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A comparison of plaque removal by different toothbrushes and toothbrushing methods.

Six toothbrushing methods were evaluated using several kinds of toothbrushes. Two kinds of electric toothbrushes were tested also. Forty-two adults who had normal dentition and clinically healthy peridontal tissue, aged 20 to 34, 36 males and 6 females, volunteered for this study. The plaque score was calculated by the modified Volpe's method on which Suzuki et al. reported before. The scoring of the plaque was restricted to the six teeth (formula: see text) The average percentage of plaque removal from the total (labial and lingual) tooth surface by different toothbrushing methods was as follows: (1) 75.2 +/- 9.9% by the Fones method with a hard brush, (2) 71.7 +/- 11.1% by the Scrub method with a hard brush, (3) 67.4 +/- 12.5% by the modified Stillman's method with a hard brush, (4) 64.7 +/- 13.7% by the National electric toothbrush with a soft brush, (5) 62.9 +/- 13.6% by the Roll method with a hard brush (6) 58.1 +/- 16.3% by the Charters method with a brush of a medium hardness, (7) 55.2 +/- 10.2% by the Bass method with a brush of a medium harness. A similar tendency was obtained independently on the labial, lingual and papillary tooth surface. The hard brush was the most effective for the plaque removal by all kinds of brushing methods.

Adult

Comparative laboratory evaluation of three toothbrushes regarding interproximal access efficacy.

A new toothbrush from the Colgate-Palmolive Company, called the Colgate Precision toothbrush, was compared to the Oral-B 40 toothbrush and Reach Full-Head soft toothbrush using a laboratory device designed to simulate clinical toothbrushing motions and pressures. The toothbrushing time was sixty seconds for each vertical or horizontal brushing motion and for each of the three brushing weights tested, 250, 500 or 750 grams. Interproximal access efficacy was determined by measuring the maximum width of the brushing stroke measured on pressure sensitive paper placed around the simulated anterior or posterior teeth. Twenty-four toothbrushes of each design were evaluated for each toothbrushing motion, tooth shape and toothbrushing weight for a total of 864 measurements. In all studies conducted, the Colgate Precision toothbrush had statistically superior total interproximal access efficacy scores compared to the Oral-B and Reach toothbrushes. In several assessments the Reach toothbrush was superior to the Oral-B 40 toothbrush.

Analysis of Variance

Clinical studies regarding the plaque removal efficacy of manual toothbrushes.

Two independent cross-over design studies were performed to compare two toothbrushes for their ability to remove plaque. In Study I, the Colgate Precision toothbrush was compared to the Oral-B 40 toothbrush; in Study II, the Colgate Precision toothbrush was compared to the Reach Full-Head soft toothbrush. A total of 54 and 72 adult male and female subjects who met the inclusion/exclusion criteria completed Study I and Study II, respectively. In each study, subjects refrained from brushing for 24 hours, and were screened for dental plaque on the facial and lingual surfaces of all natural teeth, using the Rustogi, et al. index. Based on mean scores and number of teeth, qualifying subjects were randomly assigned to one of two groups. Subjects were then scheduled to return one week later, having again abstained from all oral hygiene procedures for a 24-hour period. At this visit, each subject was evaluated for plaque, then brushed with his/her assigned toothbrush for sixty seconds, and was again scored for plaque after brushing. Subjects were instructed to resume their normal routine and return to the clinical site one week later. At this visit, a different test toothbrush was assigned to each group in a cross-over design. Plaque evaluations and toothbrushing procedures were again performed. In both studies, the Colgate Precision toothbrush was significantly more effective (p < 0.01) than either the Oral-B 40 toothbrush or the Reach Full-Head soft toothbrush in reducing whole mouth plaque scores, plaque scores at the gumline, and plaque scores at interproximal areas.

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

Comparative plaque removal efficacy of three toothbrushes in two independent clinical studies.

Two independent studies were conducted to evaluate and compare the clinical performance of three toothbrushes on plaque removal. Both studies were carried out under the same protocol. A total of 73 adult male and female subjects who met the inclusion/exclusion criteria completed Study I and 78 different subjects completed Study II. Subjects were initially screened for dental plaque eligibility. After plaque was scored on the facial and lingual surfaces of all natural teeth using the Rustogi, et al. index, qualifying subjects were randomly assigned to one of three groups on the basis of initial plaque scores and number of teeth. Subjects were then dismissed and scheduled to return for Visit 1 a week later, having abstained from all oral hygiene procedures for a prior 24-hour period. At Visit 1, each group was evaluated for plaque before brushing with their assigned toothbrush for sixty seconds. They were again scored for plaque after brushing. Subjects were dismissed and instructed to resume their normal routine and return to the clinical site for two more weekly visits. At each visit, a different test toothbrush was assigned to each group in a cross-over design. Plaque evaluations and brushing procedures were performed as in Visit 1 of the study. In both studies, the Colgate Precision toothbrush was significantly more effective (p < 0.01) than both the Oral-B 40 and Reach Full-Head soft toothbrushes in reducing the whole mouth plaque scores, as well as plaque at the gumline and at interproximal areas. The Oral-B 40 and Reach toothbrushes were not significantly different from each other with regard to plaque removal.

