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Interproximal plaque mass and fluoride retention after brushing and flossing--a comparative study of powered toothbrushing, manual toothbrushing and flossing
Abstract
To determine differences in interproximal plaque mass and fluoride retention with different modes of toothbrushing and flossing.
Forty-seven subjects in good health used four treatments in a four-period, randomized, crossover design: 1) manual brushing only; 2) manual brushing and daily flossing; 3) electric brushing using a rotational oscillation toothbrush; and 4) electric brushing using a sonic toothbrush. Subjects used a standard sodium fluoride dentifrice during the eight-day experimental periods and a fluoride-free dentifrice during the seven-day washout periods between treatments. Interproximal plaque samples were taken on Day 1 and on Day 8, weighed, and analyzed for fluoride content.
The amount of interproximal plaque was lowest with sonic brushing, which left 43-65% less plaque than all other treatments. Manual brushing and flossing yielded less plaque than manual brushing alone and rotational oscillation brushing. Differences were statistically significant (p < 0.05) for treatment; there was no time effect on plaque mass. For fluoride retention, at Day 1 sonic brushing gave at least 54% more fluoride in the interproximal plaque than all other treatments, which was significant. All treatments demonstrated a significant increase in fluoride concentration with time except manual brushing and flossing, which showed a significant decrease. At Day 8, the fluoride concentration was significantly higher for sonic brushing than for manual brushing or rotational oscillation brushing by over 40%, and all treatments exhibited significantly greater fluoride than the manual brushing and flossing combination.
The mode of toothbrushing may impact the amount of plaque retained interproximally and its fluoride concentration.
... One study [26] used the Turesky modified Quigley-Hein plaque index (TMQH). One [21] used the wet weight of plaque to measure the reduction. ...
... A decision was made to still include the studies with a moderate risk of bias and test them for heterogeneity where appropriate in the meta-analysis, thereby generating as large a dataset as possible from which to draw conclusions. [37] chart (studies [20][21][22][23][24][25][26][27][28][29][30][31][32][33] [34] App use differed between groups Key: Green = low-risk; orange = some concerns; red = high-risk. ...
... The earliest study was published in 2004 [21], and the most recent one was published in 2021 [34]. Most of the studies allowed the use of the test and control toothbrushes at home, although one did not [22]. ...
The removal of dental plaque from the gingival margins of the teeth is essential to maintaining periodontal health. Whilst it has been established that electric toothbrushes demonstrate a greater ability to remove plaque, no systematic review has specifically investigated which technology is better for removing plaque from the interdental tooth surfaces, where plaque control may be more difficult. Three databases were searched until October 2023: MEDLINE and DOSSS via EBSCOhost and Embase. Data extraction was carried out on studies which met the inclusion criteria, and a risk of bias assessment was completed. The study findings were combined via a narrative synthesis and a meta-analysis where appropriate. A total of 77 studies were found, out of which 14 were selected and included in the analysis. The mean difference in interproximal plaque reduction, measured using the Rustogi Modified Naval Plaque Index (RMNPI) at 8 weeks, was 0.09 (p < 0.00001) in favor of the oscillating–rotating toothbrush. At 6 and 12 weeks, the mean difference in plaque reduction (RMNPI) was 0.05 (p = 0.0008) and 0.04 (p = 0.0001) in favor of the oscillating–rotating toothbrush, respectively. The studies show a tendency for oscillating–rotating toothbrushes to remove more interproximal plaque than oscillating toothbrushes, especially in a short time (8 weeks).
... Toothbrushing with dentifrice takes place nearly everywhere and has been documented as the most widely used oral hygiene habit in the industrialized world. 17,20 While toothbrushing is an effective means for removing plaque on many tooth surfaces, it is incapable of removing plaque completely on its own. 4 Research has shown that toothbrushing is less effective than other means of interproximal plaque removal 9,21,22 and that proximal surfaces of posterior teeth are the least accessible smooth surfaces. 20 This limitation has contributed to the inefficiency of toothbrushing in controlling interproximal gingival bleeding. ...
... 17,20 While toothbrushing is an effective means for removing plaque on many tooth surfaces, it is incapable of removing plaque completely on its own. 4 Research has shown that toothbrushing is less effective than other means of interproximal plaque removal 9,21,22 and that proximal surfaces of posterior teeth are the least accessible smooth surfaces. 20 This limitation has contributed to the inefficiency of toothbrushing in controlling interproximal gingival bleeding. 8 Research has shown powered toothbrushing to have improved efficacy in interproximal plaque removal compared with manual toothbrushing even when combined with flossing. ...
... 8 Research has shown powered toothbrushing to have improved efficacy in interproximal plaque removal compared with manual toothbrushing even when combined with flossing. 20 Caution should be exercised when assessing these particular findings, however. The findings are based on a short-term study with relatively young (mean age 25) study subjects, the outcome measure was limited to the wet weight of interproximal plaque, and no gingival assessment was made. ...
... In the oral cavity, dental biofilm removal under non-contact brushing is subjected to different shear forces which can cause an expansion in the structure of unremoved biofilms due to its viscoelastic nature (Busscher et al., 2010a;Peterson et al., 2015). Investigators demonstrated that fluid-dynamic activity generated by power toothbrushes can change biofilm viscoelastic properties which in turn enhance antimicrobials penetration inside the remaining biofilm (He et al., 2014;Sjogren et al., 2004;Stoodley et al., 2007). In addition to fluid behaviour we also demonstrated biofilm viscoelastic behaviour showing biofilm timedependent recoil and residual strain when the shear-stress caused by the microsprays was removed (Fig. 7). ...
