The Evaluation of the Effects of Two Probiotic Strains on the Oral Ecosystem: A Randomized Clinical Trial

Introduction

In the current study, we evaluated the effectiveness of two well-defined probiotic strains, Lactobacillus paracasei LPc-G110 (CCTCC M 2013691) and Lactobacillus plantarum GOS42 (DSM 32131), during an experimental gingivitis challenge. The primary objective was to evaluate clinically the effectiveness of lozenges containing one of the two oral probiotic strains, compared with placebo lozenges, on the gingival bleeding (bleeding on marginal probing; BOMP change) after a two-week experimental gingivitis period. The secondary objectives were to assess the effects of the test products on gingival health (Modified Gingival Index; MGI), dental plaque accumulation and fluorescence, and the dynamics of immunological and microbiological aspects after the wash-in phase, followed by a two-week period refraining from oral hygiene and a two-week wash-out phase.

Methods

This single-center challenge intervention study was a triple-blind randomized placebo-controlled clinical trial with three parallel groups. The full study population consisted of 117 healthy 18-55 years old human volunteers. Subjects were instructed to use one lozenge, 3 times daily after each meal, containing either L. plantarum, L. paracasei, or lozenges without probiotics (placebo group). After a 2-week wash-in period, the subjects were requested to refrain from any form of oral hygiene for 2 weeks.

Results

There were no differences in the primary outcome (BOMP change) among the groups. However, gingival health (MGI) in individuals from the groups exposed to the test products recovered better from experimental gingivitis than the individuals in the placebo group (p = 0.021, one-way ANOVA). The two test products inhibited pro-inflammatory cytokine IL-1ß production, measured in saliva, during the experimental gingivitis period. Both test strains significantly reduced bacterial DNA in tongue samples and L. paracasei strain showed stronger microbiome-modulating potential than the L. plantarum strain.

Conclusions

The two tested lozenges with the L. paracasei or L. plantarum strains did show potential for beneficial effects for the oral health of the host during experimental gingivitis to the oral ecosystem.

Dental aerosols: microbial composition and spatial distribution

Background: High-speed dental instruments produce aerosols, which can contribute to the transmission of pathogenic microorganisms. The aim of this study is to describe the microbial load and - composition and spatial distribution of aerosols in dental clinics. Methods: In four dental clinics active and passive sampling methods were used before, during and after treatment and at different locations. Retrieved colony forming units (CFU) were sequenced for taxon identification. Results: The samples contained up to 655 CFU/plate/30 minutes and 418 CFU/m³/30 minutes during dental treatment for active and passive sampling, respectively. The level of contamination after treatment and at 1.5 m distance from the patient's head was similar to the start of the day. The highest contamination was found at the patient's chest area. The aerosols consisted of 52 different taxa from human origin and 36 from water. Conclusion: Contamination in dental clinics due to aerosols is mainly low, although high level of contamination with taxa from both human and water origin was found within 80 cm around the head of the patient. Our results stress the importance of infection control measures on surfaces in close proximity to the head of the patient as well as in dental water lines.

Plaque Removal by Young Children Using Old and New Toothbrushes

There is inconclusive evidence about the relationship between toothbrush wear and plaque removal. This randomized cross-over clinical trial aimed to validate or invalidate non-inferiority in the plaque-removal efficacy of old vs. new toothbrushes in the hands of 7- and 8-year-old children. The lower limit for non-inferiority was set a priori as a difference in plaque score < 15%. Children (n = 101) brushed, in the first session, with either their 14-month-old toothbrush or a new one, and in the second session vice versa. The mean Quigley-Hein plaque score, before and after children brushed with old brushes, was 2.9 and 2.4, and with new brushes 2.8 and 2.1. The plaque score after they brushed with the new toothbrush was 10.9% lower (p < 0.001) than after they brushed with the old toothbrush. The confidence interval of 7.6%–13.9% was within the acceptance band (< 15%), and non-inferiority of old toothbrushes in the hands of these children was validated.

