Gingival abrasion and recession in manual and oscillating-rotating power brush users

Self-determined use of provided powered oral hygiene devices leads to improved gingival health after 1 year: a longitudinal clinical trial

PURPOSE

Our study aimed to evaluate the long-term concordance and acceptance when using powered devices for everyday oral hygiene routine and gingival health in patients showing papillary bleeding.

PATIENTS AND METHODS

Thirty-one participants were recruited at the dental clinic of the University Hospital of Cologne, Germany, over a 6-week duration. At baseline, a standard dental check-up was performed, including oral hygiene indices and documentation of oral hygiene devices used. The study consisted of two consecutive phases: the first (motivational trial) was designed to prove the effectiveness and safety of a microdroplet device and a powered toothbrush compared to dental floss and a manual toothbrush over a period of 4 weeks. The second (observational) phase began with all participants receiving the powered oral homecare devices. Participants were able to use their oral hygiene measures of choice over an unsupervised period of 1 year. All participants were then rescheduled for a routine dental check-up, where oral hygiene indices and oral hygiene devices used were reevaluated.

RESULTS

After 1 year, 93.3% of participants stated they performed interdental cleaning on a regular basis (baseline 60.0%). The percentage using a powered toothbrush increased from 41.9% (baseline) to 90.0% after 1 year. Oral hygiene parameters had improved after both the motivational trial and observational phases compared to baseline (papillary bleeding index p = .000; Rustogi Modified Navy Plaque Index p < .05; Quigley-Hein Index p = .000).

CONCLUSION

In the long term, participants preferred using powered oral hygiene devices over the gold standard dental floss and manual toothbrush. Improved oral hygiene parameters after 1 year may indicate implementation of newly acquired oral-hygiene skills during the 4-week instruction phase.

Cross-angled versus flat-trim bristle tuft configurations in manual toothbrushes: A systematic review

AIM

This systematic review synthesizes and evaluates the literature regarding the effect of manual toothbrushes (MTBs) with cross-angled bristle tufts (CA-TB) compared to flat-trim (FT-TB) configurations on plaque scores and parameters of gingival health in adult patients.

MATERIALS AND METHODS

PubMed-MEDLINE and Cochrane-CENTRAL databases were searched, from their insertion up to August 1st, 2023, to detect appropriate papers. Clinical trials involving adult patients without periodontitis who performed self-brushing were eligible for inclusion. Primary outcome parameters included plaque, bleeding, and gingival scores. Secondary outcomes encompassed signs of soft and hard tissue abnormalities. A descriptive analysis was conducted. When feasible, a meta-analysis was performed using either the 'fixed' or 'random effects' model, as appropriate.

RESULTS

Nine eligible papers were retrieved, presenting 20 comparisons. There was considerable heterogeneity in the clinical and methodological design aspects of the included studies. In the descriptive analysis, eight out of 12 comparisons demonstrated a difference in plaque removal performance in favour of the CA-TB. However, data regarding bleeding and gingival index scores were inconclusive. A meta-analysis was performed on plaque, bleeding, and gingival index scores, including different indices used for scoring. The meta-analysis of short-term studies showed a medium effect statistically significant difference in the reduction of plaque scores in favour of the CA-TB (SMD = 0.75; 95% CI (0.51; 0.99)), but this was not substantiated in longer-term studies (SMD = -0.06; 95% CI(-0.44; 0.31)). No adverse events were described in any group.

CONCLUSION

Within the limitations of the present study design, short-term evaluations, as assessed with various plaque indices, show a weak certainty in favour of the cross-angled toothbrush over the flat-trim toothbrush. However, based on longer-term evaluations, there is insufficient support due to the inconsistent outcomes of the analysis.

Safety and Efficacy of Plaque Removal Using Manual and Powered Toothbrush in Cerebral Palsy Children by Parents/Caregivers: A Randomized Control Crossover Trial

Aim

The aim of our study was to check the safety and efficacy of plaque removal using manual and powered toothbrush in cerebral palsy children by parents/caregivers.

