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PubMed1997

The electric toothbrush: a review.

OBJECTIVE: To review the use of the vibratory motion of electric toothbrushes to remove plaque and improve gingival health. Recent developments of such devices include the introduction of a small rotary head motion and increasing the frequency of vibration. DATA SOURCES: Articles published in the international literature over the last 10 years. STUDY SELECTION: There are two distinct areas of research: in-vitro studies and clinical trials. In-vitro studies have investigated the effects of cavitation and acoustic microstreaming. Their potential contribution to the action of the working electric toothbrush has been demonstrated in vitro. However their occurrence in the clinical situation has not been fully described. Clinical studies on electric toothbrushes have compared their plaque removing efficacy to either manual brushing or to other commercial electric toothbrushes. CONCLUSIONS: Electric toothbrushes are more effective in plaque removal than manual brushing in closely supervised trials. There is clinical evidence that a small rotating brush rather than a side to side motion is more effective. However, further long-term clinical trials are needed to demonstrate improvements in gingival health which incorporate better controls for the different variables involved. This will assist practitioners to reach an objective assessment of such devices.

Clinical Trials as Topic↗
PubMed2000

Periodontal status of adult Sudanese habitual users of miswak chewing sticks or toothbrushes.

Miswak chewing sticks are prepared from the roots or twigs of Salvadora persica plants. They are widely used as a traditional oral hygiene tool in several African and Middle Eastern countries. The aim of this study was to assess and compare the periodontal status of adult Sudanese habitual miswak and toothbrush users. The study population comprised male miswak users (n = 109) and toothbrush users (n = 104) with age range 20-65 years (mean 36.6 years) having 18 or more teeth present. They were recruited among employees and students at the Medical Sciences Campus in Khartoum, Sudan. One examiner used the Community Periodontal Index (CPI) to score gingival bleeding, supragingival dental calculus, and probing pocket depth of the index teeth of each sextant. In addition, the attachment level was measured, which, along with the CPI, was used to assess the periodontal status of the two test groups. Gingival bleeding and dental calculus were highly prevalent in the study population. Approximately 10% of the subjects had > or =4 mm probing depth and 51% had > or =4 mm attachment loss in one or more sextants. Subjects in the age group 40-65 years had a significantly (p < 0.05) higher number of sextants with gingival bleeding and with > or =4 mm probing depth and attachment loss than the 30-39 years group. Miswak users had significantly (p < 0.05) lower dental calculus and > or =4 mm probing depth and higher > or =4 mm attachment loss as well as a tendency (p = 0.09) to lower gingival bleeding in the posterior sextants than did toothbrush users. These differences were not significant in the anterior sextants. It is concluded that the periodontal status of miswak users in this Sudanese population is better than that of toothbrush users, suggesting that the efficacy of miswak use for oral hygiene in this group is comparable or slightly better than a toothbrush. Given the availability and low cost of miswak, it should be recommended for use in motivated persons in developing countries.

Adult↗
PubMed1998

Toothbrushing forces in children with fixed orthodontic appliances.

The aim of this investigation was to determine whether toothbrushing forces are influenced by wearing fixed orthodontic appliances. Thirty children, (10 males, 20 females) with planned fixed appliance therapy and aged 10-15 years, were recruited to the study. No subject had previously worn an orthodontic appliance. At baseline, each subject brushed their teeth in their usual way, unsupervised. The toothbrush used was a purpose-designed electronic instrument that measured the force applied to the brush and transmitted force data by radio to a remote PC. After toothbrushing, subjects had orthodontic brackets fitted. Toothbrushing was repeated at 2 and 14 weeks after baseline, and brushing forces recorded. There were no significant differences between the measurements made at baseline and those made at 2 and 14 weeks. There were no differences between males and females in the forces used at any time point. It was concluded that toothbrushing forces are unaffected by placing fixed orthodontic appliances in children. The brushing forces recorded were comparable with those previously found by other investigators.

Adolescent↗
PubMed2004

Does cavitation occur around powered toothbrushes?

