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Plaque removal by worn toothbrush.

BACKGROUND/AIMS: Assessment of the influence of toothbrush wear on plaque (PI) and gingival (GI) indexes. METHOD: 20 university students were recruited. PI and GI were recorded at the starting point (T0). Each subject received a toothbrush and toothpaste. 5 measurements of toothbrush were recorded to establish the initial size. The subjects were instructed to brush 3 x a day and to refrain from using other plaque removal aids. After 1 month (T1), the subjects were randomly divided into 2 groups: group no. 1 substituted the toothbrush at each monthly visit; group no. 2 brushed only with the toothbrush provided at T0. Recalls were scheduled after 1 (T1), 2 (T2) and 3 months (T3). PI, GI and an index of wear (WI) were calculated using 5 measurements of the toothbrush head and were recorded at recalls. RESULTS: From T0 to T3, a significant increase of PI was found within both groups. Non-significant differences, but very close to the significant level (p= 0.063), in group no. 1 and significant differences in group no. 2 of GI were found. No significant differences of PI and GI were found between groups. Increase of the WI was registered from T0 to T3 (p<0.001). CONCLUSION: Each individual is capable of maintaining low PI, even if using a toothbrush that shows evidence of wear.

Adult↗

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↗

The plaque-removing efficacy of an oscillating/rotating toothbrush. A short-term study.

The purpose of the present study was to test the effectiveness of a new type of BRAUN electric toothbrush (D5) in comparison with the traditional BRAUN electric toothbrush (D3) and to a manual toothbrush (M). For this study, 60 dental students were selected who had no previous experience with the use of an electric toothbrush. The study consisted of 3 experiments. Prior to each experiment, all students were asked to abstain from all oral hygiene procedures for at least 24 h. In Exp I, the efficacy of toothbrushing was studied when one of the investigators brushed the teeth of the students. No toothpaste was used in this first part of the study. In Exp II, the efficacy of brushing was evaluated when the brushing was carried out by the students themselves. In Exp III, the efficacy of the brushing was studied after the students had received a professional instruction and oral prophylaxis. The available time for the brushing amounted to a total of 2 min per mouth. The amount of dental plaque was evaluated by means of the Silness and Löe plaque index at 6 sites around the tooth. Results showed in Exp I that both electric toothbrushes proved to remove significantly more plaque than the manual toothbrush (M 78%; D3 85%; D5 86%). In Exp II, no significant differences in plaque-removing efficacy were found between the 3 brushes (M 73%; D3 72%; D5 73%). In Exp III, the D5 proved to remove significantly more plaque than the other two brushes (M 77%; D3 77%; D5 83%).(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Plaque↗

The effects of an ultrasonic toothbrush on plaque accumulation and gingival inflammation.

The purpose of this study was to evaluate the effectiveness of an ultrasonic toothbrush to reduce plaque and gingival inflammation when compared to a manual toothbrush. 62 healthy adult patients with a plaque index of at least 2.0, a 50% bleeding index and at least 16 natural teeth participated in this study. 31 patients were randomly assigned to the manual toothbrush group (group A) and 31 were assigned to an ultrasonic toothbrush group (group B). The Turesky et al. plaque index (PI), Eastman bleeding index, and Loe & Silness gingival index (GI) were performed at baseline, 15, and 30 days at the beginning of each appointment (pre-brushing). Patients then brushed with their assigned toothbrush and a post-brushing plaque index was recorded. Kruskal-Wallis one-way analysis of variance (ANOVA) was performed to determine between group differences on the parameters of all clinical indices. Results of the pre-brushing plaque index in group B were significantly lower at 15 and 30 days compared to group A. The post-brushing plaque index demonstrated no statistically significant between or within group differences. Both groups demonstrated significant within group reductions in GI and BI from baseline to 15 days and from 15 to 30 days, however, no between group differences were noted. The results of this study support the ability of an ultrasonic toothbrush to significantly remove plaque and reduce inflammation as well as a manual toothbrush over a 30 day period.

Adult↗

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↗

Toothbrush abrasion of erosively altered enamel after intraoral exposure to saliva: an in situ study.

