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PubMed2000

Power toothbrushes, gender, and dentin hypersensitivity.

Power toothbrushes require less force for plaque removal than manual brushes. In addition, in vitro studies have indicated that brushing with low force could occlude patent dentin tubules by formation of a smear layer. Hence, lessening the force necessary to remove plaque may reduce dentin hypersensitivity. However, it was recently suggested that the use of an oscillating/rotating power toothbrush could decrease tooth sensitivity as compared to a sonic power toothbrush. Therefore, the objective of the present research was to compare the effect on dentin hypersensitivity of two different types of power brushes, the Optiva Sonicare and the Braun Oral B Ultra Plaque Remover. The null hypothesis was tested in an 8-week, randomized, parallel group, examiner-blind clinical trial. Fifty-nine subjects with a history of dentin hypersensitivity participated. Dentin hypersensitivity-associated pain was elicited using tactile and evaporative stimuli and assessed using a visual analog scale (VAS) instrument. Clinical examinations were carried out at screening and baseline and repeated after 8 weeks of twice daily use of the power brushes. Data analysis was performed on VAS scores obtained at the final visit following adjustment for group differences at baseline. A 35% to 40% reduction in pain as compared to baseline was observed in both treatment groups. Treatment-related differences were not statistically significant. A gender-related effect on dentin hypersensitivity was observed using the tactile stimulus and may merit further investigation.

Adult↗
PubMed2005

Effect of topical fluoride application on toothbrushing abrasion of resin composites.

OBJECTIVES: This in vitro study assesses toothbrushing abrasion of a microfill (Heliomolar Radioopaque) and a hybrid composite (Herculite XRV) after application of two acidic fluoride agents. METHODS: Thirty-six specimens of each resin composite were fabricated, ground flat and polished. Subsequently the 36 samples of each material were evenly assigned to three groups. In the first group, samples were treated with the fluoride varnish Bifluorid 12 (5.5% F, pH 5.6), in the second group with Elmex Fluid (1.25% F, pH 4.3). In the third group, specimens remained unfluoridated (controls). After 8h, the samples were subjected to toothbrushing abrasion (2000 brushing strokes, load: 250 g) in an abrasive slurry. Fluoridation and brushing abrasion were repeated twice. Afterwards, abrasion of the materials was quantitatively determined with a laser profilometer and statistically analyzed (ANOVA). RESULTS AND SIGNIFICANCE: With Herculite both, Bifluorid 12 (P = 0.0001) and Elmex Fluid (P = 0.0001) led to a significant increase of brushing abrasion compared to the non-fluoridated group. However, no significant difference was observed between the two fluoridation regimes. Heliomolar showed a tendency towards higher abrasion after treatment with Elmex Fluid compared to Bifluorid 12 (P = 0.0496) and the non-fluoridated group (P = 0.0496), whereas treatment with Bifluorid 12 yielded no significant difference compared to the non-fluoridated Heliomolar specimens. Fluoridation of Herculite resulted in a 106-121% increase of abrasion, whereas Heliomolar only showed an increase by 5-30%. Application of the acidic fluoride products used led to an increase in toothbrushing abrasion of the tested composite restorative materials. However, clinical long-term studies are needed to determine the effect of topical fluoride regimes on resin composite materials.

Acrylic Resins↗
PubMed1995

Clinical evaluation of the effect of an ultrasonic toothbrush on plaque, gingivitis, and gingival bleeding: a six-month study.

This study evaluated the long-term effect of an ultrasonic toothbrush used as part of a daily oral hygiene regimen on supragingival plaque, gingivitis, and gingival bleeding. Compared with a conventional toothbrush, the ultrasonic toothbrush was significantly more effective in reducing plaque formation (p < 0.05), removing plaque (p < 0.05), and reducing gingivitis (p < 0.05) during the 6-month study period.

Adult↗
PubMed1997

In vitro toothbrush-dentifrice abrasion of resin-modified glass ionomers.

