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In vitro cleaning efficacy and resistance to insertion test of interdental brushes
Clinical Oral Investigations
Abstract
The aim of this study was to compare the resistance to insertion forces and cleaning efficacy values of triangular interdental brushes (TIB) and conventional round interdental brushes (RIB). Extracted human teeth were fixed in a socket and matched to pairs simulating interdental spaces. Before and after standardized cleaning of the proximal surfaces, the pre- and postbrushing situations were registered with a digital camera. The cleaning efficacy was quantified by digital image subtraction. The forces necessary for insertion were measured with a load cell. The ratio between the relative cleaning efficacy and the forces necessary for insertion was calculated. The results of our study revealed that the relative cleaning efficacies of round and TIB were equal. There were no statistically significant differences. TIB showed significantly lower resistance to insertion values. Consequently, at identical resistance to insertion the TIB cleaned more effectively compared with the RIB, which means that the same effectiveness was reached by significantly lower forces at insertion. TIB showed a more favorable ratio between relative cleaning efficacy and resistance to insertion than RIB.
... Previous studies have proven that cleaning devices remove plaque reliably in areas with direct contact between the device and the tooth surface 40 . This situation leads to the assumption that the cleaning result is dependent on the dimensions of the contact area of the cleaning device and the tooth surface. ...
... Due to the conically tapered V-shaped bristle tufts, the brush tips also clean difficult-to-reach surfaces underneath the bracket-arch area. This reach results in a larger contact area between the tooth and bristle tips, which is crucial for efficient plaque removal 40 . In contrast, the wall shear stress of the AirFloss Ultra spray jet is not powerful enough at the margins to remove plaque adequately. ...
... When the bristles are inserted, the incongruity between the bristle design and the interdental space causes them to lie closely on top of each other, preventing the cleaning of the orally located areas of the proximal space. This phenomenon is called the "umbrella effect" 40 . Additionally, the increase in insertion resistance leads to a drift of the brush tip towards the gingiva, which may cause injuries. ...
Preventing biofilm-related risks such as gingivitis and white spot lesions during orthodontic treatments is very challenging. The cleaning efficiencies of AirFloss Ultra and I-Prox P sulcus brushes were evaluated using an orthodontic phantom model. After attaching brackets onto black-coated maxillary KaVo teeth, a plaque substitute was applied. The evaluated tooth surfaces were divided into two areas. Cleaning was performed with an AirFloss Ultra with two (A-2) or four (A-4) sprays or an I-Prox P for two (I-2) or four (I-4) seconds. Images before and after cleaning were digitally subtracted, and the percentage of fully cleaned surfaces was determined (Adobe Photoshop CS5, ImageJ). Statistical analysis was performed by ANOVA and post hoc tests with Bonferroni correction (SPSS 25, p < 0.05). The mean values of total cleaning efficacy were 26.87% for I-2, 43.73% for I-4, 34.93%, for A-2 and 56.78% for A-4. The efficacy was significantly higher for A-4 than for A-2, I-4, and I-2. There were significant differences between the four groups. Repeated cleaning led to an improved result. Within the study limitations, the AirFloss Ultra with four sprays proved to be more efficient than the sulcus brush I-Prox P for cleaning.
... We adopted the sample size of 25 for each cleaning device to detect a 5% difference in experimental cleaning efficiency and force between groups of different test products with a power of 80% as determined by a power calculation in previously published in vitro studies [8,11]. All measuring data were collected in a table (Microsoft Excel 2016, Microsoft Corporation, Redmond, WA, USA) and statistical analysis was performed using SPSS Statistics (SPSS Statistics 28, IBM, Chicago, IL, USA). ...
... Additionally, this result underlines once again the excellent intra-and interrater reliability of the ISO standard 16409:2016 independent of the required force to determine PHD as mentioned by Sekundo and Staehle [14]. Thus, it is not surprising that the mean ECF of all tested cleaning aids was always below the 3 N, as a threshold to prevent damage of hard and soft tissue [18], in line with previous experimental studies of similar test products [6,11,14]. Clinical studies with long-term observation will provide information here in the future, especially when ISO16409:2016 and PHD are used to positively impact patient communication and motivate oral health behavior. ...
Background
Up to date, interdental brushes (IDB) are the first choice for interdental cleaning because of their cleaning efficacy. Cylindrical ones must be selected individually according to the size/morphology of the interdental area (IDR), whereas conical ones cover a larger variability of IDR. However, there is a trend on the part of patients towards interdental rubber picks (IRP) which are in general conically shaped, and which seem to be linked with lower cleaning efficacy. A new IRP with an Archimedes´ screw design was developed to overcome this limitation. Therefore, the in vitro study aimed to measure the experimental cleaning efficacy (ECE) and force (ECF) during interdental use of IDBs versus the new IRP type.
Methods
Three IRPs with different tapers (PHB angled: 0.039, PHB straight S: 0.027, Vitis straight M: 0.045; all Flexipicks, Dentaid, Cerdanyola del Vallès, Spain) were compared to one IDB (Interprox micro PHD 0.9, Dentaid, Cerdanyola del Vallès, Spain). IDR were reproduced by a 3D-printer (Form2, Formlabs Sommerville, MA, USA) according to human teeth and matched to equivalent pairs (isosceles triangle, concave, convex) in three different diameters (1.0 mm,1.1 mm,1.3 mm). Covered with simulated biofilm, pre-/ post-brushing situations of IDR (standardized, computer-aided ten cycles) were photographed and quantified by digital image subtraction to calculate ECE [%]. ECF were registered with a load cell [N]. Statistically significant differences were detected using the Mann-Whitney-U-test and the Kruskal-Wallis-test with Bonferroni correction for multiple testing.
