The rational use of oral care products in the elderly

This review examines the evidence of the effectiveness of oral care products in preventing and controlling dental caries and periodontal disease in the ageing population. The strength of evidence is indicated using the following hierarchy: Type 1 (systematic reviews), Type 2 (randomised controlled trials), Type 3 (observational studies) and Type 4 (traditional reviews). Most of the evidence to support the effectiveness of fluoride products is extrapolated from studies involving children and adolescents. The few studies that have been performed in older adults suggest that fluoride toothpaste and, in the case of high caries risk individuals, the adjunctive use of other fluoride delivery systems, may be effective in preventing coronal and root caries. Some dentifrices containing triclosan have been shown to improve plaque control and gingival health and one, which contains triclosan/copolymer, reduces the progression of periodontitis in adults and high-risk individuals. Powered toothbrushes with an oscillation-rotation action are more effective in reducing plaque and improving gingival health than manual toothbrushes.Affiliation: Robin Davies is an employee of Colgate-Palmolive (UK)     

Antiviral effect of mouthwashes against SARS-COV-2: A systematic review

ObjectiveThis systematic review aimed to evaluate the antiviral effect of mouthwashes against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Material and methodsAn electronic search was performed on PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ProQuest, and Google Scholar, and was complemented by a manual search. Both clinical and in vitro studies that focused on the antiviral effect of mouthwashes against SARS-CoV-2 were included. Risk of bias assessment was performed only on the clinical studies using the RoB-2 and ROBINS-I tools.ResultsA total of 907 records were found; after initial selection by title and abstract, 33 full-text articles were selected to be evaluated for eligibility. Finally, a total of 27 studies were included for the qualitative synthesis, including 16 in vitro studies and 11 clinical trials. Antiviral effects were evaluated separately for the in vitro and clinical studies. In vitro studies included mouthwashes containing hydrogen peroxide, chlorhexidine digluconate, povidone-iodine, essential oils, cetylpyridinium chloride, and other compounds; in vivo studies included mouthwashes containing hydrogen peroxide, chlorhexidine digluconate, povidone-iodine, cetylpyridinium chloride, essential oils, chlorine dioxide, β-cyclodextrin-citrox, and sorbitol with xylitol. Povidone-iodine, cetylpyridinium chloride, and essential oils were effective in vitro, while hydrogen peroxide, chlorhexidine digluconate, povidone-iodine, cetylpyridinium chloride, β-cyclodextrin-citrox, and sorbitol with xylitol were effective in vivo. Unclear or high risk of bias was found for almost all clinical studies, and only one study presented with a low risk of bias. No further quantitative analysis was performed.ConclusionAlthough povidone-iodine, cetylpyridinium chloride, and essential oils may be an alternative to reduce the viral load in vitro and in vivo, more studies are needed to determine the real antiviral effect of these different mouthwashes against SARS-CoV-2.This work was not funded. The protocol was registered in PROSPERO (identification number: CRD42021236134).     

The effects of load and toothpaste on powered toothbrush vibrations

OBJECTIVES: The primary cleaning action of powered toothbrushes is the motion of the bristles in contact with the tooth surfaces. The aim of this study was to use scanning laser vibrometry to determine the effects of load and toothpaste on the bristle vibration characteristics of four powered toothbrushes (Oral-B Sonic Complete; Oral-B Professional Care 8000 Series; Sonicare Elite and Ultrasonex). METHODS: Toothbrushes were initially scanned, with the laser vibrometer, under unloaded conditions to provide baseline readings. Toothbrushes were then assessed under loaded conditions (1.00 N and 2.00 N), with and without toothpaste, to observe the effect on bristle motion. RESULTS: Application of 1.00 N load significantly reduced the displacement amplitudes of all powered toothbrushes (p<0.003) except for the Sonicare (p>0.497). With toothpaste, 1.00 N load caused a significant decrease in vibration displacement amplitude for all brushes (p<0.0001). The application of 2.00 N, with and without toothpaste, significantly reduced all toothbrushes vibration displacement amplitude (p<0.0001). Under all investigation conditions, the Oral-B 8000 had the largest vibration displacement amplitude of the toothbrushes tested. CONCLUSIONS: Load and toothpaste significantly affected the performance of powered toothbrushes. Understanding why these factors affect certain toothbrush designs more than others may lead to toothbrushes being designed with greater clinical efficacy.     

