ArticlePDF Available

Effect of Ultra-Soft and Soft Toothbrushes on the Removal of Plaque and Tooth Abrasion

J Dent Hyg Sci Vol. 18, No. 3, 2018, pp.164-171
Received: April 18, 2018, Revised: May 15, 2018, Accepted: May 21, 2018 ISSN 2233-7679 (Online)
Correspondence to: Do-Seon Lim
Department of Dental Hygiene, College of Health Science, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam 13135, Korea
Tel: +82-31-740-7229, Fax: +82-31-740-7352, E-mail:, ORCID:
Copyright © 2018 by Journal of Dental Hygiene Science
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (
by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Effect of Ultra-Soft and Soft Toothbrushes on the
Removal of Plaque and Tooth Abrasion
Moon-Jin Jeong
, Han-A Cho, Su-Yeon Kim, Ka-Rim Kang, Eun-Bin Lee, Ye-Ji Lee, Jung-Hyeon Choi,
Ki-Sung Kil
, Myoung-Hwa Lee
, Soon-Jeong Jeong
, and Do-Seon Lim
Department of Dental Hygiene, College of Health Science, Eulji University, Seongnam 13135,
1Department of Oral Histology and Biology, School of Dentistry, Chosun University, Gwangju 61452,
2Department of Dental Hygiene, College of Health Sciences, Youngsan University, Yangsan 50510, Korea
To improve the oral health status of Korean people, it is necessary to encourage proper oral hygiene management habits, such as toothbrushing,
through appropriate health promotion techniques. Therefore, the purpose of thi s study wa s to e valuate the removal of pl aque and tooth abrasion
using ultra-soft (filament 0.11
0.12 mm) and soft toothbrushes for toothbrushing. The plaque removal was performed using a dentiform and
Arti-spray, and the Patient Hygiene Performance (PHP) index was calcu lat ed a s th e su m total sc ore div ide d by the total n umber of surfaces. In the
abrasivity experiment, according to the num ber of brushings, a micro Vickers hardness tester was used, and a sample in the range of 280
Vickers hardness number was selected. The number of toothbrushing stroke were 1,800 (2 months), 5,400 (6 months), 10,800 (12 months), and
21,600 (24 months). The tooth abrasion was measured using a scanning electron microscope. Statistical analysis was performed using I BM S PSS
Statistics 22.0 and a p-value
0.05 was considered significant. According to the results, there was no statistically significant difference in the
degree of plaque removal between ultra -sof t an d so ft t oot hbrush es. The differe nce in to oth a brasion bet wee n before and afte r toothbrushing was
found to be greater with the soft toothbrushes than with the ultra-soft toothbrushes. Therefore, the ultra-soft toothbrush not only lowers tooth
damage by reducing tooth abrasion, but also shows a similar ability to remove plaque as soft toothbrushes.
Key Words: Dental plaque, Tooth abrasion, Toothbrushing
Oral health is an important factor in systemic health and
quality of life1). Oral diseases are diffuse, chronic,
irreversible, and progressive. Unlike other diseases, they
are preventable; therefore, the early detection of risk
factors should be prioritized to prevent the progression of
oral disease2). Toothbrushing, which is a method of oral
disease prevention, removes bacteria related to dental
caries and periodontal diseases, and is considered the most
reliable method of plaque removal3,4). The Health Plan
2020 (20162020) defines proper toothbrushing as the
most appropriate health promotion behavior that can
manage both dental caries and periodontal disease, and
states that it is necessary to encourage habitual and
appropriate oral health management in line with various
health promotion projects that are being developed for
different life cycle5). There has been a consistent discussion
concerning oral health promotion projects worldwide and
a demand for programs for the prevention of oral diseases
and health promotion1). Based on the OECD (Organization
for Economic Cooperation and Development) health
index, South Korea is ranked 24th of 28 OECD countries
in oral health status6). Therefore, it is necessary to pay
attention to exploring various ways to promote oral health6).
Toothbrushes for different ages and with different
functions have been developed and have been useful for
personal oral health management by individuals. The
Moon-Jin Jeong, et al.Effect of Ultra-Soft Toothbrush on the Teeth
factors that affect plaque removal include toothbrush
design4), toothbrushing method4), an individual’s tooth-
brushing ability7), frequency, and duration of tooth
brushing4,7), bristle shape7), material, length, diameter,
number of bristles, and arrangement8). Choosing the
appropriate bristle type is especially important because
bristles come in contact with the teeth and gums. Bristles
are classified as hard, regular, and soft/ultra-soft according
to the filament stiffness grade of the brush head9,10). Study
results on the effect of soft bristles on the cleaning ability
of toothbrush and tooth abrasion have been consistently
reported. Most commercially available toothbrushes have
mild to medium-hard bristles11). In response to teeth and
gum weakening in modern humans, soft tooth brushes
emerged and expanded the range of choice for customers.
Soft toothbrushes can brush the boundaries between the
teeth and gums in the presence of a fixed prosthesis more
effectively and can reduce gingival recession and abrasion.