AIMS/OBJECTIVES: The aim of this investigation was to determine if cavitational activity occurred around powered toothbrushes using a chemical dosimeter system based on terephthalic acid (TA). MATERIAL AND METHODS: Five powered toothbrushes were used in this investigation: Braun Plaque Remover D8, Braun Oral-B 3D, Philips Jordan Sensiflex HX2520, Sonicare PS-1 and Sonicare Elite HX 7351/02. Each brush head was inserted into a conical flask containing 50 cm3 of aqueous TA solution. Brushes were operated for 10 and 20 min and a cuvette of the solution was placed in a fluorescence spectrometer (Perkin Elmer 3000). The fluorescence emitted at wavelength 425 nm, which is proportional to *OH radical concentration, was monitored. RESULTS: Any cavitational activity that may have been produced by the powered toothbrushes was below the limit of detection of the system (<10(-8) M) for the timescales investigated. CONCLUSIONS: This work has demonstrated that cavitational activity does not occur around powered toothbrushes. Operating the toothbrushes for periods up to 20 min resulted in no cavitational activity being detected.

Equipment Design↗
PubMed1984

Frequency of gingival lesions after standardized brushing as related to stiffness of toothbrush and abrasiveness of dentifrice.

The clinical trial was primarily designed to determine to what extent the stiffness of toothbrush bristles and the abrasiveness of dentifrices influence the degree of gingival erosion. Further, the plaque removing effectiveness of the toothbrushes and dentifrices tested was evaluated. 24 dental hygienist students with clinically healthy gingivae volunteered for the study. A "soft" toothbrush with a bristle thickness of 0.15 mm, a "hard" toothbrush with a bristle thickness of 0.23 mm and 2 dentifrices of different abrasiveness were used for the experiment. The 2 brushes were also used without a dentifrice. Prior to each examination the teeth of the test subjects were brushed by the same dental hygienist. Evident signs of laceration or.ulceration at any 1 of 4 gingival aspects of each tooth were recorded as brushing injuries. The teeth were then stained with basic fuchsin and the amount of remaining plaque was assessed according to the PLQ Index (Bay & Ainamo 1974). The use of the hard brush resulted in lower plaque scores and, at the same time, more gingival erosions than the use of the soft brush. With both brushes a significantly greater number of lesions was recorded after use of an abrasive powder than when no dentifrice was employed. The difference in the amount of erosions occurring when utilizing either brush, without a dentifrice or with a moderately abrasive toothpaste, was not, however, found to be statistically significant. When assessed separately for the 2 brushes, the slight tendency towards lower PLQ scores with increasing abrasiveness of the dentifrice was not considered statistically significant. The study showed that the modes decrease observed in mean PLQ scores with increasing stiffness of the toothbrush bristles and with increasing abrasiveness of the dentifrice is accompanied by increased damage caused to the soft gingival tissues.

Adult↗
PubMed1986

The effectiveness of a rotary electric toothbrush on oral cleanliness in adults.

The effectiveness of an electric toothbrush (Rota-dent), which in design and mode of action resembles the rotating instruments used by professionals in tooth cleaning, was assessed. 40 adult periodontal patients were divided into 2 groups matched with regard to oral cleanliness: an electric toothbrush group (EB) comprising 20 patients who received an electric toothbrush as well as instruction in it's use by a dental hygienist; a control group (CO) comprising 20 patients who were provided with an oral hygiene kit containing a conventional toothbrush, an interspace brush, toothpicks, disclosing tablets and a lighted mouth mirror and who received the oral hygiene instruction by means of a self-teaching manual. All patients received professional mechanical tooth cleaning 1 week prior to the instruction. At a 3-week follow-up session, additional instruction was given by a dental hygienist according to needs. The presence or absence of dento-gingival plaque after disclosing with the Plak-lite system and gingival bleeding by gentle probing was recorded on 4 tooth surfaces of all teeth, initially and after 3 months. The findings showed a similar improvement in the status of oral hygiene in both groups, indicating that in the hands of the patients, the electric toothbrush was just as effective as the comprehensive oral hygiene kit.

Adult↗
PubMed1989

Actinobacillus actinomycetemcomitans contamination of toothbrushes from patients harbouring the organism.

