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PubMed1997

In vitro comparison of restoration wear and tensile strength following extended brushing with Sonicare and a manual toothbrush.

The purpose of this study was to compare the wear, cement margin breakdown and bond strength of restorations following 6 to 12 months of simulated use in vitro of the Sonicare and a manual toothbrush. Extracted molar teeth with Class V hybrid composite resin restorations (n = 21) or with Class V gold inlays cemented with zinc phosphate cement were tested for wear and marginal integrity following brushing for a period that simulated 6 months of typical use. One-third of the molars in each group were brushed with the Sonicare and one-third were brushed with the manual brush. The remaining third served as non-treated controls. Toothbrushing was performed under a standardized load using a piston-action brushing machine. After brushing, the enamel, dentin/cementum and restorations were examined by light and scanning electron microscopy. There was no apparent wear of tooth structure or of restorative materials with either the Sonicare or the manual brush. There was a small loss of cement from the margins of the gold inlays following toothbrushing, which was similar and not significantly different between the sonic and manual brush. To test brushing effects on crown retention, four identical metal dies were prepared to simulate premolar crown preparations. Thirty cast copings, prepared to fit the dies, were cemented with zinc phosphate cement. Toothbrushing with Sonicare or the manual toothbrush was performed as before (n = 15 for each brush), but the simulated time was extended to the equivalent of 1 year of brushing. The dislodgement force of cemented crowns was not significantly different (t-test, p > 0.10) between the manual (207 +/- 69 N) and Sonicare (221 +/- 61 N) groups. These results demonstrate that despite its high frequency bristle motion, Sonicare exerts no detrimental effects on cement margin integrity, crown bond strength or surface wear of dental and restorative materials.

Analysis of Variance↗
PubMed1997

Effects of toothbrush design and brushing proficiency on plaque removal.

A single-blind, short-term cross-over clinical trial compared the plaque removal performance of three commercially available manual toothbrushes. A sample of 25 dental hygiene students, 19 to 42 years old, served as participants. On 3 separate occasions, participants were instructed to refrain from toothbrushing or flossing for 24 hours before clinical trials. A prebrushing plaque index using disclosing solution was performed on each participant. One of the 3 test brushes was then randomly dispensed to each participant, and they were allowed to brush for 90 seconds without the aid of a mirror. A postbrushing plaque index was then performed on each participant. This procedure was repeated 2 more times at 2-week intervals so that each participant was tested with all 3 toothbrushes. Previous studies of this kind using random participant samples have suggested that brush design does indeed affect the efficacy of plaque removal. This study used participants who were well versed on efficient toothbrushing technique to determine if improved brushing skills would overshadow advantages in toothbrush design. No significant differences in performance were detected between the test brushes for any of the three scored areas.

Adult↗
PubMed2004

Maintenance of whitening with a power toothbrush after bleaching treatment.

A randomized, parallel, examiner-blind clinical study was conducted to examine the ability of 2 toothbrushes to maintain teeth whitening after at-home bleaching. Forty subjects used a 15% carbamide peroxide tray bleaching system at home for 2 weeks per the manufacturer's instructions and then were randomly assigned to use either the Sonicare Advance power toothbrush or a manual toothbrush as part of their home oral hygiene routine for 6 months. The color of the labial surfaces of the subjects' maxillary anterior dentition was assessed before bleaching and immediately, 2 months, 3 months, and 6 months after bleaching. Color was assessed by comparison with Vita Classical shade tabs and by digital image analysis in the CIE L*a*b* color space. Both groups demonstrated a rebound effect at the 2-month visit and beyond, with mean Vita shade scores significantly higher than immediately after bleaching. At the 6-month evaluation, a significant difference in the amount of rebound in each group was observed. Specifically, the rebound of the Sonicare brush group was on average 1.12 Vita shades less than that of the manual brush group. The 6-month difference was confirmed through digital image analysis, with the Sonicare brush group 4.8 L* units lighter, corresponding to 2 Vita shades, and 2.1 b* units less yellow than the manual brush group. This clinical trial demonstrates that the Sonicare Advance toothbrush better maintains whitening after bleaching treatment than a manual toothbrush.

Adult↗
PubMed2005

Development of an oscillating/rotating/pulsating toothbrush: The Oral-B professionalCaretrade mark series.

