The influence of radio frequency-based toothbrush on the accumulation of calculus and periodontal health: A randomized double-blind controlled prospective study

OBJECTIVES

The use of a toothbrush with radio frequency (RF) has shown to be of benefit regarding the reduction of plaque, calculus, and dental staining and improving teeth shade compared to conventional powered and manual toothbrushes.

AIM

To evaluate the efficacy of the RF toothbrush in the reduction of calculus accumulation and its effect on periodontal parameters as well as subject satisfaction as compared to an identical sham-tooth brush.

MATERIALS AND METHODS

Patients who are under a strict maintenance program were included. Patients were allocated to test (RF toothbrush) or control (sham) randomly and were examined at baseline, one and three months. Clinical photos were taken and a consequential calculus assessment via ImageJ software. Clinical assessment included the following: plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and recession (REC). Patient satisfaction was assessed via a questionnaire.

RESULTS

Fifty-eight patients (29 control, 29 test) were included. At baseline mean PPD, BOP, PI, REC, and calculus accumulation were similar between the groups. Mean buccal calculus was lower in the test group at one month 4.0% versus 6.7%, p < .05. Calculus accumulation within the groups was lower in the test group at 1 and 3 months when compared to baseline at the buccal aspect (2.8% vs. 8.9%, p < .05% and 3.8% vs. 8.9%, p < .05) and lingual aspect (6.7% vs. 16.5%, p < .05% and 8.9% vs. 16.5%, p < .05). No statistically significant results were found regarding periodontal parameters PPD, BOP, PI, and REC. No difference was found between groups regarding patient satisfaction.

CONCLUSION

RF seems to have an additive effect on preventing calculus accumulation on the buccal aspect of anterior mandibular teeth at 1 month. Nevertheless, at 3 months, no difference between the toothbrushes is seen regarding calculus formation and maintaining periodontal health (ClinicalTrials.gov, Identifier NCT04640857).

Salvadora persica L. chewing stick and standard toothbrush as anti-plaque and anti-gingivitis tool: A systematic review and meta-analysis

ETHNOPHARMACOLOGICAL RELEVANCE

Salvadora persica L. chewing stick, commonly known as miswak is still being used as an oral hygiene tool for plaque control and prevention against gingivitis. Various studies have reported on the therapeutics and prophylactic effects particularly on periodontal disease. This review aimed to evaluate the effectiveness of S. persica chewing stick compared to the standard toothbrush for anti-plaque and anti-gingivitis.

MATERIAL AND METHODS

A PRISMA-compliant systematic search of literature was done from the MEDLINE, CENTRAL, Science Direct, PubMed and Google Scholar. Literature that fulfilled eligibility criteria was identified. Data measuring plaque score and bleeding score were extracted. Qualitative and random-effects meta-analyses were conducted.

RESULTS

From 1736 titles and abstracts screened, eight articles were utilized for qualitative analysis, while five were selected for meta-analysis. The pooled effect estimates of SMD and 95% CI were -0.07 [-0.60 to 0.45] with an χ² statistic of 0.32 (p = 0.0001), I² = 80% as anti-plaque function and 95% CI were -2.07 [-4.05 to -0.10] with an χ² statistic of 1.67 (p = 0.02), I² = 82%.

CONCLUSION

S. persica chewing stick is a tool that could control plaque, comparable to a standard toothbrush. Further, it has a better anti-gingivitis effect and can be used as an alternative.

The Effect of Brush Motion and Rinsing When Manually Cleaning Cannulated Medical Devices

Cleaning cannulated medical devices can be challenging for perioperative and sterile processing department personnel. We performed a laboratory experimental study to evaluate differences in cleaning effectiveness using either a back-and-forth or helical spinning brushing motion and the effect of rinsing the bristles at each reintroduction of the brush in the lumen. We also tested the lumen cleanliness after high-pressure water cleansing without brushing. We inspected the devices to determine whether visible soil remained, and we measured the amount of residual organic matter using adenosine triphosphate testing to determine cleaning method effectiveness. The results showed that rinsing the brush during cleaning decreased the amount of organic material that remained in the lumen. A helical spinning motion with brush rinsing at each reintroduction of the brush may be more effective than back-and-forth brushing with rinsing, but additional testing with a larger sample size is required to determine whether this result is replicable.

Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia

BACKGROUND

Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, swab, toothbrush, or combination, together with suction of secretions, may reduce the risk of VAP in these patients.

OBJECTIVES

To assess the effects of oral hygiene care (OHC) on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs).

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 25 February 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2020, Issue 1), MEDLINE Ovid (1946 to 25 February 2020), Embase Ovid (1980 to 25 February 2020), LILACS BIREME Virtual Health Library (1982 to 25 February 2020) and CINAHL EBSCO (1937 to 25 February 2020). We also searched the VIP Database (January 2012 to 8 March 2020). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) evaluating the effects of OHC (mouthrinse, gel, swab, toothbrush or combination) in critically ill patients receiving mechanical ventilation for at least 48 hours.

DATA COLLECTION AND ANALYSIS

At least two review authors independently assessed search results, extracted data and assessed risk of bias in included studies. We contacted study authors for additional information. We reported risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, using the random-effects model of meta-analysis when data from four or more trials were combined.

MAIN RESULTS

We included 40 RCTs (5675 participants), which were conducted in various countries including China, USA, Brazil and Iran. We categorised these RCTs into five main comparisons: chlorhexidine (CHX) mouthrinse or gel versus placebo/usual care; CHX mouthrinse versus other oral care agents; toothbrushing (± antiseptics) versus no toothbrushing (± antiseptics); powered versus manual toothbrushing; and comparisons of other oral care agents used in OHC (other oral care agents versus placebo/usual care, or head-to-head comparisons between other oral care agents). We assessed the overall risk of bias as high in 31 trials and low in two, with the rest being unclear. Moderate-certainty evidence from 13 RCTs (1206 participants, 92% adults) shows that CHX mouthrinse or gel, as part of OHC, probably reduces the incidence of VAP compared to placebo or usual care from 26% to about 18% (RR 0.67, 95% confidence intervals (CI) 0.47 to 0.97; P = 0.03; I2 = 66%). This is equivalent to a number needed to treat for an additional beneficial outcome (NNTB) of 12 (95% CI 7 to 128), i.e. providing OHC including CHX for 12 ventilated patients in intensive care would prevent one patient developing VAP. There was no evidence of a difference between interventions for the outcomes of mortality (RR 1.03, 95% CI 0.80 to 1.33; P = 0.86, I2 = 0%; 9 RCTs, 944 participants; moderate-certainty evidence), duration of mechanical ventilation (MD -1.10 days, 95% CI -3.20 to 1.00 days; P = 0.30, I2 = 74%; 4 RCTs, 594 participants; very low-certainty evidence) or duration of intensive care unit (ICU) stay (MD -0.89 days, 95% CI -3.59 to 1.82 days; P = 0.52, I2 = 69%; 5 RCTs, 627 participants; low-certainty evidence). Most studies did not mention adverse effects. One study reported adverse effects, which were mild, with similar frequency in CHX and control groups and one study reported there were no adverse effects. Toothbrushing (± antiseptics) may reduce the incidence of VAP (RR 0.61, 95% CI 0.41 to 0.91; P = 0.01, I2 = 40%; 5 RCTs, 910 participants; low-certainty evidence) compared to OHC without toothbrushing (± antiseptics). There is also some evidence that toothbrushing may reduce the duration of ICU stay (MD -1.89 days, 95% CI -3.52 to -0.27 days; P = 0.02, I2 = 0%; 3 RCTs, 749 participants), but this is very low certainty. Low-certainty evidence did not show a reduction in mortality (RR 0.84, 95% CI 0.67 to 1.05; P = 0.12, I2 = 0%; 5 RCTs, 910 participants) or duration of mechanical ventilation (MD -0.43, 95% CI -1.17 to 0.30; P = 0.25, I2 = 46%; 4 RCTs, 810 participants).

AUTHORS' CONCLUSIONS

Chlorhexidine mouthwash or gel, as part of OHC, probably reduces the incidence of developing ventilator-associated pneumonia (VAP) in critically ill patients from 26% to about 18%, when compared to placebo or usual care. We did not find a difference in mortality, duration of mechanical ventilation or duration of stay in the intensive care unit, although the evidence was low certainty. OHC including both antiseptics and toothbrushing may be more effective than OHC with antiseptics alone to reduce the incidence of VAP and the length of ICU stay, but, again, the evidence is low certainty. There is insufficient evidence to determine whether any of the interventions evaluated in the studies are associated with adverse effects.

Efficacy of two soft-bristle toothbrushes in plaque removal. A randomized controlled trial

The aim of the present examiner-blind randomized controlled clinical study was to compare the efficacy two soft-bristle toothbrushes in terms of plaque removal. Seventy volunteers were randomly allocated to Group A (tapered-tip toothbrush) or Group B (end-rounded toothbrush). At baseline appointment (Day 0), volunteers underwent plaque examination using the Improved Plaque Identification Index. Under supervision, they brushed their teeth for 1 minute with their assigned toothbrushes and the plaque examination was repeated. Volunteers continued the oral hygiene regimen (assigned toothbrush and a regular dentifrice provided by the researchers) for 7 days. The experimental procedures of Day 0 were then repeated. Separate statistical analyses were performed for mean percent reduction of plaque in the whole-mouth, interproximal and gumline scores at both times, using Mann-Whitney test, p<0.05. After a single toothbrushing, on Day 0, mean percent plaque was significantly reduced in both groups (p<0.05), with statistically greater reductions of whole-mouth (21.39±12.44 vs. 11.40±11.17), gumline (6.32±7.37 vs. 2.89±4.57) and interproximal (10.82±10.49 vs. 5.21±7.68) for Group A as compared to Group B. However, on day 7, no significant difference was observed between groups for whole-mouth (29.94±20.91 vs. 26.58±18.64), gumline (14.04±18.82 vs. 13.78±17.63) and interproximal surfaces (26.41±22.77 vs. 23.12±20.98) (p>0.05). In conclusion, on Day 0, Group A presented higher efficacy in supragingival plaque removal than Group B, as reflected by whole-mouth, gumline and interproximal plaque scores.

