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Toothbrush pressures of orthodontic patients.

The intention of this study was to determine whether toothbrushing pressures varied significantly between groups of orthodontic patients who were good toothbrushers and those who were poor toothbrushers. Seventy-two patients undergoing full-banded orthodontic treatment were selected from the author's practice and were subjectively paired by him according to their habitual oral hygiene. One group of thirty-six patients who habitually displayed poor oral hygiene was compared to a group of thirty-six patients who habitually displayed good oral hygiene. A specially designed strain gauge with a force-averaging feedback mechanism was attached to each patient's manual toothbrush, and the force with which that patient brushed was averaged and recorded in pounds. The poor brushers averaged 0.20 pound, whereas the average pressure of the good brushers was 0.89 pound. The statistical evidence indicates that the difference between the two groups is highly significant and is unlikely to be due to chance alone. This study has shown that toothbrush pressures can be easily and accurately measured. The attempt to objectify a single characteristic of toothbrushing behavior in an orthodontic population is an effort to avoid the medical model explanation of behavior vis-a-vis the nonspecific and subjective word attitude. Future studies will determine whether poor toothbrushers can be changed into good toothbrushers through the progressive acquisition of greater toothbrushing forces.

Humans

[Toothbrush holder for a day-care center].

A recent investigation of the various oral hygiene activities in 23 day-care centers located in the district administered by the Verdun Community Health Department has highlighted the need for a standardized hygienic method of storing toothbrushes. The study proposed to identify the main criteria related to hygiene that must be observed in order to prevent the transmission of contagious diseases within a day-care center, through the use of toothbrushes or toothbrush holders. Furthermore, the toothbrush holder has to meet four requirements: (1) be inexpensive; (2) be easy to build or manufacture; (3) allow the storage of 15 toothbrushes at the same time; (4) permit easy identification of the toothbrush by the child or teacher. A review of the literature, together with an assessment of toothbrush holders presently used by day-care centers in the district administered by the Verdun Community Health Department, showed that there were none which completely satisfied the required criteria. Under these circumstances, the authors of the study propose a detailed plan for the construction of a toothbrush holder that will satisfy these requirements. The toothbrush holder can be used to promote dental health to the very young. A sponsor could present it as a gift to one or more day-care centers in order to demonstrate their interest in the prevention of dental disease among these children.

Child Day Care Centers

[Effectiveness of power toothbrushes].

Three power toothbrushes with different mechanical principles (blend-a-dent master-vertical oscillating system, blend-a-dent medic electric elliptical oscillating system, interplak-contra-rotationsystem of the bristle-tuft) and a conventional hand toothbrush were investigated in 60 oral hygiene-motivated persons in a three-month-study. Efficiency was tested by two parameters (plaque index, papillary-bleeding index) under statistically identical conditions. The study showed no major differences in efficiency between the power toothbrushes and the manual toothbrush. --For the whole study the power toothbrush with an elliptical oscillating system showed the best results. --Power toothbrushes are not more effective in plaque removal than a manual toothbrush. The great statistical variation of the investigated parameters in each group shows that an optimal brushing technique was more important than the choice of a certain toothbrush. --The investigation of the interproximal areas showed that a toothbrush alone is not effective enough. The additional use of dental floss and/or interdental cleaners for optimal oral hygiene is essential.

Analysis of Variance

Laboratory evaluations of toothbrush interproximal penetration ratios.

Access to interproximal tooth surfaces by toothbrush bristles has been associated with plaque removal. The ability of toothbrushes to assess the interproximal area was assessed with a new laboratory apparatus by measuring the extent of bristle-to-tooth contact in simulated toothbrushing with ink-coated toothbrush bristles. Toothbrush types evaluated were the bi-level trim Advanced Design Reach Soft, the ripple trim Crest Complete Large Soft, the flat trim Colgate Plus Full Head Adult Soft, and the flat trim Oral-B 35. Six replicates of each toothbrush were tested. Denture teeth in a Columbia Dentoform, mounted at 45 degrees, were brushed at a 300 g brushing weight for 15 horizontal strokes. Tooth #15 (upper left second molar) was then removed for measurement and the interproximal distance of ink deposition was determined under 10x magnification from the plane of the buccal contour, along the mesial side of the tooth in the lingual direction at the approximate vertical midpoint of the proximal surface. This was compared in ratio to the same measurement from the buccal contour to the midline. Mean penetration ratios were 0.84 for the Advanced Design Reach, 0.79 for Crest Complete, and 0.78 for both Colgate Plus and Oral-B 35 (overall standard error = 0.01). A one-way ANOVA showed a highly significant difference (p < 0.001) demonstrating that Advanced Design Reach penetrated significantly farther than the toothbrushes with flat or ripple trim bristle patterns. The data suggest the bi-level trim in the Advanced Design Reach toothbrush offers better penetration into the area between teeth, and may provide superior clinical or plaque removal compared to the other toothbrushes tested.

