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International Dental Journal Feb 2024Research continues to show an association between oral health and systemic health, further stressing the importance of effective daily plaque removal via toothbrushing... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Research continues to show an association between oral health and systemic health, further stressing the importance of effective daily plaque removal via toothbrushing to maintain periodontal health and overall well-being. This investigation was undertaken to compare the efficacy of oscillating-rotating, sonic, and manual toothbrushes in reducing gingivitis and plaque in randomised controlled trials (RCTs) with up to 6 months' follow-up.
METHODS
This meta-analysis was conducted from a single database (Procter & Gamble Oral Care Clinical Archive) including RCTs from 2007 to 2022. Three authors independently assessed study eligibility. Disagreements concerning selected studies were resolved by discussion with an expert colleague. Direct and indirect treatment comparisons along with transition rates to gingival health were calculated using participant-level data. Transition-to-health time was calculated using data from all time points. Subregion analyses evaluated number of bleeding sites and plaque reduction.
RESULTS
This meta-analysis included 21 gingivitis RCTs and 25 plaque RCTs. Relative to manual and sonic brushes, oscillating-rotating brushes had a higher percentage of participants who transitioned to gingival health (72% vs 21% and 54%; P < .001). Compared with manual and sonic brushes, respectively, oscillating-rotating brushes demonstrated greater bleeding site reductions (by 52% and 29%; P < .001) and superior plaque reductions (by 19% and 5%; P < .001). Oscillating-rotating brushes provided faster transitions to health than sonic brushes and showed greater efficacy across subregions. The most advanced oscillating-rotating brush demonstrated statistically significantly greater efficacy compared with traditional oscillating-rotating, manual, and sonic brushes when analysed separately. Risk of bias was deemed low for all studies.
CONCLUSIONS
Oscillating-rotating toothbrushes offer superior results for transition to health, gingivitis, and plaque reduction compared with manual and sonic brushes. The most advanced oscillating-rotating model offers enhanced efficacy vs traditional models.
Topics: Humans; Dental Plaque; Equipment Design; Gingivitis; Toothbrushing; Randomized Controlled Trials as Topic
PubMed: 37481415
DOI: 10.1016/j.identj.2023.06.009 -
Safety of oscillating-rotating powered brushes compared to manual toothbrushes: a systematic review.Journal of Periodontology Jan 2011Oscillating-rotating power toothbrushes have been proven clinically efficacious. To our knowledge, a comprehensive review of all clinical and laboratory investigations... (Comparative Study)
Comparative Study Review
BACKGROUND
Oscillating-rotating power toothbrushes have been proven clinically efficacious. To our knowledge, a comprehensive review of all clinical and laboratory investigations solely comparing the safety of these toothbrushes to the standard of care (i.e., manual toothbrushes) has not been published. The aim of this systematic review is to examine the literature concerning the relative soft and/or hard tissue safety outcomes with the use of oscillating-rotating toothbrushes compared to manual toothbrushes.
METHODS
With the use of electronic databases of the National Library of Medicine (PubMed-MEDLINE), the Cochrane Central Register of Controlled Trials (Cochrane-CENTRAL), and the Excerpta Medical Database (EMBASE), a search of in vivo and in vitro trials through May 2010 was conducted to identify appropriate studies that evaluated the effects of an oscillating-rotating power toothbrush compared to a manual toothbrush with respect to soft and/or hard tissue safety. Eligible trials incorporated a safety evaluation as a primary or secondary outcome parameter (i.e., gingival recession, observed/reported adverse events, and hard tissue effects) or used a surrogate parameter (i.e., stained gingival abrasion and brushing force) to assess safety. Data extraction for the primary- and surrogate-measure safety studies, which included mean values and SDs when available, and a meta-analysis of the gingival recession data were performed.
RESULTS
Independent screening of the titles and abstracts of 697 PubMed-MEDLINE, 436 Cochrane-CENTRAL, and 664 EMBASE papers resulted in 35 publications that met the eligibility criteria. The mean change in gingival recession was not significantly different among toothbrush groups in the two selected trials with safety as a primary outcome (weighted mean difference: 0.03). A meta-analysis of the five trials that evaluated safety with a surrogate parameter was not possible; however, there were no significant between-group differences at the study end in any trial. A descriptive analysis of the 24 selected studies assessing safety as a secondary outcome revealed few brushing-related adverse events. The heterogeneity in objectives and methodology of the four in vitro trials that met the eligibility criteria precluded generalization of the results.
