Tooth brushing habits in uninstructed adults--frequency, technique, duration and force

Cervical wear pathobiology by robot-simulated 3-year toothbrushing - New methodological approach

OBJECTIVES

An ex-vivo study was aimed at (i) programming clinically validated robot three-year random toothbrushing, (ii) evaluating cervical macro- and microwear patterns on all tooth groups of different functional age, (iii) documenting and codificating wear related morphological features at the cemento-enamel junction in young teeth and on roots in older teeth.

DESIGN

Following ethical approval random toothbrushing (44 strokes per tooth horizontally, rotating, vertically; 2x/d) with manual toothbrushes and low-abrasive dentifrice was performed in an artificial oral cavity with brushing-force 3.5 N on 14 extracted human teeth. Morphological features were examined by SEM at baseline and after simulated 3 years using the replication technique. 3D-SEM analyses were carried out with a four-quadrant back scattered electron detector. Wilcoxon-Mann-Whitney-test was used for statistical analyses.

RESULTS

3-year random toothbrushing with horizontal, rotating and vertical brushing movements revealed morphological features classified as four enamel patterns, one dentin pattern and three cervical patterns. Negative impacts were enamel, cementum and dentin loss. Positive impact on oral health was removing dental calculus and straightening cervical traumatic and iatrogenic damages. The volume loss varied from x̅=34.25nl to x̅=87.75nl. Wear extended apically from 100 to 1500 micrometres.

CONCLUSION

Robot simulated toothbrushing in an artificial oral cavity, with subsequent SEM and 3D-SEM assessment, elucidated both negative and oral health-contributing micromorphology patterns of cervical wear after simulated 3-year random toothbrushing. Cervical macro- and microwear of cementum revealed, for the first time, what we describe as overhanging enamel peninsulas and enamel islands on roots in young teeth, but no enamel islands on roots from older teeth after root cementum loss. In contrast, many older teeth exhibited enamel peninsulas.

In-vitro comparison of two different toothbrush bristles about peri-implant sulcus penetration

OBJECTIVE

The aim of this preclinical study was to compare the ability of tapered and cylindrical bristles to penetrate the peri-implant sulcus.

METHODS

A full mandibular dental arch was reproduced in plaster cast. In site #3.6 a hollow glass cylinder was positioned simulating a 4 mm diameter implant and the gingival component was recreated by using dedicated silicone. A Bass brushing technique was performed from the vestibular side in humid environment. During it, the penetration of the bristles between the gum and the implant was recorded by mean of an optic fibre fixed inside the cylinder. The protocol included 5 toothbrushes per group and 10 tests per toothbrush, for a total of 50 assessments for each of the two groups. A scale of 5 grades for bristle penetration was defined: grade 0 (× < 2 mm), grade 1 (2 ≤ × < 3 mm), grade 2 (3 ≤ × < 4 mm), grade 3 (4 ≤ × < 5 mm) and grade 4 (5 ≤ × < 8 mm). From the video recordings the highest value of penetration was identified for each test.

RESULTS

The tapered bristles showed an 8 times greater penetration capacity (p = 0.001) in respect to the cylindrical bristles (multilevel analysis). The percentage of tests reaching depths ≥3 mm was 86% for tapered group and 28% for the cylindrical group.

CONCLUSION

This preclinical study shows a clear and superior penetration capacity of the tapered bristles in respect to traditional cylindrical ones. For tapered bristles, a potentially greater hygienic efficacy around dental implants is suggested.

Effects of interdental aids on clinical periodontal indices

BACKGROUND

Removal of plaque and food particle between teeth represent interdental cleaning. Every patient's self-care program includes plaque removal efficiently and systematically. Periodontal disease, tooth decay and tooth loss may result from the absence of interdental cleaning or even an irregular and unsuccessful interdental cleaning.

AIM

The aim of the current study was to assess the effect of inter-dental aids, including dental floss and toothpicks, on gingival and plaque indices.

METHODS

A questionnaire including age, gender, education level and other information was obtained from 150 male subjects who were systemically and periodontally healthy. Clinical periodontal parameters (including plaque index and gingival index) were taken from each subject. The participants were categorized into different groups according to the use of inter-dental aids (dental floss, dental picks and without any interdental aids). The participants were divided into the toothbrush-alone group, including participants who did not use either dental floss or toothpicks; the dental floss group, including participants who used dental floss; and the toothpick group including participants who used toothpicks. Plaque and gingival indices compared among groups.

RESULTS

Statistical analysis showed that the maximum mean of Plaque index was found in the toothbrush-alone group (1.09 ± 0.43), while the lowest mean of Plaque index was found in the dental floss group (0.87 ± 0.39). Plaque index of the toothpick group was (0.99 ± 0.41) with statistically significant difference among groups (p-value = 0.04*).

CONCLUSION

In conclusion, dental floss is the most effective mean of removing interdental plaque.

Comparison of the effectiveness of two manual toothbrushes: Conventional design versus double-sided toothbrush design. A pilot study

OBJECTIVES

Dental hygiene is the most effective method in the prevention of oral diseases. However, most patients do not use the recommended teeth brushing techniques and/or time brushing is insufficient. With this objective, modifications in conventional toothbrushes have been developed to deal with these findings. The aim of this study was to compare plaque removal effectiveness of a manual toothbrush with a modified head (MTMH) with a wrap-around design versus a conventional manual toothbrush.

METHODS

This pilot prospective clinical study was designed according to STROBE guidelines. The patients suspended oral hygiene habits for 24 h (baseline). Subsequently, the teeth were brushed for 60 s. Both toothbrushes followed the same study procedure, separated by 1 month. Plaque-removing effectiveness was measured before and after tooth brushing using the modified O'Leary Plaque Index (PI).

RESULTS

Seven patients were included in this pilot study. The mean age was 37.66 ± 10.68 years. PI mean differences between baseline and after brushing were 51.99% ± 16.43 for MTMH and 27.93 ± 6.85, for conventional toothbrush (p = 0.0013). After brushing, mean PI values were 18.36% ± 6.95%, and 37.61% ± 10.57% respectively (p < 0.001).

CONCLUSION

Within the limitations of the present study, it can be concluded that the effectiveness of plaque removal by using MTMH is significantly higher than the conventional manual toothbrush.

The effect of individuals' oral hygiene habits and knowledge levels on peri-implant health and disease: a questionnaire-based observational study

BACKGROUND

Peri-implant disease and health are associated with microbial dental plaque. Therefore, oral hygiene plays a role in preventing and treating these diseases. This study aimed to determine the relationships among knowledge of peri-implant status, oral hygiene habits, and peri-implant disease and health.

METHODS

A total of 144 implants in nonsmokers with controlled systemic disease were included in the study. Peri-implant disease and the conditions of the implants were determined with periodontal indices and radiographs based on the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions and The EFP S3 level clinical practice guideline. Individuals were asked 66 questions regarding demographic information, oral hygiene habits and history, and knowledge of peri-implant diseases. One-way ANOVA was used to compare the three peri-implant disease and condition categories.

RESULTS

There was a significant difference between groups regarding toothpaste type (p < 0.05). Gum protection toothpaste was greater in the peri-implant health group. Patients' use of interdental products was very low; often, no products were used for implant prosthesis. There was no significant difference among the groups regarding oral hygiene product use or oral hygiene habits (p > 0.05). There was a significant difference between groups regarding frequency of visit (p < 0.05). The frequency of visits to the dentist for pain was greater for individuals with peri-implantitis. There is a significant difference between the groups' answers for the causative and initiating factors of peri-implant disease (p < 0.05). The peri-implant health group answered that microbial dental plaque is the most crucial initiating factor of peri-implant diseases, and bleeding on probing is the most critical determinant of peri-implant diseases at a higher rate than the other groups.

CONCLUSIONS

Patients' oral hygiene habits and knowledge levels are almost similar according to peri-implant status. Knowledge does not reflect a patient's oral hygiene behavior. Clinicians should ensure that individuals' oral hygiene practices align with their increased awareness regarding peri-implant illnesses.

New design of interdental rubber picks - does the archimedean screw design bring an improvement for experimental cleaning efficacy and force?

BACKGROUND

Up to date, interdental brushes (IDB) are the first choice for interdental cleaning because of their cleaning efficacy. Cylindrical ones must be selected individually according to the size/morphology of the interdental area (IDR), whereas conical ones cover a larger variability of IDR. However, there is a trend on the part of patients towards interdental rubber picks (IRP) which are in general conically shaped, and which seem to be linked with lower cleaning efficacy. A new IRP with an Archimedes´ screw design was developed to overcome this limitation. Therefore, the in vitro study aimed to measure the experimental cleaning efficacy (ECE) and force (ECF) during interdental use of IDBs versus the new IRP type.

METHODS

Three IRPs with different tapers (PHB angled: 0.039, PHB straight S: 0.027, Vitis straight M: 0.045; all Flexipicks, Dentaid, Cerdanyola del Vallès, Spain) were compared to one IDB (Interprox micro PHD 0.9, Dentaid, Cerdanyola del Vallès, Spain). IDR were reproduced by a 3D-printer (Form2, Formlabs Sommerville, MA, USA) according to human teeth and matched to equivalent pairs (isosceles triangle, concave, convex) in three different diameters (1.0 mm,1.1 mm,1.3 mm). Covered with simulated biofilm, pre-/ post-brushing situations of IDR (standardized, computer-aided ten cycles) were photographed and quantified by digital image subtraction to calculate ECE [%]. ECF were registered with a load cell [N]. Statistically significant differences were detected using the Mann-Whitney-U-test and the Kruskal-Wallis-test with Bonferroni correction for multiple testing.

RESULTS

Overall, the ECE (mean ± SD) was higher for IDB micro 0.9 (45.95 ± 11.34%, p < 0.001) compared to all IRPs (PHB angled: 25.37 ± 15.29%; PHB straight: 22.28 ± 16.75%; Vitis straight: 25.24 ± 12.21%; p ≤ 0.001), whereat best ECE was achieved in isosceles triangle IDR of 1.0-1.1 mm (IDB micro 0.9: 70.7 ± 7.7%; PHB angled S: 57.30 ± 4.43%; p < 0.001). The highest ECF occurred for Vitis straight M with 2.11 ± 0.46 N, while IDB micro 0.9 showed lowest ECF values (0.64 ± 0.14 N; p < 0.001).