Since hard toothbrushes can cause enamel and dentin
abrasion, and can weaken teeth covered in a prosthesis,
ultra-soft toothbrushes are recommended12). Ultra-soft
toothbrushes that use a vibration motion to clean the teeth
and gingival margin are also recommended for the manage-
ment of diabetic patients’ oral health13). Ultra-soft tooth-
brushes with bristles arranged in a conical shape have been
reported to remove dental plaques in surgical sites
following surgery more quickly than regular toothbrushes14).
They are also recommended for patients with mouth pain
or inflammation15,16). Ultra-soft toothbrushes are used as
toothbrushes for children, and as professional toothbrushes
(e.g., TePe, professional care toothbrushes, etc.)15). Use of
these toothbrushes by patients with gingiva-related problems
has also been reported17,18).
The easiest method to improve oral hygiene is tooth-
brushing. Studies have focused on the effectiveness of
toothbrushes in plaque removal and their convenience of
use. However, the choice and use of a toothbrush depends
on an individual’s preference. The choice of a toothbrush
varies according to age, and a population’s characteristics.
Various kinds of information must be provided for
patients with periodontal diseases or those who poorly
manage their oral hygiene. There is a lack of diversity in
ultra-soft toothbrushes among commercially available
toothbrushes, and data concerning the physical character-
istics and clinical effect of ultra-soft tooth brushes or the
safety of their use for plaque removal in the presence of
injury are lacking. Therefore, this study measured the
cleaning ability and abrasivity of ultra-soft toothbrushes
and analyzed their effect according to bristle thickness to
contribute to better toothbrush selection by customers and
oral health promotion.
Materials and Methods
1. Materials and subjects
1) Cleaning ability
An ultra-soft toothbrush newly released by LINKO Co.
(Seongnam, Korea) was used in this study. This ultrafine
processed toothbrush has a bristle filament measuring 0.11
to 0.12 mm and bristle tip measuring less than 0.01 mm in
thickness. Generally, soft toothbrushes have a filament
thickness of 0.18 to 0.20 mm and tooth tip less than 0.01
mm, and are 28% to 45% thicker than ultra-soft tooth-
brushes. This thickness difference has an influence on the
degree of tooth abrasion and gingival stimulation. Bristle
tips are processed into a tapered shape for easier insertion
into the gingival sulcus. Due to the slim filament, bristles
are densely arranged, soft, and elastic. Ultra-soft tooth-
brushes for children and periodontal diseases were
selected, and differences in their cleaning ability according
to age and function were investigated. The control group
included toothbrushes that were the most sold tooth-
brushes in the three most visited online markets and had a
bristle thickness of 0.2 mm or less. Ultimately, the Oral-B
toothbrush for children and Aekyung 2080 original
(Aekyung, Seoul, Korea) for periodontal diseases were
selected. A gnathostatic model (Dentiform; Nissin Dental,
Kyoto, Japan) and Arti-spray (Bausch, Hainspjitz,
Germany) were used. An artificial plaque remover was
used in the experiment.
2) Abrasivity
The same toothbrushes as those used in the cleaning
ability experiment were used. For the abrasivity experiment,
Perioe Sirintakhyo toothpaste (LG Household & Health
Dent Hyg Sci Vol. 18, No. 3, 2018
Care, Seoul, Korea), which has low abrasivity, was
selected. The experiment was conducted using acrylic
resin, Dentto-dam (Mediclus Co., Cheongju, Korea), and
bovine teeth. Regarding experimental equipment, a tooth-
brush abrasivity measuring device (DE/D15 525X; Braun,
Seoul, Korea), micro Vickers hardness tester (MMT-X7B;
Matsuzawa, Akita, Japan), scanning electron microscopy
(S-4700; Hithachi, Tokyo, Japan), and hard tissue cutting
machine (Minitom; Struers, Ballerup, Denmark) were used.
2. Method
1) Cleaning ability
Arti-spray (wide-purpose color marker for testing
occlusal contact or crown-bridge fit) was applied on the
labial surface of the anterior region in the form of the
gnathostatic model, and on the buccal surface of the
posterior region to form artificial plaques. Arti-spray was
sprayed once every five seconds at the same pressure and
from the same location to ensure even application
throughout dental surfaces. To investigate changes in the
extent of dental plaque formation over time, the spraying
time was changed after a five-second interval until the
fifth spraying19). Next, a toothbrush and a tooth, on which
artificial dental plaques had formed, were fixed on the
artificial dental plaque remover, and plaques on the
buccal, lingual, and proximal surfaces (occlusal surface
not included) were removed. Assuming that a person
brushes each surface 10 times, the surfaces were brushed
10 times each at the same speed and pressure. The bristles
and gnathostatic model were washed after each experiment.
The Patient Hygiene Performance (PHP) index was used
to determine the dental plaque index20,21).
2) Abrasivity
Bovine incisors with seemingly healthy surfaces were
cut into 1 cm×1 cm pieces, and they were cast using resin.