Monetary incentives for improving smartphone-measured oral hygiene behaviors in young children: A randomized pilot trial

AIMS

To assess feasibility, acceptability, and early efficacy of monetary incentive-based interventions on fostering oral hygiene in young children measured with a Bluetooth-enabled toothbrush and smartphone application.

DESIGN

A stratified, parallel-group, three-arm individually randomized controlled pilot trial.

SETTING

Two Los Angeles area Early Head Start (EHS) sites.

PARTICIPANTS

36 parent-child dyads enrolled in an EHS home visit program for 0-3 year olds.

INTERVENTIONS

Eligible dyads, within strata and permuted blocks, were randomized in equal allocation to one of three groups: waitlist (delayed monetary incentive) control group, fixed monetary incentive package, or lottery monetary incentive package. The intervention lasted 8 weeks.

OUTCOMES

Primary outcomes were a) toothbrushing performance: mean number of Bluetooth-recorded half-day episodes per week when the child's teeth were brushed, and b) dental visit by the 2-month follow-up among children with no prior dental visit. The a priori milestone of 20% more frequent toothbrushing identified the intervention for a subsequent trial. Feasibility and acceptability measures were also assessed, including frequency of parents syncing the Bluetooth-enabled toothbrush to the smartphone application and plaque measurement from digital photographs.

FINDINGS

Digital monitoring of toothbrushing was feasible. Mean number of weekly toothbrushing episodes over 8 weeks was 3.9 in the control group, 4.1 in the fixed incentive group, and 6.0 in the lottery incentive group. The lottery group had 53% more frequent toothbrushing than the control group and 47% more frequent toothbrushing than the fixed group. Exploratory analyses showed effects concentrated among children ≤24 months. Follow-up dental visit attendance was similar across groups. iPhone 7 more reliably captured evaluable images than Photomed Cannon G16.

CONCLUSIONS

Trial protocol and outcome measures were deemed feasible and acceptable. Results informed the study protocol for a fully powered trial of lottery incentives versus a delayed control using the smart toothbrush and remote digital incentive program administration.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT03862443.

Modified toothpaste application using prepared toothpaste delivering technique increases interproximal fluoride toothpaste delivery

OBJECTIVES

We devised a "prepared toothpaste delivering technique" (PTD technique), a modified the application of toothpaste method for using fluoride toothpaste more effectively. This study aimed to investigate the change in viscosity and fluoride intake into hydroxyapatite of a toothpaste, and deliverability of fluoride toothpaste to the interproximal site with the PTD technique using an interproximal model.

METHODS

Eight toothpaste samples were prepared at the following concentrations: ×1.00, ×1.25, ×1.50, ×1.75, ×2.00, ×3.00, ×4.00, and ×5.00. Viscosity of the toothpaste was measured by a Type-B viscometer. Dissolution rate of toothpaste and fluoride uptake into the hydroxy apatite pellet were analyzed by a fluoride selective electrode. Application paste volume and delivery rate was measured using interproximal model and image analysis software during using a finger brush front (FBF), finger brush back (FBB), and toothbrush.

RESULTS

As the dilution ratio increased, the viscosity of the toothpaste decreased sharply, F uptake decreased, and dissolution rate increased. F uptake was significantly reduced when the toothpaste was diluted more than 1.75 times. Therefore, in order to improve the effectiveness of the fluoride toothpaste, it is important to deliver the toothpaste to interproximal areas and pit clefts at low dilution. It was observed that PTD technique can be effectively implemented by the finger brush.

CONCLUSIONS

The use of a FBF surface in the analysis of an acrylic interproximal model could aid in applying pressure while blocking the space of the groove and preventing outflow of the toothpaste. It was considered that the PTD technique would improve the effects of the fluoride toothpaste, especially in the interproximal site.

Epidemiological and clinical correlates of oral squamous cell carcinoma in patients from north-west Pakistan

OBJECTIVE

To investigate the association of oral squamous cell carcinoma with demographic variables and oral health indicators. .

METHODS

The observational case-control study was conducted at the Institute of Radiotherapy and Nuclear Medicine, Peshawar, Pakistan, from November, 2015, to August, 2016.Pathologically confirmed patients with oral cancer represented the cases, while The controls were ethnically and linguistically-matched subjects without any oral pathology. Demographical, clinical and pathological data was taken down to assess variables, risk factors, and oral health indicators. Descriptive statistics and logistic regression modelling were employed for data analysis.

RESULTS

Of the 551 subjects, 341(62%) were males, and 210(38%) were females. Of the total, 276(50.1%) were cases and 275(49.9%) were controls. The mean age of the cases was 55.0}13.4 years and that of the controls was 52.8}14.9 years (p=0.073). Poor oral hygiene, periodontal diseases, material of toothbrush, and no use of mouthwash were significant predictors of oral cancer (p<0.05 each). Smoking and using smokeless tobacco were also significant variables.

CONCLUSIONS

Oral health indicators in combination with smoking conferred an increased risk of oral cancer.

Electric brushes improve outcomes in caregiver-assisted oral hygiene

An effective means of maintaining oral health is imperative for the health of long-term-care patients. This article assesses oral hygiene using an electric toothbrush compared with a manual toothbrush.

Laboratory efficacy of an oscillating-rotating toothbrush with a uniquely designed head and extremely tapered bristles

PURPOSE

This laboratory study compared a newly designed GUM oscillating-rotating power toothbrush with a unique head design that combines both standard nylon filament and extremely tapered filaments to the Oral-B oscillating-rotating-pulsating power toothbrush with the Precision Clean head and to the Oral-B Compact 35 Indicator manual toothbrush for their ability to reach and remove artificial plaque deposits from hard-to-reach interproximal and subgingival sites.

METHODS

Interproximal access efficacy (IAE) was evaluated using an artificial plaque substrate placed around simulated teeth. Subgingival access efficacy (SAE) was determined by using simulated gingiva prepared with a 0.2 mm space between the gingiva and artificial plaque substrate covering the simulated teeth. Results were recorded on the same artificial plaque substrate placed under the gingiva and around the simulated teeth.

RESULTS

The overall IAE value for the new GUM oscillating-rotating power head indicated that it was significantly more effective compared to the Oral-B power and manual toothbrushes in interproximal access (P< 0.001). The mean value for SAE for the new and commercially available power products also were significantly more effective compared to the manual toothbrush in subgingival access (P< 0.001).

CLINICAL SIGNIFICANCE

The presence of dental plaque at interproximal and subgingival sites will result in the development of gingivitis if not removed regularly and thoroughly. The demonstrated superior ability of the oscillating-rotating power toothbrush head to reach deeper into those sites versus the manual brush indicates that when used properly, the unique oscillating-rotating head with extremely tapered bristles may be effective for the treatment and prevention of gingivitis.

A Comparison of the Effects of a Powered and Manual Toothbrush on Gingivitis and Plaque: A Randomized Parallel Clinical Trial

OBJECTIVES

To compare the effect of a powered and a manual toothbrush on gingivitis and plaque following two and four weeks of home use.

METHODS

This was a randomized, parallel-design, single-blind clinical trial. Eligible participants were generally healthy non-smoking manual toothbrush users aged 18-65 years, with a plaque score of = 1.8 per Lobene and Soparkar Modified Plaque Index (MPI) following a 3-6 hour plaque accumulation period, and mild to moderate gingivitis defined as a Gingival Bleeding Index (GBI) = 1 on at least 20 sites. Subjects with advanced periodontal disease, xerostomia, excessive gingival recession, uncontrolled diabetes, and heavy deposits of calculus or rampant decay were excluded. Enrolled participants were randomly dispensed either a Philips Sonicare powered toothbrush used with the InterCare brush head (PTB) or an American Dental Association (ADA) reference manual toothbrush (MTB). Efficacy and safety variables were assessed at Baseline, and at two and four weeks following twice-daily product home use. The primary endpoint of the study was reduction of gingivitis per the Modified Gingival Index (MGI) after four weeks of home use.

RESULTS

All 148 randomized subjects (74 per group) completed the study. A statistically significant difference in MGI reduction was observed between the two study groups (p < 0.001). The least square (LS) mean and standard error reduction from Baseline was 0.72 (0.04) for the PTB group compared to 0.09 (0.04) for the MTB group. Expressed as percent reduction from Baseline, the LS mean values were 35.77% (2.19%) and 4.22% (2.19%) for PTB and MTB, respectively. Statistically significant differences were also observed for MGI reduction at Week 2, as well as for MPI and GBI reduction at Weeks 2 and 4.

CONCLUSIONS

The powered toothbrush was statistically significantly superior to a manual toothbrush in reducing gingival inflammation, gingival bleeding, and plaque following two and four weeks of home use.