OBJECTIVES: This study was conducted to compare the rate of abrasive wear and change in surface roughness of resin-modified and conventional acid-base glass ionomers when subjected to toothbrush-dentifrice abrasion. METHODS: Two resin-modified and two conventional glass ionomers were used. Samples of a high-copper amalgam and a hybrid resin composite were used as reference materials. Specimens of each material were prepared and subjected to toothbrush-dentifrice abrasion using 20,000 strokes of brushing. The amount of vertical loss of material was determined by profilometry (Surfcom-4A, Tokyo-Seimitsu, Tokyo, Japan). The surface characteristics after abrasion were evaluated on secondary electron images by SEM, and the surface hardness (KHN) was also measured for all materials. Data were analyzed by one-way ANOVA (p < 0.05), followed by a multiple comparisons test using LSD (Least-significant difference) at a level of p < 0.05. RESULTS: The abrasion resistance of resin-modified glass-ionomers was statistically lower for the amalgam and the resin composite reference materials. Statistically lower abrasion resistance and surface hardness were observed for the resin-modified glass ionomers than for their conventional acid-base counterparts when two forms of products from the same manufacturer were compared. SEM observations made after abrasion testing showed a significantly rougher surface for all glass ionomer materials than for the amalgam and the resin composite. SIGNIFICANCE: When comparisons were made between products from the same manufacturers, it was found that in vitro resistance to toothbrush-dentifrice abrasion of the resin-modified glass ionomers is inferior to that of the conventional acid-base glass ionomers. The lower abrasion resistance found in the resin-modified products appears to be related to their lower surface hardness.

Aluminum Hydroxide↗
PubMed1999

Effect of brushing with sonic and counterrotational toothbrushes on the bond strength of orthodontic brackets.

The purpose of this study was to evaluate the effect of brushing with both a sonic and mechanical counter rotary power toothbrush on the bond strength of orthodontic brackets. Forty-five extracted teeth were divided into three random groups and had orthodontic brackets bonded to them. One group was brushed with a counterrotational toothbrush, the Interplak, one group with a sonic toothbrush, the Sonicare, and a third group was not brushed and was held as a control. After the equivalent of 2 years brushing, the teeth were placed in an Instron machine and the shear force to remove the brackets was recorded. Group 1, the counter rotary power brush, had a mean of 107.5 kg/cm2, the second group, the sonic brush, had a mean of 79.7 kg/cm2, and the control group had a mean of 125. 4 kg/cm2. Single factor analysis of variance followed by the Fisher-Hayter Multiple Comparison Procedure showed a statistically significant difference between the sonic power brush and the control (P <.01), but no significant difference between the counter rotary and the control (P >.05). There was no significant difference between the two power brushes (P >.05).

Analysis of Variance↗
PubMed2000

Comparison of a double-textured prototype manual toothbrush with 3 branded products. A professional brushing study.

BACKGROUND: The consensus has been that there is no one superior design of manual toothbrush for plaque removal, despite, in some cases, encouraging findings from laboratory studies. The user appears the major variable and may mask differences in brush efficacy. AIMS: The aim of this study was to compare 2 new double-filament texture brushes with 3 established brands for plaque removal, under standardised conditions of professional brushing. METHOD: The study was a blind, randomised crossover design, balanced for residual effects. A panel of 15 subjects suspended tooth cleaning for 3 days. On day 4, plaque was scored from 6 sites per tooth before and after a 2-min professional toothbrushing. A washout period of at least 3 days was allowed between study periods. RESULTS: Overall plaque removal was 50% with no significant differences between brushes, a 3% absolute difference in average total mouth plaque separating brushes. However, at upper- and mid-buccal sites, a not significant 8% and a significant 9% difference, respectively, in plaque removal were recorded in favour of one of the prototype brushes, and at the mid-lingual site, there was a non-significant 10% difference in favour of one branded brush. Other sites were cleaned similarly by all brushes except for reduced plaque removal from buccal compared to lingual surfaces and interproximal compared to mid-surface sites. Highly significant subject differences in plaque removal were noted which may be relevant to inherent anatomical difficulties in tooth cleaning for some individuals. Period effects were not significant, supporting the consistency in brushing by the professional brusher. CONCLUSION: The method appeared capable of detecting small benefits of brush design. However, the benefits reported must be taken within the context of an overall lack of difference between brushes. The method could be used to set and record a minimum level of efficacy for toothbrushes.

Adult↗
PubMed2000

The use of professional brushing to compare 3 toothbrushes for plaque removal from individuals with gingival recession.