Materials and methods

This was a single blinded, crossover randomized control trial conducted on 60 cerebral palsy children between the age of 6 to 14 years. They were randomly divided using a flip coin method into two groups: group A-manual toothbrush and group B-powered toothbrush. The plaque index (PI), gingival index (GI), and gingival abrasion (GA) score were measured at baseline, then at an interval of 3, 6, 9, and 12 weeks. This was followed by a crossover between two groups with a washout period of 1 week.

Results

Both manual and powered toothbrush showed a significant reduction in plaque and gingival score before and after crossover when compared to baseline (p < 0.05). The GA score was reduced to 100% in both groups. However, there was no statistically significant difference between both the groups before and after the crossover. Also, through the questionnaire it was observed that both child (86.6%) and parent (70%) showed positive feedback towards powered toothbrush.

Conclusion

It can be concluded from the present study that the efficacy of a powered toothbrush is comparable to that of a manual toothbrush. Parents and caregivers, on the contrary, displayed a favorable attitude towards the use of powered toothbrushes due to their ease of use.

Clinical relevance

Cerebral palsy is one of the most common neurological disorders among children. It is associated with poor motor skills and manual dexterity that hampers their ability to brush and thus leads to poor oral hygiene. A powered toothbrush seems more appealing and is specially designed for patients with poor neuromotor coordination.

How to cite this article

Deshpande AN, Naik K, Deshpande N, et al. Safety and Efficacy of Plaque Removal using Manual and Powered Toothbrush in Cerebral Palsy Children by Parents/Caregivers: A Randomized Control Crossover Trial. Int J Clin Pediatr Dent 2023;16(2):344-349.

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.

Interdental Papillary Reconstruction by Microtunnelling Technique Using Autologous Biomatrices-A Randomised Controlled Clinical Trial

Background and objectives: The study aimed to evaluate and compare the amount of papillary gain and black triangle height reduction after intervention with a microtunnelling technique with either Connective tissue graft (CTG) or Platelet-rich fibrin (PRF) as a biomatrix at 6 months using a microsurgical approach. Materials and Methods: Twenty-six patients with interdental papillary loss were included in the study. The patients were selected randomly for the study groups with thirteen patients in each group: a control group where CTG was utilised as a matrix, and a test group where PRF was utilised as a matrix, for interdental papillary reconstruction. A microtunnelling technique was performed for both the study groups under a surgical microscope. The primary parameters assessed were interdental Papillary height (PH) and Black triangle height (BTH) at baseline, with secondary parameters Visual analogue score by dentist (VAS-D) and patient (VAS-P) assessed at 6 months. Results: Both the control and test groups showed a significant reduction in BTH within their respective group at six months (p < 0.05). The gain in papillary height significantly improved only in the CTG group at 6 months. However, significant differences could not be demonstrated for any of the variables such as BTH (p value = 0.582) and PH (p-value = 0.892) between the study groups at 6 months. Conclusions: IDP reconstruction utilising a microtunnelling approach with CTG or PRF was successful without any significant differences between the groups for the parameters assessed at 6 months.

Powered Toothbrushes: An Opportunity for Biofilm and Gingival Inflammation Control

The present review aimed at a broad investigation on the potential of powered as compared to manual toothbrushes in different aspects of clinical dentistry. Studies evaluating plaque and gingival inflammatory parameters were included, as well as those that investigated adverse effects. Emphasis was given separately to adults, youngsters, special-needs patients, and those under fixed orthodontic therapy. In general, comparisons favored powered toothbrushes. In summary, approximately 68% of the included studies, in terms of plaque/gingival inflammation in adults, presented better results for powered toothbrushes. In children and special-needs populations, approximately 40% of the included studies favored powered toothbrushes for plaque/gingival inflammation, and none favored manual ones. In orthodontic individuals, 50% of the studies also demonstrated a better effect of powered toothbrushes on plaque and gingival inflammation. All included studies that assessed adverse events did not demonstrate a difference in these effects when comparing manual vs. powered toothbrushes. It is concluded that the use of powered toothbrushes is an opportunity to enhance patterns of plaque control and associated gingival inflammation.

