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PubMed1988

Clinical evaluation of plaque removal with a double-headed toothbrush.

A blind, two-way, crossover clinical trial, completed by 44 adult subjects, instructed in specific oral hygiene techniques, was carried out to compare the effectiveness of plaque removal between a new Scandinavian double-headed toothbrush and a popular single-headed brush, each used for one week. The results showed that the double-headed brush was significantly more effective in removing plaque overall than a conventional brush. The effect was most evident on all lingual surfaces, especially in the lower arch and molar regions. It was also particularly pronounced when the double-headed toothbrush was allocated for use in the 2nd week of the study. There was no significant difference in the cleaning ability of the 2 brushes on the buccal surfaces of the teeth.

Adolescent↗
PubMed1994

The effect of systemically-administered flurbiprofen as an adjunct to toothbrushing on the resolution of experimental gingivitis.

Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely researched in an attempt to control periodontal diseases. This double-blind parallel group study investigated the effect of a systemic flurbiprofen preparation (100 mg daily), when combined with toothbrushing on the resolution of experimental gingivitis in human volunteers. 47 volunteers abstained from tooth cleaning for 21 days. On day 21, 23 subjects were prescribed 100 mg of flurbiprofen daily whereas 24 subjects were prescribed placebo. In both groups, toothbrushing was re-introduced and all subjects used the Bass technique for 2 min each day. Both treatment regimens were continued for 7 days. Plaque indices, gingival indices and gingival crevicular fluid flow were assessed at baseline (day 0) and on days 21 and 27. There were no significant differences at p = 0.05 between the groups for plaque indices or gingival crevicular fluid flow. The flurbiprofen group, however, demonstrated greater resolution of gingival inflammation by day 27 when compared to the placebo controls (p = 0.04). The plasma levels of flurbiprofen in the test group showed mean concentrations of flurbiprofen of 4.7 (+/- 2.1) micrograms/ml at 1 h after dosing. After 6 h, this had fallen to 4.4 (+/- 1.6) micrograms/ml. It is concluded that these serum concentrations of flurbiprofen are sufficient to produce significant anti-inflammatory effects in the gingival tissues.

Administration, Oral↗
PubMed1995

The use of planimetry to record and score the modified Navy index and other area-based plaque indices. A comparative toothbrush study.

Many plaque-scoring methods are based on a subjective assessment of the amount of tooth surface covered by plaque or the presence or absence of plaque at specific sites. The 2x modified Navy plaque index is an example of the latter and requires chairside decisions from 9 zones of all buccal and lingual tooth surfaces, i.e., up to 576 for a complete dentition. The present study describes a procedural modification to the index, whereby plaque is recorded using an established planimetric plaque area method. Scoring is then performed using an overlay away from the clinic. To test the method, plaque-area measurements were made during a 30-subject, crossover study to compare plaque removal following single toothbrushings with 3 different types of manual toothbrush. Consistent with many such studies, no significant differences in plaque removal were noted between the brushes. The method was found quick and simple at the chairside, provided a permanent record of plaque distribution and could be analysed by clinical or nonclinical personnel under ideal conditions. The same method could be employed for other plaque indices based on area or site subjective decisions.

Cross-Over Studies↗
PubMed1996

Comparison of a sonic and a manual toothbrush for efficacy in supragingival plaque removal and reduction of gingivitis.