BACKGROUND: Toothbrush filament configuration now varies considerably, usually with the intention of improving plaque removal overall or from specific sites. AIMS: The aim of the study was to compare 2 branded toothbrushes with a brush designed with a convex filament head arrangement to improve plaque removal from teeth with buccal gingival recession. METHODS: The study was a randomised, 3-treatment, double-blind crossover design balanced for residual effects and involving 18 healthy volunteers. On day 1, subjects suspended toothcleaning and returned to the clinic on day 4. Plaque was scored by area and index before and after 2 min of toothbrushing with the allocated brush. Brushing was performed by a hygienist allocating a timed 15 s to each of the 8 buccal and lingual quadrants. 3 days was allowed between treatment periods. RESULTS: Plaque accumulation differed considerably by site as did plaque removal. Overall plaque removal was 40%. Analysis showed significant subject differences but, no significant period or treatment differences. CONCLUSIONS: Consistent with other reports, it must be concluded that brush design is not a major variable in plaque removal. However using this "robot"-like model, the dentition of some individuals and specific dental surfaces are inherently more difficult to clean than others.

Adult↗
PubMed2001

Abrasion and stain removal by different manual toothbrushes and brush actions: studies in vitro.

BACKGROUND AND AIMS: A limited amount of data using flat trim multitufted toothbrushes shows that abrasion of substrate surfaces by a standard toothpaste varies dependent on filament stiffness and configuration; soft brushes producing the most abrasion. The aims of these studies in vitro were to assess toothpaste abrasion of acrylic and stain removal by 5 proprietary medium toothbrushes with different head filament arrangements, and a prototype brush with rectangular filaments. The prototype brush had a medium texture in the long axis and soft texture at right angles to the long axis. MATERIAL AND METHOD: Optically clear acrylic was used as the substrate for abrasion by a standard toothpaste. Loss of substrate was determined by profilometry after 5000, 10000, 15000 and 20000 linear or rotary brushing actions. Stain removal was determined spectrophotometrically from optically clear acrylic specimens stained by chlorhexidine tea soaking sequences. Stained specimens were brushed with water using linear or rotary actions and measurements taken every 10 s to 60 s. RESULTS: Abrasion was progressive with increasing strokes and the pattern for each brush and brush action was to a first approximation linear. Overall, abrasion was significantly greater with linear compared to rotary action. Also overall brushes differed in the abrasion produced with both actions and particularly at greater exposure times. Within brush differences for the two motions were all significant by 20000 strokes except for the prototype brush. Stain removal was progressive over time with each brush but the pattern was non-linear. For the proprietary brushes the rotary motion removed less stain. For the prototype brush more stain was removed with the rotary action. Overall brushes differed significantly in stain removal within each motion and for each motion most differences between the proprietary and prototype brushes reached significance. CONCLUSIONS: The differences between brushes for both abrasion and stain removal must in large part relate to the filament contact area with the substrate surface. Whilst the model may not be predictive of clinical differences, it could find use to establish minimum criteria for toothbrush action.

Acrylic Resins↗
PubMed2001

Oscillating/rotating electric toothbrushes compared: plaque removal and gingival abrasion.

OBJECTIVES: This study was designed to test the efficacy in plaque removal and the potential for gingival abrasion of 3 electric toothbrushes. The established Braun Oral-B 'Ultra' plaque remover (D9), the Philips/Jordan HP 735, and the newly designed Braun Oral-B 3D Plaque Remover (3D). MATERIAL AND METHODS: This study was designed as a split-mouth, single blind, randomised clinical study consisting of 3 identical experiments with 3 combinations of toothbrushes (exp 1:3D-HP735, exp 2:D9-HP735, exp 3:D9-3D). 40 subjects were requested not to brush their teeth 48 h prior to each examination. At this visit, both the gums and teeth were disclosed for the assessment of baseline plaque and gingival abrasion. Abrasion sites were scored as small (< or = 5 mm) or large sites (> 5 mm). Plaque was assessed according to the Quigley & Hein index at 6 sites per tooth. The participants brushed 60 s with the 2 brushes, each brush in 2 randomly selected contra-lateral quadrants. RESULTS: The increase in number of small abrasions after brushing (exp. 1) was 1.2 versus 1.7 for 3D and HP735, respectively (ns); In exp. 2 the increase was 0.9 for both D9 and HP735. In exp. 3 the increase was 0.4 sites for both D9 and 3D. Comparison of the 3D and HP735 showed a mean plaque reduction of 67% and 54%, respectively (p<0.05); when the D9 and HP735 were compared, a mean plaque reduction of 70% and 58%, respectively, was found (p<0.05); a mean plaque reduction of 74% was found in the comparison of D9 and 3D. CONCLUSION: The results show that the potential gingival abrasion after brushing is comparable for all 3 electric toothbrushes. In addition the longer the subjects used the brushes the less abrasion occurred. Finally both 3D and D9 were more effective than the HP735 in removing plaque.

