Effect of toothbrush wear on plaque control

Abstract The purpose of this study was to investigate the effect of progressive toothbrush wear on plaque control. At baseline (week 0). each of 20 subjects was given a new toothbrush which they used for the 9-week period of the study. At weeks 0, 3 and 6, all plaque was professionally removed. The amount of plaque which accumulated in each of the 3 successive 3-week experimental periods was assessed at weeks 3, 6 and 9. Toothbrush wear was evaluated by measuring the increase in the brushing surface area of toothbrushes at weeks 3, 6 and 9 as compared with week 0. The brushing surface area was measured by computer analysis of tracings of the brushing surface outlines obtained from standardized photographs. Despite progressive toothbrush wear, the amount of plaque which accumulated in each successive 3-week period decreased. The decrease in plaque scores between weeks 3 and 6 and between weeks 3 and 9 were found to be highly significant (p<0.001). Toothbrush wear varied widely amongst the subjects. When plaque scores were evaluated for the 10 subjects with highest toothbrush wear and the 10 with lowest wear, no significant differences were found between the 2 subgroups. Under the experimental conditions of this study, progressive toothbrush wear did not lead lo a decrease in plaque control. The improvement in plaque scores may have been due lo motivational effects resulting from study participation and anticipation of oral examinations. It was concluded that the wear status of a toothbrush may not be critical in ensuring optimal plaque control.     

Comparison of new and 3-month-old brush heads in the removal of plaque using a powered toothbrush

AIM: To compare the effectiveness of new and 3-month-old worn brush heads in plaque removal using a rotation-oscillation-powered toothbrush. MATERIAL AND METHODS: A single examiner blinded, randomized, cross-over study was conducted in which 34 adults attended the clinic on two occasions following 48-h periods of no oral hygiene. Following plaque scoring, subjects brushed for 2 min. with either a new brush or a brush they had used for 3 months and plaque was then re-scored. Bristle wear was assessed by measuring brushing surface areas on digital images. RESULTS: The mean plaque score percentage reductions with new brush heads were not significantly different from those achieved with 3-month-old heads for total surfaces (new=38.1%; worn=37.1%; p=0.83) and approximal surfaces (new=31.3%; worn=30.8%; p=0.9). Brushing surface area increases of the 3-month-old heads ranged from 0% to 135% (mean 26.9%). Compared with new brush heads, no significant differences were found for plaque score reductions for heads with minor, moderate or marked wear. CONCLUSION: Rotation-oscillation-powered toothbrushes with 3-month-old brush heads exhibiting various degrees of wear were as effective as new brush heads in plaque removal. Bristle age and wear on a powered toothbrush may not impede the effectiveness of plaque removal.     

Assessment of the effect of an oscillating/rotating electric toothbrush on oral health A 12-month longitudinal study

Abstract The aim of this 12-month parallel design controlled clinical trial was to assess the effect of the Braun Oral-B Plak Control electric toothbrush on supra-gingival plaque and gingival health, and to compare it with a conventional soft manual toothbrush (Jordan). A total of 111 patients aged between 20 and 63 years, from a general population, with bleeding on probing at 30% or more of all sites examined were entered into the study. At baseline, immediately after periodontal examination, all volunteers received a thorough scaling of their teeth. Volunteers in both groups were told to brush their teeth for 2 min 2× a day. Oral hygiene instruction was given at the start of the study and was not repeated. At 3, 6 and 12 months, assessments were carried out by a single clinician who was not aware which group the volunteers belonged to. Analysis of results demonstrated that over the 12 months of the study, the Braun Oral-B Plak Control was significantly more effective in improving gingival health than the manual toothbrush. There was, however, no difference between the 2 groups in terms of plaque removal, with the number of sites with visible plaque decreasing by a similar amount in both groups. In conclusion, results indicate that the Braun Oral-B Plak Control toothbrush is safe and more effective than a manual toothbrush in improving gingival health.     

Clinical development and evolution in plaque removal performance of a battery powered toothbrush

BACKGROUND AND AIM: There is growing evidence that the new generation of electric toothbrushes are more effective than manual toothbrushes. The primary aim of these studies was to compare, as an indication of the stage of development, the plaque removal properties of a prototype battery powered toothbrush with an established product. A secondary aim was to utilise the data to appraise plaque accumulation together with the patterns of removal. METHOD: The three studies presented used the same, single-examiner, randomised, single-blind cross-over design involving up to 24 healthy volunteers. The prototype brushes, E6500 versions s1, s2 and s3 and E8000 with head speeds of 6500 and 8000 oscillations/min were compared with a similar design marketed product (MP) with a head speed of 8800 oscillations/min. All brushes had circular brush heads with oscillating rotating actions. Subjects accumulated plaque over a 4-day period during which no oral hygiene measures were performed. On day 4, the plaque accumulation was scored by index. Subjects then used the allocated toothbrush for 2 min. This was followed by a re-scoring of the remaining plaque. RESULTS: Studies 1 and 2 showed significantly less plaque removed by prototype E6500 (s1) and prototype E6500 (s2), respectively, than by MP. In study 3, prototype E8000 removed similar quantities of plaque to MP (approximately 65%). In contrast prototype E6500 (s3) only removed 60% of accrued plaque. Differences, however, did not reach statistical significance. CONCLUSIONS: The study methodology was appropriate to distinguish between the study toothbrushes and was furthermore able to establish a level of comparability for one of the prototype modifications with a similar MP.     

