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PubMed1992

Dentine hypersensitivity--the effect of toothbrushing and dietary compounds on dentine in vitro: an SEM study.

Dentine hypersensitivity occurs when dentinal tubules are open on the dentine surface and patent to a vital pulp. There has been limited interest in the aetiology of dentine hypersensitivity. In particular, little is known about agents that remove the dentine smear layer to expose tubules. Toothbrushing certainly may expose dentine, but whether a toothbrush per se has the effect of opening tubules has not been established. The aim of this study in vitro was to determine whether a toothbrush could remove or create a smear layer. In addition, the combined effects of toothbrushing with dietary fluids on dentine was assessed. Toothbrushing was observed, by scanning electron microscopy, both to remove and to recreate a smear layer on dentine specimens. However, the processes took a considerable time, and under conditions of normal toothbrushing it is unlikely that the latter plays a direct aetiological role in opening tubules. Indeed, together with toothpaste it is more likely that brushing has a therapeutic action by mechanically forming a smear layer. Conversely, and importantly, toothbrushing in the presence of dietary acids enhanced smear layer removal. This finding raises the question of whether the dental profession should be advising that teeth be brushed before meals rather than after, as is often the case.

Acid Etching, Dental↗
PubMed1986

Effectiveness of children's habitual toothbrushing.

Individual toothbrushing habits are usually consistent. Frequency, pattern and duration are different aspects of the toothbrushing habit. The aim of this study was to analyze the effect of habitual toothbrushing in children. The schoolchildren (n = 110) aged 13, were examined clinically before and after brushing their teeth in the habitual way; the brushing procedure was filmed without the children's knowledge. From the film, the pattern of brushing was assessed by three dentists, and the duration measured in seconds. Frequency of toothbrushing was assessed by postal questionnaire 2 months after the clinical examination. The examination included both photographed plaque and disclosed plaque diagnosed clinically. From the photographs, plaque was measured by computer planimeter as a % of plaque area and clinically by the oral debris index recommended by WHO. Subjects who had little plaque before toothbrushing were excluded from the analyses. Frequency seemed to affect plaque removal only in boys and only in the maxillary teeth. The pattern affected plaque removal in girls, but for boys, this aspect of toothbrushing affected only the left side of the jaws. Duration had produced the strongest effect on plaque removal. Therefore, duration of toothbrushing should be emphasized more in dental health education.

Adolescent↗
PubMed1993

The plaque-removing efficacy of an oscillating/rotating toothbrush. A short-term study.

The purpose of the present study was to test the effectiveness of a new type of BRAUN electric toothbrush (D5) in comparison with the traditional BRAUN electric toothbrush (D3) and to a manual toothbrush (M). For this study, 60 dental students were selected who had no previous experience with the use of an electric toothbrush. The study consisted of 3 experiments. Prior to each experiment, all students were asked to abstain from all oral hygiene procedures for at least 24 h. In Exp I, the efficacy of toothbrushing was studied when one of the investigators brushed the teeth of the students. No toothpaste was used in this first part of the study. In Exp II, the efficacy of brushing was evaluated when the brushing was carried out by the students themselves. In Exp III, the efficacy of the brushing was studied after the students had received a professional instruction and oral prophylaxis. The available time for the brushing amounted to a total of 2 min per mouth. The amount of dental plaque was evaluated by means of the Silness and Löe plaque index at 6 sites around the tooth. Results showed in Exp I that both electric toothbrushes proved to remove significantly more plaque than the manual toothbrush (M 78%; D3 85%; D5 86%). In Exp II, no significant differences in plaque-removing efficacy were found between the 3 brushes (M 73%; D3 72%; D5 73%). In Exp III, the D5 proved to remove significantly more plaque than the other two brushes (M 77%; D3 77%; D5 83%).(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Plaque↗
PubMed1998

The effects of an ultrasonic toothbrush on plaque accumulation and gingival inflammation.

