Excessive tooth brushing force can contribute to oral health issues such as gum recession and bleeding. While some electric toothbrushes offer force feedback, manual toothbrushes remain widely used due to their affordability and accessibility but do not give this sort of information to users. Therefore, they often lack awareness of the force they apply while brushing. In this paper, we introduce HearForce, the first system to estimate tooth brushing force from manual toothbrushing using widely available earbuds. Unlike existing solutions that require significant modifications to toothbrushes, HearForce leverages in-ear microphones on commercial earbuds to capture bone-conducted toothbrushing sound propagating from the oral cavity to the ear canals. Our key insight is that variations in brushing force modulate these toothbrushing sounds due to the friction effect, allowing us to infer force levels through deep learning. However, individual habitual and anatomical differences introduce significant challenges for force estimation. To mitigate this, we propose a self-supervised representation learning network with a cross-attention mechanism to suppress user-dependent variability and a heuristic calibration strategy to adapt the model to different brushing habits. Through extensive evaluation, HearForce demonstrates force estimation capabilities with a Mean Absolute Error (MAE) of 37.3g in user-independent settings, corresponding to 11.4% of the typical force dynamic range. Our study makes the first step in the use of everyday earbuds for manual toothbrushing force monitoring, paving the way for accessible solutions to improve brushing habits for manual toothbrush users globally.

Comparison of safety, salivary flow rate, and pH with different mouthrinse formulations in addition to toothbrushing vs toothbrushing only: Results from a 2-week phase 4 randomized controlled clinical trial.

Subject. Studying periodontal microcirculatory parameters is a primary marker of the latency period of the general somatic structure. Currently, the main determinants of periodontal diseases have been observed for a long time, helping people apply disease control methods to additional patients. Objectives. The study of the possibility of using a non-invasive method for diagnosing microcirculation in periodontal tissues to develop a comprehensive treatment plan for elderly and senior patients. Methodology. The study consisted of two stages: a questionnaire survey and a clinical and laboratory examination of patients. Seventy-two respondents were asked to answer questions about their oral hygiene practices and the presence of general somatic diseases. Two groups were identified for the clinical and laboratory examination: the main group (A), which consisted of 30 patients aged 60 to 79 years; and the control group (B), which consisted of 42 patients aged 29 to 59 years. All patients underwent a standard dental examination, as well as a study of the average linear (Vs, cm/s) and volumetric (Qs, ml/s) blood flow velocity in periodontal tissues using ultrasound Dopplerography. Results. The most common condition in both groups was hypertension. Group A respondents primarily used a manual toothbrush, toothpaste, and an irrigator and visited the dentist once a year, while Group B used an electric toothbrush and floss and visited the dentist once every 6 months. Patients over 60 years old with cardiovascular disease were found to have vascular insufficiency in the oral tissues. Conclusions. The conducted study allows us to recommend that dentists, together with internists, develop a treatment and rehabilitation plan aimed at relieving the manifestations of diseases and improving the quality of life.

Background/Objectives: Periodontitis is a chronic inflammatory disease with a high global prevalence and substantial public health burden. Often diagnosed after irreversible damage has occurred, its early detection depends heavily on patient awareness. This study aimed to assess awareness of early periodontal signs, oral hygiene behaviors, and the influence of demographic and behavioral factors among Romanian adults, to inform targeted public health strategies. Methods: A prospective cross-sectional study was conducted using a structured, 20-item questionnaire adapted from previously published instruments, reviewed by dental specialists, and pretested in a pilot group for clarity. A total of 518 adults participated. Collected data included demographic information, smoking history, oral hygiene habits, and symptom recognition. Descriptive statistics were used to summarize responses, and inferential tests (t-test, Mann–Whitney U, and Cramér’s V) were applied to assess associations. A p-value < 0.05 was considered statistically significant. Results: Of the respondents, 58.1% were male and 41.9% female, with a mean age of 36 years; 67.8% resided in urban areas. Although 52.9% reported gingival bleeding, only 47.1% recognized it as abnormal. Gum recession was noticed by 46.1% but seldom interpreted as a health issue. Smoking prevalence was 40.5%, and smoking status showed significant associations with specific awareness items, though not with overall symptom awareness. Manual toothbrush use was common (48%), yet only 24% reported daily flossing. Younger adults showed better hygiene practices, but gaps persisted across all groups. Conclusions: Romanian adults show limited awareness of early periodontal symptoms and inconsistent oral hygiene behaviors. These findings highlight the urgent need for national oral health education campaigns and the integration of preventive strategies into primary care—particularly targeting rural residents, smokers, and younger populations—to reduce the burden of untreated periodontitis in Eastern Europe.