A new sonic electric toothbrush (Sonicare) and a traditional manual toothbrush were compared for efficacy in removing supragingival plaque and reducing gingival inflammation in a 12-week, single-blind clinical trial. 60 subjects with a gingival index (GI) of > 1.5 and no probing depths > 5 mm were randomly assigned to use either the manual or sonic brush, instructed in its use, and asked to brush each morning and evening for 2 minutes. Plaque scores were taken at baseline and at 1, 2, 4, and 12 weeks using the Turesky modification of the Quigley-Hein plaque index. Gingival inflammation was assessed by the GI, bleeding tendency score, presence or absence of bleeding on probing, volumetric measurements of gingival crevicular fluid (GCF), and aspartate aminotransferase (AST) levels in GCF. Repeated measures multivariate analyses of variance were used to detect time- and device-dependent differences for all clinical assessments between the 2 groups over the 5 visits. Both types of brush were effective in removing supragingival plaque. The sonic brush was statistically superior, on a percentage reduction basis, in removing supragingival plaque from the dentition taken as a whole (F-statistic; p = 0.012) and was particularly better in hard-to-reach areas such as posterior teeth (F-statistic; p = 0.003) and interproximal sites (F-statistic; p = 0.004). Both devices were equally effective in reducing gingival inflammation. The sonic brush exhibited less tendency to cause gingival abrasion than the manual brush (1 incident with sonic, 5 incidents with manual), confirming the safety of this product as an oral hygiene device.

Adult↗
PubMed1997

Comparisons of modalities of mechanical stimulation with a toothbrush on improvement of oxygen sufficiency in dog gingiva.

Mechanical stimulation with a toothbrush was applied to each quadrant of 10 dogs at a force of 200 g for 10 s using following modalities: vibration at attached gingiva, pressurization at attached gingiva, vibration at marginal gingiva and no treatment as a control. Hemoglobin oxygen saturation (SO2) in the gingiva was measured by non-invasive tissue reflectance spectrophotometry. Simultaneously, oxygen tension (pO2) in gingival tissue was monitored with an oxygen microelectrode. Both SO2 and pO2 increased within 10-20 min after stimulation and then slowly returned to the initial level at all treatment sites. The response was most prominent after vibration at attached gingiva. SO2 and pO2 increased by 12% and 42%, respectively, and significant increase continued for 75-85 min. Response after vibration at marginal gingiva was moderate in pO2 and transient in SO2. Pressurization at attached gingiva caused moderate response in SO2, but the increase in pO2 was slight. Control showed little change in both indices. These results suggest that vibration with a toothbrush at attached gingiva may cause a maximal response in improving oxygen sufficiency to gingival tissue.

Analysis of Variance↗
PubMed1997

In vitro effect of the Sensonic toothbrush on Treponema denticola.

The purpose of this in vitro study was to compare the effects of the Sensonic. Oral-B Braun mechanical and Oral-B manual toothbrushes upon the morphology and cellular integrity of Treponema denticola. This spirochete was chosen because of its frequent isolation from active lesions of inflammatory periodontal disease and its pathogenic potential. T. denticola, strain ATCC 33421, was grown in an anaerobic nitrogen rich atmosphere in enhanced 1186 mycoplasma broth. 160, 5-ml aliquots of cultured microbes were assigned to 1 of 3 brushing treatment groups and a control group. Samples were further divided into 4 groups of 10 samples each and assigned to one of 4 brushing exposure times: 15, 30, 45, and 60 seconds. After treatment, 0.2 ml of each sample was applied to a millipore filter and examined by SEM. Intact microbes were counted from 10 non-overlapping fields at 4500x. Remaining treated samples were pelleted and examined by TEM. A statistically significant reduction of intact microbes for the Sensonic treatment group at each exposure time was found when compared to Oral-B Braun, Oral-B manual, and non-treated controls. TEM examination of Sensonic treated samples revealed separation of the outer membrane at lower exposure times and only cellular debris after exposures of 45 and 60 s. These results suggest that exposure to the sonic frequency generated by the Sensonic toothbrush is capable of severely disrupting the structural integrity of T. denticola.

Analysis of Variance↗
PubMed1998

Effect of mechanical toothbrush stimulation on gingival microcirculatory functions in inflamed gingiva of dogs.