Effects of interactive power toothbrush with or without application assistance on the plaque, gingivitis, and gingival abrasion among dental students: a randomized controlled clinical trial

OBJECTIVE

The purpose of this randomized controlled study is to determine if an interactive power toothbrush (PTB) with application (app) promotes additional benefit on dental plaque, gingivitis, and gingival abrasion to that of a manual toothbrush (MTB).

MATERIALS AND METHODS

Ninety participants (dental students) diagnosed with gingivitis were randomly assigned, into three groups, 1:1:1 ratio, given an app-assisted interactive PTB (PTB-A) (Oral-B Genius® Rechargeable 8000 PTB with CrossAction brush head) or the same PTB without app-assistance (PTB-NA) or a regular MTB for home-use. Plaque was assessed using the Turesky modification of the Quigley and Hein Plaque Index (QHPI-TM), and gingivitis was evaluated using the Bleeding on Marginal Probing Index (BOMP) at baseline (T0), week 2 (T1), and week 8 (T2). Gingival abrasions were recorded at T1 and T2. Exit survey was used to assess brushing time and visual-analogue-scale (VAS) scores.

RESULTS

PTB improved QHPI-TM significantly in terms of time-dependent changes, irrespective of app-assistance. BOMP was observed to be statistically lower in PTB-A than in MTB only at T2. Brushing times were longer in PTB-A than in MTB. Gingival abrasion was less in both PTB than MTB. PTB-A had better results to MTB in cleaning ability according to subject-reported outcomes.

CONCLUSIONS

Both PTBs were more effective to MTB; however, the app-assisted interactive PTB was similar to the non-assisted one in plaque removal efficacy, gingivitis reduction, and incidence of gingival abrasion, yet better than MTB in cleaning ability.

CLINICAL RELEVANCE

Developing an application software to prevent gingival abrasion might be clinically beneficial regardless of the individual factor.

TRIAL REGISTRATION

ClinicalTrial.gov ID: NCT05150132.

The efficacy of powered toothbrushes: A systematic review and network meta-analysis

Aim

This systematic review and network meta‐analysis synthesizes the available clinical evidence concerning efficacy with respect to plaque scores following a brushing action with oscillating‐rotating (OR) or high‐frequency sonic (HFS) powered toothbrushes (PTB) compared with a manual toothbrush (MTB) as control.

Material and methods

Databases were searched up to 1 August 2021, for clinical trials that evaluated the efficacy of a PTB with OR or HFS technology compared with an MTB on plaque removal after a single‐brushing action and conducted with healthy adult patients. Meta‐analysis (MA) and a network meta‐analysis (NMA) were performed.

Results

Twenty‐eight eligible publications, including 56 relevant comparisons, were retrieved. The overall NMA results for the mean post‐brushing score showed a statistically significant difference for the comparison between an OR PTB and an MTB (SMD = −0.43; 95% CI [−0.696;−0.171]). The change in plaque score data showed a significant effect of a PTB over an MTB and OR over HFS. Based on ranking, the OR PTB was highest, followed by the HFS PTB and the MTB.

Conclusion

Within the limitations of the present study design, based on the outcome following a single‐brushing action, it can be concluded that for dental plaque removal, there is a high certainty for a small effect of a PTB over an MTB. This supports the recommendation to use a powered toothbrush for daily plaque removal. There is moderate certainty for a very small benefit for the use of a powered toothbrush with an OR over an HFS mode of action.

Good role models? Tooth brushing capabilities of parents: a video observation study

BACKGROUND

Research in adolescents reveals that they are not capable to remove dental plaque effectively. Inconsistent application of brushing techniques and neglect of certain areas while brushing are very common. As parents play a major role in the oral health education, the present study aimed to examine and describe the tooth brushing performance of the parents of adolescents.

METHODS

Parents of adolescents (N = 66) were asked to perform oral hygiene to the best of their capabilities in front of a video camera and dental plaque was recorded before and afterwards. Papillary bleeding was also assessed.

