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Biomedical subjects

P Renton-Harper

Publications and source records attributed to P Renton-Harper.

14 recordsLinked to original sources
PubMed2001

Plaque removal with the uninstructed use of electric toothbrushes: comparison with a manual brush and toothpaste slurry.

BACKGROUND: Individuals purchasing electric toothbrushes for the 1st time will mostly only have the manufacturer's instructional leaflet for information of usage. AIMS: This study was designed to simulate the 1st-time purchase and early use of an electric toothbrush with the aim of comparing plaque removal with a manual toothbrush. Secondary aims were to assess chemical plaque removal effects of a toothpaste slurry and to compare between 2 electric brushes which differed only in head speed. METHODS: A group of 16 dentate subjects participated in this single-examiner blind, randomised, crossover design balanced for residual effects. Subjects had "average" oral hygiene and had never used an electric toothbrush previously. 7 days prior to the study, all subjects received the slower oscillating rotating toothbrush under test to use at home as they wished. The test treatments were brushing with 2 oscillating rotating electric toothbrushes, a manual toothbrush and a rinse with a toothpaste slurry (3 g/10 ml water). On day 1 of each study period, subjects were rendered plaque-free, suspended oral hygiene and returned on day 5. Plaque was scored at baseline by index and area and after 30 s, 30 s (total 60 s) and 60 s (total 120 s) of the cleaning treatments. Washout periods were at least 2 1/2 days. RESULTS: Highly significant treatment differences were found between the 4 treatments because the toothpaste slurry was totally without effect. Analyses between the 3 brush treatments overall revealed no consistent significant differences. The data suggest that in the early days of electric toothbrush use, subjects perform no better than using a manual brush. CONCLUSIONS: The present study, taken with results from others showing greater benefits from the use of electric brushes, supports the idea that dental professionals should, where possible, provide advice and instruction in the use of such devices.

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↗
PubMed1999

Plaque regrowth studies: discriminatory power of plaque index compared to plaque area.

A large number of plaque-scoring methods exist for the evaluation of plaque inhibition by oral hygiene agents, products or devices. The ability of such methods to discriminate between high and low plaque scores has not been compared. In this retrospective analysis, the F-ratios for differences between treatments for plaque index and area were compared from 15, 4-day plaque regrowth studies. F-ratios favoured plaque index as having greater a discriminatory power compared to plaque area in 2/3 of the studies considered. It is concluded that, when appropriate, 2 scoring methods for plaque should be used, but if a choice is necessary, plaque index is likely to provide the greater discriminatory power over plaque area.

Analysis of Variance↗
PubMed1999

An evaluation of video instruction for an electric toothbrush. Comparative single-brushing cross-over study.

Instructions on the use of electric toothbrushes are usually derived from the written and/or diagrammatic leaflets provided with the device or perhaps less often instruction from a professional. Videos are now widely used for information transfer and the direction of physical activities. The aim of this study was to determine whether video instruction in the use of an electric toothbrush could promote efficient use of the device. The 2-min video demonstrated the use of an oscillating, rotating electric toothbrush used by a hygienist for 15 s in each buccal and lingual quadrant. A voice-over directed the observer to follow the hygienist's movements. The study was planned as a 2-phase, single-examiner blind, randomised, cross-over study accepting there would be confounding of the 2nd period by carry-over from the 1st. A group of 24 healthy volunteers participated who had average oral hygiene and never used an electric toothbrush. 12 subjects received the video first (VN) and 12 subjects the instructional leaflet with the device (NV). Single brushings were performed after suspending tooth cleaning for 48 h. Plaque was scored before and after brushing. A 2-week washout period was permitted before the crossover. In period 1, plaque removal with the video was overall significantly greater than with written instructions. The effects for posterior teeth were greater than anterior and comparison between groups for posterior minus anterior differences were highly significant in favour of the VN group. In period 2, the effect of period was dominant with both groups achieving greater plaque removal in period 2 than period 1. Plaque removal by group VN remained considerably greater than group NV Despite the confounding influences of carry-over in this particular design of study, the results support the idea that video instruction for electric toothbrushes could be a simple and efficient way of improving plaque removal by these devices. The methodology needs to be verified in a home-use type of investigation.

Adult↗
PubMed1999

Conversion of plaque-area measurements to plaque index scores. An assessment of variation and discriminatory power.