The main ecological niche of Actinobacillus actinomycetemcomitans (A.a.) seems to be the periodontal pocket, but it can also be isolated from supragingival plaque, buccal and tongue mucosa, or saliva. We examined toothbrushes from 21 patients, all identified as harbouring moderate to large numbers of A.a. in subgingival plaque, for contamination with this organism. 29% of the toothbrushes presented by our patients yielded detectable numbers of A.a. Immediately after toothbrushing this figure rose to 62%, but dropped to 50% after 1 h. Numbers of isolated A.a. on toothbrushes were weakly correlated with the degree of periodontal destruction, and significantly more numbers of A.a. on toothbrushes could be detected if the organism was found on mucous membranes or in saliva. There was no association with gingival inflammation, supragingival plaque nor mean numbers of isolated subgingival A.a.

Actinobacillus↗
PubMed1990

Improvement of gingival health by toothbrushing in individuals with large amounts of calculus.

Dental calculus itself is not thought to affect gingival health, but its rough and porous surface retains plaque better than a calculus-free surface. In a population with a high degree of supragingival calculus, the effect of toothbrushing after a careful professional prophylaxis (group A) has been compared with the effect of toothbrushing as the sole oral hygiene aid (group B). The subjects in this comparison were Indonesian soldiers, 20-25 years of age, none of whom had pathological pockets (CPITN less than or equal to 2), but all had large amounts of calculus. They had no experience of modern oral hygiene practice but were given individual instruction in toothbrushing at the start of the study and were provided with toothpaste and toothbrush. Removal of calculus in group A took an average of 1 h per subject by an experienced clinician. Gingival health in both groups improved after 2 months: group A from 63% to 34% bleeding points and group B from 61% to 36%. There was thus no obvious benefit from the professional prophylaxis received by group A. The results are particularly relevant for populations in which professional prophylaxis is not normally available. However, they were obtained in a group of young, healthy individuals and may not be extrapolated to older and less healthy populations or to individuals with deep periodontal pockets. The improvement of gingival health through toothbrushing, in spite of the presence of calculus, supports the contention that plaque, rather than calculus as a non-inflammatory scale, provides the pathogenic potential.

Adult↗
PubMed1993

Improved maintenance of plaque control by electrical toothbrushing in periodontitis patients with low compliance.

Patients showing low compliance with oral hygiene were selected from a population of patients referred for specialist treatment of periodontitis. The patients selected did not show an acceptable plaque control in spite of a prolonged training period. Plaque around 40% of the tooth surfaces, documented over a period of 4 to 40 months of frequent information and instructions, was found in 10 patients around the age of 40 years with a marked overrepresentation of men. Substitution of the ordinary toothbrush with an electrical toothbrush using the same working principles, resulted in a decreased plaque score of approximately 10% maintained over a considerable time period (12-36 months). A common complaint among the patients was that the oral hygiene procedures were time-consuming and cumbersome. They considered the electrical toothbrush as simple and time saving. Even if these possibilities were not investigated, merely the patients' positive attitude may have made the efforts of tooth cleaning including the proximal cleaning more tolerable, thus improving the compliance. Contributing to the improved compliance might also have been the electrical toothbrush per se. The cleaning technique allows the patient to concentrate on aiming the bristles at the gingival sulcus, while the brush makes the movements. In conclusion, it should be worthwhile recommending an electrical toothbrush with simple working technique to low compliant periodontitis patients restricting the recalls to twice a year.

Adult↗
PubMed1994

The long-term effect of an oscillating/rotating electric toothbrush on gingivitis. An 8-month clinical study.

The purpose of this study was to evaluate the safety and efficacy of the Braun Plak Control for the removal of supragingival plaque and improving gingival health in a long-term clinical trial, and to compare it to regular manual toothbrush. Assessed were plaque accumulation, amount of gingival inflammation, gingival bleeding on probing, and calculus. In total, 77 young individuals were selected on the basis of having 'moderate gingivitis'. They were monitored over 8 months and divided among 2 groups; a control group that used a manual toothbrush and a test group that used the Braun Plak Control. The clinical assessments were repeated after 1, 2, 5, and 8 months. At baseline, subjects were handed their assigned toothbrushes together with written oral hygiene instructions. They were instructed to brush for at least 2 min. 1 month after baseline examinations, all subjects received a professional prophylaxis and oral hygiene instruction from an experienced dental hygienist. Plaque removal was reinforced at the 2-and 5-month examination. In conclusion, results indicate that the Braun Plak Control is a safe and efficient home care device. At the end of this trial, this electric toothbrush proved to be more effective than a regular manual toothbrush.