CONCLUSION
A large body of published research in the preceding 2 decades has consistently shown oscillating-rotating toothbrushes to be safe compared to manual toothbrushes, demonstrating that these power toothbrushes do not pose a clinically relevant concern to hard or soft tissues.
Topics: Electrical Equipment and Supplies; Equipment Design; Equipment Safety; Gingiva; Gingival Recession; Humans; Stress, Mechanical; Tooth Abrasion; Toothbrushing
PubMed: 20831367
DOI: 10.1902/jop.2010.100393 -
BMC Oral Health Feb 2024To investigate the effects of combinations of mechanical (brushing and flossing) and chemotherapeutic regimens which included essential oils (EO) non-alcohol and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To investigate the effects of combinations of mechanical (brushing and flossing) and chemotherapeutic regimens which included essential oils (EO) non-alcohol and alcohol-containing mouthrinses compared to brushing only in the prevention and reduction of plaque, gingivitis, and gingival bleeding.
METHODS
This was a randomized, virtually supervised, examiner blind, controlled clinical trial. Following informed consent and screening, subjects (N = 270) with gingivitis were randomly assigned to one of the following regimens: (1) Brush Only (B, n = 54); (2) Brush/Rinse (EO alcohol-containing mouthrinse) (BA, n = 54); (3) Brush/Rinse (EO non-alcohol containing mouthrinse) (BZ, n = 54); (4) Brush/Floss (BF, n = 54); (5) Brush/Floss/Rinse (EO non-alcohol containing mouthrinse) (BFZ, n = 54). Unflavored waxed dental floss (REACH unflavored waxed dental floss), and fluoridated toothpaste (Colgate Cavity Protection) were used. Examinations included oral hard and soft tissue, plaque, gingivitis, gingival bleeding, probing depth and bleeding on probing.
RESULTS
After 12 weeks, both BA and BZ and the BFZ group were superior in reducing interproximal plaque (30.8%, 18.2%, 16.0%, respectively), gingivitis (39.0%, 36.9%, 36.1%, respectively), and bleeding (67.8%, 73.6%, 79.8%, respectively) compared to B. The BF group did not provide significant reductions in interproximal plaque but did reduce interproximal gingivitis (5.1%, p = 0.041) at Week 4 and bleeding at Weeks 4 and 12 (34.6%, 31.4%, p < 0.001 respectively) compared to B. The BFZ group did not significantly reduce interproximal plaque, gingivitis or bleeding compared to BZ.
CONCLUSIONS
This study demonstrated that the addition of EO non-alcohol containing mouthrinse to the manual toothbrushing and flossing regimen further reduces plaque, gingivitis and bleeding showing that addition of EO mouthrinses (alcohol or non-alcohol containing) to the oral hygiene regimen provides sustained reductions in plaque to help maintain gingival health after a dental prophylaxis. Dental professional recommendation of the addition of an EO non-alcohol containing mouthrinse to daily oral hygiene routines of brushing or brushing and flossing should be considered to aid supragingival plaque control and improve gingivitis prevention.
STUDY REGISTRY NUMBER
NCT05600231.
Topics: Humans; Mouthwashes; Dental Devices, Home Care; Dental Plaque; Toothbrushing; Gingivitis; Oils, Volatile; Gingival Hemorrhage; Dental Plaque Index
PubMed: 38310236
DOI: 10.1186/s12903-024-03924-4 -
International Dental Journal May 2018Regular twice-daily toothbrushing with a fluoridated toothpaste is widely recommended for schoolchildren. The '21-day Brush Day and Night (BDN) programme' includes an...
BACKGROUND
Regular twice-daily toothbrushing with a fluoridated toothpaste is widely recommended for schoolchildren. The '21-day Brush Day and Night (BDN) programme' includes an educational approach for children and school staff, with a consistent practice of toothbrushing at school for 3 weeks.