After the resin solidified, the resin block was removed
from the cast, and cut such that the side opposite to the
surface containing the bovine tooth was horizontally
oriented. The resin layer was removed, and polished with
silicon carbide paper to smooth the enamel surface. To test
that the bovine tooth was appropriate for the experiment,
the micro Vickers hardness test was used to measure the
Vickers hardness number (VHN). The four corners of the
enamel surface (upper left, upper right, lower left, and
lower right) were pressed with a 200 g load for each
corner. The pressed sites was measured at 400× magnifi-
cation using a measuring microscope to measure the
surface hardness of the enamel surface. Samples within
the normal enamel surface hardness range of 280 to 380
VHN were selected. The samples were treated in prepar-
ation for scanning electron microscope (SEM). Since the
samples were to be divided according to abrasion status,
they were divided into a healthy enamel area and area to
be brushed. Dentto-dam resins were applied to the areas
that were not going to be brushed. A total of 12 samples
were assigned to three on each groups according to the
number of toothbrushing strokes (1,800 [2 months], 5,400
[6 months], 10,800 [12 months], and 21,600 [24 months])
to measure the extent of enamel abrasion. For the rolling
toothbrushing method, it is recommended to brush each
area at least 10 times. In general, teeth are based on
brushing three times a day, and a total of 30 strokes are
made in one tooth for one day. Based on this standard, 900
strokes would be made per month, and the subjects were
assigned to groups based on this number. Next, the
toothbrush abrasion tester was used to apply an
appropriate number of toothbrushing strokes to the given
tooth surface22). After the experiment was over, Dentto-
dam was removed, and the samples were treated through a
standard procedure in preparation for SEM. They were
analyzed at 5,000× and 10,000× magnification at 10 kV23).
3. Statistical analysis
To compare the results before and after the experiment
on cleaning ability, the surface plaque index before and
after toothbrushing was calculated using the PHP index
for the control and experimental groups. A Shapiro-Wilk
normality test was used to investigate plaque removal
effectiveness. An independent t-test was performed if
normality was confirmed. All statistical analyses were
performed using IBM SPSS Statistics ver. 22.0 (IBM Co.,
Armonk, NY, USA) with the level of statistical signifi-
cance set at p0.05.
Moon-Jin Jeong, et al.Effect of Ultra-Soft Toothbrush on the Teeth
Table 3. t-test for Ultra-Soft and Soft Toothbrushes for Children and Periodontal Disease
Levene’s test t-test for equality of means
Fp-value tp-value Mean difference
PHP index Children 0.022 0.887 0.316 0.760 0.22
Periodontal disease 0.274 0.615 1.844 0.102 0.59
PHP: Patient Hygiene Performance.
Table 2. t-test for Comparison of Patient Hygiene Performance
(PHP) Index between All Experimental and Control Groups
Levene’s test t-test for equality of means
Fp-value tp-value Mean
PHP index 0.007 0.932 1.338 0.192 0.46
Table 1. Shapiro-Wilk Normality Test for Comparison of Patient
Hygiene Performance (PHP) Index between the Control and
Experimental Groups
Type of bristle Fp-value
PHP index Ultra-soft 0.942 0.409
Soft 0.940 0.382
1. Cleaning ability
To investigate differences in the level of plaque removal
between soft and ultra-soft toothbrushes, normality and
homoscedasticity tests were performed using the PHP
indices of the control and experimental groups (Table 1).
Analyzing toothbrushes for children and those for period-
ontal diseases showed that the level of plaque removal was
on average 0.46 higher for the ultra-soft toothbrushes than
the soft toothbrushes; however, a t-test found that the
difference was not statistically significant (Table 2).
A normality test was performed to investigate differ-
ences in the level of plaque removal between the soft and
ultra-soft toothbrushes for children and periodontal diseases.
Normality was confirmed and a t-test was performed
accordingly. In the case of toothbrushes for children, the
level of plaque removal was on average 0.22 higher for the
ultra-soft toothbrushes than the soft toothbrushes.
Likewise, for the toothbrushes for periodontal diseases,
the level of plaque removal was on average 0.59 higher for
ultra-soft toothbrushes than soft toothbrushes. However,
the differences were statistically non-significant in both
cases (Table 3).
2. Abrasivity
Differences in abrasivity were found in both the control
and experimental groups in the SEM. Enamel surfaces that
were performed to 1,800 brushing strokes showed smooth
surfaces in some samples. However, they generally
showed rough surfaces with deep grooves and hydroxy-
apatite crystals (Fig. 1A). On the other hand, abrasion was
observed on enamel surfaces that were performed to the
greatest number of strokes (21,600); these surfaces were
generally smooth with occasional shallow grooves (Fig.
1B). Based on this trend in which the enamel surface
becomes smoother as the number of strokes increases, it
was determined that toothbrush comparisons would be
performed in the group with 21,600 strokes (24 months) as
this group showed the greatest difference between before
and after toothbrushing to determine abrasivity.