The purpose of this study was to evaluate the effectiveness of an ultrasonic toothbrush to reduce plaque and gingival inflammation when compared to a manual toothbrush. 62 healthy adult patients with a plaque index of at least 2.0, a 50% bleeding index and at least 16 natural teeth participated in this study. 31 patients were randomly assigned to the manual toothbrush group (group A) and 31 were assigned to an ultrasonic toothbrush group (group B). The Turesky et al. plaque index (PI), Eastman bleeding index, and Loe & Silness gingival index (GI) were performed at baseline, 15, and 30 days at the beginning of each appointment (pre-brushing). Patients then brushed with their assigned toothbrush and a post-brushing plaque index was recorded. Kruskal-Wallis one-way analysis of variance (ANOVA) was performed to determine between group differences on the parameters of all clinical indices. Results of the pre-brushing plaque index in group B were significantly lower at 15 and 30 days compared to group A. The post-brushing plaque index demonstrated no statistically significant between or within group differences. Both groups demonstrated significant within group reductions in GI and BI from baseline to 15 days and from 15 to 30 days, however, no between group differences were noted. The results of this study support the ability of an ultrasonic toothbrush to significantly remove plaque and reduce inflammation as well as a manual toothbrush over a 30 day period.

Adult↗
PubMed2006

The effect of toothbrushing regimens on the plaque inhibitory properties of an experimental cetylpyridinium chloride mouthrinse.

OBJECTIVE: The objective of this study was to determine the effect of various toothbrushing regimens with a standard fluoride dentifrice on the plaque inhibitory properties of an alcohol-free, high bioavailable 0.07% cetylpyridinium chloride (CPC) mouthrinse. MATERIALS AND METHODS: The study was a randomized, single-centre, examiner blind, four-period cross-over study involving 29 healthy subjects. Four treatment regimens were evaluated: (1) Toothbrushing with dentifrice followed by a water rinse (B-W, negative control); (2) Toothbrushing with dentifrice followed by a CPC mouthrinse use (B-CPC); (3) Toothbrushing with dentifrice followed by a water rinse and then a CPC mouthrinse use (B-W-CPC); and (4) Toothbrushing with dentifrice and waiting 60 min. prior to a CPC mouthrinse use (B-60 min.-CPC). Three days before the baseline exam of treatment periods, subjects were instructed to brush only the lingual surfaces of their teeth for up to 60 s twice daily. At baseline, subjects received a plaque exam using the Turesky modification of the Quigley-Hein index (MQH) followed by a polishing on the lingual and buccal surfaces of their teeth. During treatment periods, subjects were asked to brush only the lingual surfaces of their teeth with a standard fluoride dentifrice. Rinsing with 20 ml of the experimental CPC solution was done for 30 s twice daily. The evening before the last day of treatment periods (Day 4), subjects were asked to refrain from any oral hygiene, eating, and drinking after brushing. On Day 4, plaque was scored using the MQH Index. A 10-day wash-out of normal oral hygiene was allowed between each of the four treatment periods. The data were analysed using analysis of covariance for cross-over designs. RESULTS: Twenty-five to 29 subjects were evaluable at any given visit. With respect to unbrushed buccal and brushed lingual surfaces, all three CPC regimens had highly significantly (p < or = 0.0006) lower mean plaque scores than the B-W regimen, reductions ranging from 20% to 38% in magnitude. With respect to unbrushed surfaces, there was a significant difference between the B-CPC regimen and the B-60 min.-CPC regimen (p < 0.01) in favour of the latter regimen. No other pairwise treatment comparisons were statistically significant for unbrushed sites. Results for brushed surfaces and all sites combined showed that both the B-W-CPC and the B-60 min.-CPC groups reduced mean plaque levels significantly (p < or = 0.013) more than B-CPC. There were no statistically significant differences between B-W-CPC and B-60 min.-CPC for measurements of brushed, unbrushed, or all sites combined. CONCLUSIONS: Results show that the alcohol-free, 0.07% high bioavailable CPC rinse provides an additive anti-plaque benefit beyond toothbrushing with a standard fluoride dentifrice regardless of the regimen. Of the regimens, a water rinse between toothbrushing and CPC rinsing enhances therapeutic efficacy while fitting into the patient's typical oral hygiene routine.