Plaque areas recorded graphically or photographically provide a permanent record of plaque accumulations on teeth at a moment in time. As such, these records could be re-evaluated and converted into other index scores. The purpose of this study was to determine the reproducibility of scoring a plaque index from previously recorded plaque areas and to compare such scores with the original scores of the same index. A randomised blind, crossover study comparing 5 treatments for plaque inhibition scored by plaque area and index was chosen. 2 examiners, the original scorer PRH and another, NC, 2x scored the plaque area tooth charts according to the criteria of the plaque index system used in the original study. Standard deviations of the differences showed intra-examiner repeatability to be high particularly for the original examiner. Inter-examiner reproducibility for the original index scores was considered good but less than for intra-examiner repeatability. Correlation coefficients were complimentary to the differences analysis, being very high within examiners and less high for between examiners and original and rescored index. Separation between distributions of plaque area measurements for consecutive values of the index were particular good for scores 2 versus 3 and 3 versus 4 and less good for 1 versus 2 and 4 versus 5. Reanalysis of the study for treatment differences using rescored data revealed a similar level of significance as using the original data. Rescored index had similar discriminatory power for the study as plaque area and original plaque index when both were derived from the same buccal tooth surfaces. However, discriminatory power was less by comparison with original plaque index derived from the buccal surfaces of all teeth. It is concluded that plaque area provides a permanent record of plaque distribution which can be converted into index data at a later date. Such data collection could make possible comparisons between studies using different indices.

Cross-Over Studies↗
PubMed1999

Comparison of video and written instructions for plaque removal by an oscillating/rotating/reciprocating electric toothbrush.

A previous crossover study showed that a watch-and-follow instructional video improved plaque removal by an electric toothbrush compared to the use of the instructional leaflet. This study employed a parallel design to assess the value of an instructional video for plaque removal by a new model oscillating/rotating/reciprocating electric toothbrush. 2 groups of 26 dentate subjects with average oral hygiene, who had never used an electric toothbrush, participated in this single blind, randomised parallel group designed study. On day 1 of the study, subjects received a professional prophylaxis to remove all plaque. Oral hygiene measures were then suspended and subjects returned on day 3 when a prebrushing plaque score was recorded by plaque index and area. Subjects withdrew and either read the manufacturers instructional leaflet (group L) or observed the instructional video (group V). Groups L and V then performed toothbrushing with toothpaste for 2 minutes and with group V brushing in time with the instructional video. Post-brushing plaque indices and areas were then recorded. Whole mouth, lingual, upper, lower, anterior and posterior but not buccal % reductions in plaque index and area were significantly greater in group V compared to group L. % plaque removal was also significantly greater by area at mid and distal sites but not mesial sites. Whole-mouth plaque reductions were 10% greater in group V but reached >15% at lingual surfaces. Within group differences in plaque removal at paired sites e.g., buccal/lingual, remained similar, suggesting that further improvement could be achieved by modifying the video to devote more time to the difficult-to-clean areas. In conclusion, in the early period of learning the use of an electric toothbrush, plaque removal can be improved by using an instructional video. Such watch-and-follow video routines could be extended to other areas of oral hygiene practices.

Adult↗
PubMed1998

A plaque index for occlusal surfaces and fissures. Measurement of repeatability and plaque removal.

Plaque indices have largely been developed for buccal and lingual tooth surfaces. There has been minimal interest in plaque accumulation on occlusal surfaces despite the predilection for caries at these sites. A numerical plaque index (0-5) is described based on the presence and distribution of plaque in the fissures and over the occlusal surfaces of permanent molar and premolar teeth. The repeatability of a single examiner in scoring the index was performed using 4 groups of 10 subjects. Each group of volunteers suspended tooth cleaning for 48 h and the index scored after disclosing plaque deposits. The index was rescored 60-90 min later. Plaque area was also determined by drawing the outline of plaque onto grids. Except for one condition of repeatability for one group, the 4 conditions of repeatability in scoring the index were met for all 4 groups of subjects. The sensitivity of the index and area recordings to detect plaque removed by brushing was then evaluated. A group of 10 subjects had plaque scored by index and area after suspending toothcleaning for 48 h. Subjects were then randomly allocated to brush or not brush their teeth and plaque rescored. The experiment was then repeated and brushing or not brushing crossed over. Highly significant differences between brushing and no brushing plaque indices and areas were determined. In conclusion, the occlusal fissure plaque index was easy to apply, repeatable and sufficiently sensitive to detect plaque removed by brushing. The index could find use as an additional measure of oral hygiene, in clinical trials on plaque control and possibly epidemiological studies relating to caries.