In the experiment using soft and ultra-soft toothbrushes
for children, differences in the tooth surface between
before and after toothbrushing, and therefore abrasivity,
were observed in both groups. In the group that used the
soft toothbrushes, tooth surfaces had deep groves and
occasional dents before toothbrushing. However, the
surfaces after toothbrushing had shallow grooves and were
smooth overall (Fig. 2). In the group that used ultra-soft
toothbrushes, tooth surfaces before toothbrushing exhibited
hydroxyapatite crystals and shallow grooves. After tooth-
brushing, the hydroxyapatite crystals were partially removed
and shallow grooves were observed on the tooth surface
(Fig. 3). Therefore, the soft toothbrushes for children had
higher abrasivity than the ultra-soft toothbrushes.
In the experiment using the soft and ultra-soft tooth-
brushes for periodontal diseases, differences in the tooth
surface between before and after toothbrushing, and
therefore abrasivity, were observed in both groups. In the
Dent Hyg Sci Vol. 18, No. 3, 2018
Fig. 3. Enamel surface before (A)
and after (B) brushing with ultra-
soft toothbrush in children: The sur-
face of the enamel after brushing
was partially cleared of hydroxyap-
atite crystals and overall a light
groove was observed.
Fig. 1. (A) Number of brushing
times: 1,800. (B) Number of brushing
times: 21,600. The enamel surfaces
subjected to 1,800 brush strokes
had deep grooves and were rough
due to crystallization of the apatite
crystals. However, the surface of the
enamel subjected to 21,600 brush
strokes was observed to be smooth
as a whole.
Fig. 2. Enamel surface before (A)
and after (B) brushing with a tooth-
brush in children: The surface of the
enamel after brushing was very
shallow and smooth on the whole.
group that used the soft toothbrushes the tooth surfaces
before toothbrushing were observed as very rough and
cracks. After toothbrushing, the surface of tooth was
observed very smooth as all removing cracks (Fig. 4).
However, in the group that used the ultra-smooth tooth-
brushes, hydroxyapatite crystals and shallow grooves were
observed on the tooth surfaces before toothbrushing. The
hydroxyapatite crystals were partially removed after tooth-
brushing and the surfaces were generally smooth (Fig. 5).
Therefore, the soft toothbrushes for periodontal diseases
were shown to have higher abrasivity than the ultra-soft
Toothbrushing is the most general index of oral
hygiene, it can affect the cleaning ability and abrasivity of
a tooth surface depending on the hardness of the bristles.
Dentists recommend regular toothbrushes or soft
toothbrushes over hard toothbrushes, which can potentially
damage the gingival and oral mucosa. However, customers
choose bristle hardness based on their personal pre-
ference24). Although it is generally reported that soft
toothbrush cause less abrasion than hard toothbrush25,26),
some studies have reported otherwise27,28). They claim that
soft toothbrush require a larger amount of toothpaste and
Moon-Jin Jeong, et al.Effect of Ultra-Soft Toothbrush on the Teeth
Fig. 4. Enamel surface before (A)
and after (B) brushing with soft
toothbrushes in individuals with pe-
riodontal disease: The surface of
enamel after brushing was observed
to be very smooth due to removal
of cracks.
Fig. 5. Enamel surface before (A)
and after (B) brushing using ul-
tra-soft toothbrush in individuals
with periodontal disease: The sur-
face of the enamel after brushing
was observed to have some grooves
but was smooth overall.
this increases the area of contact between the toothbrush
and tooth surface, thereby increasing abrasivity. However,
the increased area of contact also means a better cleaning
ability. Therefore, it is necessary to develop soft tooth-
brushes that use a small amount of toothpaste to satisfy
customer needs. This study was conducted to investigate
the effect of newly released ultra-soft toothbrushes that
can satisfy these needs. Cleaning ability and abrasion were
compared between the ultra-soft toothbrushes, with the
soft brushes as the control.
In the experiment on cleaning ability, the ultra-soft and
soft toothbrushes did not show a statistically significant
difference. In other words, their cleaning abilities were on
a par with one another, or the ultra-soft toothbrushes have
the same cleaning ability as the soft toothbrushes. Januar
et al.9) divided 65 students into two groups and conducted
a double-blinded cross-over clinical trial to compare
plaque removal effectiveness between toothbrushes with
sharp bristles and those with round bristles. They also used
the PHP index to assess their effectiveness. The group that
used the toothbrushes with sharp bristles had a higher
mean PHP index at seven days after the experiment.
However, no significant difference in the mean PHP index
was observed at 14 days. The bristles used in this study
measured less than 0.01 mm in thickness and was sharp.
Although direct comparison with the previous study is
difficult since Januar et al.9) did not measure bristle
thickness, it can be inferred that bristle shape or diameter
does not significantly affect cleaning ability. Agarwal et
al.29), who investigated the effectiveness of different types
of toothbrush, reported plaque indices measured from
subjects who did not brush their teeth for 24 hours before
coming to the dental clinic. Ultra-soft toothbrushes were
found to have lower plaque indices compared with soft,
regular, and hard toothbrushes, and thus had a better
cleaning ability. As can be seen, the study results regarding
the cleaning ability of toothbrushes greatly vary. If the
limitation of the present study on bovine tooth is applied to
a person in the future, it will be possible to provide data
useful for the development of oral healthcare products.