... In addition to fluid behaviour we also demonstrated biofilm viscoelastic behaviour showing biofilm timedependent recoil and residual strain when the shear-stress caused by the microsprays was removed (Fig. 7). Other studies have reported that biofilms exhibit both elastic recoil and residual strain caused by viscous flow Rupp et al., 2005;Shaw et al., 2004;Towler et al., 2003). Conventional "before" and "after" imaging would not have revealed this behaviour and the drawn conclusion would be that a device had failed to remove biofilm from the surface in the first place. ...
Using high-speed imaging we assessed Streptococcus mutans biofilm–fluid interactions during exposure to a 60-ms microspray burst with a maximum exit velocity of 51m/s. S. mutans UA159 biofilms were grown for 72h on 10mm-length glass slides pre-conditioned with porcine gastric mucin. Biofilm stiffness was measured by performing uniaxial-compression tests. We developed an in-vitro interproximal model which allowed the parallel insertion of two biofilm-colonized slides separated by a distance of 1mm and enabled high-speed imaging of the removal process at the surface. S. mutans biofilms were exposed to either a water microspray or an air-only microburst. High-speed videos provided further insight into the mechanical behaviour of biofilms as complex liquids and into high-shear fluid–biofilm interaction. We documented biofilms extremely transient fluid behaviour when exposed to the high-velocity microsprays. The presence of time-dependent recoil and residual deformation confirmed the pivotal role of viscoelasticity in biofilm removal. The air-only microburst was effective enough to remove some of the biofilm but created a smaller clearance zone underlying the importance of water and the air–water interface of drops moving over the solid surface in the removal process. Confocal and COMSTAT analysis showed the high-velocity water microspray caused up to a 99.9% reduction in biofilm thickness, biomass and area coverage, within the impact area.
... In addition, dental floss has been reported to be an important part of oral hygiene. [14][15][16][17] Flossing removes plaque from between the teeth and under the gumline-areas where a toothbrush cannot reach. These are the parts of the teeth where decay and periodontal disease often start. ...
... Reports in the literature have consistently demonstrated the use of floss is just as important and necessary as the toothbrush. 15,17,29,30 However, inadequate flossing by most people or inexperienced individuals with the use of dental floss 31 can lead to an accumulation of plaque, and ultimately gingivitis, particularly in areas that are inaccessible to a regular toothbrush. 27 See page 11 to read about a recommended flossing technique. ...
The objective of this study was to compare the plaque removal efficacy of a prototype manual Deep Clean toothbrush versus an American Dental Association (ADA) manual toothbrush and the ADA manual toothbrush in conjunction with floss.
This study was a randomized, examiner-blind, six-period cross-over, single-center study conducted in 60 adult subjects that examined plaque removal with a prototype Deep Clean manual toothbrush, an ADA reference manual toothbrush, and an ADA reference manual toothbrush followed by floss. During the course of this study, subjects used each treatment two times. Plaque was scored before and after brushing using the Rustogi Modification of the Navy Plaque Index. A mixed model analysis of covariance (ANCOVA) for a crossover design with baseline plaque score as the covariate was applied to the baseline minus one-minute post-brushing differences in average whole-mouth plaque scores. Supplemental analyses were also performed using the ANCOVA model separately for average gingival margin scores and for average interproximal scores, using the appropriate baseline score as the covariate. All comparisons were two-sided at the 0.05 level of significance.
The prototype Deep Clean manual toothbrush delivered an adjusted (via ANCOVA) mean difference between baseline and post-brushing plaque scores of 0.245, while the ADA manual toothbrush plus floss delivered an adjusted mean difference of 0.207 versus 0.196 for the ADA manual toothbrush alone. The prototype Deep Clean manual toothbrush demonstrated a statistically significantly greater reduction in plaque than the ADA manual toothbrush plus floss (p<0.001), which in turn had a statistically significantly greater reduction in plaque than the ADA manual toothbrush alone (p<0.001). The prototype Deep Clean manual toothbrush group had, on average, 25.2% and 18.3% greater plaque removal scores than the ADA manual toothbrush alone and the ADA manual toothbrush plus floss groups, respectively. Results for the interproximal and gingival margin regions also demonstrated statistically significantly (p<0.001) greater plaque removal for the prototype Deep Clean manual toothbrush group relative to the other groups.
The prototype manual Deep Clean toothbrush was found to deliver greater plaque removal by 25.2% and 18.3% compared to the control manual toothbrush group (ADA reference manual toothbrush) and ADA manual toothbrush plus floss group.
... Objective methods to quantify the amount of plaque removed by an oral hygiene treatment include measuring the weight of plaque (Altman et al. 1979, Ainamo et al. 1993, Sjögren et al. 2004, McCracken et al. 2006. For instance, Sjögren et al. (2004) compared the extent of IPP removal based on the wet weight of plaque collected from subjects following 1 and 8 days of treatment with a particular cleaning routine. ...