RESULTS

The tooth contact time (i.e. net brushing duration) averaged 155 s ± 58 s. Gingival margins showed persistent plaque at 68% ± 14% of the sections assessed. Papillary bleeding was found at 52% ± 18% of the papillae. Parents brushed inner surfaces lesser than the outer surfaces (41 s ± 24 s vs. 73 s ± 33 s) and 29% of the parents completely missed the inner surfaces of at least one sextant. On the outer surfaces parents predominantly applied circular movements (66% ± 25% of brushing time). Vertical brushing prevailed on the inner surfaces (52% ± 30%). However, horizontal scrubbing was also very common (46% ± 31%).

CONCLUSIONS

Parents' tooth brushing performance was neither effective in terms of plaque removal nor did they fully comply with tooth brushing recommendations such as considering all inner surfaces when brushing or application of other than horizontal movements to lateral surfaces. Regarding oral hygiene, parents should not only be a good role model in terms of timing, frequency and duration of tooth brushing but should also be able to demonstrate how to brush teeth completely and effectively. The current research indicates that they might lack the latter skill.

SEM Evaluation of Tooth Surface after a Composite Filling Removal Using Er:YAG Laser, Drills with and without Curettes, and Optional EDTA or NaOCl Conditioning

(1) Background: This study aimed to evaluate the microporosity of the tooth surface structure adjacent to the cemento-enamel junction (CEJ) after the removal of composite fillings with a drill in comparison with removal by an Er:YAG laser and after cleaning with a periodontal curette, chemical EDTA and NaOCl (sodium hypochlorite) conditioning. (2) Methods: The research material consisted of 30 extracted premolars with cervical composite fillings. The teeth were divided into six groups according to the method of tooth preparation: group G1 (n = 5)-a diamond drill; group G2 (n = 5)-a diamond drill + curette; group G3 (n = 5)-a diamond drill + 24% EDTA (PrefGel, Straumann, Switzerland); group G4 (n = 5)-an Er:YAG laser (LightWalker, Fotona, Ljubljana, Slovenia) set with the following parameters: power: 1.65 W (composite removal, CR), 1.2 (tooth conditioning, TC), energy: 110 mJ (CR), 80 mJ (TC), frequency: 15 Hz, pulse duration: 50 μs, tip diameter: 1 mm, air/fluid cooling: 4, distance 1.5 mm, energy density: 14.01 J/cm2 (CR), 10.19 J/cm2 (TC); group G5 (n = 5)-an Er:YAG laser + 2% sodium hypochlorite (NaOCl); group G6 (n = 5)-an Er:YAG laser + 5.25% NaOCl. In each tooth, three cavities were made and subjected to analysis. The dentin surface was evaluated using a scanning electron microscope (SEM). (3) Results: Groups G1 and G2 exhibited mechanical damage to the tooth surface structure caused by the rotary motion of a diamond drill. The SEM image showed a smear layer that could only be removed chemically using 24% EDTA gel (group G3). The tooth surfaces prepared with the Er:YAG laser (groups G4-G6) revealed a homogeneous structure without damage along with open dentinal tubules (without smear layer) and visible denaturation of collagen fibers. The sodium hypochlorite (NaOCl) conditioning did not increase the visibility of dentinal tubules. (4) Conclusions: Dentin surfaces have open dentinal tubules after removal of the composite filling using the Er:YAG laser and therefore do not require additional NaOCl conditioning.

The efficacy of a rubber bristles interdental cleaner on parameters of oral soft tissue health-a systematic review

Aim

This study aimed to establish the efficacy of a rubber bristles interdental cleaner (RBIC) as an adjunct to toothbrushing (TB) compared to that of the adjuvant use of other interdental cleaning devices and TB alone on plaque and gingivitis parameters. Additionally, the safety aspects and panellists’ appreciation were evaluated.

Materials and Methods

Databases were searched for randomized controlled clinical trials (RCTs) evaluating plaque (PI), bleeding (BS), and gingival index (GI) scores, safety assessments, and participants’ appreciation. Extracted data were summarized in a descriptive and, if possible, a meta‐analysis.