Adolescent

Oral hygiene instruction and motivation in children using manual and electric toothbrushes.

The effect of individual chairside instruction and motivation on children using either manual or electric toothbrushes was investigated. From 123 children aged 9-15 years attending the Children's Department, Eastman Dental Hospital, four groups were constructed. Group 1 acted as the control, Groups 2 and 3 used manual toothbrushes and received instruction and motivation, and Group 4 used electric toothbrushes (Touch Tronic, Teledyne Aqua Tec) and also received instruction and motivation. For all children, modified Löe and Silness' Gingival and Plaque Indices were scored, a disclosing agent applied and a prophylaxis completed. Children in Groups 2, 3 and 4 were additionally shown the disclosed plaque, and its importance was discussed. Their attempts to "get the stain off" were checked and their own brushing techniques modified. Re-examinations took place after 1 and 3 months. To estimate the reliability of the diagnosis, 172 of the 344 examinations were repeated by a second operator. The overall coefficient of correlation (between operators) was 0.8. In the control group no detectable improvement in the gingival health or oral cleanliness occurred over the 3-month study period. However, both gingival and plaque scores decreased significantly, by 35-50%, in all instructed and motivated groups within 1 month and this improvement was still observable 2 months later. There were no significant differences in improvement between motivated children using manual or electric toothbrushes.

Adolescent

Comparing shower-based oral hygiene with traditional and electric toothbrushing.

Despite the importance of self-care for disease prevention, dentists and hygienists have been largely unsuccessful as oral hygiene motivators. Because of competing values, patients commonly fail to comply with prescribed oral hygiene regimens. In this investigation, attitudes of 84 adult dental patients were evaluated following a 30-day trial in which a shower-based oral hygiene system (SBOHS) was compared with manual and electric toothbrushing regimens performed in traditional settings. While attitudinal differences between manual and electric toothbrushing groups were insignificant, the SBOHS was perceived as substantially more enjoyable, convenient and reinforcing than either conventional or electric toothbrushing performed outside the shower. Significantly more SBOHS users reported spending more time on oral self-care, taking better care of their teeth and gums, feeling better about plaque control, appreciating oral hygiene practices more and perceiving cleaner teeth and a fresher mouth after oral hygiene than either the conventional or electric toothbrush users.

Dental Devices, Home Care

The effect of instruction and supervised toothbrushing on the reduction of dental plaque in kindergarten children.

Based upon the present study the following conclusions were reached: Supervised toothbrushing with instruction for preschool children significantly and consistently decreased dental plaque scores, when compared to the control group of the same children who had only supervision. While those subjects receiving toothbrushing instructions and supervision had significant plaque reductions, at no time did the plaque scores reach zero. A symmetrical but nonuniform distribution of dental plaque prior to toothbrushing was noted as follows: Posterior teeth had higher dental plaque scores than anterior teeth. More dental plaque was present on the buccal surfaces of the maxillary teeth than on the lingual surfaces. More dental plaque was present on the lingual surfaces of the mandibular teeth than on the buccal surfaces. The distribution of dental plaque following toothbrushing remained the same as the prebrushing pattern, but the amount of dental plaque was reduced by 31 percent. Constant reinforcement is necessary to maintain effective plaque control in pre-school children.

Child Behavior

Effect of mouth rinsing and toothbrushing with fluoride solutions on caries among Norwegian schoolchildren.

The caries experience and the plaque and gingival conditions of 14-year-old children participating in fortnightly fluoride (0.2 % NaF) mouth rinsing (88 subjects) were compared with observations in children performing supervised toothbrushing with a fluoride (0.5 % NaF) solution 4-5 times per year (n = 90). Most of the children, 84 and 90% respectively, had participated in these programs for the previous 6 years. Caries was assessed only on radiographs. The mean number of decayed surfaces was 5.8 (s.d. = 4.1, n = 88) and 5.4 (s.d. = 4.1, n = 90). The mean numbers of decayed and filled surfaces were 19.3 +/- 9.2 and 27.9 +/- 10.2 for subjects with rinsing or brushing. This significant difference could not be ascribed to sex, social class, years of residence in the towns, number of dentists performing the previous treatments, toothbrushing habits, use of fluorides at home, or amount of plaque. All children had gingivitis. There were no differences in the mean number of Plaque Index score 2 or the number of Gingival Index score 2 between the children with the different preventive programs. The girls' oral hygiene was better than the boys', but the gingival conditions were the same. Sex, social class, and toothbrushing techniques tended to have a slight influence on the amount of plaque.

Adolescent

Influence of social norms on toothbrushing behavior of preschool children.

Two hundred and eighty mothers of preschool children were interviewed in order to determine first, their children's toothbrushing habits and secondly, their expectations concerning the brushing behavior of preschool children in general. The influence of social and demographic factors on children's brushing behavior was also investigated. The results showed that the practice of toothbrushing is widespread and mothers play the central role in teaching the brushing routine. However, the social norms concerning oral hygiene were imprecise, indicating that mothers had no social support for teaching their children to brush and no information on how brushing should be carried out. Dental health educators should encourage mothers of young children to develop positive attitudes towards toothbrushing and teach them the correct technique.

Age Factors