CONCLUSIONS

IRP with an Archimedes´ screw design and a higher taper were associated with advanced ECE but also higher ECF, nevertheless, ECE didn't reach the cleaning efficacy of conventional IDBs.

Novel resin-based material containing β-tricalcium phosphate nanoparticles for the reduction of dentin permeability

OBJECTIVES

To synthesize and characterize a novel dentin adhesive containing Beta-Tricalcium Phosphate (β-TCP) nanoparticles and test its ability to reduce dentin permeability (dP).

METHODS

Experimental adhesives were prepared by mixing Bis-GMA, TEGDMA, HEMA (50/25/25 wt.%), photo-initiators, and inhibitors. The following groups were tested: Experimental adhesives without β-TCP (Exp.); with 10 wt.% β-TCP (Exp.10 wt.% β-TCP); with 15 wt.% β-TCP (Exp.15 wt.% β-TCP), Scotchbond Multi-Purpose (SBMP) and Clearfil SE Protect Bond (CFPB). Degree of conversion (DC%, 10 and 20 s); Flexural Strength (FS), Knoop Hardness (KHN), and Cell Viability (OD%) tests were performed. dP was evaluated by hydraulic conductance, using human dentin disks (n=12), at three-time intervals: post-EDTA (T0); post-treatment (T1); and post-erosion/abrasion cycling (T2). Data were statistically analyzed (α=0.05).

RESULTS

For all groups, exposure time for 20 s presented a higher DC% than for 10 s. For FS, filled adhesives did not differ from unfilled and from CFPB. Experimental adhesives did not differ among them and showed lower KHN than the commercial products. Cell viability did not differ among adhesives, except Exp. 15 wt.%, which showed lower OD% than Exp., Exp. 10% and, CFPB. For dP, only Exp.10 and 15 wt.% β-TCP did not present difference between the times T1 and T2. After cycling, Exp.10 wt.% β-TCP presented lower permeability than Exp. and CFPB.

CONCLUSIONS

The incorporation of 10 wt.% β-TCP nanoparticles into the resin-based dental material did not affect its mechanical properties and biocompatibility, and promoted the greatest reduction in dentin permeability, sustaining this effect under erosive/abrasive challenges.

CLINICAL SIGNIFICANCE

A novel resin-based dental material containing β-TCP nanoparticles was able to reduce dentin permeability, maintaining its efficacy after erosive/abrasive challenges. The synthesized material did not affect dental pulp cell viability and might be promising for other conditions that require dental remineralization, such as tooth wear and dental caries.

Effectiveness of Salvadora persica toothbrush and Salvadora persica chewing stick in plaque and gingivitis control: a randomized control trial

BACKGROUND

The values of plant-based products have taken on an expanding relevance in dentistry. Salvadora persica chewing stick (miswak) has been practiced for centuries and is recommended by the World Health Organization as a customary oral hygiene tool. The therapeutic effects of S. persica chewing stick are contributed by its mechanical cleansing action, active chemicals released, or the combination of these two actions. However, the S. persica chewing stick in its natural form can be difficult to maneuver in certain parts of the mouth. This concern has inspired the innovation of the S. persica toothbrush that is designed to merge the ease of use of a toothbrush with the beneficial natural properties of S. persica preserved in its bristle. The present study aimed to compare the clinical effectiveness between S. persica toothbrush, S. persica chewing stick and the standard toothbrush in plaque and gingivitis control.

METHODS

In this single-blinded and parallel randomized controlled trial, 78 participants were randomly divided into three groups to either use (i) S. persica toothbrush (MTB); (ii) S. persica chewing stick (MCS); or (iii) standard toothbrush (STB) in a standardized manner for three weeks. Plaque Index (PI) and Periodontal Inflamed Surface Area (PISA) values, measuring plaque levels and severity of gingivitis, respectively, were evaluated at baseline, one- and three-week post-interventions.

RESULTS

The MCS group showed a significant improvement in the mean PISA values of the anterior teeth compared to the MTB and STB groups (MCS: from 16.35 ± 10.03 to 3.41 ± 1.14; MTB: from 25.20 ± 14.01 to 3.57 ± 1.19; STB: from 26.54 ± 8.64 to 6.17 ± 0.86; p < .050). All three groups reported significant improvements (p < .001) in the plaque levels and the severity of gingivitis from baseline to three weeks after the intervention.

CONCLUSIONS

Following correct techniques, S. persica toothbrush and chewing sticks are as effective as the standard toothbrush in plaque control and gingival health, which represent the reputed anti-plaque and anti-gingivitis properties of S. persica.

TRIAL REGISTRATION

This clinical trial was prospectively registered in ClinicalTrials.gov with registration NCT04650685 (25/11/2020).

Development and evaluation of the "Toothbrushing Timer with Information on Toothbrushes" application: A prospective cohort pilot study

OBJECTIVES

For people, it is challenging to be conscious of the appropriate toothbrushing time to maintain good oral health in daily life. The aim of this study was to preliminarily examine the utility of an application (app) that combines a toothbrushing timer and information on toothbrushes.

MATERIALS AND METHODS

We developed the "Toothbrushing Timer with Information on Toothbrushes" app to help users ensure appropriate toothbrushing time and learn about the beneficial characteristics of toothbrushes. A total of 18 participants were registered for the study. At baseline (T0) and after 1 month (T1) of app usage, study participants answered a digital questionnaire that comprised three questions on oral health practice, self-efficacy in oral hygiene, and quality of life related to oral health (Oral Health Impact Profile-14 [OHIP-14]).

RESULTS

Five participants were excluded from the analysis as they did not answer the digital questionnaire. Finally, 13 participants completed the survey with a follow-up of 1 month. The 13 participants were grouped into health professionals (n = 8) and non-health professionals (n = 5). The total scores for oral health practice and self-efficacy related to oral hygiene increased after a month of app usage in health professional and non-health professional groups. However, there were no significant differences between T0 and T1 in either group. The total score of OHIP-14 was lower at T1 than at T0 in both groups. Therefore, participants showed better oral health practice, self-efficacy in oral hygiene, and quality of life related to oral health at T1 compared with that at T0.

CONCLUSIONS

Our app showed positive results for the users and is useful in maintaining and promoting oral health awareness and practice. However, our pilot study lacks sufficient power and did not yield significant differences. Therefore, high-quality clinical trials with larger sample sizes are warranted for further improvement and evaluation.

Oral health profile and periodontal diseases awareness and knowledge among the jordanian population: a cross-sectional study

OBJECTIVE

To explore the oral health profile and periodontal diseases awareness and knowledge among the Jordanian population. In addition, we aimed to identify predictors of good knowledge of periodontal diseases.

METHOD

This was an online cross-sectional survey study that was conducted in Jordan between January and May 2022. A total of 13 item from the world health organisation (WHO) oral health questionnaire for adults were used to examine the oral health profile of our study participants. In addition, a previously developed questionnaire by Abdulbaqi et al. were adapted and used to examine participants' knowledge about periodontal diseases. Binary logistic regression analysis was used to identify predictors of better knowledge of periodontal diseases.

RESULTS

This study involved 1,099 participants in total. More than half of them (61.1%) claimed that throughout the previous 12 months, they had experienced pain or discomfort in their mouths or teeth. Nearly half of the participants said their teeth and gums were in good or very good condition. 70.7% said they brush their teeth once or more per day. The vast majority of them (93.0%) claimed to brush their teeth using toothpaste that contained 61.9% fluoride. The most frequent cited cause for dental visits was pain or difficulty with teeth, gums, or mouth (36.3%), according to almost one-third of study participants who said they had visited a dentist during the previous six months. The most commonly reported problems that occurs frequently due to the state of the participants' teeth or mouth were avoiding smiling because of teeth, feeling embarrassed due to appearance of teeth, and having difficulty in biting foods with 11.0%, 10.2%, and 9.0%, respectively. Tea with sugar (16.5%) was the most frequently reported beverage as being consumed frequently on a daily basis. The most popular tobacco product to be smoked often on a daily basis was cigarettes (21.6%). For periodontitis knowledge questions, the percentage of accurate responses ranged from 32.3 to 55.8%. The majority of participants (55.8%) were able to recognize that poor oral hygiene is one of the most frequent causes of malodor, whereas the least number of participants (32.3%) were able to recognize that improper teeth brushing is a frequent cause of gingival recession.

CONCLUSION

The average degree of periodontitis knowledge among Jordanians was moderate. Along with it, there were modest oral hygiene practices. In order to prevent further oral complications that have a detrimental influence on patients' quality of life, educational campaigns are required to increase public awareness of knowledge and practices in terms of proper oral hygiene and periodontitis.

Effect of Whitening Toothpastes with Different Active Agents on the Abrasive Wear of Dentin Following Tooth Brushing Simulation

The aim of this research was to evaluate the abrasive dentin wear that can be induced by three commercial whitening toothpastes following a tooth-brushing simulation (TBS) corresponding to a three-month period. Sixty human canines were selected, and the roots were separated from the crowns. Then the roots were randomly divided into six groups (n = 10) and were submitted to TBS using the following slurries: Group 1-deionized water (RDA = 5); Group 2-ISO dentifrice slurry (RDA = 100); Group 3-a regular toothpaste (RDA = 70); Group 4-a charcoal-containing whitening toothpaste; Group 5-a whitening toothpaste containing blue covasorb and hydrated silica; and Group 6-a whitening toothpaste containing microsilica. Following TBS, surface loss and surface roughness changes were evaluated using confocal microscopy. Additionally, surface morphology and mineral content changes were observed using scanning electron microscopy and energy-dispersive X-ray spectroscopy. The deionized water group presented the lowest surface loss (p < 0.05), while the charcoal-containing toothpaste presented the highest surface loss, followed by ISO dentifrice slurry (p < 0.001). Blue-covasorb-containing and regular toothpastes did not present statistically significant differences (p = 0.245), and neither didmicrosilica-containing toothpaste or ISO dentifrice slurry (p = 0.112). The surface height parameters and surface morphology changes of the experimental groups followed the surface loss patterns, while no differences were detected in mineral content after TBS.Although the charcoal-containing toothpaste exhibited the highest abrasive wear to dentin, according to ISO 11609, all the tested toothpastes exhibited appropriate abrasive behavior towards dentin.