The Oral-B range of power toothbrushes are based on a clinically proven oscillating/rotating action. This review considers the extensive series of laboratory and clinical studies involved in the development of the Oral-B power toothbrushes with three-dimensional (3D) brush head action (i.e. oscillating/rotating/pulsating), now known as the Oral-B ProfessionalCaretrade mark Series. The unique, highly effective cleaning performance of the 3D action incorporated in the D15 and D17 models is proven in both the laboratory and clinical environments, thereby establishing an evidence-based platform for the development of the most recent ProfessionalCare 7000. In the early development phase, in-vitro studies indicated that the additional pulsating action and advancements in filament technology improved approximal penetration, where plaque removal is most difficult. In-vitro models provide a useful development tool for the rapid assessment of design modifications, while controlling many factors that confound in-vivo studies, but the relevance of their findings needs to be confirmed in the clinical situation by direct improvements in oral health. Results from well-controlled, randomised clinical studies in the development programme have demonstrated the superiority of the D15 and D17 models with 3D action over a manual toothbrush and other power toothbrushes of various actions and designs in the improvement of oral health outcomes such as plaque removal (especially from approximal sites), reduction of gingival inflammation, and control of calculus and stain formation, with no greater potential to cause oral tissue abrasion. Furthermore, user acceptance of the oscillating/rotating/pulsating toothbrush may encourage long-term compliance during normal use.

Journal Article↗
PubMed2005

Three-month assessment of safety and efficacy of two electric toothbrushes.

OBJECTIVE.: This randomised, examiner-blind parallel group study was designed to evaluate the safety and efficacy of a rechargeable oscillating/pulsating toothbrush (Oral-B ProfessionalCaretrade mark 7000, Oral-B Laboratories; PC 7000) and a battery-operated toothbrush (Crest(R) SpinBrushtrade mark Pro, Procter & Gamble Company; SBP) in the reduction of gingivitis, bleeding and plaque over a 3-month period. METHODS.: After 12-18 hours of no oral hygiene, subjects had oral tissue examinations, and gingival and plaque assessments to determine eligibility in the study. Subjects were stratified and randomised into treatment groups based on initial whole mouth mean plaque (Turesky modification of Quigley Hein Plaque Index) and gingivitis (Löe & Silness Gingival Index) scores and gender. Subjects were instructed to brush twice daily with their assigned toothpaste and toothbrush. Clinical parameters were assessed at baseline, and after 1 and 3 months of use. Within treatment comparisons from baseline were analysed using t-test; between treatment comparisons were analysed using ANOVA. RESULTS.: Data were obtained from 92 subjects (PC 7000 n=45; SBP n=47). No significant differences were found in baseline plaque, gingivitis and bleeding between groups. Both treatment groups had significant reductions from baseline in plaque, gingivitis and bleeding scores. PC 7000 demonstrated significantly greater reductions compared to SBP in whole mouth plaque at 1 month: 0.39+/-0.43 vs. 0.16+/-0.42 and 3 months: 0.32+/-0.48 vs. 0.04+/-0.41. PC 7000 also demonstrated significant reductions compared to SBP in gingivitis at 3 months for whole mouth: 0.14+/-0.09 vs. 0.10+/-0.10 and approximal areas: 0.11+/-0.08 vs. 0.08+/-0.09. There were no significant differences between toothbrushes in bleeding at either time point. Safety examinations revealed no apparent difference in soft and hard tissue abnormalities between groups. CONCLUSION.: The PC 7000 toothbrush demonstrated significantly greater reductions in plaque and gingivitis compared to the SPB over a 3-month period.

Journal Article↗
PubMed2005

Efficacy of a novel brush head in the comparison of two power toothbrushes on removal of plaque and naturally occurring extrinsic stain.