Analysis of Variance

Effects of toothbrushing prior and/or subsequent to dietary acid application on smear layer formation and the patency of dentinal tubules: an SEM study.

Dentine sensitivity is a quite common condition, associated with open dentinal tubules patent all the way to the pulp. The purpose of this in vitro study was to assess the effects of toothbrushing preceded and/or followed by dietary acid application on the patency of dentinal tubules. Dentine sections were prepared from recently extracted human molars and, after removal of the smear layer, were treated as follows: 1) toothbrushing alone; 2) toothbrushing followed by exposure to orange juice; and 3) toothbrushing subsequent to orange juice exposure. All specimens were observed in the scanning electron microscope (SEM) at a standard magnification and the patency of the dentinal tubules estimated. Results showed that toothbrushing alone was the most effective in occluding the tubules, followed by toothbrushing subsequent to dietary acid application, and then by toothbrushing prior to dietary acid application. From the results of this study it may be that in cases of dentine sensitivity toothbrushing should not precede or follow dietary acid application but be separate from mealtimes. Clinical research is required to confirm the findings of this in vitro study.

Analysis of Variance

Meswak chewing stick versus conventional toothbrush as an oral hygiene aid.

This study consisted of two trials. Trial 1 compared the meswak with the toothbrush when used twice and five times a day. Trial 2 compared habitual meswak users with toothbrush users. Under experimental conditions, a significant reduction in gingivitis was found both buccally (p less than 0.01) and lingually (p less than 0.05) after using a meswak five times a day compared with a conventional toothbrush. Twice a day brushing with a meswak produced a significant reduction in gingivitis buccally (p less than 0.005) compared with toothbrushing, but lingually the difference was insignificant. There were no significant differences in plaque scores between a meswak and a conventional toothbrush when brushing was continued five times a day. Plaque scores became significantly higher when a meswak was used only twice a day compared with toothbrushing, specifically on the lingual surfaces of the teeth (p less than 0.01). Habitual meswak users showed a significant reduction in gingival bleeding (p less than 0.05) and interproximal bone height (p less than 0.02) compared with toothbrush users. The differences in plaque scores and pocket depth measurements between the two groups were insignificant. The results imply that a meswak, used five times a day, may offer a suitable alternative to a toothbrush for reducing plaque and gingivitis. However, meswak may not be sufficient for maintaining interproximal dental health when used without the support of other oral hygiene aids.

Adult

Toothbrushing effectiveness of a group of six-year-old uninstructed schoolchildren.

The main purpose of this study was to evaluate the effectiveness of toothbrushing in 124 six year-old uninstructed schoolchildren. The toothbrushing conditions were made to closely simulate the toothbrushing procedure carried out at home. The amount of plaque before and after toothbrushing was assessed using the Modified Personal Hygiene Performance Index. An overall reduction of 54.0 per cent in plaque score was observed following toothbrushing. This reduction was much more favourable than other reported studies using subjects of similar age group. However most of the plaque that remained following brushing were accumulated in the gingival areas. The highest prebrushing score and the least effective toothbrushing ability was observed among the Malay schoolchildren. The pre and postbrushing scores among the Chinese and Indians were comparable. There was no statistically significant difference in toothbrushing ability between boys and girls at this age. The children brushed their anterior teeth better than their posterior and the facial surfaces better than the lingual. The greatest percentage reduction in plaque score was observed in the occlusal/incisal areas with the gingival areas being the least accessible. The conclusions of this study points to the lack of manual dexterity of children of this age group to effectively brush their teeth and the need for proper parental supervision in assisting them to carry out the toothbrushing procedure.