The effectiveness of dentifrices without and with sodium lauryl sulfate on plaque, gingivitis and gingival abrasion--a randomized clinical trial

OBJECTIVES

The aim of this study was to compare the efficacy of a dentifrice without sodium lauryl sulfate (SLS) to a dentifrice with SLS in young adults aged 18-34 years on gingivitis.

MATERIAL AND METHODS

One hundred twenty participants (non-dental students) with a moderate gingival inflammation (bleeding on probing at 40-70 % of test sites) were included in this randomized controlled double blind clinical trial. According to randomization, participants had to brush their teeth either with dentifrice without SLS or with SLS for 8 weeks. The primary outcome was bleeding on marginal probing (BOMP). The secondary outcomes were plaque scores and gingival abrasion scores (GA) as well as a visual analogue scale (VAS) score at exit survey. Baseline and end differences were analysed by univariate analysis of covariance (ANCOVA) test, between group differences by independent t test and within groups by paired sample t test.

RESULTS

BOMP improved within groups from on average 0.80 at baseline to 0.60 in the group without SLS and to 0.56 in the group with SLS. No statistical difference for BOMP, plaque and gingival abrasion was found between both groups. VAS scores for taste, freshness and foaming effect were significantly in favour of the SLS-containing dentifrice.

CONCLUSION

The test dentifrice without SLS was as effective as a regular SLS dentifrice on gingival bleeding scores and plaque scores. There was no significant difference in the incidence of gingival abrasion.

CLINICAL RELEVANCE

In patients diagnosed with gingivitis, a dentifrice without SLS seems to be equally effective compared to a dentifrice with SLS and did not demonstrate any significant difference in gingival abrasion. In patient with recurrent aphthous ulcers, the absence of SLS may even be beneficial. However, participants indicate that they appreciate the foaming effect of a dentifrice with SLS more.

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.

Long-term efficacy of a 0.07% cetylpyridinium chloride mouth rinse in relation to plaque and gingivitis: a 6-month randomized, vehicle-controlled clinical trial

OBJECTIVE

To evaluate the effectiveness of 0.07% cetylpyridinium chloride (CPC) mouth rinse for reduction of gingival inflammation and inhibition of plaque compared to a vehicle control (VC) mouth rinse over a 6-month period.

MATERIALS & METHODS

Participants (n = 62) used their randomly assigned product as adjunct to toothbrushing. Bleeding, plaque and staining scores were assessed at baseline, 3 and 6 months. Plaque and saliva samples were taken at each assessment monitoring possible shifts in the composition of the microbiota.

RESULTS

A significant difference (P = 0.002) in favour of the CPC mouth rinse, with respect to plaque scores, was found. Bleeding scores at 6 months were not significantly different (P = 0.089). However, when correcting for baseline values, a tendency towards a significant difference in bleeding scores at end trail was observed in favour of the CPC mouth rinse (P = 0.061). Regarding staining at 3 and 6 months, a small but significant difference (8.6% and 10.4%, respectively) (P < 0.0001) was observed with lower scores for the VC group. There was a significant reduction in total anaerobic count in the CPC group at 6 months (P < 0.05). The ratio of aerobes/anaerobes was markedly increased at 3 months, especially in the CPC group. No further differences were observed between groups at 6 months.

CONCLUSIONS

The use of 0.07% CPC mouth rinse was significantly more effective in reducing plaque scores than the vehicle control. Bleeding scores were not different at 6 months. The test product was well accepted and did not cause any serious clinical side effects or negatively affected the microbiota.

Effects of sugar-free chewing gum sweetened with xylitol or maltitol on the development of gingivitis and plaque: a randomized clinical trial

OBJECTIVE

The objective of this study was to test the effect of sugar-free chewing gum sweetened with xylitol or maltitol compared to the use of a gum base or no gum on gingivitis and plaque scores under both brushing and non-brushing circumstances.

METHODS

The design of the study was a four-group, double-blinded, randomized controlled study with a 3-week duration. In each group, the participants did not brush the teeth in the lower jaw designated to develop experimental gingivitis, while maintaining normal oral hygiene procedures in the upper jaw. After professional dental prophylaxis, the participants were allocated into one of four groups (xylitol, maltitol, gum base or no gum). Chewing gum was used five times a day for 10 min.

