Self-esteem as a characteristic of adherence to diabetes and dental self-care regimens

BACKGROUND, AIMS: There are biological associations between diabetes control and oral infections. We have also found psychological associations between diabetes self-care and oral health behavior. The aim of this study was to evaluate whether self-esteem can determine diabetes adherence and oral health behavior, both of with require daily, persistent self-care. METHOD: Cross-sectional data on 149 IDDM patients was collected by means of a quantitative self-completed questionnaire. RESULTS: High self-esteem was found to relate to good adherence with exercise regimens (p=0.005) and adjustment of insulin doses (p=0.040). These associations were also found when standardized for socio-demographic variables and HbA1c-level. In the dental sphere, logistic regression analysis showed an association between self-esteem and frequency of tooth brushing. CONCLUSIONS: It can be concluded that self-esteem may be a common psychological factor influencing diabetes and dental self-care. Strengthening patients' self-esteem could help patients to maintain daily self-care.     

Dental self-efficacy as a determinant to oral health behaviour, oral hygiene and HbA1c level among diabetic patients

Abstract. Because of a mutual association between severity of periodontitis and poor control of IDDM, regular dental visits and daily oral care are important among diabetics. The aim was to develop a method for analysing dental selfefficacy and to study the relationship between dental self-efficacy and reported oral health behaviour and oral hygiene. The relationship between oral health behaviour and HbA1_c level was also studied. Data were collected in relation to 149 IDDM patients by means of a quantitative questionnaire, evaluation of dental plaque and patient records. Results showed that tooth brushing self-efficacy, approximal cleaning self-efficacy and dental visiting self-efficacy related to corresponding reported oral health behaviour (p<0.0005). Visible plaque index (VPI) correlated inversely with tooth brushing self-efficacy (r_s=?0.208, p=0.012) and dental visiting self-efficacy (r_s=?0.240, p=0.004). Approximal cleaning self-efficacy correlated with age (r_s=0.225, p=0.006) and dental visiting self-efficacy was related to higher professional level of education (p=0.009). Those having better tooth brushing self-efficacy (p=0.020), higher frequency of tooth brushing (p=0.032) and lower VPI (p<0.0005) had better HbA1c level. It was concluded that perception of dental self-efficacy plays a decisive rǒle in relation to oral health behaviour in diabetic patients, and that compliance with dental recommendations is also related to HbA1c level.     

Locus of control beliefs predicting oral and diabetes health behavior and health status.

Our study evaluates the correlation between dental and diabetes locus of control beliefs and the potentiality of locus of control beliefs in predicting oral health behavior, dental status, diabetes compliance, and HbA1c level by using situation-specific locus of control scales and considering the value dimension. Data were collected by means of a quantitative questionnaire, a clinical oral examination and patient records. The research population comprised 149 insulin-dependent diabetics who had teeth of their own. Variables were the frequencies of tooth brushing and dental visiting, oral indexes, diabetes adherence, and HbA1c level. Dental and diabetes locus of control beliefs correlated with each other. Dental locus of control associated with frequency of dental visiting, plaque index, decayed surfaces, and with root caries, but diabetes locus of control associated only weakly with adherence with diabetes self-care regimens and not at all with HbA1c level. Correlations between dental locus of control and oral indexes were stronger among those having high value for dental care. Although there were correlations between dental and diabetes locus of control beliefs, only dental locus of control beliefs are practicable for determining health behavior and health status. It is therefore concluded that locus of control beliefs are health behavior specific.     

Dental conditions in inpatients with schizophrenia:A large-scale multi-site survey

ABSTRACT: BACKGROUND: Clinical relevance of dental caries is often underestimated in patients with schizophrenia. The objective of this study was to examine dental caries and to identify clinical and demographic variables associated with poor dental condition in patients with schizophrenia. METHODS: Inpatients with schizophrenia received a visual oral examination of their dental caries, using the decayed-missing-filled teeth (DMFT) index. This study was conducted in multiple sites in Japan, between October and December, 2010. A univariate general linear model was used to examine the effects of the following variables on the DMFT score: age, sex, smoking status, daily intake of sweets, dry mouth, frequency of daily tooth brushing, tremor, the Clinical Global Impression-Schizophrenia Overall severity score, and the Cumulative Illness Rating Scale for Geriatrics score. RESULTS: 523 patients were included in this study (mean [PLUS-MINUS SIGN] SD age = 55.6 [PLUS-MINUS SIGN] 13.4 years; 297 men). A univariate general linear model showed significant effects of age group, smoking, frequency of daily tooth brushing, and tremor (all p's < 0.001) on the DMFT score (Corrected Model: F(23, 483) = 3.55, p < 0.001, R2 = 0.42) . In other words, older age, smoking, tremor burden, and less frequent tooth brushing were associated with a greater DMFT score. CONCLUSIONS: Given that poor dental condition has been related with an increased risk of physical co-morbidities, physicians should be aware of patients' dental status, especially for aged smoking patients with schizophrenia. Furthermore, for schizophrenia patients who do not regularly brush their teeth or who exhibit tremor, it may be advisable for caregivers to encourage and help them to perform tooth brushing more frequently.     

