Gingival Abrasion Research Articles

Hyperspectral imaging with deep learning for quantification of tissue hemoglobin, melanin, and scattering.

Hyperspectral cameras capture spectral information at each pixel in an image. Acquired spectra can be analyzed to estimate quantities of absorbing and scattering components, but the use of traditional fitting algorithms over megapixel images can be computationally intensive. Deep learning algorithms can be trained to rapidly analyze spectral data and can potentially process hyperspectral camera data in real time. A hyperspectral camera was used to capture wide-field reflectance images of in vivo human tissue at 205 wavelength bands from 420 to 830nm. The optical properties of oxyhemoglobin, deoxyhemoglobin, melanin, and scattering were used with multi-layer Monte Carlo models to generate simulated diffuse reflectance spectra for 24,000 random combinations of physiologically relevant tissue components. These spectra were then used to train an artificial neural network (ANN) to predict tissue component concentrations from an input reflectance spectrum. The ANN achieved low root mean square errors in a test set of 6000 independent simulated diffuse reflectance spectra while calculating concentration values more than 4000× faster than a conventional iterative least squares approach. In vivo finger occlusion and gingival abrasion studies demonstrate the ability of this approach to rapidly generate high-resolution images of tissue component concentrations from a hyperspectral dataset acquired from human subjects.

Efficacy of a water flosser compared to an interdental brush on gingival bleeding and gingival abrasion: A 4 week randomized controlled trial.

To determine the efficacy of a water flosser (WF) compared to an interdental brush (IDB) in reducing gingival inflammation. Additionally, the products were compared on the incidence of gingival abrasion. Young adults with moderate gingivitis and ≥4 accessible interdental spaces by IDB in each quadrant were selected for this study. Participants were randomly assigned a WF or an IDB as an adjunct to manual toothbrushing. Clinical signs of inflammation were measured in two randomly assigned contralateral quadrants by bleeding on pocket probing (BOPP) or bleeding on marginal probing (BOMP). Gingival Abrasion Score (GAS) was assessed per quadrant. Data was recorded at the baseline, 2 weeks and 4 weeks. Both groups WF (n = 40) and IDB (n = 38) showed a significant reduction (p = 0.000) in BOMP and BOPP from the baseline to 4 weeks for all sites and the interdental sites only. At 4 weeks the WF group compared to the IDB group showed significantly lower BOPP (p = 0.030) and BOMP scores (p = 0.003) for all sites. For the interdental sites WF showed compared to IDB for BOMP significant (p = 0.019) lower values but not for BOPP (p = 0.219). There were no differences between the groups for GAS at any time point. In patients with moderate gingivitis, after 4 weeks use the WF is more effective than the IDB in obtaining marginal gingival health.

Safety and Efficacy of Plaque Removal Using Manual and Powered Toothbrush in Cerebral Palsy Children by Parents/Caregivers: A Randomized Control Crossover Trial.

The aim of our study was to check the safety and efficacy of plaque removal using manual and powered toothbrush in cerebral palsy children by parents/caregivers. This was a single blinded, crossover randomized control trial conducted on 60 cerebral palsy children between the age of 6 to 14 years. They were randomly divided using a flip coin method into two groups: group A-manual toothbrush and group B-powered toothbrush. The plaque index (PI), gingival index (GI), and gingival abrasion (GA) score were measured at baseline, then at an interval of 3, 6, 9, and 12 weeks. This was followed by a crossover between two groups with a washout period of 1 week. Both manual and powered toothbrush showed a significant reduction in plaque and gingival score before and after crossover when compared to baseline (p < 0.05). The GA score was reduced to 100% in both groups. However, there was no statistically significant difference between both the groups before and after the crossover. Also, through the questionnaire it was observed that both child (86.6%) and parent (70%) showed positive feedback towards powered toothbrush. It can be concluded from the present study that the efficacy of a powered toothbrush is comparable to that of a manual toothbrush. Parents and caregivers, on the contrary, displayed a favorable attitude towards the use of powered toothbrushes due to their ease of use. Cerebral palsy is one of the most common neurological disorders among children. It is associated with poor motor skills and manual dexterity that hampers their ability to brush and thus leads to poor oral hygiene. A powered toothbrush seems more appealing and is specially designed for patients with poor neuromotor coordination. Deshpande AN, Naik K, Deshpande N, et al. Safety and Efficacy of Plaque Removal using Manual and Powered Toothbrush in Cerebral Palsy Children by Parents/Caregivers: A Randomized Control Crossover Trial. Int J Clin Pediatr Dent 2023;16(2):344-349.

