Manual Toothbrush Research Articles

THE EFFECT OF SPECIALIZED HYGIENE PRODUCTS ON THE MORPHOLOGY OF THE SURFACE OF THERMOPLASTIC POLYMERS USED AS THE BASES FOR REMOVABLE DENTURES

Despite the progress observed in implantology and the rapid evolution of preventive and treatment options employed to treat major dental issues, the number of patients who need prosthetics with removable dentures still remains high, with no decrease trend to be expected soon. Modern dentistry, when dealing with issues related to dentition restoration, makes full use of basic thermoplastic polymers incorporating injection molding technology, whereas the said polymers can boast of such properties as biological inertia, proper aesthetics, strength, flexibility, resistance to external effects, lightness and elasticity. The conventional techniques used for cleaning and disinfecting removable dentures made of thermoplastic polymers fail to be up to the respective advanced requirements – such dentures create environments that are favorable for adhesion and microbial colonization. Aiming to evaluate the effectiveness of the modern means used for cleaning and disinfecting removable denture structures based on thermoplastic polymers, there was a study carried out to investigate the surface of 60 experimental samples of Acry-free ® thermoplastic, including methods of scanning electron microscopy and atomic force microscopy. To analyze the effect that cleaning and disinfecting agents work on the hygienic status of partially removable dentures made of thermoplastics (manufactured for 74 patients suffering from partial adentia), the Ambjornsen E. questionnaire was employed. The developed original set of preventive measures involved thorough oral hygiene activities with a manual toothbrush and mouthwash balms, as well as a consistent use of a special toothbrush and gel paste to take care of the removable dentures, followed with ultrasonic treatment and cleansing with effervescent tablets. The data of scanning electron microscopy and atomic force microscopy showed that using the original set of preventive measures resulted in improved quality of the thermoplastic polymers surface – by 1.1 – 1.5 times, if compared with conventional hygiene and disinfection products. As the data of sociological monitoring reveal, 12 into using the developed preventive measures, over 69% of patients were satisfied with the aesthetic properties of their dentures based on thermoplastics; as for the patients sticking to the practice relying on traditional hygiene and disinfection products, the similar indicator would not exceed 25%. In order to prevent the occurrence of major dental issues, as well as to increase the useful life of dentures made of thermoplastics and used by patients with partial adentia, it is wise to employ an individual approach to the selection of preventive measures that involve specialized extra hygiene products.

A Randomized Controlled Trial for Evaluation of the Effectiveness of Oral Irrigator and Interdental Floss for Plaque Control in Children with Visual Impairment.

To evaluate the effectiveness of oral irrigator and interdental floss as adjuncts to manual tooth brushing in 8-16 years old children with visual impairment. A three-arm, parallel-group randomized controlled trial with blinded outcome assessment was carried out with the inclusion of 90 institutionalized children with visual impairment of age 8-16 years. They were equally allocated to three groups: group I: tooth brushing along with interdental flossing, group II: brushing along with a powered oral irrigator, and group III: brushing alone (control). Baseline oral hygiene index-simplified (OHI-S), gingival index (GI), and plaque index (PI) scores were recorded for all the samples and compared with post-intervention scores at 14 and 28 days intervals. Repeated measures of analysis of variance (ANOVA), one-way ANOVA, and post hoc Tukey tests were used for statistical analysis. At 28 days interval, children in group II showed a highly statistically significant reduction in OHI-S (0.46; p = 0.0001), PI (0.16; p = 0.0001), and GI (0.24; p = 0.0001) scores compared to control group. They also showed a significant reduction in OHI-S (0.25; p = 0.018), PI (0.15; p = 0.011), and GI (0.15; p = 0.0001) scores compared to group I. There is no significant reduction in the scores of children of group I compared to control group except for the GI score (0.08; p = 0.02). Oral hygiene maintenance using oral irrigator along with brushing was found to be more effective in visually challenged children. Interdental flossing, along with brushing and brushing alone was found to be less effective. This study underlines the fact that comprehensive oral hygiene care should include interdental cleaning aids for effective plaque control to prevent dental diseases in children with visual impairment. Since these children have less manual dexterity to perform good oral hygiene practices, electrically driven interdental cleaning aids like oral irrigator may help them to overcome the problem. Deepika V, Chandrasekhar R, Uloopi KS, et al. A Randomized Controlled Trial for Evaluation of the Effectiveness of Oral Irrigator and Interdental Floss for Plaque Control in Children with Visual Impairment. Int J Clin Pediatr Dent 2022;15(4):389-393.

