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PubMed1994

The clinical effects on plaque and gingivitis over three-month's use of four complex-design manual toothbrushes.

The Colgate Total (formerly Colgate Precision) was evaluated along with the New Improved Crest Complete, Reach Advanced Design and Oral-B Advantage toothbrushes to compare six-week and three-month effects on plaque and gingivitis. One-hundred and ninety-three male and female participants completed a three-month, unsupervised toothbrushing study, brushing their teeth twice daily with one of these four products and a standard fluoride dentifrice. Plaque was quantified using the Rustogi et al. refinement of the Modified Navy Plaque Index. Gingivitis levels were measured using the Lobene et al Modified Gingival index. After initial screening examinations, the qualifying population (0.6 plaque, 1.8 gingivitis) was given a complete oral prophylaxis and instructed to return after forty-eight hours of no oral hygiene for baseline evaluations. The study population was split into four balanced groups after baseline examinations and assigned, by group, to use a particular toothbrush for the study duration. Subjects returned after six weeks and three months for safety and efficacy evaluations. There were no reported or observed untoward effects at any examination time in the study. Plaque and gingivitis mean values were not significantly different at baseline between the four groups. Results from this three-month clinical study demonstrated a significant reduction (p<.0001) in plaque levels and gingivitis for all of the four toothbrushes compared to baseline. At both six weeks and three months, gingivitis and plaque means were significantly lower (p<.01) in the Colgate Total group compared to the other three toothbrushes tested. When changes from six weeks to three months were statistically analyzed only the Colgate Total toothbrush significantly reduced (p<.001) gingivitis mean scores.

Adolescent↗
PubMed1996

Toothbrushing frequency between the ages of 12 and 18 years-- longitudinal prospective studies of Finnish adolescents.

The purpose of this study was to analyse the establishment of the toothbrushing frequency as a healthy habit by Finnish adolescents between 12 and 18 years of age. The data were collected as part of the nation-wide research programme, the Adolescent Health and Lifestyle Survey. All Finns born in 1968 with birthdays on 20-25 July formed the sample (N=1106). Questionnaires were mailed to the whole sample in February 1981 (12 years of age), -83 (14 years), -85 (16 years) and -87 (18 years). The rate of return for all four questionnaires was 62 percent (six-year follow-up) and for two questionnaires (two-year follow-up studies) 79 percent (12 and 14 years), 72 percent (14 and 16 years) and 68 percent (16 and 18 years). Those adolescents who brushed their teeth more than once a day at age 12, were more stable in their behaviour during the following six years than those who brushed their teeth less often. Over two thirds of the respondents, both boys and girls, indicated one or more changes in their toothbrushing frequency in the four questionnaires during the six-year follow-up. The rate of improvement in toothbrushing frequency was higher among girls than boys, and the rate of deterioration in toothbrushing frequency was higher among boys than girls. One sixth of the adolescents still showed a deterioration in their brushing frequency between the ages of 16 and 18. It may be concluded that although toothbrushing frequency will be gradually adopted as a health habit when the adolescents mature between 12 and 18 years, only half the girls and one fifth of the boys adopt the recommended frequency. Health education should still improve performance in those groups which have not established the recommended toothbrushing frequency.

Adolescent↗
PubMed1996

The dentin abrasivity potential of a new electric toothbrush.

PURPOSE: To evaluate the safety of the new Braun Oral-B Ultra Plaque Remover (D9) electric toothbrush, by measuring its abrasivity to dentin and comparing it with the abrasivity of a standard ADA reference toothbrush. MATERIALS AND METHODS: Dentin abrasion was measured by a radiotracer technique, using a modification of the ADA recommended methodology. A V-8 cross-brushing machine, set to make 1,500 strokes, was used for the standard reference ADA toothbrush. Because the electric toothbrush would not fit on the V-8 machine, the brushing procedure was modified so the D9 was suspended from a ring stand in a shaker bath set to give 44 strokes/minute. Both toothbrushes were tested with a slurry of 25 g of Crest dentifrice in 40 ml of water. After both toothbrushes had been tested for 8.5 minutes, samples of the slurry were put in a scintillation counter and mean net counts per minute (cpm) per gram of slurry were calculated. RESULTS: The mean relative dentin abrasion (RDA) of the Braun Oral-B Ultra Plaque Remover (D9) brush was found to be low (16) and was markedly less than that of the ADA reference brush (100).