A Randomized Parallel Study to Compare the Effects of Powered and Manual Tooth Brushing on Gingival Health and Plaque

OBJECTIVES

To compare the effect of powered and manual tooth brushing on plaque and gingivitis following two and six weeks of home use.

METHODS

This was a randomized, three-arm, parallel-design clinical trial. Eligible participants were manual toothbrush users who were generally healthy non-smokers, aged 18-65 years, with a plaque score of = 1.8 per Lobene and Soparkar Modified Plaque Index (MPI), and mild to moderate gingivitis, defined as a Gingival Bleeding Index (GBI) = 1 on at least 20 sites. Subjects with advanced periodontal disease, excessive gingival recession, and heavy deposits of calculus or rampant decay were excluded. Enrolled participants were randomly dispensed one of three devices: a powered toothbrush (Philips Sonicare DiamondClean Smart with Premium Gum Care brush head) used in either Gum Heath mode (DC-GH) or Clean mode (DC-C), or an ADA reference manual toothbrush (MTB). Efficacy and safety variables were assessed at Baseline, and at two and six weeks following twice-daily product home use.

RESULTS

For the primary endpoint, reduction in gingivitis per Modified Gingival Index (MGI) at Week 2, 188 subjects completed and were included in the analysis. Expressed as percent reduction from Baseline, the adjusted mean reduction and Standard Error (SE) estimates were 60.31% (1.95%) for DC-GH, 53.08% (1.95%) for DC-C, and 16.59% (1.96%) for MTB. The difference between each power toothbrush group and the manual toothbrush was statistically significant (p < 0.0001). Statistically significant differences were also observed between DC-GH, DC-C, and manual tooth brushing for MGI at Week 6, as well as for MPI and GBI at Weeks 2 and 6.

CONCLUSIONS

The powered toothbrush, used in either Gum Health or Clean mode, was statistically significantly superior to a manual tooth brush in reducing gingival inflammation, gingival bleeding, and plaque following two and six weeks of home use.

Effects of different oral care scrubs on ventilator-associated pneumonia prevention for machinery ventilates patient: A protocol for systematic review, evidence mapping, and network meta-analysis

BACKGROUND

Ventilator-associated pneumonia (VAP) is defined as pneumonia develops in intensive care unit (ICU) patients who have been mechanically ventilated for at least 48 hours. Implementing effective oral car could reduce the incidence of VAP. However, previous studies on scrubs in oral care have failed to suggest which the best choice. Therefore, this protocol proposes to perform a network meta-analysis to evaluate the effectiveness of different oral care scrubs in preventing VAP.

METHODS

We are going to search the electronic databases: Cochrane Oral Health's Trials Register, CENTRAL, MEDLINE, EMBASE, CINAHL, and Chinese Biomedical Literature Database. Study selection and data collection will be performed independently by 2 reviewers. Cochrane Risk of Bias tool will be used to assess the risk of bias of included studies. Odds ratio (OR) and 95% confidence intervals (CIs) will be used to assess the incidence rate of VAP in critical patients. The evidence mapping (EM) method will be introduce as a tool intended to complement the conventional systematic review (SR) and is suitable for this issue, at the same time, R software will be used for representing the outcome of EM-SR. We shall assess the heterogeneity on the bias of the magnitude of heterogeneity variance parameter (I or Cochrane Q). We are also going to conduct subgroup analysis and sensitivity analysis if needed. The application of Stata and R software will be performed the calculations.

RESULTS

The results of this study will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This network meta-analysis will provide comprehensive evidence of different scrubs in oral care for preventing VAP.

PROSPERO REGISTRATION NUMBER

CRD42018117019.

A Comparison of the Effect of Two Power Toothbrushes on the Reduction of Gingival Inflammation and Supragingival Plaque

OBJECTIVES

To compare the effect of the Philips Sonicare DiamondClean Smart and Oral-B Genius 8000 powered toothbrushes on gingivitis, gingival bleeding, and supragingival plaque reduction following 42 days of home use.

METHODS

This was a randomized, parallel, examiner-blinded, prospective clinical trial with two treatment groups. Eligible participants were generally healthy volunteers who were manual toothbrush users, non-flossers, 18-65 years of age. The subject panel included non-smokers with = 50 sites of gingival bleeding according to the Gingival Bleeding Index (GBI), and a supragingival plaque score of = 1.8 per Modified Plaque Index (MPI) at 3-6 hours following last tooth brushing encounter. Eligible subjects were randomized to use either a Philips Sonicare DiamondClean Smart with Premium Plaque Control brush head (DCS) or an Oral-B Genius 8000 with FlossAction brush head (OBG) for home use. Each toothbrush was used twice daily for two minutes. All subjects used a standardized fluoride-containing dentifrice. All other oral hygiene measures were prohibited. Subjects returned at Day 14 for an interim compliance and safety assessment, and at Day 42 for the final safety and efficacy assessments.

RESULTS

Of 222 enrolled and eligible subjects, 219 completed (112 in the SDC group, 107 in the OBG group) the study. The least squares (LS) mean and 95% confidence interval (CI) estimates for gingivitis reduction and percent reduction per Modified Gingival Index (MGI) following 42 days of product home use were 1.38 (1.30, 1.46) and 51.32% (48.45%, 54.19%) for DCS, and 0.53 (0.45, 0.61) and 20.07% (17.14%, 23.00%) for OBG. The differences, expressed as either reduction or percent reduction, were statistically significant between the two groups, p < 0.001. Statistically significant differences were also observed between products at Day 42 for the gingival bleeding and supragingival plaque reduction endpoints, p < 0.001. There were two reported adverse events.

CONCLUSIONS

The Philips Sonicare DiamondClean Smart powered toothbrush reduced gingival inflammation, gingival bleeding, and supragingival plaque significantly more than the Oral-B Genius 8000 powered toothbrush following a 42-day home-use period. Both products were safe for use.

Evaluating Sanitization of Toothbrushes Using Various Decontamination Methods: A Meta-Analysis

Toothbrushes play an essential role in personal oral hygiene by effective plaque removal.However, they get heavily contaminated by bacteria, viruses, yeasts, and fungi which may originate from the oral cavity after every use as well as from the environment where they are stored. This systematic review was conducted to identify various decontamination interventions attempted scientifically and it summarizes the efficacy of each. Meta-analysis illustrated that the use of Ultra-violet rays and Microwave had a significant effect on reduction of the microbial count of a used toothbrush with a mean difference of -2.61 and CI (-4.66,-0.76) with I2=98%. When compared with non-active treatment group, the natural agents (garlic, green tree and tea-tree oil) proved to sterilize the toothbrushes effectively with mean difference of -483.34, CI (-914.79, -51.88) and I2=100%.In contrast, chlorhexidine showed the insignificant result with a mean difference of -347.55 and CI (-951.90, 256.80) with I2=100%. The evidence from this review suggests that decontaminating toothbrush reduces bacterial load. Toothbrushes exposed to radiation and natural agents proved to sanitize them effectively but chlorhexidine rendered insignificant results. Keywords: Chemical agent; disinfection; radiation; microbial load; natural agent; toothbrush.

Evaluation of the Ability of Five- to 11-Year-Olds to Brush Their Teeth Effectively with Manual and Electric Toothbrushing

Purpose: This study's purposes were to: (1) correlate toothbrushing effectiveness measured by plaque removal with children's parent- reported ability to perform life tasks and their executive function; and (2) compare plaque removal by children using a manual versus electric toothbrush. Methods: A convenience sample of 120 healthy five- to 11-year-olds was randomly and evenly assigned to manual or electric tooth- brush groups. A questionnaire was developed from items selected from previously validated social science instruments and completed by caregivers. Plaque was measured by calibrated scorers using the Oral Hygiene Index-Simplified before and after children brushed with respective toothbrushes. Statistical significance was established at P<0.05. Results: The type of toothbrush had no effect on brushing effectiveness. Ability to write a complete address, tie shoes independently, cut meat with a knife, and cut out complex shapes were associated with better toothbrushing effectiveness. Increasing ability to play a musical instrument and wash dishes independently were associated with increased plaque removal. Parents were good predictors of a child's readiness to brush, based on plaque removal scores. Conclusions: Certain life skills and quality of performance of tasks were associated with toothbrushing effectiveness in five- to 11-year-olds and may be used to determine a child's readiness to brush independently.

A randomized clinical trial to evaluate the plaque removal efficacy of an oscillating-rotating toothbrush versus a sonic toothbrush in orthodontic patients using digital imaging analysis of the anterior dentition

OBJECTIVE

To compare the plaque removal efficacy of an oscillating-rotating electric toothbrush with an orthodontic brush head versus a sonic toothbrush in adolescent patients with fixed orthodontic appliances.

MATERIALS AND METHODS

This was a randomized, examiner-blind, replicate single-use, two-treatment, four-period, crossover study with a washout period between visits of approximately 24 hours. Forty-four adolescent patients with fixed orthodontic appliances in both arches were randomized based on a computer-generated randomization schedule to one of four toothbrush treatment sequences. The primary outcome was plaque score change from baseline, measured using digital plaque imaging analysis.

RESULTS

Baseline plaque levels for both brush treatments were high, covering more than 50% of the tooth area. Effective plaque removal was observed with both brush treatments (P < .001); however, the reduction in plaque with the oscillating-rotating toothbrush was statistically significantly greater (P = .017) compared with the sonic toothbrush.

CONCLUSIONS

The study provides evidence for more effective plaque-removing efficacy of the oscillating-rotating toothbrush versus the sonic toothbrush among orthodontic patients.