Results

The search retrieved 142 unique papers; six studies with 10 comparisons were included in a descriptive analysis. Five RCTs compared RBICs with interdental brushes (IDBs), four with dental floss (DF) and one with manual TB only. No comparisons to wood sticks were retrieved. Using an RBIC resulted in no difference in plaque scores compared to DF and IDBs. For overall bleeding scores, no difference was found. Two studies analysing the accessible sites separately found RBICs to be more favourable than DF and IDBs. Conversely, one study evaluating the efficacy of RBICs compared to IDBs, according to the GI scores, showed that IDBs achieved significantly greater reduction. Moreover, RBICs caused fewer gingival abrasions and were preferred by the study participants.

Conclusion

Based on a descriptive and a meta‐analysis of the available literature, it is synthesized that in gingivitis patients, a weak to very weak certainty exists that a RBIC is indicated for gingivitis and plaque reduction. The evidence supports user safety and participants’ preferences.

How effective is a powered toothbrush as compared to a manual toothbrush? A systematic review and meta-analysis of single brushing exercises

Objectives

In adult participants, what is, following a single brushing exercise, the efficacy of a powered toothbrush (PTB) as compared to a manual toothbrush (MTB) on plaque removal?

Methods

MEDLINE‐PubMed and Cochrane‐CENTRAL were searched from inception to February 2019. The inclusion criteria were (randomized) controlled clinical trials conducted in human subjects ≥18 years of age, in good general health and without periodontitis, orthodontic treatment, implants and/or removable prosthesis. Papers evaluating a PTB compared with a MTB in a single brushing exercise were included. When plaque scores were assessed according to the Quigley‐Hein plaque index (Q&HPI) or the Rustogi modified Navy plaque index (RMNPI). From the eligible studies, data were extracted. A meta‐analysis and subanalysis for brands and mode of action being oscillating‐rotating (OR) and side‐to‐side (SS) were performed when feasible.

Results

Independent screening of 3450 unique papers resulted in 17 eligible publications presenting 36 comparisons. In total, 28 comparisons assessed toothbrushing efficacy according to the Q&HPI and eight comparisons used the RMNPI. Results showed a significant effect in favour of the PTB. The difference of Means (DiffM) was −0.14 (P < 0.001; 95%CI [−0.19; −0.09]) for the Q&HPI and −0.10 (P < 0.001; 95%CI [−0.14; −0.06]) for the RMNPI, respectively. The subanalysis on the OR mode of action showed a DiffM −0.16 (P < 0.001; 95%CI [−0.22, −0.10]) for the Q&HPI. For the SS mode of action using RMNPI, the DiffM showed −0.10 (P < 0.001; 95%CI [−0.15; −0.05]). The subanalysis for brands showed for the P&G OR PTB using the Q&HPI a DiffM of −0.15 (P < 0.001; 95%CI [−0.22; −0.08]) and the Colgate SS for RMNPI showed a DiffM of −0.15 (P < 0.001; 95%CI [−0.18; −0.12]).

Conclusion

There is moderate certainty that the PTB was more effective than the MTB with respect to plaque removal following a single brushing exercise independent of the plaque index scale that was used.

Knowledge and Attitude Toward Electric Toothbrush Use Among Dental Professionals in Saudi Arabia

Background:

Proper knowledge and awareness regarding electric toothbrushes may decrease the incidence of caries and indirectly reduce the burden of oral disease on the developing economy by preventing plaque-related disease on a population level.

Aims and objectives:

The aim of this study was to assess the knowledge and attitude toward electric toothbrush use among dentist in Saudi Arabia.

Materials and methods:

An analytical cross-sectional study was conducted among 417 dentists in Saudi Arabia. For this study, an interview-type questionnaire comprising 14 questions was designed. These questions were asked from different dentists randomly through a telephonic survey. The first part of the questionnaire was related to the basic demographic details of the dentists, that is, gender, age, type of practice, dental education, specialty, and experience, whereas the second part of the questionnaire was designed to extract the experience, attitude, and opinion of the dentists regarding electric toothbrushes. The data were compiled and analyzed using Statistical Product and Service Solutions, version 20 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were employed to calculate means and percentages for demographic data.