Dental Plaque↗
PubMed1996

A laboratory investigation of stain removal from enamel surface: comparative efficacy of three electric toothbrushes.

PURPOSE: To evaluate in a controlled laboratory investigation the efficacy of three electric toothbrushes with respect to removal of extrinsic dental stain from labial enamel surfaces of bovine permanent central incisors. MATERIALS AND METHODS: Enamel specimens were treated to produce a uniformly stained pellicle film. Staining was assessed photometrically, before and after brushing 16 specimens per group for 4.5 minutes with either the Braun Oral-B Plaque Remover (D7), the Braun Oral-B Ultra Plaque Remover (D9) or a high frequency electric toothbrush. A manual brush with the ADA reference abrasive was used as a positive control, and this was compared with the three electric toothbrushes, using a dentifrice slurry prepared from Crest toothpaste. Tension on the enamel specimens was set at 150 g, except for the high frequency toothbrush which was set at the manufacturer's recommended tension of 50 g. Stain removal was expressed as a cleaning ratio (CR), where larger values represented greater removal of stained pellicle. RESULTS: Compared with the ADA control (CR = 100), the D9 was the most effective (CR = 98) removing significantly more stain (P < 0.05) than the D7 (CR = 74). The high frequency toothbrush was found to be the least effective (CR = 48), removing significantly less stain than any of the other toothbrushes (P < 0.05).

Analysis of Variance↗
PubMed1996

A comparative clinical study of extrinsic tooth stain removal with two electric toothbrushes [Braun D7 and D9] and a manual brush.

PURPOSE: To evaluate the efficacy and safety of two oscillating/rotating toothbrushes, (Braun Oral-B Plaque Remover-D7 and Braun Oral-B Ultra Plaque Remover-D9) and a manual toothbrush with respect to removing extrinsic dental stain. MATERIALS AND METHODS: This randomized, three-way cross-over study investigated 24 subjects entering the trial, which was divided into three, 5-day periods. Over the first 4 days of the study, an intense chlorhexidine/tea rinsing regimen was employed to induce extrinsic tooth staining. On day 5, each subject was assessed for tooth stain; they then brushed for a total of 2 minutes with one of the three randomly allocated toothbrushes. Stain evaluations were repeated after 30 seconds, 1 and 2 minutes brushing, with the intensity of stain, area of stain and number of sites with < 10% stained tooth area, being recorded at each assessment. RESULTS: Analysis of the results showed that the two electric toothbrushes were significantly better at removing stain than the manual toothbrush. In addition, the D9 was consistently more effective than the D7, with the difference with respect to stain area achieving statistical significance (P < 0.05) after 2 minute's brushing. All three brushes were found to be safe, and there was no evidence of any soft or hard tissue abrasion. It was concluded that the oscillating/rotating electric toothbrushes were more effective in removing extrinsic dental stain than a manual brush, and that compared with the D7, the newly designed Braun Oral-B Ultra Plaque Remover has an increased potential for stain removal.

Adolescent↗
PubMed1997

Interproximal access efficacy of Sonicare Plus and Braun Oral-B Ultra compared to a manual toothbrush.

A laboratory testing method, which has previously been shown to correlate with in vivo plaque removal results, was used to test the interproximal access efficacy (IAE) of two powered toothbrushes (Sonicare Plus and Braun Oral-B Ultra), and a manual toothbrush. This method tests IAE by means of simulated interdental spaces covered with pressure-sensitive paper tightly apposed to the surface. Testing was performed under wet conditions using 70, 100 and 140 grams of brushing force. Brushing was done for 15 seconds. The pressure-sensitive papers were removed, dried, and the IAE was quantified by a blinded investigator who measured the markings on the papers with calipers. The Sonicare Plus interproximal access scores were significantly greater than both the Braun Oral-B Ultra and the manual toothbrush at all three brushing forces tested (p < 0.001). These findings demonstrate that in vitro methodology previously used for testing manual toothbrushes is also adaptable for testing powered brushes. While additional studies are needed to confirm the clinical relevance of the present study, these results demonstrate the superiority of interproximal access of the Sonicare Plus sonic toothbrush over the Braun Oral-B Ultra powered brush and a manual toothbrush using this method.