In the abrasivity experiment, abrasivity increased in
proportion to the number of brush strokes in two months
(1,800 strokes) and 24 months (21,600 strokes) for both
the ultra-soft and soft toothbrushes. In the 24 month
toothbrushing experiment (21,600 strokes), the soft tooth-
brushes for children and those for periodontal diseases had
Dent Hyg Sci Vol. 18, No. 3, 2018
higher abrasivity than the ultra-soft toothbrushes. This
indicates that lower bristle diameters, or, in other words,
softer bristles, and higher bristle density decrease abrasivity.
Tellefsen et al.30) studied the relationship between tooth-
brush bristle and surface roughness, and reported that as
the number of filaments increases, surface roughness
decreases, and vice versa. Wiegand et al.31) reported that
when the relative enamel abrasion of a toothpaste slurry
with abrasion is 2.1 to 3.3, a toothbrush with a filament
diameter of 0.2 mm has higher enamel loss than that with a
filament diameter of 0.15 mm, meaning that abrasivity
goes high with increases in filament diameter. Sasan et
al.32) investigated whether commercially available
toothbrushes had been classified according to the American
Dental Association standard and recommended soft
toothbrushes over hard toothbrushes since the latter can
damage the tooth surface and the gingival margin, and
since plaque removal depends more on the toothbrushing
technique than on the bristle type. These findings support
the results of this study.
The results of this study suggest that ultra-soft tooth-
brushes match the plaque removing ability of soft tooth-
brushes and reduce tooth abrasivity to minimize tooth
damage. These results may arouse new interest in ultra-
soft toothbrushes and may be useful in future research
aimed at producing toothbrushes to be sold commercially.
However, since the soft toothbrush used as the control in
the cleaning ability experiment was a commercially
available toothbrush, there were differences in the type of
toothbrush, bristle number, length, and diameter. It was
therefore difficult to systemically analyze the factors that
can affect plaque removal. However, since a toothpaste
with low abrasivity was used to control abrasion caused by
toothpaste as has been done in a previous study30), abrasion
caused by toothpaste such as filament arrangement,
density, and texture could be controlled27). As ultra-soft
toothbrushes have been shown to have lower abrasivity,
use of these toothbrushes may help reduce customers’
sensitivity by reducing tooth abrasion. By increasing the
range of choices of toothbrushes tailored to individuals’
tastes, the oral hygiene status of the nation, including the
elderly population11), may be improved.
This study was supported by research fund from Chosun
University, 2017.
1. Petersen PE: Global policy for improvement of oral health in
the 21st century-implications to oral health research of World
Health Assembly 2007, World Health Organization.
Community Dent Oral Epidemiol 37: 1-8, 2009.
2. Kim JB, Choi YJ, Back DI, et al.: Preventive dentistry. 5th ed.
Komoonsa, Seoul, pp.6-13, 2009.
3. Löe H: Oral hygiene in the prevention of caries and
periodontal disease. Int Dent J 50: 129-139, 2000.
4. Collins FM: Toothbrush technology, dentifrices and dental
biofilm removal. ADA CERP, Chicago, pp.1-11, 2009.
5. Ministry of Health and Welfare, Korea Health Promotion
Foundation: Health plan 2020, 2016-2020. Ministry of Health
and Welfare, Korea Health Promotion Foundation, Sejong,
Seoul, pp.214-217, 2015.
6. Ministry of Health and Welfare: Health at a glance 2009
OECD indicators. Ministry of Health and Welfare, Sejong,
pp.34-35, 2010.
7. Yankell SL: Toothbrushing and toothbrushing techniques. In:
Harris NO, Christen AG, eds. Primary preventive dentistry.
3rd ed. Appleton and Lange, Norwalk, pp.79-106, 1991.
8. Shory NL, Mitchell GE, Jamison HC: A study of the
effectiveness of two types of toothbrushes for removal of oral
accumulations. J Am Dent Assoc 115: 717-720, 1987.
9. Januar P, Susetyo A, Widyastuti R: The effectiveness of
sharp end and rounded end bristle toothbrush. Dent J:
Majalah Kedokteran Gigi 43: 122-125, 2010.
10. International Organization for Standardization: Dentistry--
Stiffness of the tufted area of tooth-brushes, ISO 8627:1987.
International Organization for Standardization, Geneva,
Switzerland, 1987.
11. Seo EJ, Shin SC, Seo HS, Kim EJ, Chang YS: A survey on
Koreans' behavior about the use of oral hygiene devices. J
Moon-Jin Jeong, et al.Effect of Ultra-Soft Toothbrush on the Teeth
Korean Acad Oral Health 27: 177-193, 2003.
12. Taylor H, Graham D, Cipak M, et al.: Brushing up on mouth
care: an oral health resource for those who provide care to
older adults. Dalhousie University, Halifax, pp.1-15, 2011.
13. Misra N, Maheshwari A, Misra P: Dental care in diabetes: a
review. Indian J Public Health Res Dev 3: 102-105, 2012.
14. Montevecchi M, Moreschi A, Gatto MR, Checchi L, Checchi
V: Evaluation of clinical effectiveness and subjective satis-
faction of a new toothbrush for postsurgical hygiene care: a
randomized split-mouth double-blind clinical trial. Scientific
WorldJournal 2015: 828794, 2015.