Adult↗
PubMed1997

Assessment of the effect of an oscillating/rotating electric toothbrush on oral health. A 12-month longitudinal study.

The aim of this 12-month parallel design controlled clinical trial was to assess the effect of the Braun Oral-B Plak Control electric toothbrush on supragingival plaque and gingival health, and to compare it with a conventional soft manual toothbrush (Jordan). A total of 111 patients aged between 20 and 63 years, from a general population, with bleeding on probing at 30% or more of all sites examined were entered into the study. At baseline, immediately after periodontal examination, all volunteers received a thorough scaling of their teeth. Volunteers in both groups were told to brush their teeth for 2 min 2 x a day. Oral hygiene instruction was given at the start of the study and was not repeated. At 3, 6 and 12 months, assessments were carried out by a single clinician who was not aware which group the volunteers belonged to. Analysis of results demonstrated that over the 12 months of the study, the Braun Oral-B Plak Control was significantly more effective in improving gingival health than the manual toothbrush. There was, however, no difference between the 2 groups in terms of plaque removal, with the number of sites with visible plaque decreasing by a similar amount in both groups. In conclusion, results indicate that the Braun Oral-B Plak Control toothbrush is safe and more effective than a manual toothbrush in improving gingival health.

Adult↗
PubMed2004

Clinical development and evolution in plaque removal performance of a battery powered toothbrush.

BACKGROUND AND AIM: There is growing evidence that the new generation of electric toothbrushes are more effective than manual toothbrushes. The primary aim of these studies was to compare, as an indication of the stage of development, the plaque removal properties of a prototype battery powered toothbrush with an established product. A secondary aim was to utilise the data to appraise plaque accumulation together with the patterns of removal. METHOD: The three studies presented used the same, single-examiner, randomised, single-blind cross-over design involving up to 24 healthy volunteers. The prototype brushes, E6500 versions s1, s2 and s3 and E8000 with head speeds of 6500 and 8000 oscillations/min were compared with a similar design marketed product (MP) with a head speed of 8800 oscillations/min. All brushes had circular brush heads with oscillating rotating actions. Subjects accumulated plaque over a 4-day period during which no oral hygiene measures were performed. On day 4, the plaque accumulation was scored by index. Subjects then used the allocated toothbrush for 2 min. This was followed by a re-scoring of the remaining plaque. RESULTS: Studies 1 and 2 showed significantly less plaque removed by prototype E6500 (s1) and prototype E6500 (s2), respectively, than by MP. In study 3, prototype E8000 removed similar quantities of plaque to MP (approximately 65%). In contrast prototype E6500 (s3) only removed 60% of accrued plaque. Differences, however, did not reach statistical significance. CONCLUSIONS: The study methodology was appropriate to distinguish between the study toothbrushes and was furthermore able to establish a level of comparability for one of the prototype modifications with a similar MP.

Adult↗
PubMed2004

Subgingival plaque microbiota in Saudi Arabians after use of miswak chewing stick and toothbrush.

BACKGROUND: The chewing stick, the miswak, is used in many developing countries as the traditional means for oral hygiene. It is prepared from the roots, twigs and stem of Salvadora persica or other alternative local plants. OBJECTIVES: To compare the effects of the chewing stick miswak (from S. persica) and toothbrush on subgingival plaque microflora among Saudi Arabian individuals. Further, to investigate whether components extracted from S. persica may interfere with the subgingival plaque micro-organisms. MATERIAL AND METHODS: Fifteen healthy Saudi Arabian male volunteers aged 21-36 years were included in a single-blind, randomized cross-over study. The participants were taught how to use each device properly. Plaque sampling for DNA test was performed at the baseline, 1 week after professional tooth cleaning, and after 3 weeks of either miswak or toothbrush use. Identification and quantification of microbial species were performed by the checkerboard method, using whole genomic, digoxigenin-labelled DNA probes. Inhibition zones around miswak were examined on agar plates with Actinobacillus actinomycetemcomitans and the leukotoxicity of this bacterium was analyzed in a bioassay with macrophages+/-extracts of miswak. RESULTS: Miswak and toothbrushing had a similar influence on the levels of the subgingival microbiota. However, A. actinomycetemcomitans was significantly more reduced by miswak (p<0.05) than by toothbrushing. These results were supported by our in vitro results which, indicated that extracts from S. persica might interfere with the growth and leukotoxicity of A. actinomycetemcomitans. CONCLUSIONS: In contrast to toothbrush use, miswak use significantly reduced the amount of A. actinomycetemcomitans in the subgingival plaque.