OBJECTIVE
This study aims to evaluate the improvement in oral hygiene knowledge and behaviour in schoolchildren involved in BDN, the sustainability of this after 6-12 months, and if any particular age group was more receptive to it than others.
MATERIALS AND METHODS
Ten countries and 7,991 children, 2-12 years old, participated in this longitudinal study, with two BDN interventions at the beginning and 6-12 months afterward. Data were collected via a self-reported questionnaire at baseline/first intervention (T0), 21 days after first intervention (T0D21), at the second intervention (T1), and 21 days after second intervention (T1D21). Improvement in knowledge and behaviour was compared using the chi-square test with an alpha level of 5%. The final data sample of 5,148 schoolchildren was evaluated, and the analysis revealed that 25% more of the schoolchildren brushed their teeth twice a day after the first intervention. The programme was more effective among the 7-9 years age group. The BDN intervention increased brushing-frequency in children at the first intervention, and this was sustained after 6-12 months. Therefore, this programme illustrated a sustainable approach to improve children's oral health knowledge and behaviour.
Topics: Age Factors; Child; Child, Preschool; Female; Global Health; Health Knowledge, Attitudes, Practice; Humans; Male; Oral Health; Program Evaluation; School Health Services; Toothbrushing
PubMed: 29660791
DOI: 10.1111/idj.12410 -
The Journal of Evidence-based Dental... Jun 2017Current evidence pertaining to the effectiveness of flossing and caries prevention is potentially being misinterpreted by health oversight bodies, which may have...
Current evidence pertaining to the effectiveness of flossing and caries prevention is potentially being misinterpreted by health oversight bodies, which may have significant implications for current and future public flossing guidelines. We identify and discuss several methodological deficiencies, including the lack of validated measures of flossing skill, over-reliance on self-reported flossing behavior, and the lack of current guidelines on how to interpret and apply evidence-based findings to specific clinical scenarios that are present in the studies of flossing effectiveness included in the Cochrane Review. As such, we argue that it is premature for health oversight bodies to conclude that flossing is ineffective in the prevention of dental caries. Our research group, which is funded by the National Institutes of Health (NIH), is developing a valid and reliable provider-observed measure of tooth brushing and flossing skill that may help promote higher quality flossing evidence in the future.
Topics: Dental Caries; Dental Devices, Home Care; Humans; Oral Hygiene; Self Report; Toothbrushing
PubMed: 28501067
DOI: 10.1016/j.jebdp.2017.03.008 -
BMC Oral Health Jun 2022Toothbrushes require flexibility to access all dental surfaces and remove plaque effectively, but they should also aim to prevent or limit overbrushing and consequent...
BACKGROUND
Toothbrushes require flexibility to access all dental surfaces and remove plaque effectively, but they should also aim to prevent or limit overbrushing and consequent damage to teeth and gums. In two studies, the physical properties and cleaning performance of specialist test toothbrushes with flexible necks were compared to a reference rigid-necked toothbrush.
METHODS
In Study 1, a universal testing machine (Instron E 10,000) with a specially designed setup was used to test the deflection behaviour of toothbrush head and neck. Untufted toothbrushes were fixed in a custom holder and force was applied to the head while the deflection was measured. In Study 2, one control and five test toothbrushes were assessed using a robot system to simulate the cleaning of artificial plaque from defined surfaces of artificial replicated human teeth in a model oral cavity (typodonts).
RESULTS
Study 1 showed that the flexible-neck toothbrush deflected 2 to 2.5 times more than the rigid-neck reference toothbrush when same force was applied to the toothbrush head. Study 2 revealed that all five test toothbrushes showed statistically superior simulated plaque removal to the reference toothbrush. This superiority was observed for all test toothbrushes employing horizontal and rotating brushing action (all p = 0.001) but only three of the five toothbrushes when vertical brushing was employed (all p = 0.001). Cleaning efficacy of the test toothbrushes was demonstrated both interdentally and at the gumline locations. The Complete Protection toothbrush showed the most effective cleaning performance followed by the Repair and Protect and Rapid Relief toothbrushes.