15. Ames NJ, Sulima P, Yates JM, et al.: Effects of systematic
oral care in critically ill patients: a multicenter study. Am J
Crit Care 20: e103-e114, 2011.
16. Cherny NI, Fallon M, Kaasa S, Portenoy RK, Currow DC:
Oxford textbook of palliative medicine. 5th ed. Oxford
University Press, Oxford, pp.447-456, 2015.
17. Agnihotri R, Bhat GS, Bhat KM: Amlodipine-induced
gingival overgrowth: considerations in a geriatric patient.
Geriatr Gerontol Int 11: 365-368, 2011.
18. Scattarella A, Petruzzi M, Ballini A, Grassi FR, Nardi GM:
Oral lichen planus and dental hygiene: a case report. Int J
Dent Hyg 9: 163-166, 2011.
19. Lee CH, Anh SH, Jang YH: An experimental study on plaque
removal effect through the acting types of the electric
toothbrushes. J Korean Soc Dent Hyg 11: 465-474, 2011.
20. Lim SH, Hwang JM: Relationship of oral health management
behavior to plaque index systems. J Dent Hyg Sci 15:
159-165, 2015.
21. Kim KE, Ahn E, Han JH: Variation in the index of dental
plaque removal and practice assessment after instruction on
toothbrushing. J Dent Hyg Sci 15: 220-225, 2015.
22. Son JH, Lim DS, Ma DS, Park DY: Abrasion of resin
infiltrated enamel by tooth brushing. J Korean Acad Oral
Health 37: 9-15, 2013.
23. Han JS: Evaluation of air-powder abrasive system on tooth
abrasion. J Korean Dent Assoc 28: 381-389, 1990.
24. Kyoizumi H, Yamada J, Suzuki T, Kanehira M, Finger WJ,
Sasaki K: Effects of toothbrush hardness on in vitro wear and
roughness of composite resins. J Contemp Dent Pract 14:
1137-1144, 2013.
25. Harrington JH, Terry IA: Automatic and hand toothbrushing
abrasions studies. J Am Dent Assoc 68: 343-350, 1964.
26. Harte DB, Manly RS: Effect of toothbrush variables on wear
of dentin produced by four abrasives. J Dent Res 54: 993-998,
27. Dyer D, Addy M, Newcombe RG: Studies in vitro of abrasion
by different manual toothbrush heads and a standard
toothpaste. J Clin Periodontol 27: 99-103, 2000.
28. Wiegand A, Kuhn M, Sener B, Roos M, Attin T: Abrasion of
eroded dentin caused by toothpaste slurries of different
abrasivity and toothbrushes of different filament diameter. J
Dent 37: 480-484, 2009.
29. Agarwal V, Agarwal S, Ranjan R: Effects of bristle hardness
& duration of manual tooth brushing on plaque control.
Indian J Community Health 29: 123-128, 2017.
30. Tellefsen G, Liljeborg A, Johannsen A, Johannsen G: The
role of the toothbrush in the abrasion process. Int J Dent Hyg
9: 284-290, 2011.
31. Wiegand A, Schwerzmann M, Sener B, et al.: Impact of
toothpaste slurry abrasivity and toothbrush filament stiffness
on abrasion of eroded enamel: an in vitro study. Acta Odontol
Scand 66: 231-235, 2008.
32. Sasan D, Thomas B, Mahalinga BK, Aithal KS, Ramesh PR:
Toothbrush selection: a dilemma? Indian J Dent Res 17:
167-170, 2006.
Full-text available
Background: Numerous designs of manual toothbrush are available in the market with the claims of superiority in plaque removal. It often makes the public confuse which is the best design. The sharp end bristle toothbrush is a modification that commercially available in the market. Purpose: The objective of the study was to compare the effectiveness in plaque removal of the sharp end bristle toothbrush and the rounded end bristle toothbrush. Methods: This clinical trial was a double blind crossover design. The subjects were 65 dental students, divided into two groups for comparing the 2 types of toothbrush. On the 1st day, the allocated toothbrushes were distributedto each group according to their designation, and the subjects were instructed to use the toothbrushes according their normal daily practices. On the 1st, 7th, and 14th day, the subjects were scored using the patient hygiene performance index (PHP index) and the gingival index. Based on cross over design, the same procedure was repeated during the 2 week second test periods using different type of toothbrush respectively. Results: The mean scores of the 2 groups showed no significant difference on the beginning the study. Though minor differences were observed in the effectiveness of toothbrush, but the comparison of the two types of toothbrush showed no statistically significant differences on 7th and 14th day. Conclusion: There were no significant differences between sharp end and rounded end bristle toot brusher. There is no manual toothbrush superiorly designed than the others single superior design of manual toothbrush.Latar belakang: Berbagai jenis desain sikat gigi saat ini terdapat di pasaran, dengan masing-masing menyatakan keunggulannya dalam membersihkan plak. Penelitian ini dilakukan terhadap dua jenis sikat gigi manual yaitu sikat gigi dengan ujung bulu sikat runcing dan ujung bulus sikat bulat. Tujuan: Penelitian ini dilakukan untuk membandingkan efektivitas membersihkan plak antara 2 jenis sikat gigi. Metode: Penelitian ini merupakan percobaan klinis dengan desain penyilangan (crossover) secara tertutup ganda (double blind). Subyek penelitian 65 mahasiswa dibagi 2 kelompok. Pada hari pertama, sikat gigi dibagikan pada masing-masing kelompok yang telah ditentukan jenis sikat giginya, dan diinstruksikan untuk menggunakannya sesuai kebiasaan mereka. Pada hari ke 1, 7, dan 14 dilakukan pengukuran indeks PHP dan indeks gingiva. Berdasarkan desain penyilangan, proses yang sama diulangi pada masing-masing kelompok dengan menggunakan jenis sikat gigi yang berbeda. Hasil: Pada awal penelitian tidak terdapat perbedaan skor pada ke 2 kelompok. Meski terdapat sedikit perbedaan, namun tidak terdapat perbedaan yang bermakna dalam efektivitas kedua jenis sikat gigi setelah penggunaan selama 7 dan 14 hari. Kesimpulan: Tidak ada perbedaan yang bermakna antara sikat gigi jenis ujung bulu sikat bulat dan ujung bulu sikat runcing. Tidak terdapat satupun jenis sikat gigi yang paling baik.
