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PubMed2003

The role of auditory cues in modulating the perception of electric toothbrushes.

Recent research shows that what people hear can influence what they feel. We investigated whether the perception of an electric toothbrush might also be affected by the sound that it makes. Participants were required to make stereotypical brushing movements with a standard electric toothbrush while they rated either the pleasantness or the roughness of the vibrotactile stimulation they felt on their teeth. The results demonstrate that the perception of the sensations experienced during toothbrush use were systematically altered by variations in the auditory feedback elicited by the brushing action. Participants reported that the toothbrush felt more pleasant and less rough when either the overall sound level was reduced, or when just the high-frequency sounds were attenuated. These results highlight the significant role that auditory cues can play in modulating the perception and evaluation of everyday products in use, and provide a paradigm for future study in this area.

Adult↗
PubMed2002

Clinical evidence for the efficacy and safety of powered toothbrushes.

Powered toothbrushes are becoming increasingly popular among the general population, and there are many models on the market from which to choose. The design of these toothbrushes is changing constantly, as one would expect with a developing and expanding market, and from the dental professional's standpoint, it is difficult to evaluate products from the literature simply because the designs of clinical trials for powered toothbrushes are so varied. For example, the cohort recruited for testing the products is seldom the same from one study to the next. The aim of this paper is to provide a brief overview of the findings from some of the more contemporary trials of powered toothbrushes and to examine some of the factors that might have an effect on the observations and outcomes.

Clinical Trials as Topic↗
PubMed2006

The toothbrush: a rare but potentially life-threatening cause of penetrating oropharyngeal trauma in children.

We present the case of a 10-year-old girl with pharyngeal injury caused by a toothbrush, the snapped head of which lodged in her upper oropharyngeal wall. Initial examination of the oral cavity did not reveal bleeding, a foreign body, or a wound. Nasopharyngoscopy showed lodgment of the toothbrush piece in the upper oropharynx, pulsating in synchrony with heartbeats. Computed tomography showed the toothbrush head near the carotid artery. The foreign body was surgically removed without any intraoperative or postoperative complications. The diagnosis and management of oropharyngeal injuries by stick-like foreign bodies, such as a toothbrush or chopsticks, are discussed.

Carotid Arteries↗
PubMed1983

Toothbrushing with hydrogen peroxide-sodium bicarbonate compared to toothpowder and water in reducing periodontal pocket suppuration and darkfield bacterial counts.

This study attempted to isolate and test the therapeutic effectiveness of toothbrushing with hydrogen peroxide-sodium bicarbonate supplemented with scaling and systemic antibiotics. Forty-two subjects selected for pocket suppuration were divided into two groups. Group I was treated sequentially with brushing, scaling and systemic antibiotics. Group II was treated with brushing and scaling performed concurrently. Half of each group were control subjects using an inert toothpowder. Subjects were monitored by darkfield microscopy for spirochetes and motile rods. In Group I, toothbrushing alone showed approximately a 1/3 reduction in the number of suppuration sites, no difference between experimental and control subgroups and no significant changes in the darkfield counts. Scaling, whether subsequent to the toothbrushing (Group I) or concurrent with the toothbrushing (Group II), showed a statistically significant reduction (about 70%) in the number of suppuration sites in all subgroups. Darkfield counts after scaling were reduced significantly in some subgroups but not in others. The addition of systemic antibiotics in Group I resulted in an almost total elimination of suppuration sites and spirochetes in 15 subjects, but there were no significant differences between the test and control subgroups. In both Groups I and II, neither experimental peroxide-bicarbonate subgroup could be differentiated statistically from its toothpowder-water control at any time.

Anti-Bacterial Agents↗
PubMed2002

Six-month comparison of powered versus manual toothbrushing for safety and efficacy in the absence of professional instruction in mechanical plaque control.