Oral hygiene interventions to prevent ventilator‐associated pneumonia: A network meta‐analysis

AbstractBackgroundVentilator‐associated pneumonia (VAP) is a common complication in ventilated patients. The endotracheal tube acts as a conduit for oral cavity pathogenic bacteria into the lungs due to an imperfect cuff seal. Oral hygiene is designed to remove plaque and debris where bacteria multiply, reducing the risk of ventilator‐associated pneumonia.AimsTo assess the comparative effects of oral hygiene agents and modalities on VAP incidence in critically ill mechanically ventilated patients and to assess their relative ranking according to their effects.Study DesignSystematic review and network meta‐analysis (PROSPERO registration CRD42021259690). We retrieved randomized controlled trials using oral hygiene procedures from a recent Cochrane review and updated the search to December 2021.ResultsWe included 30 RCTs with 3980 participants. Some interventions, such as miswak and nanosil, may result in a large decrease in VAP incidence (miswak RR 0.05, 95% CI 0.00–1.21; nanosil RR 0.08, 95% CI 0.01–0.88), but some confidence intervals include substantial benefits and harms. Powered toothbrushing and manual toothbrushing may result in a large decrease in VAP incidence (powered toothbrushing RR 0.55, 95% CI 0.30–1.00; manual toothbrushing RR 0.65, 95% CI 0.40–1.04); however, the confidence intervals may indicate little to no significant difference. The certainty of the evidence was mostly low due to the small sample size and risk of bias.ConclusionsLow‐certainty evidence indicates that miswak and nanosil may reduce VAP incidence. Moreover, toothbrushing may also reduce VAP incidence and mortality. High‐quality RCTs are needed to establish the relative effectiveness of these interventions.Relevance to Clinical PracticeSeveral oral agents may decrease VAP incidence and mortality. Powered toothbrushing and manual toothbrushing may decrease VAP incidence and mortality.

Interplay Between the In-Vitro Cleaning Performance and Wear of Manual Toothbrushes.

This in-vitro study deals with the question of whether the wear and tear of the manual toothbrush over a simulated timeframe up to 24 months has an effect on its cleaning performance. The purpose was to find indications as to whether and when a toothbrush needs to be replaced based on its cleaning performance. Models equipped with artificial teeth (coated with titanium dioxide) were brushed in-vitro using a brushing machine with clamped manual toothbrushes. The machine carried out even, horizontal brush strokes (120 brush strokes/min) for 1 min with a constant contact pressure of 2.5 N. The percentage of the area of titanium dioxide removed from the buccal, mesial and distal surfaces of the artificial teeth corresponded to the cleaning performance. The manual toothbrushes were used on bovine roots to simulate the wear and tear after 2, 4, 6, 12, 18, 24 months of use. The cleaning performance was re-evaluated after each simulated timepoint of wear. In addition, the brushes were photographed after each cycle. An increase in the in-vitro cleaning performance of the toothbrush was observed up to 6 months of wear compared to the starting point. After that, the cleaning performance decreased somewhat, but always remained above the initial cleaning performance. Based on the in-vitro cleaning performance after 24 months, the toothbrush would not have to be replaced. However, this in-vitro study cannot determine when a toothbrush should be replaced, because in-vivo it is also dependent on a variety of other factors such as fraying and microbial colonisation. Direct transfer of results from this study to everyday clinical practice is therefore difficult.