... Objective methods to quantify the amount of plaque removed by an oral hygiene treatment include measuring the weight of plaque (Altman et al. 1979, Ainamo et al. 1993, Sjögren et al. 2004, McCracken et al. 2006. For instance, Sjögren et al. (2004) compared the extent of IPP removal based on the wet weight of plaque collected from subjects following 1 and 8 days of treatment with a particular cleaning routine. McCracken et al. compared the dry weight of plaque collected from preselected test sites versus the Turesky PI to ass2ess IPP removal with a power toothbrush (PTB). ...
To establish clinical models that accurately and objectively assess the levels of interproximal plaque (IPP) by measuring the total protein concentration.
The multiple treatment (MTM) and single-treatment models (STM) were designed as randomized, double-blinded, crossover studies whereby IPP was collected using floss. The total protein concentration in the plaque was then measured using a fluorescence microplate assay. To demonstrate sensitivity, the levels of residual IPP were compared for two distinctly different plaque removal routines: brushing versus brushing+flossing.
Eighteen subjects completed the study for the MTM, while 16 participants completed the study for the STM. The results showed that both models were able to distinguish between treatments. Moreover, fundamental profiles were established that describe the mean changes in the IPP concentration over time and by treatment. Finally, a comparison between our results and a direct measure of IPP, i.e., plaque weight, demonstrated the potential of using protein as a quantitative means to assess IPP levels.
The MTM and STM provide an objective, quantitative assessment of IPP based on the total protein concentration in plaque.
... An oscillating electric floss is a dental device that uses a motor to produce back-and-forth movements to clean teeth. The flosser element is stretched taut on a floss holder, which is mounted on a drive shaft that is rotationally oscillated by the motor [36]. There are currently no articles comparing the efficacy of WFs versus electric flossers in the management of periodontal disease. ...
This study investigated the efficacy of water flossers (WFs), devices used to irrigate the interdental and subgingival areas, compared to other interdental care methods, in the management of periodontal disease. A computerized PubMed search was conducted by the author, encompassing the years 1962 to 2023. The year 1962 was selected due to it being the introduction of the first WF. Keywords included "oral irrigator", "efficacy," and "water flossers." The review provided a broad comparative assessment of WFs, rather than an exhaustive detailed article review. We discussed the history and evolution of commercially available WFs and introduced a novel classification system. The research also evaluated the performance of WFs in comparison to traditional and novel interdental care methods, focusing on crucial clinical parameters such as plaque removal efficiency and reduction in gingival inflammation. The results of the study reveal that WFs appear to be superior in the management of periodontal disease and have demonstrated effectiveness in a variety of indices. However, it's worth noting that the author did not statistically analyze any of the data. We identified gaps in the literature and found opportunities for further clinical studies. These findings hold implications for optimal periodontal disease prevention and management, addressing the evolving landscape of oral care practices.
... Sjögren and Birkhed have developed a toothpaste technique called the modified fluoride toothpaste technique (MFTT), in which a slurry rinse is performed using fluoride toothpaste after brushing [4]. The MFTT has been reported to enhance the effectiveness of fluoride toothpaste and reduce adjacent interdental caries in preschool children by an average of 26% [6][7][8]. Additionally, Al Mulla et al. reported using a similar method, 2+2+2+2 [9]. These toothpaste techniques enhance the caries effect of dentifrices by maintaining high levels of fluoride in the oral cavity for extended periods. ...
In home care, the toothpaste technique, which can enhance the caries-preventive effect without changing the amount of dentifrice and fluoride ion concentration, is of great significance. This study aimed to construct a model and experimental system that reproduces the interdental part and to clarify the relationship between the change in dentifrice viscosity due to dilution and washout in the high-risk approximal area of caries. Additionally, the effectiveness of the toothpaste technique and appropriate devices for delivering dentifrice to the interdental area at a low dilution were investigated. Diluted toothpaste samples were prepared (: ×1.00, ×1.25, ×1.50, ×1.75, ×2.00, ×3.00, and ×4.00). An acrylic interproximal model was created for this experiment. The flow characteristics and viscosity by dentifrice dilution were measured. In the case of low dilution of 57% (1.75×) or more, it was shown that the dentifrice in the high-risk area may be washed out early because of the decrease in viscosity, and the caries-preventive effect may be reduced. It was also suggested that to keep the dentifrice in the interdental area for 120 s at the end of brushing, a dilution must be devised to a concentration of at least 50% (2.00×). The prepared toothpaste delivery (PTD) method of delivering dentifrice to the interdental area while maintaining it at a low dilution is an effective toothpaste technique in terms of dentifrice dilution and viscosity. The use of finger brushes in the PTD method could increase the efficiency of dentifrice delivery.
... [12][13][14] Toothbrush and toothpaste are still the most reliable means of dental plaque control, provided cleaning is sufficiently thorough and performed at regular interval. [15][16][17] Nevertheless, this means of plaque control is not adequate due to the limited ability of the toothbrush to reach the interdental areas. 14,18 These areas are the sites where plaque and inflamation are most pronounced 19 and regular interdental cleaning can result in better oral hygiene outcomes regarding dental plaque and gingivitis 20 . ...
Objectives
The purpose of this systematic review was assess whether flossing before or after influences plaque index reduction.