A novel rapidly mineralized biphasic calcium phosphate with high acid-resistance stability for long-term treatment of dentin hypersensitivity

OBJECTIVES

Treating dental hypersensitivity (DH) rapidly and maintaining long-term effectiveness remains challenging. We aimed to address this problem by fabricating a novel rapidly mineralized biphasic calcium phosphate (RMBCP), which could rapidly elicit mineralization to form hydroxyapatite (HA) and perform excellent acid-resistant stability, thus effectively blocking the exposed dental tubules and protecting them from acid attack.

METHODS

RMBCP was firstly synthesized by precisely adjusting the molar ratio of acetic acid and calcium hydroxide and characterized by X-ray diffraction (XRD), X-ray fluorescence microprobe (XRF), Fourier-transform infrared (FTIR) spectrometer, scanning electron microscope (SEM), and transmission electron microscope (TEM). Subsequently, using a commercialized desensitizing agent, 45S5 bioglass (BG), as the control group, the mineralization performance of RMBCP was investigated in simulated body fluid (SBF), Dulbecco's modified eagle medium (DMEM), and even slightly acidic artificial saliva (pH=6.6). Moreover, the biocompatibility of RMBCP was studied. Finally, the tubule occlusion effect and acid-resistant stability of RMBCP were evaluated in vitro and in vivo.

RESULTS

The rapid mineralization behavior of RMBCP could easily adhere to the dentin surface and block the dentinal tubules completely in vitro and in vivo within 7days. RMBCP performed high acid-resistant stability to maintain the long-term therapeutic effect of DH treatment.

SIGNIFICANCE

Developing novel bioactive calcium phosphate materials with the ability to trigger mineralization for HA formation rapidly will be an effective strategy for the long-term treatment of dentin hypersensitivity.

Oral hygiene, mouthwash usage and cardiovascular mortality during 18.8 years of follow-up

Aim(s) We tested the following hypotheses: would better oral hygiene self-care (OHS) influence cardiovascular (CVD) mortality? Will using mouthwash in addition to OHS affect CVD mortality? How does mouthwash usage impact the oral microbes?Design and methods Among 354 dentate subjects from the Kuopio Oral Health and Heart study, the association of OHS with CVD mortality was assessed using Cox regression analyses, adjusting for age, sex, smoking, dyslipidemia, diabetes, hypertension and education. Additionally, whether using mouthwash would affect this relationship was evaluated.Results In the multivariable-adjusted models, OHS was associated with a 51% reduction in the risk of CVD mortality (hazard ratio [HR] 0.49 [0.28-0.85]; p = 0.01). Even those who had coronary artery disease at baseline showed a marginally significant benefit (0.50 [0.24-1.06]; p = 0.07). However, mouthwash usage did not change OHS effects (HR = 0.49 [0.27-0.87]; p = 0.01), indicating no additional benefits nor detriments. All tested microbes trended to decrease with mouthwash usage in the short term, but none were statistically significant.Conclusion Good OHS significantly lowered the risk of CVD mortality relative to poor OHS. Mouthwash usage did not show any long-term harm or benefit on CVD mortality beyond the benefits rendered by brushing and flossing.

Caregivers’ knowledge, attitudes, and oral health practices at long-term care facilities in KwaZulu-Natal

Background

Vulnerable individuals residing at long-term care facilities require special oral health consideration. Examining concepts of oral health and hygiene practices of caregivers becomes essential for understanding the quality of oral health services provided to residents.

Aim

This study explored the oral health-related knowledge, attitudes and practices (KAP) of caregivers.

Setting

Long-term care facilities in the eThekwini District, KwaZulu-Natal.

Methods

A cross-sectional study was conducted at seven long-term care facilities among 188 caregivers who completed a self-administered questionnaire. Data were collated and analysed using the Statistical Package for the Social Sciences (SPSS) version 24. Inferential techniques included an analysis of variance (ANOVA) test. A p-value ≤ 0.05 was considered to be statistically significant.

Results

Participants reported that dentures do not to be cleaned (n = 139; 73.9%). Participants (n = 70; 37.2%) reported that some medications have oral side effects. Most participants (n = 173; 92%) were optimistic about improving their oral health knowledge and skills. Participants (n = 108; 57.4%) only reported flossing when they had food trapped between their teeth. Few participants (n = 30; 16%) reported visiting the dentist every 6 months.

Conclusion

Participants had a positive attitude to improve their oral health-related knowledge and practices. However, the study showed that there is a need to scale-up oral health education and training activities for caregivers.

Contribution

It is envisaged that findings of this study will demonstrate the importance of oral health-related knowledge among caregivers in providing better oral health care through improved attitudes and practices.

Change in oral hygiene behaviour after non-surgical periodontal therapy - A retrospective analyses

AIM

This retrospective analysis investigates changes in daily oral hygiene behaviour after the initial phase of non-surgical periodontal therapy (NSPT).

MATERIALS AND METHODS

This retrospective study includes 189 consecutive periodontitis patients treated for moderate to severe periodontitis. The authors used the oral hygiene behaviour questionnaire (OHB-9) to assess and evaluate the oral hygiene self-care practices at both intake and evaluation after an active phase of NSPT which consisted of repeated oral hygiene instruction (OHI), supra- and subgingival debridement and polishing. In addition, data on pocket probing depth and bleeding upon pocket probing (BOP) were extracted and PISA and PESA scores were collected. All these parameters are descriptive of the periodontal status at intake and the clinical response to NSPT.

RESULTS

The OHB-9 showed an increased oral hygiene self-care level after the active phase of NSPT. At the evaluation, 85% of patients used a power toothbrush (PTB), representing an increase of 26% as compared with the intake. In addition, 64% reported brushing 3 min or longer, representing an increase of 33%. The use of woodsticks (WS) and interdental brushes (IDB) at least once a day increased with 15% and 40% respectively. The distribution changes on the answering scale were significant for IDB, WS and brushing duration. However, no significant relationship was found between oral hygiene behaviour at the evaluation and the improvement of the gingival inflammation evaluated by BOP percentage.

CONCLUSION

The finding of the OHB-9 questionnaire reported was an increase of patients who brushed longer and used the PTB, WS and IDB on a daily basis. The observed improvements in gingival inflammation assessed as bleeding on probing tendency were not significantly associated with oral hygiene behaviour at the evaluation of NSPT.

Effect of acidic media on flexural strength and fatigue of CAD-CAM dental materials

OBJECTIVE

To investigate the effect of acidic media, including beverages and gastric fluids on flexural strength and fatigue of CAD-CAM materials.

METHODS

Four CAD-CAM materials (high-translucency zirconia (Ceramill Zolid HT+), lithium disilicate (IPS e-max CAD), hybrid ceramic (Vita Enamic), and nanohybrid resin composite (Grandio Blocs) were prepared and immersed in one of five media (gastric HCl, white wine, Coca-Cola, orange juice, and artificial saliva) in an incubator (37 ℃, 24 h). Surface topography and roughness were obtained using a scanning electron microscope (SEM) and a stylus contact profilometer, respectively. Initial 3-point flexural strength was measured for half of the bars (n = 20/gp) using a universal testing machine (0.5 mm/min). The other bars underwent 10⁶ cyclic fatigue loadings before measurement of residual 3-point flexural strength. Data were statistically analyzed (two-way and three-way ANOVA, Tukey's post-hoc, p < 0.05). Weibull distributions were plotted for reliability analysis.

RESULTS

Zirconia bars has the highest initial flexural strengths followed by lithium disilicate, while resin composite and hybrid ceramic groups had the lowest strength regardless of the erosive medium. Cyclic fatigue significantly reduced initial flexural strengths for all materials except for hybrid ceramic and resin composite. Weibull moduli were the highest for zirconia, lithium disilicate and resin composite and lowest for hybrid ceramic.

SIGNIFICANCE

Erosive media significantly changed surface roughness of CAD-CAM materials except for zirconia and resin composite without jeopardizing the flexural strength of the CAD-CAM materials. Despite the higher flexural strengths for zirconia and lithium disilicate, resin composite and hybrid ceramic were more resistant to cyclic fatigue.

Cleansing efficacy of an auto-cleaning toothbrushing device with nylon bristles: a randomized-controlled pilot study

OBJECTIVES

To compare the cleansing efficacy of an auto-cleaning device with nylon bristles (Y-brush®) to that of manual toothbrushing.

MATERIALS AND METHODS

Twenty probands refrained from oral hygiene for 3 days. Rustogi Modified Navy Plaque Index was assessed before and after (randomized) toothbrushing either with the auto-cleaning device for 5 s per jaw or with a manual toothbrush for a freely chosen time up to 4 min. The clinical investigation was repeated in a cross-over design. In a third trial period, the brushing time for auto-cleaning was increased to 15 s per jaw. The study was supplemented by plaster cast analyses.

RESULTS

Full-mouth plaque reduction was higher with manual toothbrushing than with auto-cleaning for 5 s per jaw (p < 0.001). There was no statistically significant difference on smooth tooth surfaces but on marginal and interdental sites. Increasing the brushing time of auto-cleaning to 15 s per jaw resulted in a comparable full-mouth plaque reduction as with manual toothbrushing (p = 0.177). In 95% of individuals, the device was too short not completely covering second molars. In 30.67% of teeth, the gingival margin was not covered by bristles.

CONCLUSIONS

Auto-cleaning devices with nylon bristles have a future potential to reach plaque reduction levels comparable to manual toothbrushing, although manufacturers must focus on improving an accurate fit.

CLINICAL RELEVANCE

Under the premise of an ameliorated fit, the auto-cleaning device might be recommendable for people with low brushing efficacy. Interdental sites remain a failure point if adjunct interdental cleaning is not viable.

Assessment of the oral health literacy and oral health behaviors among nurses in China: a cross-sectional study

PURPOSE

Oral health is important for general health; nurses are expected to possess good oral health awareness and work together for public oral health promotion. The purpose of this study is to investigate oral health literacy (OHL)and oral health behaviors of nurses, and explore the association between oral health literacy with demographic variables and oral health behaviors.

METHODS

A cross-sectional study in a tertiary hospital was conducted using a short-form Health Literacy in Dentistry-14 (HeLD-14) and a 16-items oral health behaviors questionnaire. Information about the subjects' demographic details including age, gender, place of residence, marital status, marital status, education level, monthly household income, working experience, etc. were collected. Independent sample t- test, One- way ANOVA, and multivariable regression were used to identify the association of oral health literacy with demographic variables and oral health behaviors.