Association between oral hygiene and gingival abrasion in a rural population in southern Brazil: A multilevel secondary analysis.

To evaluate associations between oral hygiene and gingival abrasion (GA) in a rural population from southern Brazil. A population-based sample representative of individuals from a rural community in southern Brazil was included. Individuals aged 15 years or older and who had five teeth or more present were selected for this analysis. GA extent was defined as the total number of abrasions per individual. An adjusted multilevel negative binomial regression analysis was used to investigate the associations between site-, tooth- and individual-level variables and GA. Mean ratios (MR) and 95% confidence intervals (95% CI) were calculated. Five hundred ninety-five dentate individuals aged 15-82 years were analysed. In the adjusted models, brushing more than twice a day (MR=1.13; 95% CI 1.02-1.26) and brushing with a hard/medium-bristle toothbrush (MR=1.11; 95% CI 1.01-1.23) were significantly associated with more generalized GA. The extent of GA was independently associated with greater brushing frequency and the use of a toothbrush with harder bristles in residents of a rural area.

Effects of interactive power toothbrush with or without application assistance on the plaque, gingivitis, and gingival abrasion among dental students: a randomized controlled clinical trial.

The purpose of this randomized controlled study is to determine if an interactive power toothbrush (PTB) with application (app) promotes additional benefit on dental plaque, gingivitis, and gingival abrasion to that of a manual toothbrush (MTB). Ninety participants (dental students) diagnosed with gingivitis were randomly assigned, into three groups, 1:1:1 ratio, given an app-assisted interactive PTB (PTB-A) (Oral-B Genius® Rechargeable 8000 PTB with CrossAction brush head) or the same PTB without app-assistance (PTB-NA) or a regular MTB for home-use. Plaque was assessed using the Turesky modification of the Quigley and Hein Plaque Index (QHPI-TM), and gingivitis was evaluated using the Bleeding on Marginal Probing Index (BOMP) at baseline (T0), week 2 (T1), and week 8 (T2). Gingival abrasions were recorded at T1 and T2. Exit survey was used to assess brushing time and visual-analogue-scale (VAS) scores. PTB improved QHPI-TM significantly in terms of time-dependent changes, irrespective of app-assistance. BOMP was observed to be statistically lower in PTB-A than in MTB only at T2. Brushing times were longer in PTB-A than in MTB. Gingival abrasion was less in both PTB than MTB. PTB-A had better results to MTB in cleaning ability according to subject-reported outcomes. Both PTBs were more effective to MTB; however, the app-assisted interactive PTB was similar to the non-assisted one in plaque removal efficacy, gingivitis reduction, and incidence of gingival abrasion, yet better than MTB in cleaning ability. Developing an application software to prevent gingival abrasion might be clinically beneficial regardless of the individual factor. ClinicalTrial.gov ID: NCT05150132.

A Comparison of Manual Nylon Bristle Toothbrushes versus Thermoplastic Elastomer Toothbrushes in Terms of Cleaning Efficacy and the Biological Potential Role on Gingival Health

Background: It is well-known that toothbrushing might be associated with the development of oral soft tissue lesions. There is currently a continuing increase in the demand for new safety and performing materials in daily homecare oral hygiene including soft and extra-soft toothbrush bristles that tend to be safer. The aim of this study was to compare the efficacy of plaque control and the potential effects on gingival health of two different toothbrush bristle models. Methods: In a three-month period, a total of forty subjects were evaluated for Oral Hygiene Index (OHI), Gingival Index (GI) and Plaque Index (PI) scores as well the Gingival Abrasion Assessment (GAA) between a toothbrush entirely made from a rubber-like material called thermoplastic elastomer (TPE) and a soft toothbrush (standard control with nylon bristles) in a clinical, single-blind, controlled, parallel-group trial. Results: The use of the TPE toothbrush allows a reduction in the PI, improves the OHI and modifies the GAA in the TPE group over a period of three months compared with a conventional soft bristle toothbrush applied for the same period, leading in this way evidence for a good influence of the TPE bristles on overall oral hygiene conditions. Conclusions: From the comparison between our data and the literature studies, we can state that the material and shape of the bristles of the toothbrush affect the home practice of oral hygiene. The TPE bristles reduce the presence of plaque formation and gingival bleeding, oral soft tissue injuries acquired during homecare oral hygiene.