Adult↗
PubMed2006

Cynical hostility as a determinant of toothbrushing frequency and oral hygiene.

AIM: Our aim was to investigate whether cynical hostility, self-reported toothbrushing frequency and objectively assessed levels of oral hygiene were associated. MATERIAL AND METHODS: The present study sample consisted of 4156 30-64-year-old dentate Finns. The questionnaire and the home interview included information about socioeconomic and sociodemographic factors and behavioural variables, such as toothbrushing frequency, dental attendance, smoking and cynical hostility. The level of oral hygiene was assessed during a clinical oral examination. The chi(2) test and ordinal logistic regression analyses were used. RESULTS: After controlling for sociodemographic and socioeconomic factors, smoking habits and reported dental attendance, the subjects belonging to the lowest cynical hostility level were found to brush their teeth significantly more often and to have better oral hygiene compared with those belonging the highest cynical hostility level. Toothbrushing frequency was adjusted when oral hygiene was used as the outcome variable. The association of cynical hostility with toothbrushing frequency and the oral hygiene seems to be partly dependent on the level of education. CONCLUSIONS: Cynical hostility is a psychosocial risk marker for the frequency and quality of toothbrushing and it could be a connecting trait between general health behaviour and oral health behaviour.

Adult↗
PubMed1980

Toothbrushing in relation to other health habits in Finland.

The dimensionality of health behavior is disputable. In the present study an effort was made to shed more light on this problem. Interview data were obtained from 3209 13--19-year-old Finnish adolescents concerning the subjects' smoking habits, use of alcohol, physical activity, toothbrushing and dietary habits. A clear positive relationship was observed between toothbrushing and the use of sugar-containing snacks. Use of alcohol seemed to have slight adverse effect on toothbrushing. Smoking was also weakly related with sporadic toothbrushing. Sports-oriented girls seemed to be regular toothbrushers. It was concluded that the possible comprehensive nature of health behavior should be more appreciated.

Adolescent↗
PubMed1987

Toothbrushing frequency in relation to family size and bedtimes in English schoolchildren.

Data from a survey of 3727 14-yr-old children from 31 secondary schools in England in 1984-85 were analysed to obtain information about toothbrushing frequency, social group, number of siblings, and time of going to bed. Subjects completed a questionnaire, anonymously, in class. One third of respondents cleaned their teeth once or less per day. Toothbrushing frequency was found to increase significantly with improvement in social status in males (P less than 0.05), while a similar non-significant trend was found in females. Toothbrushing frequency decreased significantly as the number of siblings increased (P less than 0.01) and a trend towards decreasing brushing frequency as bedtimes became later was observed. These findings indicate that family factors do influence toothbrushing practice in adolescents. These factors need to be understood more thoroughly if toothbrushing habits in school-age children are to be improved.

Adolescent↗
PubMed2004

Fluoride ingestion from toothpaste: fluoride recovered from the toothbrush, the expectorate and the after-brush rinses.