Results
Overall, the ECE (mean ± SD) was higher for IDB micro 0.9 (45.95 ± 11.34%, p < 0.001) compared to all IRPs (PHB angled: 25.37 ± 15.29%; PHB straight: 22.28 ± 16.75%; Vitis straight: 25.24 ± 12.21%; p ≤ 0.001), whereat best ECE was achieved in isosceles triangle IDR of 1.0–1.1 mm (IDB micro 0.9: 70.7 ± 7.7%; PHB angled S: 57.30 ± 4.43%; p < 0.001). The highest ECF occurred for Vitis straight M with 2.11 ± 0.46 N, while IDB micro 0.9 showed lowest ECF values (0.64 ± 0.14 N; p < 0.001).
Conclusions
IRP with an Archimedes´ screw design and a higher taper were associated with advanced ECE but also higher ECF, nevertheless, ECE didn’t reach the cleaning efficacy of conventional IDBs.
... In cross-section, they are usually circular, but there are also products with triangular incisions. 33,38,39 Advantages and disadvantages of these different designs have been discussed in a number of studies. Some have found superior performance of hourglass-shaped IDBs, 2,4 while others have reported equal cleaning effects for cylindrical IDBs. ...
... 29 Tests on the effectiveness of such oral hygiene aids mostly refer to the supragingival areas of the proximal spaces and the adjacent vestibular and oral surfaces. [2][3][4]16,17,20,25,28,38,39 There is a dearth of literature on the coverage of subgingival areas, especially in the case of deep pockets. 33 Satisfactory interdental cleaning is particularly difficult given narrow interdental spaces, especially if combined with persistent deep pockets at the site. ...
Purpose:
The subgingival area is only reached to a limited extent during home oral hygiene with the aids available to date. The question was investigated whether a newly developed, flattened cross-sectional design of interdental brushes (IDBs) can extend their subgingival reach.
Materials and methods:
In part I, the passage-hole diameters (PHD) of IDBs of different sizes and side-bristle lengths, with circular and flattened cross-sections, were compared according to the ISO standard 16409/2016. In part II, handling of flattened IDBs was described based on a case report of a patient with generalised stage 4, grade C periodontitis with locally persistent pockets.
Results:
Depending on the brush's size, flattening of IDBs reduced the PHD by 1-18 intervals. IDBs with longer side bristles could thus be inserted into interdental spaces with equal force. This may increase the potential range of IDBs in the vertical dimension. Regular instruction and check-ups are necessary to enable correct handling, as the flattened brushes can only be used in two positions. The observations documented in the case report (duration: 1.5 years) showed that flattened IDBs were associated with reduced signs of inflammation (reduction of pocket depths from 6 to 3 mm, absence of bleeding on probing).
Conclusion:
IDBs with a flattened cross-sectional design have not been previously described in the literature. It was shown that flattening of IDBs leads to a size-dependent decrease in PHD. Based on a case report, it was hypothesised that the design change of the IDBs could be clinically relevant in the case of persistent deep pockets in narrow interdental spaces. However, this can only be verified or falsified by clinical studies.
... We used three interdental gap sizes of 1.0 mm (small), 1.1 mm (medium) and 1.3 mm (large) in four morphologies (isosceles triangle, convex, concave space of 3-5 mm height), resulting in nine different artificial interdental areas. Subsequently, the interdental area replicas were stained by one investigator (K.S.) with Occlu Spray Plus (Hager & Werke, Duisburg, Germany) as described in previous studies [10,16,17]. A standardized powder thickness (mean ± SD: 20 ± 5 µm) was ensured by a standardized procedure and appropriate time protocol. ...
... A power calculation for the determination of the sample size was based on the results of a previously published in vitro study on the cleaning efficacy (percent of removed simulated biofilm) and resistance to insertion of two different interdental brushes [17]. According to this sample size calculation (sub-group analysis was considered beforehand), we found n = 25 samples per group as sufficient to detect five percent difference for experimental cleaning efficacy between the groups of different test products with a power of 80%. ...
Background
Interdental brushes (IDB) are according to the actual evidence the first choice for cleaning interdental areas (IDR). Their size should be chosen individually according to the IDR morphology. However, interdental rubber picks (IRP) are appreciated better by the patients and are hence becoming more and more popular but the evidence regarding their efficacy is still limited. The aim of this in vitro study was to measure the experimental cleaning efficacy (ECE) and force (ECF) during the use of interdental brushes versus newer wireless types with rubber filaments (IRP), both fitted and non-fitted for different IDR.
Methods
The medium size of a conical IRP (regular, ISO 2) with elastomeric fingers versus four sizes (ISO 1, 2, 3, 4) of cylindric IDB with nylon filaments (all Sunstar Suisse SA, Etoy, Switzerland) were tested. Interdental tooth surfaces were reproduced by a 3D-printer (Form 2, Formlabs Sommerville, MA, USA) according to human teeth and matched to morphologically equivalent pairs (isosceles triangle, concave, convex) fitting to three different gap sizes (1.0 mm, 1.1 mm, 1.3 mm). The pre-/post brushing situations at IDR (standardized, computer aided ten cycles) were photographically recorded and quantified by digital image subtraction to calculate ECE [%]. ECF were registered with a load cell [N].