Results:

Among the dental participants, 171 (41.0%) were general practitioners, 163 (39.0%) were specialist, 23 (5.6%) were postgraduate students, and 60 (14.4%) were graduate dentists. A total of 271 (65%) respondents believed better patient compliance to be the main benefit of the electric toothbrush, whereas 325 (77.9%) respondents believed that poor patient compliance was the reason for patient’s poor plaque control. Similarly, 319 (76.5%) dentists endorsed patients with manual dexterity issues. Those dentists primarily recommended electric toothbrushes to patients with medical problems.

Conclusions:

Knowledge of dentists in Saudi Arabia is adequate regarding electric toothbrushes; efforts should be made to improve knowledge and awareness on the use of powered toothbrushes at the patients’ level.

Oral cleanliness in daily users of powered vs. manual toothbrushes - a cross-sectional study

Background

Toothbrushing is a daily routine. Still, when adults are asked to manually perform oral hygiene to the best of their abilities, a considerable amount of plaque persists. Little is known about the performance of people who use a powered toothbrush. The present study thus analysed whether the capability to achieve oral cleanliness is better in people for whom powered toothbrushing is a daily routine.

Methods

University students, who either performed powered (N = 55) or manual (N = 60) toothbrushing for more than 6 months on a daily basis were asked to clean their teeth to the best of their abilities by their own device. Plaque was assessed prior to and immediately after brushing. Furthermore, gingival bleeding, recessions, periodontal pocket depths and dental status were assessed. Oral hygiene performance was video-taped and analyzed with respect to brushing duration, sites of brushing and application of interproximal cleaning devices.

Results

No differences between groups were found with respect to plaque before and after brushing, clinical parameters and overall brushing duration (all p > 0.05, all d < 0.156). After brushing, plaque persisted at approximately 40% of the sections adjacent to the gingival margin in both groups.

Conclusions

No advantage of daily powered toothbrushing as compared to daily manual toothbrushing was seen with respect to oral hygiene or clinical parameters. The capability to achieve oral cleanliness was low, irrespective of the type of toothbrush under consideration. Additional effort is thus needed to improve this capability.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0790-9) contains supplementary material, which is available to authorized users.

A new tooth brushing approach supported by an innovative hybrid toothbrush-compared reduction of dental plaque after a single use versus an oscillating-rotating powered toothbrush

Background

An innovative hybrid toothbrush was designed functioning either in manual mode, in powered mode (sonic) or in combined mode (manual and powered). The primary aim of this study was to evaluate and compare the clinical efficacy of this first hybrid toothbrush (Elgydium Clinic/Inava Hybrid) used in combined mode to a marketed oscillating-rotating powered toothbrush (Oral-B Vitality) in the reduction of dental plaque after a single use. The secondary aims were to evaluate the tolerance and acceptability of each device.

Methods

It was a randomized, examiner-blind, single-center study performed on two parallel groups: hybrid toothbrush (n = 33) versus oscillating-rotating toothbrush (n = 33). A brushing exercise was conducted for two minutes on subjects presenting a “Silness and Löe Plaque Index” (PI) between 1.0 and 2.0 and a “Modified Gingival Index” between 1.0 and 2.0. They were not to have ever used an electric toothbrush. To assess the device effect after brushing, a paired t-test was applied on the change outcome (After-Before brushing). An unpaired t-test was used to compare the efficacy of both devices. A global tolerance assessment of each powered toothbrush was done on all the subjects. The number and percentage of reactions related to each toothbrush was collected and the final tolerance assessment was estimated.

Results

After a single use, the hybrid toothbrush used in combined mode presented a global anti-plaque efficacy characterized by a significant decrease of the global PI of 45% on average (p < 0.0001; paired t-test). It was as effective as the oscillating rotating toothbrush in plaque removal (p > 0.05; unpaired t-test). The global tolerance of both toothbrushes was judged as “Good” and they were equally appreciated by the users.

Conclusion

The results of this one-time use trial demonstrate the efficacy of the hybrid toothbrush used in combined mode for plaque removal. The hybrid toothbrush design allows each user to adapt tooth brushing to his preference (manual / sonic / combined), his skills or his mouth condition. We hypothesize that such an individualized approach can favor long term compliance with oral health recommendations and improve global oral wellness.