Aim: This study compares the oral health status and hygiene practices of 30 pregnant and 30 non-pregnant women in Sofia, Bulgaria, using the DMFT, FMPS, and PBI. Oral hygiene habits, including brushing frequency, toothbrush type, duration, and technique, were also assessed. Materials and methods: A cross-sectional study (January&amp;ndash;June 2025) included 30 pregnant women (second/third trimester, aged 18&amp;ndash;40 years) and 30 non-pregnant women (aged 18&amp;ndash;40 years) from a private dental clinic. Exclusion criteria included systemic diseases and high-risk pregnancies. DMFT, FMPS, and PBI were evaluated by a dentist using standardized tools. Oral hygiene habits were collected via a validated questionnaire. Results: Pregnant women had lower mean DMFT, but higher FMPS and PBI, compared to non-pregnant women. Brushing frequency was similar (90% twice daily). Pregnant women used manual toothbrushes more, brushed for shorter durations and used less circular brushing. Conclusion: Pregnant women exhibit better caries experience (lower DMFT) but poorer oral hygiene (higher FMPS) and higher gingival inflammation than non-pregnant women, despite similar brushing frequency. Targeted oral health education promoting electric toothbrushes and circular brushing techniques is needed to improve maternal oral health.&amp;nbsp;

This in vitro study evaluated dentin abrasion and surface roughness caused by two sonic toothbrushes with different filament coatings compared with those caused by a standard ADA reference manual toothbrush. Standardized dentin samples (n = 8 per group) were prepared from bovine incisors, embedded in acrylic blocks, polished, and hardness-verified using the Vickers method. A central brushing area was created by masking two reference zones with adhesive tape. Brushing simulations were performed in a laboratory device for 10,000 cycles at a load of 1.5 N using a toothpaste slurry (RDA 129) that was prepared at a 1:1.6 water-to-paste ratio. The tested toothbrushes included the ADA reference manual toothbrush (uncoated nylon filaments), the Curaprox Hydrosonic Pro toothbrush (uncoated PBT filaments), and the Curaprox Hydrosonic Black is White toothbrush (charcoal-coated PBT filaments). Dentin loss was measured by noncontact optical profilometry, and surface roughness was assessed by determining the Ra, Rq and Sa values. Data normality was verified using the Shapiro–Wilk test, and differences among groups were analyzed by one-way ANOVA with Bonferroni correction (α = 0.05). Compared with the ADA reference manual toothbrush, both the sonic toothbrushes caused significantly greater dentin loss (p < 0.001), with no significant difference between the sonic models (p > 0.05). The changes in roughness followed a similar pattern. These findings suggest that, under standardized laboratory conditions, sonic toothbrushes, regardless of the use of a filament coating, cause more dentin wear than a manual reference brush. Moreover, greater dentin abrasion was associated with less roughness, indicating an inverse relationship between tissue loss and surface roughness.