Methods
This systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyzes and registered with the International Prospective Register of Systematic Reviews under number CRD42019126239. The PICO question was, “does flossing before or after brushing have any effect on reducing dental plaque?”. An electronic search was performed until April 2020 in the following databases: PubMed/MEDLINE, Scopus Web of Science and Cochrane Library. The initial database search resulted in 9679 references, after detailed analysis of the titles and abstracts of the selected studies, the inclusion / exclusion criteria were applied, 06 complete articles were downloaded and selected for further analysis. After the complete 02 articles were selected, 60 patients with a mean age of 23.1 years were studied, and compared dental flossing before or after dental brushing.
Results
The results showed that there was no statistical difference between Brush-Floss and Floss-Brush in reducing plaque index (p = 0.91, RR: 0.01, 95% CI: -0.16, 0.18).
Conclusions
Flossing before or after brushing has no significant effect on reducing dental plaque index. However, more clinical studies should be conducted.
... Normal salivary function is mediated by the muscarinic M3 receptor. [69][70][71] Efferent nerve signals mediated by acetylcholine also stimulate salivary glandular epithelial cells and increase salivary secretions. 72 Individuals with xerostomia often complain of problems with eating, speaking, swallowing, and wearing dentures. ...
Diabetes mellitus (DM) is a complex disease with varying degrees of systemic and oral complications. The periodontium is also a target for diabetic damage. In recent years, a link between periodontitis and diabetes mellitus has been postulated. The oral cavity serves as a continuous source of infectious agents that could further worsen the diabetic status of the patient and serve as an important risk factor deterioration of diabetes mellitus. The present review highlights the relationship between diabetes mellitus and periodontitis. The potential mechanisms involved in the deterioration of diabetic status and periodontal disease are also discussed.
... Direct investigation of the plaque removal performance "in vivo" is impossible because interproximal spaces in a closed dental arch are not directly visible. 43 Hence, researchers must rely on "in-vitro" models that allow removal of the teeth and visualization of the facing interproximal surfaces. An "in-vitro" study evaluated 72 extracted human teeth, grouped as incisors, premolars, and molars, and embedded in acrylic resin. ...
Aim
This study aimed to establish the efficacy of a rubber bristles interdental cleaner (RBIC) as an adjunct to toothbrushing (TB) compared to that of the adjuvant use of other interdental cleaning devices and TB alone on plaque and gingivitis parameters. Additionally, the safety aspects and panelists’ appreciation were evaluated.
Materials and Methods
Databases were searched for randomized controlled clinical trials (RCTs) evaluating plaque (PI), bleeding (BS), and gingival index (GI) scores, safety assessments, and participants’ appreciation. Extracted data were summarized in a descriptive and, if possible, a meta‐analysis.
Results
The search retrieved 142 unique papers; six studies with 10 comparisons were included in a descriptive analysis. Five RCTs compared RBICs with interdental brushes (IDBs), four with dental floss (DF), and one with manual TB only. No comparisons to wood sticks were retrieved. Using an RBIC resulted in no difference in plaque scores compared to DF and IDBs. For overall bleeding scores, no difference was found. Two studies analyzing the accessible sites separately found RBICs to be more favorable than DF and IDBs. Conversely, one study evaluating the efficacy of RBICs compared to IDBs, according to the GI scores, showed that IDBs achieved significantly greater reduction. Moreover, RBICs caused fewer gingival abrasions and were preferred by the study participants.
Conclusion
Based on a descriptive and a meta‐analysis of the available literature, it is synthesized that in gingivitis patients, a weak to very weak certainty exists that a RBIC is indicated for gingivitis and plaque reduction. The evidence supports user safety and participants’ preferences.
... On the other hand, the plaque substitute and the teeth themselves do not correspond exactly to real conditions. To measure the cleaning efficacy more precisely, in vivo studies are required using measurable parameters such as the approximal plaque or the stage of inflammation of the interdental papilla 32 . Because of the greater plaque formation on the buccal sites of maxillary teeth compared to mandibular teeth, maxillary teeth are thought to be more difficult to clean than lower teeth 33 . ...
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.
... In addition to restoration design, personal home care and consistent professional maintenance have proven to be critical for the long-term outcome of dental implants (Serino & Strom, 2009;Silverstein & Kurtzman, 2006). It has been reported that a normal toothbrush alone is not enough to clean interproximal areas (Berchier, Slot, Haps, & Van der Weijden, 2008;Sjogren, Lundberg, Birkhed, Dudgeon, & Johnson, 2004). Interproximal brushes have shown to remove interproximal plaque of dental implants (Chongcharoen et al., 2012), as they are able to penetrate into the peri-implant sulcus. ...
Objectives
To compare the removal of simulated biofilm at two different implant‐supported restoration designs with various interproximal oral hygiene aids.
Methods
Mandibular models with a missing first molar were fabricated and provided with single implant analogues (centrally or distally placed) and two different crown designs (CCD: conventional and ACD: alternative crown design). Occlusion spray was applied to the crowns to simulate artificial biofilm. Thirty participants (dentists, dental hygienists and laypersons) were equally divided and asked to clean the interproximal areas with five different cleaning devices to further evaluate if there were differences in their cleaning ability. The outcome was measured via standardized photos and the cleaning ratio, representing the cleaned surfaces in relation to the respective crown surface. Statistical analysis was performed by linear mixed‐effects model with fixed effects for cleaning tools, surfaces, crown design and type of participant, and random effects for crowns.