Results
Overall, a higher ECE was recorded for IDB compared to IRP (58.3 ± 14.9% versus 18.4 ± 10.1%; p < 0.001). ECE significantly depended on the fitting of the IDB. ECE was significant higher in isosceles triangle compared to concave and convex IDR for both IDB and IRP (p ≤ 0.001). ECF was lower for IDB (0.6 ± 0.4N) compared to IRP (0.8 ± 0.5N; p ≤ 0.001). ECE in relation to ECF increases with smaller IDB. For IRP highest values of ECF were found in the smallest IDR.
Conclusions
Within the limitations of an in vitro study, size fitted IDB cleaned more effectively at lower forces compared to conical IRP.
... The different sizes of the interdental area were created in relation to the three sizes of the test device IRP-F in small, regular and large and adjusted to the two sizes of the IRP-S in extrasmall/small and medium-large/large. Subsequently, the interdental area replicas were stained by one investigator (J.R.) with Occlu Spray Plus (Hager & Werke, Duisburg, Germany) as described in previous studies [14,15]. A standardized powder thickness (mean ± SD: 20 ± 5 μm; supporting information in figure S1) was ensured by a standardized procedure and appropriate time protocol. ...
... A power calculation for the determination of the sample size was based on the results of a previously published in vitro study on the cleaning efficacy (percent of removed simulated biofilm) and resistance to insertion of two different interdental brushes [15]. According to this sample size calculation (sub-group analysis was considered beforehand), we found n = 25 samples per group as sufficient to detect 5 % difference for experimental cleaning efficacy between the groups of different test products with a power of 80%. ...
Background:
Interdental rubber picks (IRP) have become a frequent and convenient alternative for interdental cleaning. However, only little evidence exists supporting the effectiveness of newer designs available on the market. Therefore, a new in vitro model was evaluated to measure the experimental cleaning efficacy (ECE), as well as the force needed for insertion and during the use of IRP, with high reproducibility.
Methods:
Five different sizes of commercially marketed IRP with elastomeric fingers (IRP-F) (GUM SOFT-PICKS® Advanced, Sunstar Deutschland GmbH, Schönau, Germany) or slats (IRP-S) (TePe EasyPick™, TePe D-A-CH GmbH, Hamburg, Germany) were tested. Interdental tooth surfaces were reproduced by a 3D-printer (Form 2, Formlabs Sommerville, MA, USA) according to human teeth and matched to morphologically equivalent pairs (isosceles triangle, concave, convex) fitting to different gap sizes (1.0 mm, 1.1 mm, 1.3 mm). The pre-/post brushing situations at interdental areas (standardized cleaning, computer aided ten cycles) were photographically recorded and quantified by digital image subtraction to calculate ECE [%]. Forces were registered with a load cell [N].
Results:
IRP-F have to be inserted with significant higher forces of 3.2 ± 1.8 N compared to IRP-S (2.0 ± 1.6 N; p < 0.001) independent of the size and type of artificial interdental area. During cleaning process IRP-S showed significantly lower values for pushing/pulling (1.0 ± 0.8 N/0.5 ± 0.4 N) compared to IRP-F (1.6 ± 0.8 N/0.7 ± 0.3 N; p < 0.001) concomitant to significantly lower ECE (19.1 ± 9.8 vs. 21.7 ± 10.0%, p = 0.002). Highest ECE was measured with largest size of IRP-F/IRP-S independent the morphology of interdental area.
Conclusions:
New interdental cleaning aids can be tested by the new experimental setup supported by 3D printing technology. Within the limitations of an in vitro study, IRP-F cleaned more effectively at higher forces compared to IRP-S.
... 5 Ara yüz fırçaları, ara yüz temizliğinde en etkin araçlar olarak bilinse de silindirik şekilleri sebebiyle embrasür bölgesine tam adaptasyon gösterememe ve kullanım güçlüğü gibi limitasyonlara sahiptir. 3,6 Bu sebeple embrasür bölgesinin anatomisine uygun, üçgen şekilli ve farklı kıl dizaynına sahip açılı ara yüz temizlik araçları üretilmiştir. Literatürde farklı ara yüz temizleme araçlarının temizleme etkinliğini inceleyen sınırlı sayıda çalışma bulunmaktadır. ...
... 11 Ara yüzlere komşu yumuşak ve sert doku sağlığının idamesinde ara yüz fırçalarının en etkili metot olduğu sonucuna varılmıştır. 6,9,11,12 Tüm avantajlarının yanı sıra, dikkatli kullanılmadığında metal gövdenin diş ve kök yüzeyinde travma oluşturması nedeniyle dentin hassasiyetini tetikleme ve interdental papilin zedelenmesi gibi dezavantajları da mevcuttur. 3,13 Bu sebeple üreticiler, kullanım kolaylığı sağlamak amacıyla metal içermeyen esnek gövdeli plastik ara yüz temizleyici araçları piyasaya sunmuşlardır. ...
... Structural equation modelling revealed that reduction in gingival inflammation and probing pocket depth using interdental brushes is due to the indirect plaque removal effect rather than a direct effect of interdental papillae compression (12). It was demonstrated in vitro that bristle stiffness as well as bristle shape had no significant influence on interproximal brushing efficacy (13,14). These results were confirmed clinically (5,15), so it can be concluded that bristle shape and stiffness have no relevant influence on clinical outcomes of interdental brushes, whereas its combination use with toothbrushes is to be recommended. ...
... As interdental brushes are proven to be effective in periodontal maintenance care compared with other proximal oral hygiene devices (6, 7), the ideal construction of interdental brushes is of increased interest. Previous studies showed no superior efficacy of modified profiles of interdental brushes as compared to conventional round interdental brushes (5,14). Additionally, bristle filament stiffness had no clinical impact on brushing efficacy (13). ...