Analysis of Variance↗
PubMed1997

Evaluation of tapered-end toothbrushes regarding subgingival access efficacy.

The purpose of this in vitro study was to determine how two toothbrushes with highly tapered-end bristle designs compared to a conventional, slightly tapered toothbrush. Toothbrushing was carried out in the laboratory in order to evaluate the simulated subgingival efficacy of the three toothbrush designs. The performance of the three brushes was assessed by measuring the "subgingival regions" of gold-coated typodont left maxillary central teeth where the gold coating had been removed during brushing. The two toothbrushes with highly tapered bristles were statistically significantly (p < 0.01) more effective in removing the gold coating than the conventional toothbrush with slightly tapered bristles on the subgingival area on the anterior typodont teeth.

Analysis of Variance↗
PubMed2005

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.

Dental Devices, Home Care↗
PubMed2004

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.

Dental Devices, Home Care↗
PubMedDate not supplied

Clinical evaluation of the efficacy and safety of an ultrasonic toothbrush system in an elderly patient population.

Twelve dentulous patients, age 65 or older, with no medical or pharmacologic predisposition to gingival hyperplasia were enrolled in a controlled clinical trial to evaluate the effect of the unaided use of an ultrasonic toothbrush on supragingival plaque and gingival bleeding. Subjects used the ultrasonic toothbrush in lieu of their conventional toothbrushes for a 30-day period. Clinical measurements of the plaque index and bleeding index were made at baseline and at 15 and 30 days. At the end of the 30-day test period, the use of the ultrasonic toothbrush resulted in significant reductions in plaque score, proportion of high plaque surfaces, and bleeding index. The reduction of the bleeding index indicates significant improvement in oral health. In this study, the use of an ultrasonic toothbrush effectively improved oral hygiene and health in a population that often exhibits decreased manual dexterity. Strategies for oral health care assessment and education for guidance of effective interventions are included in checklist form; level of care classification, cost in both time involved and equipment, and purchase instructions also are discussed. Further study is warranted to evaluate this instrument for cognitively impaired elders, who often rely on caregivers for oral hygiene procedures.

Aged↗
PubMed1994

A two-month study of the effects of oral irrigation and automatic toothbrush use in an adult orthodontic population with fixed appliances.

Forty-seven adult orthodontic patients with fixed orthodontic appliances were divided into three study groups: (1) oral irrigation with automatic toothbrush, (n = 16); (2) oral irrigation with manual toothbrushing, (n = 16); (3) control group with continued normal toothbrushing only, (n = 15). Gingival and plaque indices, bleeding after probing, and gingival sulcus depths were assessed at baseline, 1-month, and 2-month periods. Marked and significant gingival and plaque improvements from baseline were measured in all three study groups. After 1 to 2 months use of the automatic toothbrush and/or the oral irrigation device, there was a significant reduction in plaque when compared with the control group who used only the manual toothbrush (p = 0.026). Also, there was a significant reduction in gingival inflammation (p = 0.045) and evidence for reducing bleeding after probing (p = 0.037). No significant differences were found in probe depths among the three study groups, however, use of both devices reduced the pocket depth significantly from baseline by 0.5 mm (p < 0.0002). For this population of orthodontic patients, significant reductions in plaque, gingival inflammation, and a tendency for reduced bleeding after probing occurred in both groups with the power device. These improvements were most attributable to the effect of the oral irrigation device.

Adult↗
PubMed1999

A comparative study of the Philips HP 735, Braun/Oral B D7 and the Oral B 35 Advantage toothbrushes.