RESULTS

220 participants completed the study and provided evaluable data. The increase in bleeding on marginal probing (BOMP) and plaque scores (PS) in the non-brushed (lower) jaw with experimental gingivitis was significant in all groups (P < 0.001). As compared to the gum base, the increase in BOMP in the xylitol and maltitol group was significantly lower. In the brushed upper jaw, no significant changes for BOMP were observed from the baseline to the end point of the study, and there were no significant differences in BOMP and PS between the groups.

CONCLUSION

In circumstances where regular brushing is performed, no effect of chewing gum was observed on bleeding and plaque scores. In the absence of brushing, chewing xylitol or maltitol gum provided a significant inhibitory effect on gingivitis scores compared to chewing gum base. The difference when compared to the group not using gum was not significant.

Gingivitis and plaque scores of 8- to 11-year-old Burmese children following participation in a 2-year school-based toothbrushing programme

AIM

The present study assessed whether gingivitis and plaque scores of 8- to 11-year-old school children who participated in a SBTB programme for 2 years were lower than those of children who did not participate in the programme.

MATERIAL AND METHODS

The present study was performed using an examiner-blind, parallel group design and was performed in Burma (Myanmar) in 2006. Three of the five schools where daily SBTB programmes took place after lunch and which were performed under teacher supervision were randomly selected; three non-participating schools (non-SBTB) from the same area were assigned as controls. Twenty-five children per school were examined for gingivitis (bleeding on marginal probing) and plaque (Quigley & Hein).

RESULTS

In total, 150 8- to 11-year-old children participated, with 75 children in either group. The test group (SBTB) exhibited an overall mean bleeding score of 0.76. For the control group (non-SBTB), this score was 0.83. With respect to the overall mean plaque scores, the test group exhibited a score of 2.93, whereas the control group exhibited a score of 2.91. No statistically significant differences between the test and the control group were observed.

CONCLUSION

The present study did not reveal a statistically significant effect of daily SBTB programmes in 8- to 11-year-old school children with respect to gingivitis and plaque scores.

The effect of 1% chlorhexidine gel and 0.12% dentifrice gel on plaque accumulation: a 3-day non-brushing model

AIM

The purpose of the study was to compare the effects of four treatments on 'de novo' plaque accumulation. Treatments included tray application of 1% chlorhexidine gel (CHX-Gel), 0.12% chlorhexidine dentifrice-gel (CHX-DFG), a regular dentifrice (RDF) tray application, or 0.2% chlorhexidine mouthwash (CHX-MW) in a 3-day non-brushing model.

MATERIAL AND METHODS

The study was designed as a single blind, randomized parallel clinical trial. After professional prophylaxis, subjects abstained from all other forms of oral hygiene during a 3-day non-brushing period. Subjects were randomly assigned to one of the four test groups (CHX-Gel, CHX-DFG, RDF applied in a fluoride gel tray or rinsing with a CHX-MW). After 3 days, the Quigley & Hein plaque index (PI) and Bleeding on Marginal Probing (BOMP) index was assessed. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale.

RESULTS

After 3 days, the full-mouth PI means were 0.88 for the CHX-gel regimen, 0.79 for CHX-MW, 1.16 for CHX-DFG and 1.31 for the RDF regimen. The two dentifrices (CHX-DFG and RDF) were significantly less effective than the CHX-Gel or the CHX-MW.

CONCLUSION

Within the limitations of the present 3-day non-brushing study design, it can be concluded that the effect of a 1% CHX-Gel application tray is significantly greater than that of 0.12% CHX-DFG or RDF in inhibiting plaque accumulation. The 1% CHX-Gel applied via a tray and 0.2% CHX-MW rinse were comparably effective.

Parotid gland swelling following mouthrinse use

BACKGROUND

Unilateral or bilateral swelling of the parotid gland is a reported side effect of rinsing the mouth with chlorhexidine. Although the incidence rate is extremely low, there have been several case reports on this topic and the authors of these reports have suggested several explanations for the mechanism of this complication.