Effectiveness of plaque removal with an experimental chewable brush in children between age 9 and 13 years

AIM

To evaluate the effectiveness of plaque removal of an experimental chewable brush in comparison with a manual brush in children between age 9 and 13 years.

METHOD

This single blinded randomised controlled study included a total of 60 healthy children between age 9 and 13 years that fulfilled the selection criteria. Selected children were randomly assigned to manual toothbrush group (MT) and chewable toothbrush group (CT). Children were instructed to use the respective toothbrushes under supervision. Effectiveness of plaque removal was evaluated by recording Turesky's modification of Quigley-Hein index scores (TMQHI) before and after brushing on single use. Difference in the pre-brushing and post-brushing plaque scores between the groups were statistically compared by using Mann-Whitney U test.

RESULTS

TMQHI plaque scores of selected children for the MT and CT groups was found to be statistically similar before using the toothbrush (p = 0.072). Difference between overall plaque reduction scores were found to be 1.0 for MT and 1.13 for CT, which did not reveal statistical significance (p = 0.308). In order to evaluate efficiency of chewable toothbrush, TMQHI scores for buccal and lingual scores were analysed separately, and found no statistical significance in plaque removal on either surfaces (p = 0.944 for buccal, p = 0.080 for lingual).

CONCLUSIONS

Chewable toothbrush was found to be as effective in total plaque removal as manual tooth brushing in the children between age 9 and 13 years. The chewable brush may be an appropriate oral hygiene adjunct for school children spending a considerable amount of time out of home.

Randomized clinical trial on the efficacy of electric and manual toothbrushes in plaque removal and gingivitis control in visually impaired school students

OBJECTIVE

To evaluate the efficacy of electric or manual toothbrushes in plaque removal and gingivitis control in visually impaired adolescents.

METHOD AND MATERIALS

A randomized, controlled, examiner-blind crossover design was used in the study. Study subjects were 12- to 16-year-old visually impaired students from the School for the Blind in Guangzhou. Students in the test group used electric toothbrushes, whereas those in the control group used manual toothbrushes. The study consisted of two stages. Oral health status of the students was recorded at baseline, 2 weeks, and 4 weeks of each stage. In total, 42 visually impaired students were recruited in the study at baseline during the first stage. Quigley-Hein Plaque Index (Q-H PI) and Loe and Silness Gingival Index (GI) were used. One-way repeated measures analysis of variance followed by post hoc analysis was used to compare the mean Q-H PI and GI scores obtained at baseline, 2-week, and 4-week examinations between the test and control groups.

RESULTS

In total, 33 subjects completed the study. No significant differences were noted between the two groups regarding Q-H PI and GI at baseline, whereas Q-H PI and GI values of the test group were significant reduced compared with those of the control group at 2 weeks and 4 weeks (P < .001).

CONCLUSION

An electric toothbrush reduced plaque and gingivitis more than manual toothbrushing among visually impaired school children.

A Comparison of Oral Hygiene Products and Professional Care: A six-week randomized clinical trial

Purpose: To investigate the anti-gingivitis efficacy of a novel oral hygiene routine consisting of a two-step stannous fluoride dentifrice and hydrogen peroxide whitening gel system, an interactive oscillating-rotating electric toothbrush, and expanded polytetrafluoroethylene floss.Methods: A total of 52 participants (n=52;mean age 35.8±11.23 years) were enrolled in the study and randomized 1:1 to the experimental hygiene group or control (dental prophylaxis followed by use of standard sodium fluoride dentifrice and a manual toothbrush). Participants were instructed to brush twice daily; those in the experimental group were instructed to floss once daily. Oral examinations were conducted at Baseline, Week 2, Week 4, and Week 6.Results: Both groups experienced significant declines in the mean number of bleeding sites from Baseline at all time points, evident as early as Week 2. Bleeding sites continued to decline throughout the trial in the experimental group, whereas they showed an increasing trend between Weeks 2 and 6 in the control group. The experimental group had 55% fewer bleeding sites at Week 2, 85% fewer bleeding sites at Week 4, and 98% fewer bleeding sites at Week 6 (p<0.0001 for all) as compared to the control group. At Week 6, 84% of participants in the experimental group had no bleeding, while all participants in the control group had bleeding.Conclusion: The experimental oral hygiene group showed significantly greater reductions in gingival bleeding than the control oral hygiene group, with benefits seen as early as Week 2 and increasing over the six-week study.

Toothbrushing-Should We Advise Mechanical or Power Brushes? Results of an International Delphi Conference

BACKGROUND AND AIM

To develop evidence-based answers to a series of questions in relation to toothbrushing using a modified Delphi consensus approach. Oral hygiene and especially toothbrushing have been a fundamental part of the efforts to prevent caries and gingivitis. The questions discussed involved the frequency and duration of brushing, the effectiveness and safety of powered brushes and the recommendations for children and orthodontic patients.

REVIEW RESULTS

The Delphi panel agreed that twice daily brushing for 2 minutes and a systematic pattern is advised. Moreover, it was concluded that evidence suggests that power brushes are safe and more effective in the short and long-term compared to manual brushes in terms of plaque removal and gingivitis reduction. For children and orthodontic patients, the likelihood of enhancing compliance/convenience with use of a power brush was highlighted.

CONCLUSION

Toothbrushing constitutes a fundamental part of the efforts to prevent caries and gingivitis.

CLINICAL SIGNIFICANCE

Twice daily brushing for 2 minutes and a systematic pattern is advised. Power brushes are safe and could provide benefits, for adults, children and orthodontic patients.

A 6-month clinical evaluation of a high frequency sonic toothbrush in comparison with an oscillating-rotating power toothbrush and a traditional sonic toothbrush in reducing gingivitis and plaque

PURPOSE

To compare the 6-month clinical efficacy of a novel high frequency sonic power toothbrush (A) with an oscillating-rotating (O-R) power toothbrush (B) and a traditional sonic toothbrush (C) in reducing plaque and gingivitis.

METHODS

This was a single-center, randomized, examiner-blind, parallel group design consisting of two two-treatment sub-trials. Gingivitis was assessed using the Modified Gingival Index (MGI) and Gingival Bleeding Index (GBI). Plaque was assessed using the Rustogi Modified Navy Plaque Index (RMNPI) at Baseline, Month 3, and Month 6. Statistical analysis between A versus B and A versus C were evaluated. Data were analyzed using an ANCOVA with the baseline score as the covariate.

RESULTS

In total, 120 subjects (40 per group) were randomized to treatments and 119 subjects completed the study. All power toothbrushes provided statistically significant reductions in gingivitis and plaque relative to Baseline (P< 0.001). Reductions in MGI and GBI scores were not statistically significantly different between A and B at Months 3 and 6. While A had statistically significant 20.1% and 29.0% greater reductions in total RMNPI and interproximal RMNPI respectively, compared to B at Month 6 (P< 0.05). Reductions in gingivitis and plaque indices were not statistically significantly different between A (41,000 oscillations/minute) and C (31,000 oscillations/minute) at Month 3. Compared to C, A demonstrated 14.0% and 14.5% greater reductions in MGI and GBI respectively, and 26.0% greater reduction in interproximal RMNPI versus baseline at Month 6 (P< 0.05). No adverse events were reported for the power toothbrushes.

CLINICAL SIGNIFICANCE

The new high frequency sonic power toothbrush was not significantly different from the oscillating-rotating power toothbrush in gingivitis reduction while it demonstrated statistically significantly greater reductions in plaque. The new high frequency sonic power toothbrush was significantly more efficacious than the traditional sonic toothbrush in reducing plaque and gingivitis after long term use.

A Randomized Controlled Clinical Trial to Evaluate the Efficacy of an Oscillating-Rotating Electric Toothbrush, a Stannous Fluoride Dentifrice, and Floss on Gingivitis

OBJECTIVES

To evaluate the gingival health efficacy of an oscillating-rotating electric toothbrush, a stannous fluoride dentifrice, and dental floss in adults with mild-to-moderate gingivitis.

METHODS

This was a single-center, randomized, controlled, examiner-blind, two-treatment, eight-week parallel group study in adults with at least 20 gingival bleeding sites. Eligible subjects were randomized equally to one of two groups: experimental oral hygiene group that included an Oral-B® oscillating-rotating electric toothbrush with round brush head (D20/EB20), Crest® stabilized stannous fluoride dentifrice (SnF2 1100 ppm F, NaF 350 ppm F), and Oral-B® Glide® floss; or regular oral hygiene control group that included a regular manual toothbrush (Oral-B® Indicator 35) and Crest® anti-cavity sodium fluoride dentifrice (NaF 1450 ppm F). Subjects followed manufacturer's instructions and used their assigned products over an eight-week period. Gingival health was measured at baseline, Week 4, and Week 8 using three assessments: Gingival Bleeding Index (GBI), number of bleeding sites, and Modified Gingival Index (MGI). Analysis of Covariance was used to compare gingival health between treatment groups.

RESULTS

One hundred and twenty subjects, mean age 44 years (range: 21 to 74 years), were assessed at baseline (60 per group); 113 subjects (57 in control group, 56 in experimental group) completed the study with fully evaluable data. At baseline, the groups were balanced; overall means were 0.41 for GBI, 51.7 for bleeding sites, and 1.44 for MGI. Only the experimental group showed statistically significant reductions from baseline (p < 0.0001) for all three gingivitis assessments at both Weeks 4 and 8. At these time points, better gingival health for the experimental group was seen as significantly lower adjusted mean scores versus the control group (p < 0.0001) for all three assessments. Reductions in favor of the experimental group at Weeks 4 and 8, respectively, were 51% and 45% for GBI, 46% and 40% for number of bleeding sites, and 37% and 20% for MGI. The study treatments were well tolerated.