Antiplaque and antigingivitis efficacy of new and worn manual toothbrushes: A systematic review and meta-analysis.

To systematically review the literature about the antiplaque and antigingivitis efficacy of new and worn manual toothbrushes. Five databases were searched to identify randomized controlled trials, involving adults, comparing the clinical efficacy of new and worn manual toothbrushes. Experimental groups need to have different usage time in changing their manual toothbrush. Two reviewers performed studies selection, data extraction and risk of bias assessment independently. Meta-analyses were performed comparing the toothbrushes after a single use (antiplaque efficacy) and after multiple uses (antiplaque and antigingivitis efficacy). Eight studies were included, totalling 344 individuals. In studies with a single-use design, no statistically difference was found between new and worn toothbrushes for antiplaque efficacy (SMD:-0.39; 95%CI:-0.80 to 0.03). Studies with a multiple-use design showed no statistically difference between groups for the antigingivitis efficacy (MD:-0.10; 95%CI:-0.24 to 0.03). However, higher antiplaque efficacy was demonstrated in new toothbrushes in the studies with a multiple-use design (SMD:-0.75; 95%CI:-1.37 to -0.14). The certainty of the evidence ranged from very low (antiplaque) to low (antigingivitis). New and worn toothbrushes presented similar antiplaque and antigingivitis efficacy. However, further randomized controlled trials, with a lower risk of bias, are needed to enhance the certainty of this evidence.

Comparison of Power versus Manual Toothbrush in Reducing Gingivitis

Introduction: Dental plaque is a bacterial biofilm consisting of complex communities of bacterial species. Materials and Methods: The study was a single-blind, parallel arm, randomized, controlled interventional trial. Total 46 male and female subjects (32 female and 16 males) with a mean age of 26 years were enrolled according to the admission criteria and accepted into this study. The subjects were assigned to either the powered brush or the manual brush based on levels of inflammation (% BOP, MGI-52), and plaque levels (53, 54, 55) using screening data. Results: BOP decreased from baseline 22% to 17% at 2 weeks and 16% at 4 weeks for Power users (Group A). For Manual users (Group B), BOP decreased from baseline 27% to 21% at 2 weeks and 19% at 4 weeks; so both groups had a reduction in BOP but there was no statistical significance for either group. Conclusion: Both groups demonstrated a reduction in signs of gingivitis (BOP and GI) in this non-flossing population after being repeatedly trained in toothbrush use over a 4-week period. Both toothbrushes were equally effective in reducing overnight plaque as a single use exercise after initial professional training.

Cleansing efficacy of an auto-cleaning toothbrushing device with nylon bristles: a randomized-controlled pilot study

ObjectivesTo compare the cleansing efficacy of an auto-cleaning device with nylon bristles (Y-brush®) to that of manual toothbrushing.Materials and methodsTwenty probands refrained from oral hygiene for 3 days. Rustogi Modified Navy Plaque Index was assessed before and after (randomized) toothbrushing either with the auto-cleaning device for 5 s per jaw or with a manual toothbrush for a freely chosen time up to 4 min. The clinical investigation was repeated in a cross-over design. In a third trial period, the brushing time for auto-cleaning was increased to 15 s per jaw. The study was supplemented by plaster cast analyses.ResultsFull-mouth plaque reduction was higher with manual toothbrushing than with auto-cleaning for 5 s per jaw (p < 0.001). There was no statistically significant difference on smooth tooth surfaces but on marginal and interdental sites. Increasing the brushing time of auto-cleaning to 15 s per jaw resulted in a comparable full-mouth plaque reduction as with manual toothbrushing (p = 0.177). In 95% of individuals, the device was too short not completely covering second molars. In 30.67% of teeth, the gingival margin was not covered by bristles.ConclusionsAuto-cleaning devices with nylon bristles have a future potential to reach plaque reduction levels comparable to manual toothbrushing, although manufacturers must focus on improving an accurate fit.Clinical relevanceUnder the premise of an ameliorated fit, the auto-cleaning device might be recommendable for people with low brushing efficacy. Interdental sites remain a failure point if adjunct interdental cleaning is not viable.