METHODS

In this report, two cases of parotid gland swelling are discussed. Both patients developed unilateral parotid swelling following the use of a mouthwash, case 1 after using a chlorhexidine mouthwash following flap surgery and case 2 after using a hexetidine mouthwash in an approved clinical trial that was testing different mouthwashes.

RESULTS

In both of the cases, differential diagnoses were made to explain the cause of the parotid swelling. However, discontinuing use of the product resulted in an eventual complete resolution of symptoms in both patients.

CONCLUSIONS

Swelling of the parotid gland following use of a mouthwash has previously been reported, although previous reports found this side effect only in patients who used chlorhexidine mouthwashes. This complication has therefore been informally linked to chlorhexidine. The present case report questions this hypothesis and suggests that parotid gland swelling may not be related to the type of mouthwash used, but may instead be a consequence of the rinsing action itself.

Inhibition of “De Novo” Plaque Formation With 0.12% Chlorhexidine Spray Compared to 0.2% Spray and 0.2% Chlorhexidine Mouthwash

BACKGROUND

Chlorhexidine (CHX) is widely accepted as the most effective product in the control of supragingival plaque. It is available in different delivery devices. The aim of this study was to test whether 0.12% CHX spray was as effective as 0.2% CHX spray and 0.2% CHX mouthwash in a 3-day "de novo" plaque formation model.

METHODS

Ninety volunteers were enrolled into a single-blind, randomized, three-group parallel study. They received a thorough dental prophylaxis prior to the test period. Subjects were divided randomly into three equal groups. They were requested to refrain from all forms of mechanical oral hygiene and instructed to use only their assigned product during the 3-day experimental period. After 3 days, the plaque growth was assessed using the Quigley and Hein plaque index (Q&H PI) at six sites per tooth.

RESULTS

After 3 days, the CHX mouthwash group had a mean Q&H PI of 1.17 compared to 1.41 for the 0.2% CHX spray and 1.49 for the 0.12% CHX spray. The difference between the mouthwash and the two sprays was statistically significant, whereas the two sprays did not differ significantly from each other.

CONCLUSIONS

Within the limitations of this 3-day "de novo" plaque formation study, the two sprays were not as effective as the mouthwash in plaque inhibition. No significant difference was found between the two sprays. To achieve the same effectiveness as a mouthwash, a higher dose (number of puffs) of CHX spray may be necessary.

The effect of 0.12% chlorhexidine dentifrice gel on plaque accumulation: a 3-day non-brushing model

BACKGROUND

Maintaining an adequate low level of plaque through daily tooth brushing is often not feasible. Effective chemotherapeutic agents as an adjunct to mechanical plaque control would therefore be valuable. Chlorhexidine (CHX) mouthwash has proved to be an effective inhibitor of plaque accumulation.

AIM

The purpose of the present study was to assess the effect of application of 0.12% CHX dentifrice gel on de novo plaque accumulation.

MATERIAL AND METHODS

The study was designed as a single blind, randomized three-arm parallel clinical trial. At the beginning of the test period all volunteers received a thorough professional oral prophylaxis. Subjects were randomly assigned to one of three regimens. During a 3-day non-brushing period, subjects abstained from all forms of mechanical oral hygiene. One regimen (test group) used 0.12% chlorhexidine dentifrice gel (CHX-DGel, Perio.Aid) applied in a fluoride gel tray, the benchmark control group used a regular dentifrice applied in a fluoride gel tray (RegD, Everclean HEMA). The positive control group rinsed with a 0.12% chlorhexidine mouthwash (CHX-MW, Perio.Aid). The Quigley and Hein plaque index (PI) from all subjects was assessed after 3 days of de novo plaque accumulation. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale scores. After the experimental period, habitual oral hygiene procedures were resumed.