The aim of this 3-group, 3-treatment, single-blind, parallel group study was to evaluate and compare the efficacies of the Philips/Jordan HP 735 powered toothbrush, the Braun/Oral B D7 powered toothbrush and the Oral B Advantage B35 manual toothbrush in a cohort of 75 young adults (18-25 years). Following an appointment for screening, full mouth mean (+/-sd) modified Turesky plaque index (PI) and Löe & Silness gingival index (GI) were recorded at baseline. After 24 h abstinence from all oral hygiene measures, PI was recorded and each subject was given one of the test brushes with detailed instructions for use. The subject then brushed under supervision for 90 s, during which time mean (+/-sd) toothbrushing forces (TBF) were recorded. PI were recorded immediately after supervised brushing and the subjects were then discharged for 6 weeks to use the allocated toothbrush at home. After 6 weeks, PI, GI and TBF were again recorded. Comparisons between the brushing groups for all parameters, at baseline, 24 h and 6 weeks were tested using ANCOVA. There were no significant differences for PI and GI between groups at baseline, or for PI following supervised brushing at 24 h. After 6 weeks subjects using the powered brushes had lower mean PI (+/-sd) scores than those using manual brushes but the differences were significant only at interproximal sites; HP 735 1.44 (0.52), D7 1.44 (0.53), B35 1.75 (0.51) (p=0.05). At 6 weeks, mean (+/-sd) GI were; HP 735 1.49 (0.21), D7 1.61 (0.21), B35 1.64 (0.22) (p=0.033). Mean GI scores for the HP 735 group were similar at baseline and at 6 weeks although for the other brushes, the GI scores actually increased over this period. Mean (+/-sd) TBF (grammes/force) at baseline and 6 weeks respectively for the brushes were; HP 735 233 (205), D7 159 (58), B35 279 (122) (p=0.026): HP 735 194 (86), D7 141 (57), B35 297 (113) (p=0.0001). The within-group variability for the HP 735 TBF reduced considerably over 6 weeks, a likely consequence of the click-force threshold feature of this brush.

Adolescent↗
PubMed1999

An evaluation of video instruction for an electric toothbrush. Comparative single-brushing cross-over study.

Instructions on the use of electric toothbrushes are usually derived from the written and/or diagrammatic leaflets provided with the device or perhaps less often instruction from a professional. Videos are now widely used for information transfer and the direction of physical activities. The aim of this study was to determine whether video instruction in the use of an electric toothbrush could promote efficient use of the device. The 2-min video demonstrated the use of an oscillating, rotating electric toothbrush used by a hygienist for 15 s in each buccal and lingual quadrant. A voice-over directed the observer to follow the hygienist's movements. The study was planned as a 2-phase, single-examiner blind, randomised, cross-over study accepting there would be confounding of the 2nd period by carry-over from the 1st. A group of 24 healthy volunteers participated who had average oral hygiene and never used an electric toothbrush. 12 subjects received the video first (VN) and 12 subjects the instructional leaflet with the device (NV). Single brushings were performed after suspending tooth cleaning for 48 h. Plaque was scored before and after brushing. A 2-week washout period was permitted before the crossover. In period 1, plaque removal with the video was overall significantly greater than with written instructions. The effects for posterior teeth were greater than anterior and comparison between groups for posterior minus anterior differences were highly significant in favour of the VN group. In period 2, the effect of period was dominant with both groups achieving greater plaque removal in period 2 than period 1. Plaque removal by group VN remained considerably greater than group NV Despite the confounding influences of carry-over in this particular design of study, the results support the idea that video instruction for electric toothbrushes could be a simple and efficient way of improving plaque removal by these devices. The methodology needs to be verified in a home-use type of investigation.

Adult↗
PubMed1999

Comparison of video and written instructions for plaque removal by an oscillating/rotating/reciprocating electric toothbrush.

A previous crossover study showed that a watch-and-follow instructional video improved plaque removal by an electric toothbrush compared to the use of the instructional leaflet. This study employed a parallel design to assess the value of an instructional video for plaque removal by a new model oscillating/rotating/reciprocating electric toothbrush. 2 groups of 26 dentate subjects with average oral hygiene, who had never used an electric toothbrush, participated in this single blind, randomised parallel group designed study. On day 1 of the study, subjects received a professional prophylaxis to remove all plaque. Oral hygiene measures were then suspended and subjects returned on day 3 when a prebrushing plaque score was recorded by plaque index and area. Subjects withdrew and either read the manufacturers instructional leaflet (group L) or observed the instructional video (group V). Groups L and V then performed toothbrushing with toothpaste for 2 minutes and with group V brushing in time with the instructional video. Post-brushing plaque indices and areas were then recorded. Whole mouth, lingual, upper, lower, anterior and posterior but not buccal % reductions in plaque index and area were significantly greater in group V compared to group L. % plaque removal was also significantly greater by area at mid and distal sites but not mesial sites. Whole-mouth plaque reductions were 10% greater in group V but reached >15% at lingual surfaces. Within group differences in plaque removal at paired sites e.g., buccal/lingual, remained similar, suggesting that further improvement could be achieved by modifying the video to devote more time to the difficult-to-clean areas. In conclusion, in the early period of learning the use of an electric toothbrush, plaque removal can be improved by using an instructional video. Such watch-and-follow video routines could be extended to other areas of oral hygiene practices.

