Comparison of 2 electric toothbrushes in plaque-removing ability Professional and supervised brushing

Abstract. The purpose of the present study was to compare the Braun Plak Control® (D7) and Philips HP 500® (MM) in their plaque removing efficacy. Furthermore the brushing force applied by the panellist on the brush-head with both these brushes was evaluated. For this study, 35 university students (non-dental) were selected. The study consisted of 3 experiments. Prior to each experiment, all subjects were asked to abstain from all oral hygiene procedures for at least 48 h. In Exp. I, the efficacy of toothbrushing was studied when one of the investigators brushed the teeth of the panellists. In Exp. II, the efficacy of the brushing was studied after the students had received a professional instruction. In Exp. III, the brushing force used during a single brushing exercise was evaluated. The available time for the brushing amounted to a total of 2 min per mouth. Dental plaque was evaluated by means of the Silness and Löe and Quigley and Hein plaque indices assessed at 6 sites per tooth. Results showed that both in Exp. I and Exp. II, the D7 removed significantly more plaque than the MM electric toothbrush. The plaque reduction assessed according to Silness and Löe in Exp. I was for the D7, 1.07 and for the MM, 0.78. In Exp. II, the reduction was 1.08 and 0.88, respectively. The results of Exp. III show that the mean brushing force was comparable for both brushes (D7=I73 g, MM=I75 g). All 35 subjects were allowed to choose one electric toothbrush as compensation for their participation. The majority (n=26) of subjects preferred the D7 to the MM. In conclusion, the results of the present study show that given a choice, there was a preference of the panellists for the D7. No difference in brushing force was observed between the 2 brushes. Evaluation of plaque removing efficacy showed that the Braun Plak Control® is more effective than the Philips HP 500®.     

Toothbrushing force in relation to plaque removal

Abstract This was a 2-part study. The purpose of the 1st part was to examine the relationship between brushing force and plaque removal efficacy comparing a regular manual toothbrush (M) with an electric toothbrush the Braun Oral-B Plak Control* (B). The study consisted of a single oral prophylaxis followed by 5 experiments which differed solely in respect to toothbrushing force. At baseline (after 24-h plaque accumulation), the amount of dental plaque was evaluated and subsequently, the subject's mouth was brushed by a dental hygienist. Brushing was carried out in a random split-mouth order. Either the 1st and 3rd quadrants or the 2nd and 4th quadrants were brushed with 1 toothbrush and the 2 remaining quadrants with the other. The available time for the brushing procedure was 2 min. After brushing, the amount of remaining dental plaque was assessed. The force used in experiment 1 through 5 was 100, 150, 200, 250, 300 g, respectively. The results show that when brushing force is increased, more plaque is removed with either of the two brushes. Except for the high brushing force (300 g), the electric toothbrush removed more plaque than the manual brush. The purpose of the 2nd part was to evaluate the habitual brushing force which individuals use with various toothbrushes. Besides a manual toothbrush (M), 3 electric toothbrushes were examined, the Rotadent® (R). Interplak® (I) and Braun® (B). 20 subjects were selected on the basis of being ‘good brushers” (plaque score at screening <25%). At baseline, each subject randomly received 1 of the 4 brushes. They were allowed a training period of 3 weeks at the end of which they were asked to abstain from brushing for at least 24 h. The plaque (Turesky modification of the Quigley & Hein) was scored, after which the subjects brushed their teeth (2 min) with the assigned toothbrush equipped with a strain gauge. A computer set–up measured (100 Hz) and calculated the mean brushing force. After brushing, the amount of remaining plaque was assessed. The design of the study was a 4-way cross-over. The results show that with a manual brush, considerably more force is used than with the electric brushes (R=96. 1 = 119. B= 146, M=273). No significant relation between brushing force and plaque removal was demonstrated for any of the brushes.     