Analysis of Variance↗
PubMed2001

Video instruction to establish a panel of experts to compare tooth cleaning by 4 electric toothbrushes.

BACKGROUND AND AIMS: Laboratory robots can reveal differences in the cleaning of artificial tooth surfaces by different electric toothbrushes. The primary aim of this study was to establish, through video instruction, a panel of experts in tooth cleaning with an oscillating rotating electric toothbrush in an attempt to mimic the highly reproducible laboratory robot. A secondary aim was to use the "expert" panel, in an attempt to distinguish between tooth cleaning efficacy of 4 head/model combinations of the oscillating rotating electric brush. METHOD: A 24-subject panel, after video training and home habituation for up to 12 weeks with the basic model of electric brush, participated in a single examiner blind, 4-cell, randomised, cross-over study balanced for residual effects. In each period, subjects suspended tooth cleaning for 4 days. Plaque was then scored by area before and after tooth brushing for 2 min in tandem with the instructional video with the allocated brush head/model combination. RESULTS: Differences between subjects was significant, but overall plaque removal with all brushes was of the order of 85% with one subject achieving >97% plaque removal. There were significant differences between the brushes with the oscillating rotating brush with the faster head movement, in most analyses, significantly more effective than the slower oscillating rotating brush with 2 head combinations. The faster oscillating rotating brush was also significantly more effective than the most recently introduced oscillating rotating reciprocating model. CONCLUSIONS: Previous studies have shown that single uses of watch-and-follow video instruction significantly improve toothcleaning with electric toothbrushes. The present study shows that extended training using these videos results in almost complete plaque removal even when prebrushing plaque levels have been enhanced by a 4-day period of no oral hygiene. Furthermore, the establishment of an "expert" panel can distinguish between brushes of different cleaning efficiencies. However, given the level of achievement of all panel members with all brushes, the absolute differences observed are of doubtful clinical significance for gingival health. Finally, the slightly-reduced plaque removal by the 3 directional head action brush can be explained by the inability within the present protocol to habituate the subjects in its use.

Adolescent↗
PubMed2001

Computer-based intraoral image analysis of the clinical plaque removing capacity of 3 manual toothbrushes.

BACKGROUND: (I) Introducing an intraoral camera system with a special positioner to allow computer-based analysis of reproducible images on lingual tooth surfaces and (II) comparing plaque removal by three manual toothbrushes with different brushhead designs (convex, multilevel and flat trimmed) on lingual mandibular tooth surfaces. METHOD: In a clinical single-blind, crossover, 24-h plaque-regrowth study on 25 subjects, a computer-based index (PPI) was used to evaluate pre- and postbrushing plaque on lingual surfaces of mandibular premolars and molars. Subjects brushed their teeth under standardized conditions at three visits, each time with a different, randomly assigned toothbrush. RESULTS: The intraoral camera system allowed a reproducible and relatively convenient access to the lingual surfaces of the mandibular teeth and provided an increase in objectivity. Overall, each brush achieved statistically significant plaque removal, however, none reached clinical relevance. The multilevel brush was superior at specific sites, but failed to show statistically significant superiority in terms of overall plaque reduction. Without regard of the toothbrush used, the right handed subjects were less efficient in removing plaque from the right side compared to the left. CONCLUSIONS: The method is able to detect even small differences in plaque reduction. None of the different brushhead designs was able to compensate an insufficient brushing techniques.

Adult↗
PubMed2002

Clinical efficacy of a new sonic/ultrasonic toothbrush.

OBJECTIVES: The purpose of this clinical study was to evaluate the efficacy of the Ultra Sonex Ultima(R) in comparison with a conventional manual toothbrush. MATERIAL AND METHODS: In all, 64 healthy volunteers (32 females, 32 males) took part in the parallel-design treatment-blind study. After a screening examination and stratification by age, sex and papillary bleeding index (PBI), the participants were randomly assigned to two groups with 32 subjects each. Four weeks later, the Turesky modification of the Quigley-Hein plaque index (PI), the approximal plaque index (API), and the PBI were recorded at baseline. Four and 8 weeks after baseline, the indices were recorded again. RESULTS: During the study period of 8 weeks, the API showed no difference between the manual and the electric toothbrush. For the median PI, a statistically significant difference (p < 0.001) was found after 4 (manual: 2.16 vs. electric: 1.34) and 8 weeks (1.96 vs. 0.92). After 4 weeks, the median PBI was 0.75 for the manual and 0.43 for the electric brush (p < 0.01). The values after 8 weeks were 0.63 (manual) and 0.29 (electric, p < 0.001). CONCLUSION: The Ultra Sonex Ultima may be more efficacious than manual toothbrushes in removing plaque and preventing gingivitis in patients without severe periodontal disease.