OBJECTIVES.: To compare the safety and efficacy of an oscillating/pulsating power toothbrush (Oral-B ProfessionalCaretrade mark 7000; PC 7000) fitted with either the standard FlexiSoft (PC 7000/EB17) brush head or the novel Pro Polisher (PC 7000/EB-Prophy) and a high-frequency toothbrush (Philips Sonicare(R) Elite(R); SE), in their relative ability to remove plaque and naturally occurring extrinsic dental stain over a six-week period. METHODS.: This randomised, examiner-blind, parallel group study involved 90 healthy subjects from a general population. All subjects received a baseline plaque (Turesky et al. modified Quigley-Hein Plaque Index), stain (Lobene Stain Index) and tooth shade (VITAPAN(R) Shade Guide) [Vita] assessment and an oral tissue examination. After training in the use of their randomly assigned device, subjects were instructed to brush twice daily for 2 min and returned after 3, 4 and 6 weeks of product use for a repeat of each clinical assessment. RESULTS.: Reductions from baseline in mean plaque and extrinsic dental stain scores were significant at Weeks 3, 4 and 6 in all three treatment groups. By Week 6, mean reductions from baseline in whole mouth plaque scores were 32%, 27% and 14% in the PC 7000/EB-Prophy, PC 7000/EB17 and SE groups, respectively. For the body of the tooth, mean reductions from baseline at Week 6 in total stain were 89%, 89% and 80%, respectively. Between treatment group comparisons consistently revealed that the PC 7000 toothbrush plus the EB-Prophy or EB17 brush head removed significantly more plaque and extrinsic stain (total stain, stain area and stain intensity) than the SE toothbrush at 3, 4 and 6 weeks. The EB-Prophy group had a greater proportion of subjects showing a 2-3+ change in Vita shade scores at each time point compared to the other two brushes; at Week 6 the proportions were 67% in the PC 7000/EB-Prophy group, 30% in the PC 7000/EB17 group, and 7% in the SE group. The PC 7000/EB17, PC 7000/EB-Prophy and the SE were found to be safe as used in the study. CONCLUSIONS.: The oscillating/rotating/pulsating PC 7000 (fitted with either the standard EB17 or novel EB-Prophy brush head) is more effective at removal of plaque and naturally occurring extrinsic tooth stain, and the PC 7000 plus EB-Prophy in the improvement of tooth shade, than the high-frequency SE toothbrush.

Journal Article↗
PubMed1982

The relationship of weight loss to surface roughness of composite resins from simulated toothbrushing.

This study was designed to measure percentage of weight loss during simulated toothbrushing of five different composite resins. The surface roughness of each composite resin was also measured after each year of simulated toothbrushing for a period of 5 years. The following conclusions were reached: 1. Despite the loss of toothbrush efficiency, all composite resins tested tended to have a decreasing wear rate with the increasing time of toothbrushing. 2. Profile (with a soft filler) and Isopast (with a microsized filler) showed the greatest resistance to abrasion and retained the smoothest surface. 3. Prestige, which demonstrated the greatest percent weight loss, also has a soft barium filler. Loss of the filler as an alkaline reaction in water due to soluble barium compounds may cause the binder to release filler particles prematurely.

Acrylic Resins↗
PubMed1998

Toothbrushing abrasion of polyacid-modified composites in neutral and acidic buffer solutions.

STATEMENT OF PROBLEM: Polyacid-modified composites are recommended for use in lesions that are subjected to toothbrushing abrasion and acidic challenges, such as cervical lesions. There is little information whether these materials are able to withstand degradation due to erosive attacks and toothbrushing abrasion. PURPOSE: This study evaluated the resistance of polyacid-modified composites against toothbrushing abrasion under acidic and neutral conditions. METHODS: Forty specimens fabricated of each of two polyacid-modified composites (Dyract, Compoglass) were investigated. For each composite group, 20 specimens were placed in a neutral solution (pH: 6.8) and 20 specimens were placed in an acidic solution (pH: 3.0) for 24 hours. All specimens were brushed in an automatic toothbrushing machine, then subjected to storage in the respective buffer solution (8 hours), followed by brushing three times. Abrasion was determined profilometrically. RESULTS: For both materials, abrasion in the acidic environment was significantly higher compared with neutral conditions. Thus, Compoglass composite demonstrated a lower abrasion resistance than Dyract composite. CONCLUSION: The abrasion resistance of the investigated materials was reduced under acidic conditions.

Acids↗
PubMed2003

The efficacy of a toothbrush disinfectant spray--an in vitro study.