Acceptance of the xylitol chewing gum regimen by preschool children and teachers in a Head Start program: a pilot study

PURPOSE: This pilot study evaluated the acceptance and compliance of a xylitol chewing gum regimen by both children and classroom teachers in a Head Start program. METHODS: Thirty-five children chewed 100% xylitol gum (XyliFresh 100%, Leaf, Inc., 500 Field Dr., Lake Forest, IL 60045 U.S.A.) three times a day over a three week period. Children's acceptance was evaluated using a picture selection test. Teachers' acceptance was evaluated using a questionnaire. The children's and teachers' compliance was evaluated using a daily checklist that was completed by each teacher. RESULTS: Positive ratings were given for xylitol gum chewing (94%) and for taste (86%). Children's acceptance and compliance for chewing was excellent. Children chewed the gum at designated times and none of the children swallowed the gum. Teachers' acceptance of the chewing program was low. Three out of five participating teachers thought the gum chewing disturbed the classroom routine and four were not willing to participate in the program next year. Teachers' compliance was good and they followed by instructions during a three-week period. CONCLUSIONS: This study supports the suggestion that chewing xylitol gum is well accepted by children. Collaboration and education is essential to motivate teachers to adopt and supervise school-based prevention programs.     

Manual versus powered toothbrushes: a summary of the Cochrane Oral Health Group's Systematic Review. Part II.

PURPOSE: A systematic review examining the clinical effectiveness of power versus manual toothbrushes was conducted by the Cochrane Collaborations Oral Health Group. Their review examined clinical trials conducted through 2001 and used international standards to identify, access, evaluate, analyze, and report the data. Part I of this series discussed distinguishing characteristics of evidence-based publications, such as systematic reviews, whereas this report provides a summary of the Cochrane Review, its importance to the profession, and discusses the strengths and limitations of systematic reviews. METHODS: Search strategies to identify published clinical trials on power toothbrushes were developed, and manufacturers were contacted for additional published and unpublished information. Trials were selected based on pre-established criteria; including whether they compared power versus manual toothbrushes used a randomized research design tested products in the general population without disabilities, provided data on plaque and gingivitis, and were at least 28 days in length. Six reviewers independently extracted information in duplicate. Indices for plaque and gingivitis levels were expressed as standardized mean differences for data distillation. Data distillation was accomplished using a meta-analysis, with a mean difference between power and manual toothbrushes as the measure of effectiveness. RESULTS: Searches identified 354 trials, of which 29 met inclusion criteria. These trials involved 2.547 participants who provided data for meta-analysis. Results indicated that for both plaque and gingivitis, all types of power toothbrushes worked as well as manual toothbrushes, however only the rotating oscillating toothbrush consistently provided a statistically significant though modest benefit over manual toothbrushes in reducing plaque (7%) and gingivitis (17%). None of the battery powered toothbrush studies met the inclusion criteria. CONCLUSION: The Cochrane systematic review used international standards to examine more than 30 years of published studies. A concern is that only one type of electric toothbrush, the rotating oscillating toothbrush consistently demonstrated a statistically significant benefit over manual toothbrushes, and the majority of studies did not meet the standards for inclusion in moving forward it will be important to conduct methodologically sound studies demonstrating the ability of power toothbrushes to reduce the incidence and prevalence of caries and periodontal disease.     

Anticariogenic effect of xylitol versus fluoride – a quantitative systematic review of clinical trials

The objective of this study was to appraise the clinical evidence and its bias risk regarding the anticariogenic effect of xylitol in comparison with that of fluoride. Databases were searched for clinical trials up to 18 March 2011. Article inclusion criteria were as follows: caries-related primary outcomes were tested; xylitol was compared with topical fluoride in some form; two-arm (or more) clinical trial including test/control group(s); prospective study design. Article exclusion criteria were as follows: no computable data were reported; test and control groups were not followed up in the same way; chewing gum was the main form of clinical application in either group. Individual continuous datasets were extracted from accepted articles. Selection and performance/detection bias were assessed. Sensitivity analysis was used to investigate attrition bias risk. Egger’s regression and funnel plot was used to investigate publication bias risk. Twelve articles were included. Of these, six were accepted and six excluded, and 21 continuous datasets were extracted. Owing to the high clinical heterogeneity, no meta-analysis was performed. The addition of xylitol to existing fluoride regimes may be beneficial in the prevention of caries. However, all identified trials were limited by potential risk of selection, performance/detection and attrition bias. The funnel plot and Egger’s regression results (−2.80; 95% confidence interval −4.01, −1.58; P = 0.0001) indicated possible publication bias risk. External fluoride access may have confounded the measured anticariogenic effect of xylitol. The evidence found contains a high risk of bias and may be limited by confounder effects. Future high-quality randomised controlled trials are needed in order to provide conclusive evidence on this topic.Key words: Xylitol, fluoride, caries, systematic review     