To investigate interproximal biofilm reduction with an angled interdental brush as compared to a straight interdental brush (standard control) in a clinical, single-centre, single-blind, controlled, parallel-group trial.
Recruitment and examinations of the subjects were performed at the Witten/Herdecke University School of Dental Medicine. 128 volunteers, aged 20-65 years, were recruited and stratified according to sex and age. Two groups with 64 subjects each used either straight (standard control) or angled (test group) handgripped interdental toothbrushes of the same bristle stiffness. After a 12-day home-care habituation period, participants received a professional tooth cleaning followed by a 48-h plaque regrowth period. At the intervention appointment, plaque was recorded with a fluorescent revelator and soft tissue damage was noted (T0 ). Interdental brushing was performed by the participant for 2 min, and clinical parameters were recorded again (T1 ). The primary efficacy end point was the difference in modified Proximal Plaque Index (mPPI) after brushing compared to baseline. Secondary efficacy end points were mPPI differences in subgroups (anterior vs. posterior teeth; vestibular vs. oral tooth surfaces). Safety end point was the Danser gingival abrasion index (DI).
mPPI showed lower scores after brushing within all (sub)groups (P < 0.01). mPPI brushing efficacy (ΔT0 - T1 ) in subjects using straight interdental brushes was significantly higher as compared to angled interdental brushes (P < 0.0001). Straight interdental brushes were significantly more effective in posterior teeth, when used from vestibular and from oral tooth surfaces (P < 0.0001, P < 0.01 and P < 0.0001, respectively). No significant differences were found between the groups in anterior teeth and concerning soft tissue damage.
Straight interdental brushes may better remove plaque interproximally when compared to angled interdental brushes.
... Several in-vitro studies compared different interdental cleaning aids including IRPs, nevertheless, oftentimes the experimental method neglected the variety of human tooth morphologies in IDR [18,21,22] and to our best knowledge, all of them tested under dry conditions, which only represents a small spectrum of patients with dry mouth and not the majority. So, we reconsidered our in-vitro model and concluded that the lack of saliva results in higher force values. ...
Background:
The familiar aids for interdental cleaning such as dental floss or interdental brushes (IDB) are often associated with difficult handling or an increased potential for trauma. Interdental picks (IRP), which have no metal core and silicone flaps instead of nylon brushes, offer the alternative. However, in-vitro studies found a lower cleaning effectiveness combined with higher forces for cleaning compared with conventional IDBs. The aim of this in-vitro study was to measure the experimental cleaning forces (ECF) using IRP with versus without an artificial saliva (AS; GUM Hydral, Sunstar Suisse SA, Etoy, Switzerland).
Methods:
The test set-up was developed to investigate the cleaning of 3D-printed interdental area (IDR) mimicking human teeth (Form 2, Formlabs Sommerville, MA, USA) under standardized conditions. Three different morphologies (isosceles triangle, convex, concave) and three different sizes (1.0 mm,1.1 mm,1.3 mm) were used. Two different IRPs (GUM Soft-picks Advanced: SPA versus GUM Soft-picks Advanced Plus: SPA+, Sunstar Suisse SA, Etoy, Switzerland) in three sizes (small, regular, large), were used with versus without AS. ECF during ten cleaning cycles were recorded by a load cell [N].
Results:
Using AS leaded to significant lower values for ECF than without (1.04 ± 0.66 N versus 1.97 ± 1.01 N, p < 0.001). In general, a lower ECF was recorded for convex IDR compared to isosceles triangle and concave morphologies (p < 0.001) as well as for gap sizes of 1.3 mm compared to the smaller sizes (p < 0.001). For SPA+ we found significantly higher force values than for SPA (1.67 ± 0.93 N versus 1.31 ± 0.97 N, p < 0.001) independent of the use of AS.
Conclusion:
Within the study´s in-vitro limitations, we found AS reduced ECF of IRPs by half and allowed using larger diameters interdentally, which could be associated with (1) a higher cleaning effectiveness and (2) a higher acceptance e.g. of patients with dry mouth. This has to be confirmed by further clinical investigations.
... 3a und b) lassen sich leichter in den Interdentalraum einführen und erzielen im Vergleich zu herkömmlichen runden Bürsten querschnitten eine bessere Rei nigungsleistung. 34 ...
Neben einer zahnfreundlichen Ernährung ist eine optimale und regelmäßige häusliche Mundhygiene das beste Mittel zur Vermeidung von Erkrankungen der Zähne und des Zahnhalteapparates (Axelsson & Lindhe 1978). An dieser Feststellung hat sich auch in den vergangen Jahrzehnten nichts geändert, denn immer noch gilt es die Belagsansammlungen mittels mechanischer Plaquekontrolle anzugehen, neu allerdings ist die Forderung nach Schonung aller oraler Strukturen (Stellungnahme der DGZMK von 2007). Dörfer & Staehle (2010) stellen in einem Übersichtsartikel zum Thema Plaquekontrolle fest, dass das Bewusstsein der deutschen Bevölkerung für die häusliche Mundhygiene geschärft und die Umsetzung dieser als soziale Norm akzeptiert ist. Zwar wissen beispielsweise ca. 90% der Bevölkerung, dass alle 2-3 Monate die Zahnbürste zu wechseln ist, aber maximal 2/3 setzen dies auch wirklich in die Tat um (EMROS 2006, Ziebolz et al. 2006).