Trial Registration

ISRCTN12394494, 20/02/2018 - Retrospectively registered.

Healing of toothbrush-induced abrasions to keratinized mucosa of the palate in humans: A pilot study

BACKGROUND AND OBJECTIVE

To the best of our knowledge, the healing time for toothbrush-induced gingival abrasions in humans has not yet been explored. The aim of this study was to evaluate the time needed to heal for toothbrush-induced abrasions of the keratinized mucosa of the palate.

MATERIAL AND METHODS

In patients without, with mild periodontitis or with periodontitis, gingival abrasion lesions were induced at the keratinized mucosa of the palate by brushing up to 2 minutes. Healing as observed clinically was followed via calibrated digital photographs of the lesion after staining, every 24 hours until the lesion had resolved. In patients without or with only mild periodontitis, the healing time of lesions caused by 30 seconds and 1 minute of brushing was also recorded.

RESULTS

Thirty-one participants (11 without or with mild periodontitis, 20 with periodontitis) met the inclusion criteria. In patients without or with mild periodontitis, the lesions induced by brushing for 2 minutes diminished by 48.7% of their original surface area within 24 hours. In patients with periodontitis the respective outcome was 45.4% (P = .87). Abrasions caused by 2 minutes of brushing needed more than 24 hours to heal completely. When decreasing the time exposed to trauma, fewer lesions were visible at baseline and the time needed to heal decreased. The subgroup of smokers was too small to evaluate any effect.

CONCLUSION

The longer the exposure time of the keratinized mucosa of the palate to trauma, the more lesions were visible, the larger the abrasions were and the more time they needed to heal completely. More studies are needed to investigate the role of smoking, gingival biotype and to link these findings with gingival recessions.

Efficacy of a rubber bristles interdental cleaner compared to an interdental brush on dental plaque, gingival bleeding and gingival abrasion: A randomized clinical trial

AIM

To determine the efficacy of a rubber bristles interdental cleaner (RBIC) compared to an interdental brush (IDB) in reducing gingivitis and additionally to evaluate participants' attitudes and possible side effects.

MATERIAL AND METHODS

The study was a 2-treatment, parallel, split-mouth, examiner-blind RCT, evaluating the reversal of experimental gingivitis. In total, 42 systemically healthy volunteers were recruited that were currently non-users of interdental cleaning devices. After familiarization and prophylaxis, participants refrained from brushing mandibular teeth for 21 days, followed by 4-week product use of the assigned interdental cleaning device as adjunct to manual toothbrushing. Bleeding on marginal probing (BOMP), dental plaque index score (PI) and gingival abrasion score (GAs) were assessed in the lower jaw.

RESULTS

Overall, no statistically significant differences between the RBIC and IDB in reducing BOMP and PI were obtained. Analysing the sites that were accessible for the RBIC/IDB only showed that the sites treated with the RBIC had significantly less BOMP after 4 weeks (P = .009). The RBIC also caused less GAs (P => .016) and was considered more pleasurable to use by the participants (P = .0001).

CONCLUSIONS

In accessible sites, the RBIC, in conjunction with manual toothbrushing, was found to be more effective in reducing gingival inflammation after 4 weeks. The RBIC caused less abrasion of the gingiva and was appreciated more by the participants.

Gingival Margin Stability After Mucogingival Plastic Surgery. The Effect of Manual Versus Powered Toothbrushing: A Randomized Clinical Trial

BACKGROUND

Oscillating-rotating power toothbrushes have been proven to be clinically efficacious. To the best of the authors' knowledge, a clinical evaluation of the safety of these toothbrushes after surgical root coverage procedures has not been published. The aim of this study is to evaluate the gingival margin (GM) stability with the use of an oscillating-rotating toothbrush compared with a manual toothbrush.

METHODS

Sixty healthy individuals with at least one Miller Class I or II gingival recession underwent a surgical root coverage procedure. Soft-bristle manual and powered toothbrushes were given to participants randomly assigned to control and test groups, respectively. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), and recession depth (RD) were recorded at baseline and 1, 3, and 6 months after completion of the surgical procedure. Data analyses were performed using linear random-intercept models to take into account within-participant correlations over time. Temporal trend differences across treatments by including treatment-time interaction terms were then tested using a global Wald test.

