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PloS One 2022Dental caries and periodontal disease are very common chronic diseases closely linked to inadequate removal of dental plaque. Powered toothbrushes are viewed as more... (Observational Study)
Observational Study
Dental caries and periodontal disease are very common chronic diseases closely linked to inadequate removal of dental plaque. Powered toothbrushes are viewed as more effective at removing plaque; however, the conflicting evidence and considerable unexplained heterogeneity in their clinical outcomes does not corroborate the relative merits of powered tooth brushing. To explain the heterogeneity of brushing patterns with powered toothbrushes, we conducted a observational study of tooth brushing practices of 12 participants in their naturalistic setting. Integrated brush sensors and a digital data collection platform allowed unobtrusive and accurate capture of habitual brushing patterns. Annotated brushing data from 10 sessions per participant was chosen for scrutiny of brushing patterns. Analysis of brushing patterns from the total 120 sessions revealed substantial between- and within-participant variability in brushing patterns and efficiency. Most participants (91.67%) brushed for less than the generally prescribed two minutes; individual participants were also inconsistent in brushing duration across sessions. The time devoted to brushing different dental regions was also quite unequal. Participants generally brushed their buccal tooth surfaces more than twice as long as the occlusal (2.18 times longer (95% CI 1.42, 3.35; p < 0.001)) and lingual surfaces (2.22 times longer (95% CI 1.62, 3.10; p < 0.001); the lingual surfaces of the maxillary molars were often neglected (p < 0.001). Participants also varied in the epochs of excessive brushing pressure and the regions to which they were applied. In general, the occlusal surfaces were more likely to be brushed with excessive pressure (95% CI 0.10, 0.98; p = 0.015). Our study reveals that users of powered toothbrushes vary substantially in their use of the toothbrushes and diverge from recommended brushing practices. The inconsistent brushing patterns, between and within individuals, can affect effective plaque removal. Our findings underscore the limited uptake of generic oral self-care recommendations and emphasize the need for personalized brushing recommendations that derive from the objective sensor data provided by powered toothbrushes.
Topics: Dental Care; Dental Caries; Dental Plaque Index; Equipment Design; Humans; Periodontal Diseases; Toothbrushing
PubMed: 35587489
DOI: 10.1371/journal.pone.0263638 -
Caries Research 2011In vitro and in situ studies modelling the wear of dental hard tissues due to erosion and abrasion are characterised by a high variation in study designs and... (Review)
Review
In vitro and in situ studies modelling the wear of dental hard tissues due to erosion and abrasion are characterised by a high variation in study designs and experimental parameters. Based on a summary of the existing protocols, the present review aimed to describe and discuss the parameters which must be carefully considered in erosion-abrasion research, especially when it is intended to simulate clinical conditions. Experimental characteristics and parameters were retrieved from a total of 42 in vitro and 20 in situ studies. The key experimental characteristics included parameters of erosion (duration and pH) and abrasion (duration, kinds of toothbrush and toothpaste, brushing force, and time point) as well as co-factors (e.g. dental hard tissue). The majority of studies used models with alternating erosion/abrasion treatments intended to simulate clinical conditions, while other studies exaggerated clinical conditions intentionally, often using only a single erosion/abrasion treatment. Both in vitro and in situ models shared a high level of standardisation, but several studies showed a trend to severe erosion (e.g. >5 min/cycle) or extensive brushing (e.g. >100 brushing strokes/cycle) at a high frequency and repetition rate. Thus, studies often tend to produce a higher amount of wear than in the clinical situation, especially as modifying biological factors (e.g. the dilution of the erosive solution by saliva and the protective effect of the pellicle) cannot be simulated adequately. With respect to the existing models, it seems advisable to diminish duration and frequency of erosion and abrasion to more realistic clinical conditions when the everyday situation is to be simulated. Experimental parameters must be chosen with care to ensure that the problem is investigated in an appropriate mode at standardised conditions and with adequate measuring systems to allow prediction of clinical outcomes.