BACKGROUND: Reports suggest powered toothbrushing may provide some clinical benefit over manual tooth-brushing, but most studies have been of short duration with subjects trained in toothbrush use. The aim was to determine if the oscillating-rotating powered brush (PB) could safely provide clinical benefits over and above a manual brush (M) in subjects with no formal instruction or experience in powered brush use. METHODS: This 6-month, single-masked, parallel design, randomized clinical trial compared the PB with an American Dental Association (ADA)-accepted soft-bristle manual brush in a non-flossing gingivitis population (n = 157). Subjects were given written instructions but no demonstration on toothbrush use at baseline. Efficacy was assessed by changes in gingival inflammation, plaque, calculus, and stain, while changes in clinical attachment levels and recession measurements provided safety data. A prophylaxis was provided after baseline assessment. The 6-month plaque index (PI) was recorded immediately post-brushing after covert timing of the subjects, and correlation analyses were run to assess the relationship of brushing time to PI. Paired t tests, analysis of variance (ANOVA), and analysis of covariance (ANCOVA) were used to assess within and between treatment group differences for PB (n = 76) versus M groups (n = 81). RESULTS: Measures of inflammation showed a statistically significant drop for both brushes at 3 and 6 months. Mean overnight full-mouth PI scores were significantly lower at 3 months for the PB (1.57) compared to the M group (1.80), P = 0.0013. Immediate post-brushing PI at 6 months was also significantly lower for the PB (1.10) versus M (1.39) (P= 0.0025). There was an overall negative correlation for PI and brushing time (r = -0.377, P= 0.0001). Mean calculus index (CI) scores were lower for the PB at 3 (P= 0.0304) and 6 months (P = 0.0078), while no significant differences in stain were observable. Clinical attachment level and recession measurements showed no significant between-group changes from baseline for either brush on canine teeth or on teeth with recession at baseline. CONCLUSION: The oscillating-rotating toothbrush safely provides clinical benefits in plaque and calculus reduction over a manual brush even in subjects with no formal oral hygiene instruction.

Adolescent↗
PubMed2006

Additional effect of dentifrices on the instant efficacy of toothbrushing.

BACKGROUND: Inconclusive evidence exists in the literature with regard to the additional effect of the use of dentifrice on plaque removal. The present study was undertaken to test whether the use of dentifrice during toothbrushing contributes to the instant cleaning efficacy of the brushing procedure. METHODS: Three groups of patients, 40 subjects each, were randomly assigned to one of three dentifrices that differed with respect to the relative dentin abrasivity (RDA) value. After a 48-hour plaque accumulation, subjects brushed under supervision in a split-mouth order with or without the use of dentifrice (total time=2 minutes). RESULTS: Plaque reductions varied between 51% and 58% for the three dentifrices. The overall analysis showed a mean difference of 3% in plaque reduction in favor of brushing without dentifrice (P=0.017). The type of dentifrice did not influence this observed difference (P=0.506). Also, the order of the brushing procedure (starting the brushing procedure with or without dentifrice) had no interaction with the effect of dentifrice on the brushing (P=0.187). CONCLUSIONS: The use of dentifrice does not contribute to the instant mechanical plaque removal during manual toothbrushing. A higher dentifrice abrasivity does not seem to contribute to increased plaque removal with a manual toothbrush. It appears that the mechanical action provided by the use of a toothbrush is the main factor in the plaque-removing process.

Adult↗
PubMedDate not supplied

Toothbrush selection: a dilemma?

The toothbrush is a fundamental tool used for accomplishing plaque control. Various types of toothbrushes available in the market keep the buyer in a state of dilemma as to which one to choose, due to lack of information about the "quality" of it. This study has been designed to understand whether all the products available in the market adhere to the specifications laid down by the ADA, which is universally accepted in standardization of a tooth brush. 95% of the brushes surveyed contain less number of bristles per tuft than specified and a large percentage deviate from the standard prescribed value for their bristle diameter and other dimensions. Few brushes labeled as "Soft" were "Medium" and labeled "Medium" were "Hard". The study will bring to light the quality of toothbrushes available in India for a rationalised selection of appropriate toothbrush by the community at large.

American Dental Association↗
PubMed1998

A testing system for electric toothbrushes.