The plaque-removing efficacy of an oscillating/rotating toothbrush

Abstract The purpose of the present study was to test the effectiveness of a new type of BRAUN electric toothbrush (D5) in comparison with the traditional BRAUN electric toothbrush (D3) and to a manual toothbrush (M). For this study, 60 dental students were selected who had no previous experience with the use of an electric toothbrush. The study consisted of 3 experiments. Prior to each experiment, all students were asked to abstain from all oral hygiene procedures for at least 24 h. In Exp I, the efficacy of toothbrushing was studied when one of the investigators brushed the teeth of the students. No toothpaste was used in this first part of the study. In Exp II, the efficacy of brushing was evaluated when the brushing was carried out by the students themselves. In Exp III, the efficacy of the brushing was studied after the students had received a professional instruction and oral prophylaxis. The available time for the brushing amounted to a total of 2 min per mouth. The amount of dental plaque was evaluated by means of the Silness and Löe plaque index at 6 sites around the tooth. Results showed in Exp I that both electric toothbrushes proved to remove significantly more plaque than the manual toothbrush (M 78%; D3 85%; D5 86%). In Exp II, no significant differences in plaque-removing efficacy were found between the 3 brushes (M 73%; D3 72%; D5 73%). In Exp III, the D5 proved to remove significantly more plaque than the other two brushes (M 77%; D3 77%; D5 83%). In conclusion, within the limitations of this study, both electric toothbrushes showed that they have the ability to remove more plaque than a manual toothbrush. The D5 proved to remove more plaque than the D3 after professional oral hygiene instruction.     

Approximal brush head used on a powered toothbrush

AIM: This study was designed to test whether the approximal efficacy of a powered toothbrush (Braun Oral-B 3D Plaque Remover) can be improved when a pointed-shaped brush head (PBH) specifically designed for these approximal areas is used as compared with the standard cup-shaped brush head (CBH). MATERIAL AND METHODS: Forty non-dental students were included. They all received the powered toothbrush and two different brush heads (CBH+PBH). Instructions were given to use each brush head twice every day (2 min. with the CBH followed by 1 min. with the PBH). Two weeks later they received an appointment for the first experiment (Exp 1), prior to which they abstained from all oral hygiene procedures for 48 h. Plaque was assessed at 6 sites/tooth. Next, the dental hygienist brushed for 2 min. (30 s/quadrant) with the CBH. Plaque was scored again. Subsequently, the dental hygienist brushed the approximal areas for another minute: in two randomly selected contra-lateral quadrants for 30 s with the CBH and in the opposing quadrants for 30 s with the PBH. The next approximal plaque was scored a third time. After 2-3 weeks, Exp 2 was carried out comparable to Exp 1; only this time the panelists brushed themselves. RESULTS: Exp 1 showed approximal plaque scores at the baseline of 1.70 and 1.72 and at post-brushing 0.21 and 0.26 for the CBH + PBH and CBH only, respectively (p<0.05). The additional increase in approximal plaque reduction after 30 s of brushing with PBH was 22% and for the CBH 19% (p<0.05). Exp 2 showed approximal plaque scores at baseline of 1.76 and 1.74 and post-brushing of 0.21 and 0.24 for the CBH+PBH and the CBH, respectively. The additional approximal plaque reduction of 30 s brushing with PBH was 19% and 18% with the CBH (no significant difference). DISCUSSION/CONCLUSION: An additional 1 min. showed minor differences (1-3%) between brush heads. The effect of the 1 min. extra brushing (+/-18%) itself was much larger. It seems therefore beneficial to advise the patient to brush longer. A second different brush head may stimulate to do so.     