Adult↗
PubMed1979

An epidemiologic approach to toothbrushing and dental abrasion.

Abrasion lesions were recorded in 818 individuals representing the adult population of 430,000 residents of the Stockholm region, Sweden. The subjects were asked about toothbrushing habits, toothbrush quality and dentifrice usage; these factors were related to abrasion criteria. Abrasion was prevalent in 30% and wedge-like or deep depressions were observed in 12%. The relationship between abrasion and toothbrushing was evident, the prevalence and severity of abrasion being correlated to toothbrushing consumption. The importance of the toothbrushing technique for the development of abrasion lesions was elucidated. Horizontal brushing technique was strongly correlated to abrasion. It was demonstrated by treating the data with the statistical AID analysis that toothbrushing factors related to the individual (brushing frequency and brushing technique) exert a greater influence than material-oriented toothbrushing factor such as dentifrice abrasivity and bristle stiffness.

Adolescent↗
PubMedDate not supplied

Toothbrush abrasion of erosively altered enamel after intraoral exposure to saliva: an in situ study.

The aim of this in situ study was to test the effect of toothbrush abrasion on enamel previously exposed to a standardized artificial erosive agent. To generate moderate erosive lesions, slabs of the buccal surface of human premolars were immersed in a solution of citric acid for 3 min. Then they were attached to intraoral appliances and each one was exposed for 0 min (= toothbrushing immediately after intraoral exposure), 30 or 60 min to the oral milieu of 1 of 7 female subjects with a mean age of 22 years. Immediately thereafter the volunteers brushed the slabs for 30 s with toothpaste using their preferred brushing technique. For each test person the secretion rate of resting and paraffin-stimulated saliva, buffering capacity and pH were measured. The following mean losses of substance at the surface were registered: 0.258+/-0.141 microm (toothbrushing immediately after intraoral exposure), 0. 224+/-0.087 microm (toothbrushing after intraoral exposure of 30 min) and 0.195+/-0.075 microm (toothbrushing after intraoral exposure of 60 min). Toothbrush abrasion in situ was significantly lower after 60-min exposure to the oral environment than after 0-min (p<0.001). Also, the 30- and 60-min values were significantly different from each other (p<0.001). Multiple linear regression analyses revealed that in this model toothbrush abrasion was associated with the intraoral exposure to saliva (p = 0.026), the severity of the erosive attack (p<0.001) and the secretion rate of resting saliva (p = 0.029). If no other preventive measures are taken we suggest that individuals at risk for erosive tooth wear wait at least 1 h before brushing their teeth after consuming erosive foodstuffs or beverages.

Adult↗
PubMedDate not supplied

Toothbrush abrasion of surface softened enamel studied with tapping mode AFM and AFM nanoindentation.

The aim of the present in vitro study was to investigate the toothbrush abrasion of surface softened enamel using tapping mode atomic force microscopy (TM-AFM) and AFM nanoindentation. TM-AFM investigations showed that the typical prismatic pattern as observed after demineralisation was retained after toothbrushing. The exposure to artificial saliva resulted in the deposition of a 'sausage-shape' material with random orientation. Brushing of these samples did not lead to a complete removal of this deposited material. Enamel mineral loss increased with increasing demineralisation time and increased further, although only to a small extent, due to subsequent toothbrushing. Exposure to artificial saliva did not alter the amount of enamel mineral lost due to the brushing treatment. AFM nanoindentation investigations showed that the three different demineralisation treatments caused three statistically different reductions in both surface hardness and reduced elastic modulus values, with the shortest exposure time having the least effect on the nanomechanical properties of the enamel samples. Toothbrushing did result only in a small increase in hardness and reduced elastic modulus. The present study has shown that toothbrushing of surface softened enamel leads to minor changes in the surface morphology and nanomechanical properties. The amount of enamel lost due to toothbrushing was independent of the demineralisation time and was lower compared to the mineral loss caused by the demineralisation treatments. Furthermore, the exposure to artificial saliva offers minimal protective effect to the softened enamel surface against toothbrushing.