Adult↗
PubMed2000

Studies in vitro of abrasion by different manual toothbrush heads and a standard toothpaste.

BACKGROUND: Loss of dentine at the buccal cervical region of teeth has a multifactorial aetiology. However, a considerable amount of circumstantial evidence, supported by laboratory experiments, implicates toothbrushing with toothpaste as a consistent factor. Most interest has centred around the abrasivity of toothpastes, particularly since a toothbrush alone has negligible effects on dentine. The influence of filament stiffness on toothpaste abrasion was the subject of some studies, mostly at least 2 decades ago, and produced conflicting conclusions. Numerous changes to toothbrush design and construction have taken place in recent years. AIMS: The aim of this study was to measure the abrasion of a standard substrate, acrylic, by a standard toothpaste carried on modern brands of toothbrushes classified by manufacturers as hard (3 brands), medium (3 brands) and soft (6 brands). METHOD: The substrate was brushed for 20,000 strokes with at least 6 heads from each brand. Measurements of substrate loss were made at 5000 stroke increments by profilometry. RESULTS: Substrate loss for all brushes showed a pattern of abrasion which was to a first approximation linear. Overall, hard brushes caused least abrasion and soft brushes the most, with differences between groups being significant. Within-group differences between brands reached significance for soft and medium brushes but not hard brushes. CONCLUSIONS: The results could be explained by increased retention of toothpaste by smaller diameter filaments and denser tufts on soft brushes and the greater flexion of filaments increasing the area of contact with the surface. Calculations on the clinical outcome of these data in vitro indicate that toothbrushing with toothpaste alone would produce minimal damage to dentine even over many years. Differences between brushes therefore are probably of little clinical significance. Certainly, the data do not support the use of hard brushes, particularly in view of the potential detrimental effects to gingival tissues.

Hardness↗
PubMed2001

Efficacy of manual and powered toothbrushes (II). Effect on microbiological parameters.

BACKGROUND/AIM: The purpose of the present investigation was to determine the effect of self-performed supragingival plaque removal using either manual (Crest Complete) or power (Braun 3D Plaque Remover) toothbrushing on supra and subgingival plaque composition. METHODS: 47 periodontal maintenance subjects completed this single-blind 6 month longitudinal study. At baseline, samples of supra and separately subgingival plaque were taken from the mesial aspect of each tooth in each subject using sterile curettes and individually analyzed for their content of 18 bacterial taxa using checkerboard DNA-DNA hybridization. After random assignment to groups receiving either a manual (n=25) or power toothbrush (n=22), subjects received instruction in oral hygiene and used their assigned toothbrush 2x daily for 6 months. Clinical monitoring and microbiological sampling were repeated at 3 and 6 months. Significant differences in microbiological measures over time were sought using the Quade test and between brushing groups at each time point using the Mann-Whitney test. RESULTS: Mean total counts were significantly reduced for supra- and subgingival plaque samples in the manual group and subgingival samples in the powered brushing group. Actinomyces naeslundii and Actinomyces israelii/gerencseriae were the most numerous organisms detected at baseline and showed the greatest reductions in counts in both brushing groups. Streptococcus constellatus/intermedius was significantly reduced in both groups, while Streptococcus mitis/oralis/sanguis was significantly reduced in the manual toothbrushing group. Mean counts of species were more markedly altered in subgingival plaque. Major reductions occurred in both groups for A. naeslundii, A. israelii/gerencseriae, Peptostreptococcus micros, Veillonella parvula, Prevotella intermedia/nigrescens, S. mitis/oralis/sanguis and S. constellatus/intermedius. All taxa examined were reduced in prevalence (% of sites colonized) in the subgingival plaque samples for both brushing groups. The reductions in prevalence were greater for A. naeslundii, S. constellatus/intermedius, V. parvula, A. israelii/gerencseriae, S. mitis/oralis/sanguis, P. micros, Streptococcus mutans and P. intermedia/nigrescens. Mean prevalence was decreased more for Porphyromonas gingivalis, Campylobacter rectus/showae, Treponema denticola and Bacteroides forsythus in supragingival plaque than subgingival plaque. CONCLUSIONS: The major finding was the effect of supragingival plaque removal on the composition of the subgingival microbiota. Counts and prevalence of most taxa examined were markedly decreased in both toothbrushing groups. This reduction should translate to a decreased risk of periodontal disease initiation or recurrence. Further, the decreased prevalence of periodontal pathogens in supragingival plaque lowers potential reservoirs of these species.