Topics: Animals; Dental Enamel; Dental Pellicle; Dentin; Forecasting; Humans; Hydrogen-Ion Concentration; Research Design; Saliva; Stress, Mechanical; Time Factors; Tooth Abrasion; Tooth Erosion; Toothbrushing; Toothpastes
PubMed: 21625133
DOI: 10.1159/000325946 -
International Journal of Dental Hygiene Nov 2021The aim of this study was to compare the efficacy of two brushing methods (manual vs. sonic) in terms of plaque control after a session of professional mechanical plaque... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
The aim of this study was to compare the efficacy of two brushing methods (manual vs. sonic) in terms of plaque control after a session of professional mechanical plaque removal (PMPR).
METHODS
Subjects with gingivitis underwent a session of PMPR and were randomly assigned to sonic (SB) or manual brushing (MB). Oral hygiene instructions were provided at baseline (BL), 2 (T0a), 4 (T0b) and 6 weeks (T1) and 6 months (T2). Plaque Index (PI), Gingival Index (GI) and bleeding on probing (BoP) were measured at BL, T1 and T2. The proportion of sites with PI, GI and BoP was modelled at site level using a negative binomial regression fitted via generalized linear mixed model accounting for intra-patient correlation.
RESULTS
Thirty-two subjects were selected, 16 assigned to each group and 31 completed the study. PI, BoP and GI were comparable at BL. At T1, PI was successfully maintained at 6.21% for SB and 22.81% for MB, while at T2 reached 11.34% for SB and 28% for MB, favouring the SB group (p < 0.001). GI and BoP were significantly lower in the SB group at T1, with a BoP reduction for SB about 3 times higher than MB (p < 0.001). These parameters then levelled at T2 between the groups, with BOP reaching 0.14% versus 0.05% (p = 0.356) and GI 1.75% versus 3.52% (p = 0.020).
CONCLUSION
Sonic brushing seemed to maintain a lower PI score compared to a manual brush at 6 months. BoP and GI resulted comparable.
Topics: Dental Plaque; Dental Plaque Index; Equipment Design; Gingivitis; Humans; Single-Blind Method; Toothbrushing
PubMed: 34328264
DOI: 10.1111/idh.12541 -
Journal of Esthetic and Restorative... Jun 2020The aim of this study was to evaluate and compare surface roughness, gloss, and color change of dental enamel after being brushed with toothpastes containing diamond...
OBJECTIVE
The aim of this study was to evaluate and compare surface roughness, gloss, and color change of dental enamel after being brushed with toothpastes containing diamond powder and traditional abrasives.
MATERIALS AND METHODS
Seventy enamel slabs were derived from 70 bovine incisors. The slabs were brushed with six different toothpastes and artificial saliva as a negative control. The specimens were then stained with black tea mixed with citric acid (3 days, pH = 4) and again brushed with the same toothpastes. R (contact profilometer), gloss (glossmeter), and color (CIE L* a* b* system) values were measured after each step.
RESULTS
Emoform-F Diamond (contains diamond powder and traditional abrasives) offered significantly the best improvement of R and gloss values after the first brushing sequence and the best recovery of the brightness of enamel after staining and second brushing sequence (P < .05). AMC 2.5 (contains only diamond powder as abrasive) was not able to offer such improvement.
CONCLUSION
Diamond powder as an additional abrasive in toothpastes could be able to offer a further improvement of R , gloss, and color values of enamel.
Topics: Animals; Cattle; Color; Dental Enamel; Diamond; Surface Properties; Toothbrushing; Toothpastes
PubMed: 32277866
DOI: 10.1111/jerd.12588 -
Australian Dental Journal Sep 2021This study investigated the preferences of dentists in Australia in providing professional implant maintenance and implant-specific oral hygiene instructions (OHI).
BACKGROUND
This study investigated the preferences of dentists in Australia in providing professional implant maintenance and implant-specific oral hygiene instructions (OHI).
METHODS
General dentists were surveyed online about their preferences in peri-implant diagnostics, maintenance provision, armamentarium used, and implant OHI techniques and frequency.