The effect of mechanical toothbrush stimulation on gingival microcirculatory functions was examined with and without removal of supragingival plaque in inflamed gingiva of 6 dogs. After removal of the ligatures, 4 treatment modalities: mechanical stimulation by vibration (MS), removal of supragingival plaque (PR), combination (MS+PR) and no treatment (NT), were administered to each quadrant for 2 weeks. Both quadrants with plaque removal showed a marked decrease in the gingival index score, while slight and moderate decreases were observed in NT and MS quadrants, respectively. Changes in gingival crevicular fluid flow, pocket oxygen tension and hemoglobin oxygen saturation in the gingiva were significant in the MS, PR and MS+PR quadrants. Significant treatment-by-time effects were found for all of the parameters of microcirculatory function between NT and MS quadrants, and gingival crevicular fluid flow between PR and MS+PR quadrants, respectively. These findings suggest that mechanical stimulation with a toothbrush may offer an additional benefit to gingival microcirculatory functions in inflamed gingiva.

Animals↗
PubMed2005

Approximal brush head used on a powered toothbrush.

AIM: This study was designed to test whether the approximal efficacy of a powered toothbrush (Braun Oral-B 3D Plaque Remover) can be improved when a pointed-shaped brush head (PBH) specifically designed for these approximal areas is used as compared with the standard cup-shaped brush head (CBH). MATERIAL AND METHODS: Forty non-dental students were included. They all received the powered toothbrush and two different brush heads (CBH+PBH). Instructions were given to use each brush head twice every day (2 min. with the CBH followed by 1 min. with the PBH). Two weeks later they received an appointment for the first experiment (Exp 1), prior to which they abstained from all oral hygiene procedures for 48 h. Plaque was assessed at 6 sites/tooth. Next, the dental hygienist brushed for 2 min. (30 s/quadrant) with the CBH. Plaque was scored again. Subsequently, the dental hygienist brushed the approximal areas for another minute: in two randomly selected contra-lateral quadrants for 30 s with the CBH and in the opposing quadrants for 30 s with the PBH. The next approximal plaque was scored a third time. After 2-3 weeks, Exp 2 was carried out comparable to Exp 1; only this time the panelists brushed themselves. RESULTS: Exp 1 showed approximal plaque scores at the baseline of 1.70 and 1.72 and at post-brushing 0.21 and 0.26 for the CBH + PBH and CBH only, respectively (p<0.05). The additional increase in approximal plaque reduction after 30 s of brushing with PBH was 22% and for the CBH 19% (p<0.05). Exp 2 showed approximal plaque scores at baseline of 1.76 and 1.74 and post-brushing of 0.21 and 0.24 for the CBH+PBH and the CBH, respectively. The additional approximal plaque reduction of 30 s brushing with PBH was 19% and 18% with the CBH (no significant difference). DISCUSSION/CONCLUSION: An additional 1 min. showed minor differences (1-3%) between brush heads. The effect of the 1 min. extra brushing (+/-18%) itself was much larger. It seems therefore beneficial to advise the patient to brush longer. A second different brush head may stimulate to do so.

Dental Plaque↗
PubMed2005

Sonic-powered toothbrushes and reversal of experimental gingivitis.

OBJECTIVE: To compare two sonic toothbrushes in relation to the reversal of experimental gingivitis. MATERIALS AND METHODS: Subjects refrained from brushing mandibular teeth for 21 days. During a 4-week treatment phase, the right or left side of the mouth was brushed with either the Sonic Complete (SC) or Sonicare Elite (SE) toothbrush as randomly allocated. Plaque and gingivitis were assessed on day 0, after 21 days of no oral hygiene and after 1, 2 and 4 weeks of brushing twice daily. RESULTS: Thirty-four subjects provided evaluable data. The experimentally induced gingivitis (EIG) resulted in higher bleeding and plaque scores compared with day 0. The mean plaque scores at day 21 changed from 3.09 to 1.30 for the SC, and from 3.02 to 1.21 for the SE. At the end of the treatment period, there was no significant difference between the two brushes. The mean bleeding scores changed from 1.87 (day 21) to 0.97 for the SC, and from 1.83 to 0.92 for the SE. For the assessments at 1, 2 and 4 weeks post-EIG, both brushes showed a significant decrease in bleeding scores. There were no statistically significant differences between brushes.