Results
The mean cleaning ratio for the investigated tools and crown designs were (in%): Super floss: 76±13/ACD and 57±14/CCD (highest cleaning efficiency), followed by dental floss: 66±13/ACD and 56±15/CCD, interdental brush: 55±10/ACD and 45±9/CCD, electric interspace brush: 31±10/ACD and 30±1/CCD, microdroplet floss: 8±9/ACD and 9±8/CCD. There was evidence of an overall effect of each factor “cleaning tool”, “surface”, “crown design” and “participant” (p<0.0001).
Conclusions
ACD allowed more removal of the artificial biofilm than CCD with Super floss, dental floss and interdental brush. Flossing and interproximal brushing were the most effective cleaning methods. A complete removal of the artificial biofilm could not be achieved in any group.
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... In the manual mode, the user can keep his familiar brushing technique; in the sonic mode, the "non-contact" brushing linked to fluid dynamics completes the soft mechanical scrubbing. Sonic toothbrushes used in combination with a fluoride toothpaste demonstrate significantly less interproximal plaque and deliver significantly higher concentration of fluoride in that plaque, compared to manual or oscillatingrotating toothbrushes [32]. A standardized in vitro test -performed on a phantom tooth model cleaned by a robot proved that the hybrid toothbrush (combined mode) eliminates ten times more plaque in the approximal spaces compared to a conventional ADA manual toothbrush (internal data). ...
Background:
An innovative hybrid toothbrush was designed functioning either in manual mode, in powered mode (sonic) or in combined mode (manual and powered). The primary aim of this study was to evaluate and compare the clinical efficacy of this first hybrid toothbrush (Elgydium Clinic/Inava Hybrid) used in combined mode to a marketed oscillating-rotating powered toothbrush (Oral-B Vitality) in the reduction of dental plaque after a single use. The secondary aims were to evaluate the tolerance and acceptability of each device.
Methods:
It was a randomized, examiner-blind, single-center study performed on two parallel groups: hybrid toothbrush (n = 33) versus oscillating-rotating toothbrush (n = 33). A brushing exercise was conducted for two minutes on subjects presenting a "Silness and Löe Plaque Index" (PI) between 1.0 and 2.0 and a "Modified Gingival Index" between 1.0 and 2.0. They were not to have ever used an electric toothbrush. To assess the device effect after brushing, a paired t-test was applied on the change outcome (After-Before brushing). An unpaired t-test was used to compare the efficacy of both devices. A global tolerance assessment of each powered toothbrush was done on all the subjects. The number and percentage of reactions related to each toothbrush was collected and the final tolerance assessment was estimated.
Results:
After a single use, the hybrid toothbrush used in combined mode presented a global anti-plaque efficacy characterized by a significant decrease of the global PI of 45% on average (p < 0.0001; paired t-test). It was as effective as the oscillating rotating toothbrush in plaque removal (p > 0.05; unpaired t-test). The global tolerance of both toothbrushes was judged as "Good" and they were equally appreciated by the users.
Conclusion:
The results of this one-time use trial demonstrate the efficacy of the hybrid toothbrush used in combined mode for plaque removal. The hybrid toothbrush design allows each user to adapt tooth brushing to his preference (manual / sonic / combined), his skills or his mouth condition. We hypothesize that such an individualized approach can favor long term compliance with oral health recommendations and improve global oral wellness.
Trial registration:
ISRCTN12394494 , 20/02/2018 - Retrospectively registered.
... particularly in posterior areas. 7 Periodontal and gingival lesions are predominantly observed at these sites, 8 which are also frequently affected by caries. 9,10 Therefore, interdental cleaning accompanied by toothbrushing are cornerstones in achieving plaque control in daily oral care. ...
Background and aim
Mechanical plaque control methods such as brushing and flossing are highly recommended to remove dental plaque. The aim of this study is to evaluate the efficacy of the sequence of brushing and flossing on reducing interdental plaque and increasing fluoride retention in that area.
Methods
This randomized controlled crossover trial was conducted on 25 dental students. After prophylaxis, they were asked to discontinue all forms of oral hygiene for 48 hours. The study was performed in two phases with two‐week washout intervals. In one phase, they first brushed, then flossed (sequence 1: brush‐floss group). In the other phase they initially used dental floss then brushed (sequence 2: floss‐brush group). At each phase, dental plaque (using the Rustogi Modified Navy Plaque Index) and fluoride concentrations (using a fluoride ion specific electrode) were measured before and after flossing and brushing, and the dental plaque reduction and fluoride increase were compared between the two groups using the mixed model test. A significance level of 5% was selected.
Results
In the floss‐brush group interdental and whole plaque was reduced significantly more than the brush‐floss group (p = 0.001, p = 0.009 respectively). However, marginal plaque did not show any statistically significant difference between the two groups (p = 0.2). Fluoride concentrations in interdental plaque were significantly higher in the floss‐brush group than the other group (p = 0.027).
Conclusion
The results showed that flossing followed by brushing is preferred to brushing then flossing in order to reduce interdental plaque and increase fluoride concentration in interdental plaque.
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... [14] Brushing the teeth with dentifrice is universal and has been documented as the most widely used oral hygiene habit in the industrialized world. [15] Toothbrush and toothpaste help in the mechanical removal of cariogenic and periodontopathic plaque, thereby achieving primary prevention of oral diseases. [16,17] The use of tooth powder instead of toothpaste was found to be more in the non-medical graduates' group. ...