Ein schier unerschöpfliches Angebot an Hilfsmitteln zur individuellen Plaquekontrolle steht zur Verfügung, wobei Neuentwicklungen der Industrie hinsichtlich ihrer Wirksamkeit kritisch hinterfragt werden sollten. Die folgende Übersicht der mechanischen Mundhygienehilfsmittel stellt keinesfalls den Anspruch auf Vollständigkeit, sondern kann lediglich einen kleinen Ausschnitt spezieller Hilfsmittel zur Plaquekontrolle aus parodontalprophylaktischer Sicht wiedergeben. Der Artikel gibt den Inhalt eines vom Autor gehaltenen Vortrages im Rahmen des 40. Deutschen Fortbildungskongress für die Zahnmedizinische Fachangestellte wieder.
... Eighteen articles were removed from the review because they did not meet the inclusion criteria such as intervention phase less than four weeks, 19-25 missing interdental brush intervention, 19,30-32 missing dental floss comparison, [26][27][28][29] or study was a review article. 17,33,34 Additional studies were excluded if the risk of bias was high (see Table 3). ...
BDS, BSc(Hons.), LLB(Hons.), MSc, DDS(Edin.), DDRRCR, FDSRCPS, FRCD(C). AbstrACt Background: Daily oral biofilm disruption by clients is recommended by oral health professionals to prevent oral diseases and to maintain optimal oral and overall health. Since periodontal diseases and caries are prevalent interproximally, the adjunctive use of interdental aids is highly recommended. Objectives: To evaluate the effectiveness of interdental brushing as an adjunct to toothbrushing for the primary outcome of interproximal gingival bleeding and a secondary outcome of interproximal plaque. Methods: Only randomized controlled trials were included. Studies were included irrespective of publication status and language. Hand searching was conducted in two peer reviewed journals, with references mined. Pharmaceutical companies that develop and manufacture interdental brushes were also contacted for unpublished or ongoing clinical trials. Sixty-two studies were retrieved from the literature with seven studies meeting the inclusion/ exclusion criteria. Forest plots and Chi-square tests were used to determine the presence of heterogeneity. Random effects model, relative risk and 95% confidence intervals were used in the analysis. Results: Four studies were included in the meta analysis for bleeding outcome. Although some heterogeneity was present among the studies, the interdental brush groups demonstrated statistical significance for reducing interproximal bleeding compared to the dental floss groups, p = 0.003. Plaque outcomes were analyzed using seven studies, with interdental brush demonstrating statistically significant differences to dental floss, p = 0.024. Conclusion: Interdental brush is an effective alternative to dental floss for reducing interproximal bleeding and plaque in clients with filled or open embrasures.
There are many interdental cleaning aids available for patient use, including toothpicks, dental floss and interdental brushes (IDBs). Most are available in various shapes and sizes. The aim of this laboratory study was to evaluate and compare the cleaning efficacy of waist-shaped interdental brushes to those of cylindrical shape. Four groups of IDBs, ranging in diameter from 2 mm to 9 mm, were tested. To reduce production and material bias, all brushes tested were from the same manufacturer. Cleaning efficacy was tested on two different devices: 1. a geometrical model, using opposing rectangular blocks at separation distances of 1 mm to 4 mm and 2. an anatomical model, displaying a standardized maxillary segment from canine to 3rd molar. The surfaces in both devices were coated with a titanium oxide slurry, then cleaned under standardized conditions and planimetrically evaluated. The measurements took place after 1, 5 and 10 cleaning strokes, respectively. Both models showed significant superiority in the cleaning efficacy of the waist-shaped brush (p < 0.001), at 1, 5 and 10 strokes. In the anatomical model, where the entire interdental space was evaluated, the waist-shaped brushes even cleaned significantly better (36%) with just 5 strokes than the cylindrical counterparts with 10 strokes (33%, p = 0.003). Based on the present results, it can be concluded that interdental brushes with a waist-shaped form showed cleaning potential superior to their cylindrical-shaped counterparts, under standardized laboratory conditions.
Aim: Aim of the study was to evaluate the efficacy of manual toothbrush (STIM® 42 Orthodontic toothbrush) with or without an interdental brush (IDB) (STIM® PROXA-Extra fine) on gingival status in patients undergoing fixed orthodontic therapy. Materials and methods: In a randomized control trial of 60 subjects undergoing orthodontic therapy with Begg’s appliance enrolled for the study. They were placed in a maintenance regimen with (STIM® 42 orthodontic toothbrush) after thorough scaling and root planning (SRP) for four weeks before the commencement of the study. This was done to attain uniformity and avoid bias in both the groups at the baseline. At the end of four weeks, subjects were randomly divided into two groups, group I–30 subjects used STIM® 42 Orthodontic toothbrush only and group II–30 subjects used STIM® PROXA-extra fine as an adjunct to STIM® 42 Orthodontic toothbrush for four weeks. Clinical parameters such as bonded bracket plaque index (BBPI), gingival index (GI), and gingival bleeding index (GBI) were recorded at baseline, 1, 2 and 4 weeks. Analysis of data was done using repeated measures analysis of variance (ANOVA) and unpaired student t-test using Statistical Package for the Social Sciences (SPSS) 22 software. Results: Result of the study showed a statistically significant reduction (p < 0.001) in BBPI, GI and GBI in group. II subjects when compared to group. I. Conclusion: Manual orthodontic brush along with IDB proved to be superior, in controlling plaque, gingival inflammation and gingival bleeding in subjects undergoing fixed orthodontic treatment. Clinical significance: Our study supports the use of interdental brushes along with manual toothbrush during fixed orthodontic treatment. It can significantly improve plaque control, thereby improving gingival health. To promote gingival health dentists need to motivate and reinforce this beneficial practice among their patients undergoing fixed orthodontic treatment. © 2018, Jaypee Brothers Medical Publishers (P) Ltd. All rights reserved.