CONCLUSIONS

Over an eight-week period, an oral hygiene routine with an oscillating-rotating electric toothbrush, stannous fluoride dentifrice, and floss significantly improved gingivitis compared to regular hygiene with a manual toothbrush and an anti-cavity sodium fluoride dentifrice.

Connected toothbrushes: Bridging the gap to personalized oral health

PURPOSE

To describe the health-related metrics available from a connected toothbrush and potential insights into individualized toothbrushing behavior and performance.

METHODS

A total of 1,926 patients used a new connected electronic toothbrush within a 4-month period. Data were collected from the brush using a smartphone application including frequency of use, duration and surface coverage of each brushing session across 16 zones covering occlusal, buccal and lingual surfaces.

RESULTS

The population was comprised of 73% males, and 11% were left handed. Overall, there was no statistical difference between gender or handedness and mean duration (124 seconds) or mean proportional zonal duration (70%) of a brushing session. Both duration and zonal duration improved with usage of brush up to 60 days.

CLINICAL SIGNIFICANCE

The use of connected toothbrushes in patients' home care routines can improve overall brushing duration and zonal duration and offers the opportunity to understand authentic brushing habits on both an individual and population level. As such these data are of interest to practicing clinicians, clinical trialists and public health dentists. Such brushes are in their infancy and further developments will enhance these insights into whole mouth care and the link to oral and general health.

Effect of pulsed ultrasound toothbrush on Streptococcus mutans biofilm removal

PURPOSE

To evaluate the effect of pulsed ultrasound toothbrush on the removal of biofilm formed by Streptococcus mutans (S. mutans).

METHODS

S. mutans biofilm grown on apatite pellet was destructed with four different sonic action toothbrushes: 1) pulsed ultrasound with sonic vibration (PUV); 2) continuous ultrasound with sonic vibration (CUV); 3) sonic vibration only (SV); and 4) no ultrasound nor sonic vibration (control). After 3 minutes of noncontact brushing, the amount of water-insoluble glucan was measured, and the residual biofilm was observed by scanning electron microscopy.

RESULTS

PUV group revealed the smallest amount of the residual water-insoluble glucans (32 ± 19%), followed by the CUV group (54 ± 12%) and the SV group (64 ± 13%). The PUV group showed a significantly lower amount of the residual water-insoluble glucan than the SV group, while no significant difference was found between SV and CUV. The bacterial adherence and aggregation notably decreased in the PUV group, compared to the remaining three groups.

CLINICAL SIGNIFICANCE

The sonic vibration with pulsed ultrasound showed more reduction of the biofilm compared to the control and the sonic vibration with and without continuous ultrasound. Thus, pulsed ultrasound action may be beneficial for biofilm removal of interproximal regions.

An 8-Week Clinical Comparison of an Oscillating-Rotating Electric Rechargeable Toothbrush and a Sonic Toothbrush in the Reduction of Gingivitis and Plaque

OBJECTIVES

To evaluate and compare the efficacy of a marketed oscillating-rotating electric rechargeable toothbrush to a marketed sonic toothbrush in the reduction of gingivitis and plaque over an 8-week period.

METHODS

This was a randomized, examiner-blind, parallel group, eight-week study. Subjects with presence of mild-to-moderate plaque and gingivitis received an oral examination and were evaluated for baseline gingivitis (Modified Gingival Index; MGI), gingival bleeding (Gingival Bleeding Index; GBI), and plaque (Rustogi Modified Navy Plaque Index). Qualified subjects were randomly assigned to an entry-level oscillating-rotating electric rechargeable brush handle (Oral-B® PRO 1000, D16U) with a round brush head with angled bristles (Oral-B® CrossAction, EB50) or a premium sonic brush (Philips Sonicare® Diamond Clean Toothbrush with AdaptiveClean brush head). One hundred and fifty subjects were instructed to brush twice daily with their assigned brush and a fluoride dentifrice for eight weeks before returning for an oral examination and gingivitis and plaque evaluations. The same methods were used at baseline and Week 8 for all evaluations.

RESULTS

One hundred and forty-eight subjects completed the study, 74 in each group. After eight weeks of use, both brushes reduced MGI, GBI, total number of bleeding sites, whole mouth plaque, gingival margin plaque, and proximal plaque (p < 0.001 for each). The oscillating-rotating brush provided statistically significantly greater reductions than the sonic brush for all gingivitis measures, with a 34.8%, 48.4%, and 42.6% greater reduction for MGI, GBI, and number of bleeding sites, respectively, after eight weeks of use (p < 0.001 for each). Significantly greater whole mouth (26.2%) and proximal (38.5%) plaque reductions were also demonstrated at Week 8 for the oscillating-rotating brush versus the sonic brush (p < 0.001).

CONCLUSIONS

The entry-level oscillating-rotating brush performed better than the premium sonic brush in the reduction of plaque and gingivitis in this eight-week randomized and examiner-blind study.

Effectiveness of Different Bristle Designs of Toothbrushes and Periodontal Status among Fixed Orthodontic Patients: A Double-blind Crossover Design

AIM

The aim of the present study was to evaluate the effectiveness of different bristle designs of toothbrushes and the periodontal status among patients undergoing fixed orthodontic treatment.

MATERIALS AND METHODS

This randomized controlled trial (RCT) consisted of 45 adolescents (comprising 20 males and 25 females) undergoing fixed orthodontic treatment. The study participants were randomly allocated to three groups, each group being assigned a locally available toothbrush with a particular design of toothbrush bristle. In the first test phase, group I study participants were allocated to toothbrush with flat bristles, group II study subjects were allocated to toothbrush with zigzag bristles, and group III study participants were allocated to toothbrush with crisscross bristles. The study participants were recalled after 4 weeks to check the effectiveness of the allocated toothbrushes. A washout period of 1 week was maintained to ensure that there was no carryover effect of the different bristle designs. In the second test phase, each patient used the opposite toothbrush bristle design (group I: toothbrush with zigzag bristles, group II: toothbrush with crisscross bristles, and group III: toothbrush with flat bristles). Plaque scores were measured using Turesky-Gilmore-Glickman modification of Quigley-Hein plaque index (PI).

RESULTS

In both phase 1 and 2 of this RCT, toothbrush with crisscross bristles exhibited maximum plaque reduction among the three different bristle design toothbrushes following 30 days (p = 0.312 ± 0.102 and 0.280 ± 0.110, respectively), which was statistically significant.

CONCLUSION

It was concluded that all the three designs of toothbrushes were effective in removing plaque in patients with fixed orthodontic appliances. But among the three different toothbrushes, toothbrush with crisscross bristles showed the highest mean plaque reduction.

CLINICAL SIGNIFICANCE

Plaque accumulation around the orthodontic brackets and gingival margins is quite common among the fixed orthodontic patients, who encounter difficulty in maintaining good oral hygiene. Specially designed toothbrushes are very essential for effective plaque removal among the patients undergoing fixed orthodontic treatment.

Accidental Ingestion Of Toothbrush: An Unusual Foreign Body

Toothbrush is a rare foreign body to be ingested accidentally. The unusual shape of the toothbrush with no theoretical possibility of spontaneous passage mandates an interventional approach. If left untreated, it can lead to pressure necrosis, bleeding, perforation and ulceration. An endoscopic attempt in an expert clinic if available is the ideal approach. If failed, surgical management by laparoscope or mini laparotomy should be done. The evaluation for underlying psychiatric disorders like bulimia, schizophrenia or generalized eating disorder should be considered to prevent such recurrence. Here, we present a case of 55 years of age, male living a normal life with no known comorbid, who ingested accidentally a toothbrush two weeks prior to presentation and was managed at our surgical department after a failed endoscopic attempt.

The Effect of a Toothbrush Handle Design in Combating Microbial Contamination

OBJECTIVES

This study aims to assess the difference in microbial contamination of a toothbrush with a smooth handle versus a toothbrush with a grooved handle design.

METHODS

Twenty-six volunteers were randomized into two groups. The first group used a smooth handle toothbrush for two months, followed by a grooved handle toothbrush for two months. The second group had the order reversed. Following the two-month use, the toothbrushes were submitted for microbial analysis. Effect size, as well as Wilcoxon signed-rank test were used to calculate the differences between total colony count, bacterial DNA, and endotoxin levels from the two toothbrush handle types.

RESULTS

There was no significant difference in colony count between the smooth (mean 580 CFU/mL, SD 1,684 CFU/mL) and grooved (mean 19,059 CFU/mL, SD 80,972 CFU/mL) handles (p = 0.12). Total DNA count was significantly less (p = 0.01) on the smooth handle (mean 68,038 RFU/mL, SD 81,659) compared to the grooved handle (mean 209,312 RFU/mL, SD 257,169 RFU/mL). Endotoxin levels were significantly less (p = 0.01) on the smooth handle (mean 0.16 EU/mL, SD 0.30 EU/mL) compared to the grooved handle (mean 0.43 EU/mL, SD 0.49 EU/mL).

CONCLUSIONS

The smooth handle toothbrush had significantly less bacterial contamination compared to the grooved handle toothbrush, as measured by total DNA count and endotoxin levels.