RESULTS

A total number of 317 nursing nurses participated in the survey, with a mean OHL score of 36.72, SD10.531, 21.8% were categorized as good, 34.1% medium and 44.2% poor oral health literacy; monthly household income, self-rated oral health, brushing time, use of fluoride toothpaste, and regular oral examination were signficantly associated with OHL scores.

CONCLUSION

The overall oral health literacy of the nurse population is at a moderate to low level. These findings may help to map and design an oral health education intervention to improve oral health literacy amongst nurses, especially nurses with low monthly household income and poor self-assessed oral health status. Nursing administrators and nursing educators should pay more attention to the oral health status of the nurse population.

Oral Hygiene Practices and the Awareness of Perio-Systemic Interrelationship Among the Population of Ranchi City: A Hospital-Based Study

BACKGROUND

The concept of the pathogenesis and etiology of periodontal disease, with their infectious and chronic natures, usually facilitates acknowledging the possibility of these infections influencing events elsewhere in the body. Concurrent awareness and recognition of the interaction between systemic and oral diseases are one of the enormous advances that require a periodontist to not only strictly direct their knowledge toward prevention and treatment but also spread awareness about the same among the unknown. Thus, the primary goal of our study was to assess public awareness of periodontal and systemic interrelationships with oral hygiene practices in Ranchi, Jharkhand.

METHODOLOGY

 A total of 800 subjects between ages 18 and 60 years visiting the outpatient department of periodontology, Dental Institute, Rajendra Institute of Medical Sciences (RIMS), were randomly selected for inclusion in the study. After the oral hygiene checkup, the patients were presented with a self-constructed questionnaire form, where patients' awareness and knowledge about perio-systemic interrelationship and their patterns about oral hygiene practices were assessed.

RESULTS

The data collected was analyzed using mean and standard deviation (SD), while the chi-square (χ²) test was to evaluate the mean difference. The results of our study showed a fair oral hygiene index, minimal oral hygiene practices, and a lack of awareness regarding the interrelationship between bad oral health and systemic diseases among the population of Ranchi. Out of 800 subjects, the majority (around 44.25%) visited a dentist only if and when needed, and around 80% of the population continued using their toothbrushes for more than six months. In fact, awareness regarding the perio-systemic interrelationship was only among 5.12% (3.25% ± 1.87%) of the total population.

CONCLUSION

Within the limitations of our study, it can be concluded that there is a need to educate the general population about the pros and cons of maintaining oral hygiene. Dental awareness, along with periodontal health care and its impact on systemic health, should be intensified through various means.

Oral Hygiene Practices among Adults with Intellectual Disabilities-A Pilot Study

It is known that the oral health status of people with intellectual disabilities (IDs) is likely to be compromised as compared with the general population. Until recently, the trend of oral hygiene among the adult population with intellectual disabilities in Brunei Darussalam had yet to be studied. Thus, the aim of this study was to determine the oral hygiene practices, oral health knowledge and dental appointment patterns among the adult population with IDs in Brunei Darussalam. A cross-sectional study was conducted at different service providers in Brunei Darussalam for adults with IDs. An easy-to-read questionnaire was distributed to the participants. The responses of the questionnaire for IDs were analyzed. A total of 34 participants were recruited. It was found that all participants were practicing their daily oral hygiene routine. In terms of dental visits, more than half visit the dentist at least once a year. The majority of the participants agreed that visiting the dentist every 6 months was essential. This study showed that adults with IDs in Brunei Darussalam were aware of the importance of oral health and were maintaining their daily oral hygiene, although not with the ideal method. It is important for clinicians to not only educate the individuals with IDs but also their carer(s) when it comes to oral health knowledge, as carers play a key role in the oral health of the people under their care.

Effect of tapered-end and round-end bristles on the abrasive dentine wear applying increasing brushing forces

OBJECTIVE

To investigate the effect of toothbrush bristles end configuration on the abrasive dentine wear at different brushing forces.

MATERIAL AND METHODS

One hundred and sixty bovine dentine samples were randomized into eight groups (n = 20). Groups (1 to 4) were brushed with tapered-end bristles at 1-, 2-, 3-, and 4-N brushing forces, respectively. Groups (5 to 8) were brushed with round-end bristles with the same brushing forces. The brushing sequence was carried out using an abrasive slurry (RDA = 121) for 25 min. Profiles were recorded using a contact profilometer. Mean and standard deviation were calculated for the abrasive dentine wear in each group. Two-way ANOVA was used to locate any significance. The significance values were corrected after Tukey (α = 0.05).

RESULTS

Brushing with tapered-end bristles resulted in statistically significantly less abrasive dentine wear than round-end bristles regardless of the applied brushing force (1 N: 4.4 ± 1.5 vs. 7.7 ± 2.0 µm; 2 N: 7.7 ± 2.1 vs. 12.2 ± 2.7 µm; 3 N: 11.3 ± 2.6 vs. 19.4 ± 3.7 µm; 4 N: 11.2 ± 2.1 vs. 25.3 ± 4.8 µm). The interaction between bristle configuration and brushing force was statistically significantly (p < 0.001).

CONCLUSION

Tapered-end toothbrushes might be a safer choice for patients, especially when showing signs of non-carious cervical lesion. However, other toothbrush properties should also be considered.

Robot and mechanical testing of a specialist manual toothbrush for cleaning efficacy and improved force control

Background

Toothbrushes require flexibility to access all dental surfaces and remove plaque effectively, but they should also aim to prevent or limit overbrushing and consequent damage to teeth and gums. In two studies, the physical properties and cleaning performance of specialist test toothbrushes with flexible necks were compared to a reference rigid-necked toothbrush.

Methods

In Study 1, a universal testing machine (Instron E 10,000) with a specially designed setup was used to test the deflection behaviour of toothbrush head and neck. Untufted toothbrushes were fixed in a custom holder and force was applied to the head while the deflection was measured. In Study 2, one control and five test toothbrushes were assessed using a robot system to simulate the cleaning of artificial plaque from defined surfaces of artificial replicated human teeth in a model oral cavity (typodonts).

Results

Study 1 showed that the flexible-neck toothbrush deflected 2 to 2.5 times more than the rigid-neck reference toothbrush when same force was applied to the toothbrush head. Study 2 revealed that all five test toothbrushes showed statistically superior simulated plaque removal to the reference toothbrush. This superiority was observed for all test toothbrushes employing horizontal and rotating brushing action (all p = 0.001) but only three of the five toothbrushes when vertical brushing was employed (all p = 0.001). Cleaning efficacy of the test toothbrushes was demonstrated both interdentally and at the gumline locations. The Complete Protection toothbrush showed the most effective cleaning performance followed by the Repair and Protect and Rapid Relief toothbrushes.

Conclusion

The addition of a flexible-neck component to the toothbrush designs helped to reduce stiffness and may allow more effective cleaning compared to rigid designs with controlled force distribution on the teeth and gums. This may help to provide plaque control at all potential risk areas in an in vitro robot model and could support good oral hygiene in-use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02211-4.

Czech and Slovak Dental Students' Oral Health-Related Knowledge, Attitudes, and Behaviours (KAB): Multi-Country Cross-Sectional Study

Dentists play a key role in the primary prevention of oral diseases and related systemic complications; therefore, their views on behavioural interventions need to be aligned with the current agendas for oral health. Likewise, dental students’ oral health-related knowledge, attitudes, and behaviours (KAB) are of practical importance, as they are the future opinion leaders for oral health in their respective communities. A cross-sectional survey-based study was designed to evaluate the oral health KAB of dental students in both the Czech Republic and Slovakia. The study utilized translated versions of the Hiroshima University Dental Behavioural Inventory (HU-DBI), and it aimed to recruit students from all Czech and Slovak dental schools. A total of 487 students were included in this study, out of which 372 (76.4%) were females, 271 (55.6%) were enrolled in preclinical years, 68 (14%) reported smoking tobacco at least once a week, and 430 (88.3%) reported problematic internet use. The mean HU-DBI score of Czech and Slovak dental students (8.18 ± 1.80) was comparable with the previously reported scores of dental students in Nordic and Western European countries. Czech students (9.34 ± 1.29) had a significantly higher score than their Slovak counterparts (7.56 ± 1.73). In both countries, preclinical students (8.04 vs. 8.35), the students who reported tobacco smoking (7.63 vs. 8.27), and those who reported problematic internet use (8.11 vs. 8.70) had significantly lower HU-DBI scores than their counterparts, respectively. In the Czech Republic, the significant increases in HU-DBI scores occurred after the first academic year when the students received preventive dentistry courses; therefore, one can put forward that early implementation of preventive elements in undergraduate dental curricula may yield better and more sustainable oral health gains for the students. Future research on Czech and Slovak dental curricula need to re-evaluate the oral hygiene and anti-smoking components and their impact on students’ views and attitudes.

Effect of the toothbrush tuft arrangement and bristle stiffness on the abrasive dentin wear

The geometrical properties of toothbrushes play a role in developing abrasive tooth wear and non-carious cervical lesions. This study investigated the interplay between the toothbrush tuft arrangement (crossed vs. parallel) and bristle stiffness (soft vs. medium) on the abrasive dentin wear using three slurries with different levels of abrasivity (RDA: 67, 121 and 174). Twelve groups of bovine dentin samples (n = 20) were brushed with a combination of the aforementioned variables. Abrasive dentin wear was recorded with a profilometer and the resulting abrasive wear of each group was calculated and compared with each other using two-way ANOVA and pairwise tests. Toothbrushes with parallel tuft arrangement caused statistically significantly higher dentin wear compared to crossed tuft arrangement, regardless of the abrasivity level of the used slurry and the bristle stiffness. Soft crossed tuft toothbrushes caused statistically significantly higher abrasive dentin wear than medium crossed tuft toothbrushes, while soft and medium parallel tuft toothbrushes caused the same amounts of dentin wear, regardless of the RDA value of the used slurry. These results could be helpful for dentists and dental hygienists when advising patients. Crossed tuft toothbrushes could be a less-abrasive choice in comparison to parallel tuft toothbrushes.