Purpose The purpose of this study was to evaluate plaque and gingivitis reduction efficacy of an entry-tier oscillating-rotating (OR) electric toothbrush, used in two brushing modes (Daily Clean and Sensitive), as compared to a manual toothbrush.Methods This was a three-treatment, three-period crossover study, assessing plaque with the Rustogi Modification of the Navy Plaque Index after a single brushing and after one week of use. Additionally, in the first treatment period only, participants were assessed for gingivitis (Modified Gingival Index; MGI) and bleeding at baseline, week 1 and week 2 while using their assigned product for two weeks. All participants had baseline evidence of gingivitis and plaque.Results: Forty-two participants were randomly assigned to three treatment groups. The OR toothbrush, used in either mode compared with the manual toothbrush, produced statistically significantly greater reductions in the number of bleeding sites at week 1 and week 2 (p≤.001) and in MGI score at week two (p≤.001). By week 1, the bleeding site reduction with the OR toothbrush in either mode was at least twice as great as the manual toothbrush. The OR toothbrush used in Daily Clean mode also achieved statistically significantly greater MGI reduction at week 1 (p=.011). Both OR toothbrush groups showed statistically significantly greater plaque reduction compared with the manual toothbrush group after a single use (whole mouth, lingual, buccal, interproximal, and gingival margin plaque; p<.001) and after one week of repeated use (whole mouth, lingual, buccal, and interproximal plaque; p≤.022).Conclusion The entry-tier OR toothbrush provided significantly greater plaque and gingivitis reductions when used in either mode as compared to the manual toothbrush.

Improving oral health in patients with acutely dysphagic stroke is a plausible approach to prevent pneumonia. We aimed to determine whether a phase 3, definitive trial of oral health care (OHC) treatments, supported by staff education and training, is feasible in stroke unit care. The CHOSEN (Chlorhexidine or Toothpaste, Manual or Powered Brushing to prevent Pneumonia Complicating Stroke) trial was conducted and reported in line with the Consolidated Standards of Reporting Trials 2010 statement extended to feasibility trials. We aimed to recruit 120 participants with acute stroke and dysphagia within 24 hours of admission, from 4 stroke units in the northwest of England, randomized (1:1:1:1) to 1 of 4 OHC treatments: manual toothbrush or powered toothbrush with either nonfoaming toothpaste or chlorhexidine 1% gel. Stroke unit nursing staff received standardized education and training. Feasibility was assessed using a priori criteria. Between January 2022 and end of January 2023, 626 patients were screened. A total of 101 participants (median age, 73 [interquartile range, 62-80] years; median National Institutes of Health Stroke Scale score, 10 [interquartile range, 5-18]; 44% women) were enrolled (77% of eligible patients approached). Adherence was 91%, with no substantial difference between the OHC treatments, and 88% completed follow-up. There were 19 serious adverse events but no marked differences between allocated OHC treatments. In exploratory secondary analyses, again there were no substantial differences in survival, incident pneumonia, modified Rankin Scale score, or quality of life at 3 months between the OHC treatment allocations. OHC treatments incorporating chlorhexidine and powered brushing and supported by standardized staff training appeared feasible and safe in patients with acutely dysphagic stroke. Progression criteria were met for a definitive trial of efficacy and cost effectiveness. URL: https://doi.org/10.1186/ISRCTN52421361; Unique identifier: ISRCTN52421361.

A 4-week randomized clinical trial evaluating plaque and gingivitis effects of a new oscillating-rotating electric toothbrush.

Introduction: Changes in the physical properties of manual toothbrush bristles are key indicators of toothbrush effectiveness. While wide-head-type manual toothbrushes have recently gained popularity in Japan, limited research has examined how their bristle properties change over time. This study aimed to investigate time-dependent changes in the overall and individual tuft bristle characteristics of wide-head-type toothbrushes, compared with conventional compact-head-type toothbrushes.Methods: Sixteen participants from Hiroshima University were initially enrolled. After excluding three individuals who withdrew for personal reasons, 13 participants completed the study. Toothbrushes were collected at baseline (T0), after one month (T1), and after two months (T2), with new toothbrushes provided at each time point. In total, 18 wide-head-type and 21 compact-head-type toothbrushes were analyzed. Seven tuft locations were assessed in the wide-head type, and eight in the compact-head type. Bristle splaying and abrasion were measured using a digital microscope and scanning electron microscopy (SEM). For overall bristle splaying, 864 tufts in total were assessed for the wide-head type (48 tufts per toothbrush) and 357 tufts in total for the compact-head type (17 tufts per toothbrush). For individual tuft bristle splaying and abrasion, 126 tufts in total were analyzed for the wide-head type (seven tufts per toothbrush) and 168 tufts for the compact-head type (eight tufts per toothbrush).Results: No significant changes were observed in overall bristle splaying over the two-month period for the wide-head-type toothbrush. The wide-head-type toothbrush had fewer spread tufts than the compact-head-type. During the study period, the total abrasion score per tuft was significantly lower for the wide-head-type toothbrush than for the compact-head-type. Additionally, significant bristle splaying and abrasion were observed only in the rightmost middle region tuft of the wide-head type.Conclusions: Wide-head-type toothbrushes were less susceptible to tuft splaying and abrasion. The number of spread tufts influenced overall brush deformation. Variations in tuft location may differentially affect the rate of bristle wear.