PURPOSE: To assess in vitro the contributions of mechanical and acoustic microstreaming forces around electric toothbrushes to remove cheese using an experimental model. MATERIALS AND METHODS: Four toothbrushes, Braun Oral-B Plaque Remover (D7), Braun Oral-B Ultra Plaque Remover (D9), Interplak (IP) & Sonicare (SC), were investigated. A model system consisting of a layer of 0.2 mm thick cheese was applied to a microscope slide. The toothbrushes were operated in contact with the slide under loads of 0.3 N dry or with the bristles immersed in 2 mm of water. Turbulence around the moving head was assessed with the bristles placed non-contacting, 1 mm above the slide. An experiment with contact for 2 seconds and then 10 seconds non-contact was also made. The slides were stained and image analyzed. The area of removal was measured together with the "average cleaning/brush contact unit area", (the area of removal was divided by bristle contact area. RESULTS: The removal pattern varied. D9 and SC were efficient when operated dry. When the brushes were operated in water, the D9, SC, and IP were efficient in removing the cheese. With no contact, SC produced disruption of the cheese layer while the other brushes did disturb the surface but did not remove completely the cheese. This disturbance without removal was not recorded by image analysis. When the vibrating brushes were allowed to touch the medium and then moved away, a large amount of removal occurred. Larger amounts of removal took place with the D7, D9 and the SC. The use of brushes with a larger head and bristle contact produced a larger area of removal. However, when the "average cleaning/brush contact unit area" was used, the smaller headed brushes produced a larger amount of removal relative to their size. These differences in the removal characteristics between the four electric toothbrushes in vitro suggest that such a model system may prove useful in testing such devices before they are assessed clinically.

Analysis of Variance↗
PubMed1998

New studies on estimated and actual toothbrushing times and dentifrice use.

Toothbrushing is the most widely recommended and practiced method of dental home care. While there is considerable information available in the literature on the time spent brushing the teeth, there is minimal information relating actual brushing time with the time patients estimate they normally brush. This paper reports in detail a study conducted in Switzerland in the 1980's, and supplements this information using the same protocol with two different Swiss populations conducted in the 1990's. In the early Swiss study, on volunteers registering at a dental clinic, the mean actual toothbrushing time was approximately 68 seconds. In the two recent studies, conducted with Swiss army soldiers or three groups of inhabitants in a town near Zurich, the actual toothbrushing means were 83.5 and 72.8 seconds, respectively. In the three studies conducted, the time subjects estimated they had brushed ranged between 134.1 to 148.1 seconds. In all studies, the difference between actual and estimated times was significantly different (p < 0.01). The amount of toothpaste used during toothbrushing was evaluated in two of the studies. In both evaluations, the amount of dentifrice used was approximately 1 gram. Dental professionals should be aware that there is a consistent difference in the time that patients believe they brush, and the time they actually spend brushing.

Dental Plaque↗
PubMed1998

A comparison of electric toothbrushes in their potential to cause gingival abrasion of oral soft tissues.

PURPOSE: It has previously been established that gingival abrasion associated with the Braun Oral-B Ultra Plaque Remover (D9) is minimal and comparable to that observed with a manual toothbrush. The purpose of this single-use study was to compare gingival abrasion with the D9 and a novel electric toothbrush, the Braun Oral-B 3D Plaque Remover (3D). MATERIALS AND METHODS: 49 subjects (non-dental students) with at least 24 natural teeth and an absence of periodontal probing depths of 5 mm or greater were included in this study. Following a familiarization phase, all subjects received a single prophylaxis and were asked not to brush their teeth for 24 hours prior to their appointment. At this visit, the gums were disclosed by Mira-2-Tone solution and all gingival abrasion on the soft tissues was assessed and recorded. Subjects then brushed their teeth in a random split-mouth order with the two electric toothbrushes, using brush heads of the same design (EB9). The gums were then re-disclosed and gingival abrasions were recorded. They were recorded as either small sites of abrasion (< or = 5 mm) or large sites of abrasion (> 5 mm). RESULTS: The mean number of small traumas increased from 2.57 at baseline to 4.04 after brushing with the D9 and from 1.98 to 4.14 after brushing with the 3D. There was no statistically significant difference between the two groups. For both toothbrushes, more small traumas were found in the upper jaw compared with the lower jaw. No increase in number of large traumas was observed.

Adolescent↗
PubMed2000

Laboratory interproximal access efficacy of two toothbrushes with cross-angulated bristling.

Interproximal access efficacy (IAE) has been evaluated in a laboratory method using pressure-sensitive paper placed around simulated anterior and posterior teeth, using horizontal or vertical brushing motions. The two toothbrushes evaluated in this study were the Oral-B Cross Action Medium 40 and the Dr. Best X-Activ Mittel. Twenty-four tests on each toothbrush design were conducted, and results were statistically analyzed using ANOVA. In all of the individual evaluations, using either vertical or horizontal brushing motions on either anterior or posterior simulated teeth, the Dr. Best X-Activ Mittel toothbrush was significantly (p < 0.001) more effective than the Oral-B Cross Action Medium 40 in achieving IAE. When individual IAE data from the vertical, horizontal, anterior and posterior assessments were combined to assess overall IAE, the Dr. Best X-Activ Mittel toothbrush had a significantly (p < 0.001) higher mean value than the Oral-B Cross Action Medium 40 mean value.