Effect of brushing on surface roughness, fluoride release, and biofilm formation with different tooth-colored materials

Background/purpose

Tooth brushing, material mechanical ageing procedure, is the most effective way in removing biofilm. The purpose of this study was to investigate the surface roughness, fluoride-release, and S. mutans biofilm formation on various tooth-colored restorative materials before and after brushing.

Materials and methods

Discs of materials, a nanocomposite (Filtek Z350XT; CO), a giomer (Beautifil II; GIOMER), a resin-modified glass-ionomer material (Fuji II LC; RMGI), and a conventional glass-ionomer material (Fuji IX GP Extra; GI), were prepared, polished with abrasive discs (SofLex), and divided into brushed and not brushed groups. The surface roughness of specimens was observed using a contact profilometer, fluoride-release was measured using a fluoride-specific ion electrode, and S. mutans biofilm formation, biovolume and live/dead cells, was observed under a confocal laser scanning microscope.

Results

Higher roughness was observed on GI and RMGI than on CO and GIOMER. Brushing had no effect on the roughness. The fluoride-release of GI and RMGI was higher than that of GIOMER. The fluoride-release decreased after brushing in all materials. The biovolume of S. mutans was not significantly different between GIOMER, RMGI and GI, while CO showed the highest. Brushing resulted in a higher biovolume for all materials, except CO, which showed no change. After brushing, all the tested materials demonstrated identical biovolumes. There were no significant differences in live/dead cells among all groups.

Conclusion

Brushing demonstrated a negative effect on the fluoride-release and biovolume of S. mutans biofilms for all tested materials except nanocomposites.

In vitro evaluation of Sensi-IP®: A soluble and mineralizing sensitivity solution

OBJECTIVES

Sensi-IP®OG (SIP-OG) and Sensi-IP®FF (SIP-FF) are soluble bioactive glasses developed to treat dentin hypersensitivity and promote remineralization. Evaluation of their therapeutic potential to reduce dentin hypersensitivity and recover enamel strength was evaluated using standardized in vitro assessments based on simulated use.

METHODS

To assess dentin occlusion a visual occlusion methodology was employed. Dentin discs were subjected to twice-daily simulated brushing (for 5 days) using 0.67 g of toothpaste for 10 s. Simple prototype toothpastes containing SIP-OG and SIP-FF were compared to commercially available controls: Colgate® Sensitive Pro-Relief (CPR) and Sensodyne® Repair and Protect with NovaMin® (SRP). Samples were stored in artificial saliva between treatments. All samples were assessed at baseline and subsequent to each treatment and were scored on a 5-point categorical scale for occlusion. For enamel surface effects, test articles of SIP-OG, SIP-FF, and SIP-FF with NaF were compared to a positive (with NaF) and a negative (no NaF) control paste. Enamel samples were subjected to a pH cycling regime, providing exposure to the toothpaste slurry (i.e., 2 parts deionized water to 1 part toothpaste), mineralizing solution, and demineralizing solution over 5 days of simulated use. Samples were stored overnight in mineralizing solution. Samples were evaluated for fluoride uptake and changes to surface microhardness.

RESULTS

Visual occlusion scores (1 fully occluded to 5 unoccluded) were 2.6, 3.8, 4.4 and 4.0 after 1 day of simulated use for SIP-OG, SIP-FF with NaF, Colgate® Sensitive Pro-Relief and Sensodyne® Repair and Protect, respectively, decreasing to 1.0, 1.8, 3.1 and 3.9 after 5 days of application. SIP-OG provided superior occlusion at the significance level of p ≤ 0.05 at 1, 2, 3, 4, and 5 days. SIP-FF with NaF provided superior occlusion at the significance level of p ≤ 0.05 at 2, 4, and 5 days. Fluoride uptake ranged from 9.0 μg/cm² for SIP-OG to 12.4 μg/cm² for SIP-FF with NaF. Surface microhardness after acid cycling allowed recovery of 59 % of surface microhardness after treatment with SIP-OG or SIP-FF with NaF. SIP-OG achieved significant surface microhardness recovery versus SIP-FF alone, a NaF control paste, and a fluoride free control paste at the significance level of p ≤ 0.05. SIP-FF with NaF achieved surface microhardness recovery versus SIP-FF alone, a NaF control paste, and a fluoride free control paste at the significance level of p ≤ 0.05.

CONCLUSIONS

Superior occlusion of dentin tubules was observed with both novel additives compared to commercially available toothpastes. A build-up effect with increasing occlusion was noted with repeated application for both novel additives and ascribed to mineralization effects, as supported by surface microhardness recovery on initial enamel lesions.

Prevalence and determinants of oral health conditions and treatment needs among slum and non-slum urban residents: Evidence from Nigeria

Oral diseases constitute a neglected epidemic in Low and Middle-Income Countries (LMICs). An understanding of its distribution and severity in different settings can aid the planning of preventive and therapeutic services. This study assessed the oral health conditions, risk factors, and treatment needs among adult residents in the slum and compared findings with non-slum urban residents in Ibadan, Nigeria. The Multistage sampling was used to select adult (≥18-years) residents from a slum and a non-slum urban sites. Information sought from participants included dietary habits, oral hygiene practices, and the use of dental services. Oral examinations were performed in line with WHO guidelines. Associations were examined using logistic regression. Mediation analysis was undertaken using generalized structural equation modeling. The sample comprised 678 slum and 679 non-slum residents. Median age in slum vs non-slum was 45 (IQR:32-50) versus 38 (IQR:29-50) years. Male: female ratio was 1:2 in both sites. Prevalence of oral diseases (slum vs non-slum sites): dental caries (27% vs 23%), gingival bleeding (75% vs 53%) and periodontal pocket (23% vs 16%). The odds of having dental caries were 21% higher for the slum dwellers compared to non-slum residents (OR = 1.21, 95% CI:0.94 to 1.56); and 50% higher for periodontal pocket (OR = 1.50, 95%CI: 1.13 to 1.98), after adjusting for age and sex. There was little evidence that tooth cleaning frequency mediated the relationship between place of residence and caries (OR = 0.95, 95%CI: 0.87 to 1.03 [indirect effect], 38% mediated) or periodontal pocket (OR = 0.95, 95%CI: 0.86 to 1.04, 15% mediated). Thirty-five percent and 27% of residents in the slum and non-slum sites respectively required the "prompt and urgent" levels of treatment need. Oral diseases prevalence in both settings are high and the prevalence was generally higher in the slum with correspondingly higher levels of prompt and urgent treatment needs. Participants may benefit from targeted therapeutic and health promotion intervention services.

Hydroxyapatite Film Coating by Er:YAG Pulsed Laser Deposition Method for the Repair of Enamel Defects

There are treatments available for enamel demineralization or acid erosion, but they have limitations. We aimed to manufacture a device that could directly form a hydroxyapatite (HAp) film coating on the enamel with a chairside erbium-doped yttrium aluminum garnet (Er:YAG) laser using the pulsed laser deposition (PLD) method for repairing enamel defects. We used decalcified bovine enamel specimens and compacted α-tricalcium phosphate (α-TCP) as targets of Er:YAG-PLD. With irradiation, an α-TCP coating layer was immediately deposited on the specimen surface. The morphological, mechanical, and chemical characteristics of the coatings were evaluated using scanning electron microscopy (SEM), scanning probe microscopy (SPM), X-ray diffractometry (XRD), and a micro-Vickers hardness tester. Wear resistance, cell attachment of the HAp coatings, and temperature changes during the Er:YAG-PLD procedure were also observed. SEM demonstrated that the α-TCP powder turned into microparticles by irradiation. XRD peaks revealed that the coatings were almost hydrolyzed into HAp within 2 days. Micro-Vickers hardness indicated that the hardness lost by decalcification was almost recovered by the coatings. The results suggest that the Er:YAG-PLD technique is useful for repairing enamel defects and has great potential for future clinical applications.

Effects of the association of high fluoride- and calcium-containing caries-preventive agents with regular or high fluoride toothpaste on enamel: an in vitro study

OBJECTIVES

The aim of this in vitro study was to compare the caries-preventive effect of various high fluoride- and calcium-containing caries-preventive agents (> 22.000 ppm F^- [ppm]) in adjunct to use of regular (1450 ppm) or high (5000 ppm) fluoride toothpaste on sound as well as demineralized enamel.

MATERIALS AND METHODS

Bovine enamel specimens (n = 276; 5 mm × 3.5 mm × 3 mm) having one sound surface [ST] and one artificial caries lesion [DT] were randomly allocated to 12 groups. Interventions before pH-cycling were no intervention ([SC₁/SC₅]), application of varnishes/solutions containing NaF (22,600 ppm; Duraphat [NaF₁/NaF₅]); NaF + tricalcium phosphate (22,600 ppm; Clinpro White Varnish [TCP₁/TCP₅]); NaF + CPP-ACP (22,600 ppm; MI Varnish [CPP₁/CPP₅]); silver diammine fluoride (35,400 ppm; Cariestop 30%[SDF₁/SDF₅]); and NaF + calcium fluoride (45,200 ppm; Biophat[CaF₁/CaF₅]). During pH-cycling (28 days, 6 × 120 min demineralization/day) half of the specimens in each group were brushed (10 s; 2 × /day) with either 1,450 (NaF; named, e.g., TCP₁) or 5,000 ppm (NaF; e.g., TCP₅) dentifrice slurry. Differences in integrated mineral loss (∆∆Z) and lesion depth (∆LD) were calculated between values after initial demineralization and after pH-cycling using transversal microradiography.

RESULTS

After pH-cycling, SC₁/SC₅ showed significantly increased ∆Z_DT/LD_DT values, indicating further demineralization (p < 0.05; paired t-test). Decreased ∆Z_DT values, indicating non-significant remineralization, could only be observed in CaF₁/CaF₅ (p > 0.05; paired t-test). Additional use of all varnishes/solutions significantly decreased ∆∆Z_DT/∆∆Z_ST and ∆LD_DT/∆LD_ST compared to SC₁/SC₅ (p < 0.05;ANCOVA). Between 1450 and 5000 ppm dentifrices, a significant difference in ∆∆Z_DT/∆∆Z_ST and ∆LD_DT/∆LD_ST could only be observed for SC₁/SC₅ (p < 0.05; ANCOVA).