Clinical evidence for polyol efficacy

Xylitol is a safe dental caries preventive when incorporated into chewing gum or confections used habitually. The goal of this paper is to identify and assess the work on xylitol and other polyols and dental caries since 2008. Xylitol is effective when used by the mother prenatally or after delivery to prevent mutans transmission and subsequent dental caries in the offspring. One new completed trial confirmed that children of mothers who used xylitol lozenges after delivery had less dental caries than a comparison group. A similar study confirmed that the use of xylitol gum by the mother either prevented or postponed MS transmission to the offspring. Xylitol use among schoolchildren delivered via a gummy bear confection reduced S. mutans levels, but a once per day use of xylitol-containing toothpaste did not. Randomized trials, with caries outcomes, assessing xylitol-containing lozenges in adults and xylitol-containing gummy bears in children will release results in the coming year. Other studies are ongoing but are not systematic and will fail to answer important questions about how xylitol, or other polyols, can address the global dental caries problem.     

Quality of trials in a systematic review of powered toothbrushes: suggestions for future clinical trials

BACKGROUND: This study aimed to assess the quality of reports of randomized controlled trials (RCTs) comparing manual and powered toothbrushes and provide advice on how future trials might be improved. METHODS: Studies were identified in the Cochrane systematic review of RCTs comparing powered versus manual toothbrushes. Reports were assessed against predefined criteria on the design of the studies to determine the effectiveness of the brushes in everyday home use and on their methodological quality. RESULTS: Only 42 of 297 identified studies satisfied the inclusion criteria and were eligible for inclusion in the review. Many studies were excluded for more than one reason. Fifteen studies employed split-mouth designs that may have changed toothbrushing behavior. Of 42 included RCTs, the generation of randomization sequence was adequate in 15 trials and concealment of allocation was adequate in 16 trials. Intention-to-treat analysis was reported in only five studies. Plaque data were reported using 10 different indices and gingivitis with nine indices. Only 12 trials lasted 3 months or longer, and there were no data on the benefits of powered toothbrushes for periodontal attachment. CONCLUSIONS: Some designs created an artificial research environment that may have undermined the findings. Authors of toothbrush trials should consider the Consolidated Standards of Reporting Trials statement. Greater standardization of the indices used is required. Trials of longer duration would enhance the evaluation of powered toothbrushes. Data on thresholds for clinically significant differences in plaque and gingivitis levels would help to determine whether oral hygiene aids provide important health benefits.     

Efficacy of oscillating rotating versus side-to-side powered toothbrushes on plaque and gingival index reduction: A systematic review

BackgroundThe authors conducted a systematic review to assess the efficacy of oscillating rotating (OR) versus side-to-side (SS) powered toothbrushes on plaque and gingival index reduction.MethodsThe authors searched 3 electronic databases and the gray literature for randomized clinical trials in which investigators compared OR with SS powered toothbrushes. Two authors independently screened the studies, performed data abstraction, and assessed the risk of bias. The authors used random-effects model meta-analyses to pool results across trials and the Grading of Recommendations Assessment, Development and Evaluation approach to rate the certainty of evidence.ResultsThis systematic review included 24 trials in which researchers enrolled a total of 2,998 patients. There was moderate-certainty evidence that SS toothbrushes may result in little to no difference in plaque index reduction from baseline to 4 weeks compared with OR toothbrushes (standardized mean difference, 0.02; 95% confidence interval, –0.46 to 0.42). There was moderate-certainty evidence that SS toothbrushes may result in little to no difference in gingival index reduction from baseline to 4 weeks compared with OR toothbrushes (standardized mean difference, 0.13; 95% confidence interval, –0.47 to 0.22). There was moderate-quality evidence suggesting little to no difference in adverse events.ConclusionsThe evidence does not suggest the superiority of either OR or SS toothbrushes for plaque or gingival index reduction.Practical ImplicationsClinicians and patients considering the use of either of these toothbrushes are unlikely to observe more benefits with one type versus the other.     

Sugar alcohols: what is the evidence for caries-preventive and caries-therapeutic effects?