Equipment Design↗
PubMed2001

Plaque removal efficacy of an electric and a manual toothbrush with additional interdental tufts.

This clinical study compares the plaque removal efficacy of the Philips/Jordan 2-Action Plaque Remover electric toothbrush with that of the Oral-B 35 Advantage manual toothbrush. In this single-blind randomized split-mouth study, subjects brushed under supervision after having abstained from all oral hygiene for 24 hours. Plaque scored after brushing was used to compare the efficacy of the toothbrushes. Both toothbrushes have special tufts to promote interdental cleaning. It was found that these tufts improve interdental cleaning. Overall, the Philips/Jordan brush removed significantly more plaque than the Oral-B manual brush.

Adult↗
PubMed2001

A comparative single-use clinical study of the efficacy of two manual toothbrushes with angled bristles.

PURPOSE: To compare the safety and plaque removal efficacy of two angled-bristled toothbrushes. MATERIALS AND METHODS: The brushes were compared using a single-use, cross-over designed study, where healthy subjects from a normal population brushed their teeth with their assigned toothbrush for a timed 60 seconds. Pre- and post-brushing plaque levels were evaluated after disclosing, using the Proximal/Marginal Plaque Index. At the first visit, 100 subjects with a plaque index of > or = 2.20 after 23-25 hours of no oral hygiene were enrolled in the study. At the end of the study, data from 91 subjects were suitable for analysis. The two treatment sequence groups, X-Aktiv/CrossAction and CrossAction/X-Aktiv, were balanced for age and gender and, at each visit, pre-brushing plaque scores did not differ significantly between the two groups. Data from the two visits were pooled, after which plaque removal efficacies were compared. RESULTS: Both toothbrushes were found to be safe and both significantly reduced plaque levels (P< or = 0.0001), but the CrossAction was significantly more effective than the X-Aktiv for whole mouth and marginal sites, as well as the difficult-to-access approximal areas (P< or = 0.0008). For the whole mouth, the CrossAction was 11.8% more effective; for marginal sites the difference was 12.6%, and for approximal sites the difference was 11.4%. It is concluded that the Oral-B CrossAction toothbrush is significantly more effective with respect to plaque removal than the Dr. Best X-Aktiv.

Adult↗
PubMed1994

[The electric toothbrush. Present situation].

During the last decade several electric toothbrushes have been introduced with an innovative brushing technique. Scientific research indicates that after proper oral hygiene instruction these toothbrushes can be more effective than a manual toothbrush. This increased efficacy is mainly caused by an improved plaque removal from the proximal surfaces. Besides effectiveness, reasons such as facility and boosting of motivation can be reasons to advise the use of an electric toothbrush. However, these secondary arguments have sofar not been supported by scientific data.

Dental Plaque↗
PubMed2001

An evaluation of sodium bicarbonate chewing gum as a supplement to toothbrushing for removal of dental plaque from children's teeth.

The purpose of this human clinical study was to determine whether a commercial chewing gum containing 5% sodium bicarbonate (ARM & HAMMER DENTAL CARE The Baking Soda Gum [AHDC]) was effective in removing dental plaque when used as a supplement to regular toothbrushing by children. Healthy children (N = 28, average age = 11 years) were randomly distributed into 2 groups. One group was instructed to chew 2 tablets of AHDC chewing gum for 20 minutes 2 times each day (after lunch and dinner) in addition to their normal toothbrushing regimen. The other group used a sugarless mint tablet twice daily during the same period in addition to toothbrushing. After 1 week of using their assigned product, all participants were again examined for oral health and plaque. After a 1-week washout period, subjects were crossed over to the opposite group. Among the 21 participants completing the study, the AHDC chewing gum significantly (P < .0001) reduced plaque by 15% after 1 week compared to the mint tablet control, as measured by the Modified Quigley-Hein Plaque Index. When longitudinally compared to the baseline plaque scores, the gum resulted in a significant (P < .01) 10% reduction of plaque on the teeth. Subanalysis of the data showed that the AHDC chewing gum was particularly effective on the lingual surfaces and the posterior teeth and least effective on the facial surfaces of the anterior teeth, which do not readily come into direct contact with the gum during mastication. The bicarbonate gum demonstrated significant plaque reduction in all other areas of the mouth, even on tooth surfaces not directly contacted during chewing. Compliance with the chewing gum regimen was excellent, and oral health exams did not indicate any adverse events among children using either the chewing gum or mint tablets. In this study, regular use of AHDC chewing gum was safe and effective in removing dental plaque and served as a significant complement to the daily toothbrushing regimen of children.