The plaque-removing efficacy of a finger brush (I-Brush)

OBJECTIVE: The purpose of the present study was to test the effectiveness of a finger toothbrush (I-Brush) in removing plaque compared with a flat-trimmed manual toothbrush. MATERIAL AND METHODS: For this study, 37 subjects were selected, without previous experience of the use of the I-Brush. Each subject received a finger brush (I-Brush), a manual toothbrush (Butler GUM 311), two written brushing instructions for both types of brushes, and a brush calendar. Subjects were given a period of 3 weeks to become familiar with the two types of brushes. During this period, the subjects were instructed to use the two types of brushes on alternate days. The brush calendar helped as a reminder and served to ensure compliance. No instructions regarding brushing time or frequency of brushing were given to the subjects, except that they should conform to their usual oral habits. After 3 weeks, all subjects were asked to abstain from oral hygiene procedures for 48 h prior to the experiment. In this experiment, the amount of dental plaque was scored by a trained examiner. The examiner (N.A.M.R.) used the modified Silness & Loe (1964) plaque index at six sites per tooth. After scoring, each subject received a new finger brush and a new manual toothbrush. The subjects brushed according to a split mouth protocol. Two contra-lateral quadrants were chosen randomly and were brushed with one randomly chosen brush and the two opposing contra-lateral quadrants with the alternate brush. The brushing was performed under supervision in front of a mirror. The available time for brushing was 2 min. for the entire dentition. Finally, the remaining plaque was scored again. RESULTS: The overall reduction in plaque was 79% for the manual toothbrush and 62% for the finger brush. The plaque removing efficacy of the finger brush was poorest at the approximal vestibular surfaces (55% plaque reduction) compared with the manual toothbrush (77% plaque reduction). CONCLUSION: The plaque reduction of the finger brush is not an acceptable alternative to the use of a regular manual toothbrush.     

Role of brushing technique and toothbrush design in plaque removal

Abstract – Twenty-four adults participated in an intraindividual crossover experimental study to compare the plaque removing ability of straight multitufted and V-shaped brushes. Twelve of the participants had loss of periodontal tissue resulting in open but healthy interdental areas while the other 12 displayed no periodontal breakdown. In part 1 the participants were asked to brush their teeth using their own brushing technique and length over two 12-day periods during which time they, at random, used one brush for the first and the other brush for the second period. In part 2 the participants were professionally brushed by two dental assistants using four brushing techniques (The Bass, The Roll, The Circular Scrub and The Horizontal Scrub) randomly assigned to the four quadrants of the mouth. Cleaning was performed once a day for two 5-day periods, during which time the participants refrained from brushing and interdental cleaning. Initial toothbrush assignment was randomized. At the beginning of the study and each test period no plaque or gingival inflammation was visible. At the end of each period the accumulated plaque was registered. The results showed that there was no difference between the two brushes tested in the unsupervised part. The plaque removing ability when using either of the brushes varied between participants. When professionally used the straight multitufted and V-shaped toothbrushes did not show any difference in plaque removal on buccal and lingual surfaces. Interproximally the V-shaped toothbrush was better at plaque removal than the straight one. However, plaque still remained after brushing with the V-shaped toothbrush, which indicates that toothbrushing always must be supplemented with interdental aids and that the shape of brushes as well as the techniques used are of little importance. Interproximal areas with tissue breakdown and loss of interdental papillae accumulated more plaque than those with no periodontal tissue breakdown.     

Professional brushing study comparing the effectiveness of sonic brush heads with manual toothbrushes: a single blinded,randomized clinical trial

The aim of this study was to evaluate the plaque removal efficacy of four toothbrushes: the Philips Sonicare Elite with medium and mini brush heads, the Elmex Sensitive, and the American Dental Association (ADA) reference toothbrush. This study was a randomized, controlled, investigator-blinded, four-brush crossover design study, which examined plaque removal following a consecutive repeated use. All brushes were used on each participant in a randomly assigned quadrant of the mouth. A total of 90 subjects participated in the study. Prior to the experiment, they received a professional prophylaxis and were requested to refrain from toothbrushing for 48 h. Teeth were professionally brushed consecutively for 10 to 90 s per quadrant. A Turesky-modified Quigley Hein Index score was assessed at baseline and after each brushing interval by one blinded investigator. Results showed reduction of mean plaque scores for all brushes with time from 10 to 90 s. After 30 s (2-min whole mouth equivalent) of brushing, the Sonicare brushes cleaned 19, the ADA brush 16, and the Elmex Sensitive 10 of in average 28 tooth surfaces. With time, the number of additional cleaned surfaces decreased. Time is an important variable in the evaluation of plaque-removing efficacy since absolute efficacy increases with time and differs per toothbrush. No differences could be found between the two brush heads of the Sonicare.     