Relationship among metabolic control, oral parameters and self-efficacy in diabetic patients

The aim of the present study was to evaluate the relationship between patients' answers to behavioral questionnaires on diabetes and oral health, oral parameters and metabolic control of diabetes. A cross-sectional study was conducted on fifty type 2 diabetic subjects selected according to specific criteria, mainly: diagnosis of type 2 diabetes mellitus occurred at least 6 months before the study, presence of > or = 5 natural teeth and having at least two recent glycated hemoglobin (HbA1c measurements. Three questionnaires were administered to the patients after a preliminary testing phase. The questionnaires were: Multidimensional Diabetes Questionnaire (MDQ), organized in three sections; Stress Evaluation Questionnaire for Diabetics, a single questionnaire; and Dental Self-efficacy, organized in three sections. Clinical parameters were O'Leary Plaque Index, and percentage of bleeding on probing. Diabetic metabolic control was calculated using HbA1c measurements. Reliability of questionnaires was analyzed using Cronbach's alpha coefficient. Relationship among variables was tested by Pearson Correlation analysis. A p-value <0.05 was significant. RESULTS: The mean age of the study sample was 52.2 years; 38 individuals were women (77%), and 12 were men (23%). The majority had only completed elementary education (55%). Mean plaque index score was 53.51% (SD 21.6), mean bleeding on probing was 36.33% (SD 23.65). Mean HbA1c value was 9.22% (SD 2.6). Dental self-efficacy for using dental floss and visiting a dentist was low, but it was high for tooth brushing. There was a significant correlation between the MDQ and HbA1c Percentage of bleeding on probing had a correlation with self-efficacy for dental visits. The MDQ section I had a correlation with O'Leary Plaque Index, sections II and III had a correlation with self-efficacy for tooth brushing, section III had a correlation with self-efficacy for visiting a dentist. In conclusion, self-efficacy questionnaires for tooth brushing and visiting a dentist had a significant correlation with self-efficacy for diabetes control.     

Smoking, tooth brushing and oral cleanliness among 15-year-olds in Tehran, Iran

PURPOSE: To assess smoking, tooth brushing and oral cleanliness and their relationships among 15-year-olds in Tehran, Iran. MATERIALS AND METHODS: A cross-sectional study based on World Health Organization criteria and the methods of the Second International Collaborative Study was carried out in autumn 2004 among 15-year-olds (n=502) in Tehran. Data were based on a self-administered questionnaire and a clinical dental examination. RESULTS: Smokers comprised 5% of the boys and 2% of the girls (p = 0.02). Smoking was more common among students of less-educated parents (50% vs. 30%, p < 0.05). Of all students, 26% reported twice-daily tooth brushing; those of higher socio-economic backgrounds and girls did so more frequently. Of the smokers, 11% reported no tooth brushing compared to 6% of the non-smokers. Oral cleanliness was good for 13%, moderate for 32%, and poor for 55%; the rates associated positively with female gender (p = 0.002), having higher-educated parents (p = 0.03), and reporting a higher frequency of tooth brushing (p < 0.001). Those students reporting twice-daily tooth brushing had less dental plaque and gingival bleeding (p < or = 0.01) on both anterior and posterior teeth. In multivariable analyses, the best predictors for a good level of oral cleanliness were female gender (OR = 2.0) or twice-daily tooth brushing (OR = 1.7). CONCLUSION: Oral cleanliness and tooth brushing among 15-year-olds were at poor levels, particularly among boys. Such poor levels call for intensive attempts to enhance rates of twice-daily tooth brushing and to improve its quality. For this age group, anti-smoking purposes should be combined into school-based oral health promotion programmes as well.     