Analysis of Variance↗
PubMed2001

A laboratory comparison of the efficacy of battery-operated, non-rechargeable power toothbrushes.

PURPOSE: To evaluate the cleaning efficacy of three battery-operated, non-rechargeable, oscillating/rotating power toothbrushes, using a robot system to simulate normal clinical toothbrush use. MATERIALS AND METHODS: The study compared the cleaning efficacy of the new Braun Oral-B D4/EB4 with the Actibrush and the Dr. Best Powerclean in two independent experiments. Plaque substitute was applied to the artificial teeth of typodonts, which were cleaned by the robot system for a total of 2 minutes at a brushing force of 1.95 N. The remaining plaque substitute on buccal + lingual/palatal and occlusal surfaces, as well as gingival margin and interproximal sites, was measured using a computerized vision system. RESULTS: The new D4/EB4 was found to remove more plaque substitute than the Actibrush at all sites, and for all surfaces, lingual surfaces and occlusal surfaces the difference in favor of the D4/EB4 was statistically significant (P < 0.05). In comparison with the Powerclean toothbrush, the D4/EB4 was significantly more effective at all sites (P < 0.001). These results indicate that not all battery-operated oscillating/rotating power toothbrushes have equal efficacy with respect to plaque removal and that, in this series of laboratory experiments, the Braun Oral-B D4/EB4 was more effective than the Actibrush and the Dr. Best Powerclean.

Dental Plaque↗
PubMed2002

Evaluation of toothbrush-induced dentin substrate wear using an in vitro ridged-configuration model.

PURPOSE: To measure the dentin substrate wear associated with toothbrush use utilizing an in vitro specimen modeled to simulate the prominences of teeth and thus more closely simulate the clinical situation. MATERIALS AND METHODS: Dentin sections were cast within resin to produce a specimen configuration with three half-round ridges: a central ridge containing dentin (3 x 10 mm) and two similar ridges on each side of the central ridge. The specimens were brushed for the equivalent of the amount of time an individual tooth surface would be brushed in a 2-year period using a machine that simulated typical movement of a toothbrush across the specimen under controlled load and fluid conditions. Brushing was done with either a manual toothbrush (MTB), the Braun Oral-B 3D Excel (PTB1) or the Sonicare Elite (PTB2) and various loads. Dentin substrate loss was measured by profilometry. RESULTS: Using this ridged specimen configuration, the results showed that the MTB and PTB1 had the highest amount of dentin substrate wear in both average depth and average maximum depth measurements. Increased toothbrush force from 90 g to 150 g increased the dentin substrate wear of both PTBs. PTB1 produced approximately 4-5 times greater average wear than PTB2 (P < 0.05).

Algorithms↗
PubMed2000

Removal of supragingival plaque in an intraoral model by use of the Sonicare toothbrush.

This study was performed to evaluate plaque removal efficacy of a mechanical toothbrush in a controlled in vivo trial. The study used enamel sections, obtained from extracted human teeth, to evaluate the efficacy of supragingival plaque removal by a mechanical powered toothbrush in various modes of use. Enamel sections were positioned in milled depressions on metal extensions of a maxillary partial denture that bilaterally extended along the buccal corridors. Four sections were used per side, positioned zero, 2 or 3mm from the surface of the metal extension. The prosthesis was worn for 16 hours, whereupon four enamel sections (two per side) were removed. Intra-oral brushing was then performed for 5 or 15 seconds on the remaining four sections. The total of adherent bacteria was then assayed from all enamel sections. Ten to twenty trials were performed (n=4 pairs/trial) for each set of variables. When the electric toothbrush was used as a manual brush ('off'), it was equivalent in plaque removal to a conventional toothbrush (Oral-B 35; P = 0.49). However, when the powered brush was in its active mode ('on'), it removed more bacteria (P < 0.0001); this efficacy was observed even when the bristle tips were at a distance from the plaque surface.

Analysis of Variance↗