CONCLUSION
The addition of a flexible-neck component to the toothbrush designs helped to reduce stiffness and may allow more effective cleaning compared to rigid designs with controlled force distribution on the teeth and gums. This may help to provide plaque control at all potential risk areas in an in vitro robot model and could support good oral hygiene in-use.
Topics: Dental Plaque; Dental Plaque Index; Equipment Design; Humans; Mechanical Tests; Robotics; Toothbrushing
PubMed: 35676648
DOI: 10.1186/s12903-022-02211-4 -
Clinical and Experimental Dental... Feb 2022To compare gloss retention of four different resin composites with their corresponding CAD/CAM composite blocks.
OBJECTIVES
To compare gloss retention of four different resin composites with their corresponding CAD/CAM composite blocks.
MATERIALS AND METHODS
Four direct resin composites (Filtek Supreme XTE A2 Body (3M, USA), Tetric EvoCeram A2 (Ivoclar Vivadent, Liechtenstein), GrandioSO x-tra A2 (VOCO, Germany), G-aenial Universal A2 (GC, Japan)), and their corresponding CAD/CAM composite blocks were tested. A total of 288 samples were prepared and three different tests were performed: brushing, exposition to acidic fluoride gel and exposition to alcoholic solution. Gloss values were obtained by means of a glossmeter at T0 before aging and T60 after 1 h of aging.
RESULTS
Mean gloss values ranged from 0.9 after brushing tests to 79.0 after the alcohol test witnessing a high gloss variability depending on the materials and the aging test. Statistical analysis by means of two-way repeated measures ANOVA followed by Fisher's LSD post-hoc test revealed significant differences between materials, storage media, and their interactions.
CONCLUSION
Gloss retention seems to be dependent on the composite type (direct or CAD/CAM block) and composite brand and varies in respect to the type of aging. CAD/CAM materials showed a higher resistance toward alcohol exposure.
Topics: Computer-Aided Design; Japan; Materials Testing; Surface Properties; Toothbrushing
PubMed: 34647425
DOI: 10.1002/cre2.505 -
International Journal of Environmental... Mar 2022Guidelines for using toothpaste during tooth-brushing in public places during the coronavirus epidemic are lacking. In addition, the advantages and disadvantages of...
Guidelines for using toothpaste during tooth-brushing in public places during the coronavirus epidemic are lacking. In addition, the advantages and disadvantages of using toothpaste in terms of droplet generation during brushing, the number of droplets generated, and their scatter range are unknown; therefore, we investigated the relationships between diluted toothpaste viscosity, the number of droplets generated, and the droplets' flight distance. We developed a system to quantitate droplet generation during tooth-brushing. Brushing with water generated 5965 ± 266 droplets; 10.0× diluted toothpaste generated 538 ± 56, 4.00× diluted toothpaste generated 349 ± 15, and 2.00× diluted toothpaste generated 69 ± 27 droplets. Undiluted toothpaste generated no droplets. Droplet number tended to increase with increased toothpaste dilution ratio and decreased viscosity ( = -0.993). The maximum flight distances were 429 ± 11, 445 ± 65, 316 ± 38, and 231 ± 21 mm for water, 10.0×, 4.00×, and 2.00× diluted toothpaste, respectively. The maximum flight distance and toothpaste viscosity correlated negatively ( = -0.999). Thus, the less diluted the toothpaste, the fewer the droplets generated during brushing, and the shorter their flight distance. The use of an appropriate amount of toothpaste is recommended to prevent droplet infection during tooth-brushing.
Topics: Indicator Dilution Techniques; Toothbrushing; Toothpastes; Water
PubMed: 35409838
DOI: 10.3390/ijerph19074157 -
BMC Oral Health Jul 2019There is a need for analytical techniques for measuring Erosive Tooth Wear (ETW) on natural surfaces in clinical studies. The purpose was to investigate the use of two...
BACKGROUND
There is a need for analytical techniques for measuring Erosive Tooth Wear (ETW) on natural surfaces in clinical studies. The purpose was to investigate the use of two instruments aimed to assess initial to more advanced stages of ETW.