The efficacy of a rubber bristles interdental cleaner on parameters of oral soft tissue health-a systematic review.

AimThis study aimed to establish the efficacy of a rubber bristles interdental cleaner (RBIC) as an adjunct to toothbrushing (TB) compared to that of the adjuvant use of other interdental cleaning devices and TB alone on plaque and gingivitis parameters. Additionally, the safety aspects and panellists’ appreciation were evaluated.Materials and MethodsDatabases were searched for randomized controlled clinical trials (RCTs) evaluating plaque (PI), bleeding (BS), and gingival index (GI) scores, safety assessments, and participants’ appreciation. Extracted data were summarized in a descriptive and, if possible, a meta‐analysis.ResultsThe search retrieved 142 unique papers; six studies with 10 comparisons were included in a descriptive analysis. Five RCTs compared RBICs with interdental brushes (IDBs), four with dental floss (DF) and one with manual TB only. No comparisons to wood sticks were retrieved. Using an RBIC resulted in no difference in plaque scores compared to DF and IDBs. For overall bleeding scores, no difference was found. Two studies analysing the accessible sites separately found RBICs to be more favourable than DF and IDBs. Conversely, one study evaluating the efficacy of RBICs compared to IDBs, according to the GI scores, showed that IDBs achieved significantly greater reduction. Moreover, RBICs caused fewer gingival abrasions and were preferred by the study participants.ConclusionBased on a descriptive and a meta‐analysis of the available literature, it is synthesized that in gingivitis patients, a weak to very weak certainty exists that a RBIC is indicated for gingivitis and plaque reduction. The evidence supports user safety and participants’ preferences.

Sampling strategy of an epidemiological survey using a satellite image program.

ABSTRACTOBJECTIVETo describe the sampling strategy of an epidemiological survey with the aid of satellite images, including details of the multistage probability sampling process.METHODSA probability sample of individuals living in the rural area of Rosário do Sul, state of Rio Grande do Sul, Brazil, aged 15 years old or more, was evaluated. Participants answered questionnaires (medical history, sociodemographic characteristics, habits, alcohol use, quality of life, stress, rumination, and self-perceived periodontal diseases), and were subjected to clinical oral examinations as well as anthropometric measurements (blood pressure, height, weight, abdominal and waist circumferences). Oral evaluation comprehended a complete periodontal exam at six sites per tooth, including the following assessments: furcation involvement; dental abrasion; tooth decay, including the indexing of missing and filled surfaces; O’Brien index; gingival abrasion; oral cavity and lip lesions; complete periapical radiographic exam, and use of prostheses. Besides this oral clinical approach, subgingival plaque, crevicular gingival fluid, saliva, and blood samples were collected. Examiners were trained and calibrated during previous evaluations. A pilot study allowed the logistic of the performed exams to be adjusted as needed.RESULTSAmong 1,087 eligible individuals, 688 were examined (63.3%). Age, sex, and skin color data were compared to data from the last demographic census (2010) of the Brazilian Institute of Geography and Statistics, which served to validate the sampling strategy.CONCLUSIONSThe careful methods used in this study, in which satellite images were used in the delimitation of epidemiological areas, ensure the quality of the estimates obtained and allow for these estimates to be used in oral health surveillance and health policies improvements.

Healing of toothbrush-induced abrasions to keratinized mucosa of the palate in humans: A pilot study.