A comparative study of electric toothbrushes for the effectiveness of plaque removal in relation to toothbrushing duration

Abstract The purpose of the present study was to test the plaque-removing efficacy of 4 different toothbrushes in relation to duration of toothbrushing. The brushes studied were a manual toothbrush (M), a conventional electric toothbrush – the Blend-a-Dent® (BPC), the Interplak® (IP) and the Braun Plak Control® (BPC). For this study, 20 subjects were selected. The study was divided into 5 experiments which differed only in respect to the brushing time. The available time in experiment 1 through 5 was 7.5, 15, 30, 45, 90 s per quadrant respectively. Prior to each experiment, all subjects were asked to abstain from oral hygiene procedures for at least 24 h. The efficacy of toothbrushing in each experiment was studied while one investigator (MAL) brushed the teeth of the subjects. In each subject, all 4 brushes were tested. Each brush was assigned to a quadrant in a random order. No toothpaste was used throughout this study. The amount of dental plaque was evaluated before and after brushing by means of the Silness & Löe plaque index at 6 sites around each tooth investigated. The results show an increase in efficacy for all brushes varying from 7.5 s per quadrant to 90 s per quadrant (mean plaque reduction in terms of percentage 7.5 s-90 s: M =40%-75%, BL = 45%-82%, BPC = 51%-94%. IP=64%-92%). The IP removed significantly more plaque than the other 3 after 7.5 s of brushing. From 15 s through 90 s, the IP and BPC were equally effective. Both were, at all times, significantly more effective than the M and BL. This difference was mainly caused by a greater plaque removal from the interproximal areas, since brushing for 30 s or more with all 4 brushes removed about 90% of the plaque from the vestibular and lingual surfaces. Evaluation of the efficacy in relation to brushing time showed for all brushes that the greater part of the effect is reached after 30 s of brushing per quadrant. The brushing time appears to be an important variable in the evaluation of plaque removing effectiveness since the efficacy increases with time and differs per toothbrush.     

Plaque removal with a novel manual toothbrush (X-Active) and the Braun Oral-B 3D Plaque Remover

Objectives: The study was designed to test the efficacy in plaque removal of three toothbrushes: two manual brushes, the Butler GUM 311^® and the Dr Best X‐Active^®, and one electric toothbrush the Braun Oral‐B 3D Plaque Remover (3D)^®. Method: The study was a split‐mouth, single‐blind, randomized clinical study consisting of three identical experiments testing three combinations of toothbrushes (experiment 1: 3D versus Butler; experiment 2: 3D versus Dr Best; experiment 3: Butler versus Dr Best), in which the teeth of the panellists were brushed by a dental hygienist. In a fourth experiment, the panellists brushed their own teeth (3D versus Dr Best). Thirty‐five subjects participated in the study and received a professional prophylaxis prior to the first experiment. They were requested to refrain from brushing their teeth for 48 h prior to each experiment. Plaque was assessed according to the Silness & Löe plaque index at six sites per tooth. Next, the dental hygienist (experiments 1–3) or the panellist (experiment 4) brushed for 60 s with their first assigned brush in two randomly selected contralateral quadrants. Brushing was repeated (60 s) with the second brush in the opposing two contralateral quadrants. Prior to experiment 4, panellists were given two thorough hands‐on professional instructions in the use of the 3D and the Dr Best toothbrushes. Results: In experiment 1, the 3D showed a mean plaque reduction of 72% compared to 63% with the Butler (P<0.01). In experiment 2, the 3D showed a mean plaque reduction of 79% and the Dr Best 76% (P<0.05). In experiment 3, the Butler showed a mean plaque reduction of 81% and the Dr Best 85% (P=0.01). In the hands of the panellists (experiment 4), the 3D showed a mean plaque reduction of 88% and the Dr Best 84% (P<0.05). Conclusions: A 5‐week training period with repeated hands‐on instruction gives panellists the skill to perform brushing with efficacy comparable to that of professional brushing. In agreement with a previous study, the 3D was more effective than a flat‐trimmed manual toothbrush ( Van der Weijden et al. 1994 ). Brushing with the criss‐cross resulted in small statistical differences with the 3D and the flat‐trimmed manual toothbrush. The clinical relevance of these statistically significant results should be the subject of a longitudinal study.     