... Flossing is a preventative health behavior, which removes plaque from areas that brushing cannot reach, [9] thereby preventing cavities and gum disease [10]. Flossing has been shown to be associated with greater plaque reduction than brushing alone [11]. Flossing is most effective when performed daily, preferably in the evening, to prevent bacteria build-up when asleep [12]. ...
Aims: Dental caries and periodontal diseases which are the two most prevalent oral diseases are dental biofilm dependent. this effect of dental plaque is particularly evident in the interproximal region. the aim of this study was to determine the factors that are associated with knowledge and positive attitude towards the use of dental floss at the Lagos state University teaching Hospital, Ikeja, (LAsUtH) and two private dental clinics in Ikeja and Magodo, Lagos state. Methods: this prospective descriptive study was conducted at the oral diagnosis clinic of LAsUtH and at two private dental clinics in Lagos state. A structured interviewer administered questionnaire was used to obtain information on socio-demographic items and on the participant's perception regarding gum inflammation, their oral hygiene practices and their knowledge, attitude and practices related to flossing. results: the study population included dental patients aged 22–68 years. Majority of the respondents in this present study had poor knowledge and attitude on the use of dental floss. respondents attending the private clinics had significantly better knowledge on the practice of oral hygiene and the use of dental floss (p = 0.000) and they also had a more positive attitude even though the association was not significant. (p = 0.364) the study participants that had a good knowledge and positive attitude on dental floss usage and oral hygiene had lower mean OHI-s, GI and DMFt scores even though the association was not significant. conclusion: this study demonstrated a poor level of knowledge and attitude to the use of dental floss among the respondents. Oral health care professionals should spend adequate time to educate their patients on the benefits of interproximal cleaning especially floss usage. they should also enhance the self-efficacy and knowledge of their patients about the benefits of interdental hygiene.
... die Fluoridretention nach einmaliger Applikation hochkonzentrierter Fluoridpräparate vor dem Hintergrund der Anwendung einer fluoridfreien oder fluoridhaltigen Zahnpaste zur täglichen Mundhygiene. Die Plaqueentnahme erfolgte aus den Approximalräumen der Probanden, da die Plaque aus dem Interdentalraum mit einer Handzahnbürste nicht vollständig entfernt werden kann [16]. Aufgrund der begrenzten interdentalen Plaqueentfernung stellen die Approximalflächen der Zähne eine Kariesprädilektionsstelle dar [12]. ...
Introduction: Aim of the study was to examine the retention of fluoride from highly concentrated fluoride preparations the interdental plaque after one-time application and use of non-fluoridated toothpaste and after application of a fluoride gel combined with a fluoridecontaining toothpaste for daily prophylaxis. Methods: Two groups of volunteers (mean age 23 and 28 years, resp.) were involved in this study. After professional tooth cleaning all participants conducted oral hygiene with a non-fluoridated toothpaste. After 14 days, plaque samples were taken for determing the baselinefluoride value. Subsequently, the fluoride gels Elmex Gelée and Sensodyne Pro Schmelz Fluoride Gelée, as well as the fluoride varnish Duraphat were applied in three consecutive testing sequences. Plaque samples were taken after 24 hours, four, seven, 14, 21 and 28 days and the plaque-fluoride content (PFC) was determined by using a fluoride-sensitive electrode. Results: Following the fluoride application the PFC increased significantly. An increased PFC was estimated 14 days after application of Elmex Gelée and Duraphat and seven days after application of Sensodyne Pro Schmelz Fluorid Gelée. The increased PFC was significantly higher after using of a fluoride toothpaste compared to the use of a non-fluoridated toothpaste. After additional application of Elmex Gelée the PF was increased for further four days. Conclusion: The daily use of fluoride-containing toothpaste is most important for an elevated PFC. The combination with the weekly application of a fluoride gel could ensure higher PFC. This procedure is especially recommended in patients with an increased caries risk.
... Oral biofilm left behind in the oral cavity, although a priori, of course, undesirable, has been demonstrated to be able to take up fluoride (24) and antimicrobials and act as an intra-oral reservoir. Recently, it was shown that sonic brushing increased the amount of fluoride, over an 8 d period, in oral biofilms in interproximal spaces, by 40%, compared with rotational oscillating brushing and manual brushing (25). This can be understood in terms of the present result that oral biofilm left behind after sonic brushing is fluffed-up in its expanded state and is thus more open for penetration by fluoride and antimicrobials. ...
Busscher HJ, Jager D, Finger G, Schaefer N, van der Mei HC. Energy transfer, volumetric expansion, and removal of oral biofilms by non‐contact brushing. Eur J Oral Sci 2010; 118: 177–182. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci
Non‐contact removal of oral biofilms offers advantages beyond the reach of bristles, but it is unknown how energy transfer for removal from brush‐to‐biofilm occurs. In the present study we evaluated non‐contact, oral biofilm removal by oscillating‐rotating and sonic toothbrushes, and their acoustic output up to 6 mm distance. Whereas some brushes removed biofilm when used at a distance of up to 6 mm, others lost efficacy at a distance of 2–4 mm from the biofilm. Loss of efficacy was accompanied with high standard deviations and volumetric biofilm expansion. Both sonic and oscillating‐rotating brushes caused fluid flows and the inclusion of air‐bubbles, while non‐contact acoustic energy‐transfer was demonstrated to decay with distance for both types of brushes. We put forward the following mechanism for non‐contact removal: (i) brush energy is absorbed by biofilm, resulting in the visco‐elastic expansion of the biofilm; (ii) if the energy absorbed is sufficient and deformation is beyond the yield point, biofilm removal occurs; and (iii) if deformation is in the plastic range but below the yield point (i.e. at the limiting distance for non‐contact removal), biofilm is expanded but not removed.