To the best of our knowledge, the healing time for toothbrush-induced gingival abrasions in humans has not yet been explored. The aim of this study was to evaluate the time needed to heal for toothbrush-induced abrasions of the keratinized mucosa of the palate. In patients without, with mild periodontitis or with periodontitis, gingival abrasion lesions were induced at the keratinized mucosa of the palate by brushing up to 2minutes. Healing as observed clinically was followed via calibrated digital photographs of the lesion after staining, every 24hours until the lesion had resolved. In patients without or with only mild periodontitis, the healing time of lesions caused by 30seconds and 1minute of brushing was also recorded. Thirty-one participants (11 without or with mild periodontitis, 20 with periodontitis) met the inclusion criteria. In patients without or with mild periodontitis, the lesions induced by brushing for 2minutes diminished by 48.7% of their original surface area within 24hours. In patients with periodontitis the respective outcome was 45.4% (P=.87). Abrasions caused by 2minutes of brushing needed more than 24hours to heal completely. When decreasing the time exposed to trauma, fewer lesions were visible at baseline and the time needed to heal decreased. The subgroup of smokers was too small to evaluate any effect. The longer the exposure time of the keratinized mucosa of the palate to trauma, the more lesions were visible, the larger the abrasions were and the more time they needed to heal completely. More studies are needed to investigate the role of smoking, gingival biotype and to link these findings with gingival recessions.

A PhD completed. Trauma to the gingiva by oral hygiene aids and oral piercings

Maintaining healthy teeth and soft oral tissue is important. Clinical research has shown manual toothbrushes with end-rounded filaments to cause significantly less gingival abrasions than those without end-rounding. Tapered filaments are an alternative to end-rounded filaments, but there is no solid evidence for their effectiveness. For the interdental spaces that the toothbrush doesn't reach, the use of special oral hygiene aids is advised. Clinical studies of gingivitis patients have shown that both interdental brushes and plastic-rubber bristles reduce gingivitis after 4 weeks of use. Plastic-rubber bristles result in a significant improvement in the tendency for interdental bleeding compared with interdental brushes, and they cause less abrasion of the gingiva. Other factors that can potentially traumatise soft and hard oral tissue are oral piercings. Wearing oral piercings is not without risk. Tongue and lip piercings are associated with the risk of gingival recession, and tongue piercings are associated with tooth fractures. To prevent the risk of complications, patients should be discouraged from wearing oral piercings.

Gingival Trauma: Tooth Brushing and Oral Piercings

Maintaining healthy teeth and soft oral tissues for life is important. Gingival abrasions are reversible localized epithelial trauma of the gingiva. These soft tissue lesions are caused by oral hygiene procedures and are usually not detected during clinical examinations. One approach to assess gingival abrasions is to distinguish them from the normal gingiva by staining the undamaged gingiva with a commercially available plaque disclosing solution. Soft tissues in the oral cavity have the capacity to recover, but repeated trauma of the gingiva may result in gingival abrasions and/or recessions. Manual toothbrushes with end-rounded filaments cause significantly less gingival abrasions. Another factor that can potentially traumatize soft and hard oral tissues is oral jewelry. Oral piercings are not without risks, considering the serious complications for oral and general health reported in the literature. Both lip and tongue piercings are highly associated with the risk of gingival recession, and tongue piercings are associated with tooth injuries. To prevent the risk of complications, patients should be discouraged from wearing oral or perioral jewelry.

The effects of different levels of brush end rounding on gingival abrasion: a double-blind randomized clinical trial.

The objective of this study was to evaluate the effect of different levels of filament end rounding on gingival abrasions (GAs). The study was a crossover, split-mouth, contra-lateral, double-blinded, randomized design using professional brushing. Three manual toothbrushes, with 0%, 40-50% and >90% end-rounded filaments, were investigated. Participants refrained from all oral hygiene procedures for 48 h prior to each of the three visits. Prior to brushing, oral soft tissue (OST) and GAs were assessed. Based on the randomization, during every visit contra-lateral quadrants were brushed with one of the three test brushes. After brushing, GAs were re-assessed. The means of the GAs prebrushing and post-brushing and differences per brush were calculated. Subanalyses were performed based on the size of the abrasion and its location. A total of 46 generally healthy participants without periodontitis completed the study and provided a full data set. All brushes had statistically significant increases of abrasions following their use (P < 0.001). Non-end-rounded brushes provided significantly more GAs than did the 40-50% and the >90% brushes (P ≥ 0.001). A subanalysis showed that significantly more small-sized (P ≥ 0.002) abrasions located at the gingival margin (P < 0.001) occurred when a non-end-rounded brush was used. No significant differences were found between the 40-50% and >90% end-rounded brushes in any of the analyses. OST deviations were not observed. Based on the results of this experiment involving professional brushing, it can be concluded that 40-50% or greater end-rounded filaments can provide a significant reduction in gingival abrasions compared to non-end-rounded filaments.