Evaluation of the incidence of gingival abrasion as a result of toothbrushing

Abstract. The aims of the present study were: (1) to establish the incidence of gingival abrasion as a result of toothbrushing. using a manual and electric toothbrush: (2) to establish the influence of filament end-rounding on the incidence of gingival abrasion and the efficacy of toothbrushing: (3) to assess whether the speed of the electric brush has a feedback-effect on the brushing force used and to correlate the incidence of gingival abrasion with force. 2 experiments were earned out. In the first experiment, 50 subjects brushed for 3 weeks every other day with either a manual (Butler 411) or an electric toothbrush (Braun/Oral-B Ultra Plaque Remover-D9). All received brief instructions and were asked to abstain from oral hygiene 24 hrs before their appointment. After disclosing the teeth and gums with Mira-2-Tone solution, plaque and gingival abrasion were assessed. Next, the panellists brushed in a random split-mouth order. After brushing and a second disclosing, plaque and abrasion were re-assessed. The results showed that the incidence of gingival abrasion was comparable for the manual and the D9. Using a similar design as in experiment no. 1, in experiment no. 2 a new group of 47 subjects brushed for 3 weeks alternating between the Braun/Oral-B Plaque Reniover-D7 and D9. At the appointment, the subjects first brushed in a split-mouth order with the D9 with 2 different types of endrounding. Plaque and abrasion were assessed. Immediately following this brushing exercise, the subjects re-brushed with the D7 (2800 rot/min) and the D9 (3600 rot/min) during which brushing force was measured. The results of this experiment showed that end-rounding has no effect on plaque removal but does effect the incidence of gingival abrasion. Brushing force is not influenced by the speed of the brushhead and no correlation with the incidence of gingival abrasion was observed. In conclusion, the results of this study show that gingival abrasion is not influenced by brushing force, but is affected by filament endrounding.     

Role of brushing technique and toothbrush design in plaque removal

Twenty-four adults participated in an intraindividual crossover experimental study to compare the plaque removing ability of straight multitufted and V-shaped brushes. Twelve of the participants had loss of periodontal tissue resulting in open but healthy interdental areas while the other 12 displayed no periodontal breakdown. In part 1 the participants were asked to brush their teeth using their own brushing technique and length over two 12-day periods during which time they, at random, used one brush for the first and the other brush for the second period. In part 2 the participants were professionally brushed by two dental assistants using four brushing techniques (The Bass, The Roll, The Circular Scrub and The Horizontal Scrub) randomly assigned to the four quadrants of the mouth. Cleaning was performed once a day for two 5-day periods, during which time the participants refrained from brushing and interdental cleaning. Initial toothbrush assignment was randomized. At the beginning of the study and each test period no plaque or gingival inflammation was visible. At the end of each period the accumulated plaque was registered. The results showed that there was no difference between the two brushes tested in the unsupervised part. The plaque removing ability when using either of the brushes varied between participants. When professionally used the straight multitufted and V-shaped toothbrushes did not show any difference in plaque removal on buccal and lingual surfaces. Interproximally the V-shaped toothbrush was better at plaque removal than the straight one.(ABSTRACT TRUNCATED AT 250 WORDS)     

Spatial extent of gingival cell activation due to mechanical stimulation by toothbrushing