Adolescent↗
PubMed1983

Toothbrushing, flossing, and dental visits in relation to socioeconomic characteristics of white American families.

This study investigated the patterns of preventive dental behaviors, including toothbrushing, flossing, and dental visits with respect to certain selected socioeconomic characteristics, namely population density, age, family income, size of family, presence of children, and level of education. The sample of the study included 685 white American families. The results indicated that an individual's preventive dental behavior is related to certain socioeconomic characteristics. The individual who lives in an urban area, possesses a higher income or who has a higher educational level is more apt to take preventive dental actions. Among the socioeconomic variables, family income and educational level made significantly stronger differences with respect to toothbrushing, flossing, and dental visits. Dental visits, compared to other dental activities appeared to be more easily influenced by socioeconomic variables.

Dental Care↗
PubMed1986

Effect of filming on toothbrushing performance in uninstructed adults in north-east England.

Video recordings were obtained of 90 adults aged 18-22 yr brushing their teeth. Thirty subjects were unaware they were being filmed and 60 subjects had been informed that they would be filmed while they brushed their teeth. From repeated viewing of the tapes the areas of the mouth that were brushed, the total brushing time and the proportion of time spent brushing each of 16 areas of the mouth were obtained for each subject. Subjects who knew they were being filmed brushed significantly more mandibular occlusal surfaces, and lingual areas in both arches than subjects who were unaware they were being filmed. There was no significant difference in the mean toothbrushing time between the two groups. The informed group spent proportionally less time brushing posterior buccal areas and more time on occlusal and lingual areas than the group who were unaware they were being filmed, the difference being statistically significant for the mandibular arch areas. It was concluded that knowledge of filming alters toothbrushing behaviour to a small extent so that care should be taken when interpreting behavioural changes in future intervention studies.

Adolescent↗
PubMed1994

Caries development after substitution of supervised fluoride rinses and toothbrushings by unsupervised use of fluoride toothpaste.

In a nonfluoridated community of Finland, where fortnightly fluoride rinsing with 0.2% sodium fluoride has been used for nearly two decades, a total of 313 children 7-8 yr old were recruited and randomly divided into two groups. 206 children completed the 3-yr trial. The control group (n = 94) participated in the rinsing program which included supervised toothbrushings, while the test group (n = 112) received a new fluoride toothpaste tube (0.15% F) for home use every second month. Annual dental recordings, treatment plannings and the treatment itself were all carried out by one clinician. At the end of the study the number of caries-free children of the toothpaste group was lower (P < 0.01) and the caries increment higher (P < 0.05) than that of the mouthrinse group. Out of the mean of four dental visits per child and year some 1.5 were prophylactic by nature. No differences were found between the number of treatment visits, time or prophylactic care of the two groups. Unsupervised use of fluoride toothpaste may not be a sufficient substitute for the school-based fortnightly fluoride rinses and supervised toothbrushings in caries prevention of children with erupting permanent teeth.

Child↗
PubMed1978

Contamination of toothpaste and toothbrush by Streptococcus mutans.

Toothbrushes and toothpaste tubes used by persons infected with S. mutans were examined for the presence of this microorganism. Fifteen minutes after brushing greater than 10(6) S. mutans were isolated from the toothbrushes and after ordinary storage for 24 h 10(4) were recovered. From two out of 10 toothpaste tubes S. mutans was isolated from the orifice of the tube. The implications of these findings for the spread of the microorganism are discussed.

Dentifrices↗
PubMed1988

Cervical abrasion in relation to toothbrushing and periodontal health.