Child

Laboratory evaluations of interproximal access of two differently bristled manual toothbrushes.

The Colgate Rippled Bristles toothbrush was compared to the Oral-B 40 toothbrush using a laboratory device which simulates horizontal and vertical brushing movements under pressures of 250, 500 and 750 grams. Interproximal access was determined by measuring the width of the brushing stroke on pressure-sensitive paper surrounding anterior or posterior tooth shapes. The Colgate Rippled toothbrush was consistently superior to the Oral-B 40 toothbrush in accomplishing interproximal access in the laboratory tests performed here. On anterior-shaped teeth, the superiority (p < 0.05-0.01) was evident at all pressures tested, with both horizontal and vertical brushing movements. On posterior tooth shapes the Colgate Rippled toothbrush was superior (p < 0.01) to the Oral-B 40 toothbrush at all brushing weights and with both vertical and horizontal motions. When total interproximal access efficacy means were calculated for all brushing weights, the Colgate Rippled toothbrush was superior (p < 0.05-0.01) to the Oral-B 40 toothbrush on both anterior and posterior tooth shapes in the vertical and horizontal brushing motions.

Analysis of Variance

Dentine hypersensitivity--the effect of toothbrushing and dietary compounds on dentine in vitro: an SEM study.

Dentine hypersensitivity occurs when dentinal tubules are open on the dentine surface and patent to a vital pulp. There has been limited interest in the aetiology of dentine hypersensitivity. In particular, little is known about agents that remove the dentine smear layer to expose tubules. Toothbrushing certainly may expose dentine, but whether a toothbrush per se has the effect of opening tubules has not been established. The aim of this study in vitro was to determine whether a toothbrush could remove or create a smear layer. In addition, the combined effects of toothbrushing with dietary fluids on dentine was assessed. Toothbrushing was observed, by scanning electron microscopy, both to remove and to recreate a smear layer on dentine specimens. However, the processes took a considerable time, and under conditions of normal toothbrushing it is unlikely that the latter plays a direct aetiological role in opening tubules. Indeed, together with toothpaste it is more likely that brushing has a therapeutic action by mechanically forming a smear layer. Conversely, and importantly, toothbrushing in the presence of dietary acids enhanced smear layer removal. This finding raises the question of whether the dental profession should be advising that teeth be brushed before meals rather than after, as is often the case.

Acid Etching, Dental

Effectiveness of children's habitual toothbrushing.

Individual toothbrushing habits are usually consistent. Frequency, pattern and duration are different aspects of the toothbrushing habit. The aim of this study was to analyze the effect of habitual toothbrushing in children. The schoolchildren (n = 110) aged 13, were examined clinically before and after brushing their teeth in the habitual way; the brushing procedure was filmed without the children's knowledge. From the film, the pattern of brushing was assessed by three dentists, and the duration measured in seconds. Frequency of toothbrushing was assessed by postal questionnaire 2 months after the clinical examination. The examination included both photographed plaque and disclosed plaque diagnosed clinically. From the photographs, plaque was measured by computer planimeter as a % of plaque area and clinically by the oral debris index recommended by WHO. Subjects who had little plaque before toothbrushing were excluded from the analyses. Frequency seemed to affect plaque removal only in boys and only in the maxillary teeth. The pattern affected plaque removal in girls, but for boys, this aspect of toothbrushing affected only the left side of the jaws. Duration had produced the strongest effect on plaque removal. Therefore, duration of toothbrushing should be emphasized more in dental health education.

Adolescent

An epidemiologic approach to toothbrushing and dental abrasion.

Abrasion lesions were recorded in 818 individuals representing the adult population of 430,000 residents of the Stockholm region, Sweden. The subjects were asked about toothbrushing habits, toothbrush quality and dentifrice usage; these factors were related to abrasion criteria. Abrasion was prevalent in 30% and wedge-like or deep depressions were observed in 12%. The relationship between abrasion and toothbrushing was evident, the prevalence and severity of abrasion being correlated to toothbrushing consumption. The importance of the toothbrushing technique for the development of abrasion lesions was elucidated. Horizontal brushing technique was strongly correlated to abrasion. It was demonstrated by treating the data with the statistical AID analysis that toothbrushing factors related to the individual (brushing frequency and brushing technique) exert a greater influence than material-oriented toothbrushing factor such as dentifrice abrasivity and bristle stiffness.