Cross-Over Studies↗
PubMed1998

Home use oral hygiene product trials; timing of the last brushing before scoring; an assessment of variation.

Home use studies to evaluate oral hygiene products often standardise the time lag between plaque scoring and the previous toothbrushing. Most protocols have favoured an evening before brushing regimen, but the rationale and even the validity of this approach has not been evaluated. In this study, a group of 30 adult subjects participated in a 4-period randomised single-blind crossover evaluation of within-subjects and between-subjects variation in plaque levels after two different brushing times. Thus, on 2 occasions, plaque was scored after an "evening before" brushing and on the other 2 occasions plaque was scored after a "morning before" brushing. As expected, mean plaque levels were lower after morning brushing, but only by 11%. There was little difference for lingual plaque (4%) but a greater difference for buccal plaque (18%). Comparisons for within-subjects variation, which ideally should be low, favoured morning brushing but differences were small and not significant. Comparisons for between subjects variation, which ideally should be high to permit discrimination between high and low plaque formers, also favoured morning brushing but were only significant for lingual plaque. Intraclass correlation coefficients of reliability revealed that overall repeatability was high for both morning and evening regimens; marginally favouring morning brushing. Analyses using all four scores per subject disregarding timing of brushing increased within subjects variation and decreased repeatability, particularly for buccal plaque. In conclusion, the data support the concept of standardising the time between plaque scoring and the previous tooth-brushing. There were no clear statistically significant grounds for preferring one brushing regimen to the other, however the data favoured the morning brushing.

Adult↗
PubMed1997

Studies on stannous fluoride toothpaste and gel (2). Effects on salivary bacterial counts and plaque regrowth in vivo.

There has been a resurgence of interest in stannous fluoride (SF) products in particular to provide oral hygiene and gingival health benefits. The aim of this study was to assess the persistence of antimicrobial action of a number of SF formulations in the mouth and relate these to plaque inhibitory activity. The formulations were 2 SF toothpastes (SF1, SF2), 2 SF plus stannous pyrophosphate toothpastes (SFSP1, SFSP2), a SF gel (G), a NaF toothpaste (C) and saline (S) as control. Both studies involve 2 different groups of 21 healthy dentate volunteers. The studies were single, blind, randomised, crossover designs balanced for residual effects, with a minimum 2 1/2 day washout period. Salivary bacterial counts were determined before and to 7 h after a single rinse with the formulations. Plaque regrowth from a zero baseline (day 1) was measured by index and area on day 5, after 2x daily rinsing with slurries of the formulations or saline. For bacterial counts, highly significant treatment differences were found. Bacterial counts were variably reduced by all treatments to 30 min then showed a variable rate of return towards baseline. All test agents were significantly better than S at some timepoints. The order for greatest persistence of action downwards was; (1) SFSP2; (2) SFSP1, G, and SF1; (3) SF2; (4) C; (5) S. Highly significant differences in plaque regrowth between treatments were found with similar mean ordering of efficacy as for salivary bacterial counts from most effective downwards namely; (1) SFSP1 and SFSP2; (2) SF1; (3) SF2; G and C; (4) S. The results were consistent with a parallel study measuring tea staining in vitro, whereby formulations causing the most staining produced the greatest persistence of action and plaque inhibitory activity. This suggests the availability of stannous ions was important for the clinical effects. It is concluded that stannous ions can enhance the plaque inhibitory action of toothpaste via a persistent antimicrobial action.

Analysis of Variance↗
PubMed1996

Local and systemic chemotherapy in the management of periodontal disease: an opinion and review of the concept.