Full-text available
The aim of this RCT was to evaluate plaque control and gingival health promotion effectiveness of a new toothbrush with extra-soft filaments in postsurgical sets. Ten consecutive patients with at least two scheduled symmetrical periodontal surgeries were selected. Following the first periodontal surgery, a test (TB1) or control (TB2) toothbrush was randomly assigned. After the second surgery, the remaining toothbrush was given. Patients were asked to gently wipe the surgical area from days 3 to 7 postoperatively and to gently brush using a roll technique from day 7 till the end of the study. Baseline evaluation took place on the day of surgery and follow-ups were performed at days 7, 14, and 30 postoperatively. A more evident PI reduction was recorded for test toothbrush where a regular decrease was observed till day 14; then, this parameter tended to stabilize, remaining however lower than that recorded for the control toothbrush. There were no statistical differences in the GI between test and control toothbrushes. All patients introduced the test toothbrush at surgical site at third day; the control toothbrush was introduced within a mean of 9 days. The introduction of the test toothbrush 3 days after periodontal surgery may be recommended.
Full-text available
The purpose of this study was to evaluate abrasion of Icon® infiltrated, sound bovine enamel by using confocal laser scanning microscopy (CLSM) after toothbrush abrasion tests.
Full-text available
Aim: To investigate and compare the effects of toothbrushes with different hardness on abrasion and surface roughness of composite resins. Materials and methods: Toothbrushes (DENT. EX Slimhead II 33, Lion Dental Products Co. Ltd., Tokyo, Japan) marked as soft, medium and hard, were used to brush 10 beam-shaped specimens of each of three composites resins (Venus [VEN], Venus Diamond [VED] and Venus Pearl [VEP]; HeraeusKulzer) with standardized calcium carbonate slurry in a multistation testing machine (2N load, 60 Hz). After each of five cycles with 10k brushing strokes the wear depth and surface roughness of the specimens were determined. After completion of 50k strokes representative samples were inspected by SEM. Data were treated with ANOVA and regression analyses (p < 0.05). Results: Abrasion of the composite resins increased linearly with increasing number of brushing cycles (r² > 0.9). Highest wear was recorded for VEN, lowest for VED. Hard brushes produced significantly higher wear on VEN and VEP, whereas no difference in wear by toothbrush type was detected for VED. Significantly highest surface roughness was found on VED specimens (Ra > 1.5 µm), the lowest one on VEN (Ra < 0.3 µm). VEN specimens showed increased numbers of pinhole defects when brushed with hard toothbrushes, surfaces of VEP were uniformly abraded without level differences between the prepolymerized fillers and the glass filler-loaded matrix, VED showed large glass fillers protruding over the main filler-loaded matrix portion under each condition. Conclusion: Abrasion and surface roughness of composite resins produced by toothbrushing with dentifrice depend mainly on the type of restorative resin. Hardness grades of toothbrushes have minor effects only on abrasion and surface roughness of composite resins. No relationship was found between abrasion and surface roughness. Clinical significance: The grade of the toothbrush used has minor effect on wear, texture and roughness of the composite resin.
Full-text available
No standard oral assessment tools are available for determining frequency of oral care in critical care patients, and the method of providing oral care is controversial. To examine the effects of a systematic program of oral care on oral assessment scores in critically ill intubated and nonintubated, patients. Clinical data were collected 3 times during critical care admissions before and after institution of a systematic program of oral care in 3 different medical centers. The oral care education program consisted of instruction from a dentist or dental hygienist and a clear procedure outlining systematic oral care. The Beck Oral Assessment Scale and the mucosal-plaque score were used to assess the oral cavity. Data were analyzed by using linear mixed modeling with controls for severity of illness. Scores on the Beck Scale differed significantly (F = 4.79, P = .01) in the pattern of scores across the 3 days and between the control group (before oral education) and the systematic oral care group. Unlike the control group, the treatment group had decreasing scores on the Beck Scale from day 1 to day 5. The mucosal-plaque score and the Beck Scale scores had strong correlations throughout the study; the highest correlation was on day 5 (r = 0.798, P < .001, n = 43). Oral assessment scores improved after nurses implemented a protocol for systematic oral care. Use of the Beck Scale and the mucosal-plaque score could standardize oral assessment and guide nurses in providing oral interventions.