Aim:
The aim of this study was a comparison of the handling and acceptance of two kinds of interdental brushes (interdental brush with a handle [HB] and a newly invented interdental cleaning device [NB]).
Methods and materials:
In a randomized crossover trial, 40 test subjects with an average number of 23.5 interdental areas were examined. At two appointments with a "washout" period of one week, the volunteers tried out both cleaning tools (HB and NB). They were asked to clean as many interdental spaces as possible. The percentage of spaces, which could be reached, is the IRI (Interdental Reachability Index). Furthermore, subjective impressions were determined.
Results:
The average IRI using HB was 64% compared to 80% using of NB (P<.001); 62.5% of the volunteers found the cleaning with HB painful and 15% the cleaning with NB. The subjective feeling after cleaning was 1.75 with NB compared to 2.2 with HB (P=.015), grading the feeling, from 1 for "very good" to 5 for "poor." The acceptance of regular interdental hygiene was rated 1.95 in the case of the NB and 2.85 in the case of the HB. After both appointments, the test subjects declared that they would use the NB 3.05 times and the HB 1.78 times a week.
Conclusion:
This study shows that the test subjects reached more interdental spaces with NB than with the HB. NB can improve the usage of interdental brushes. Regarding subjective comfort, participants also favoured NB over HB.
Aim:
The purpose of this study was to compare the effectiveness of conically shaped versus cylindrically shaped interdental brushes (IDB) in patients receiving supportive periodontal therapy.
Materials and methods:
Periodontal maintenance patients volunteered to be enrolled into this randomized controlled examiner-blind parallel study. At baseline and after 3 months, plaque scores, bleeding upon pocket probing scores and probing pocket depth (PPD) were assessed. The type of IDB (conical or cylindrical) was randomly assigned to each patient and individual instruction was provided regarding the method of use and the appropriate size. Only those approximal sites that had sufficient space for the IDB were eligible, and for those sites the data were analysed separately. Analyses were performed for all eligible approximal surfaces and a sub-analysis was performed for vestibular and lingual surfaces.
Results:
In total, 51 participants attended the baseline and the 3-month clinical appointments. Overall, there was no difference between conical and cylindrical IDBs. However, the conical IDB showed significantly higher plaque and bleeding scores at the lingual approximal sites. The cause of this difference was an increase in plaque and bleeding scores compared with baseline. With respect to the PPD, no difference between the IDBs was observed.
Conclusion:
Within the limitations of this experiment, the conical IDBs are less effective than cylindrical IDBs with respect to lingual approximal plaque removal. Thus, in patients receiving supportive periodontal therapy, the cylindrical shape should be the first choice of IDB to obtain and maintain gingival health around natural teeth.
The aim of this randomized clinical trial was to compare the plaque control effectiveness and handling of an interdental brush with a short curved handle and a triangular cross-section of the brush head (IDB) and an interdental brush with a long straight handle in combination with a monotufted brush head (MTB).
In a split-mouth design, 110 multibracket patients were randomly assigned to group A using the MTB in the first and third quadrants and the IDB in the second and fourth quadrants or to group B who proceeded the other way around. A crossover was performed after 3 months. The plaque index (PI) was scored every 6 weeks for a period of 24 weeks, and handling was evaluated using visual analogue scales (VAS). Wilcoxon tests were used to determine differences in PI and VAS scores between the two brushes and for PI differences between the different observation periods. Differences concerning personal preference and perceived cleaning efficacy were analysed with chi-square tests. The significance levels used were P < 0.001 and P < 0.01.
The PI decreased significantly, but no statistically significant difference was found between the two brushes. Subjects experienced less pain and reported better access behind the archwire with the IDB. The use of an interdental brush reduced the PI irrespective of the design of the brush head. In direct comparison, adolescent patients preferred the IDB. Further trials are required to investigate the effectiveness of the IDB in reducing decalcification during orthodontic treatment.
Background: Cheilitis is a common problem, the cause of which is often obscure.
Objective: Data on 75 cases of recalcitrant cheilitis were analyzed. These had been referred to a tertiary care center.
Methods: Each of the 75 patients had undergone a detailed history, physical examination, and patch tests.
Results: Of the patients, 53 were female (67%), and the age range was 9 to 79 years. Of the cases, 36% included irritant contact dermatitis (ICD), 25% included allergic contact dermatitis (ACD), 19% were attributed to atopic eczema, and in 9% the dermatitis was of unknown cause. Nine percent were noneczematous. The materials causing ACD were medicaments applied to the lips, lipstick ingredients, sunscreen agents, toothpaste ingredients, colophony in dental floss and toothpicks, nail varnish, cosmetics, and nickel in the mouthpiece of a flute.
Conclusion: The most common cause of cheilitis was irritation, frequently caused by liplicking. About one quarter was caused by ACD. Medicaments, lipsticks, sunscreens, and toothpaste were the most common allergens. Atopic eczema is a commonly overlooked cause of cheilitis. However, there is a troublesome group of patients, 9% in this series, who are often severely affected, but the cause of their cheilitis remains obscure.
• A review of our experience with cicatricial pemphigoid revealed three patients with cicatricial pemphigoid and rheumatoid arthritis and one patient with ankylosing spondylitis who had a high titer of rheumatoid factor. A comparison of these four patients with patients who had bullous pemphigoid and rheumatoid arthritis shows similarities between cicatricial pemphigoid and bullous pemphigoid in relation to the development of rheumatoid arthritis.