BACKGROUND: Mechanical stimulation by toothbrushing enhances gingival fibroblast proliferation and collagen synthesis, and reduces inflammatory cell infiltration. The aim of this study was to investigate the spatial extent of proliferation of fibroblasts and endothelial cells in dog gingiva in response to mechanical stimulation by toothbrushing. METHODS: All maxillary fourth premolars and mandibular first molars of 6 mongrel dogs were used. Dental plaque was removed with a curet. One of each pair of bilateral teeth (in the same jaw) was assigned to the brushing group, and the corresponding tooth (opposite side) was assigned to the control group. The Bass method was used to brush the limited mesial half of the tooth at 1.96 N for 20 seconds with a fitted plastic stent. Immediately before fixation of tissue, the surface of brushed gingiva was notched to indicate the borderline between the brushed and non-brushed areas. Histometrical analyses of the sections were performed using assays for proliferating cell nuclear antigen (PCNA) and von Willebrand factor. RESULTS: The numbers of fibroblasts and PCNA-positive fibroblasts in the subepithelial connective tissue adjacent to oral sulcular epithelium significantly increased in brushed gingiva, not only in the brushed area but also in the non-brushed area 0 to 0.5 mm from the notch. Increased numbers of vascular endothelial cells were observed only in the brushed area. CONCLUSION: The effect of mechanical stimulation by toothbrushing on gingival cell proliferation was not observed more than 0.5 mm from the brushed area. These results indicate that effective activation of gingival cell proliferation requires mechanical stimulation of gingiva in all areas.     

Relationship between the plaque removal efficacy of a manual toothbrush and brushing force

Abstract. This survey investigated the association between the efficacy of plaque removal and toothbrushing forces during a normal brushing regime. The 94 subjects participating in this study were requested not to brush 24 h prior to the experiment. Panellists brushed for 1 min with a manual toothbrush. Before and after brushing, plaque was assessed using the Turesky modification of the Quigley & Hein plaque index. A second 1-min exercise of brushing was carried out to assess the toothbrushing force. The mean plaque reduction was 39%, with vestibular surfaces being cleaned most effective (69%) and the lingual surfaces the least (21%). The mean brushing force was 330 g. No correlation was observed between efficacy and brushing force ( r =0.14, p =0.16). The relationship between pre- and post-brushing plaque was stronger ( r =0.68, p <0.001). Multiple regression analysis entering squared values of force as an independent variable into the equation, indicated that the relation between efficacy and force was not linear. A curve could be fitted to the plot (p=0.0004), demonstrating that up to a certain level of force, an increase of force is associated with an increase in efficacy ( r =0.33, p <0.01). Beyond this point, application of higher forces resulted in reduced efficacy ( r =-0.49, p =0.03). As was calculated in this particular test this'transition'level of force was 407.4 g. The absence of a correlation between brushing force and plaque removal efficacy suggests that in a'user model'brushing situation, other factors than brushing force are of major influence on the amount of plaque removed.     

Comparison of modified Bass technique with normal toothbrushing practices for efficacy in supragingival plaque removal

Abstract Objectives: This study was designed to compare the efficacy in supragingival plaque removal of normal toothbrushing practices and a particular toothbrushing technique, the modified Bass method. Subjects and methods: The research consisted of two identical experiments with two toothbrushing methods: the normal toothbrushing practices and the modified Bass technique. Forty‐six secondary, non‐dental students (10 males and 36 females) with ages ranging from 18 to 30 years were selected. Dental plaque was assessed according to the Turesky modification of Quigley–Hein Index. Subjects were requested not to brush their teeth 48 h prior to the baseline record of plaque index. Participants were instructed to brush twice daily during 3 min for the duration of the 3‐week trial using their usual toothpaste. Plaque index was recorded at 2, 7 and 21 days. Results: The modified Bass (Mod‐Bass) technique was significantly (P < 0.05) more effective in removing supragingival plaque than normal toothbrushing practices both in all, buccal and lingual sites. After 21 days, the normal practices did not significantly decrease mean plaque indices compared to the scores calculated after 7 days (P > 0.05), but did so with the modified Bass technique (P < 0.05). The modified Bass technique was specially efficient at the lingual sites where it was 2.9‐fold more effective than normal practices in reducing plaque scores (P < 0.01). Conclusion: The results show that a particular toothbrushing technique as modified Bass method is significantly superior to normal toothbrushing practices in supragingival plaque removal. The introduction of a specific toothbrushing technique, such as modified Bass technique represents an important improvement in the oral hygiene of the patients.     