Cervical abrasion and some factors related to oral hygiene habits and periodontal health were investigated in 250 subjects aged 21-60 yr. The subjects were considered dentally aware since they had visited their dentist on a regular basis over the past several years. A high occurrence rate of cervical abrasion was noted with 85% of subjects exhibiting at least one superficial lesion. Manifest or deep lesions, although less common, were present in 22% of subjects. Both prevalence and severity increased with age. The severity expressed as the mean number of lesions was 7.3 for the total sample. It increased significantly with calculus index, frequency of periodontal pockets, and reduction of the alveolar bone height. No significant associations were observed between abrasion and oral hygiene factors. It is concluded that cervical abrasion, although most likely related to toothbrushing, may not be synonymous with periodontal health. Ineffective toothbrushing may not only fail to prevent disease but may also cause cervical abrasion.

Adult↗
PubMedDate not supplied

Testing toothbrushing ability of elderly patients.

An individual's ability to perform adequate oral care may become jeopardized by medical and physical insults associated with the aging process. Declines in oral care abilities may be difficult to identify, and usually go unnoticed and unaddressed. This study examined a tool developed to assess toothbrushing ability in elderly patients. The Toothbrushing Ability Test (TAT) was examined for its ability to predict brushing effectiveness (measured by plaque levels) and to determine its interrater and intrarater reliability. Fifty-eight dentate subjects, age 65 and older, from the Portland Veterans Affairs Medical Center and a community nursing home participated. Results showed highly significant Spearman correlations between TAT scores and plaque levels (r = 0.719; p < 0.000). Correlations also revealed high interrater (r = 0.87) and intrarater reliability (r = 0.82). The results suggest that the TAT is a practical and effective screening tool for assessing oral self-care ability in the elderly.

Aged↗
PubMed2005

Efficacy of removal of sucrose-supplemented interproximal plaque by electric toothbrushes in an in vitro model.

Electric toothbrushes were evaluated using a model of plaque removal by fluid shear forces. Sucrose supplementation during plaque development did not affect the removal of bacteria from biofilm exposed to low-energy shear but did increase their resistance to high-energy shear. The toothbrush supplying high-energy shear forces removed significantly more viable bacteria.

Bacteria↗
PubMed1993

An in vitro and in vivo study of toothbrush bristle splaying.

The extent to which a toothbrush is worn out, as evidenced by bristle splaying, is an important determinant of cleaning efficacy. In order for this aspect of oral hygiene to be studied, an accelerated means of producing a life-like pattern of bristle splaying was investigated and compared with splaying induced by a human test-panel. Porcelain denture teeth were brushed under a static applied load in a slurry of dentifrice, by means of a revolving "figure 8" motion, for up to 12,000 revolutions. This was found to induce an increase in the degree of splaying (as measured by "wear index") that was well-fitted (R2 = 0.96) by a second-order expression of the form: WI = WIi + Ritj - Ctj2 where WI = wear index, WIi = initial wear index, Ri = initial rate of increase in WI, tj = brushing time measured in either machine revolutions (tr) or weeks of human use (tw), and C = a separate constant for each brushing mode (machine or human panel). The rate of splaying was found to be strongly influenced by the quality of the bristle filament, but not by small differences in toothbrush design. The splaying pattern induced by the machine could not be distinguished visually from that in a set of brushes used at home by human volunteers. A strong correlation was found between the splaying produced by machine-brushing and by a panel who brushed free-style at home for 13 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Electric toothbrushes--for whom are they designed?

Powered toothbrushes were first introduced on a large scale in the early 1960s. However, because of a clear lack of superiority compared with manual brushes, and problems with mechanical breakdowns, their sales decreased significantly. However, recommendation for their use continued in special populations with dexterity and cognition problems. The 1990s ushered in an era of new technology, and studies began to suggest superiority of some powered brushes, particularly those using oscillating-rotating or counter-rotational actions. Some studies have shown interproximal cleansing abilities superior to those of manual brushes and yielding results similar to those achieved with the use of a manual brush and floss. Both controlled and open-labeled studies have suggested that electric brushes improve gingival health with patients who routinely used manual brushes prior to using these new powered brushes, and safety has been clearly established. In recommending powered toothbrushes, practitioners should familiarize themselves with the products available, with the clinical studies supporting their benefits compared with manual brushes, their safety and ease of use, and the patient's economic status.

Child↗