To compare the differences in formation of abfraction lesions using three different types of toothbrushes, i.e. mechanical electric toothbrush, sonic electric toothbrush, and ordinary manual toothbrush. Seventy-one subjects were recruited publicly and randomly divided into three groups with 24 subjects in the mechanical electric toothbrush group (experimental group 1 ), another 24 subjects in the sonic electric toothbrush group (experimental group 2), and 23 subjects in the ordinary manual toothbrush group (control group). The observation period was 12-15 months. During the beginning and the end of the experiment, oral digital impressions were obtained by using 3Shape TRIOS 3 intraoral scanning device (Denmark). The two 3D Object (.stl) files obtained were compared and overlapped by using EXO CAD software，and the numerical values of the cervical changes of all canines, first premolars, and second premolars on the labial and buccal sides of the gingival margin after comparison and overlap were measured using 3Shape 3D ViewerTM software. The cervical defect values of the mechanical electric toothbrush group were significantly higher than those of the sonic electric toothbrush group and the ordinary manual toothbrush group (P＜0.001), and the cervical defect values of the sonic electric toothbrush group were significantly higher than those of the ordinary manual toothbrush group (P＜0.001). There was no significant difference in gender within each group between the mechanical electric toothbrush group and the sonic electric toothbrush group (P＞0.05), while the cervical defect values of the male subjects in the ordinary manual toothbrush group were significantly higher than those of the female subjects (P＜0.001). The cervical defect value of the mechanical electric toothbrush group was significantly higher than that of the conventional manual toothbrush group at 14, 25, 35, 43, 44 and 45 tooth positions among the three groups (P＜0.05). Meanwhile, the cervical defect value of the mechanical electric toothbrush group was significantly higher than that of the sonic electric toothbrush group at 44 tooth position (P＜0.05). There was no significant difference in the defect value among all groups (P＞0.05). Compared with ordinary manual toothbrushes, mechanical electric toothbrushes and sonic electric toothbrushes are more effective in promoting the formation of abfraction lesions. The teeth in the lower right mandible are more susceptible to abfraction lesions caused by mechanical electric toothbrushes.

WHICH ORAL HYGIENE PROTOCOL SHOULD BE FOLLOWED BY PATIENTS WITH FIXED ORTHODONTIC APPLIANCES? A RANDOMIZED CLINICAL TRIAL.

Oral health is a fundamental aspect for the general wellbeing of all people, as it directly affects quality of life and overall health. Maintaining good dental hygiene is key to preventing problems such as cavities, gum disease, bad breath and other oral disorders. However, many people do not brush effectively due to a lack of knowledge about proper technique and the tools necessary for complete oral hygiene. This article aims to explore the different toothbrush options available, focusing especially on how technological advances have enabled the creation of innovative devices that enhance the brushing experience. Through a review of manual toothbrushes, electric toothbrushes and computer-assisted intelligent systems, it seeks to provide a clear view on the most effective tools for maintaining proper dental hygiene. Aimed at anyone interested in improving their oral health, this article aims to teach how to choose the right toothbrush according to individual needs, in addition to presenting technological solutions that facilitate a correct brushing technique. It will also explore modern tools that, through interaction and learning, transform the dental hygiene process into a more effective and motivating experience, promoting a healthy smile over the years.