Adolescent

Long-term oral effects of manual or electric toothbrushes used by mentally handicapped adults.

This study investigated the long-term oral hygiene effects in mentally handicapped patients using an electric toothbrush as compared to manual brushing. Twenty-three moderately handicapped patients were selected and sampled into two study and two control groups. The two study groups used electric toothbrushes, while the control groups used manual toothbrushes. One of each study and control groups were aided by parent or staff in brushing. Plaque and gingival indexes were scored at day 0, after 3 months and after 16 months. Instruction in toothbrushing procedures and information about oral hygiene was given. When the study was completed, no significant changes were found in or between the groups regarding plaque scores. The gingival score of the unaided electric toothbrush group was significantly reduced after 16 months. This improvement was probably attributed to frequent recalls and a well-designed prophylactic program. The main conclusion of this study is that an electric toothbrush is not superior to a manual toothbrush.

Adult

An electron microscopic comparison of bristle end-rounding of three commercial toothbrushes.

The results from three separate examinations using SEM photomicrographs and shape factor (SF) measurements show that Oral-B P-35 brushes have a highly significant difference in bristle end-rounding when compared to Colgate Precision and Crest Complete toothbrushes. The proportion of Oral-B P-35 bristles with highly rounded ends was substantially greater than that for Colgate Precision and Crest Complete toothbrushes. Oral-B also had fewer bristles in the very sharp-edged category than both Complete and Precision toothbrushes. Each toothbrush sample in these studies was purchased from geographically dispersed retail outlets throughout the United States. Scanning electron micrographs were made from a representative random sample of bristles, then digitized and evaluated using image analysis software. The comparisons were made on the basis of the number and distribution of bristles having varying degrees of roundness as determined by shape-factor analysis. Previous studies asserted that low shape-factor values indicate sharp bristle edges that are less conducive to good oral hygiene than end-rounded bristles with high SF values. In separate studies, Oral-B P-35 had a significantly higher number of highly end-rounded bristles than did either the Colgate Precision or Crest Complete toothbrushes. The averages for end-roundness fall in the order of Oral-B P-35 > Complete > Precision. Thus we conclude that the potential for harming dental tissues is less for the Oral-B P-35 toothbrush than for either the Colgate Precision or Crest Complete toothbrushes.

Analysis of Variance

[Toothbrushes in the ecology of Candida albicans].

Two hundred and twenty nine patients were sorted out at random from different services at the Hospital Universitario de Caracas, Venezuela, to investigate simultaneously the presence of Candida albicans in the mouth and in their toothbrushes. None of them showed signs of candidiasis. From the oral cavity of each patient two samples were taken by rubbing throughout the mucous membrane. One of them was cultured in oxgall agar and the other one in diluted milk agar. At the same time, the toothbrushes of the patients were cultured in oxgall agar or in diluted milk agar. The results showed evidence of C. albicans in the mouth of 28% of the patients hospitalized for different reasons, and in the 18% of the toothbrushes studied. Both media were found equally efficient for the diagnosis and identification of C. albicans in nascent culture, even with material contaminated with other yeasts and bacteria. The use of dental prosthesis, in patients without teeth and those with a few teeth, appears to be a predisposing factor for the colonization by C. albicans in healthy mouths. Out of 57 healthy mouth-carriers of C. albicans, 33 (58% of them ) had also C. albicans in their toothbrushes. These findings seem to point to the toothbrushes as being the possible reservoir and reinfection source in some cases of candidiasis. To patients suffering with oral candidiasis the use of some method for disinfecting the toothbrushes must be recommended when planning the treatment.

Candida albicans

Toothbrushing efficiency in smokers and non-smokers.

The present study was conducted to determine whether smokers have more plaque than non-smokers, and whether higher plaque scores subsequently found in smokers could be explained by differences in toothbrushing time, efficiency and frequency. Plaque was scored from photographs, before and after toothbrushing, in 64 smokers and 64 non-smokers, aged 20-40 years, matched for age and sex. The results showed that in both sexes smokers had more plaque than non-smokers. Male smokers brushed for a shorter time, and had more plaque after toothbrushing, than male non-smokers. A similar, though non-significant trend was found in females. There was no association between tobacco consumption and frequency of toothbrushing. It was concluded that the poorer oral cleanliness found in smokers both before and after toothbrushing may be explained, in part at least, by their shorter toothbrushing time.