OBJECTIVES: Toothbrushes are contaminated by micro-organisms which may be sources of infection, re-infection or cross infection. The object of this research is to test the efficacy of a proprietary toothbrush spray disinfectant (Brushtox) against specific test bacteria and fungi and to consider its potential. METHODS: Three bacteria and two fungi representing a broad microbial spectrum with relevance to oral bacteria were used in four laboratory tests including an in vitro toothbrush disinfection test. RESULTS: Brushtox proved to be almost 100% effective in three tests and showed significant inhibitory action in the standard agar diffusion test. CONCLUSION: Brushtox is an effective disinfectant agent for bacteria and fungi on toothbrushes. The solution may be valuable in the control of a wide variety of oral infections and secondary infections, especially in frail or debilitated individuals or those on immuno-suppressive therapy, and also in healthy individuals.

Aerosols↗
PubMed1998

Comparative study of electric and manual toothbrushes in patients with fixed orthodontic appliances.

The objective of this three treatment, three period, single blind, cross-over trial was to evaluate the efficacy of three toothbrushes in a cohort of children undergoing fixed appliance orthodontic therapy. The brushes used were: (1) Dental Logic HP550 with regular brush head HP5924 (Philips, U.K.); (2) Braun Oral B Plaque Remover (D7) with dedicated orthodontic brush head OD5-1 (Braun AG, Germany); and (3) a manual dedicated orthodontic toothbrush (P35, Oral B Laboratories, Calif.). Sixty orthodontic patients, aged 10 to 16 years and wearing upper and lower fixed appliances, were screened and recruited with parental consent. After an oral soft tissue examination at baseline, the percentage of plaque-covered tooth surfaces and gingival bleeding sites were recorded using visible plaque and gingival bleeding indexes. Each subject was randomly allocated to one of three groups (n = 20) with brushing sequences 1-2-3, 2-1-3, 3-2-1. The first brush was given 2 weeks after baseline (visit 1). The time interval for using each brush was 4 weeks at the end of which visible plaque and gingival bleeding indexes were recorded and a further prophylaxis given. Statistical analysis was undertaken with analysis of variance. Data were analyzed on a site-specific basis; buccal smooth and interproximal surfaces, lingual smooth and interproximal surfaces. At baseline the mean visible plaque index for all subjects were; buccal smooth, 52.5% (+/- 22.5%); buccal interproximal, 70.5% (+/- 18.5%); lingual smooth, 68.5% (+/- 21%); lingual interproximal, 76% (+/- 16%). At visit 1, the plaque scores at all surfaces had reduced significantly compared to baseline, but there had been no active treatment. This was attributed to a Hawthorne effect. Subsequently, there were no significant effects on visible plaque (or gingival bleeding) indexes with any toothbrush at any tooth surfaces. This suggests that the new HP550 is equally effective as specifically designed orthodontic toothbrushes in removing plaque from patients with fixed orthodontic appliances.

Adolescent↗
PubMed2000

In vitro evaluation of the retention of three species of pathogenic microorganisms by three different types of toothbrush.

The retention and survival of microorganisms on toothbrushes pose a threat of recontamination for certain patients at risk. In order to measure the influence of brush design and optimize the choice of toothbrush model for complementary studies, the in vitro retention of three microbial species (Porphyromonas gingivalis ATCC 33277, Streptococcus mutans ATCC 25175 and Candida albicans ATCC 26555) was evaluated for three types of toothbrush. Two series of standardized experiments were carried out for each brush and microorganism. The first series tested the retention of the microorganisms on the head portion of the brush, while the second measured retention on the head of the brush and the part of the handle inserted in the mouth during brushing. For each series, the microorganisms were counted at T0 and T24 (after storage of the brushes at room temperature for 24 h). Depending on the microorganism studied, from 0.2% to 2% of the initial inoculum was retained on the brush. The number detected increased with the size of the exposed area. After 24 h, P. gingivalis and S. mutans were found on only one type of brush. C. albicans survived on all three. These results confirm that microorganisms can quickly colonize toothbrushes.

Candida albicans↗
PubMed1999

Gingival recession and toothbrushing in an Italian School of Dentistry: a pilot study.

The aim of this pilot study was to evaluate the prevalence of gingival recession at buccal tooth surfaces in a student population of Bologna University Dental School. A total of 55 subjects, attending the 1st and 5th year of the course were examined. The clinical examination involved assessment of plaque, calculus, width of keratinized gingiva, buccal probing depth and buccal gingival recession. Information about toothbrushing behavior was collected in an interview. The multiple regression analysis showed that level of education (p=0.002), toothbrushing technique (p=0.013) and toothbrushing frequency (p=0.016) are significant contributors to gingival recession. Notwithstanding the limits of a preliminary study, a higher prevalence of buccal recession is observed in the final year students, which have also a significantly lower % of buccal surfaces with calculus (p=0.014). In addition, it clearly appears that there is the necessity to investigate other factors connected with toothbrushing (pressure, time, toothpaste quantity) in order to provide an oral hygiene education without undesired effects.