Three laboratory assessments of a new triple-head toothbrush and the Oral-B 40 toothbrush

OBJECTIVE: The objective of this series of laboratory studies was to assess a new triple-head toothbrush, the DR BEST FreiKopf, compared to the Oral-B 40 toothbrush, for interproximal access efficacy (IAE), gingival margin cleaning (GMC), and subgingival access (SA) as measures of toothbrush efficacy. METHODOLOGY: In each procedure, six toothbrushes of each product were tested four times for a total of twenty-four tests on each toothbrush design. In the IAE assay, the tooth brushing technique involved independent evaluations of each toothbrush in a vertical or horizontal brushing motion, tooth shapes simulating anterior and posterior teeth, and a brushing weight of 250 g. The brushing apparatus was set to brush 15 seconds at two strokes per second with a 50 mm stroke. In the GMC assay, the tooth brushing technique involved independent evaluations of each toothbrush in a horizontal brushing motion, tooth shapes simulating posterior teeth, and a brushing weight of 500 g. Simulated gingivae were prepared from self-curing dental acrylic. The brushing apparatus was set to brush for 60 seconds at two strokes per second with a 15 mm stroke. In the SA evaluations, the tooth shapes simulating posterior teeth were used, as well as a brushing weight of 500 g for 60 seconds at two strokes per second with a 15 mm stroke. All readings were measured with 3x magnification by one investigator. RESULTS: The mean IAE value on anterior and posterior tooth shapes, with vertical and horizontal brushing, and overall, was significantly (p < 0.001) higher for the triple-head toothbrush than for the Oral-B 40 toothbrush. In the GMC assay, the triple-head toothbrush had a significantly (p < 0.001) superior mean value compared to the Oral-B 40 product tested. In the SA study, the triple-head toothbrush was significantly (p < 0.001) superior compared to the Oral-B 40 toothbrush product tested. CONCLUSIONS: The triple-head toothbrush has demonstrated superiority to a traditional flat-head toothbrush for access into interproximal areas, and for removing deposits from the gingival margin, as well as below the gumline, in these laboratory assays.     

The elmex SENSITIVE toothbrush: effect on plaque reduction and subjective satisfaction after two months

OBJECTIVE: The elmex SENSITIVE extra soft toothbrush, with soft conical filaments designed for plaque removal specifically in the cervical area and interdental spaces, and gentleness for hypersensitive teeth with exposed dentine, was evaluated for plaque removal effectiveness, safety, and subjective satisfaction. METHODS: One-hundred and seven healthy adults participated in the clinical trial designed according to American Dental Association (ADA) guidelines, and were randomly divided into a test group (N = 54) using the elmex brush, and a control group (N = 53) using the ADA reference brush. Subjects were chosen with gingival recession resulting in exposed dental necks and reported sensitivity, and were given a pre-study cleaning by a hygienist. Clinical examinations included the Rustogi plaque index (before and after brushing), and an examination for any soft lesion adverse effects, at baseline, 30, and 60 days. A subjective questionnaire, measuring satisfaction, sensitivity, and painless brushing, was administered at 30 and 60 days. An ANCOVA model, with baseline level as the covariate, was employed for testing clinical differences between groups at one and two months. The Mann-Whitney test measured differences in the satisfaction questionnaires. RESULTS: The total plaque index, after brushing and at one and two months, demonstrated a significantly higher mean level for the control compared to the test group (3.05 vs. 2.16; p = 0.001 and 3.47 vs. 2.56; p = 0.0003, respectively). Similar significant differences were detected for plaque levels at the gingival margin and the proximal dental surfaces, after brushing at one and two months. No significant differences were found pre-brushing at any of the measurement points. Most subjective assessments of the two brushes at one and two months revealed significant differences in favor of the test brush. CONCLUSION: These results indicate an effective toothbrush for promoting oral health, and patient acceptance of a toothbrush with soft conical filaments intended specifically for sensitive teeth.     

Self-efficacy as a common variable in oral health behavior and diabetes adherence

Successful treatment of dental caries, periodontal diseases and diabetes requires persistent daily self-care. The aim of this study was to evaluate the perception of self-efficacy as a common behavioral factor determining oral health behavior, diabetes self-care, and actual health status. Cross-sectional data relating to 149 insulin-dependent diabetes mellitus (IDDM) patients were collected from patient records, and by clinical oral examination and a quantitative questionnaire. The study population was recruited from different locations, and the participation percentage was 80%. Self-efficacy scales associated with corresponding behaviors, and a dental self-efficacy scale also correlated with dental caries. Dental self-efficacy correlated with diabetes self-efficacy, diabetes adherence, and with HbA1c. Also, logistic regression analysis revealed that dental self-efficacy was related to diabetes adherence. Further, those diabetics reporting a high frequency of dental visiting had higher diabetes self-efficacy. As a conclusion, good dental self-efficacy has a positive influence on diabetes adherence. The results suggest that the perception of self-efficacy may be a common behavioral factor determining diabetes self-care and oral health behavior.     