OBJECTIVES: The aim of this study was to determine the effects of rinsing and spitting on fluoride ingestion from toothpaste during normal oral-hygiene procedures of younger children, and hence to make recommendations on rinsing during toothbrushing. METHODS: The brushing habits of 166 Dutch and 185 Irish children between 1.5 and 3.5 years were observed during home visits. The weight of the toothpaste tube was determined before and after use. After brushing, the toothbrush and any associated expectorate and rinses, combined with any toothpaste spilled during the brushing procedures, were collected. The amounts of fluoride retained on the toothbrush and in the associated expectorate and rinses were measured. RESULTS: Over 90% of the Dutch children used a special toddlers' toothpaste with < or =500 ppm F. Eleven per cent of the younger (<2.5 years) Dutch children and 22% of the older children rinsed after brushing. Of the Irish children approximately 52% used a children's toothpaste containing around 500 ppm F. Of the younger Irish children 31% spat without rinsing, while another 31% rinsed during or after brushing. For the older Irish children, these percentages were 14 and 70%, respectively. On average, 22% of the fluoride dispensed on the toothbrush was retained on the brush after brushing irrespective of the rinsing and spitting behaviour of the children. The maximum ingestible amount of fluoride from toothpaste assuming no rinsing or spitting was calculated. CONCLUSIONS: Fluoride ingestion from toothpaste is significantly reduced by rinsing and/or spitting during toothbrushing. Recommendations that younger children use small amounts of toothpaste (< 0.5 g) and that children using toothpaste with > or = 1000 ppm F rinse their mouths after brushing continue to be valid.

Cariostatic Agents↗
PubMed2004

Wear resistance of packable resin composites after simulated toothbrushing test.

PURPOSE: The purpose of this study was to determine the wear resistance of five different packable composites versus two different composite controls using a laboratory toothbrushing simulation test. MATERIALS AND METHODS: Twelve samples measuring 5 mm in diameter and 3 mm thick were prepared from the following resin composites: Packable resin composites SureFil (Dentsply Ind. Com. Ltda, Petrópolis, Rio de Janeiro, Brazil), Alert (Jeneric Pentron Incorporated, Wallingford, CT, USA), Filtek P60 (3M ESPE Dental Products, St. Paul, MN, USA), Prodigy Condensable (sds Kerr, Orange CA, USA), Solitaire (Heraeus Kulzer GmbH, Wehrheim, Germany), and control resin composites Z100 Restorative (3M ESPE) and Silux Plus (3M ESPE). Finishing and polishing were conducted with Sof-Lex disks (3M ESPE), and baseline weight (grams) and surface roughness (measured with Hommel Tester T 1000, Hommelwerke, GmbH, Alte Tuttinger Strebe 20. D-7730 VS-Schwenningen, Germany) were recorded. Specimens were aged for 2 weeks until they reached a weight that remained constant for 5 consecutive days, and then were subjected to 100,000 cycles of brushing (representative of 4.2 yr) using a toothbrushing testing machine. Toothbrush heads with soft bristle tips (Colgate Classic, Colgate-Palmolive Co., Osasco, São Paulo, Brazil) with dentifrice suspension (Colgate MFP, Colgate-Palmolive Co.) in deionized water were used under a 200 g load. Changes in weight and surface roughness were determined after toothbrushing cycles. RESULTS: Significant differences of weight loss and surface roughness were found (paired t-test, p < .05). Weight loss percentage (mean [SD]) ranged from 0.38 to 1.69% (analysis of variance and Tukey's least significant difference, p < .05); the weight loss of the materials ranked from least to most as follows: SureFil (0.38 [0.56]), Alert (0.52 [0.18]), Z100 (1.16 [0.27]), Filtek P60 (1.31 [0.17]), Solitaire (1.51 [0.45]), Prodigy Condensable (1.55 [0.471), and Silux Plus (1.69 [0.66]). Regarding surface roughness, Prodigy Condensable (0.19 [0.08]), Solitaire (0.28 [0.06]), and Z100 (0.30 [0.07]) became less rough after toothbrushing, whereas all the others were rendered rougher: Alert (0.49 [0.29]), Filtek P60 (0.28 [0.08]), Silux Plus (0.39 [0.091), and SureFil (0.81 [0.32]). CONCLUSION: SureFil and Alert were statistically more resistant to wear (less weight loss) than were the other materials. SureFil became significantly rougher than did all the others. CLINICAL SIGNIFICANCE: Overal, packable resin composites are unlikely to show superior wear resistance with regard to weight loss and surface roughness compared with current resin composites also indicated for posterior restorations.

Analysis of Variance↗