SKILLS OF INDIVIDUAL ORAL HYGIENE IN CHILDREN WITH ORTHODONTIC PATHOLOGY

Relevance. Orthodontic pathology contributes to the deterioration of the hygienic condition of the oral cavity in children and increases the risk of developing dental caries and inflammatory periodontal diseases. In this regard, rational and effective oral hygiene becomes especially relevant.&#x0D; Aim of this study is to analyze the results of a questionnaire of children with orthodontic pathology regarding the skills of individual oral hygiene and oral hygiene products they use.&#x0D; Materials and methods. A dental examination of 138 children aged from 14 to 17 years with orthodontic pathology was carried out. Before starting the treatment, the children filled out a specially developed questionnaire that contained 20 questions with suggested answer options. The children were surveyed in the presence of parents; the children answered the questions independently by filling out a Google form, parents were not allowed to intrude into the survey.&#x0D; Results. 73 children (52.9%) followed the recommendations to brush their teeth twice a day in the morning and in the evening. 47 (34.1%) children reported about brushing their teeth in the morning only and 6 (4,3%) children brushed their teeth in the evening. 35 (25.4%) children admitted that they did not brush their teeth every day. 76 children (55.1%), i.e. more than half, were fount to spend no more than 1 minute for toothbrushing, another 35 surveyed children (25.4%) indicated that their brushing time, as a rule, did not exceed 2 minutes, and only 25 children (18.1%) followed the recommended time of 3-5 minutes. Among all the participants, 53 children (38.4%) regularly brushed their teeth after meals, 28 (20.3%) – before meals. 57 children (41.3%) reported no established order between meals and oral routine in the morning, some of them said that oral hygiene might depend on food, others paid no attention to the sequence between meal and oral hygiene. 66 (47.8%) children are not interested in the immediate result of the performed cleaning, 42 children (30.4%) received some information about the quality of oral cavity care only at a dentist’s appointment, 30 children (21.7%) monitored the state of oral hygiene by using mirror without the additional dye indicators. The vast majority of children, 57.2%, used a manual toothbrush for oral hygiene, 31 children (22.5%) reported about regular use of an electric toothbrush, and 28 children (20.3%) indicated for periodic alternation regarding the use of toothbrushes of one or another type of teeth. 58 children (42.0%) indicated that the main motivational incentives for choosing brushes were their design and colour, while 33 (23.9%) and 24 (17,4%) children chose brushes based on the advice of their dentists or parents, respectively. 15 children&#x0D; (10.9%) chose toothbrushes without attaching any importance to this. Every 2-3 months, 67 children (48.6%) replaced a worn-out toothbrush with a new one, every 4-6 months – 27 children (19.6%), 40 children (29.0%) were not interested in the replacement period. All the participants used toothpaste, but half of them, namely, 70 children (50.7%), were guided by its organoleptic properties, colour, package design, etc. when choosing paste; 49 children (35.5%) followed the recommendations of dentists, while 11 children (8.0%) did not think about what toothpaste to choose. Toothpastes with complex action or anti-caries activity were used by 44 (31.9%) and 40 (29.0%) children, respectively, but 22 children (15.9%) did not pay any attention to toothpaste composition, indications and contraindication. Some children are informed about interdental hygiene products. Thus, 21 children (15.2%) reported about regular use of dental floss for interdental cleaning, 12 children (8.7%) also used it, but only occasionally, 26 children (18.8%) indicated that they used an irrigator, but at the same time 105 children (76.1%) never used dental floss, and 112 (81.2%) used an irrigator.&#x0D; Conclusion. According to the results of the questionnaire, the level of awareness of children with orthodontic pathology about rational and effective individual oral hygiene routine and products is far from being completely satisfactory. The development of additional oral hygiene recommendations for children with such problems seems appropriate and necessary.

Oral Health Care of People with Down Syndrome in Germany.

Background: Due to a dearth of information on preventive and supportive oral care for people with Down Syndrome (PDS) in Germany, caregivers of PDS were surveyed on the topic. Methods: An anonymized questionnaire was sent to the 610 members of the German Down Syndrome Association. The study was approved by the ethics committee of Witten/Herdecke University (# 165/2017). Results: The parents/caregivers of 207 PDS responded. These PDS were between 1 and 55 years old (mean age 24.4 years) and included 111 males and 96 females. At their first dental appointment, 40.7% (n = 82) had been younger than three years. Although 78.3% (n = 162) tooth brushed twice daily, only 30.9% (n = 64) brushed for 2–3 min; 84.0% (n = 135) did not use other dental hygiene products apart from toothbrushes. Age-specific differences were found: Although only 30.8% (n = 12) of PDS < 18 years (n = 39) independently performed dental self-care; this was 67.3% (n = 113) for PDS ≥ 18 years (n = 168). A statistically significant (p < 0.001; Chi-Square-Test) difference in toothbrush preferences emerged: While PDS < 18 years mainly used manual toothbrushes, PDS ≥ 18 years preferred electric toothbrushes. In contrast to 72.6% of PDS ≥ 18 years, only 51.3% of PDS < 18 years accepted most types of toothpaste. Conclusions: Age-dependent differences in tooth brushing behaviour became evident within the group of PDS in Germany. Hence, better age-specific, inter-professional dental prophylaxis concepts need to be developed and offered for all age groups of PDS. These concepts should include personalized check-up intervals and hands-on instruction in dental hygiene procedures by dental practitioners.

Home oral hygiene is associated with blood pressure profiles: Results of a nationwide survey in Italian pharmacies.

Periodontal diseases are associated with cardiovascular risk factors/diseases, and whether home oral hygiene practices are inversely related to the same conditions could carry relevant practical implications. We investigated the association of home oral hygiene habits with hypertension. During World Hypertension Day 2020, a nationwide cross-sectional survey was conducted on volunteers ≥18 years at 733 Italian pharmacies. Participants underwent standardized blood pressure (BP) measurement and answered a questionnaire on cardiovascular risk factors, oral health status, and home oral hygiene habits (toothbrushing daily frequency and manual/electric toothbrush). The association between home oral care habits and BP was assessed using multivariate logistic regression. Interactions between exposures and outcome were formally tested. Among the 4506 participants (44.8% males, 66.1± 37.8 years), 47.6% reported brushing ≥3 times/day and 23.4% declared using the electric toothbrush. Brushing ≥3 versus &lt;3 times/day and use of electric versus manual toothbrush were associated with 19% (odds ratio [OR]: 0.81, 95% confidence interval [CI] 0.70-0.94) and 28% (OR: 0.72, 95% CI 0.61-0.85) lower odds of hypertension, respectively. No significant additive interaction was observed in the association of exposures with the outcome. Regular daily brushing and electric toothbrushing are associated with a better BP profile in a real-world context. Future interdisciplinary research is warranted to test these findings.

Status Quo in Mechanical Plaque Control Then and Now: A Review.

There are various kinds of dental diseases, of which dental caries and disease of periodontal origin are the most common. A very strong connection has been proven between oral inflammation and general health of an individual. Dental Biofilm is the main cause for gingivitis and periodontitis. Dental plaque may also be referred to as microbial plaque that consists of highly organized structures of different microbiotas attached to the hard tooth structure, which may be bound by salivary glycoproteins. Plaque control is a term that refers to removal of already formed or the control of formation of this microbial biofilm. There have been various methods practiced for plaque control; they are broadly classified into mechanical methods and chemical plaque control methods. Mechanical plaque control further includes many other methods such as manual toothbrushes and smart toothbrushes, which includes power-driven toothbrushes, sonic and ultrasonic toothbrushes, solar-powered toothbrushes (ionic toothbrushes), disposable toothbrushes, and laser toothbrushes; this also includes interdental cleaning aids. Continuous advancements with the integration of technology have been made in the field of mechanical plaque control to improve its quality.

A Randomized Clinical Study of the Plaque Removal Efficacy of a Novel Manual Toothbrush With Micro-Pulse Bristles on Fixed Orthodontic Patients.

BackgroundFixed orthodontic appliances on tooth surfaces, such as brackets and bands, complicate oral hygiene and increase plaque accumulation, contributing to gingivitis, periodontitis, and tooth decay. While manual toothbrushes are an essential part of oral hygiene, there is little clinical evidence to demonstrate how effective manual toothbrushes with novel designs are at removing plaque from orthodontic patients. This study aims to evaluate three types of manual toothbrushes (Pulsar, conventional flat trim (C-TB), and orthodontic type (O-TB)) for their efficacy in plaque removal among patients undergoing fixed orthodontic treatment.MethodologyThe study followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. It was a three-treatment, three-period, examiner-blinded crossover clinical trial conducted with a single brushing exercise. Twenty-four subjects were randomized to one of three different bristle designs (Pulsar, C-TB, and O-TB). The primary outcome measure was the difference (baseline minus post-brushing) in plaque scores assessed using the Turesky-Modified Quigley-Hein Plaque Index during each study period.ResultsOf the 27 subjects enrolled in the study, 24 met the inclusion criteria and completed all three periods of the study. The mean age was 19.58 ± 1.55 years, with a range of 18-23 years. The differences between treatments in plaque score reduction after brushing were statistically significant (p-value <0.001). The treatment differences were statistically significant (p-value <0.001), favoring the C-TB toothbrush and the O-TB over the Pulsar design. On the contrary, the difference between the O-TB and C-TB types was not statistically significant.ConclusionsC-TB and O-TB remove significantly more plaque than Pulsar toothbrushes after a single brushing exercise. Nevertheless, the C-TB tested in this study was more effective in removing dental plaque than the O-TB in patients wearing fixed orthodontic appliances. Considering the limitations of this study, additional research is required before evidence-based advice concerning the relative performance of the Pulsar toothbrushes in fixed orthodontic patients can be proven.

Powered Toothbrushes: An Opportunity for Biofilm and Gingival Inflammation Control.

The present review aimed at a broad investigation on the potential of powered as compared to manual toothbrushes in different aspects of clinical dentistry. Studies evaluating plaque and gingival inflammatory parameters were included, as well as those that investigated adverse effects. Emphasis was given separately to adults, youngsters, special-needs patients, and those under fixed orthodontic therapy. In general, comparisons favored powered toothbrushes. In summary, approximately 68% of the included studies, in terms of plaque/gingival inflammation in adults, presented better results for powered toothbrushes. In children and special-needs populations, approximately 40% of the included studies favored powered toothbrushes for plaque/gingival inflammation, and none favored manual ones. In orthodontic individuals, 50% of the studies also demonstrated a better effect of powered toothbrushes on plaque and gingival inflammation. All included studies that assessed adverse events did not demonstrate a difference in these effects when comparing manual vs. powered toothbrushes. It is concluded that the use of powered toothbrushes is an opportunity to enhance patterns of plaque control and associated gingival inflammation.

Effectiveness of Apple Cider Vinegar and Mechanical Removal on Dental Plaque and Gingival Inflammation of Children With Cerebral Palsy.

BackgroundThis study was designed to evaluate the effect of apple cider vinegar (ACV) 5% and mechanical plaque removal with a manual toothbrush on dental plaque and gingivitis. The objective was to study available, natural, and inexpensive ways to improve oral health status among the studied group.Materials and methodsA randomized clinical trial was performed on 50 children with cerebral palsy aged from three to six years. Participants were divided into two groups (n=25, apple cider vinegar, manual brushing without toothpaste). Plaque accumulation and gingival status were evaluated using Turesky of the Quigley-Hein plaque index (TQHPI) and modified gingival index (MGI) seven times: pre-intervention baseline (T0), post-intervention at one month (T1), two months (T2), three months (T3), four months (T4), five months (T5), six months (T6).ResultsPlaque accumulation and gingivitis decreased significantly for the ACV group between T0 and T6 (p<0.05) and demonstrated significantly lower plaque accumulation and gingivitis compared to the manual brushing group (p<0.05) at T5 and T6. The manual brushing group showed decreasing in TQHPI between T0 and T3, then TQHPI increased significantly (p<0.05) at T4, T5, and T6.ConclusionsTo sum up, this in vitro study has demonstrated the possibility of using apple cider vinegar to reduce plaque and gingivitis. In addition, without additives, apple cider vinegar has both mechanical and chemical effects on dental plaque, and it may be a natural, available, inexpensive, and harmless substance that can improve the quality of oral care for difficult groups of children and people with special needs. Unlike toothbrushes, especially electric toothbrushes, they are effective, but they may be expensive and not available to all children.

The Comparative Plaque Removal Efficacy of Charcoal Based and Non Charcoal Based Manual Toothbrushes: A Clinical Study

Background: The studyaimed to compare the plaque removal efficacy of a novel- charcoal-based and a non-charcoal-based manual toothbrush of standardised toothbrush design. Materials And Methods: Sixteen undergraduate students of Sri Ramakrishna Dental College and hospital, Coimbatore, were included in this clinical study. This is a randomised clinical trial with a split-mouth design in which the quadrants that undergo tooth brushing using charcoal-based (test) and non-charcoal-based (control) toothbrushes are randomly selected by tossing a coin. The subjects were asked to refrain from all kinds of oral hygiene practices for 48 hours, following which pre-brushing and post-brushing plaque scores were evaluated by Turesky Gilmore modification of Quigley-Hein plaque index using a two-tone disclosing solution. Tooth brushing was performed by the examiner for a standard time (45sec/quadrant) using the Modified Bass brushing technique with fluoridated toothpaste. Results: The study's results showed no statistical significance between the values. However, the correlation between the total plaque scores and the assigned toothbrushes was also analysed, and a positive correlation was observed between the total plaque score and the test toothbrush. Conclusion: The plaque removal efficacy of charcoal bristled manual toothbrushes with 0.01mm diameter was found to be more or less the same compared with the similar non-charcoal-based counterpoint (1.89,1.39) respectively. Key-words: Charcoal-based toothbrush, Modified Bass brushing technique

Robot and mechanical testing of a specialist manual toothbrush for cleaning efficacy and improved force control.

BackgroundToothbrushes 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.MethodsIn 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).ResultsStudy 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.ConclusionThe 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.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-022-02211-4.

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.

The role of toothbrush in the transmission of corona- and influenza viruses — results of an in vitro study

ObjectivesThe aim of this in vitro study was to investigate viruses’ stabilities on manual toothbrushes using feline coronavirus (FeCoV) as representative of coronaviruses and an Avian influenza A virus H1N1 for influenza viruses.Material and methodsTwo viruses, FeCoV (Strain Munich; titer 107.5 TCID50/ml) and H1N1 (RE 230/90; titer 106.5 TCID50/ml), were used in this study. Manual toothbrushes were disassembled into bristles, bristle fixation, and back of the toothbrush head, contaminated with the viruses and air-dried for 24 h. In a second experiment, whole toothbrush heads were contaminated, rinsed with water (5 ml for 15 s) and then air-dried.ResultsFor FeCoV, immediately after contamination, the following average titers were recovered: fixation: 106.41, back of head: 106.81 and bristles: 106.63 TCID50/ml. Following air-drying of 12 (fixation) and 24 h, titers of ≤ 102.5, 103.75, and 102.72 TCID50/ml were found in the respective groups, with a detection limit of 102.5 TCID50/ml. For H1N1, immediately after contamination, the following average titers could be recovered: fixation: 105.53, back of head: 105.97 and bristles: 105.75 TCID50/ml. Following air-drying of 8 (fixation) and 24 h, titers were ≤ 102.5, 103.63, and 103.53 TCID50/ml in the respective group, again with 102.5 TCID50/ml being the detection limit. In case of water rinse, no infectious virus could be recovered after 12 h.ConclusionViral load of both viruses is reduced by air-drying, especially following water rinsing.Clinical relevanceThe toothbrush itself plays an insignificant role in the self-transmission of coronavirus and influenza virus.

Plaque removal by a novel prototype power toothbrush versus a manual toothbrush: A randomized, exploratory clinical study.

ObjectivesThis exploratory study investigated plaque removal with a prototype constant, low rotation speed Power Toothbrush (PTB) with two brushing actions: “Gumline” (head rotates in the horizontal axis) and “Interdental” (head rotates in the vertical axis). Gumline alone and “Combined” (Gumline + Interdental) modes were compared with a Reference PTB and a Reference Manual Toothbrush (MTB) after one brushing.Materials and MethodsThirty‐nine participants were randomized to use each toothbrush once either in the sequence (A) Prototype PTB (in Gumline then Combined mode), (B) reference MTB, and (C) reference PTB or the sequence BAC. There was a minimum 3‐day washout between the use of each toothbrush. Plaque removal was measured using the Rustogi Modified Navy Dental Plaque Index (RMNPI) with change from baseline investigated using an analysis of covariance model. RMNPI scores were calculated on a “whole mouth” basis and along the gingival margin and at proximal sites only.ResultsFor the primary efficacy variable, a significant difference was found in favor of the prototype PTB in gumline mode versus the reference MTB for whole mouth plaque score (difference: −0.06; standard error: 0.014; 95% confidence interval [CI] −0.09 to −0.04; p < .0001). Similar significant differences were found in gingival margin and proximal areas (p < .0001). The prototype PTB in gumline mode removed significantly less plaque than the prototype PTB in combined mode and the reference PTB (p < .0001; whole mouth/gingival/proximal areas). The prototype PTB in combined mode removed significantly more plaque than the reference MTB (p < .0001; whole mouth/gingival/proximal areas) and the reference PTB for whole mouth (p = .0214) and gingival margin areas (p = .0010). The reference PTB also removed significantly more plaque than the reference MTB (p < .0001; whole mouth/gingival/proximal areas). All brushes were generally well‐tolerated.ConclusionThe prototype PTB design, providing two distinct cleaning modalities, can effectively remove plaque to a significantly higher degree than an MTB and a marketed PTB, depending on mode.

Effectiveness of an Essential Oil Mouthwash in Maintaining Proper Oral Health in Orthodontic Patients—An In Vivo Study

Introduction: Patients undergoing orthodontic therapy face greater difficulties in maintaining good oral hygiene. To improve mechanical plaque removal, a common strategy is to incorporate a chemotherapeutic agent. Thus, the effects of adding essential oil mouthwash to a standard oral hygiene regimen to maintain oral health were evaluated. Material and Method: Two groups were created with 25 patients each. Gingival index and orthodontic plaque index were calculated as initial reading. Gingival index and orthodontic plaque index were calculated again after 6 months. Result: In the control group, the mean score of gingival index and orthodontic plaque index were significantly increased from baseline reading (T1) to after 6 months reading (T2). In the experimental group, increase in the mean score of gingival index and orthodontic plaque index was not statistically significant. Conclusion: When an essential oil mouthwash is added to the daily oral hygiene regimen (conventional manual toothbrushing + brushing with monotufted brush), it maintained the gingival health and amount of plaque accumulation in orthodontic patients over a period of 6 months.