METHODS
Human premolar enamel samples (2x3mm) (n = 24), were polished flat and mounted in resin cylinders (4 cylinders, 6 samples in each). Part 1: Baseline analyses by White Light Interferometer (WLI), Surface Reflection Intensity (SRI: TableTop and OptiPen) and Surface Hardness (SH). Erosion (1% citric acid (pH 3.6) for 1, 2, 4, 6, 8, 10 min. SRI and SH analyses after every erosion episode and by WLI after 10 min. New indentations were made and enamel loss; was measured by change in indentation depths from toothbrush abrasion (200 g, 60 strokes, 30 s). Another series of 2 × 5 min erosion (totally15 min and 20 min) was analysed with SH and SRI after each erosion, and by WLI (on samples and impressions of samples) after 20 min. Part 2 investigated WLI performance in the interface where initial erosion increases in severity and substance loss occurs. The samples were repolished. Baseline analyses by WLI, SRI (TableTop and OptiPen) and SH. Four cylinders were etched for 1, 2, 4, 8 min respectively and analysed by SRI, SH on samples, and WLI on samples and impressions).
RESULTS
Part1: SRI decreased from baseline to ~ 6 min etch and increased slightly after abrasion, the two devices correlated well (ICC 0.98 p < 0.001, Spearmans rs 0.91 p < 0.001). SH decreased nearly linearly to 10 min etch, but increased distinctly after abrasion. Mean enamel loss from abrasion alone was 0.2 μm (change in indentation depths). After 10 min etch, it was 0.27 μm (WLI) and after 20 min etch, it was 2.2 μm measured on samples vs 2.4 μm on impressions of samples (7% higher). Part 2: From baseline to 8 min etch; SRI and SH decreased whereas WLI presented increasing etch depths.
CONCLUSIONS
With some adjustments, the use of SRI and WLI in combination seems to be a promising strategy for monitoring ETW in clinical studies.
Topics: Citric Acid; Dental Enamel; Hardness; Humans; Tooth Abrasion; Tooth Attrition; Tooth Erosion; Tooth Wear; Toothbrushing
PubMed: 31349831
DOI: 10.1186/s12903-019-0834-1 -
The Cochrane Database of Systematic... Dec 2010Powered brushes were first introduced commercially in the 1960s. A recent systematic review suggested the superiority of certain modes of powered over manual... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Powered brushes were first introduced commercially in the 1960s. A recent systematic review suggested the superiority of certain modes of powered over manual toothbrushing for plaque and gingivitis reduction. That review did not allow for direct comparison between different modes of powered toothbrush.
OBJECTIVES
To compare different modes of powered toothbrushing against each other for plaque reduction and the health of the gingivae. Other factors to be assessed were calculus and stain removal, cost, dependability and adverse effects.
SEARCH STRATEGY
The following databases were searched: Cochrane Oral Health Group's Trials Register (to 26 July 2010); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3); MEDLINE via OVID (1950 to 26 July 2010); EMBASE via OVID (1980 to 26 July 2010); CINAHL via EBSCO (1982 to 26 July 2010). There were no language restrictions.
SELECTION CRITERIA
Trials were considered for inclusion with the following criteria: random allocation of participants; no compromised manual dexterity; unsupervised powered toothbrushing for at least 4 weeks. The primary outcomes were the plaque and gingivitis scores after powered toothbrush use during trial period.
DATA COLLECTION AND ANALYSIS
Data extraction was performed independently and in duplicate. The authors of trials were contacted to provide missing data where possible. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using the random-effects model. Potential sources of heterogeneity were assessed.
MAIN RESULTS
The review included data from 15 trials with 1015 participants. Due to the dearth of trials assessing the same mode of action, no definitive conclusions can be stated regarding the superiority of one mode of powered toothbrush over any other. Only minor and transient side effects were reported. Cost, dependability were not reported.
AUTHORS' CONCLUSIONS
Further trials of good quality are required to establish if any mode of action has superiority over the other modes of action for powered toothbrushes.
Topics: Dental Devices, Home Care; Dental Plaque; Gingivitis; Humans; Randomized Controlled Trials as Topic; Toothbrushing
PubMed: 21154357
DOI: 10.1002/14651858.CD004971.pub2