CONCLUSION

Under the conditions chosen, all fluoride varnishes/solutions significantly reduced demineralization. Furthermore, a significant dose-response characteristic for fluoride varnishes could be revealed. However, no additional benefit could be observed, when varnishes were combined with high fluoride instead of regular fluoride dentifrices.

CLINICAL RELEVANCE

For children and adolescents with high caries risks varnishes containing more than 22,600 ppm should be further investigated, as they offered higher caries-preventive effects in vitro. Furthermore, there seems to be no difference in the demineralization-inhibitory capacity of fluoride varnishes when used in combination with either standard or highly fluoridated dentifrices.

Duration of toothbrushing with fixed appliances: a randomized crossover clinical trial

OBJECTIVE

Fixed orthodontic appliances might result in dental adverse effects, if sufficient oral hygiene is not maintained. Since recommendations on toothbrushing times are lacking scientific justification in orthodontic populations, the aim of the present study was to comparatively quantify the duration of toothbrushing with a manual and a powered toothbrush in two distinct age groups.

TRIAL DESIGN

Two-centre, two-period crossover balanced randomized clinical trial with computer-generated numbers and blinding at the outcome-assessing level.

METHODS

Children and adults with fixed appliances with at least 22 aligned teeth were recruited at a university clinic and private practice in Bavaria, Germany. Plaque was disclosed with staining tablets and participants brushed their teeth with their habitual technique in front of a mirror and without interference until staining was, to their own satisfaction, completely removed. The primary outcome was duration of toothbrushing in seconds. Secondary outcomes were percentage plaque reduction and questionnaire data on dental attitudes and behaviours. Data were analysed with linear mixed models.

RESULTS

Twenty-eight participants were randomized to the first and 27 to the second toothbrush sequence. The combined effect of age and toothbrush on the duration of toothbrushing was evident (n = 52, F(1, 50.8) = 5.1, P = 0.028). Children brushed 14.5 seconds less [n = 28, 95% confidence interval (CI) = -31.3 to 2.3, P = 0.090], yet adults 13.3 seconds more (n = 24, 95% CI = -4.6 to 31.3, P = 0.143) with the manual than powered toothbrush. Brushing times ranged from 2 minutes and 45 seconds to 3 minutes and 17 seconds with plaque reduction at 76% and good dental attitudes and behaviours.

CONCLUSIONS

Both children and adults with fixed appliances might equally reach an effective plaque reduction with either manual or powered toothbrushes and their habitual brushing technique in around three minutes, if plaque is visible.

REGISTRATION

DRKS-German Clinical Trials Register ID: DRKS00012463.

FUNDING

Oral-B Procter & Gamble.

Self-Reported Knowledge and Practice of Interdental Aids among People of Riyadh, Saudi Arabia - A Cross-Sectional Study

Background:

Periodontal disease is a common pathological oral ailment which affects the supporting structures of the teeth. Dental plaque is one of the major causes for gingivitis and periodontitis. If left untreated, this will lead to tooth loss. Studies have shown that oral prophylaxis will reduce gingival and periodontal inflammation by removing the plaque in all the surfaces. The objective was to assess knowledge and practice of interdental aids among people of Riyadh, Saudi Arabia.

Methodology:

A descriptive study was conducted among people using questionnaire.

Results:

96% of the subjects brushed their teeth with brush and paste. 59% of the study subjects had knowledge regarding interdental aids, whereas only 15% of them practiced it. 72% of the people mentioned that dentists gave information regarding interdental aids.

Conclusions:

Among the study subjects, even though there were deficits in few areas, overall knowledge about interdental aids was good and it increased with increasing level of education.

The effectiveness of the information-motivation-behavioral skills model-based intervention on preventive behaviors against respiratory infection among community-dwelling older adults

OBJECTIVE

To evaluate the effectiveness of an information-motivation-behavioral skills (IMB) model-based multi-component intervention on engagement and the quality of preventive behaviors against respiratory infections among community-dwelling older adults.

METHODS

This study was a controlled pretest-posttest study in which 91 community-dwelling older adults aged above 65 years were included. The intervention group (n = 42) received the six-week intervention theoretically based on the IMB model that comprised weekly group education and 5-10 min of tele-counseling per week.

RESULTS

The results showed that, after the intervention, the improvement in the level of knowledge, self-efficacy, self-reported engagement, and the quality of respiratory infection preventive behaviors was significantly greater in the intervention group compared to the control group. There was no significant difference between the two groups for the perceived threat of respiratory infection.

CONCLUSION

The IMB model-based intervention improved the engagement and quality of preventive behaviors by increasing the level of knowledge and self-efficacy in community-dwelling older adults.

PRACTICE IMPLICATIONS

The IMB model-based multi-component intervention can be an effective approach to improve preventive behaviors and will contribute to the preparation of communities for outbreaks of respiratory infections.

Efficacy of sonic versus manual toothbrushing after professional mechanical plaque removal: A 6-month randomized clinical trial

Aim

The aim of this study was to compare the efficacy of two brushing methods (manual vs. sonic) in terms of plaque control after a session of professional mechanical plaque removal (PMPR).

Methods

Subjects with gingivitis underwent a session of PMPR and were randomly assigned to sonic (SB) or manual brushing (MB). Oral hygiene instructions were provided at baseline (BL), 2 (T0a), 4 (T0b) and 6 weeks (T1) and 6 months (T2). Plaque Index (PI), Gingival Index (GI) and bleeding on probing (BoP) were measured at BL, T1 and T2. The proportion of sites with PI, GI and BoP was modelled at site level using a negative binomial regression fitted via generalized linear mixed model accounting for intra‐patient correlation.

Results

Thirty‐two subjects were selected, 16 assigned to each group and 31 completed the study. PI, BoP and GI were comparable at BL. At T1, PI was successfully maintained at 6.21% for SB and 22.81% for MB, while at T2 reached 11.34% for SB and 28% for MB, favouring the SB group (p < 0.001). GI and BoP were significantly lower in the SB group at T1, with a BoP reduction for SB about 3 times higher than MB (p < 0.001). These parameters then levelled at T2 between the groups, with BOP reaching 0.14% versus 0.05% (p = 0.356) and GI 1.75% versus 3.52% (p = 0.020).

Conclusion

Sonic brushing seemed to maintain a lower PI score compared to a manual brush at 6 months. BoP and GI resulted comparable.

Effectiveness of medical coating materials in decreasing friction between orthodontic brackets and archwires

Objective

The aim of this in vitro study was to evaluate the changes in friction between orthodontic brackets and archwires coated with aluminum oxide (Al₂O₃), titanium nitride (TiN), or chromium nitride (CrN). In addition, the resistance of the coatings to intraoral conditions was evaluated.

Methods

Stainless steel canine brackets, 0.016-inch round nickel–titanium archwires, and 0.019 × 0.025-inch stainless steel archwires were coated with Al₂O₃, TiN, and CrN using radio frequency magnetron sputtering. The coated materials were examined using scanning electron microscopy, an X-ray diffractometer, atomic force microscopy, and surface profilometry. In addition, the samples were subjected to thermal cycling and in vitro brushing tests, and the effects of the simulated intraoral conditions on the coating structure were evaluated.

Results

Coating of the metal bracket as well as nickel–titanium archwire with Al₂O₃ reduced the coefficients of friction (CoFs) for the bracket–archwire combination (p < 0.01). When the bracket and stainless steel archwire were coated with Al₂O₃ and TiN, the CoFs were significantly lower (0.207 and 0.372, respectively) than that recorded when this bracket–archwire combination was left uncoated (0.552; p < 0.01). The friction, thermal, and brushing tests did not deteriorate the overall quality of the Al₂O₃ coatings; however, some small areas of peeling were evident for the TiN coatings, whereas comparatively larger areas of peeling were observed for the CrN coatings.

Conclusions

Our findings suggest that the CoFs for metal bracket–archwire combinations used in orthodontic treatment can be decreased by coating with Al₂O₃ and TiN thin films.

Reductions in clinical inflammation and oral neutrophils with improving oral hygiene

OBJECTIVE

This study compared the effects of oral hygiene with a toothpaste formulated with zinc (test) to a fluoride dentifrice (control) for effects on oral polymorphonuclear leukocyte (PMN) as a measure of whole mouth inflammation along with effects on clinical parameters of dental plaque and gingivitis.

MATERIALS AND METHODS

Adults (age range 18-60 years, n = 212) completed this double-blind, parallel design study. After washout, a baseline oral rinse sample was evaluated for PMN prior to clinical assessments for gingivitis and dental plaque. Subjects were randomly assigned to brush twice daily with either the test or the control toothpaste. Post-treatment evaluations repeated all baseline assessments after 4-week, 6-week and 12-week use of dentifrice with all assessments conducted 12 hours after brushing.

RESULTS

PMN reductions in the test were 16.8%, 18.7% and 42.5% at the 4-week, 6-week and 12-week evaluations respectively and significantly different from the control (p < 0.05). The test toothpaste also demonstrated progressively increasing reductions in gingivitis and dental plaque that ranged from 7.6 to 33.3% and 2.3 to 9.1% respectively versus the control (p < 0.05).

CONCLUSIONS

The test dentifrice demonstrated progressive reductions in oral PMN representing whole mouth inflammation in conjunction with improvements in oral hygiene as compared to the control toothpaste.

CLINICAL RELEVANCE

A hallmark of oral inflammation includes the accumulations of PMN in the afflicted gingival regions to reduce the influences of proliferating microorganisms. Brushing with a zinc dentifrice demonstrated progressive reductions in oral PMN and improvements in oral hygiene as evidenced by progressively lower dental plaque and gingival indices.

Microtask Detection

Information systems, such as task management applications and digital assistants, can help people keep track of tasks of different types and different time durations, ranging from a few minutes to days or weeks. Helping people better manage their tasks and their time are core capabilities of assistive technologies, situated within a broader context of supporting more effective information access and use. Throughout the course of a day, there are typically many short time periods of downtime (e.g., five minutes or less) available to individuals. Microtasks are simple tasks that can be tackled in such short amounts of time. Identifying microtasks in task lists could help people utilize these periods of low activity to make progress on their task backlog. We define actionable tasks as self-contained tasks that need to be completed or acted on. However, not all to-do tasks are actionable. Many task lists are collections of miscellaneous items that can be completed at any time (e.g., books to read, movies to watch), notes (e.g., names, addresses), or the individual items are constituents in a list that is itself a task (e.g., a grocery list). In this article, we introduce the novel challenge of microtask detection, and we present machine-learned models for automatically determining which tasks are actionable and which of these actionable tasks are microtasks. Experiments show that our models can accurately identify actionable tasks, accurately detect actionable microtasks, and that we can combine these models to generate a solution that scales microtask detection to all tasks. We discuss our findings in detail, along with their limitations. These findings have implications for the design of systems to help people make the most of their time.