Chelating Agents↗
PubMed2006

Manual versus powered toothbrushes: what is the evidence?

UNLABELLED: Powered toothbrushes are a significant segment of the oral care market. Numerous clinical trials have compared the effectiveness of manual and powered toothbrushes for their effectiveness in improving oral health and the results are often conflicting. Recent Systematic Reviews by the Cochrane Oral Health Group have distilled this information and provided unbiased conclusions, namely that: powered toothbrushes with an oscillating rotating action are more effective than manual toothbrushes in reducing plaque and gingivitis; other types of powered toothbrushes produced less consistent reductions in plaque and gingivitis than manual brushes. Further studies are required to determine the relative effectiveness of manual and powered toothbrushes in improving the status of patients with periodontitis. CLINICAL RELEVANCE: This review provides the dental professional with an unbiased summary of current evidence regarding the relative effectiveness of manual and powered toothbrushes.

Dental Devices, Home Care↗
PubMed2003

Manual versus powered toothbrushes: the Cochrane review.

BACKGROUND: In a report released in January 2003, The Cochrane Collaboration Oral Health Group provided a systematic review of the effectiveness of powered versus manual toothbrushes, which generated much interest in the popular press. METHODS: The Cochrane researchers developed and implemented search strategies for the Cochrane Oral Health Group's Trial Register, the Cochrane Central Register of Controlled Trials, MEDLINE and the Cumulative Index to Nursing and Allied Health Literature. They contacted manufacturers for additional information. Trials were selected if they met the following criteria: compared power versus manual toothbrushes, had a randomized design, drew participants from a general population without disabilities, provided data regarding plaque and gingivitis, and were at least 28 days in length. Reviewers evaluated only studies published in 2001 or earlier. Six reviewers from the Cochrane study independently extracted information in duplicate. Indexes for plaque and gingivitis were expressed as standardized values for data distillation. Data distillation was accomplished using a meta-analysis, with a mean difference between powered and manual toothbrushes serving as the measure of effectiveness. RESULTS: The searches identified 354 trials, only 29 of which met the inclusion criteria. These trials involved about 2,500 subjects and provided data for meta-analysis. The results indicated that only the rotating oscillating toothbrush consistently provided a statistically significant, although modest, clinical benefit over manual toothbrushes in reducing plaque and gingivitis. CONCLUSIONS AND CLINICAL IMPLICATIONS: Some powered toothbrushes with a rotation-oscillation action achieve a significant, but modest, reduction in plaque and gingivitis compared with manual toothbrushes.

Dental Plaque↗
PubMed2003

Optimum force and duration of toothbrushing to enhance gingival fibroblast proliferation and procollagen type I synthesis in dogs.