A clinical trial on the effectiveness of professional toothbrushing using dentifrice and water.

The purpose of this trial was to compare the plaque removal effectiveness of professional toothbrushing with dentifrice and with only water. Fifty three subjects were divided into a dentifrice and a water group. Both groups had their teeth professionally brushed for one minute using either dentifrice or water. Plaque scores were recorded before and immediately after brushing. The results of this trial show that toothbrushing with dentifrice was more effective in removing plaque compared to brushing with water alone. The amount of plaque reduction was low, and varied with tooth surfaces. The mid buccal surface had the greatest reduction of plaque. No significant differences were observed on the distobuccal and distolingual surfaces when the dentifrice group was compared with the water group.     

Fluoride in dental plaque after a single toothbrushing with monofluorophosphate dentifrice

Many studies have shown that topical fluoride applications can produce a fluoride reservoir in dental plaque. Since the most common topical fluoride application is via toothbrushing with fluoridated dentifrices, the aim of this study was to measure fluoride uptake by dental plaque after a single toothbrushing with monofluorophosphate (MFP) toothpaste and to follow the plaque until its fluoride concentration returned to the prebrushing levels. In a fluoridated area, plaque samples were collected from 26 children who brushed with MFP toothpaste, 22 children who brushed with a fluoride-free control toothpaste, before brushing and at intervals of 10 minutes, 1 hour and 2 hours after brushing. A combination fluoride electrode was used to determine the fluoride content of the samples. In conclusion, our study has shown that brushing with fluoridated water has a positive effect on the fluoride level of the plaque and the addition of MFP did not make a significant change, although it had a short term effect. A negative correlation was established between plaque wet weight and its fluoride content whenever the plaque equilibrated.     

Tooth brushing habits in uninstructed adults—frequency, technique, duration and force

Professional recommendations for individual oral hygiene mostly include tooth brushing at least twice daily for 2–3 min with gentle force using the Bass technique or modifications of it. This study evaluated whether habitual tooth brushing actually meets these standards. Uninstructed adults (n = 103; mean age 31 ± 6 years; 61 female, 42 male) with habitual manual tooth brushing were given a self-administered questionnaire about the frequency of brushing and a computer system recorded their brushing technique, duration and force. The majority (79.6%) of participants brushed twice daily. The mean brushing duration was 96.6 ± 36.0 s, the mean brushing force was 2.3 ± 0.7 N (max. 4.1 N), and no significant differences were found for quadrants. Most subjects (73.8%) brushed with circling, 8.7% with horizontal/scrubbing, 13.6% with horizontal/circling and 3.9% with vertical/sweeping movements. Modified Bass technique was not observed. When appropriate brushing habits were defined as brushing at least twice daily for 120 s with a brushing force of less than 3 N and with circling or vertical sweeping movements, only 25.2% of the participants fulfilled all criteria, emphasising the ongoing need for oral hygiene education.     