The aim of this in situ study was to test the effect of toothbrush abrasion on enamel previously exposed to a standardized artificial erosive agent. To generate moderate erosive lesions, slabs of the buccal surface of human premolars were immersed in a solution of citric acid for 3 min. Then they were attached to intraoral appliances and each one was exposed for 0 min (= toothbrushing immediately after intraoral exposure), 30 or 60 min to the oral milieu of 1 of 7 female subjects with a mean age of 22 years. Immediately thereafter the volunteers brushed the slabs for 30 s with toothpaste using their preferred brushing technique. For each test person the secretion rate of resting and paraffin-stimulated saliva, buffering capacity and pH were measured. The following mean losses of substance at the surface were registered: 0.258+/-0.141 microm (toothbrushing immediately after intraoral exposure), 0. 224+/-0.087 microm (toothbrushing after intraoral exposure of 30 min) and 0.195+/-0.075 microm (toothbrushing after intraoral exposure of 60 min). Toothbrush abrasion in situ was significantly lower after 60-min exposure to the oral environment than after 0-min (p<0.001). Also, the 30- and 60-min values were significantly different from each other (p<0.001). Multiple linear regression analyses revealed that in this model toothbrush abrasion was associated with the intraoral exposure to saliva (p = 0.026), the severity of the erosive attack (p<0.001) and the secretion rate of resting saliva (p = 0.029). If no other preventive measures are taken we suggest that individuals at risk for erosive tooth wear wait at least 1 h before brushing their teeth after consuming erosive foodstuffs or beverages.

Adult↗

Microbial contamination of toothbrushes and their decontamination.

PURPOSE: The objective was to determine the level of contamination of toothbrushes by mutans streptococci using microbiological identification, to access the bacterial contamination using scanning electron microscopy (SEM) and to evaluate the efficacy of two toothbrush disinfectants. METHODS: Nineteen children used their toothbrushes once a day, for five consecutive days. The toothbrushes were then immersed into disinfectant solutions for 20 h: Group I--0.12% chlorhexidine gluconate; Group II--1% sodium hypochlorite; Group III--sterile tap water. They were then placed into test tubes containing CaSa B, for 3 to 4 days at 37 degrees C. The number of MS cfu was counted and the toothbrushes were submitted to SEM analysis. RESULTS: There was no bacterial growth in Groups I and II; Group III showed MS growth (range, 21 to 120 cfu). Scanning electron microscopy showed biofilm formation on toothbrush bristles. CONCLUSION: Immersion in 0.12% chlorhexidine gluconate and 1% sodium hypochlorite are efficient methods for toothbrush disinfection.

Anti-Infective Agents, Local↗

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↗

Clinical plaque removal efficacy of three toothbrushes.

A single-blind, randomized clinical study compared plaque removal efficacy of three toothbrush designs under conditions simulating normal use. Ninety (90) subjects with substantially complete dentition used one of the three toothbrushes: Advanced Design Reach, Crest Complete and Oral-B 40. Subjects were examined for plaque before and after a single brushing using the Global Plaque Index to estimate plaque on the entire tooth surface, and the Proximal/Marginal Plaque Index (PMI), a new index, was used to estimate plaque at proximal and marginal surfaces of the teeth. The Advanced Design Reach toothbrush reduced plaque scores significantly more than did the other toothbrushes tested (p < 0.05) using either scoring method. At marginal and proximal sites, combined or separate, Advanced Design Reach toothbrush was significantly more effective than the other toothbrushes in plaque removal and produced significantly more plaque free sites than the other two toothbrushes. Evaluation of all anterior and posterior parts of the dentition with the Global Plaque Index indicated that Advanced Design Reach was superior in removing plaque in these regions. Both plaque indices were highly correlated (correlation coefficient 0.91) indicating excellent consistency by the dental examiner.

Adolescent↗

Plaque removal efficacy of two children's toothbrushes: a one-month study.