The most widely used sugar alcohols are: xylitol, sorbitol, mannitol, maltitol, lactitol and the products Lycasin and Palatinit. It is often claimed that xylitol is superior to the other sugar alcohols for caries control. This paper examines clinical studies on the caries-preventive and therapeutic effects of sugar alcohols with emphasis on sorbitol and xylitol. It is concluded that chewing sugar-free gum 3 or more times daily for prolonged periods of time may reduce caries incidence irrespective of the type of sugar alcohol used. It may be sufficient to do this only on school days. Sucking xylitol-containing candies or tablets may have a similar effect as chewing xylitol chewing gum. Clinical trials suggest greater caries reductions from chewing gums sweetened with xylitol than from gums sweetened with sorbitol. However, the superiority of xylitol was not confirmed in 2 out of 4 clinical trials comparing the caries-preventive effect of xylitol- with sorbitol-sweetened gums. The caries-preventive effects of polyol-containing gums and candies seem to be based on stimulation of the salivary flow, although an antimicrobial effect cannot be excluded. There is no evidence for a caries-therapeutic effect of xylitol. These conclusions are in line with those of recent reviews and with the conclusions of the Scientific Committee on Medicinal Products and Medical Devices of the EU Commission.     

Contamination of a toothbrush with antibacterial properties by oral microorganisms

OBJECTIVES: The aim of this study was to examine the contamination and the survival rate of periodontopathic and cariogenic species on new toothbrushes with antibacterial properties (coated bristles with triclosan), after a single use in periodontitis patients. The decontamination effect of the use of toothpaste was also evaluated. METHODS: Ten patients, who consulted the Department of Periodontology, for treatment of chronic periodontitis, were selected. In each patient four different toothbrushes were used. Two quadrants, randomly selected, were each brushed using a different antibacterial toothbrush. In one of these two quadrants toothpaste was used. The same happened with the remaining quadrants, only with regular toothbrushes. After brushing, the toothbrushes were rinsed and stored in room temperature and a dry environment. After 0, 4 and 24h, four tufts, from each toothbrush, were cut and processed for selective and non-selective culturing techniques, followed by identification and quantification of all species found. RESULTS: Immediately after brushing the toothbrushes harbored a significant number of microorganisms, with no statistically significant difference between the two types of brushes (regular and antibacterial). The reduction of microorganisms from 0 to 4h after brushing was statistically significant (p<0.05). The difference was less obvious from 4 to 24h. When toothpaste was used, brushes harbored significantly (p<0.05) lower numbers of colony-forming units (CFU) compared to those without the use of toothpaste. CONCLUSIONS: The antibacterial toothbrush with triclosan coated tufts failed to limit the bacterial contamination. The toothpaste, on the other hand, significantly reduced the contamination of toothbrushes.     

The potential of dental-protective chewing gum in oral health interventions

BACKGROUND: The authors provide an overview of chewing gum as a delivery vehicle for dental-protective agents, highlighting xylitol and its potential application in caries-prevention programs for children. TYPES OF STUDIES REVIEWED: The authors reviewed selected clinical investigations and previous reviews associated with chewing gum containing substances such as calcium, bicarbonate, carbamide, chlorhexidine, fluoride and xylitol and their effects on reducing caries. They searched the MEDLINE database by using the key words "dental caries," "oral health," "calcium," "bicarbonate," "carbamide," "chlorhexidine," "fluoride" and "xylitol." RESULTS: Chewing gum is being used as a delivery vehicle for substances such as calcium, bicarbonate, carbamide, chlorhexidine, fluoride and xylitol to improve oral health and reduce caries. These substances exhibit properties that are protective of the oral environment and mediate common oral diseases. The debate for advocating xylitol use in caries prevention is advancing; however, chewing gum use by young schoolchildren in the United States is hindered by choking hazard concerns and lack of specific xylitol dosing recommendations. CLINICAL IMPLICATIONS: The use of chewing gum containing dental-protective substances, particularly xylitol, in caries-prevention programs can reduce the tooth decay epidemic. Chewing gum use by children in the school setting should be reconsidered.     