DENTAL PRACTITIONERS' ATTITUDES,SUBJECTIVE NORMS AND INTENTIONS TO PRACTICE ATRAUMATIC RESTORATIVE TREATMENT (ART) IN TANZANIA

The aim of this study was to describe the attitude and subjective norm of dental practitioners towards practicing the atraumatic restorative treatment (ART) in Tanzania. A pre-tested questionnaire on attitudes and subjective norms to practice ART was mailed to all 147 dental practitioners working in the regional and district government clinics. The independent variables were: gender, working experience, qualification and ever heard of ART. The dependent variables were: attitude, subjective norm and intention to practice ART. Chi-square tests and multiple regression analysis were used to test for effects between independent and dependent variables. Significance level was set at 5%. A total of 138 practitioners returned completed questionnaires. More experienced dental practitioners encountered moderate social pressure than less experienced dental practitioners, who met strong social pressure (p=0.045). A total of 73.2% of dental practitioners felt that ART was worth introducing in Tanzania, 92.8% recommended ART training for all dental practitioners and 97.8% recommended inclusion of ART in dental curricula. Positive attitude, strong subjective norm and high intention to practice ART were recorded in 76.3%, 28.1% and 90.6% of the practitioners, respectively. Only subjective norm had a statistically significant influence on the intention to practice ART (p<0.0001). The results indicated that dental practitioners were willing to have ART introduced in Tanzania and had positive attitudes towards practicing this technique. Nevertheless, their intention to perform ART was strongly influenced by social pressures. Therefore, in order to have a successful introduction of ART in Tanzania, people who matter in the daily practice of dental practitioners need to accept and appraise the ART approach positively.     

Identifying risk factors for predicting caries in school-aged children using dental health information collected at preschool age

The study was done to identify toddlers who have an increased risk of developing dental decay at school age. Six variables-Cariostat score, mother's ethnicity, evidence of baby bottle tooth decay, mother;s dental health status, toddler's age at first tooth, and frequency of brushing - showed a significant association with decay status at school age with odds ratios ranging from 1.89 to 2.63. The Cariostat score and the frequency of brushing remained significant in a logistic regression. No interaction terms were significant. The Cariostat caries activity test would be a useful screening tool for identifying toddlers most likely to develop decay or could be used periodically as the deciduous molars erupt and become colonized with oral bacteria. The findings confirm that good oral hygiene practices can have an impact on future dental health, and caregivers should be encouraged to brush young children's teeth regularly.     

预测糖尿病患者牙种植术后发生种植体周围炎风险的列线图模型建立与分析

目的: 探讨糖尿病患者牙种植术后发生种植体周围炎的危险因素,并建立相关列线图预测模型。方法: 回顾性分析2016年1月—2018年12月行牙种植修复治疗的257例糖尿病患者的临床资料,采用整群随机抽样法将数据分为训练集（n=153）和验证集（n=104）。分别使用单因素和Logistic回归分析,确定糖尿病患者发生种植体周围炎的独立危险因素;同时建立相关列线图预测模型,采用Bootstrap 法对模型进行内部验证,外部验证通过验证集自抽样法完成。采用SPSS 22.0软件包对数据进行统计学分析。结果: 吸烟指数>200支/年（OR=6.364,95%CI：1.943~20.840）、HbA1c>7%（OR=4.680,95%CI：1.497~14.628）、牙周病史（OR=3.779,95%CI：1.359~10.507）、前牙区种植（OR=7.183,95%CI：2.371~21.756）、刷牙频率≤1次/d（OR=4.796,95%CI：1.471~15.637）和未定期洁治（OR=4.994,95%CI：1.745~14.295）是糖尿病患者种植牙术后发生周围炎的独立危险因素（P<0.05）。基于以上6项危险因素建立预测糖尿病患者发生种植体周围炎的列线图模型,校准曲线验证显示,训练集和验证集的预测值与实测值基本一致。ROC曲线验证显示,训练集和验证集的C指数分别为0.867和0.822,说明列线图模型具有良好的预测精准度。结论: 吸烟指数>200支/年、HbA1c>7%、牙周病史、前牙区种植、刷牙频率≤1次/d和未定期洁治是糖尿病患者发生种植体周围炎的独立危险因素,基于以上危险因素建立的列线图模型能够直观、准确预测糖尿病患者发生种植体周围炎的概率。     