Background: Oral health is an integral part of general health. Poor oral health can have adverse effect on general health hence a good oral health is very essential, which in turn is achieved by good oral hygiene. Dental caries and periodontal disease are the most commonly occurring diseases affecting mankind. Dental plaque is a very important factor in the causation of both the diseases. (2) Aim & Objective: To evaluate efficacy of four different types of toothbrushes, with difference in duration of brushing along with different bristle hardness in removal of microbial plaque. Material & Methods: In a randomized controlled trial, four groups with 40 subjects used manual toothbrushes with either hard, medium, soft and ultra-soft bristles. On baseline examination, clinical parameter plaque index (Sillness & Loe, 1964) was recorded. Selected subjects were refrained from all kinds of oral hygiene measures for 24 hrs before clinical appointment. On the day of clinical appointment scores of pre and post brushing were recorded in each patient when brushing time was set for 1 minute and same procedure was repeated after a wash off period of 3 days and similar recordings were made with brushing time of 112 minute. Primary outcome was measured with differences in the plaque index (Sillness & Loe, 1964) compared to baseline. Results: Significant reduction in mean value of plaque score was observed on comparing pre-brushing and post-brushing data in all the subjects irrespective of bristle hardness in both 1 minute and 112 minute groups. On increasing time duration from 1 minute to 112minute intergroup comparison revealed that significant correlation exist in mean plaque score reduction in subjects using medium bristle brush, soft bristle brush, ultra-soft bristle brush. However, no significant reduction in plaque score was observed on increasing duration from 1 minute to 11/2 minute in subjects using hard bristle brush. Conclusion: Manual toothbrushes with hard bristles better remove plaque, but may also cause more soft tissue trauma compared to brushes with softer bristles. © 2017, Indian Association of Preventive and Social Medicine. All rights reserved.
The prevalence of diabetes is increasing worldwide. Diabetic population is growing fastest in south Asian region. Currently India is having more than 45 million diabetics. As the longevity of diabetic patients is being increased due to effective diagnostic protocols, increasing awareness and better treatment options available, more and more dentist has to come across diabetic population with dental problems. Therefore, it is important for dentists to be aware of medical and dental management considerations for this expanding patient population. Diabetes mellitus can have a significant impact on the delivery of dental care. 1.
The prevalence of diabetes is increasing worldwide. Diabetic population is growing fastest in south Asian region. Currently India is having more than 45 million diabetics. As the longevity of diabetic patients is being increased due to effective diagnostic protocols, increasing awareness and better treatment options available, more and more dentist has to come across diabetic population with dental problems. Therefore, it is important for dentists to be aware of medical and dental management considerations for this expanding patient population. Diabetes mellitus can have a significant impact on the delivery of dental care1.
A self-administered survey was conducted on the dental hygiene students at three different colleges located in Gyeonggi Province and South Chungcheong Province respectively from October, 2013, to the same month of 2014 to grasp their oral health management behavior, differences in plaque index according to plaque index systems and the correlation of the two. And their plaque index was measured. The findings of the study were as follows: 62.8% of the respondents replied they got a dental checkup over the past year, and 84.1% answered they received preventive dental treatment once at least or more. 80.5% replied they used a fluorine-containing dentifrice. 90.9% answered they used the rolling method to brush their teeth, and 50.0% replied it took three minutes to brush their teeth. They got a mean of 27.88 when O`leary index was used among plaque index systems. Their PHP index and PHP-M index were respectively a mean of 1.30 and a mean of 12.12. Their plaque index became lower when they spent more time brushing their teeth, and the toothbrushing time made a statistically significant difference to that (p
This study was conducted to examine O`leary index, patient hygiene performance (PHP) index, and toothbrushing practice assessment in subjects of college students in 20s who had been randomly selected. The purpose of this study is to examine if it is easy for rolling method which is recommended by many dental professionals in Korea to implement and to effectively remove dental plaque. Also, the correlations between dental plaque index and toothbrushing practice assessment with the course of time was confirmed, after instruction session on toothbrushing was provided. STATA 11.0 (StataCorp) was used for analysis. There was no significant difference on the three ways of O`leary index, PHP index, and toothbrushing practice assessment in using rolling method, bass technique and toothpick method when comparing the average resulting from first to third instruction session on toothbrushing. O`leary index, PHP index, and toothbrushing practice assessment were inspected with Kruskal-Wallis test which is used for non-parametric statistics. They were checked three times: the first, before the toothbrushing instruction was given; the second, two weeks after the toothbrushing session was given; and the third, 4 weeks after the session. The results are as follows: O`leary index stood at the lowest in the first experiment but showed the highest in the second (p