Use of xylitol chewing gum in daycare centers: a follow-up study in Savonlinna, Finland

The use of toothbrushes in daycare centers has been questioned because of the possibility of infections spreading through unsupervised brushing. Several field studies have demonstrated a caries-preventive effect of xylitol chewing gum--a measure that could be a practical way of taking care of oral hygiene during daycare hours without brushing. A community trial was conducted in Savonlinna, Finland to test the caries-preventive effect of xylitol chewing gum at these centers. A total of 921 children were recruited. The daycare centers were randomly distributed to xylitol chewing gum or brushing groups. An additional 270 children who had not been in daycare centers were later organized into an external reference group in order to check whether the children in the daycare centers were representative of all children in Savonlinna. The results revealed a statistically significant but clinically small difference between the xylitol and brushing groups in favor of the xylitol group. Many families used the daycare services irregularly. Changes in workplace, periods of unemployment, the birth of other children in the family, etc., affect the likelihood of families keeping their children in a daycare center for many years. Despite the fact that conditions were not optimal, oral health status in the xylitol group was a little bit better than in the control group. The use of xylitol can therefore be recommended, especially if the personnel do not have the possibility to supervise the brushing.     

Anticariogenic effect of xylitol versus fluoride - a quantitative systematic review of clinical trials

The objective of this study was to appraise the clinical evidence and its bias risk regarding the anticariogenic effect of xylitol in comparison with that of fluoride. Databases were searched for clinical trials up to 18 March 2011. Article inclusion criteria were as follows: caries-related primary outcomes were tested; xylitol was compared with topical fluoride in some form; two-arm (or more) clinical trial including test/control group(s); prospective study design. Article exclusion criteria were as follows: no computable data were reported; test and control groups were not followed up in the same way; chewing gum was the main form of clinical application in either group. Individual continuous datasets were extracted from accepted articles. Selection and performance/detection bias were assessed. Sensitivity analysis was used to investigate attrition bias risk. Egger's regression and funnel plot was used to investigate publication bias risk. Twelve articles were included. Of these, six were accepted and six excluded, and 21 continuous datasets were extracted. Owing to the high clinical heterogeneity, no meta-analysis was performed. The addition of xylitol to existing fluoride regimes may be beneficial in the prevention of caries. However, all identified trials were limited by potential risk of selection, performance/detection and attrition bias. The funnel plot and Egger's regression results (-2.80; 95% confidence interval -4.01, -1.58; P = 0.0001) indicated possible publication bias risk. External fluoride access may have confounded the measured anticariogenic effect of xylitol. The evidence found contains a high risk of bias and may be limited by confounder effects. Future high-quality randomised controlled trials are needed in order to provide conclusive evidence on this topic.     

咀嚼无糖口香糖对牙龈炎的影响

目的探讨无糖口香糖对牙龈炎的临床疗效。方法选择患有牙龈炎的志愿者88例，根据基线探诊出血百分比和性别分为试验组和对照组，试验组要求每日使用益达草本精华木糖醇口香糖4次，每次20min，两组使用统一提供的不含任何抗菌斑药物成分的牙膏和牙刷，在试验的第6周、第12周检查全口牙探诊出血百分比。结果基线探诊出血百分比咀嚼口香糖组与对照组差异无统计学意义，在12周试验过程中，咀嚼口香糖组探诊出血百分比值呈逐渐下降趋势，第6周、第12周探诊出血百分比低于对照组（P〈0.05）。结论咀嚼无糖口香糖作为辅助手段对牙龈炎有一定疗效。     

Mechanical Self-performed Oral Hygiene of Implant Supported Restorations: A Systematic Review

A systematic review of self-performed oral hygiene practices for optimal maintenance of dental implant-supported restorations reveals a lack of evidence to support best practices.BackgroundThe standard of the patients' home care is a key factor for long term stability of dental implants and the prevention of biological complications. The objective of this systematic review is to evaluate and summarize the literature with respect to various mechanical oral hygiene modalities around implant-supported restorations.MethodsMEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to October 2013 to identify eligible studies. Five studies that met the inclusion criteria were included. Two cohort studies about powered toothbrushes and three (randomized) controlled trials comparing powered to manual toothbrushes were reviewed. All studies showed an improvement in the clinical parameters over time. Powered toothbrushes were found to perform better than manual toothbrushes but no firm conclusions can be made between treatment modalities.ConclusionsThere is a lack of evidence with respect to effective and optimal self-performed oral hygiene around dental implants. At present, home care recommendations are based on the knowledge that is available with respect to cleaning of natural teeth. It becomes evident that there is an urgent need for academic institutions and industry to initiate and support high quality randomized controlled clinical trials on this topic in the near future.     