Adolescent↗
PubMed2002

A systematic review of powered vs manual toothbrushes in periodontal cause-related therapy.

BACKGROUND: Power-driven toothbrushes (PDT) have been designed to improve the efficacy of oral hygiene. It is not clear how they compare in efficacy with manual toothbrushes in cause-related periodontal therapy. OBJECTIVES: To evaluate the effectiveness of the use of a PDT as compared with a manual toothbrush (MT), in terms of gingival bleeding or inflammation resolution, in cause-related periodontal therapy. MATERIAL AND METHODS: An electronic (MEDLINE and Cochrane Oral Health Group Specialised Trials Register) and a manual search were made to detect studies which permitted the evaluation of the efficacy of PDT in the reduction of gingival bleeding or inflammation, and their effect on other secondary variables. Only randomized studies in adults, published in English up to June 2001, which compared a PDT with an MT, and evaluated the evolution of gingival bleeding or inflammation were included. The selection of articles, extraction of data and assessment of validity were made independently by several reviewers. RESULTS: Twenty-one studies were finally selected. The heterogeneity of the data prevented a quantitative analysis. A higher efficacy in the reduction of gingival bleeding or inflammation in the PDT patients was detected in 10 studies. This effect appears to be related to the capacity to reduce plaque, and is more evident in counter-rotational and oscillating-rotating brushes. No solid evidence was found for a higher efficacy of sonic brushes. In short-term studies with prophylaxis after initial examination, independently of the type of PDT tested, no significant differences were found. CONCLUSION: The use of PDT, especially counter-rotational and oscillating-rotating brushes, can be beneficial in reducing the levels of gingival bleeding or inflammation. There is a need for methodological homogeneity in future studies in this field to enable quantitative analysis of their results.

Adult↗
PubMed2006

Erosion of enamel by non-carbonated soft drinks with and without toothbrushing abrasion.

OBJECTIVE: To investigate how enamel loss due to erosion, and due to cycling of erosion and abrasion, depends on compositional parameters of soft drinks, and particularly whether the thickness of the erosive softened layer is a function of drink composition. SETTING: University dental hospital research laboratory in the UK, 2004. MATERIALS AND METHODS: Six drinks were chosen based on their popularity and composition: apple juice, orange juice, apple drink, orange drink, cranberry drink and 'ToothKind' blackcurrant drink. Group A samples (n = 36) were exposed to soft drinks at 36 degrees C for six consecutive 10 minute periods. Group B samples (n = 36) were subjected to alternating erosion and toothbrushing, repeated six times. Enamel loss was measured using optical profilometry. RESULTS: Group A: significant enamel loss was seen for all drinks (p < 0.001). Erosion was correlated with pH and calcium concentration but not phosphate concentration or titratable acidity. Group B: significant additional material loss due to toothbrush abrasion occurred with all drinks. Abrasive enamel loss differed between the drinks and was positively correlated with drink erosive potential. CONCLUSION: Enamel loss by erosion is exacerbated by subsequent abrasion. The amount of softened enamel removed by toothbrushing is a function of the chemical composition of the erosive medium.

Analysis of Variance↗
PubMed2004

Effects of toothbrushing frequency on proliferation of gingival cells and collagen synthesis.

BACKGROUND: Mechanical stimulation by toothbrushing enhances proliferation of fibroblasts and junctional epithelium (JE). These changes in gingiva may depend on the interval between toothbrushing. The effects of toothbrushing frequency on proliferation of gingival fibroblasts and basal cells of JE were evaluated. METHODS: Twelve mongrel dogs were used. Each tooth was brushed for 20 s at 1.96 N. The subepithelial connective tissue of JE was examined for proliferating cell nuclear antigen (PCNA)-positive fibroblasts and procollagen type-I C-peptide (PIP)-positive fibroblasts. JE was examined for PCNA-positive basal cells. RESULTS: Gingiva that received brushing twice a day showed increases in the density of fibroblasts and ratio of PCNA-positive fibroblasts to total fibroblasts at 4 weeks. The ratio of PIP-positive fibroblasts increased at 8 weeks in gingiva brushed twice a day and once a day. PCNA-positive basal cell ratio increased at 4 weeks in gingiva brushed twice a day and once a day. CONCLUSIONS: A high frequency of brushing was associated with increased numbers of PCNA-positive fibroblasts, PIP-positive fibroblasts and PCNA-positive basal cells. Gingival cell proliferation increased and reached a plateau earlier in gingiva brushed twice a day than in gingiva brushed once a day.