... Even the nature of brushing can impact efficacy of fluoride delivery. A four-day clinical trial revealed that sonic brushing increased the concentration of retained fluoride in plaque biofilm increased by greater than 40% compared to rotary brushing, manual brushing, and manual brushing and flossing [28]. Further research into the physical relationships among power brushing, fluid dynamic activity, and the role of localized oxygen gradients in oral biofilms should be explored in the context of increasing fluoride retention and delivery. ...
Dental biofilms are implicated in the formation of caries and periodontal disease. A major constituent of the supragingival biofilm is Streptococcus mutans, which produces lactic acid from sucrose fermentation, enhancing enamel demineralization and eventual caries development. Caries prevention through F inhibits enamel demineralization and promotes remineralization. Fluoride also exerts effects on metabolic activities in the supragingival biofilm such as aerobic respiration, acid fermentation and dentrification. In experimental S. mutans biofilms, adding 1000 ppm F to an acidogenic biofilm resulting from 10% sucrose addition increased pH to pre-sucrose levels, suggesting inhibition of acid fermentation. F effects on metabolic activity and sucrose utilization in interproximal plaque biofilms were also recorded. Addition of 10% sucrose reduced pH from neutral to 4.2, but subsequent addition of 1000 ppm F increased pH by 1 unit, inhibiting acid fermentation. 10% Sucrose addition also stimulated denitrification, increasing production of nitrous oxide (N(2)O). Addition of 1000 ppm F suppressed denitrification, indicating an additional mechanism by which F exerts effects in the active interproximal biofilm. Finally, fluid dynamic activity by power tooth brushing enhanced F delivery and retention in an experimental S. mutans biofilm, suggesting a potential novel benefit for this intervention beyond mechanical plaque removal.
... The features of an ideal tooth-binding micelle formulation should include: (1) a high drug solubility in the solution and a high binding capacity of the micelle to HA surface, such that the maximal amount of drug can be immobilized onto the tooth surface; (2) a small particle size, so that the micelles can have access to narrow areas such as between caries-prone toothtooth contact areas (34) and potentially penetrate the biofilm; (3) a fast binding kinetic to increase patient compliance; and (4) a sustained release behavior to provide prolonged antimicrobial exposure to dental biofilm. From the results of the micelle formulation optimization and characterization in this study, we have chosen the combination of P123/ALN-F127, which has a small particle size and high binding capacity, to proceed with the next step of our study-in vitro biofilm evaluation. ...
To develop tooth-binding micelle formulations of triclosan for the prevention and treatment of dental caries.
Alendronate (ALN) was conjugated to the chain termini of different Pluronic copolymers to confer tooth-binding ability to the micelles. Using 3 different formulation methods, Pluronics and ALN-modified Pluronics were used to prepare triclosan-loaded tooth-binding micelles. The formulation parameters were optimized for triclosan solubility, particle size, hydroxyapatite (HA) binding capability and in vitro drug release profile. The optimized formulation was tested on an in vitro biofilm model.
Direct dissolution was selected as the best formulation method. Triclosan-loaded tooth-binding micelles were able to inhibit initial biofilm growth of Streptococcus mutans UA159 by 6-log CFU/HA disc compared to the untreated control. These tooth-binding micelles were also able to reduce the viability of preformed biofilm by 4-log CFU/HA disc compared to the untreated control.
Triclosan-loaded tooth-binding micelle formulations have been successfully developed and optimized in this study. These micelle formulations demonstrated promising anti-cariogenic bacteria capabilities and may find applications in the prevention and treatment of dental caries.
... In vitro studies have shown that powered brushing with both sonic and rotary action significantly increased the transport of F − through S. mutans biofilm-colonized membranes compared with diffusion alone, illustrating the potential importance of convective transport for the delivery of F − . 61 This effect may explain the results of a clinical study by Sjögren and colleagues, 69 who found that sonic brushing for four days increased the retained F − concentration in the plaque by more than 40 percent compared with the results of other treatments (that is, manual brushing, manual brushing and flossing, and powered rotary brushing), suggesting that sonic brushing increased the delivery of F − into the interproximal plaque. ...
The biofilm concept of dental plaque now is widely accepted in the dental clinic, particularly with respect to its importance to oral hygiene. A number of reviews have focused on the microbial ecology of biofilm with regard to oral health; however, there has been less focus on how the interaction of biofilms and hydrodynamics with mass transfer (the movement of molecules and particulates) and physiological processes may relate to caries.
The authors reviewed reports in the microbiology and dental literature addressing microbiological, engineering and clinical aspects of biofilms with respect to mass transport and microbial physiology, with an emphasis on fluoride ions (F(-)).
and Practical Implications. These data illustrate how dental plaque biofilms may affect the delivery of cariogenic agents, such as sucrose, or anticariogenic agents, such as F(-), into and out of the biofilm, with subsequent consequences for the development of physio-chemical microenvironments at the tooth surface. Increasing the flow rate in an overlying fluid (such as saliva or mouthrinse) increases transport from the fluid into and through biofilms. Increasing the delivery of anticariogenic agents such as F(-) into the plaque biofilm, by generating strong fluid flows, may be a useful strategy for enhancing the anticaries effects of F(-) in areas of the mouth where complete biofilm removal is not possible with routine daily cleaning techniques.