Combined effect of end-rounded versus tapered bristles and a dentifrice on plaque removal and gingival abrasion.

Two previous clinical studies evaluated the effect of end-rounded versus tapered bristles of soft manual brushes on the removal of plaque and gingival abrasion. However, the combined effect of an abrasive dentifrice on these outcomes has yet to be understood. The purpose of the present study was to compare the incidence of gingival abrasion and the degree of plaque removal obtained after the use of toothbrushes with tapered or end-rounded bristles in the presence or absence of an abrasive dentifrice. The study involved a randomized, single-blind, crossover model (n = 39) with a split-mouth design. Subjects were instructed to refrain from performing oral hygiene procedures for 72 hours. Quadrants were randomized and subjects brushed with both types of toothbrushes using a dentifrice (relative dentin abrasion = ± 160). Plaque and gingival abrasion were assessed before and after brushing. After 7 days, the experiment was repeated without the dentifrice. The average reduction in plaque scores and the average increase in the number of abrasion sites were assessed by repeated-measures ANOVA and Bonferroni's post-hoc tests. End-rounded bristles removed significantly more plaque than tapered bristles, regardless of the use of a dentifrice. The dentifrice did not improve plaque removal. In the marginal area (cervical free gingiva), no difference in the incidence of gingival abrasion was detected between toothbrush types when used with a dentifrice (p ≥ 0.05). However, the dentifrice increased the incidence of abrasion (p < 0.001), irrespective of the toothbrush type tested. End-rounded bristles therefore removed plaque more effectively without causing a higher incidence of gingival abrasion when compared with tapered bristles. An abrasive dentifrice can increase the incidence of abrasion, and should be used with caution by individuals who are at risk of developing gingival recession.

The effectiveness of dentifrices without and with sodium lauryl sulfate on plaque, gingivitis and gingival abrasion--a randomized clinical trial.

ObjectivesThe aim of this study was to compare the efficacy of a dentifrice without sodium lauryl sulfate (SLS) to a dentifrice with SLS in young adults aged 18–34 years on gingivitis.Material and methodsOne hundred twenty participants (non-dental students) with a moderate gingival inflammation (bleeding on probing at 40–70 % of test sites) were included in this randomized controlled double blind clinical trial. According to randomization, participants had to brush their teeth either with dentifrice without SLS or with SLS for 8 weeks. The primary outcome was bleeding on marginal probing (BOMP). The secondary outcomes were plaque scores and gingival abrasion scores (GA) as well as a visual analogue scale (VAS) score at exit survey. Baseline and end differences were analysed by univariate analysis of covariance (ANCOVA) test, between group differences by independent t test and within groups by paired sample t test.ResultsBOMP improved within groups from on average 0.80 at baseline to 0.60 in the group without SLS and to 0.56 in the group with SLS. No statistical difference for BOMP, plaque and gingival abrasion was found between both groups. VAS scores for taste, freshness and foaming effect were significantly in favour of the SLS-containing dentifrice.ConclusionThe test dentifrice without SLS was as effective as a regular SLS dentifrice on gingival bleeding scores and plaque scores. There was no significant difference in the incidence of gingival abrasion.Clinical relevanceIn patients diagnosed with gingivitis, a dentifrice without SLS seems to be equally effective compared to a dentifrice with SLS and did not demonstrate any significant difference in gingival abrasion. In patient with recurrent aphthous ulcers, the absence of SLS may even be beneficial. However, participants indicate that they appreciate the foaming effect of a dentifrice with SLS more.