The use of planimetry to record and score the modified Navy index and other area-based plaque indices A comparative toothbrush study

Abstract. Many plaque-scoring methods are based on a subjective assessment of the amount of tooth surface covered by plaque or the presence or absence of plaque at specific sites. The 2× modified Navy plaque index is an example of the latter and requires chairside decisions from 9 zones of all buccal and lingual tooth surfaces, i.e., up to 576 for a complete dentition. The present study describes a procedural modification to the index, whereby plaque is recorded using an established planimetric plaque area method. Scoring is then performed using an overlay away from the clinic. To test the method, plaque-area measurements were made during a 30-subject, crossover study to compare plaque removal following single toothbrushings with 3 different types of manual toothbrush. Consistent with many such studies, no significant differences in plaque removal were noted between the brushes. The method was found quick and simple at the chairside, provided a permanent record of plaque distribution and could be analysed by clinical or nonclinical personnel under ideal conditions. The same method could be employed for other plaque indices based on area or site subjective decisions.     

Effect of brushing force and time on plaque removal using a powered toothbrush

OBJECTIVES: Primary objective - To determine the effect of varying brushing forces and brushing times upon the plaque-removing efficacy of a powered toothbrush. Secondary objective - to determine the optimum combination of brushing force and time for plaque removal. MATERIAL AND METHODS: This randomised, single-blind, 16-cell, cross-over trial compared the efficacy of plaque removal of a powered toothbrush (PTB) used with four brushing forces (75, 150, 225 and 300 g) and over four brushing times (30, 60, 120 and 180 s). Twelve volunteers (18-30 years) were recruited and trained to use the Philips/Jordan Sensiflex 2000 PTB, which was modified so that specified forces and times could be recorded. Each subject was asked to abstain from all oral hygiene procedures for 24 hs prior to each brushing event, to allow plaque accumulation. Plaque was recorded using a modified Quigley & Hein index (PI) at six points per tooth before and after each episode of brushing, and the differences in the means (pre- to postbrushing) were compared. Three-way anova was undertaken to compare differences between plaque-removing efficacy for the 16 combinations of force and time. Subjects, brushing time and brushing force were used as fixed effects within the analysis. RESULTS: All 12 subjects participating completed the 16 combinations of force and time over which plaque removal was assessed. Statistically significant differences in PI reductions were found between different brushing times and forces over all tooth surfaces (p<0.001). The interaction of varying brushing force and brushing time was significant for full mouth (FM) and interproximal (IP) sites (p<0.03). No statistical significance was demonstrated for smooth surface (SS) sites, nor was it detected for the interaction of subjects with brushing force or subjects with brushing time (p>0.05). CONCLUSION: We conclude that brushing time and brushing force have significant effects upon the level of plaque removal by a PTB, and at 120 s brushing time the improvement in plaque removal with forces in excess of 150 g was negligible.     

The development and validation of an occlusal site-specific plaque index to evaluate the effects of cleaning by tooth brushes and chewing gum

These studies sought to develop and validate an occlusal site-specific plaque index to be used to measure plaque removal by brushing or chewing gum. The index divides the occlusal surfaces into imaginary zones from which scores are apportioned on a 0-4 basis dependent on the perceived % plaque coverage of each zone. Examiner calibration was conducted over 2 studies assessing inter-examiner reproducibility and intra-examiner repeatibility, respectively. Study 1 involved 2 examiners who recorded scores from the same 3 groups of subjects who had suspended tooth cleaning for 4 days. Analyses for inter-examiner reproducibility showed no significant mean differences between examiners or no significant differences between variances of the 2 examiners scores. Study 2 involved the same 2 examiners individually scoring 3 groups of subjects 2 x (approximately 60 min apart) for occlusal plaque. Analysis for intra-examiner repeatability showed no significant mean differences between the 2 scorings of each examiner. Furthermore, there were no significant differences between the variances of each examiner's scores except for 1 examiner in the repeatability exercise for the 1st group of subjects. Study 3 involved groups of subjects at 2 separate clinical sites (Bristol, England and Berne, Switzerland) being scored for occlusal plaque before and after toothbrushing with water or after no toothbrushing. Data from individual examiners and examiners combined revealed a significant reduction in occlusal plaque with brushing compared to no brushing. Study 4 was the same as study 3 but occlusal plaque was scored before and after chewing gum or not chewing gum. The Bristol examiner recorded a significant reduction in plaque by chewing gum compared to not chewing gum but the Berne examiner did not. The latter may have resulted from a considerable disparity in the number of evaluable occlusal surfaces between the two study sites. The index could be employed as part of the overall assessment or oral hygiene or used in clinical trials to study mechanical and chemical plaque control agents.     