Relation of different measures of psychological characteristics to oral health habits, diabetes adherence and related clinical variables among diabetic patients

Among diabetic patients, oral health status and oral health behavior have been found to relate to metabolic control. The aim was to analyse which psychological characteristics, i.e. intention, self-efficacy, locus of control or self-esteem related to health behavior most comprehensively explain oral health habits, diabetes adherence, dental caries, deepened periodontal pockets, and the metabolic parameter HbA1c (glycosylated hemoglobin). The study subjects consisted of a group of 149 insulin-dependent diabetic patients. Data were obtained from self-completed questionnaires. The proportions of variance explained by the linear regression model were used as measures in the comparisons. It was found that oral health habits and diabetes adherence correlated. Both dental and diabetes self-efficacy scores were related to oral health habits and diabetes adherence. This indicates that self-efficacy is the best overall determinant of various health behavior practices. The ability of psychological characteristics to explain oral health was limited. Improvement of self-efficacy therefore may have a positive effect on various aspects of health behaviors.     

Tooth brushing and gingival abrasion

It has been known for some time that tooth brushing can have unwanted effects on the gingiva and hard dental tissues. The aim of this study is to evaluate two factors that may be of influence on the incidence of gingival abrasion during tooth brushing. The first factor being the possible influence of feedback through oral sensory perception and the second the possible abrasive effects of dentifrice. From the sensory feedback experiment it became clear that a significantly greater number of abrasions occurred when the test subjects would brush their own teeth than when they would have their teeth brushed by a dental hygienist. From the dentifrice experiment it became clear that the use of dentifrice has no significant effect on the occurrence of gingival lesions.     

Preventive Behaviors as Correlates of Periodontal Health Status

Objectives: This investigation examined current practices of brushing, flossing, and periodic dental visits and their association with periodontal health status. Methods : Data were collected using face-to-face interviews and 40-minute in-home dental examinations with a probability sample of adults 18 years of age or older, having at least one tooth, and living in housing units in the Detroit tricounty area. Complete examinations were performed on 319 individuals. Results : On average, subjects reported brushing their teeth about twice a day. About one-third of the population reported flossing at least once a day. Loss of periodontal attachment was related to frequency of brushing while subjects who exhibited acceptable flossing ability had less plaque and calculus, shallower pocket depths, and less attachment loss. Subjects reporting a periodic dental visit at least once a year had less plaque, gingivitis, and calculus than subjects reporting less frequent visits. In regression analyses, brushing thoroughness, flossing ability and frequency, and dental visit frequency were predictors of lower plaque, gingivitis, and calculus scores. In turn, these scores were predictors of shallower pocket depths and less attachment loss. Conclusions : Brushing, flossing, and periodic dental visits were correlated with better periodontal health. The behaviors appeared to be indirectly related to pocket depth and attachment loss through their associations with plaque, gingivitis, and calculus levels.     

Toothbrushing in Finland

Oral hygiene behavior was surveyed in June 1971 by interviews with a sample comprising 1063 persons drawn to cover the total Finnish population aged 15 years and over. The interview revealed that the frequency of brushing as reported by dentulous interviewees was distributed as follows: less than once a day (32%), once a day (25%) and more than once a day (43%). Six percent of the interviewees stated that they did not brush their teeth. Most commonly the brushing was performed either as the last thing before retiring for the night (67%) or immediately after waking up in the morning (47%). There was a strong positive correlation between high socioeconomic status and high frequency of toothbrushing. Freshening of the breath and mouth was the most common (55%) reason for brushing the teeth and forgetfulness was the most frequent reason for neglecting it (56%). The investigation showed tha the dental health behavior of the Finnish people with respect to brushing of the teeth has much room for improvement.     

Oral hygiene and associated factors among frail older assisted living residents

The aim of this study was to determine the associations of older assisted living residents’ tooth brushing habits with health and nutritional status. We assessed the tooth brushing habits, nutritional status, oral health, use of dental services, and morbidity of 1,447 assisted living residents in the Helsinki metropolitan area of Finland. Of the residents, 17% did not clean or had not cleaned their teeth and/or dentures daily. Those not cleaning their teeth and/or dentures daily were more often male, less educated and had a mean length of stay in assisted living longer than those who cleaned their teeth and/or dentures daily. They were more often malnourished and dependent in ADLs. In addition they more often had poorer oral health and used fewer dental services. Poor tooth brushing habits indicate poor oral and subjective health. More attention should focus on the oral hygiene of frail older assisted living residents.     