Tratamiento de la melanosis gingival y evaluación de la repigmentación melánica. Reevaluación clínica al cabo de 2 años

Hyperpigmentation of the gingiva is an aesthetic problem in some patients, particularly if the pigment is in the facial area of the gum and is visible during smiling and speaking. ObjectiveThe purpose of this study was to evaluate the degree of repigmentation of gingival melanosis treated with the combination of using the scalpel and gingival abrasion. Material and methodSix patients were evaluated with a diagnosis of physiological melanin pigmentation at the gingiva of the maxilla, and for aesthetic reasons needed the pigment removed (depigmentation) with a scalpel and a rotary abrasive. The parameters evaluated were the intensity of pigmentation index (PI) and gingival pigmentation index (GPI). ResultsAfter a mean of 18months ± 4.5 months after the procedure, 2 patients had a mild repigmentation, and 4 cases with an absence of IP, and all 6 cases showed an PGI of zero in the postoperative period. ConclusionThe removal of melanin spots combining the use of the scalpel and abrasion is an effective technique, and has a low rate of repigmentation after 18 months follow-up.

THE IMPACT OF TOOTHBRUSH FILAMENT DESIGN ON GINGIVAL HEALTH DURING HEALING. A RANDOMIZED, CONTROLLED, INVESTIGATOR-BLINDED CLINICAL TRIAL

Objectives. The primary objective of the study was to test toothbrushes with different types of filaments (conical vs. rounded) with respect to cause gingival abrasion after surgical intervention of wisdom teeth. A secondary objective was to evaluate the efficacy of plaque removal and the improvement of gingival conditions to alleviate wound healing and to avoid gingivitis. Methods. One hundred and seventy-three healthy subjects with surgical intervention of wisdom teeth participated in a randomized, single blind study and were randomly allocated to control group (standard ADA reference toothbrush) or test group (meridol® special toothbrush with conical filaments). Clinical examinations included gingival abrasion, plaque index and gingival index, and were conducted at baseline, 7 and 28 days. Results. For the gingival abrasion the mean number of lesions of all sizes was after 28 days significantly lower in the test group (p-value <0.001) compared to control group. Plaque index was not significantly different between the two groups in the last visit. At day 28 the gingival index was significantly lower in the test group (p=0.031) compared to control group. Conclusions. The toothbrush with conical filaments induced significantly less gingival abrasions than the standard ADA toothbrush and showed superior results in improving gingival health (gingival index). Both toothbrushes were comparable effective with respect to plaque removal. Clinical Relevance. Scientific rationale for study: Supra and sub-gingival biofilm leads to gingival inflammation. Post-surgical removal of the biofilm from gingival surfaces promotes healing after wisdom tooth extraction. Tooth brushing leads to gingival abrasion. Earlier investigations with toothbrushes having conical filaments suggest less gingival tissue damage. Principal findings: The results showed that the toothbrush with conical filaments caused significantly less gingival abrasions than the toothbrush with rounded filaments. Practical implications: Toothbrush filament design should be considered when choosing toothbrush for oral hygiene after oral surgery.

Comparison of the clinical effects of white brand toothbrushes versus Vitis Suave®.

Background There has been an increase in the use of white label manual toothbrushes and a greater increase in inquiries for discomfort of the gingiva and mucosa. Material and Methods A randomized, double-blind, cross-over clinical trial was made of four white brand toothbrushes versus a control brush (Vitis Suave®), with the recording of plaque index, bleeding upon probing, and gingival abrasions following utilization of the different brushes. Results All the brushes except Deliplus® were equally effective in terms of plaque removal (p<0.05). Vitis Suave® and Veckia® were the brushes associated to the greatest increase in minor abrasions (p<0.01), while Veckia®, Carrefour® and Deluxe® significantly increased the number of medium intensity abrasions (p<0.05). These brushes also increased the number of large abrasions, though statistical significance was not reached in this case. Conclusions The white brand brushes proved effective in controlling bacterial plaque, but were associated to more intense soft tissue abrasion. Key words:Gingival abrasions, manual tooth brushing, white brand, clinical effects.

Vertical brushing versus horizontal brushing: a randomized split-mouth clinical trial.