RESULTS
Most of the 303 respondents (96%) provided maintenance services; 87.6% reviewed implants regularly while 10.7% only performed diagnostics after detecting clinical signs/symptoms. Supragingival prosthesis cleaning was performed by 77.9% of respondents, 35.0% performed subgingival debridement, 41.9% treated peri-implant mucositis and 18.2% treated peri-implantitis. About 15% did not treat nor refer peri-implant disease, including significantly more non-implant providers and dentists without implant training. Maintenance armamentarium commonly included floss (76.3%), prophylaxis (73.9%), plastic curettes (43.3%) and stainless-steel ultrasonics (38.0%). Brushing (86.5%), flossing (73.9%) and interdental brush use (68.3%) were most commonly recommended. Implant OHI was repeated routinely by 57.4% of dentists who provided it. Dentists with greater implant training and experience were more likely to perform reviews and complex maintenance procedures.
CONCLUSIONS
Peri-implant diagnostics performed, treatments provided and armamentarium varied among dentists. Implant providers and those with higher levels of training had more preventative approaches to implant OHI. Possible shortcomings in disease management and OHI reinforcement were identified.
Topics: Dental Implants; Dentists; Humans; Hygiene; Peri-Implantitis; Toothbrushing
PubMed: 33538341
DOI: 10.1111/adj.12831 -
European Journal of Orthodontics May 2022Fixed orthodontic appliances might result in dental adverse effects, if sufficient oral hygiene is not maintained. Since recommendations on toothbrushing times are... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Fixed orthodontic appliances might result in dental adverse effects, if sufficient oral hygiene is not maintained. Since recommendations on toothbrushing times are lacking scientific justification in orthodontic populations, the aim of the present study was to comparatively quantify the duration of toothbrushing with a manual and a powered toothbrush in two distinct age groups.
TRIAL DESIGN
Two-centre, two-period crossover balanced randomized clinical trial with computer-generated numbers and blinding at the outcome-assessing level.
METHODS
Children and adults with fixed appliances with at least 22 aligned teeth were recruited at a university clinic and private practice in Bavaria, Germany. Plaque was disclosed with staining tablets and participants brushed their teeth with their habitual technique in front of a mirror and without interference until staining was, to their own satisfaction, completely removed. The primary outcome was duration of toothbrushing in seconds. Secondary outcomes were percentage plaque reduction and questionnaire data on dental attitudes and behaviours. Data were analysed with linear mixed models.
RESULTS
Twenty-eight participants were randomized to the first and 27 to the second toothbrush sequence. The combined effect of age and toothbrush on the duration of toothbrushing was evident (n = 52, F(1, 50.8) = 5.1, P = 0.028). Children brushed 14.5 seconds less [n = 28, 95% confidence interval (CI) = -31.3 to 2.3, P = 0.090], yet adults 13.3 seconds more (n = 24, 95% CI = -4.6 to 31.3, P = 0.143) with the manual than powered toothbrush. Brushing times ranged from 2 minutes and 45 seconds to 3 minutes and 17 seconds with plaque reduction at 76% and good dental attitudes and behaviours.
CONCLUSIONS
Both children and adults with fixed appliances might equally reach an effective plaque reduction with either manual or powered toothbrushes and their habitual brushing technique in around three minutes, if plaque is visible.
REGISTRATION
DRKS-German Clinical Trials Register ID: DRKS00012463.
FUNDING
Oral-B Procter & Gamble.
Topics: Adult; Child; Dental Plaque; Dental Plaque Index; Equipment Design; Humans; Orthodontic Appliances, Fixed; Single-Blind Method; Toothbrushing
PubMed: 34849694
DOI: 10.1093/ejo/cjab075 -
Brazilian Oral Research 2014Dental erosion is the loss of dental hard tissues caused by non-bacterial acids. Due to acid contact, the tooth surface becomes softened and more prone to abrasion from... (Review)
Review
Dental erosion is the loss of dental hard tissues caused by non-bacterial acids. Due to acid contact, the tooth surface becomes softened and more prone to abrasion from toothbrushing. Dentifrices containing different active agents may be helpful in allowing rehardening or in increasing surface resistance to further acidic or mechanical impacts. However, dentifrices are applied together with brushing and, depending on how and when toothbrushing is performed, as well as the type of dentifrice and toothbrush used, may increase wear. This review focuses on the potential harmful and helpful effects associated with the use of dentifrices with regard to erosive wear. While active ingredients like fluorides or agents with special anti-erosive properties were shown to offer some degree of protection against erosion and combined erosion/abrasion, the abrasive effects of dentifrices may increase the surface loss of eroded teeth. However, most evidence to date comes from in vitro and in situ studies, so clinical trials are necessary for a better understanding of the complex interaction of active ingredients and abrasives and their effects on erosive tooth wear.