Analysis of Variance↗
PubMed2004

A clinical study to assess the ability of a powered toothbrush to remove chlorhexidine/tea dental stain.

AIM: A single-center, single-blind, two-way crossover study was performed to compare the effects of an electric powered toothbrush with a conventional manual toothbrush at removing chlorhexidine/tea tooth staining. METHODS: This study used 24 subjects. During the week before the study, the subjects received a prophylaxis to remove all staining, plaque and calculus deposits. On the Monday of the following week, subjects returned to the clinic to receive a further prophylaxis. Under direct supervision, they then rinsed with a 0.2% chlorhexidine mouthrinse, immediately followed by a rinse with a warm black tea solution. This cycle was repeated hourly eight times throughout the day and on the following days until the Friday. Throughout this period, volunteers omitted all other forms of oral hygiene except rinsing with the chlorhexidine mouthwash. On the Friday, the level of stain was assessed both prior to and immediately after brushing with the allocated brush with toothpaste for 1 min. This was done in an adjoining room (out of sight of the clinical scorer). Subjects were then instructed to use the toothbrush at home according to their normal oral hygiene practices. On the following Friday, subjects returned to the clinic when the stain present was re-assessed. Each subject received a thorough prophylaxis to remove all plaque calculus and staining before starting the second period of the study and again on completion of the study. RESULTS: The study showed relatively little difference between the ability of the two brushes to remove stain at a single test brushing. However, there was some evidence that the powered brush was more effective than the manual brush in minimising stain level during the home use period, overall and in particular for gingival crescent sites. CONCLUSIONS: This study has suggested that the powered brush may become more effective at reducing dental stain, the longer the brush is used under normal home conditions.

Adult↗
PubMed1995

Between-meal eating, toothbrushing frequency and dental caries in 4-year-old children in the north of Sweden.

Two hundred and forty-nine 4-year-old children were examined for dental caries, and data were collected on frequency of toothbrushing, use of fluorides, and intake of nine different snack products. Dental caries experience of children who brushed once or twice daily with parental help was significantly lower than that of children who brushed irregularly. The intake of snacks was high. Buns and cakes, ice cream, and sweet beverages were consumed more often than sweets. Children who had high snack intakes and brushed irregularly had significantly higher caries experience than those with low snack intakes and regular toothbrushing. Therefore irregular toothbrushing was shown to potentiate the impact of frequent snacking.

Analysis of Variance↗
PubMed1996

A comparison of the ability of foam swabs and toothbrushes to remove dental plaque: implications for nursing practice.

This study aimed to assess the impact which the use of a toothbrush and the use of foam swabs had on the removal of dental plaque over a 6-day period. Three experiments were completed and duplicated using the author's mouth and one of these experiments was completed a third time on a volunteer's mouth. A plaque scoring system which quantified the amount of plaque on teeth in areas adjacent to periodontal tissue, and therefore capable of initiating inflammation, was used after plaque had been disclosed. Plaque at the gum/tooth margin (gingival crevice plaque) and plaque between teeth (approximal plaque) was measured. At the end of each 6-day period, which commenced with all tooth surfaces clean, the ability of the toothbrush to remove plaque was consistently better than that of swabs, and usually achieved complete visible plaque removal from all sites. In contrast, plaque remained in all sites which had been cleaned using foam swabs (after using a 'swabbing' or 'scrubbing' technique). However, it was possible to remove plaque from a number of gingival crevice sites with a swab when a varied 'any technique' was used on the visible disclosed plaque. The plaque in all approximal sites still remained after this technique. An experiment to measure the effect of using foam swabs on plaque which had been allowed to accumulate over a 6 day period produced similar results. The results from this study suggest that the success of a toothbrush in removing plaque is affected by user technique (total visible plaque removal was not achievable), and that foam swabs are not able to remove plaque from some 'sheltered' areas of teeth (total visible plaque removal was not achievable). The implications of these findings to nursing practice are discussed.

Clinical Nursing Research↗