Fact or Fiction? Powered Toothbrushing is More Effective than Manual Toothbrushing

PURPOSE

To answer the question of whether powered toothbrushing is more effective than manual toothbrushing, this paper reviews various aspects of powered toothbrushes in terms of efficacy, safety, acceptability and special considerations for certain patient groups. Future research directions and gaps in the current knowledge are also discussed.

MATERIALS AND METHODS

The literature review was conducted using PubMed. A hand search of the references of the retrieved articles was also performed.

RESULTS

Powered toothbrushes have been found to be as effective as manual toothbrushes in removing plaque and reducing gingival inflammation. They are safe with no adverse effects on hard or soft tissues. Among the powered toothbrushes, there is evidence to suggest that rotation-oscillation toothbrushes may be more effective than others. The results seem to suggest that certain special-needs patient groups, such as the elderly and the disabled, may benefit from the use of powered toothbrushes.

CONCLUSION

Powered toothbrushes are as effective as manual toothbrushes in facilitating oral hygiene. They may be recommended for certain patient groups to improve the efficacy of oral hygiene measures. More data on the safety and acceptability of powered toothbrushes are necessary.

Removal of naturally grown human biofilm with an atmospheric pressure plasma jet: An in-vitro study

The removal of biofilm is a prerequisite for a successful treatment of biofilm-associated diseases. In this study, we compared the feasibility of an atmospheric pressure plasma device with a sonic powered brush to remove naturally grown supragingival biofilm from extracted teeth. Twenty-four periodontally hopeless teeth were extracted. Argon jet plasma with an oxygen admixture of 1 vol% and a sonically driven brush were used to remove biofilm with application times of 60 s, 180 s and 300 s. The treatment efficiency was assessed with light microscopy, scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS). The highest biofilm removal rate was observed after an application time of 180 s/300 s with the sonic brush (80.4%/86.2%), plasma (75.5%/89.0%). These observations were confirmed by SEM. According to XPS analysis, plasma treatment decreased the amount of carbon and nitrogen, indicative of an extensive removal of proteins. Plasma treatment of naturally grown biofilm resulted in an effective cleaning of the tooth surface and was comparable to mechanical treatment. Treatment time had a significant influence on plaque reduction. These results showed that plasma could be a useful adjuvant treatment modality in cases where biofilm removal or reduction plays a decisive role, such as periodontitis and peri-implantitis. Plasma-treated biofilm on an extracted tooth.

Comparison of two Manual Toothbrushes in Effectiveness of Plaque Removal: A pilot study

Purpose: This pilot study compared the effectiveness of plaque removal of two manual toothbrushes; a novel toothbrush design and a control reference toothbrush.Methods: Thirty-eight individuals meeting specific criteria consented to participate and were randomly assigned to one of two groups. Subjects were given both study toothbrushes eight days prior to data collection to use on alternate days for two minutes twice daily for familiarization. Subjects refrained from any oral hygiene procedures for twenty-four hours prior to data collection at which time a baseline plaque score was recorded using the O'Leary Plaque Control Record. Following the baseline plaque score recording, timed brushing was supervised by a research assistant, using a split mouth design, followed by a post-brushing plaque score. All plaque scores were recorded by the same examiner blinded to group assignment. Pre- and post-brushing scores were compared using t-tests and analysis of variance (ANOVA) to determine differences. Subjects also completed a qualitative survey on the two brushes.Results: When compared to overall plaque scores, no significant differences were shown between the two brushes or when compared to all interproximal surfaces, all smooth surfaces and left vs. right sides. Both brushes performed better on the left side. The control brush was slightly more effective than the novel brush in the mandible (p=0.0222) and on lingual (p=0.0169) surfaces. Results of the survey showed that the subjects significantly favored the novel brush.Conclusion: Both brushes were effective, although the reference brush was slightly more effective in plaque removal than the novel design brush in the mandible and on lingual surfaces; however, the novel brush was preferred by participants.

Energy output and in vitro biologic effects of an ionic toothbrush

The Soladey™ toothbrush has a moisture-permeable titanium dioxide (TiO2) resin core in the replacement brush end of a handle activated by light conversion power cells. Purported to have an antibacterial effect and remove more plaque than an ordinary toothbrush, this study was undertaken to establish output measurements of the dry and wet TiO₂ core of the toothbrush during typical illumination of the handle, then quantify lipid peroxidation in three distinct lipid-containing solutions, and bactericidal effects in a live bacterial suspension grown from suctioned oral secretions.

METHODS

Within a range of illumination of the power cells in the handle, corresponding flow of electrons emitted from dry and wetted TiO2 cores was measured. The claim that an antibacterial effect can be attributed to generation of reactive oxygen-mediated lipid peroxidation of cell membranes was tested by exposing three lipid substrates to the light-activated ionic toothbrush tips for incremental periods of time. Products of lipid peroxidation were quantified using 3 commercially available assays, and bactericidal effects were assessed by scoring colony-forming units.

RESULTS

Illumination of the handle generated quantifiable increases in electrons flowing from the wetted TiO₂ core. Immersion of the TiO₂ core end of illuminated toothbrush handles into lipid substrates showed linear effects of incremental exposure times on products of lipid peroxidation, but no evidence of a bactericidal effect occurring within 15 minutes.

CONCLUSIONS

This validates capacity of the wetted current- activated TiO₂ core to generate time-dependent lipid peroxides, particularly in the sonicated matrix containing disrupted cell membranes. Finding no time-dependent reduction in colony- forming units and less lipid peroxidation in a suspension of intact cells casts doubt that the ionic toothbrush has an immediate antibacterial effect while brushing teeth. If a toothbrush with a TiO₂ core is self-disinfecting between uses, bactericidal effects requiring longer periods of exposure might still confer a hygienic advantage.

Effectiveness of a motionless ultrasonic toothbrush in reducing plaque and gingival inflammation in patients with fixed orthodontic appliances

OBJECTIVE

To compare the effectiveness of a motionless ultrasonic toothbrush to a manual toothbrush in reducing dental plaque, gingival inflammation, and mutans streptococci in patients with fixed orthodontic appliances.

MATERIALS AND METHODS

Twenty-five orthodontic patients were recruited to this crossover study. The patients were randomized into two groups starting with manual or motionless ultrasonic toothbrushes for 30 days. After a 30-day washout period, the patients switched to the other toothbrush type for 30 days. Plaque and gingival indices were evaluated by two calibrated-blinded examiners before and after each 30-day period of brushing. Salivary samples were also collected for quantification of mutans streptococci.

RESULTS

On the bracket side, the motionless ultrasonic toothbrush showed a significantly higher mean plaque index bracket score after 30-day usage than baseline (P = .049), while the manual toothbrush group showed no difference between the before and after brushing periods (P = .10). The changes in plaque index bracket score were significantly more favorable in the manual toothbrush group than in the ultrasonic toothbrush group (P = .04). In contrast, no difference was observed on the nonbracket side. There was no significant difference in the changes of gingival index or the numbers of mutans streptococci between the two groups.

CONCLUSION

Manual toothbrushing performed better than brushing with the motionless ultrasonic toothbrush in plaque removal on the bracket side in orthodontic patients. However, no difference was observed in terms of gingival status and the numbers of mutans streptococci.

Influence of manual and power toothbrushes on clinical and microbiological findings in initial treatment of periodontitis - A randomized clinical study

PURPOSE

This randomized clinical study compared the influence of manual and power toothbrushes on clinical and microbiological findings in initial treatment of periodontitis.

METHODS

A total of 72 participants with a mean age of 55.7 years were randomly assigned to three groups (n= 24):oscillating-rotating (OR), sonic-active (SA) and manual toothbrush (MTB). At baseline, after 4 weeks and after 12 weeks, the following parameters were assessed:modified Quigley-Hein-Index (QHI), papilla bleeding index (PBI), periodontal pocket depth (PPD), bleeding on probing (BOP) and recession. For microbiological analysis (PCR) of 11 periodontal pathogenic bacteria, samples of sulcular fluid were taken from the deepest pockets. Statistical analysis was performed using ANOVA, with the level of significance set at α= 5%.

RESULTS

All clinical parameters:PBI, modified QHI, PPD, BOP and recession showed an improvement after 12 weeks compared to baseline, regardless of which toothbrush system was used. Regarding PBI, the SA group showed significantly greater improvement compared to OR and MTB (P< 0.01). In plaque removal (QHI) only OR was significantly more effective than MTB (P= 0.01). Periodontal parameters showed a significantly higher reduction of PPD for SA compared to MTB and MTB compared to OR (Plt; 0.05), while for BOP only a significantly higher reduction in SA compared to OR was detected (P= 0.01) Microbiological analysis showed an improvement in prevalence of several bacteria without significant differences between groups.

CLINICAL SIGNIFICANCE

Patients might benefit from powered TB systems, especially in initial treatment of periodontitis.

The release of silver nanoparticles from commercial toothbrushes

The use of silver nanoparticles (NPs) in commercial products has become increasingly common in the past decade, mostly due to their antimicrobial properties. Using Ag NP-containing articles may lead to particle release, which raises concern of human and environmental safety. The published literature addressing particle release is scarce, especially when it comes to quantifying exposure to NPs specifically. In this study, we have experimentally investigated the release of total Ag and Ag NP from commercially available toothbrushes i.e. biodegradable toothbrushes for adults and toothbrushes for children. Toothbrushes were immersed and abraded in tap water for 24h corresponding to more than the whole intended usage time of a toothbrush. The total amount of released Ag was quantified by inductively coupled plasma-mass spectrometry (ICP-MS) analysis, and the Ag NPs were characterized by single particle ICP-MS and transmission electron microscopy (TEM). The median size of the released Ag NPs ranged from 42 to 47nm, and the maximum total Ag release was 10.2ng per toothbrush. The adult toothbrushes were generally releasing more total Ag and NPs than children toothbrushes. In conclusion, our results indicate that the use of Ag NP-impregnated toothbrushes can cause consumer as well as environmental exposure to Ag NPs.