RESULTS

Ninety-six systemically healthy subjects completed the study. After 3 days, the full-mouth PI for the CHX-DGel regimen was 1.87 compared with 1.93 for the RegD regimen and 1.55 for the CHX-MW regimen. The two dentifrices (CHX-DGel and RegD) were significantly less effective as the CHX-MW (P=0.0006). No significant difference between scores of the dentifrices was found.

CONCLUSION

Within the limitations of the present 3-day non-brushing study design, it can be concluded that application of 0.12% CHX dentifrice gel is not significantly different from application of regular dentifrice on plaque accumulation. Use of a 0.12% CHX mouthwash is significantly more effective. CHX-DGel appears a poor alternative for a dentifrice. It is not an effective inhibitor of plaque growth and does not possess fluoride.

A thin or thick probe handle: does it make a difference?

OBJECTIVES

The aim of the present study was to assess the probing force exerted when using two manual periodontal probes with different handle diameters in hands of different dental professionals.

METHODS

For this study two periodontal probes with handle diameters of 54 and 92 mm were used. The 11 subjects responsible for the measurements were periodontists, postgraduate periodontal students and dental hygienists. Per measurement session, 20 measurements were performed by each subject. Each probe was used 10 times. After the first baseline measurement session, a second session was performed 1 week later and a last third session another 3 weeks later. Orders for using each probe were randomized for each subject and each session.

RESULTS

The mean overall force with the thin probe was 55.2 g and with the thick probe 59.4 g. The difference of 4.2 g between the two probe types was found to be statistically significant (P = 0.041).

CONCLUSION

The present study showed that the diameter of the probe handle also had an effect on the force exerted with a periodontal probe. However, the clinical relevance of this difference may be minor, when considering the interindividual variance of forces exerted when probing.

Sonic-powered toothbrushes and reversal of experimental gingivitis

OBJECTIVE

To compare two sonic toothbrushes in relation to the reversal of experimental gingivitis.

MATERIALS AND METHODS

Subjects refrained from brushing mandibular teeth for 21 days. During a 4-week treatment phase, the right or left side of the mouth was brushed with either the Sonic Complete (SC) or Sonicare Elite (SE) toothbrush as randomly allocated. Plaque and gingivitis were assessed on day 0, after 21 days of no oral hygiene and after 1, 2 and 4 weeks of brushing twice daily.

RESULTS

Thirty-four subjects provided evaluable data. The experimentally induced gingivitis (EIG) resulted in higher bleeding and plaque scores compared with day 0. The mean plaque scores at day 21 changed from 3.09 to 1.30 for the SC, and from 3.02 to 1.21 for the SE. At the end of the treatment period, there was no significant difference between the two brushes. The mean bleeding scores changed from 1.87 (day 21) to 0.97 for the SC, and from 1.83 to 0.92 for the SE. For the assessments at 1, 2 and 4 weeks post-EIG, both brushes showed a significant decrease in bleeding scores. There were no statistically significant differences between brushes.

An oscillating/pulsating electric toothbrush versus a high-frequency electric toothbrush in the treatment of gingivitis

OBJECTIVES

The objective of this study was to compare the effect of an oscillating/pulsating power toothbrush (Oral-B ProfessionalCare 7000; PC 7000) and a high-frequency power toothbrush (Philips Sonicare Elite; SE) on the reversal of experimental gingivitis.

METHODS

The study had a randomised, examiner-blind, split-mouth design. After dental prophylaxis, subjects refrained from brushing mandibular teeth for 21 days to allow development of gingivitis. During a 4-week treatment phase, the right or left side of the mouth was brushed with either the PC 7000 or the SE toothbrush as randomly allocated. Plaque and gingivitis were assessed at baseline (Day 0), after 21 days of no oral hygiene, and after 1, 2 and 4 weeks of brushing twice daily. Gingival abrasion was assessed at Day 0 and after 1, 2 and 4 weeks of product use.