Adult↗
PubMed2000

A laboratory and clinical investigation comparing 2 oscillating/rotating electric toothbrushes.

BACKGROUND/AIMS: The purpose of the study was to investigate the efficacy of plaque removal by 2 different toothbrushes in a laboratory model and in a clinical study. METHOD: The 2 brushes used were the Philips/Jordan HP 735 and the Braun Oral-B Ultra Plaque Remover (D9). Both were compared in a laboratory study (using a robot system) and a short-term clinical study. For the laboratory study, plaque substitute was applied to the artificial teeth of ten typodonts, which were cleaned by a robot for 2 min. The remaining plaque substitute was measured on buccal and lingual/palatal surfaces, as well as gumline and interproximal sites, using a computerized vision system. The clinical study included 23 non-dental students. All subjects received a single oral prophylaxis and were asked not to brush their teeth for 48 h prior to their appointment. After the amount of plaque had been evaluated at 6 sites per tooth, subjects brushed in a random split-mouth order with the 2 electric toothbrushes, after which the amount of plaque was re-evaluated. RESULTS: The results of the laboratory study showed that, for all surfaces combined, the mean removal of plaque substitute for both brushes was the same. However, at the vestibular and the approximal vestibular surfaces, the reduction in plaque substitute was significantly higher (p<0.01) with the Braun toothbrush compared to the Philips. In the clinical study, the mean overall plaque reduction for the Braun toothbrush (74%) was significantly higher than for the Philips (66%). Further analysis revealed that the significant difference in favour of the Braun brush was mainly due to plaque removal from the approximal vestibular and the approximal lingual sites. CONCLUSIONS: In conclusion, both the laboratory and clinical study show that the Braun Oral-B Ultra Plaque Remover (D9) is more effective than the Philips/Jordan HP 735. Both study models indicate that this difference is greatest on the approximal vestibular surfaces.

Adult↗
PubMed2002

Relative effectiveness of powered and manual toothbrushes in elderly patients with implant-supported mandibular overdentures.

AIM: The aim of this study was to compare the clinical effectiveness of a powered toothbrush (Braun Oral-B Plaque Remover 3-D) and a manual soft toothbrush (Oral-B Squish-grip brush) for the control of supragingival plaque and soft tissue inflammation around implants supporting mandibular overdentures. MATERIAL AND METHODS: The study sample involved 40 edentulous subjects, aged 55-80 years, having 2 unsplinted mandibular implants supporting a complete removable overdenture opposed by a maxillary complete denture. In this single-blinded, randomised, cross-over clinical trial, two 6-week experimental phases were separated by a 2-week wash-out period. 2 weeks prior to each experimental phase (pre-entry visits), implant abutments were polished to remove all plaque and a standardised instruction in the use of the toothbrush was given. Modified plaque and bleeding indices were recorded at the start and end of each experimental period. Mean index scores at each phase were analysed using paired t-test, and the mean number of sites showing a change in plaque or mucositis were compared using the Mann-Whitney U-test. Combined data from 2 different implant systems were considered after controlling for implant type. RESULTS: Only minor changes in plaque and bleeding scores were observed following the two test periods. There were no statistically significant differences between the manual and powered toothbrushes. CONCLUSION: Manual and powered brushes were found to be of comparable efficacy with regard to improvement in peri-implant bleeding and plaque indices.

Aged↗
PubMed2002

Toothbrushing promotes gingival fibroblast proliferation more effectively than removal of dental plaque.