Preventive oral health behaviors among African-Americans and whites in Detroit

OBJECTIVE: This study compared the preventive oral health behaviors of African-Americans and whites. METHODS: Face-to-face interviews were conducted with a probability sample of 384 African-American and 358 white adults living in the greater Detroit area. Questions focused on brushing, flossing, and dental visits. RESULTS: More than 95 percent of both groups reported brushing daily; however, whites were more likely to brush all teeth, including parts that do not show. Frequency of flossing did not differ between groups. African-Americans, however, were less likely to floss all of their teeth. Whites were more likely than African-Americans to get dental check-ups at least once a year and much less likely to indicate they had never had a dental check-up. African-Americans tended to have less education and lower family income than whites and were more likely than whites to have Medicaid. Race differences in brushing thoroughness and annual check-ups were greatly reduced when income, education, and insurance were controlled statistically. CONCLUSIONS: African-Americans are less likely than whites to brush thoroughly, floss thoroughly, and get dental check-ups. These differences are partly traceable to differences in socioeconomic status and access to professional oral health care.     

Oral health knowledge, attitude and behaviour among Saudi school students in Jeddah city

OBJECTIVES: To assess the knowledge, attitude and behaviour in relation to periodontal health status among Saudi intermediate and high school students living in Jeddah, Kingdom of Saudi Arabia. METHODS: A dental health questionnaire was distributed to a random sample of a total of 2586 Saudi students from intermediate and high school, aged 12-18 years residing in Jeddah. RESULTS: While about 87.1% knew that tooth brush helps prevent periodontal disease, only 33.1% knew that using dental floss helps in preventing periodontal disease. Females used brushing and flossing more than males, while males used miswak more than females. Tooth brushing (P<0.001) and dental floss (P<0.015) were used more frequently among private subjects, while miswak was utilized more frequently among governmental school students (P<0.005). Dental pain was found to be the main reason for visiting the dentist among the target group. CONCLUSIONS: It appears that knowledge, attitude, and behaviour concerning periodontal health among young Saudi school students living in Jeddah city are in need of improvement.     

In vitro safety evaluation of a new ultrasound power toothbrush

OBJECTIVE: To evaluate the safety of a novel ultrasound power toothbrush using a series of laboratory tests simulating extended brushing on the natural tooth surface, dental restorations, crowns, and orthodontic brackets. METHODS: To evaluate safety on the natural tooth and restored surfaces, human molars (n = 60) were prepared with restorations centered on the facial cementoenamel junction. The specimens received restorations of either 1) amalgam, 2) nanofilled composite resin, 3) glass ionomer, 4) cast gold-cemented with glass ionomer, or 5) pressed ceramic adhesively cemented with a composite resin cement. Orthodontic specimens (n = 33) were created by cementing brackets onto the buccal surfaces of extracted teeth. Crown specimens (n = 32) were created by cementing cast metal crowns onto identical pre-molar metal dies using zinc phosphate. All specimens were exposed to extended brushing in an environment controlled for time, brush head force, and dentifrice slurry. Treatment was assigned randomly to the specimens, and brushing was done with either the ultrasound toothbrush (Ultreo), or one of two positive controls: a manual toothbrush (Oral-B 35) and an oscillating-rotating power toothbrush (Oral-B Triumph). Negative control specimens remained unbrushed. Qualitative analysis via scanning electron microscopy was utilized to evaluate the tooth surface and restoration integrity. Shear and tensile testing was used to evaluate orthodontic bracket and crown retention, respectively. RESULTS: Exposure of the teeth and restored surface to the manual toothbrush resulted in some bristle furrows on cementum/dentin root surfaces, especially at the heights of contour and light grooves on the composite resin surfaces. The two power toothbrushes had no signs of root surface wear. None of the toothbrushes demonstrated breakdown of the restorative margins, any loss of cement, or any effect on the enamel. No significant treatment effect on the orthodontic bracket or crown retention force was found (ANOVA, p > 0.05). CONCLUSION: The new Ultrasound toothbrush was found to be safe on natural tooth surfaces and restorative materials, as established in comparison to positive and negative controls. Furthermore, no safety concerns related to orthodontic bracket or dental crown retention were identified with any treatment.