BACKGROUND: Toothbrushing enhances gingival fibroblast proliferation, which promotes wound healing. Optimum force and duration of toothbrushing for stimulation of fibroblast proliferation are key factors in maximizing effects of toothbrushing on periodontal wound healing. We therefore evaluated the effects of different durations and forces of toothbrushing on proliferative activity and procollagen synthesis of gingival fibroblasts. METHODS: Twelve dogs were used. In each dog, buccal gingivae of 12 teeth were examined for 3 weeks. Nine of these 12 teeth were each assigned to 1 of 9 different combinations of brushing force (0.98, 1.96, or 2.45 N) and duration (10, 20, or 40 seconds). The remaining 3 teeth received plaque removal without brushing, via a scaler. RESULTS: Force and duration of toothbrushing affected both proliferating cell nuclear antigen (PCNA)-positive and procollagen Type I C-peptide (PIP)-positive fibroblast ratios (P < 0.05). The highest ratio of PCNA-positive fibroblasts was produced by brushing at 1.96 N for 20 seconds. The highest ratio of PIP-positive fibroblasts was produced by brushing at 1.96 N for 10 seconds. CONCLUSIONS: Toothbrushing at certain forces and durations enhanced the proliferative activity and procollagen synthesis of gingival fibroblasts. The toothbrushing duration that increased procollagen synthesis (10 seconds) was shorter than that which increased fibroblast proliferative activity (20 seconds).

Analysis of Variance↗
PubMedDate not supplied

Microbial contamination of toothbrushes and their decontamination.

PURPOSE: The objective was to determine the level of contamination of toothbrushes by mutans streptococci using microbiological identification, to access the bacterial contamination using scanning electron microscopy (SEM) and to evaluate the efficacy of two toothbrush disinfectants. METHODS: Nineteen children used their toothbrushes once a day, for five consecutive days. The toothbrushes were then immersed into disinfectant solutions for 20 h: Group I--0.12% chlorhexidine gluconate; Group II--1% sodium hypochlorite; Group III--sterile tap water. They were then placed into test tubes containing CaSa B, for 3 to 4 days at 37 degrees C. The number of MS cfu was counted and the toothbrushes were submitted to SEM analysis. RESULTS: There was no bacterial growth in Groups I and II; Group III showed MS growth (range, 21 to 120 cfu). Scanning electron microscopy showed biofilm formation on toothbrush bristles. CONCLUSION: Immersion in 0.12% chlorhexidine gluconate and 1% sodium hypochlorite are efficient methods for toothbrush disinfection.

Anti-Infective Agents, Local↗
PubMed2000

Laboratory evaluation of two bi-level toothbrush products for subgingival access and gingival margin cleaning.

Recent technological advances have enabled the production of split or feathered endings of individual toothbrush filaments. The purpose of this laboratory study was to compare a bi-level manual toothbrush containing standard end-rounded bristles with the same shaped toothbrush containing feathered filaments, 3 mm deep, on the outer raised bi-level rows to achieve subgingival access (SA) and remove artificial plaque at the gingival margin, or gingival margin cleaning (GMC). Simulated gingivae were prepared with a 0.2 mm space between the gingivae and tooth surface. The toothbrushes were aligned with the papillae at the gingival margin, and were tested using wet brushing conditions for 60 seconds at two strokes per second with a 15 mm stroke. Four toothbrushes of each type were evaluated four times, for a total of 16 assays per design. The SA maximum depth was recorded on pressure-sensitive paper under the simulated gingivae, and the length of gingival margin cleaning was recorded as the GMC efficacy. Readings were performed with 3x magnification by one investigator. In these laboratory assays, the bi-level toothbrush with feathered outer-row bristles significantly (p < 0.001) increased the ability of the bristles to achieve SA by 35.7% and GMC efficacy by 54.5% compared to an identical bi-level toothbrush with end-rounded bristles.

Dental Plaque↗
PubMed2001

Laboratory evaluations of a toothbrush with diamond-shaped filaments for stiffness and efficacy.