Validation of motion tracking as tool for observational toothbrushing studies

Video observation (VO) is an established tool for observing toothbrushing behaviour, however, it is a subjective method requiring thorough calibration and training, and the toothbrush position is not always clearly visible. As automated tracking of motions may overcome these disadvantages, the study aimed to compare observational data of habitual toothbrushing as well as of post-instruction toothbrushing obtained from motion tracking (MT) to observational data obtained from VO. One-hundred-three subjects (37.4±14.7 years) were included and brushed their teeth with a manual (MB; n = 51) or a powered toothbrush (PB; n = 52) while being simultaneously video-filmed and tracked. Forty-six subjects were then instructed how to brush their teeth systematically and were filmed/tracked for a second time. Videos were analysed with INTERACT (Mangold, Germany); parameters of interest were toothbrush position, brushing time, changes between areas (events) and the Toothbrushing Systematic Index (TSI). Overall, the median proportion (min; max) of identically classified toothbrush positions (both sextant/surface correct) in a brushing session was 87.8% (50.0; 96.9), which was slightly higher for MB compared to PB (90.3 (50.0; 96.9) vs 86.5 (63.7; 96.5) resp.; p = 0.005). The number of events obtained from MT was higher than from VO (p < 0.001) with a moderate to high correlation between them (MB: ρ = 0.52, p < 0.001; PB: ρ = 0.87; p < 0.001). After instruction, both methods revealed a significant increase of the TSI regardless of the toothbrush type (p < 0.001 each). Motion tracking is a suitable tool for observing toothbrushing behaviour, is able to measure improvements after instruction, and can be used with both manual and powered toothbrushes.

Demineralization Inhibitory Effects of Highly Concentrated Fluoride Dentifrice and Fluoride Gels/Solutions on Sound Dentin and Artificial Dentin Caries Lesions in vitro

OBJECTIVES

The aim of this in vitro study was to compare the demineralization inhibitory effect of gels/solutions used in combination with either standard or highly fluoridated dentifrices on sound dentin as well as on artificial dentin caries-like lesions.

METHODS

Bovine dentin specimens (n = 240) with two different surfaces each (sound [ST] and artificial caries lesion [DT]) were prepared and randomly allocated to twelve groups. Weekly interventions during pH-cycling (28 days, 6 × 120 min demineralization/day) were: the application of gels/solutions containing amine fluoride/sodium fluoride (12,500 ppm F [ppm]; pH = 4.4; AmF); NaF (12,500 ppm; pH = 6.6; NaF1); NaF (12,500 ppm; pH = 6.3; NaF2); silver diamine fluoride (14,200 ppm; pH = 8.7; SDF); acidulated phosphate fluoride (12,500 ppm; pH = 3.8; APF), and no intervention (standard control; S). Furthermore, half of the specimens in each group were brushed (10 s; twice per day) with dentifrice slurries containing either 1,450 ppm (e.g., AmF1450) or 5,000 ppm (e.g., AmF5000). Differences in integrated mineral loss (ΔΔZ) and lesion depth (ΔLD) were calculated between values before and after pH-cycling using transversal microradiography.

RESULTS

After pH-cycling Ss showed significantly increased ΔZDT and LDDT values, indicating further demineralization. In contrast, except for one, all groups including fluoride gels/solutions showed significantly decreased ΔZDT values. Additional use of most fluoride gels/solutions significantly enhanced mineral gain, mainly in the surface area; however, acidic gels/solutions seemed to have negative effects on lesion depths.

SIGNIFICANCE

Under the present pH-cycling conditions the highly fluoridated dentifrice significantly reduced caries progression and additional application of nearly all of the fluoride gels/solutions resulted in remineralization. However, there was no difference in the remineralizing capacity of fluoride gels/solutions when used in combination with either standard or highly fluoridated dentifrices.

Effects of mechanical abrasion challenge on sound and demineralized dentin surfaces treated with SDF

This study evaluated the effect of mechanical abrasion on the surface integrity, color change (ΔE) and antibacterial properties of demineralized and sound dentin surfaces treated with silver-diammine-fluoride (SDF). The dentin specimens were divided into two groups: sound and demineralized dentin, then divided into three sub-groups, control (no-treatment), SDF, and SDF + potassium-iodide (KI). Each sub-group was further divided into two groups, one exposed to mechanical brushing and the other without brushing. Specimens were analyzed for the ΔE, surface roughness/surface loss and antibacterial properties (CFU, optical density and fluorescent microscope). Repeated Measures ANOVA was used for statistical analysis of color change while one-way ANOVA was used for CFU analysis. SDF and SDI + KI groups showed significant reduction in ΔE with brushing in the sound dentin group unlike the demineralized group. The surface roughness values were higher for both SDF and SDF + KI groups but roughness values significantly decreased after brushing. Both SDF and SDF + KI groups revealed significantly less surface loss than control. The SDF group showed high anti-bacterial effect after brushing, unlike SDF + KI group. So, we concluded that mechanical brushing improved the esthetic outcome. While, SDF and SDF + KI could protect the dentin surface integrity. SDF-treated dentin possesses an antibacterial property even after mechanical brushing.

Characterisation of mechanical and surface properties of novel biomimetic interpenetrating alumina-polycarbonate composite materials

OBJECTIVE

To determine the mechanical and surface characteristics of two novel biomimetic interpenetrating phase alumina-polycarbonate (Al₂O₃-PC) composite materials, comprising aligned honeycomb-like porous ceramic preforms infiltrated with polycarbonate polymer.

METHOD

Two composite materials were produced and characterised. Each comprised a porous structure with a ceramic-rich (polymer-poor) top layer, graduated through to a more porous ceramic-poor (polymer-rich) bottom layer. In addition, pure polycarbonate and dense alumina specimens were subjected to the same characterisation namely: density, compression, three-point bend, hardness, surface loss and surface roughness testing. Scanning electron microscopy and micro computerised tomography were employed for structural examination.

RESULTS

Three-dimensional aligned honeycomb-like ceramic structures were produced and full interpenetration of the polymer phase was observed using MicroCT. Depending on the ceramic volume in the initial aqueous ceramic suspension, the density of the final interpenetrating composites ranged from 2.64 to 3.01g/cm³, compressive strength ranged from 192.43 to 274.91MPa, flexural strength from 105.54 to 148.47MPa, fracture toughness from 2.17 to 3.11MPa.m^½, hardness from 0.82 to 1.52GPa, surface loss from 0.71 to 1.40μm and surface roughness, following tooth brushing, from 0.70 to 0.99μm. Composite specimens showed characteristic properties part way between enamel and polycarbonate.

SIGNIFICANCE

There was a correlation between the initial solid ceramic loading in the aqueous suspension, used to produce the porous ceramic scaffolds, and the subsequent characteristic properties of the composite materials. These novel composites show potential as aesthetic orthodontic bracket materials, as their properties fit part way between those of ceramic, enamel and polycarbonate.

Influence of teeth anatomical characteristics on the efficacy of manual toothbrushing manoeuvres

Purpose

The aim of the study was to investigate the efficacy of two toothbrushing techniques on the amount of plaque accumulation and to evaluate how the changes were correlated to the anatomical characteristics of the anterior maxillary arch.

Methods

Thirty subjects of both genders were included, they were asked not to brush for 12 h. Afterwards, they were asked to manually brush the left side of their maxillary arch with the modified Bass technique and the right side adopting the roll technique. The comparison of photographs taken before and after the manoeuvres, using a plaque disclosing agent, allowed the researchers to measure the changes in plaque accumulation measured using the Quigley and Hein plaque scoring classification. Linear regression analysis was used to evaluate the correlation between such changes and the teeth and arch anatomical characteristics.

Results

A mean reduction of 9.6 ± 5.2% considering both arches after brushing was observed. The changes in plaque accumulation were not different between the two techniques. The length of the line obtained joining the contact point between the central incisors and the contact point between the second premolar and the first molar on the left side and the distance between that line and the lateral incisor on the same side positively correlated to the decrease in the plaque scores (P = 0.046 and P = 0.044, respectively).

Conclusion

Both tested techniques were effective in plaque removal in the anterior maxillary arches. However, the research for the anatomical factors influencing the amount of efficacy of the toothbrushing manoeuvres was inconclusive. We can hypothesise that the adoption of one adequate technique could be more important than the teeth characteristics.

The Knowledge, Attitude and Practices of the Caregivers about Oral Health Care, at Centers for Intellectually Disabled, in Southern Region of Saudi Arabia

Oral health is perhaps the most neglected aspect of healthcare for persons living in rehabilitation centers, compared to the general population. The caregivers play a vital role in administering daily oral care to residents in rehabilitation centers: The aim of the present questionnaire-based study was to evaluate the caregivers’ knowledge, attitude and practices towards oral healthcare at centers for the intellectually disabled in the Southern region of Saudi Arabia (SA). The present study was designed as a cross-sectional one-point time survey. The samples were selected by using a non-probability convenience sampling method. The self-administered closed-ended questionnaire comprised of 22 items divided into four sections, which was designed to elicit the demographic information, awareness of oral care, attitude towards oral health and practice of the oral healthcare regime among the participants. Of the164 participants, 53.0% and 47.0% were male and female, respectively. Most of the participants—54.9%—were between 30–39 years of age. Participants were almost equally distributed between educational groups, and about 87% had more than 2 years of experience. A brief overview showed a fair level of knowledge and attitude among 61.6% and 58.5% of respondents, respectively. Participants with an education level above that of high school showed good knowledge and attitude scores (p < 0.05), whereas females showed better attitude scores compared to the males (p < 0.05). Respondents mentioned the difficulties they faced while treating the subjects. The special healthcare workers generally had acceptable oral health knowledge and practices. Caregivers who had lower education levels should be advised for training programs that addressed the importance of oral health services.