Periodontal disease appears to arise from the interaction of pathogenic bacteria with a susceptible host. The main aims of disease management have been to establish a high standard of oral hygiene and to professionally and thoroughly debride the root surface Chemical agents could be considered for both aspects of management. Chemoprevention using supragingivally delivered agents such as chlorhexidine may be questioned for value in the pre-treatment hygiene phase but have well-established efficacy immediately preoperatively and during the post-operative weeks. Long-term maintenance use of chlorhexidine is problematic due to local side effects. Antiplaque toothpastes show modest benefits to gingivitis but are not proven to prevent recurrence of periodontitis. Chemotherapy may be directed at subgingival plaque, using antimicrobials, or at the host response using anti-inflammatory agents. Antimicrobials can be locally or systemically delivered. In most cases antimicrobial chemotherapy should be considered adjunctive to mechanical debridement. The advantages of local and systemic chemotherapy must be balanced against the disadvantages and potential side effects of agents. Antimicrobial chemotherapy offers little or no benefit to the treatment of most chronic adult periodontitis patients and should be reserved for the more rapid or refractory types of disease, and after the debridement phase. Despite the large number of studies there are insufficient comparative data to support any one local delivery system or systemic regimen as superior to another. Systemic versus local antimicrobials have not been compared to date. Host response modifying drugs such as non-steriodal anti-inflammatory drugs (NSAIDS) offer the potential to reduce breakdown and promote healing, including bone regeneration. However until more data are available, NSAIDs should not be used in the management of chronic periodontal diseases, there being no specific agent(s) or regimen established for use. Chemotherapy has an important place in the management of chronic periodontal diseases but routine use must be considered as an over prescription of these valuable agents.

Adult↗
PubMed1996

A comparison of chlorhexidine, cetylpyridinium chloride, triclosan, and C31G mouthrinse products for plaque inhibition.

There are a large number of mouthrinse products available to the general public for use as adjuncts to oral hygiene. Many have not been evaluated and relatively few comparisons of products have been made. This study compared 4 mouthrinse products containing cetylpyridinium chloride (CPC), chlorhexidine, C31G, or triclosan with saline rinse included as a placebo control. Twenty dentate volunteers took part in this 4-day plaque regrowth study which had a single blind, randomized cross-over design balanced for residual effects. On day 1 of each study period, volunteers were rendered plaque free by a professional prophylaxis, suspended normal oral hygiene measures, and rinsed twice daily for 1 minute with 15 mL of the allocated rinse. On day 5, subjects were scored for disclosed plaque by plaque index and plaque area. By both measures the order of decreasing product efficacy was chlorhexidine, CPC and triclosan, C31G, and saline. All the differences in favor of the chlorhexidine product were highly significant as were those in favor of the other rinses compared to saline. It is concluded that the findings of this study reflect the actual chemical benefits of the products divorced from the indeterminate variable of toothbrushing.

Adult↗
PubMed1992

NdYAG laser treatment of dentinal hypersensitivity.

Eighteen per cent of all patients have some degree of sensitivity and a range of therapies has been devised to alleviate this condition. An electronic monitoring machine was constructed which allowed for air stream, directed at a patient's tooth, to be started by the clinician and halted by the patient when the sensation of pain in the tooth became too unpleasant to tolerate. The time for which the patient could tolerate the air flow was electronically measured in units of 1/50th second. By measuring the patient's reaction time on each visit and correcting the readings obtained for 'tooth pain time' using these figures, a quantitative measure of sensitivity change is achieved. Using this system, a clinical trial has been conducted to test the efficacy of the NdYAG dental laser. The 30 patients treated had an average tooth pain time initially of 1.2 seconds. Following laser treatment patients were recalled at 3, 7 and 14 days. At the 2-week review, this figure had increased to 7.8 seconds, which was found to be statistically significant. Control (unlased) teeth demonstrated an average improvement of only 1.7 seconds (not statistically significant). Patients' subjective assessment of sensitivity pain on a 0-10 scale averaged 8.0 before treatment. This reduced to 3.7 after treatment. Treatment of this condition can thus be performed easily and painlessly with a predictable response and considerable patient satisfaction.

Adult↗
PubMed1991

Lasers in dentistry.

Clinical lasers are of two types; soft lasers are essentially an aid to healing with relatively few rigorous studies available to support their use. Surgical hard lasers, however, can cut both hard and soft tissues and replace the scalpel and drill in many areas. From initial experiments with the ruby laser most clinicians are using Argon, CO2 and now NdYAG systems. The first dental laser based on a NdYAG engine provides handpieces of similar size to conventional instrumentation and, being fed by a fibre-optic 'cable', has the flexibility for intra-oral use that the CO2 lasers, widely used in oral surgery, lack. Furthermore, extensive clinical investigation has demonstrated their safety in clinical practice and the fact that procedures can usually be performed without a local anaesthetic is obviously seen as a considerable advantage by patients. Sterilising as it cuts, the NdYAG laser promises to find uses not only in caries removal and soft tissue surgery, but also in endodontics and gingival curettage.

Dental Instruments↗