The purpose of these studies was to evaluate four toothbrushes with a similar flat profile for stiffness and efficacy in removing artificial plaque deposits from interproximal areas, or depth of removal from broad tooth surfaces, and to relate these findings to bristle stiffness. The test toothbrush had 5-mil diameter, elongated diamond-shaped bristles (D). Three toothbrushes contained 5-mil (5), 6-mil (6), or 7-mil (7) diameter round bristles. Stiffness studies were performed using the ISO 8627 method. In the efficacy studies, toothbrushing was conducted with a vertical or horizontal brushing motion on simulated anterior or posterior teeth using a brushing weight of 250 g. The bristles were placed at a 90 degrees angle to the tooth surface, and brushing was performed for 15 seconds at two strokes per second with 50 mm strokes. Each of the toothbrush designs was tested 24 times. Interproximal access efficacy (IAE) was recorded as the maximum width of simulated plaque deposit removed. Depth of deposit removal (DDR) was determined using a color comparative scale, where 0 = no deposit change and 4 = maximum removal. The averages of wet and dry stiffness measurements were found to be 7 > D > 6 > 5; all values were in the range accepted as soft texture. The means for total IAE were ranked D > 5 > 6 > 7, and total DDR mean rankings were D > 7 > 6 > 5. For the round bristles, stiffness was inversely related to IAE and paralleled the DDR rankings. Using ANOVA, the D and 5-mil toothbrushes had significantly higher (p < 0.05) IAE means compared to the 6- or 7-mil products. The D toothbrush had significantly higher (p < 0.05) DDR means than the 5-mil product. The diamond-shaped bristles in these flat profile products resulted in improved depth of deposit removal compared to the same design with 5-mil round bristles.

Dental Plaque↗
PubMed2001

Safety of three toothbrushes.

PURPOSE: To assess the oral soft tissue safety and tolerability of two electric toothbrushes, the Crest Spin Brush and Colgate ActiBrush, and one manual toothbrush, the Oral B 40. MATERIALS AND METHODS: A total of 104 subjects were enrolled in this single center, randomized, examiner-blind parallel study over a 4-wk test period. Subjects were randomized to treatment and were instructed to brush in their normal manner, twice per day for 60 s. A detailed oral soft tissue examination and interview were conducted by a trained clinician at baseline, 3 days and 4 wks to assess clinical signs and symptoms associated with use of the toothbrushes. RESULTS: Over the 4-wk period, a total of 19 subjects (18% of the study population) were observed for signs/symptoms. The adverse events were distributed across test groups with 12 subjects in the Oral B 40 group, 4 subjects in the Crest Spin Brush group, and 3 subjects in the Colgate ActiBrush group experiencing at least one adverse event. All adverse events were mild in severity indicating the general safety of all three toothbrushes. The most frequently encountered event was localized gingivitis. The Oral B 40 test group was observed with more adverse events when compared to the Crest Spin Brush and Colgate ActiBrush at 4 wks but not at 3 days. The proportion of subjects experiencing an adverse event in the Crest Spin Brush test group was similar to that of Colgate ActiBrush group. All three toothbrushes were generally well tolerated by subjects enrolled in the study with the Crest Spin Brush and Colgate ActiBrush being the best tolerated. CLINICAL SIGNIFICANCE: The results of this study indicated that abnormal oral soft tissue findings were distributed among the treatment groups, indicating that daily use of an electric toothbrush is at least as safe as a manual toothbrush.

Adult↗
PubMed2000

Development and laboratory evaluation of a new toothbrush with a novel brush head design.

Despite many developments in manual toothbrush design, plaque removal at the back of the mouth and at approximal surfaces remains inadequate, yet it is at these sites in particular that plaque accumulates and leads to the development of gingival disease. Improved oral hygiene can be achieved by better brushing technique and by increasing brushing time, but a change in behavior patterns is almost impossible to achieve for the majority of individuals. What is required is a brush head design that maximizes plaque removal, regardless of how the user brushes. As a result of a detailed investigation into the action of bistles during brushing, the Oral-B CrossAction toothbrush has been developed. It incorporates bristles angled at 16 degrees in a unique CrissCross design arranged along the horizontal axis of the toothbrush. Laboratory studies have demonstrated that this development significantly enhances interproximal penetration and cleaning effectiveness when compared with an identical brush head with vertical rather than angled bristles. Laboratory comparisons with more than 80 leading manual toothbrushes from around the world demonstrate a consistent, significant advantage for the new CrossAction toothbrush, both with respect to interproximal penetration and cleaning effectiveness. These results suggest that the CrossAction toothbrush has the potential to remove greater amounts of plaque, especially from the approximal surfaces, than conventional toothbrushes incorporating vertical bristles or more traditional tuft designs.