Topics: Dentifrices; Humans; Tooth Erosion; Toothbrushing
PubMed: 24554098
DOI: 10.1590/S1806-83242013005000035 -
Journal (Canadian Dental Association) May 2006The design of the modern conventional manual toothbrush can be attributed to Dr. Robert Hutson, a Californian periodontist, who in the early 1950s developed the... (Review)
Review
UNLABELLED
The design of the modern conventional manual toothbrush can be attributed to Dr. Robert Hutson, a Californian periodontist, who in the early 1950s developed the multitufted, flattrimmed, end-rounded nylon filament brush that became known as the Oral-B manual toothbrush. The trademark Oral-B emphasized that this was an oral brush, designed to clean all parts of the oral cavity, not merely a toothbrush. Flat-trimmed conventional toothbrushes based on the original Oral-B design have good plaque-removing capability when used carefully. However, limitations in terms of patients" brushing technique and brushing time necessitated a radical change in bristle pattern to improve performance, especially at approximal sites and along the gumline.
RATIONALE FOR PRODUCT DEVELOPMENT
Detailed studies of the tooth-brushing process, using advanced scientific and ergonomic research methods, led to new toothbrush designs intended to maximize the efficacy of brushing efforts. These studies showed that the point of greatest interproximal penetration occurs when the direction of brushing changes; bristles angle back into the interproximal space, moving down and back up the adjoining approximal surface. These mechanics were further optimized on the basis of standardized evaluations of brush-design characteristics, including combinations of tuft lengths, insertion angles and tuft layout. With conventional vertical bristles these improvements yield limited benefits because only a few bristles are correctly positioned at the interproximal junction when the brush changes direction. Ultimately, a design with bristle tufts arranged at 16 masculine from vertical along the horizontal brush head axis was identified, in which the maximum number of bristles operated at the optimum angle throughout the brushing cycle. This design was significantly more effective (p < 0.001) than others in terms of penetration (by 9.6%) and cleaning effectiveness per brush stroke (by 15.5%).
EFFECTIVENESS
This discovery paved the way for a new toothbrush design with a unique patented array of tufts, which became known as the Oral-B CrossAction brush. This design was selected for extensive independent studies designed to evaluate plaque removal at the gingival margins and in the approximal areas and longer-term control of gingivitis, relative to current standard designs. In a series of studies (published in 2000), 14 single-brushing comparisons and 2 longer-term studies demonstrated the consistent superiority of the Oral-B CrossAction brush over the equivalent commercial standards. Since then, several additional studies have contributed further positive performance data for the CrossAction brush. Two of the studies demonstrated that plaque removal by this brush was superior to that of 15 other manual toothbrushes, and further investigations contributed similarly positive data. Longer-term data have confirmed superior CrossAction performance and the long-term benefits of improved efficacy, particularly for gingivitis.
DISCUSSION
Novel approaches to toothbrush design have produced a toothbrush that, when tested in a large number of clinical studies, has consistently met or exceeded established standards of efficacy. The literature contains a wealth of performance data on various toothbrush designs, but none of these designs shows the year-on-year consistency and reproducibility of the Oral-B CrossAction.