The effect of adding calcium lactate to xylitol chewing gum on remineralization of enamel lesions

The purpose of the study was to determine whether adding calcium lactate to chewing gum containing xylitol enhances remineralization of enamel surfaces using an early caries lesion model. Enamel slabs were cut from human extracted sound teeth and artificial subsurface lesions created within each. Half the enamel slabs were used as controls and stored in a humidifier while half were mounted into oral appliances worn by 10 volunteers (22-27 years old, 2 males and 8 females) in a three-leg trial, during which they wore the appliance without chewing gum, chewed gum containing xylitol + calcium lactate or chewed gum containing only xylitol 4 times a day for 2 weeks. Calcium concentrations in the enamel surfaces of control and test slabs were measured by X-ray spectrometry and degrees of remineralization were calculated. The mean degree of remineralization was greater after chewing xylitol-Ca gum (0.46 +/- 0.10) than after no gum (0.16 +/- 0.14) or after chewing xylitol gum (0.33 +/- 0.10) (p < 0.01). In conclusion, chewing gum containing xylitol + calcium lactate could enhance remineralization of enamel surface compared to chewing gum containing only xylitol or no gum chewing.     

Systematic review and meta-analysis of randomized controlled studies comparing oscillating-rotating and other powered toothbrushes

BackgroundThe aim of this study was to systematically review and analyze the difference in efficacy of oscillating-rotating toothbrushes compared with other powered toothbrushes.MethodsThe authors performed a systematic search of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors used the population, intervention, comparison, and outcome format to develop a search strategy to answer the study question. The authors searched PubMed-MEDLINE databases. Inclusion criteria were randomized controlled clinical trials comparing oscillating-rotating (OR) toothbrushes with other powered toothbrushes published from January 1, 2009 through March 1, 2019.ResultsThe authors’ search resulted in 454 articles; 21 articles were downloaded for review, 15 articles were included in the report, and 12 could be used for meta-analysis. All of the studies were randomized controlled clinical trials that assessed plaque removal and gingival inflammation indexes. Results of the meta-analysis of the randomized controlled clinical trials showed that OR toothbrushes had superior, statistically significant outcomes for whole-mouth plaque reduction, assessed using the Rustogi Modified Navy Plaque Index (P < .01), and gingivitis, assessed by using number of bleeding sites (P < .001), but not for the modified gingival index (P > .05) or gingival bleeding index (P > .05).Practical ImplicationsThere is some evidence to suggest that OR powered toothbrushes might remove more plaque and reduce the number of bleedings sites better than other powered toothbrushes, specifically, sonic action toothbrushes.     

Delivery of vitamin E acetate and sunflower oil to gums from fluoride toothpaste containing 0.1% vitamin E acetate and 0.5% sunflower oil

Objectives : To measure delivery of vitamin E acetate and sunflower oil (as triolein) to gums after use of a fluoridated toothpaste with 0.1% vitamin E acetate, 0.5% sunflower oil and a gum‐health active system (0.3% triclosan (TCN) and 0.75% zinc citrate trihydrate) compared to a control fluoridated toothpaste containing zinc citrate trihydrate and TCN only. Methods: Study 1 : 25 subjects completed the study. Swab samples were taken from gum surfaces before and after use of the toothpastes. Samples were analysed for vitamin E acetate via HPLC. Study 2 : 24 subjects completed the study. Test sampling procedures and products were identical to those in Study 1 except samples were analysed for triolein using GC. Results: Study 1 : Significantly higher vitamin E acetate (50.7ppm) was measured in gum swab samples after brushing with the product containing 0.5% sunflower oil, 0.1% vitamin E acetate compared to the control product (1.4ppm). Study 2 : Use of the test product also gave a significantly greater level of triolein on gum surfaces (26.4ppm) when compared to use of the control product (11.4ppm). Conclusions : The test toothpaste formulated with 0.1% vitamin E acetate and 0.5% sunflower oil was effective in delivering vitamin E acetate and sunflower oil to gums.     

Manual versus powered toothbrushes: what is the evidence?

Powered toothbrushes are a significant segment of the oral care market. Numerous clinical trials have compared the effectiveness of manual and powered toothbrushes for their effectiveness in improving oral health and the results are often conflicting. Recent Systematic Reviews by the Cochrane Oral Health Group have distilled this information and provided unbiased conclusions, namely that: powered toothbrushes with an oscillating rotating action are more effective than manual toothbrushes in reducing plaque and gingivitis; other types of powered toothbrushes produced less consistent reductions in plaque and gingivitis than manual brushes. Further studies are required to determine the relative effectiveness of manual and powered toothbrushes in improving the status of patients with periodontitis. CLINICAL RELEVANCE: This review provides the dental professional with an unbiased summary of current evidence regarding the relative effectiveness of manual and powered toothbrushes.