Cleaning Efficacy of Manual Toothbrushes Around Brackets - A Pilot Randomised Control Trial

PURPOSE

To test the cleaning efficacy of different manual toothbrushes in orthodontic patients in a single-blind randomised clinical trial. The brushes tested were selected based on previous in vitro tests.

MATERIALS AND METHODS

Thirty-five regular orthodontic patients with a minimum of six bonded brackets on the maxillary anterior teeth were randomly assigned to three experimental groups: staged (2-level) (Candida Parodin, 12 patients) and V-shaped (Oral-B Ortho, 12 patients) toothbrush head designs were compared in a two-phase study to planar control brushes (Paro M 43, 11 patients). First, all participants were advised to brush their teeth twice daily for 2 min for 3 weeks. Prior to the start and at the end of the study, the gingival index was assessed to evaluate the level of oral hygiene. Afterwards, cleaning efficacy was assessed planimetrically by disclosing the respective teeth after two days of not performing any oral hygiene measures.

RESULTS

Of the initial 35 participants, two did not attend after 3 weeks and had to be excluded. After 3 weeks, the control (5 out of 180 sites or -2.8% with GI ≥ 2) and staged groups (16 out of 216 sites or 7.5% with GI ≥ 2) showed minor improvement in the oral hygiene level. In contrast, the V-shaped group (29 out of 198 sites or 14.6 % with GI ≥ 2) showed a statistically significant improvement of the oral hygiene level. Planimetric evaluation, however, showed no superior cleaning efficacy of any of the tested head designs.

CONCLUSIONS

The use of V-shaped and staged toothbrush head designs might be beneficial in patients with inadequate oral hygiene undergoing orthodontic treatment with a fixed appliance. Further large-scale investigations are, however, necessary to validate the presented results.

The Role of Auditory Cues in Modulating the Perception of Electric Toothbrushes

Recent research shows that what people hear can influence what they feel. We investigated whether the perception of an electric toothbrush might also be affected by the sound that it makes. Participants were required to make stereotypical brushing movements with a standard electric toothbrush while they rated either the pleasantness or the roughness of the vibrotactile stimulation they felt on their teeth. The results demonstrate that the perception of the sensations experienced during toothbrush use were systematically altered by variations in the auditory feedback elicited by the brushing action. Participants reported that the toothbrush felt more pleasant and less rough when either the overall sound level was reduced, or when just the high-frequency sounds were attenuated. These results highlight the significant role that auditory cues can play in modulating the perception and evaluation of everyday products in use, and provide a paradigm for future study in this area.

Plaque Removal by Young Children Using Old and New Toothbrushes

There is inconclusive evidence about the relationship between toothbrush wear and plaque removal. This randomized cross-over clinical trial aimed to validate or invalidate non-inferiority in the plaque-removal efficacy of old vs. new toothbrushes in the hands of 7- and 8-year-old children. The lower limit for non-inferiority was set a priori as a difference in plaque score < 15%. Children (n = 101) brushed, in the first session, with either their 14-month-old toothbrush or a new one, and in the second session vice versa. The mean Quigley-Hein plaque score, before and after children brushed with old brushes, was 2.9 and 2.4, and with new brushes 2.8 and 2.1. The plaque score after they brushed with the new toothbrush was 10.9% lower (p < 0.001) than after they brushed with the old toothbrush. The confidence interval of 7.6%–13.9% was within the acceptance band (< 15%), and non-inferiority of old toothbrushes in the hands of these children was validated.

The influence of the utilization time of brush heads from different types of power toothbrushes on oral hygiene assessed over a 6-month observation period: A randomized clinical trial

PURPOSE

This randomized clinical trial investigated the influence of the utilization time of brush heads from different types of power toothbrushes [oscillating rotating (OR) and sonic action (SA)93; on oral hygiene (plaque accumulation and gingival inflammation) over a 6-month observation period.

METHODS

49 participants were randomly allocated into two groups: use of the same brush head over 6 months (NR: non-replacement) or replacement of brush head every 4 weeks over 6 months (R: replacement). Each group was subdivided into two subgroups according to kind of toothbrush (TB) used (OR and SA). Modified Quigley-Hein plaque index (QHI), papilla bleeding index (PBI), and gingival index (GI) were recorded at baseline and 2, 8, 12, 16, and 24 weeks after baseline. After 24 weeks, participants of both groups (R and NR) received a new brush head. At week 26, final QHI, PBI, and GI were recorded.

RESULTS

QHI decreased between baseline and follow-up visits in R groups (P< 0.05), with the exception of week 12 (P= 0.26). In NR groups, no significant decrease was detected (P> 0.05). There was no significant effect of time on PBI or GI in any of R subgroups (P> 0.05). In NR oscillating/rotating TB: significant increase in PBI and GI was detected 24 weeks after baseline (PBI: P= 0.02, GI: P= 0.03); sonic action TBs showed significant decrease in PBI at every follow-up visit (P< 0.05), except at 24 weeks after baseline (P= 0.73). GI was significantly decreased at 2 weeks after baseline only (P< 0.01).

CLINICAL SIGNIFICANCE

Six-month use of the same brush head reduced effectiveness in removing plaque, and gingival inflammation appeared to increase after a utilization time of over 4 months. Replacing brush heads is advised after 4 months.

ED approach to electrical toothbrush associated hand injury, a unique case of non-oropharyngeal injury

Puncture wounds are common injuries treated in the emergency department (ED). Prior studies have shown that toothbrushes are common reservoirs for oral flora, especially in regions near the head of the toothbrush near the bristles. ED providers must be aware of the danger associated with bacterial contamination of the associated wound and should be familiar with different pathogens and options for treatment. We present a unique case of a 30-year-old male with non-intraoral injury who presented to the ED after puncturing his left palm with the metal post of an electric toothbrush.

Study of Caries Prevalence among Miswak and Non-Miswak Users: A Prospective Study

INTRODUCTION

Various types of oral hygiene measures have been practiced by different populations around the world, as there is difference in the oral hygiene products including toothpicks and toothpowders. Miswak or tooth cleaning stick, for mechanical tooth cleaning, can be traced back at least to pre-Islamic times. Currently, many of the world populations still use chewing sticks as the single method for tooth brushing. The present study was done to study the incidence and prevalence of caries among Miswak and non-Miswak users.

MATERIALS AND METHODS

The study was done consisting of 120 cases and 120 control group (60 boys and 60 girls in each group) from the secondary school. The materials used were light, explorer, mirror, gloves, upper and lower teeth models, Miswak, and common toothbrush. After the recording of the primary data, Miswak was given to case group and the students were trained to use it on the teeth models. After 2 years, the examination of the teeth was done using the same method as before start of the study and by the same investigators. All the data were recorded, tabulated, and analyzed with the help of Statistical Package for the Social Sciences (SPSS) statistics version 17 using Student's t-test.

RESULTS

From the 240 participants, only 211 had continued the study for the total period of time. Out of these, 111 were from the study group and 100 from the control group. On comparison of the decayed-missing-filled (DMF) index scores of the study and control groups, before and after completion of the study, had also shown that the caries index was increased and the difference was found to be statistically significant.

CONCLUSION

From the study, it can be concluded that the study group using Miswak had less number of caries incidence than the control group of non-Miswak.

CLINICAL SIGNIFICANCE

Miswak can be used as teeth cleaning aid in day-to-day life as it can reduce the caries incidence.

Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia

BACKGROUND

Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions, may reduce the risk of VAP in these patients.

OBJECTIVES

To assess the effects of oral hygiene care on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs).

SEARCH METHODS

We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 17 December 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2015, Issue 11), MEDLINE Ovid (1946 to 17 December 2015), Embase Ovid (1980 to 17 December 2015), LILACS BIREME Virtual Health Library (1982 to 17 December 2015), CINAHL EBSCO (1937 to 17 December 2016), Chinese Biomedical Literature Database (1978 to 14 January 2013), China National Knowledge Infrastructure (1994 to 14 January 2013), Wan Fang Database (January 1984 to 14 January 2013) and VIP Database (January 2012 to 4 May 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 17 December 2015. We placed no restrictions on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) evaluating the effects of OHC (mouthrinse, swab, toothbrush or combination) in critically ill patients receiving mechanical ventilation for at least 48 hours.

DATA COLLECTION AND ANALYSIS

At least two review authors independently assessed search results, extracted data and assessed risk of bias in included studies. We contacted study authors for additional information. We pooled data from trials with similar interventions and outcomes. We reported risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, using random-effects models unless there were fewer than four studies.