Adult

Toothbrush age and wear as it relates to plaque control.

An investigation was conducted to test the hypothesis that age and wear of toothbrushes do not affect plaque removal. 40 preclinical dental students between the ages of 19 and 26 years were assigned randomly to 2 groups. 1 group of 19 subjects used a toothbrush for 10 weeks while the 21 subjects in the other group were given new toothbrushes every 2 weeks for 10 weeks. A baseline of zero plaque and calculus was obtained on the first visit. On subsequent visits, 2 weeks apart, the gingival status of each group was evaluated using the gingival index, and plaque levels were scored using the patient hygiene performance index. The brushing surface area of the toothbrushes was measured with a caliper as well as being graded subjectively according to their condition (good, fair or poor). Results were statistically analysed at the end of the 10-week period. It was found that after 10 weeks, the subjects using the same toothbrush for the whole period had significantly more plaque than those who replaced their brushes every 2 weeks. As brushes deteriorated, they became less effective. No differences in gingival state were detected. There was appreciable variation in toothbrush wear among subjects, some reducing their brush to a poor state in 2 weeks whereas with others the brush was rated as "good" after 10 weeks.

Adult

Gingival recession in relation to history of hard toothbrush use.

Gingival recession studies in the U.S. have related primarily to sex and age with little consideration of toothbrush hardness. This preliminary study examined the relation between a history of hard toothbrush use and gingival recession. A total of 182 subjects, male and female, between 18 and 65 years of age, with a minimum of 18 natural teeth, no advanced periodontitis or history of periodontal surgery were examined. Gingival recession was scored as present whenever the free gingival margin was apical to the cemento-enamel junction and root surface was exposed. History of hard toothbrush use was ascertained. Eighty-two subjects had a history of hard toothbrush use, 77 did not, and 23 did not know. The percentage of subjects with recession increased with age from 43% to 81%, with a figure of 63% for all age groups combined. Males tended to show slightly greater levels of recession than females. Regression analysis showed that females had about 4 percentage points less receded surfaces than males. Recession was also found to be more pronounced for subjects with a history of hard toothbrush use, with a mean of 9.4% receded surfaces versus 4.7% for those who had never used a hard brush. For users of hard toothbrushes, the percent of surfaces with recession showed a significant and dramatic increase with increasing brushing frequency; this effect did not exist for those without a history of hard brush use. The relation with age was highly significant, with regression analysis showing that the percent of surfaces with recession tends to increase about 3.5 percentage points per decade.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Clinical evaluation of the efficacy and safety of a new sonic toothbrush.

The efficacy and safety of a new sonic toothbrush were studied in this single-blind study. The sonic toothbrush combines acoustic vibrations and dynamic fluid activity surrounding the bristles with direct mechanical scrubbing of tooth surfaces. Fifty-one subjects were randomly assigned to either the sonic or the manual toothbrush. Plaque scores were assessed before and after a 2-minute brushing at baseline and 1, 2, and 4 weeks. Gingivitis and sulcular bleeding scores were also taken at each evaluation. To assess long-term safety, 29 subjects returned after 6 months of product use. Repeated measures analysis of variance of the total mean plaque score indicated a significant difference between the devices over time (P < 0.01), with the sonic toothbrush demonstrating a greater level of plaque removal on all tooth surfaces. On average, the plaque reduction from the baseline score for the sonic toothbrush was 3 times greater than the manual brush. However, when broken down by dental region, the sonic toothbrush demonstrated an improved level of plaque removal ranging from 1.5 to 11.9 times better than the manual brush, with the greatest improvement in the interproximal and lingual areas. Both the gingivitis and sulcular bleeding scores exhibited a similar, significant reduction (P < 0.005) over time for both devices with an approximate 17% decrease in the gingivitis index and a 33% decrease in sulcular bleeding sites. Safety assessment after 6 months of use indicated no soft tissue abnormalities which could be attributed to the products.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult