Power Toothbrush Research Articles

Toothbrush abrasivity in a long-term simulation on human dentin depends on brushing mode and bristle arrangement.

ObjectiveThe aim of this study was to evaluate the susceptibility of dentin to brushing abrasion using four different toothbrushes (rotating-oscillating, sonic and two types of manual toothbrushes) with the same brushing forces.MethodsDentin samples (n = 72) were selected from 72 impacted third molars. Half of the surface of dentin samples was covered with an adhesive tape, creating a protected and a freely exposed area in the same specimen. Brushing was performed with either a: sonic (Sonicare PowerUp, Philips GmbH, Hamburg, Germany), b: oscillating-rotating (Oral B Vitality Precisions Clean, Procter & Gamble, Schwalbach am Taunus, Germany) or two different manual toothbrushes c: flat trim brush head toothbrush (Dr. Best: Original, Glaxo-Smith-Kline, Bühl, Germany) and d: rippled-shaped brush head toothbrush (Blend-a-Dent, Complete V-Interdental, Blend-a-med, Schwalbach, Germany) in a custom made automatic brushing machine. The brushing force was set to 2 N and a whitening toothpaste (RDA = 150) was used. The simulation period was performed over a calculated period to mimic a brushing behavior of two times a day brushing for eight years and six months. Dentin loss was quantitatively determined by profilometry and statistically analyzed by Wilcoxon and Mann-Whitney-U Test (p < 0.05).ResultsThe mean (standard deviation) surface loss was 21.03 (±1.26) μm for the sonic toothbrush, 15.71 (±0.85) μm for the oscillating-rotating toothbrush, 6.13 (±1.24) μm for the manual toothbrush with flat trim brush head and 2.50 (±0.43) μm for the manual toothbrush with rippled-shaped brush head. Differences between all groups were statistically significant at p<0.05.ConclusionUsing the same brushing force and a highly abrasive toothpaste, manual toothbrushes are significantly less abrasive compared to power toothbrushes for an 8.5—year simulation.

The effects of power toothbrushing on periodontal inflammation in a Canadian nursing home population: A randomized controlled trial.

The aim of this study was to investigate whether twice-daily use of a rotating-oscillating power toothbrush (Oral-B Professional Care 1000™ ) in nursing home (NH) residents over a 6-week period, compared to usual care (UC), would reduce periodontal inflammation. In this repeated measures single-blinded randomized controlled trial, 59 residents of one NH in Winnipeg, Canada, were randomized to receive either twice-daily tooth brushing with a rotating-oscillating power toothbrush (PB) or UC by caregivers. Consent was obtained from residents or their proxies. Participants had some natural teeth, periodontal inflammation, non-aggressive behaviour, no communicable diseases, were non-smokers and non-comatose. Outcomes were measured at baseline and 6weeks, which included: inflammation (MGI, Lobene), bleeding (PBI, Loesche) and Plaque (Turesky). Comparisons of group changes in outcomes were analysed using an ANOVA with a repeated measure. Of 59 original study participants, one withdrew, one died prior to study commencement and three died before study completion. All oral parameters improved significantly for the remaining 54 residents over time (P<.0001), with no differences between groups. These results demonstrate that it is possible for caregivers to improve periodontal inflammation of residents over a 6-week period. Despite no significant group differences, periodontal inflammation of all study participants improved significantly, particularly in the reduction of bleeding, a direct measure of periodontal inflammation, which is a unique finding.

Oral Health Behaviour and Oral Hygiene of Dental Professionals and Laypersons - A Survey Performed in Lower Saxony, Germany.

The aim of this survey-based cross-sectional study was to analyse the oral health behaviour of dental professionals and persons without professional dental knowledge (layperson group) regarding the use and selection of tools for their personal dental hygiene. A total of 356 persons participated in the survey (dental professional group: 160; layperson group: 196). Information regarding dental hygiene habits, such as toothbrush use, toothbrushing habits, and the use of additional dental hygiene tools was determined using a standardised questionnaire. Data were analysed using the chi-squared and Wilcoxon tests, with significance set at p < 0.05. 93% of the dental professional group and 89% of layperson group used manual toothbrushes (p = 0.03). Power toothbrushes were used by 57% of those surveyed in the dental professional group and 37% of those in the layperson group (p < 0.01). In the dental professional group, the duration of toothbrushing was significantly longer and it was performed more often compared to layperson group (p < 0.001). The use of dental floss and interdental brushes in the layperson group (dental floss 38%, interdental brush 5%) was considerably lower than in the dental professional group (dental floss 84%, interdental brush 11%; p < 0.001). The results of the survey on oral health behaviour revealed significant differences between the groups. The acceptance of additional tools for personal dental hygiene was low, such as dental floss and interdental brushes. Given the great importance of these tools for biofilm control, they should be emphasised in motivational measures and instructions regarding oral care performed at home.

CHANGES IN ORAL HYGIENE HABITS OVER A DECADE IN TURKEY

Ponte Academic JournalNov 2017, Volume 73, Issue 11 CHANGES IN ORAL HYGIENE HABITS OVER A DECADE IN TURKEYAuthor(s): Gulden Eres ,Ceren Su Akgun Demirtas, Ayca Dilara Yilmaz, Ilkim KaradagJ. Ponte - Nov 2017 - Volume 73 - Issue 11 doi: 10.21506/j.ponte.2017.11.34 Abstract:According to the 2014 Turkey Country Report, beauty and personal care recently achieved strong improvement. The aim of the present study was to evaluate the changes in the use of oral hygiene aids over a decade. The study population was randomly chosen from among patients aged 18-80 who were referred to the admission desk of our faculty of dentistry. In total, 662 patients (362 women) were interviewed face to face from 2003-2004 (first survey). The interview inquired about oral care habits at home, oral care product use and the education level of the participants. A similar interview was performed with 749 participants (411 women) from 2013-2014 (second survey), and an effort was made to include similar numbers of males and females with similar ages as in the first survey. The data from the first and second surveys were compared based on the participa ts� education level, and the results showed a significant difference in the use of manual and power toothbrushes in the second survey (p=0.001). Moreover, the number of participants brushing their teeth twice per day was significantly different from the number of those brushing less at both time points (p=0.001). The number of participants using dental floss once per day was lower than the number of those not flossing at both time points (p=0.003 and p=0.001). Additionally, a comparison of the numbers of subjects using mouthwash at the two time points revealed statistically significant differences (p=0.003, p=0.001, and p=0.007) among the three education levels, with higher use in the second survey. Finally, the frequency of toothbrush replacement was significantly different at both time points (p=0.004 and p=0.001) among the three types of education levels. Our results thus revealed inadequate progress concerning optimum oral hygiene practices. Download full text:Check if you have access through your login credentials or your institution Username Password

Bristle splaying and its effect on pre-existing gingival recession-a 12-month randomized controlled trial.

The link between bristle splaying and gingival recession is unclear. In a 12-month, parallel group, randomized, controlled clinical trial, 110 systemically healthy participants with pre-existing gingival recessions (pre-GR) were assigned to brush their teeth with either a manual (MT) or a powered toothbrush (PT). Every 3months, toothbrushes and brush heads were replaced. Wear was measured using the Bristle-Splaying-Index (BSI), matched between groups and correlated to the change of pre-GR. Data from 109 subjects (PT, 55; MT, 54) were analyzed. The overall mean BSI was found to be significantly lower (p<0.001) in the PT group (median 5.5; second and third quartile 1.9-10.0) as compared to the MT group (21.5; 15.0-30.5). After 12months, pre-GR decreased significantly in the PT group (∆0.2±0.1mm; p<0.001) and remained stable in the MT group (∆0.1±0.1mm; p>0.05). In the MT group, higher BSI values were associated with a higher risk for increasing or stable recession over 12months: odds ratio (95% CI)=27.9 (1.7; 452.9); p=0.019. After a mean using time of 3months, the PT group demonstrated a lower BSI than the MT group, and the greater bristle splaying was associated with a higher risk of increased (or stable) GR in subjects using a MT but not a PT. Compared to a manual toothbrush, powered toothbrushes seem to be utilized with less force and can be considered safe to use in patients with pre-existing gingival recession.

Gingival Margin Stability After Mucogingival Plastic Surgery. The Effect of Manual Versus Powered Toothbrushing: A Randomized Clinical Trial.

Oscillating-rotating power toothbrushes have been proven to be clinically efficacious. To the best of the authors' knowledge, a clinical evaluation of the safety of these toothbrushes after surgical root coverage procedures has not been published. The aim of this study is to evaluate the gingival margin (GM) stability with the use of an oscillating-rotating toothbrush compared with a manual toothbrush. Sixty healthy individuals with at least one Miller Class I or II gingival recession underwent a surgical root coverage procedure. Soft-bristle manual and powered toothbrushes were given to participants randomly assigned to control and test groups, respectively. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), and recession depth (RD) were recorded at baseline and 1, 3, and 6 months after completion of the surgical procedure. Data analyses were performed using linear random-intercept models to take into account within-participant correlations over time. Temporal trend differences across treatments by including treatment-time interaction terms were then tested using a global Wald test. Use of a powered toothbrush resulted in a significantly greater reduction of recorded periodontal clinical indices compared with a manual device (FMPS, P = 0.05; FMBS, P = 0.005; RD, P = 0.004). No significant differences were noticed between the two experimental groups both for PD (P = 0.03) and clinical attachment level (P = 0.11). Complete root coverage was significantly higher in participants who used the powered toothbrush compared with the manual toothbrush at 6 months (control, 66.67%; test, 96.67%; P = 0.002). Use of an oscillating-rotating powered toothbrush with a soft-bristle head resulted in higher GM stability after root coverage procedures compared with the use of a manual soft-bristled toothbrush.

Comparative Evaluation of Three Different Types of Tooth Brush on Surface Abrasion of Enamel &amp; Nanohybrid Composite - An in Vitro Study

To evaluate& compare the ability of different tooth brush systems on the surface abrasion of enamel N Group 2(n=10) brushed with zig-zag bristles tooth brush , Group 3 (n=10)with powered tooth brush & Group4 (n=5) was taken as control group. A commercially available dentifrice was used throughout the study. A single specimen was brushed for 2 times daily for 2 min period for 1 week using a customized brushing apparatus. The pre- and post-roughness value change were analyzed and recorded & were analused using Wilcoxon ,Kruskal Wallis & Mann Whitney U test. Results: There was no statistical significant difference seen on enamel & on composite in all the four groups that is, all the three groups performed equally without any statistical significant difference.

Three-year randomized study of manual and power toothbrush effects on pre-existing gingival recession.

AimTo compare long‐term effects of brushing with an oscillating–rotating power toothbrush or an ADA reference manual toothbrush on pre‐existing gingival recession.Materials and MethodsIn this controlled, prospective, single‐blind, parallel‐group study, healthy subjects with pre‐existing recession were randomized and brushed with a power toothbrush (n = 55) or an ADA reference manual toothbrush (n = 54) for a 3‐year study period. Subjects were required to brush their teeth twice daily for 2 min. using a standard fluoride toothpaste. During the study, subjects were assessed for clinical attachment loss and probing pocket depths to the nearest mm at six sites per tooth by the same calibrated examiner. Gingival recession was calculated at pre‐existing sites as the difference between clinical attachment loss and probing pocket depths. Hard and soft oral tissues were examined to assess safety.ResultsAfter 35 ± 2 months, mean gingival recession did not differ significantly between groups, but was significantly reduced from baseline (p < 0.001), from 2.35 ± 0.35 mm to 1.90 ± 0.58 mm in the power and from 2.26 ± 0.31 mm to 1.81 ± 0.66 mm in the manual group.ConclusionsGingival recession in subjects with pre‐existing recession was significantly reduced after 3 years of brushing with either a power or manual toothbrush.

Effect of a Multidirectional Power Toothbrush and a Manual Toothbrush in Individuals Susceptible to Gingival Recession: A 12-Month Randomized Controlled Clinical Study.

Clinical studies have explored the relationship between toothbrushing and development of gingival recession (GR), but relevant GR data for the multidirectional power toothbrush (PT) are lacking. The aim of this study is to evaluate the effect of brushing with either a multidirectional PT or American Dental Association reference manual toothbrush (MT) on mid-buccal preexisting GR (PreGR) during 12 months. This was a 12-month prospective, single-masked, parallel-group, randomized, controlled clinical study. Healthy participants without periodontitis with at least two teeth showing PreGR ≥2 mm were randomized to a group brushing with either an MT or PT. The primary outcome parameter was change at sites with PreGR ≥2 mm. All clinically based GR measurements were performed by one calibrated examiner at baseline, 6, and 12 months. Secondary outcomes were changes of GR at all mid-buccal sites (with or without PreGR), changes in percentage of GR sites demonstrating a change of ≥1 mm, and changes in probing depths. A total of 107 participants completed the study (PT: 55, MT: 52). During the 12-month study period the mean recession at sites with PreGR ≥2 mm decreased significantly from 2.2 to 2.1 mm in both groups (P <0.05). The extent of GR parameters did not differ between MT and PT groups at any time point. GR evaluated clinically and on stone casts was well correlated. Neither the PT nor MT led to an increase in PreGR during 12 months of daily use.

Daily reduction of oral malodor with the use of a sonic tongue brush combined with an antibacterial tongue spray in a randomized cross-over clinical investigation

The objective of this clinical investigation was to test the effectiveness on breath odor of a newly designed sonic tongue brush (TongueCare+, TC). It consists of a soft silicone brush optimally designed based on the tongue’s anatomy to remove bacterial biofilm from the tongue’s complex surface, and it is coupled with a sonic power toothbrush handle. TC was used in combination with an antibacterial tongue spray (BreathRx, BRx) containing 0.09% cetylpyridinium chloride and 0.7% zinc gluconate. A total of 21 participants with oral malodor exceeding the threshold for recognition took part in this cross-over clinical investigation, which consisted of a single use of four treatment arms with one week washout period in between. The treatments consisted of: (1) TC + BRx, (2) TC + water, (3) BRx and (4) water. Malodor levels and bacterial density were monitored up to 6 h by organoleptic scoring and selective plating, respectively. The organoleptic score and bacterial density were significantly lower after using TC + BRx compared to all alternative treatments at all time points. A significant decrease in both parameters was detected after a single use of TC + BRx, from levels characteristic of high oral malodor, to barely noticeable levels after treatment and this was maintained up to 6 h. Moreover, we identified a significant positive correlation between bacterial density and organoleptic score, confirming that bacterial tongue biofilm is the root cause of oral malodor in these subjects. The results of this clinical investigation demonstrated that the combined treatment of a sonic tongue brush with the antibacterial tongue spray is able to deliver more than 6 h of fresh breath following a single use. The clinical investigation was registered at the ISRCTN registry under study identification number ISRCTN38199132.

Efficacy of homecare regimens for mechanical plaque removal in managing gingivitis a meta review.

Based on evidence as presented in systematic reviews what is the efficacy and safety of available homecare toothbrush regimens for mechanical plaque removal on plaque and gingivitis in adults? Three Internet sources were used (up to and including August 2014) to search for appropriate papers that satisfied the study purpose. Plaque scores and gingivitis scores were considered to be the primary parameter of interest. Safety was considered an important facet in relation to efficacy. Data and conclusions as presented in the selected papers were extracted. The potential risk of bias was estimated and the emerging evidence was graded. Independent screening of 176 unique reviews resulted in 10 published and eligible systematic reviews. They were categorized into one review evaluating the effect of an oral hygiene instruction with a toothbrush on plaque and gingivitis scores, five evaluating the efficacy of manual and power toothbrushes and three reviews evaluating toothbrush safety and one evaluating toothbrush contamination. Tooth brushing is effective in reducing levels of dental plaque. With respect to gingivitis power toothbrushes have a benefit over manual toothbrushes. The greatest body of evidence was available for oscillating-rotating brushes. Tooth brushing generally can be considered safe for the teeth and their investing tissues.

Primary prevention of periodontitis: managing gingivitis.

Periodontitis is a ubiquitous and irreversible inflammatory condition and represents a significant public health burden. Severe periodontitis affects over 11% of adults, is a major cause of tooth loss impacting negatively upon speech, nutrition, quality of life and self-esteem, and has systemic inflammatory consequences. Periodontitis is preventable and treatment leads to reduced rates of tooth loss and improved quality of life. However, successful treatment necessitates behaviour change in patients to address lifestyle risk factors (e.g. smoking) and, most importantly, to attain and sustain high standards of daily plaque removal, lifelong. While mechanical plaque removal remains the bedrock of successful periodontal disease management, in high-risk patients it appears that the critical threshold for plaque accumulation to trigger periodontitis is low, and such patients may benefit from adjunctive agents for primary prevention of periodontitis. The aims of this working group were to systematically review the evidence for primary prevention of periodontitis by preventing gingivitis via four approaches: 1) the efficacy of mechanical self-administered plaque control regimes; 2) the efficacy of self-administered inter-dental mechanical plaque control; 3) the efficacy of adjunctive chemical plaque control; and 4) anti-inflammatory (sole or adjunctive) approaches. Two meta-reviews (mechanical plaque removal) and two traditional systematic reviews (chemical plaque control/anti-inflammatory agents) formed the basis of this consensus. Data support the belief that professionally administered plaque control significantly improves gingival inflammation and lowers plaque scores, with someevidence that reinforcement of oral hygiene provides further benefit. Re-chargeable power toothbrushes provide small but statistically significant additional reductions in gingival inflammation and plaque levels. Flossing cannot be recommended other than for sites of gingival and periodontal health, where inter-dental brushes (IDBs) will not pass through the interproximal area without trauma. Otherwise, IDBs are the device of choice for interproximal plaque removal. Use of local or systemic anti-inflammatory agents in the management of gingivitis has no robust evidence base. We support the almost universal recommendations that all people should brush their teeth twice a day for at least 2min. with fluoridated dentifrice. Expert opinion is that for periodontitis patients 2min. is likely to be insufficient, especially when considering the need for additional use of inter-dental cleaning devices. In patients with gingivitis once daily inter-dental cleaning is recommended and the adjunctive use of chemical plaque control agents offers advantages in this group.

Study of the effects of oral irrigation and automatic tooth brush use in orthodontic patients with fixed appliances

Objective: To compare effectiveness of: 1) Conventional tooth brush alone (control) 2) Powered tooth brush alone 3) Conventional tooth brushing with oral irrigation device 4) Powered tooth brush with oral irrigation device, as home use oral hygiene methods in adult fixed orthodontic patients. Materials and methods: Sixty orthodontic patients with fixed orthodontic appliances were divided into four study groups: (A) brushing with automatic tooth brush twice daily ( n = 15); (B) oral irrigation with manual toothbrushing, ( n = 15); (C) oral irrigation with automatic tooth brushing, ( n = 15); (D) control group with continued normal tooth brushing only, ( n = 15). Gingival and plaque indices, bleeding after probing, and gingival sulcus depths were assessed at baseline, 1-month, and 2-month periods. Results: Paired t test was used for within group analysis. Tukey's honestly significant difference (HSD) statistical analysis was used for the inter-group multiple comparisons. Level of significance was at P P = 0.68) and group D ( P = 0.93) in the time period of 1 month to 2 months. After 1 to 2 months use of the automatic tooth brush, there was a significant reduction in plaque when compared with the control group who used only the manual tooth brush ( P = 0.04). For this population of orthodontic patients, powered brushes alone or along with oral irrigation do not have additional beneficial effect when comparisons are made with other groups. Conclusion: All plaque control methods evaluated in the study provides significant improvement in reduction of plaque accumulation and gingival inflammation. Powered brushes alone or along with oral irrigation do not seem to be additionally beneficial when comparisons are made with other groups.

Clinical and subclinical effects of power brushing following experimental induction of biofilm overgrowth in subjects representing a spectrum of periodontal disease

Investigate short-term effects of power brushing following experimental induction of biofilm overgrowth in periodontal disease states. Overall, 175 subjects representing each of five biofilm-gingival interface (BGI) periodontal groups were enrolled in a single-blind, randomized study. After stent-induced biofilm overgrowth for 21days subjects received either a manual or a power toothbrush to use during a 4weeks resolution phase. At baseline and during induction and resolution, standard clinical parameters were measured. Subclinical parameters included multikine analysis of 13 salivary biomarkers and 16s Human Oral Microbe Identification Microarray (HOMIM) probe analysis of subgingival plaque samples. All groups exhibited significantly greater reductions in bleeding on probing (BOP) (p=0.002), gingival index (GI) (p=0.0007), pocket depth (PD) (p=0.04) and plaque index (p=0.001) with power brushing compared to manual. When BGI groups were combined to form a shallow PD (PD≤3mm) and a deep PD group (PD>4mm) power brushing reduced BOP and GI in subjects with both pocket depths. Power brushing significantly reduced IL-1β levels at resolution while changes in bacterial levels showed non-significant trends between both brushing modalities. Short-term changes in select clinical parameters and subclinical salivary biomarkers may be useful in assessing efficacy of power brushing interventions in a spectrum of periodontal disease states.

Cost‐effectiveness of personalized plaque control for managing the gingival manifestations of oral lichen planus: a randomized controlled study

To undertake cost-effectiveness and cost-benefit analyses of an intervention to improve oral health in patients presenting with the gingival manifestations of oral lichen planus (OLP). Eighty-two patients were recruited to a 20-week randomized controlled trial. The intervention was personalized plaque control comprising powered tooth brushing and inter-dental cleaning advice. The primary outcome measure was the oral health impact profile (OHIP) with secondary outcomes of pain, plaque index, mucosal disease score and cost-effectiveness. Private cost data and stated willingness-to-pay (WTP) values for treatment were obtained from intervention patients at 20weeks. Overall, 81% of intervention patients showed improvement in both plaque index and mucosal disease score at 20weeks compared to 30% of controls that continued with their usual plaque control regimen. All intervention group patients stated a positive WTP value. The mean net value of the treatment was £172 compared to the incremental cost of the treatment estimated at £122.75. The cost-effectiveness analysis resulted in an incremental cost-effectiveness ratio of £13 per OHIP point. The tailored plaque control programme was more effective than control in treating the gingival manifestations of oral lichen planus. The programme is cost effective for modest values placed on a point on the OHIP scale and patients generally valued the treatment in excess of the cost.

The safety of oscillating-rotating powered toothbrushes

PubMed-Medline, the Cochrane Central Register of Controlled Trials (Cochrane-CENTRAL), Embase, together with the reference lists of selected studies were searched. Both in vitro and in vivo studies were included with selection being undertaken by two reviewers with a third as arbiter if required. Human randomised clinical trials (RCT) or controlled clinical trials conducted in healthy subjects were included where, the intervention included a rechargeable, oscillating-rotating power toothbrush compared with a manual toothbrush control and a safety assessment was included. Similar criteria were used for in vitro studies. Two independent reviewers extracted the data with any discrepancies being decided by a third reviewer. Missing data were calculated and designated accordingly. Meta-analysis was performed where possible using a random-effects model. Thirty-five publications met the criteria. The mean change in gingival recession was not significantly different among toothbrush groups in the two selected trials with safety as a primary outcome (weighted mean difference: 0.03). A meta-analysis of the five trials that evaluated safety with a surrogate parameter was not possible; however, there were no significant between-group differences at the study end in any trial. A descriptive analysis of the 24 selected studies assessing safety as a secondary outcome revealed few brushing-related adverse events. The heterogeneity in objectives and methodology of the four in vitro trials that met the eligibility criteria precluded generalisation of the results. A large body of published research in the preceding two decades has consistently shown oscillating-rotating toothbrushes to be safe compared to manual toothbrushes, demonstrating that these power toothbrushes do not pose a clinically relevant concern to hard or soft tissues.

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Safety of Oscillating‐Rotating Powered Brushes Compared to Manual Toothbrushes: A Systematic Review

Oscillating-rotating power toothbrushes have been proven clinically efficacious. To our knowledge, a comprehensive review of all clinical and laboratory investigations solely comparing the safety of these toothbrushes to the standard of care (i.e., manual toothbrushes) has not been published. The aim of this systematic review is to examine the literature concerning the relative soft and/or hard tissue safety outcomes with the use of oscillating-rotating toothbrushes compared to manual toothbrushes. With the use of electronic databases of the National Library of Medicine (PubMed-MEDLINE), the Cochrane Central Register of Controlled Trials (Cochrane-CENTRAL), and the Excerpta Medical Database (EMBASE), a search of in vivo and in vitro trials through May 2010 was conducted to identify appropriate studies that evaluated the effects of an oscillating-rotating power toothbrush compared to a manual toothbrush with respect to soft and/or hard tissue safety. Eligible trials incorporated a safety evaluation as a primary or secondary outcome parameter (i.e., gingival recession, observed/reported adverse events, and hard tissue effects) or used a surrogate parameter (i.e., stained gingival abrasion and brushing force) to assess safety. Data extraction for the primary- and surrogate-measure safety studies, which included mean values and SDs when available, and a meta-analysis of the gingival recession data were performed. Independent screening of the titles and abstracts of 697 PubMed-MEDLINE, 436 Cochrane-CENTRAL, and 664 EMBASE papers resulted in 35 publications that met the eligibility criteria. The mean change in gingival recession was not significantly different among toothbrush groups in the two selected trials with safety as a primary outcome (weighted mean difference: 0.03). A meta-analysis of the five trials that evaluated safety with a surrogate parameter was not possible; however, there were no significant between-group differences at the study end in any trial. A descriptive analysis of the 24 selected studies assessing safety as a secondary outcome revealed few brushing-related adverse events. The heterogeneity in objectives and methodology of the four in vitro trials that met the eligibility criteria precluded generalization of the results. A large body of published research in the preceding 2 decades has consistently shown oscillating-rotating toothbrushes to be safe compared to manual toothbrushes, demonstrating that these power toothbrushes do not pose a clinically relevant concern to hard or soft tissues.

Clinical study investigating abrasive effects of three toothpastes and water in an in situ model

This in situ study compared the abrasive effect of repeated brushings (over 10 days) of a low relative abrasive dentine (RDA) toothpaste with moderate and high relative abrasive dentine (RDA) toothpastes, on human dentine in situ. The study design was single centre, single blind, randomized, split mouth, two period, four-treatment cross-over, in situ study in 20 healthy subjects. Subjects wore bi-lateral lower buccal appliances each fitted with four dentine sections with treatment applied with a power toothbrush, during each 10 day study period. Samples were measured at baseline, day 5 and day 10 by contact profilometry, and baseline and day 10 with non-contact profilometry. Nineteen subjects were included in the efficacy analysis. Results as measured by contact and non-contact profilometry from brushing with the moderate RDA paste and high RDA paste showed significantly (p<0.0001) more abrasion to dentine than brushing with the low RDA paste or water after 10 days. Dentine loss following tooth brushing with the low RDA paste was not significantly different from brushing with water, after 10 days. The methodology successfully showed clear differentiation between the amount of dentine lost following toothbrushing with the low RDA paste compared to the moderate or high RDA pastes. Dentine loss following brushing with the low RDA paste showed a comparable degree of abrasion to brushing with water.

In vitro staining effects of stannous fluoride and sodium fluoride on ceramic material

Long-term fluoride application on the teeth of patients receiving radiation therapy for head and neck tumors results in excessive staining and roughening of ceramic restorations. The purpose of this in vitro study was to compare the staining effects of 2 fluoride treatments on ceramic disks by simulating 1 year of clinical exposure at 10 minutes per day. In addition, 2 different surface preparations were tested. Eighty ceramic disks (IPS Empress), 20 x 2 mm, were fabricated. Half of the disks were glazed, and the remaining disks were polished. All disks were brushed for 3 minutes with a soft-bristle power toothbrush and mild dentifrice (baseline) and were immersed in 1 of the 2 fluoride products (0.4% SnF(2), Gel-Kam Gel, or 1.1% NaF, Prevident 5000) for 10 days (n=20). Means and standard deviations of color change (Delta E), surface roughness (Ra, um), and surface gloss (GU) of the ceramic material were measured with a reflection spectrophotometer, a profilometer, and a gloss meter, respectively, at baseline and after fluoride treatment. Two- and 3-way ANOVA (alpha=.05), with surface preparation (polished vs. glazed) and fluoride treatment (0.4% SnF(2) or 1.1% NaF) as independent variables and condition (baseline vs. after fluoride treatment) as a repeated measure, was used to analyze the data. Fisher's PLSD intervals (alpha=.05) were calculated for comparisons among the means. The polished specimens had significantly higher Delta E values, significantly higher surface gloss values, and significantly lower surface roughness values than the glazed specimens before fluoride treatment (P<.001). After both fluoride treatments, ceramic disks exhibited significantly higher surface roughness values when polished and significantly lower surface gloss values when glazed or polished (P<.001). The glazed specimens presented significantly higher surface roughness (P<.001) and lower surface gloss values (P<.001) when treated with 0.4% SnF(2) as compared to NaF. For the polished specimens, there was no significant difference in surface roughness and surface gloss values between the 2 fluoride treatments. Use of 0.4% SnF(2) and 1.1% NaF gels, in vitro, caused significant color change in the polished IPS Empress ceramic disks. Polishing of the ceramic surface before immersion in either fluoride agent caused the ceramic tested to be more resistant to etching by the 2 solutions tested. The NaF caused less deterioration of the porcelain surface and was less stain inducing than SnF(2).