(Arch Dermatol 114:415-417, 1978)
To the Editor.—
When the usual factors for perlèche are not evident, such as infection, irritation, malocclusion, avitaminosis, and lip-licking (perléche is patois for "pour lecher"—"to lick"), irritation from the use of dental floss should be considered. This has been observed in two patients with recurrent unilateral perlèche on the right. The patients called attention to this. Dental floss, unwaxed, for the bicuspids and molars rubbed against the commissure area of the lips, especially when the mouth was wide open. Recurrences of the perlèche were prevented by stopping the use of dental floss. If dental floss is needed for dental hygiene, especially for teeth back in the mouth, as the molars, perhaps waxed floss should be used and the mouth should not be opened too widely. With the extensive use of dental floss, such irritation of the commissures must not be uncommon.
The removal of interproximal plaque was compared using a standard toothbrush alone, a toothbrush with unwaxed dental floss and a toothbrush with an interdental brush. 30 previously treated periodontal patients were given the cleaning aids in a three-way crossover study design. After each 1 month trial period, scores for gingivitis, buccal/lingual plaque and proximal plaque were recorded. Mean GI scores for subjects were 0.37 using the toothbrush only, 0.36 using the toothbrush with floss and 0.32 using the toothbrush with the interdental brush. Mean buccal/lingual plaque scores were 0.64 using the toothbrush only, 0.62 using the toothbrush with floss and 0.51 using the toothbrush with the interdental brush. Mean plaque scores were 2.32 with the toothbrush only, 1.71 using the toothbrush with floss and 1.22 using the toothbrush with the interdental brush. Statistically significant differences were seen in proximal plaque scores between the 3 treatment groups. The results indicate that the interdental brush used in combination with a toothbrush is more effective in the removal of plaque from proximal tooth surfaces than a toothbrush used alone or in combination with dental floss.
Clinical and histologic observations of 14 marginal tissue clefts associated with improper floss manipulation are presented. Newly acquired lesions were characteristically inflamed, ulcerated and symptomatic while clefts of chronic duration were asymptomatic and un-noticed by the patient. Cleft sites exhibiting varying degrees of epithelialization generally presented apical bifurcations suggesting reinjury by the patient during lateral positional shifts of the floss. The terminology "flossing cleft" is suggested by the authors to describe linear or V-shaped interdental marginal tissue deformities that result from dental floss-induced injury. While these clefts may serve as a potential source of bacteremia during vigorous flossing and associated oral tissue manipulation, in no instances were they determined to constitute a morphologic impediment to effective plaque control efforts.
A case was reported where a piece of dental floss broke and was retained in an interproximal area. The patient came to the clinic a few days later with a periodontal abscess. After the retained fragment of dental floss was removed, the abscess resolved. Therefore, a retained portion of dental floss should be immediately removed to prevent gingival irritation and tissue injury.
The plaque-removing efficacy when using waxed dental floss and three interdental brushes was compared in an intraindividual clinical trial. Nine adult patients treated for periodontal disease, with a reduced but healthy periodontium and large interdental spaces were subjects in the study. Each subject tested the four interdental cleaning aids in random sequence over a 2-wk period. The duration of the study was 8 wk. The results indicated that the use of interdental brushes is preferable to that of dental floss in cleaning interdental areas where the papilla is missing. No difference in achieved cleanliness was noted after use of the different interdental brushes tested. No gingival damage or damage to the hard tissue of the teeth was observed after use of interdental brushes or dental floss.
The purpose of the present study was to compare in untreated patients suffering from moderate to severe periodontitis the efficacy of dental floss (DF) and interdental brushes (IDB) in the reduction of plaque, gingival inflammation, and probing depth in a 6-week period prior to subgingival debridement. Twenty-six patients (12 female, 14 male; mean age 37.4 years; range 27 to 72 years) were instructed to use DF for one side of the dentition and IDB for the other side as an adjunct to the daily toothbrushing for 6 weeks. Oral hygiene instructions for toothbrushing and the use of the two devices were given at baseline and at week 3. Measurements were carried out at baseline and at 6 weeks including plaque scores, probing depth, and 2 bleeding scores (periodontal pocket bleeding index and angulated bleeding index). With the IDB, the approximal plaque score at baseline of 3.09 reduced to 2.15 at 6 weeks and with DF from 3.10 to 2.47, respectively. IDB proved to remove significantly more plaque than DF. Baseline probing depth of 5.84 mm for IDB sites and 5.59 mm for DF sites was reduced to 5.01 mm at 6 weeks for both regimens. Analysis showed that the use of IDB resulted in a greater pocket reduction. Both bleeding indices were slightly reduced with IDB and DF, but no differences between devices were found. In relation to patient acceptance, more problems were observed with DF, and IDB were felt to be more efficacious. In conclusion, the results of the present study indicate that in combination with a manual toothbrush, the use of interdental brushes is more effective in removal of plaque and results in a larger reduction of probing depth than the use of dental floss. Although the differences were small, they indicate, in combination with patient preferences, that interdental brushes are to be considered preferable to floss for interdental plaque removal in patients suffering from moderate to severe periodontitis.
Cheilitis is a common problem, the cause of which is often obscure.
Data on 75 cases of recalcitrant cheilitis were analyzed. These had been referred to a tertiary care center.
Each of the 75 patients had undergone a detailed history, physical examination, and patch tests.