The aim of this randomized, single-blind, splitmouth design, clinical trial was to evaluate the effectiveness in plaque removal of two brushing methods, the vertical and the horizontal, in a sample of healthy young adults. Forty-nine subjects were enrolled and 43 completed the study. All subjects abstained from oral hygiene practices for 48 hours. Plaque and gingival abrasions were recorded according to the Rustogi Modified Navy Plaque Index (RMNPI) and the van der Weijden method by one calibrated examiner before and immediately after the brushing session. A dental hygienist performed the two brushing methods using a randomized split-mouth design. The average plaque scores from the whole mouth, interproximal surfaces, and gingival margin were obtained before and after brushing, and the differences were evaluated using one-way analysis of variance. The differences in mean plaque scores between pre- and postbrushing were statistically significant for both methods. Considering the interbrushing differences, the vertical method produced lower plaque scores compared to the horizontal for the whole mouth (P=.02). In the interproximal surfaces, the vertical method removed more plaque compared to the horizontal one (P<.01). In the gingival margin no statistically significant differences in plaque scores were recorded. Only 10 gingival abrasions were registered, mainly produced by the horizontal method. RESULTS suggest that both toothbrushing methods are effective in plaque removal; nevertheless, the vertical brushing method has demonstrated to remove more plaque from the interproximal surfaces than the horizontal method.

Efficacy of straight versus angled interdental brushes on interproximal tooth cleaning: a randomized controlled trial

To investigate interproximal biofilm reduction with an angled interdental brush as compared to a straight interdental brush (standard control) in a clinical, single-centre, single-blind, controlled, parallel-group trial. Recruitment and examinations of the subjects were performed at the Witten/Herdecke University School of Dental Medicine. 128 volunteers, aged 20-65years, were recruited and stratified according to sex and age. Two groups with 64 subjects each used either straight (standard control) or angled (test group) handgripped interdental toothbrushes of the same bristle stiffness. After a 12-day home-care habituation period, participants received a professional tooth cleaning followed by a 48-h plaque regrowth period. At the intervention appointment, plaque was recorded with a fluorescent revelator and soft tissue damage was noted (T0 ). Interdental brushing was performed by the participant for 2min, and clinical parameters were recorded again (T1 ). The primary efficacy end point was the difference in modified Proximal Plaque Index (mPPI) after brushing compared to baseline. Secondary efficacy end points were mPPI differences in subgroups (anterior vs. posterior teeth; vestibular vs. oral tooth surfaces). Safety end point was the Danser gingival abrasion index (DI). mPPI showed lower scores after brushing within all (sub)groups (P<0.01). mPPI brushing efficacy (ΔT0 -T1 ) in subjects using straight interdental brushes was significantly higher as compared to angled interdental brushes (P<0.0001). Straight interdental brushes were significantly more effective in posterior teeth, when used from vestibular and from oral tooth surfaces (P<0.0001, P<0.01 and P<0.0001, respectively). No significant differences were found between the groups in anterior teeth and concerning soft tissue damage. Straight interdental brushes may better remove plaque interproximally when compared to angled interdental brushes.

Plaque‐removing efficacy of new and used manual toothbrushes – a professional brushing study

The present study assessed whether 3-month-old used manual toothbrushes are less effective in reducing plaque scores compared with new toothbrushes with or without the use of dentifrice. The present study was performed employing a single-use, examiner-blinded, professional brushing model. Four brushing modalities were randomly allocated to one of four quadrants, that is, 3-month-old used toothbrushes and new toothbrushes both with and without the use of dentifrice. Prebrushing and post-brushing plaque scores (Quigley Hein plaque index) and gingival abrasion (GA) scores were obtained. A dental hygienist performed the professional brushing procedure. The 3-month-old used toothbrushes were assessed for wear. No significant differences were observed among the treatments with regard to the prebrushing scores. The post-brushing plaque scores ranged from 1.59 for the new brush with dentifrice to 1.76 for the old brush with dentifrice. There was a significant difference (P = 0.036) among the four treatments regarding the old brush with dentifrice, which removed less plaque than the other treatment modalities. Regarding GA scores, no significant differences were observed. With regard to toothbrush wear after 3 months of use, the scores varied widely among the individually evaluated brushes. The present study did not show a clinically relevant difference in plaque score reductions following a 2-minute brushing exercise among 3-month-old used and new manual toothbrushes. However, the wear rate of the brushes seemed to be the determining factor in loss of efficacy, rather than the age of the toothbrush. Furthermore, dentifrice did not show an additional effect on instant plaque removal.