Actinomyces↗
PubMed2002

Comparative professional plaque removal study using 8 branded toothbrushes.

BACKGROUND AND AIM: Considerable interest has been shown in the plaque removal properties of modern toothbrush designs. The primary aim of the study was to compare the plaque removal properties of 8 relatively recent designs of manual toothbrush using a professional tooth brusher and within a commonly used time frame. A secondary aim was established to utilise the data to observationally appraise plaque accumulation together with the patterns of removal as a consequence of using the timed professional tooth brusher. METHOD: The method was an 8-period, single-examiner, randomized, blind cross-over study involving 24 healthy volunteers, balanced for residual effects. Subjects accumulated plaque over a 4 day no oral hygiene period. On day 4, the accumulated plaque was scored by plaque index at the mesial, mid and distal sites of each of the buccal and lingual surfaces of the assessed teeth. Subjects were then removed from the assessment area where they received a professional brushing timed to last 48 s. Brushing was completed according to pre-study training without toothpaste and was followed by a re-scoring of the remaining plaque. A washout period of 3 days was then allowed prior to the next period during which normal oral hygiene was resumed. RESULTS: Similar quantities of plaque accumulated in each arch, although the difference between the buccal and lingual surfaces was of the order of 30%. The professional toothbrusher removed approximately 40% of the accumulated plaque in the 48 s allocated. The buccal surfaces were most effectively cleaned (approximately 45%) compared with the lingual (approximately 25%), with the plaque removal in the mesial and mid sections approaching 40% and 60% respectively. The difference in performance between the test brushes corresponded to 5% of the residual plaque values with none being significantly more efficient overall. Pair wise site comparisons did produce differences of the order of 10% (p=0.004) at the mesio-buccal, and 8% (p=0.030) at the mid-buccal sites respectively in favour of 2 brushes compared to one other brush. CONCLUSIONS: These data derived from a standardized brushing method support the contention of many researchers that there is no one superior design of manual toothbrush. The minor and few site differences in favour of some brushes are unlikely to be of clinical significance to gingival health. This leaves uncontested the conclusion that the user is by far the most significant variable. Perhaps methods such as used in the present study could be more gainly employed to set a minimum standard of toothbrush efficacy.

Analysis of Variance↗
PubMed2002

Comparison of new and 3-month-old toothbrushes in plaque removal.

OBJECTIVES: It is often recommended that manual toothbrushes should be replaced every 3 months. The aim of this study was to compare the effectiveness of new and 3-month-old toothbrushes in the removal of dental plaque. MATERIALS AND METHODS: A single examiner blind, randomized study was performed in which 40 adult patients attended the clinic on two occasions following 48-h periods of no oral hygiene. Following plaque scoring, patients brushed with a new toothbrush at one visit and with a brush that they had used previously for 3 months at the other visit. Brushing time was 60 s. Plaque was then re-scored and percentage reductions in plaque scores calculated. The amount of wear of the 3-month-old brushes was determined by measurement of brushing surface areas. RESULTS: Plaque scores after each 48-h period of no oral hygiene were not significantly different. The percentage reductions in plaque scores achieved with the new brushes were not significantly different from those achieved with the 3-month-old brushes. Both the new and the 3-month-old toothbrushes reduced plaque scores by approximately 34%. Compared with new brushes in the same subjects, no significant differences were found for plaque score reductions for 3-month-old brushes with minor, moderate or marked wear. CONCLUSION: The 3-month-old toothbrushes were as effective as new brushes in plaque removal.

Adult↗