Evaluation of several brushing motion combinations in relation to plaque-removing efficacy with Oral-B CrossAction Power: a professional brushing study

Abstract:  Aim:  The aim of this study was to evaluate the additional effect of a newly developed battery-operated brush Oral-B® CrossAction Power with a hybrid brush head design (CAPB). The brush combines an oscillating/rotating part, a PowerHead®, with a non-moving part with CrissCross® bristles. It was compared with a manual control toothbrush Butler® GUM 311 (CTB). Material and methods:  Thirty subjects were requested not to brush their teeth 48 h prior to the examination, when plaque removal efficacy was assessed by scoring plaque before and after brushing. Plaque was assessed according to the Silness & Loë Index at six sites per tooth. Subjects were brushed by a dentist using one of the four randomly chosen procedures of brushing in each quadrant. The CAPB was used with three different modes of brushing each in different randomly chosen quadrants, with the manual toothbrush being used in the remaining quadrant as a control. Results:  The baseline plaque levels ranged from 1.69 to 1.74 and the end levels ranged from 0.39 to 0.45. In terms of percentage, the results with the four procedures run from 75% to 79%. These differences between the battery brush and manual brush irrespective of the brushing mode used were not statistically significant. Conclusion:  The results of this Professional Brushing Study show that the CrossAction Power® toothbrush was as effective as a regular manual toothbrush.     

Effect of a stannous fluoride dentifrice on plaque formation and removal: a digital plaque imaging study

OBJECTIVE: A repeated measures digital imaging technique (Digital Plaque Image Analysis-DPIA) was used to assess the antiplaque effectiveness of a 0.454% stannous fluoride dentifrice. METHODOLOGY: Subjects were qualified to enter the study based upon a previous assessment of dental plaque accumulation while brushing with a standard (non-antimicrobial) fluoridated dentifrice. Fourteen qualifying subjects were entered into a cross-over study design, including the use of a standard 0.243% sodium fluoride (NaF) dentifrice, or a 0.454% stannous fluoride (SnF,) dentifrice. Cross-over periods were separated by a one-week washout. During the assigned treatments, subjects visited the imaging laboratory on six separate days over two weeks, reporting each day for three separate assessments of plaque accumulation, as assessed by DPIA. On each "grading day," subjects entered for plaque assessments prior to morning tooth brushing, and without consuming any food or beverages. Following this morning "pre-brushing" assessment, subjects brushed with the assigned dentifrice and then had plaque immediately reassessed (morning post-brushing). Subjects also reported to the imaging clinic for an afternoon plaque regrowth assessment. Subjects were again required to avoid food and drink for one hour prior to this measurement. RESULTS: The SnF2 dentifrice was observed to produce statistically significant reductions in dental plaque, measuring 24.4% in the morning pre-brushing, and 27.9% in the afternoon assessment. Tooth brushing was observed to significantly reduce plaque on the teeth in the morning post-brushing for subjects using either the standard NaF or the SnF2 dentifrice. There were no statistically significant differences in plaque coverage on teeth following tooth brushing with the NaF (6.3% coverage) or SnF2 (6.2% coverage) dentifrices. CONCLUSION: Use of a 0.454% SnF2 dentifrice produced statistically significant reductions in dental plaque formation as compared to the similar use of a standard 0.243% NaF dentifrice.     

Measurement of plaque growth following toothbrushing

A method measuring plaque by area has been developed which can be used to evaluate the antiplaque effect of agents such as dentifrices when used in combination with toothbrushing. The extent of disclosed plaque 24 hours after treatment on tooth surfaces previously cleaned of all observable plaque was drawn by the examiner onto accurate enlarged scale drawings of the outline of the labial surfaces of all incisors, canines, premolars and 1st molars. Areas were then measured by an electronically recording planimeter. Three separate blind crossover trials were performed using this plaque area measurement in which a minimum of 15 subjects brushed normally on one occasion only, with either a calcium carbonate dentifrice or water. Compared with when subjects brushed with water, a statistically significant reduction of 45%-52% in plaque was observed in subjects 24 hours after brushing with the dentifrice in each of the three trials. In a study with 27 subjects, the periodontal condition of the papillae was found to be related to plaque present on labial surfaces on adjacent teeth as measured by this method. The teeth adjacent to papillae which bled on probing had 77% greater plaque area than teeth adjacent to papillae which did not bleed. Plaque area measured by this method on a continuous scale has a sensitivity advantage over the commonly used four-point plaque indices, especially when comparing effective antiplaque treatments or combination of treatments.