BackgroundPlaque is causative factor for gingivitis and periodontitis. Mechanical plaque removal is one of most commonly used method. Toothbrush has many modifications since decade. New bristles claim to remove more plaque and improve oral hygiene. The objective was to assess the effectiveness of three different bristle designed toothbrushes in terms of plaque removal and gingival inflammation.MethodsA concurrent parallel randomized clinical trial was done among 105 female undergraduate medical students in which both examiner and analyser were blinded throughout the study period. The population was divided into three groups A, B and C (1:1:1) according to computer generated random list and assigned three different toothbrushes Oral B pro health (Crisscross), Oral B shiny clean toothbrush (Zigzag), Oral B sensitive care (Flat), respectively. Along with the toothbrushes, a fluoridated toothpaste was also provided. At baseline proper oral hygiene instruction and brushing method was demonstrated. Baseline plaque and gingival ghbvindex score was assessed by using Silness J and Loe H (1964) and Loe H and Silness J (1963), respectively. The follow up data collections were done at 7,14 and 21 days. Friedman’s test was used to assess the association of plaque and gingival scores in different follow up. Pairwise PI and GI score were recorded and intergroup comparison of plaque and gingival scores were calculated by using Kruskal Wallis test.ResultThere were 35 participants allotted in each group. When compared to overall plaque and gingival score, there were significant reduction in every follow up (p < 0.001). However, Zigzag tooth brush showed more reduction in plaque and gingival score; mean rank scores were 38.69 and 26.56, respectively but it was not statistically significant (p > 0.05).ConclusionThis study showed that the three different toothbrushes were equally effective in plaque removal and reduction of gingival inflammation. The Zigzag toothbrush showed maximum reduction in plaque and gingival inflammation; however, the difference was not significant.Clinical Trial registrationThe study was retrospectively registered in ANZCTR on 21/02/2025 with trial registration number ACTRN12625000213448.

This present study has two primary objectives: firstly, to compare the effectiveness of an electric toothbrush versus a manual toothbrush in biofilm removal; secondarily, to assess the effectiveness of individualised instructions provided by the operator. Fifty-five paediatric patients were enrolled in the study. Data collection involved three main steps: 1) Pre-brushing PCR index collection; 2) Post-brushing PCR index collection; 3) Post-brushing PCR index collection after providing individual instructions. The tooth surfaces were colored with a liquid plaque detector. To assess whether there was a statistically significant difference in plaque values before and after brushing, a Wilcoxon signed-rank test was conducted. The Wilcoxon test with continuity correction was performed to compare the two brushing methods. It is possible to confirm a correlation between instructions provided by the operator and lower plaque index. As regards the comparison between manual and electric toothbrush, in our study one tool did not emerge as more effective than the other.

This randomized crossover trial involving adult participants with ≥ 10% plaque coverage on anterior teeth compared dental plaque regrowth dynamics between an oscillating-rotating (O-R) electric toothbrush and a manual toothbrush using Digital Plaque Imaging Analysis. Thirty-four participants were randomized to one of 4 treatment sequences, each having four 8-day treatment periods. Participants brushed twice daily with the assigned toothbrush. Morning and afternoon plaque were evaluated on Days 1, 3, and 8. The primary variable was afternoon percent plaque coverage, using repeated measures analysis from Days 1, 3, and 8. The O-R toothbrush produced lower mean plaque levels versus the manual toothbrush for all endpoints (p ≤ 0.001). The benefit for the O-R toothbrush increased over time, demonstrating 16.4% (p = 0.001) and 28.1% (p < 0.001) lower afternoon plaque levels on Days 1 and 8, respectively, compared to the manual brush. Trends were similar for morning plaque. Repeated measures analyses showed a 21.2% reduction in overall afternoon plaque and a 23.5% reduction in overall morning plaque for the O-R brush versus the manual brush (p < 0.001). The O-R toothbrush controlled plaque regrowth better than a manual toothbrush and should be considered to reduce plaque-related diseases as part of a generalized prophylaxis and treatment plan. ISRCTN Registry: ISRCTN 28649560.

ANTIPLAQUE AND ANTIGINGIVITIS EFFECTS OF A NOVEL ORAL CARE REGIMEN FEATURING STANNOUS FLUORIDE TOOTHPASTE, A UNIQUE TOOTHBRUSH, AND CETYLPYRIDINIUM CHLORIDE MOUTHWASH: A RANDOMIZED CLINICAL TRIAL.