MAIN RESULTS

We included 38 RCTs (6016 participants). There were four main comparisons: chlorhexidine (CHX) mouthrinse or gel versus placebo/usual care; toothbrushing versus no toothbrushing; powered versus manual toothbrushing; and comparisons of oral care solutions. We assessed the overall risk of bias as low in five trials (13%), high in 26 trials (68%), and unclear in seven trials (18%). We did not consider the risk of bias to be serious when assessing the quality of evidence (GRADE) for VAP incidence, but we downgraded other outcomes for risk of bias.High quality evidence from 18 RCTs (2451 participants, 86% adults) shows that CHX mouthrinse or gel, as part of OHC, reduces the risk of VAP compared to placebo or usual care from 25% to about 19% (RR 0.74, 95% confidence intervals (CI) 0.61 to 0.89, P = 0.002, I2 = 31%). This is equivalent to a number needed to treat for an additional beneficial outcome (NNTB) of 17 (95% CI 10 to 33), which indicates that for every 17 ventilated patients in intensive care receiving OHC including chlorhexidine, one outcome of VAP would be prevented. There is no evidence of a difference between CHX and placebo/usual care for the outcomes of mortality (RR 1.09, 95% CI 0.96 to 1.23, P = 0.18, I2 = 0%, 15 RCTs, 2163 participants, moderate quality evidence), duration of mechanical ventilation (MD -0.09 days, 95% CI -1.73 to 1.55 days, P = 0.91, I2 = 36%, five RCTs, 800 participants, low quality evidence), or duration of intensive care unit (ICU) stay (MD 0.21 days, 95% CI -1.48 to 1.89 days, P = 0.81, I2 = 9%, six RCTs, 833 participants, moderate quality evidence). There is insufficient evidence to determine the effect of CHX on duration of systemic antibiotics, oral health indices, caregivers' preferences or cost. Only two studies reported any adverse effects, and these were mild with similar frequency in CHX and control groups.We are uncertain as to the effects of toothbrushing (± antiseptics) on the outcomes of VAP (RR 0.69, 95% CI 0.44 to 1.09, P = 0.11, I2 = 64%, five RCTs, 889 participants, very low quality evidence) and mortality (RR 0.87, 95% CI 0.70 to 1.09, P = 0.24, I2 = 0%, five RCTs, 889 participants, low quality evidence) compared to OHC without toothbrushing (± antiseptics). There is insufficient evidence to determine whether toothbrushing affects duration of mechanical ventilation, duration of ICU stay, use of systemic antibiotics, oral health indices, adverse effects, caregivers' preferences or cost.Only one trial (78 participants) compared use of a powered toothbrush with a manual toothbrush, providing insufficient evidence to determine the effect on any of the outcomes of this review.Fifteen trials compared various other oral care solutions. There is very weak evidence that povidone iodine mouthrinse is more effective than saline/placebo (RR 0.69, 95% CI 0.50 to 0.95, P = 0.02, I2 = 74%, three studies, 356 participants, high risk of bias), and that saline rinse is more effective than saline swab (RR 0.47, 95% CI 0.37 to 0.62, P < 0.001, I2 = 84%, four studies, 488 participants, high risk of bias) in reducing VAP. Due to variation in comparisons and outcomes among trials, there is insufficient evidence concerning the effects of other oral care solutions.

AUTHORS' CONCLUSIONS

OHC including chlorhexidine mouthwash or gel reduces the risk of developing ventilator-associated pneumonia in critically ill patients from 25% to about 19%. However, there is no evidence of a difference in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay. There is no evidence that OHC including both antiseptics and toothbrushing is different from OHC with antiseptics alone, and some weak evidence to suggest that povidone iodine mouthrinse is more effective than saline/placebo, and saline rinse is more effective than saline swab in reducing VAP. There is insufficient evidence to determine whether powered toothbrushing or other oral care solutions are effective in reducing VAP. There is also insufficient evidence to determine whether any of the interventions evaluated in the studies are associated with adverse effects.

Association between clinical and salivary microbial parameters during orthodontic treatment with removable appliances with or without use of fluoride mouth rinse

AIM

To evaluate the correlation between clinical and salivary microbial parameters during treatment with removable orthodontic appliances with or without use of fluoride mouth rinse.

MATERIALS AND METHODS

A group of 48 patients completed this randomized, controlled, parallel-group, clinical pilot study. 24 patients of the test group (TG) rinsed after tooth brushing with a fluoride mouth rinse (100 ppm AmF/150 ppm NaF) while 21 patients of the control group (CG) did not. Clinical parameters [Approximal Plaque Index (API), Papillary Bleeding Index (PBI)] as well as levels of salivary mutans streptococci (MS) and lactobacilli (LB) were assessed at baseline and after 3, 6, 9 and 12 months. Compliance was documented by participants. Appliance wear-times were estimated retrospectively by the patients. All participants received the same brushing instructions and were supplied with the same toothbrush/toothpaste.

RESULTS

A significant correlation of API values with MS levels (p=0.0003) or with LB levels (p=0.001) was observed. Furthermore, appliance wear-times were significantly associated with API values (p=0.02). The changes of MS or LB levels between beginning and end of the study did not differ significantly between study groups. The changes of the API scores showed slightly different median values (-3.5 in the TG vs. 0 in the CG), the difference, however, was not significant.

CONCLUSIONS

The results emphasise the need for a careful monitoring of the oral hygiene status in patients with removable orthodontic appliances. Larger controlled clinical trials are necessary to investigate treatment options such as use of supplementary fluoride mouth rinse.

A randomized 3-month clinical comparison of a power toothbrush to a manual toothbrush in the reduction of gingivitis

PURPOSE

To compare the anti-gingivitis effect of a power toothbrush relative to a manual toothbrush control.

METHODS

This was a 3-month, randomized and controlled, single-center, parallel group, examiner-blinded clinical study. 123 Chinese adults in good general health and with at least 15 gingival bleeding sites, as measured by the Gingival Bleeding Index, were enrolled into the study. At baseline, pre-treatment gingivitis levels were assessed using the Mazza Bleeding Index. Subjects were then randomly assigned to receive either an oscillating-rotating power toothbrush [Oral-B Professional Care 7000 (D17u/EB17)] or a flat-trim manual toothbrush with tapered filaments (Lion Dentor Systema). Subjects brushed at home twice-daily with their assigned toothbrush and a marketed sodium fluoride dentifrice (Crest Cavity Protection dentifrice), and were reevaluated at Months 1, 2, and 3.

RESULTS

113 evaluable subjects completed the study. Both groups showed significant reductions in gingivitis from baseline for all time points measured (P< 0.001). At Months 1, 2 and 3, the power toothbrush demonstrated significantly greater gingivitis reductions of 7.11%, 9.20% and 8.47%, respectively, than the manual toothbrush (P< 0.01), and significantly fewer bleeding sites (17.3%, 23.9% and 24.3%, respectively, P< 0.05). No adverse events were reported or observed for either brush during the study.

CLINICAL SIGNIFICANCE

The power brush provided statistically significantly greater reductions in gingivitis compared with a manual toothbrush at Months 1, 2 and 3.

Effect of a dedicated oral care program on periodontal status of medically compromised patients at the Toronto Rehabilitation Institute Dental Clinic

Medically compromised patients attending the dental clinic at the Toronto Rehabilitation Institute have considerable gingival inflammation and breath odor. The objective of this study was to evaluate the effect of toothbrushing on the periodontal status of these patients and to determine if there were any additional benefit in combining brushing with an application of an antibiotic rinse. During the first 7 days of the study, the teeth of 11 participants were brushed twice a day by a dental hygienist using a soft-bristle suction toothbrush without toothpaste. Soft interproximal brushes were used to clean interproximal surfaces from the facial aspect. During the second week, facial and interproximal cleaning were repeated in the same patients, but the toothbrush and interproximal brush were dipped in 10-mL of a solution consisting of water and 40 mg/mL of metronidazole with nystatin. Each patient underwent an oral examination and biofilm sampling at baseline, after brushing without toothpaste (week 1), and after brushing with antibiotic solution (week 2). After week 1, tissues improved substantially, and there was a notable change in the biofilm on the teeth. The addition of an antibiotic solution increased healing and resulted in a further decrease in oral biofilm. Medically compromised patients would benefit considerably from a treatment regimen of antibiotic solution to decrease oral infection followed by a daily oral care program of brushing and interdental cleaning to maintain healthy oral tissues.

Influence of Bristle Stiffness of Manual Toothbrushes on Eroded and Sound Human Dentin--An In Vitro Study

Aim

The aim of this study was to determine the influence of manual toothbrushes with different bristle stiffness on the abrasivity on eroded and sound human dentin.

Materials and Methods

Dentin specimens were made from impacted third molars and attributed to three groups: erosion-abrasion (EA), abrasion (A) and erosion (E). The specimens from EA and E were treated with 1% citric acid (pH 2.3) for 1 min rinsed, and neutralized with artificial saliva for 15 min. This cycle was repeated five times. Thereafter, specimens from EA and A were treated with three toothbrushes types with different bristle stiffness (soft, medium, and hard) in a custom-made toothbrushing machine. The brushing was performed at a load of 3 N with a toothpaste slurry for 630 s. This procedure was repeated five times, in group EA after each erosion cycle. EA and A groups passed through five cycles with a total of 6300 strokes. The abrasivity was analyzed by contact-free profilometry. Kruskal-Wallis and Mann-Whitney U tests were performed for statistical analysis.

Results

With respect to bristle stiffness there was no statistically significant difference in dentin loss within the EA group. In group A, a statistically significantly higher dentin loss was found for the soft in comparison to the hard bristles. No statistically significant differences were measured between soft/medium and medium/hard toothbrushes. The amount of dentin loss from specimens in the EA group was significantly higher than in the A group.

Conclusions

Within the limitations of this study, the dentin loss in the Abrasion group was higher with soft bristles than with hard ones. This result might have an influence on the toothbrush recommendations for patients with non-carious cervical lesions.