Of the patients, 53 were female (67%), and the age range was 9 to 79 years. Of the cases, 36% included irritant contact dermatitis (ICD), 25% included allergic contact dermatitis (ACD), 19% were attributed to atopic eczema, and in 9% the dermatitis was of unknown cause. Nine percent were noneczematous. The materials causing ACD were medicaments applied to the lips, lipstick ingredients, sunscreen agents, toothpaste ingredients, colophony in dental floss and toothpicks, nail varnish, cosmetics, and nickel in the mouthpiece of a flute.
The most common cause of cheilitis was irritation, frequently caused by liplicking. About one quarter was caused by ACD. Medicaments, lipsticks, sunscreens, and toothpaste were the most common allergens. Atopic eczema is a commonly overlooked cause of cheilitis. However, there is a troublesome group of patients, 9% in this series, who are often severely affected, but the cause of their cheilitis remains obscure.
The aim of this study was to compare the effectiveness of the automated Interclean Interdental Plaque Remover with that of interdental brushes and Ultrafloss.
The interdental hygiene effectiveness of 35 healthy patients suffering from gingivitis was studied by an examiner daily over a period of 1 week. The sizes of the interdental spaces were classified and corresponding-sized interdental brushes or floss was selected. In a random, split-mouth design both interdental cleaning methods, mechanical and manual, were applied while the patients continued to use standard brushing techniques. Disclosed proximal plaque, the papillary bleeding index, and interdental bleeding tendency on stimulation were evaluated.
The papillary bleeding index was reduced from an average value of 40% to 25%. Only 5% of interproximal plaque remained after manual interdental cleaning, whereas 40% of plaque was still present after use of the Interclean device. Cleaning efficiency of manual and mechanical methods was comparable in only 1 interproximal space size. At the end of the study, the interdental bleeding on stimulation was significantly higher in the automatically cleaned interspaces than in the manually cleaned spaces.
Manual interproximal cleaning was more effective than the automated device.
We report an unusual case of a toddler who ingested dental floss and who subsequently was intubated in a community ED prior to transfer to our pediatric tertiary care center for endoscopic removal of the foreign body.
The aim of this study was to evaluate the cleaning efficacy of interdental brushes with different stiffnesses, e.g. soft and hard interdental brushes with identical brush diameter.
Cylindrical soft and hard interdental brushes with diameters of 2,3 and 5 mm each were tested. Sixteen extracted human molars were fixed in split cast models to simulate eight interdental spaces. After coating the teeth with a dye to simulate plaque, digital photographs were taken from the proximal surfaces in a highly standardised set-up. The teeth were repositioned and the proximal surfaces were cleaned in a standardised manner. Post-brushing digital photographs were taken as before. After digital subtraction, the cleaned area was measured by pixel count and the relative cleaning efficacy was calculated.
The cleaning efficacy values of soft and hard interdental brushes of corresponding size in extra-small, small, medium and large interdental spaces as well as overall showed no statistically significant difference. In small, medium and large interdental spaces, increasing brush diameters resulted in higher cleaning efficacy; these differences were statistically significant. Irregular values were seen in extra-small interdental spaces.
Both hard and soft interdental brushes cleaned the proximal tooth surfaces effectively. The filament stiffness had no statistically significant influence on the cleaning efficacy.
Cleaning efficacy of different interdental brushes
- Haus D D Wolff
- D Jörß
- T Pioch
- Dörfer
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Wolff D, Haus D, Jörß D, Pioch T, Dörfer CE (2003) Cleaning efficacy of different interdental brushes. J Clin Periodontol 30:52 (abstract #196)
Aids for an effective interdental hygiene-a difficult choice
- C E Dörfer
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Dörfer CE (2002) Aids for an effective interdental hygiene—a difficult choice. ZMK 18:376–382
Modern aspects of interdental hygiene. Part II
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Dörfer CE (1998) Modern aspects of interdental hygiene. Part II. Zahnärztl Mitt 88:376–385
Needs related plaque control measures based on risk prediction. Paper presented at the European workshop on mechanical plaque control, Castle of Münchenwiler, Berne, Switzerland hygiene: interdental brushes versus dental floss
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Axelsson P (1998) Needs related plaque control measures based on risk prediction. Paper presented at the European workshop on mechanical plaque control, Castle of Münchenwiler, Berne, Switzerland hygiene: interdental brushes versus dental floss. J Periodontol 69:759–764
Cleaning possibilities of tunneled teeth-an experimental investigation
- C E Dörfer
- K Weidtmann
- CE Dörfer
Dörfer CE, Weidtmann K (1998) Cleaning possibilities of tunneled teeth—an experimental investigation. Dtsch Zahnärztl Z 53:349–353
Force effect on the proximal tooth surfaces by interdental brushes
- Dörfer Ce
- S Spiry
- Staehle
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Dörfer CE, Spiry S, Staehle HJ (1995) Force effect on the proximal tooth surfaces by interdental brushes. Dtsch Zahnärztl Z 50:904–908
Cleaning efficacy of an interdental cleaning aid in comparison with interdental floss. Results of an in-vitro study
- C E Dörfer
- CE Dörfer
Dörfer CE (1999) Cleaning efficacy of an interdental cleaning aid in comparison with interdental floss. Results of an in-vitro study. Dtsch Zahnärztl Z 54:494–498
Modern aspects of interdental hygiene
- C E Dörfer
- CE Dörfer
Needs related plaque control measures based on risk prediction
- P Axelsson
Cleaning efficacy of interdental brushes in-vitro
- C E Dörfer
- S Spiry
- H J Staehle
- CE Dörfer
Force effect on the proximal tooth surfaces by interdental brushes
- C E Dörfer
- S Spiry
- H J Staehle
- CE Dörfer