Topics: Dental Devices, Home Care; Dental Plaque; Equipment Design; Humans; Toothbrushing
PubMed: 16684475
DOI: No ID Found -
Indian Journal of Dental Research :... 2021The aim of this 12 week, single-blind clinical trial was to compare the efficacy of Manual (Oral-B Pro Health Gum care), Powered (Oral-B Cross action Power Dual) and... (Clinical Trial)
Clinical Trial
AIM
The aim of this 12 week, single-blind clinical trial was to compare the efficacy of Manual (Oral-B Pro Health Gum care), Powered (Oral-B Cross action Power Dual) and Charcoal (Colgate slim Soft Charcoal) toothbrushes in plaque control.
MATERIALS AND METHODS
60 systemically healthy students were selected at random among the students of a Dental College, living under similar environment and dietary conditions. Plaque and calculus were removed professionally and three varieties of toothbrush were distributed among them. Plaque index (PI), sulcus bleeding index (SBI) and gingival index (GI) were assessed at baseline, 3, 6 and 12 weeks. Assessment of colony forming units (CFU) was done at baseline and 12 week. The learning effect over a period of time was also assessed.
RESULTS
Over the 12-week period, PI reduced significantly (P < 0.001) with % reduction in plaque from 47% to 59%, 41% to 53% and 45% to 55% for manual, powered and charcoal brush. A significant reduction in GI and SBI was also seen with all the brushes. An insignificant difference in PI, GI and SBI was seen between the brushes. CFU count before and after brushing reduced gradually and statistically significantly (P < 0.001) for all the brushes; however, by end of 12 week period, there was no significant difference (P > 0.05). The learning effect increased from 35% to 60%, 24% to 56% and 31% to 58% for three brushes, respectively, but was more pronounced for powered brush.
CONCLUSION
It can be concluded that all the three brushes (manual, powered and charcoal) are clinically effective in removing plaque, with learning effect more pronounced for powered brush and if proper technique is followed, no brush is superior to the other.
Topics: Dental Plaque; Dental Plaque Index; Equipment Design; Gingivitis; Humans; Single-Blind Method; Toothbrushing
PubMed: 35229778
DOI: 10.4103/ijdr.IJDR_179_20 -
JDR Clinical and Translational Research Jan 2022Nationwide prevention programs in Germany aim to promote oral health. The group prevention program starts in kindergarten and ends when the children are about 12 y old....
OBJECTIVES
Nationwide prevention programs in Germany aim to promote oral health. The group prevention program starts in kindergarten and ends when the children are about 12 y old. While in a recent study, toothbrushing behavior of 12-y-old children was analyzed, the present study's objective was to examine the children's ability to achieve oral cleanliness and to analyze how toothbrushing behavior and compliance with the toothbrushing recommendations taught in the group prevention programs predict oral cleanliness.
METHODS
Twelve-year-old randomly selected children ( = 174) were asked to brush their teeth to the best of their abilities, and simultaneously a video was recorded for behavioral analyses. Plaque levels were measured before and immediately after toothbrushing. In addition, dental status and gingival bleeding were assessed.
RESULTS
After brushing to the best of their abilities, there was plaque on 50% (±24.72%) of all measured sites at the gingival margin (Marginal Plaque Index). Regression analyses revealed approximately 22% of the variance of marginal plaque on the outer surfaces to be explained by the time brushed by circular movements (β = -0.41; < 0.001) and the number of sextants brushed for at least 7.5 s (β = -0.171; < 0.05). Circular movements explained most additional variance (Δ = 0.113; < 0.001). With respect to inner surfaces, none of the behavioral aspects explained any variance of oral cleanliness.
CONCLUSION
Despite regular group prevention measures, 12-y-old children show limited skills to clean their teeth adequately. Furthermore, none of the recommended behaviors relates to oral cleanliness after toothbrushing at inner surfaces. As a consequence, it is necessary to explore further which behavioral sequences effectively improve oral cleanliness.
KNOWLEDGE TRANSFER STATEMENT
This study illustrates that children's compliance to toothbrushing recommendations is not necessarily related to toothbrushing effectiveness. Clinicians should therefore assess the effectivity of recommendations individually and provide individual guidance for improvement.
Topics: Child; Dental Plaque; Dental Plaque Index; Gingival Hemorrhage; Health Behavior; Humans; Toothbrushing
PubMed: 33251929
DOI: 10.1177/2380084420975333