conducted until June 2016 and retrieved 10 eligible publications that included 20 comparisons. On average, 49.2% of plaque was removed when brushing was performed with a dentifrice, and 50.3% of plaque was removed when toothbrushing was performed without a dentifrice. The descriptive analysis indicated that the majority of the comparisons did not show an additional effect of dentifrice use. Regarding the meta-analysis of post-brushing scores, no significant difference was observed between toothbrushing with and without a dentifrice (DiffM 0.00, 95%CI [-0.05: 0.05], p = 0.91). The meta-analysis of incremental data (as means or percentages) supported and strengthened these findings.

CONCLUSION

The cumulative evidence for this systematic review demonstrates that there is moderate certainty that toothbrushing with a dentifrice does not provide an added effect for the mechanical removal of dental plaque.

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.

Periodontal Research: Basics and beyond - Part I (Defining the research problem, study design and levels of evidence)

Research in the field of periodontology has witnessed a tremendous upsurge in the last two decades unveiling newer innovations in techniques, methodologies, and material science. The recent focus in periodontal research is an evidence-based approach which offers a bridge from science to clinical practice. This three part review series intends to take a reader through a maze of periodontal research, unraveling and simplifying various issues in the design, conduct and interpretation of various study designs routinely used in the field of periodontal research. This understanding would facilitate a researcher with a focused and an enhanced vision toward formulating studies which can more efficiently translate sound scientific phenomena into clinically meaningful results.

Influence of different toothpaste abrasives on the bristle end-rounding quality of toothbrushes

OBJECTIVES

To evaluate the influence of different toothpaste abrasives on the bristle wear and bristle tip morphology of toothbrushes with different degrees of hardness.

MATERIAL AND METHODS

Ninety samples of bovine incisor teeth were used in this study. The samples were randomly divided into three groups according to the bristle hardness of the toothbrush used: soft bristles (S); extra-soft bristles (ES); hard bristles (H). The toothbrushes of each group were randomly divided into six subgroups with five toothbrushes each, according to the abrasive of the toothpaste used in the simulation: Negative control (distilled water); toothpaste 1 (silica); toothpaste 2 (hydrated silica); toothpaste 3 (calcium carbonate, calcium bicarbonate and silica); toothpaste 4 (tetrapotassium pyrophosphate, silica and titanium dioxide); toothpaste 5 (calcium carbonate). The samples were placed in a toothbrushing simulating machine that simulating three months of brushing. The toothbrush bristles were evaluated by the bristle wear index, and the bristle tips morphology was evaluated by the bristle tip morphology index.

RESULTS

The ES brush presented the highest bristle wear among the toothbrushes. Additionally, the S brushes showed better morphology of the bristles followed by ES and H brushes. The type of abrasive only influenced the bristle tip morphology of the ES brushes. The toothpaste 3 induced the worse bristle tip morphology than all the other toothpastes.

CONCLUSIONS

Different abrasives have influence only on the bristle tip morphology of the ES brushes.

Oral Health Knowledge of Periodontal Disease among University Students

Objectives. The aim of this study was to evaluate levels of oral health knowledge of periodontal disease among nondental university students. Materials and Methods. Two hundred and fifty university students (mean age 20.1 years ± 2.5) were recruited into this study. The participants completed a structured questionnaire during a personal interview. The questionnaire consisted of items to assess participants' personal data (age, gender, level of study, and specialty) and oral heath knowledge related to periodontal disease. Statistical significance was based on probability values of less than 0.05. Results. Participants showed poor knowledge of causes, signs, symptoms, and preventive measures of gum disease. The level of study had no relationship with students' knowledge of the initiating factors of periodontal disease (P < 0.05), but had a significant relationship with the knowledge of periodontal disease's signs, preventive measures, and relations to general health and systemic disease (P < 0.05). Students from scientific disciplines had more knowledge of periodontal disease's causes, preventive measures, and relations to general health and systemic disease (P < 0.05) than those from humanity disciplines. Conclusions. There were significant differences in oral health knowledge regarding periodontal disease between students from different levels of studies and different disciplines.

The use of a profilometer for both quantitative and qualitative measurements of toothpaste abrasivity

AIM

To evaluate the abrasivity of different toothpastes both quantitatively and qualitatively with a profilometer technique and to correlate these findings to the radioactive dentin abrasivity (RDA) value.

MATERIALS AND METHODS

Acrylic plates were exposed to brushing in a brushing machine with 11 different toothpastes. The results were evaluated using a profilometer. A surface roughness value (Ra-value), that is, a qualitative measurement, and also a volume value, that is, a quantitative measurement, were calculated from the profilometer results. These values were then correlated to each other and to the RDA-value. A comparison between RDA, Ra and volume measurements was performed using linear fitting procedure.

RESULTS

The results showed that the correlation between RDA and Ra measurements was low (R(2) = 0.04) and also that the correlation between RDA and volume measurements was low (R(2) = 0.00002). Correlation between Ra and abraded volume was high (R(2) = 0.87).

CONCLUSIONS

It is important to consider not only the RDA-value when evaluating toothpaste abrasivity. From the profilometer results both a quantitative (volume) and qualitative (roughness) measurement of the abrasivity of a toothpaste can be obtained.

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.