To assess the impact of formulation chemistry on gingivitis effects of two experimental 0.454% stannous fluoride (SnF2) dentifrices with low tin bioavailability versus positive and negative controls. Adults with gingivitis were enrolled in this double-blind, parallel group, randomized clinical trial. Gingivitis was assessed with the Löe-Silness Gingivitis Index (LSGI) at baseline, 1 month, and 3 months. The four treatments were: experimental dentifrice A (0.454% SnF2, pH 4.7, soluble tin = 592 ppm), experimental dentifrice B (0.454% SnF2, pH 5.8, soluble tin = 102 ppm), positive control (0.454% SnF2 commercial dentifrice, soluble tin = 2,037 ppm), and negative control (0.76% sodium monofluorophosphate, soluble tin = 0 ppm). Participants brushed for 1 minute twice daily with their assigned dentifrice and a standard manual toothbrush. The primary clinical endpoint was number of gingival bleeding sites. In vitro analyses characterized tin uptake into biofilm and bacterial glycolysis. Of 120 participants randomized to treatment, 115 completed the study. Baseline mean number of bleeding sites (SD) was 35.11 (17.479). At 1 and 3 months, respectively, the mean was 19.52 and 16.64 for the positive control, 26.91 and 21.71 for Experimental dentifrice A, 31.01 and 27.59 for Experimental dentifrice B, and 33.20 and 29.59 for the negative control. At 1 and 3 months, the positive control showed significantly fewer bleeding sites versus all treatments (P≤ 0.04) and Experimental dentifrice A had significantly less bleeding versus the negative control (P≤ 0.041). Experimental dentifrice B was not significantly different from the negative control (P≥ 0.438) at either timepoint. Tin biofilm uptake and in vitro PGRM exhibited a similar trend. SnF2 dentifrice formulation chemistry influences the level of antigingivitis efficacy, which was also reflected in tin bioavailability, tin uptake into biofilm, and bacterial glycolysis inhibition.

This study investigated the plaque removal efficacy of a suction-type sonic toothbrush compared to a conventional manual toothbrush in preschool children aged 30 to 59 months. Using a randomized, double-blind, crossover design with a 2-week washout period, 20 pediatric participants were allocated to two study phases, each using either the suction-type sonic toothbrush or the manual toothbrush with caregiver assistance. The plaque removal effectiveness was assessed through the Silness and Löe plaque index and quantitative light-induced fluorescence values, including ΔR30 and ΔR120 indicators of plaque index. The result showed no statistically significant differences in plaque removal efficacy between the two toothbrushes, although both showed similar improvements. Caregiver feedback revealed high acceptability of the suction-type sonic toothbrush due to its convenience and engaging features, such as a light and suction function, which enhanced the tooth brushing experience. Although limited by the short follow-up period and small sample size, the findings suggest that suction-type sonic toothbrushes may offer practical benefits for young children requiring caregiver assistance.

Daily toothbrushing is an essential habit for preventing dental diseases. However, existing technologies to monitor the effectiveness of toothbrushing are very limited. In this paper, we present the design of iBrush, a system that can detect incorrect brushing techniques, localize brushing surfaces, and estimate brushing duration on each surface using an off-the-shelf smartwatch during manual toothbrushing. iBrush employs a novel toothbrush design in which small magnets are attached to the handle of a toothbrush so that its orientation and motion can be captured by the magnetic sensor in the user's smartwatch. iBrush also uses the inertial sensor on the smartwatch to classify different types of arm/wrist brushing movements. Combining the toothbrush orientation and the hand movement patterns, our system can recognize the effectiveness of toothbrushing. Acoustic signals collected from the smartwatch and user-specific toothbrushing order are also utilized to improve recognition accuracy. We implemented the proposed system on a commercial smartwatch. In extensive experiments with 12 users over three weeks, our system successfully incorrect toothbrushing brushing techniques with an F1 score of 90.5% and localized the sixteen brushing surfaces with a F1 score of 85.6%.