Reach Wonder Grip toothbrush for children was evaluated for plaque removal efficacy and compared to the Colgate Plus Junior (extra soft). The subjects appeared at the test site with overnight (14-18 hours) plaque accumulation. After qualifying for the study, sixty-eight (68) subjects were randomly assigned one of the test brushes. They then participated in the test evaluation at the clinical site wherein plaque levels were measured before and after a one minute brushing. Plaque removal efficacy was evaluated by the Global Plaque Index (percent of tooth surface covered by stained deposit). The subjects then used the assigned toothbrush at home for one month and returned to the test site to repeat the baseline evaluations. After their final plaque evaluations, the subjects were given a new toothbrush from each brand to use at home for one week and the subject and the parent were asked to complete a preference questionnaire. Sixty-seven (67) subjects completed the one month study. After one month's use of twice per day brushing, neither of the test toothbrushes demonstrated any evidence of oral irritation that could be related to toothbrushing. The results indicated that Reach Wonder Grip for Children was significantly more effective (p < 0.05) than Colgate Plus Junior in removing overall (Global) plaque at the initial exam period. The preference questionnaire indicated that the Reach Wonder Grip toothbrush was preferred by both the children and their parents. It is concluded that the new Reach Wonder Grip toothbrush for children is safe and effective for plaque removal.

Child↗

A clinical study of comparative plaque removal performance of two manual toothbrushes.

A single-blind, two-phase cross-over clinical trial compared the plaque removal performance of two commercially available manual toothbrushes, Colgate Precision Full Head soft and Crest Complete soft. One hundred and one eligible adult male and female subjects refrained from toothbrushing for 24 hours and were then scored for dental plaque using the Rustogi, et al. refinement of the Modified Navy Plaque Index (Rustogi, et al. Index) on the facial and lingual surfaces of all natural teeth. Upon qualifying, subjects were stratified according to Mean Plaque Index (MPI) values and randomly assigned to one of two balanced groups. Seven days later, having refrained from oral hygiene procedures for a period of 24 hours, subjects returned for plaque scoring and the initial test toothbrushing. Their plaque was disclosed with a red disclosing solution and pre-brushing plaque scores were recorded. Subjects were assigned a test toothbrush (according to group) and brushed for an unsupervised, timed 60 seconds. They returned to the clinic and were again disclosed and evaluated for plaque. These post-brushing plaque scores were also recorded. This completed Visit 1. Subjects were instructed to resume their normal, unsupervised routine and return to the clinical site one week later for Visit 2, again with 24-hour oral hygiene abstention. At that time the alternate test toothbrush was assigned to each group in a cross-over design. Plaque scoring, toothbrushing and repeat plaque scorings were performed and recorded as at Visit 1. Before and after disclosing, plaque scoring and toothbrushing were again performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

The role of the electric toothbrush in the control of plaque and gingivitis: a review of 5 years clinical experience with the Braun Oral-B Plaque Remover [D7].

The Braun Oral-B Plaque Remover (D7) (previously known as D5) is a well established electric toothbrush available worldwide. It has a round brush head with a diameter of 13 mm, with bristle tufts arranged in three circular rings, and an oscillating/rotating action. Since its introduction in 1991, a significant number of well designed clinical investigations have been published comparing the D7 with manual toothbrushes, as well as with other electric devices. A review of the findings from these various studies indicates that while both the D7 and manual toothbrushes effectively remove plaque and improve gingival condition, the efficacy of the D7 is clearly greater than that of the manual toothbrush. It is suggested that this advantage is related in particular to greater efficiency in interproximal, vestibular and lingual sites. Compared to other electric toothbrushes, there is evidence that the D7 also offers greater efficacy, but this requires clarification in further clinical investigations. It is concluded that the greater efficacy of the D7 over that of a manual toothbrush, together with the motivational effect that has been shown to be associated with electric toothbrush use, should offer potential for improved oral hygiene control.

Dental Plaque↗

Efficacy of a new electronic toothbrush in removing bacterial dental plaque in young adults.