RESULTS

Of 38 enrolled subjects, 35 provided evaluable data. The experimentally induced gingivitis (EIG) phase resulted in higher bleeding and plaque scores as compared to Day 0. During the treatment phase, plaque and bleeding scores were significantly lower with the PC 7000 than the SE toothbrush. After 4 weeks of use, the mean plaque scores changed from 2.78 (Day 21 of EIG phase) to 0.70 for the PC 7000 and from 2.67 (Day 21) to 0.88 for the SE. The mean bleeding scores changed from 1.86 (Day 21) to 1.24 for the PC 7000 and from 1.88 (Day 21) to 1.42 for the SE. No major differences were found between brushes with regard to gingival abrasion.

CONCLUSIONS

The oscillating/pulsating power toothbrush (Oral-B ProfessionalCare 7000) was more effective than the high-frequency power toothbrush (Philips Sonicare Elite) at plaque removal and improvement of gingival condition, with no greater potential for causing gingival abrasion.

Three different rinsing times and inhibition of plaque accumulation with chlorhexidine

AIM

This study assessed the plaque inhibiting effect of a 0.2% chlorhexidine (CHX) solution (Corsodyl) with three different rinsing times following a 72 h non-brushing period.

MATERIAL AND METHODS

The clinical investigation was a single-blind, randomised study involving 90 volunteer students (40 male and 50 female, mean age 23.2 years). Subjects were randomly allocated to one of three groups for which the protocol only differed with respect to the duration of rinsing. At the start of the trial, all participants received a dental prophylaxis to remove all plaque deposits. Subjects refrained from all mechanical oral hygiene procedures, but rinsed two times per day for the allocated duration with CHX mouth rinse over a period of 72 h. The chlorhexidine preparation was of 0.2% concentration used at a dose of 10 ml for either 15, 30 or 60 s. After 72 h, the Quigley & Hein plaque index (PI) from all volunteers was recorded at six sites per tooth. All participants received a questionnaire to evaluate their perception of rinsing duration.

RESULTS

After 72 h, the mean whole-mouth PI was 1.33, 1.18 and 1.24, respectively, for the 15, 30 and 60 s rinsing group. The difference in plaque scores between the three groups was not statistically significant. Results from the questionnaire showed a significant difference between the groups for their perception of rinsing duration.

CONCLUSIONS

No significant difference was observed in the level of plaque after 72 h of non-brushing whether the subjects rinsed for 15, 30 or 60 s with 0.2% chlorhexidine.

The plaque-removing efficacy of a finger brush (I-BrushR)

OBJECTIVE

The purpose of the present study was to test the effectiveness of a finger toothbrush (I-Brush) in removing plaque compared with a flat-trimmed manual toothbrush.

MATERIAL AND METHODS

For this study, 37 subjects were selected, without previous experience of the use of the I-Brush. Each subject received a finger brush (I-Brush), a manual toothbrush (Butler GUM 311), two written brushing instructions for both types of brushes, and a brush calendar. Subjects were given a period of 3 weeks to become familiar with the two types of brushes. During this period, the subjects were instructed to use the two types of brushes on alternate days. The brush calendar helped as a reminder and served to ensure compliance. No instructions regarding brushing time or frequency of brushing were given to the subjects, except that they should conform to their usual oral habits. After 3 weeks, all subjects were asked to abstain from oral hygiene procedures for 48 h prior to the experiment. In this experiment, the amount of dental plaque was scored by a trained examiner. The examiner (N.A.M.R.) used the modified Silness & Loe (1964) plaque index at six sites per tooth. After scoring, each subject received a new finger brush and a new manual toothbrush. The subjects brushed according to a split mouth protocol. Two contra-lateral quadrants were chosen randomly and were brushed with one randomly chosen brush and the two opposing contra-lateral quadrants with the alternate brush. The brushing was performed under supervision in front of a mirror. The available time for brushing was 2 min. for the entire dentition. Finally, the remaining plaque was scored again.

RESULTS

The overall reduction in plaque was 79% for the manual toothbrush and 62% for the finger brush. The plaque removing efficacy of the finger brush was poorest at the approximal vestibular surfaces (55% plaque reduction) compared with the manual toothbrush (77% plaque reduction).

CONCLUSION

The plaque reduction of the finger brush is not an acceptable alternative to the use of a regular manual toothbrush.