Adult↗
PubMed2001

Effect of sonic and mechanical toothbrushes on subgingival microbial flora: a comparative in vivo scanning electron microscopy study of 8 subjects.

OBJECTIVES: The purpose of this initial study was to evaluate the effects of both a sonic and a mechanical toothbrush versus the effects of no treatment on depth of subgingival penetration of epithelial and tooth-associated bacteria. METHOD AND MATERIALS: Eight adult subjects exhibiting advanced chronic periodontitis with at least 3 single-rooted teeth that were in separate sextants with facial pockets > or = 4 mm and < or = 8 mm and that required extraction constituted the experimental sample. Teeth were either subjected to 15 seconds of brushing with a mechanical toothbrush or a sonic toothbrush or left untreated. The test tooth and the associated soft tissue wall of the periodontal pocket were removed as a single unit. Samples were processed and coded for blind examination by scanning electron microscopy. Distributional and morphologic characteristics of dominant bacteria with specific emphasis on spirochetes were evaluated for both epithelial- and tooth-associated plaque. RESULTS: No differences were found in morphotypes or distributional and aggregational characteristics of epithelial-associated microbes in the 1- to 3-mm subgingival zone between the mechanical and sonic toothbrush-treated groups and the control group. Both toothbrush groups featured disruption of microbes that extended up to 1 mm subgingivally. Root surfaces on the sonic-treated samples appeared plaque-free at low magnification; however, at 4,700x, a thin layer of mixed morphotypes and intact spirochetes was found subgingivally and slightly subgingivally. In comparison, mechanical brush samples featured incompletely removed plaque, both subgingivally and subgingivally, with intact spirochetes present on subgingival root surfaces. CONCLUSION: Results suggest similar effects for both sonic and mechanical toothbrushes on epithelial- and tooth-associated bacterial plaque in periodontal pockets and adjacent root surfaces that extend up to 1 mm subgingivally. Further, the presence of intact subgingival spirochetes suggests limited exposure to acoustical or mechanical energy from the toothbrushes evaluated.

Acoustics↗
PubMed2003

Comparative effect of chewing sticks and toothbrushing on plaque removal and gingival health.

PURPOSE: The aim of the study was to compare the effect of the chewing stick (miswak), and toothbrushing on plaque removal and gingival health. MATERIALS AND METHODS: The participants comprised 15 healthy Saudi Arabian male volunteers aged 21 to 36 years, attending the Dental Center at Al-Noor Specialist Hospital in Makkah City in Saudi Arabia. The study was designed as a single, blind, randomized crossover study. The Turesky modified Quigley-Hein plaque and Löe-Silness gingival indices and digital photographs of plaque distribution were recorded at baseline, one week after professional tooth cleaning, and again following three weeks use of either the miswak or toothbrush. Professional tooth cleaning was repeated, and after a further three weeks use of either the miswak or toothbrush (using the alternative method to that used in the first experimental period), plaque and gingival indices, and digital photographs of plaque distribution were recorded anew. RESULTS: Compared to toothbrushing, the use of the miswak resulted in significant reductions in plaque (p < 0.001) and gingival (p < 0.01) indices. Image analysis of the plaque distribution showed a significant difference in reduction of plaque between the miswak and toothbrush periods (p < 0.05). CONCLUSION: It is concluded that the miswak is more effective than toothbrushing for reducing plaque and gingivitis, when preceded by professional instruction in its correct application. The miswak appeared to be more effective than toothbrushing for removing plaque from the embrasures, thus enhancing interproximal health.

Adult↗