Although a high level of oral cleanliness is essential for long-term maintenance of dental health, many people cannot maintain good oral hygiene consistently. A new electronic toothbrush has been developed that induces a small electric charge onto tooth surfaces. This charge damages electrostatic bonding of plaque proteins to tooth surfaces; thus, plaque removal is enhanced while the toothbrush is used. Young men were issued identical toothbrushes; some were electrically active. Plaque levels were assessed at baseline, and after two and four weeks, concurrently with oral-hygiene instruction and professional prophylaxis. The electrically active toothbrushes demonstrated better plaque removal than the inactive toothbrushes. This better performance was statistically significant linguopalatally, indicating that significantly more plaque was removed where mechanical access was poorest. Thus, the electrical activity of this toothbrush significantly enhances plaque removal where toothbrushing access is limited.

Adult↗

Clinical study of comparative plaque removal performance of two manual toothbrushes.

A clinical study was performed to evaluate and compare plaque removal performance of the two commercially available products; the Colgate Precision Full Head Soft toothbrush and Reach Full Head soft toothbrush. Twenty high school students, male and female subjects participated, each refraining from toothbrushing for 24 hours. Plaque was scored according to the Personal Hygiene Performance (PHP) Index of Podshadley and Haley, as modified by Martens and Meskin. Following screening, the subjects were divided into two balanced groups on the basis of initial plaque scores. At Visit 1, each group having refrained from toothbrushing for 24 hours, was evaluated for plaque before brushing for 60 seconds with the assigned toothbrush, after which plaque was again scored. At Visit 2, one week later, the same procedure was followed. Subjects were instructed to resume their normal routine and return to the clinical site for Visit 2. On completion of the study, the data collected were subjected to statistical analysis which indicated that the Colgate Precision Full Head soft toothbrush removed significantly more plaque than Reach Full Head soft toothbrush.

Adolescent↗

An in vitro investigation of the efficacy of CPC for use in toothbrush decontamination.

PURPOSE: A product designed as a toothbrush disinfectant containing cetylpyridinium chloride (CPC), a quaternary ammonium compound, recently was introduced. The purpose of this study was to provide additional evidence that CPC provides a practical solution for destroying residual microorganisms on air-dried toothbrushes and toothbrushes stored in a travel container. METHODS: Sterile synthetic toothbrushes were inoculated with optical density standardized laboratory cultures of Staphylococcus epidermidis or Candida albicans. Half were then disinfected with CPC and half were used as untreated controls. The toothbrushes were vortexed in sterile saline solution, diluted in a ten-fold series, and plated on 5% blood agar or Sabouraud dextrose agar. The plates were incubated at 37 degrees C in a normal atmosphere for 48 hours, and colonies were counted. RESULTS: CPC produced significant decreases in residual microorganisms. Using the CPC spray treatment on air-dried toothbrushes, Staphylococcus epidermidis essentially was reduced 100-fold, while Candida albicans had a 94% reduction of growth. Bacterial counts were higher in the samples stored in closed containers as compared to the air-dried samples. CONCLUSION: CPC appeared to be an effective toothbrush disinfectant for the organisms evaluated. It is practical and economical. CPC could easily fit into the recommendations of a practice committed to infection control.

Anti-Infective Agents, Local↗

A new in vitro method for testing the interproximal cleaning potential of toothbrushing.

A new laboratory method was developed and used to evaluate the approximal penetration of different toothbrushing techniques. Before brushing, the approximal surfaces on teeth numbers 33 to 38 were covered by a colored coating. After brushing from both the buccal and lingual sides, the teeth were removed and the remaining coatings on the approximal surfaces were photographed and magnified, and their areas were determined by computerization. Two conventional toothbrushing techniques and two toothbrushing techniques specially designed to enhance interproximal access were used. It was found that considerable areas on the approximal surfaces were left untouched by the toothbrush bristles, regardless of the toothbrushing technique employed. The findings suggest that improvements in toothbrush design will be a more important contribution to the attainment of effective interproximal brushing than the development of new brushing techniques. This test method shares many similarities with in vivo conditions and seems also well suited for evaluating interproximal cleaning potential of new toothbrushes.

Analysis of Variance↗