OBJECTIVES: Removal of dental plaque is an essential element of periodontal treatment. However, there have also been studies of the effects of the mechanical stimulation provided by toothbrushing on gingival host-defense mechanisms. The aim of the study was to evaluate the effects of toothbrushing on gingival fibroblast proliferation in dogs over time, compared to effects of plaque removal without brushing. METHODS: The mouths of six mongrel dogs were divided into four quadrants: two for daily toothbrushing, and two for daily plaque removal with a curette. After 1, 3 and 5 weeks of treatment, histometrical analyses were performed to assess inflammatory cell infiltration, proliferating cell nuclear antigen (PCNA)-positive fibroblasts, procollagen type I-positive fibroblasts in the subepithelial connective tissue of junctional epithelium. RESULTS: Toothbrushing increased the number of PCNA-positive fibroblasts in the first week, increased the number of type I procollagen-positive fibroblasts at the fifth week, and reduced inflammatory cell infiltration at the third week. CONCLUSION: These findings suggest that mechanically stimulated fibroblasts begin proliferating within a week, and this cell division results in an increased number of fibroblasts at the third week. It takes 5 weeks before differences in collagen synthesis between brushing and plaque removal areas are detectable.

Animals↗
PubMed2002

A clinical evaluation of a novel data logger to determine compliance with the use of powered toothbrushes.

OBJECTIVES: The primary objective of this study was to evaluate the viability of an electronic data logger to record the brushing episodes of patients receiving standardised oral hygiene instructions. The secondary objective was to estimate the compliance of a group of patients diagnosed with chronic periodontal disease with brushing time instructions for the daily use of a powered toothbrush over a 2-month period. MATERIAL AND METHODS: 17 modified Philips Jordan Sensiflex 2000 powered toothbrushes (PTBs) were provided to patients (32-67 years) attending for non-surgical management of chronic periodontal disease. The PTBs incorporated an electronic data logger which recorded, for each individual brushing event: the length of time the brush was used (identifying the brushing speed setting); the maximum, minimum and average current during operation; and the time spent charging in between two consecutive brushing events. The patients were given detailed instructions with the PTB and were told to use it for 2 min each morning and 2 min in the evening. The patients returned for non-surgical management over two visits prior to reinforcement of the oral hygiene instructions 1 month after PTB allocation. Subjects were asked to complete a simple brushing diary to record their use of the toothbrush on a daily basis. After 2 months of using the PTBs at home, the brushes and diaries were collected and the data downloaded from the data loggers. RESULTS: Of the 17 data loggers allocated, two recorded no information and two subjects did not return for the follow-up appointments. The data from the remaining 13 data loggers were evaluated for level of compliance. An event of brushing between 120 and 130 s was considered to be compliant, one of between 90 and 120 or 130-150 s was partially compliant and brushing for < 90 s or > 150 s was recorded as non-compliant. Percentage compliance for all the events (2087 recordings) was 34%, partial- and non-compliance were calculated as: 18%; 48% of events, respectively. CONCLUSION: This data logger has provided previously unrecorded data on the brushing times for a group of patients using a powered toothbrush at home during non-surgical management of chronic periodontal disease. The data suggested that almost half (48%) of the brushing events recorded by the data loggers were greater than 30 s above or below the instructed brushing time.

Adult↗
PubMed2002

Toothbrushing affects the protein composition of whole saliva.

Saliva is increasingly used for diagnostic purposes, but little is known about the potential effect of toothbrushing on the composition of saliva. Therefore, saliva collected before and 0, 15, 30 and 45 min after toothbrushing according to the Bass method was analysed for relevant protein composition. The flow rate initially increased (+15%) after toothbrushing, followed by a decrease after 15 min (-15%). The concentration of salivary immunoglobulin A (S-IgA) decreased (-40%) whereas the albumin concentration increased (+400%) within 20 min. Flow rate and S-IgA concentration returned to baseline values within 30 min. The albumin concentration, however, was still increased after 45 min. No significant increases were observed in the concentrations of total protein and amylase. Our results show that toothbrushing has a significant effect on the protein composition of saliva, by contamination with serum constituents. This should be taken into account when saliva is used for diagnostic purposes.

Adult↗
PubMed1998

An unusual case of trauma: a toothbrush embedded in the buccal mucosa.

Severe trauma from a toothbrush is unusual in childhood. This case report illustrates a case where a toothbrush was so embedded in the buccal soft tissues that it needed to be removed under a general anaesthetic. Other cases are outlined where life-threatening conditions rapidly arose following toothbrush trauma to the oro-pharynx, both patients having been initially discharged without treatment from a casualty department. Apparently minor oro-pharyngeal lacerations should be approached with caution when a penetrating injury from a toothbrush or any object has occurred.

Accidental Falls↗