RESULTS

Use of a powered toothbrush resulted in a significantly greater reduction of recorded periodontal clinical indices compared with a manual device (FMPS, P = 0.05; FMBS, P = 0.005; RD, P = 0.004). No significant differences were noticed between the two experimental groups both for PD (P = 0.03) and clinical attachment level (P = 0.11). Complete root coverage was significantly higher in participants who used the powered toothbrush compared with the manual toothbrush at 6 months (control, 66.67%; test, 96.67%; P = 0.002).

CONCLUSION

Use of an oscillating-rotating powered toothbrush with a soft-bristle head resulted in higher GM stability after root coverage procedures compared with the use of a manual soft-bristled toothbrush.

Efficacy of homecare regimens for mechanical plaque removal in managing gingivitis a meta review

FOCUSED QUESTION

Based on evidence as presented in systematic reviews what is the efficacy and safety of available homecare toothbrush regimens for mechanical plaque removal on plaque and gingivitis in adults?

MATERIAL & METHODS

Three Internet sources were used (up to and including August 2014) to search for appropriate papers that satisfied the study purpose. Plaque scores and gingivitis scores were considered to be the primary parameter of interest. Safety was considered an important facet in relation to efficacy. Data and conclusions as presented in the selected papers were extracted. The potential risk of bias was estimated and the emerging evidence was graded.

RESULTS

Independent screening of 176 unique reviews resulted in 10 published and eligible systematic reviews. They were categorized into one review evaluating the effect of an oral hygiene instruction with a toothbrush on plaque and gingivitis scores, five evaluating the efficacy of manual and power toothbrushes and three reviews evaluating toothbrush safety and one evaluating toothbrush contamination.

CONCLUSION

Tooth brushing is effective in reducing levels of dental plaque. With respect to gingivitis power toothbrushes have a benefit over manual toothbrushes. The greatest body of evidence was available for oscillating-rotating brushes. Tooth brushing generally can be considered safe for the teeth and their investing tissues.

Three-year randomized study of manual and power toothbrush effects on pre-existing gingival recession

AIM

To compare long-term effects of brushing with an oscillating-rotating power toothbrush or an ADA reference manual toothbrush on pre-existing gingival recession.

MATERIALS AND METHODS

In this controlled, prospective, single-blind, parallel-group study, healthy subjects with pre-existing recession were randomized and brushed with a power toothbrush (n = 55) or an ADA reference manual toothbrush (n = 54) for a 3-year study period. Subjects were required to brush their teeth twice daily for 2 min. using a standard fluoride toothpaste. During the study, subjects were assessed for clinical attachment loss and probing pocket depths to the nearest mm at six sites per tooth by the same calibrated examiner. Gingival recession was calculated at pre-existing sites as the difference between clinical attachment loss and probing pocket depths. Hard and soft oral tissues were examined to assess safety.

RESULTS

After 35 ± 2 months, mean gingival recession did not differ significantly between groups, but was significantly reduced from baseline (p < 0.001), from 2.35 ± 0.35 mm to 1.90 ± 0.58 mm in the power and from 2.26 ± 0.31 mm to 1.81 ± 0.66 mm in the manual group.

CONCLUSIONS

Gingival recession in subjects with pre-existing recession was significantly reduced after 3 years of brushing with either a power or manual toothbrush.

Role of Salvadora persica chewing stick (miswak): A natural toothbrush for holistic oral health

From an ancient tool to a modern way of improving oral health, miswak (chewing stick) has proven to be an effective tool for oral health. The miswak removes the bacterial plaque by mechanical and chemical actions. It provides a cheap and easily accessible way of improving oral health of the individuals and populations. The use of miswak was promoted centuries ago by Prophet Muhammad (Peace be Upon Him). In the modern era, the beneficial role of using miswak such as antiseptic, antimicrobial, anticariogenic and analgesic effects have been proven scientifically. This article reviews the various oral health benefits of miswak in the light of religious, scientific and social evidences.