Comparison of video and written instructions for plaque removal by an oscillating/rotating/reciprocating electric toothbrush

A previous crossover study showed that a watch-and-follow instructional video improved plaque removal by an electric toothbrush compared to the use of the instructional leaflet. This study employed a parallel design to assess the value of an instructional video for plaque removal by a new model oscillating/rotating/reciprocating electric toothbrush. 2 groups of 26 dentate subjects with average oral hygiene, who had never used an electric toothbrush, participated in this single blind, randomised parallel group designed study. On day 1 of the study, subjects received a professional prophylaxis to remove all plaque. Oral hygiene measures were then suspended and subjects returned on day 3 when a prebrushing plaque score was recorded by plaque index and area. Subjects withdrew and either read the manufacturers instructional leaflet (group L) or observed the instructional video (group V). Groups L and V then performed toothbrushing with toothpaste for 2 minutes and with group V brushing in time with the instructional video. Post-brushing plaque indices and areas were then recorded. Whole mouth, lingual, upper, lower, anterior and posterior but not buccal % reductions in plaque index and area were significantly greater in group V compared to group L. % plaque removal was also significantly greater by area at mid and distal sites but not mesial sites. Whole-mouth plaque reductions were 10% greater in group V but reached >15% at lingual surfaces. Within group differences in plaque removal at paired sites e.g., buccal/lingual, remained similar, suggesting that further improvement could be achieved by modifying the video to devote more time to the difficult-to-clean areas. In conclusion, in the early period of learning the use of an electric toothbrush, plaque removal can be improved by using an instructional video. Such watch-and-follow video routines could be extended to other areas of oral hygiene practices.     

Comparison of a sonic and a manual toothbrush for efficacy in supragingival plaque removal and reduction of gingivitis

Abstract A new sonic electric toothbrush (Sonicare®) and a traditional manual toothbrush were compared for efficacy in removing supragingival plaque and reducing gingival inflammation in a 12-week, single-blind clinical trial. 60 subjects with a gingival index (GI) of >1.5 and no probing depths >5 mm were randomly assigned to use either the manual or sonic brush, instructed in its use, and asked to brush each morning and evening for 2 minutes. Plaque scores were taken at baseline and at 1.2, 4. and 12 weeks using the Turesky modification of the Quigley-Hein plaque index. Gingival inflammation was assessed by the GI. bleeding tendency score, presence or absence of bleeding on probing, volumetric measurements of gingival crevicular fluid (GCF). and aspartate aminotransferase (AST) levels in GCF. Repeated measures multivariate analyses of variance were used to delect time- and device-dependent differences for all clinical assessments between the 2 groups over the 5 visits. Both types of brush were effective in removing supragingival plaque. The sonic brush was statistically superior, on a percentage reduction basis, in removing supragingival plaque from the dentition taken as a whole (F-statistic; p=0.012) and was particularly better in hard-to-reach areas such as posterior teeth (F-statistic; p=0.003) and interproximal sites (F-statistic; p=0.004). Both devices were equally effective in reducing gingival inflammation. The sonic brush exhibited less tendency to cause gingival abrasion than the manual brush (1 incident with sonic, 5 incidents with manual), confirming the safely of this product as an oral hygiene device.     

Tapered toothbrush filaments in relation to gingival abrasion, removal of plaque and treatment of gingivitis

Abstract: Objectives: To compare a tapered filament toothbrush (TFTB) to a control toothbrush (ADA) in their potential to cause gingival abrasion and improve the gingival condition following a period of experimental gingivitis. Methods: Thirty‐two subjects refrained from brushing mandibular teeth for 21 days. During a subsequent 4‐week treatment phase, the left or right side of the mouth was brushed with either the TFTB or ADA as randomly allocated. Gingival abrasion, plaque and gingival bleeding were assessed. Results: During the treatment phase gingival abrasion showed a trend to be lower with the TFTB than the ADA, which was significant at the 2‐week assessment. The mean plaque scores changed from 2.98 (day 21) to 1.59 for the TFTB and from 3.00 (day 21) to 1.31 for the ADA. The mean bleeding scores changed from 1.86 (day 21) to 1.35 for the TFTB and from 1.85 (day 21) to 1.20 for the ADA. Plaque and bleeding scores were significantly lower with the ADA. Conclusions: Both toothbrushes improved gingival health and effectively removed plaque. Although there was a tendency towards fewer sites with gingival abrasion with the TFTB brush, it was less effective than the ADA in the removal of plaque biofilm and reduction of bleeding. Subjects considered the TFTB to be more pleasant to use.