Does delayed toothbrushing after the consumption of erosive foodstuffs or beverages decrease erosive tooth wear? A systematic review and meta-analysis

OBJECTIVE

Controversy exists regarding the effectiveness of delayed toothbrushing in decreasing erosive tooth wear (ETW). The purpose of this systematic review and meta-analysis was to assess the effects of delayed toothbrushing on ETW.

MATERIALS AND METHODS

This systematic review and meta-analysis was conducted according to the PRISMA statement and registered in PROSPERO (CRD42020200463). PubMed, Embase, and Web of Science databases were systematically searched with no publication year limits. Screening and data extraction were performed independently by two reviewers. In situ and in vitro studies comparing ETW after delayed and immediate toothbrushing following an erosive attack were included. Review Manager software 5.3 (The Cochrane Collaboration, Oxford, UK) was used for statistical analyses. Heterogeneity was assessed with the Cochran Q test and I² statistics.

RESULTS

Of the 565 potentially relevant studies, 26 full-text articles were assessed for eligibility. Twelve articles were included in the systematic review, and 11 were included in the qualitative analyses. No significant difference in the ETW of human enamel was observed between delayed and immediate toothbrushing (P = 0.13), whereas significantly less ETW of bovine enamel was observed after delayed toothbrushing (P < 0.001). No significant difference in the ETW of bovine dentin was observed between delayed and immediate toothbrushing (P = 0.34). Studies on human dentin were not available. Subgroup analyses revealed a significant contribution of the use of fluoridated toothpaste to decreasing the ETW of human enamel after erosion and toothbrush abrasion (P = 0.02).

CONCLUSIONS

Bovine and human teeth behaved differently in response to erosion and toothbrush abrasion. Delayed toothbrushing after an erosive attack was not effective at decreasing the ETW of human enamel compared to immediate toothbrushing, whereas it was effective at decreasing the ETW of bovine enamel.

CLINICAL RELEVANCE

Delayed toothbrushing alone after the consumption of erosive foodstuffs or beverages is not capable of preventing erosive enamel wear.

Efficacy of a Hybrid Toothbrush versus Comparative Manual Toothbrush for Plaque Removal - Randomized In-Use Study

Purpose

An innovative hybrid toothbrush was designed to function either in manual sonic mode or combined mode (manual and sonic). The primary objective was to assess the efficacy of a new hybrid powered toothbrush (PTB) used in combined mode versus a comparative manual toothbrush (MTB) for plaque removal, after 14 days of twice-daily use under normal conditions. The secondary objectives were to evaluate the gingival state, to evaluate the tolerance of the hybrid PTB and to evaluate its acceptability.

Materials and Methods

This study was a monocentric, block-randomized, dual treatment, parallel group, and examiner-blinded trial with before and after evaluation. It was conducted on two groups of 55 subjects presenting a visible plaque accumulation (score ≥2 as measured by the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI)). On Day 1/Day 8/Day 15, the same investigator conducted blind clinical examinations on each subject and evaluated TMQHPI and Papillary Bleeding Score (PBS). On Day 1, the subjects received either the hybrid PTB or the comparative MTB and used it twice daily under normal conditions of use.

Results

The hybrid PTB used in its combined mode eliminates dental plaque more efficiently than the comparative MTB, especially in difficult-to-access areas such as posterior and interproximal dental surfaces, while remaining gentle on the gingivae. The PBS was significantly lower with the hybrid toothbrush compared with the reference manual one.

Conclusion

The new device confirmed previous findings and should improve oral hygiene following the manufacturer's instructions. Moreover, the specific design of the toothbrush means that it can be used according to the oral environment conditions and personal feeling.

Data on toothbrushing study comparing infrared-based motion tracking versus video observation

Investigations of toothbrushing habits are an important vector to understand their influence on brushing effectiveness. User compliance in toothbrushing is known to deviate from professional recommendations in brushing time, evenness across all areas of the dentition, and brushing force [1,2]. Despite the recent development of tools designed to guide users to optimised brushing habits [3,4], research on habit evaluation and tracking is limited and typically relies on labour-intensive video observation (VO) [5]. Here we present raw data on toothbrush position as determined by an automated motion tracking (MT) capability and by human VO and provide a technical description of the MT capability. The MT system described in this article was developed in collaboration with Soft2Tec GmbH (Rüsselsheim, Germany) as a potential substitute for the VO tool. The MT system consists of a monocular vision module and a target module with active infrared LED trackers. The MT system determined the position and orientation of a toothbrush relative to the jaw while subjects brushed under realistic conditions. For VO, a trained assessor coded video recording data from toothbrushing sessions. The data presented here describes a clinical study (103 subjects; 46 completed two sessions, 57 completed one session, altogether 149 events) comparing toothbrushing behaviour recorded with the MT system and with VO simultaneously. The raw data was deposited in Mendeley Data, under data identification number doi:10.17632/4f384xrbhm.1 [https://data.mendeley.com/datasets/4f384xrbhm/1].

Effectiveness of a digital device providing real-time visualized tooth brushing instructions: A randomized controlled trial

Introduction

The aim of this trial was to investigate whether a digital device that provides real-time visualized brushing instructions would contribute to the removal of dental plaque over usual brushing instructions.

Methods

We conducted a single-center, parallel-group, stratified permuted block randomized control trial with 1:1 allocation ratio. Eligibility criteria included people aged ≥ 18 years, and exclude people who met the following criteria: severely crowded teeth; using interdental cleaning implement; having external injury in the oral cavity, or stomatitis; having less than 20 teeth; using orthodontic apparatus; visited to a dental clinic; having the possibility of consulting a dental clinic; having a dental license; not owning a smartphone or tablet device; smoker; taken antibiotics; pregnant; an allergy to the staining fluid; and employee of Sunstar Inc. All participants received tooth brushing instructions using video materials and were randomly assigned to one of two groups for four weeks: (1) an intervention group who used the digital device, providing real-time visualized instructions by connection with a mobile application; and (2) a control group that used a digital device which only collected their brushing logs. The primary outcome was the change in 6-point method plaque control record (PCR) score of all teeth between baseline and week 4. The t-test was used to compare the two groups in accordance with intention-to-treat principles.

Results

Among 118 enrolled individuals, 112 participants were eligible for our analyses. The mean of PCR score at week 4 was 45.05% in the intervention group and 49.65% in the control group, and the change of PCR score from baseline was −20.46% in the intervention group and −15.77% in the control group (p = 0.088, 95% confidence interval −0.70–10.07).

Conclusions

A digital device providing real-time visualized brushing instructions may be effective for the removal of dental plaque.

Cleansing efficacy of an auto-cleaning electronic toothbrushing device: a randomized-controlled crossover pilot study

Objectives

To compare the cleansing efficacy of a representative “ten seconds” auto-cleaning device with that of uninstructed manual toothbrushing in a pilot study.

Materials and methods

Twenty periodontally healthy probands refrained from oral hygiene for 3 days. Baseline full-mouth plaque scores (Rustogi Modified Navy Plaque Index, RMNPI) were assessed. After randomization, probands cleaned their teeth either with the auto-cleaning test device according to the manufacturer’s protocol or with a manual toothbrush. Plaque reduction was assessed by two aligned blinded investigators. After a 2-week recovery, the clinical investigation was repeated in a crossover design. The brushing pattern of the auto-cleaning device was analyzed in probands’ casts.

Results

Full-mouth plaque reduction was 11.37 ± 3.70% for the auto-cleaning device and 31.39 ± 5.27% for manual toothbrushing (p < 0.0001). The investigation of the auto-cleaning device’s brushing pattern in dental casts revealed a positive relationship of bristle rows in contact with tooth surfaces and the cleansing efficacy in the respective areas. A maximum of 2/4 bristle rows were in contact with the tooth surfaces; in some areas, the bristles had no contact to the teeth.

Conclusions

Uninstructed manual toothbrushing is superior to auto-cleaning. The alignment and density of the auto-cleaning device’s bristle rows need to be improved, and assorted sizes would be necessary to cover different jaw shapes.

Clinical relevance

The auto-cleaning device has been developed to accommodate individuals with poor dexterity or compliance. To date, it is unable to provide sufficient plaque reduction due to an inappropriate bristle alignment and poor fit with diverse dental arches.

Design and Development of a Novel Oral Care Simulator for the Training of Nurses

OBJECTIVE

A Novel Oral Care Simulator was designed and developed to measure and visualise the facial and lingual forces exerted on teeth by the action of tooth brushing, considering the irregular geometry and structural composition of human dentition and the emulation of the realistic biomechanical deflection of the teeth.

METHOD

FEA simulations were carried out on a central incisor under facial loading and an appropriate force sensing mechanism was designed. An anatomically accurate mandibular jaw and 16 teeth were 3D printed, on which 16 force sensing structures were embedded. The signals from the sensors were amplified using a multichannel signal amplifier built using instrumentation amplifiers which were then visualised through a GUI.

RESULTS

The developed simulator is capable of indicating the magnitude of a force upto 15 N exerted on to the facial and lingual surfaces of teeth at a frequency of 60 Hz and above and it is capable of alerting the user if the force exceeds a pre-specified threshold.

CONCLUSION

The designed force sensing mechanism considers the irregular geometry and structural composition of human dentition in measuring the facial and lingual forces. It provides a reliable feedback by indicating the force and emulating the realistic biomechanical deflection of teeth.

SIGNIFICANCE

Nurses who care for the disabled, elderly and sick have explicitly stated the requirement for a simulator to train themselves on brushing the teeth of their subjects as their incorrect technique can cause longterm dental damage, for which a device has not been developed to date.

The investigation of synergistic activity of protamine with conventional antimicrobial agents against oral bacteria

In this study, we applied protamine, which is an antimicrobial peptide, to oral healthcare in combination with conventional antimicrobial agents. First, we explored the antimicrobial activity of protamine, with or without other antimicrobial agents, against Streptococcus mutans (S. mutans). Co-treatment with protamine and 3-methyl-4-isopropylphenol (IPMP) decreased the viability of S. mutans synergistically within 10 min. Interestingly, sodium fluoride (NaF) did not exhibit synergistic activity with protamine. Next, S. mutans and Streptococcus gordonii (S. gordonii) were co-treated with protamine and IPMP for 5 min to simulate tooth brushing. As a result, this co-treatment killed S. mutans faster than S. gordonii. Therefore, co-treatment with protamine and IPMP could be incorporated into oral healthcare products to prevent dental caries.