... Particularly, powered toothbrushes seem to have better efficacy in removing plaque than manual ones, improving, by regular use, the oral hygiene level. [9][10][11][12][13] Powered toothbrushes use vibrating, rotating or oscillating brush heads that achieve plaque removal primarily through direct physical contact between bristles and tooth surface. One generation of powered toothbrushes, also called sonic toothbrushes, was designed to combine bristle contact with the production of localized hydrodynamic shear forces that dramatically improve the efficacy of plaque removal. ...
To evaluate the in vitro differential effect of sonic energy, delivered by Sonicare Advance, on cariogenic and non-cariogenic bacteria biofilms.
A wild strain of Streptococcus mutans, Lactobacillus acidophilus, Streptococcus salivarius and Veillonella alcalescens was isolated from human dental plaque. For each of the four microorganisms a biofilm adherent to bovine enamel disks, coated with artificial saliva, was obtained. Biofilms were divided into four groups and were exposed to acoustic energy delivered by Sonicare for 0 (control group), 5, 15 and 30 seconds. The distance between the end of the bristles and the disk surface was set to 7 mm, to ensure that the biofilm removal was simply due to fluid forces and not to the contact with the bristle tips during the brushing cycle. A colorimetric technique (MTT assay), based on the reduction of a yellow tetrazolium salt to a purple formazan, was used to evaluate the reduction of the adherent biomass after the exposure to the sonic energy.
ANOVA results showed that sonic energy exposure significantly reduced the biomass of S. mutans and S. salivarius adherent to the disks, while L. acidophilus and V. alcalescens seemed to remain basically unaffected. In the two streptococcal groups, the increase of the exposure time led to different reduction trends; while S. salivarius exhibited a progressive decrease over time, S. mutans showed a rapid reduction of the adherent biomass after a 15-second exposure to Sonicare.
... The respective value for Germany was 14.3% as reported by Staehle and Kerschbaum. 4 It was shown recently that a power toothbrush with sonic action was more effective in reducing interproximal plaque than a manual brush in combination with dental floss. 5 Therefore, using a sonic brush may be an alternative to using a combination of a manual brush and dental floss. However, there is no solution for subjects who reject using an electric brush. ...
Dental floss is only used by a small part of the population on a daily basis. Therefore, an easy, applicable alternative is needed. This alternative could be a mouthrinse with antimicrobial activity for daily use. The aim of the present study was to evaluate the efficacy of two mouthrinses in reducing interdental plaque and gingivitis compared to dental floss.
A total of 156 healthy volunteers were randomly assigned to the following groups: 1) toothbrushing and rinsing (0.06% chlorhexidine and 0.025% fluoride); 2) toothbrushing and rinsing (0.1% cetylpyridiniumchloride and 0.025% fluoride); 3) toothbrushing and flossing; and 4) toothbrushing only (N = 39 subjects in each group). At baseline, the modified proximal plaque index (MPPI) and papillary bleeding index (PBI) were recorded. Thereafter, subjects had to brush in the usual manner during 8 weeks. Additionally, test groups had to rinse once a day (groups 1 and 2: 30 seconds) or to floss (group 3). Eight weeks after baseline, indices were recorded again and improvements were calculated. Analysis of variance (ANOVA) and the Bonferroni test served for statistical analysis.
After 8 weeks, reductions for all indices were found in all groups (P <0.05). With respect to the MPPI, mouthrinse groups performed better than the control and floss groups: 1) 0.73; 2) 0.82; 3) 0.40; and 4) 0.32 (P <0.05). The PBI showed no statistically significant difference between groups: 1) 0.46; 2); 0.50; 3); 0.42; and 4) 0.37.
The results suggest that, in combination with toothbrushing, daily use of the tested mouthrinses may result in a higher interproximal plaque reduction than daily flossing.
... • Absence of manual brushes in the methodology (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). • Lack of analysis of the indices of plaque and gingival (38)(39)(40) or only interproximal plaque analysis (41). ...
This review of the literature intends to evaluate the effect of brushes with high frequency motion when compared with manual toothbrushes regarding the indices of plaque and gingival bleeding.
Patients presenting gingivitis and/or chronic periodontitis were evaluated in addition to patients having osseointegrated implants and fixed orthodontic appliances. Pertinent literature was reviewed to select articles according to previously defined inclusion criteria.
In the assessed studies results showed significant decreases in plaque and gingival indices by utilization of both types of brushes. However, in the selected studies where sonic brushes were tested in orthodontic and dental implant patients there was a more significant decrease in the indices. Furthermore, there was no indication of gingival recession attributed to product use.
Future studies with a more homogeneous methodology and better experiment designs will be needed.
... In response to the shortcomings of the visual indices for assessing interproximal plaque (IPP) accumulation, objective means by which to quantify IPP have been reported. Such alternatives include measurement of plaque weight (Ainamo et al. 1993, Sjögren et al. 2004, McCracken et al. 2006) as well as indirect assessments based on total DNA content (Stilwell et al. 2006) and total protein concentration (Altman et al. 1979, FDA 1996, Bellamy et al. 2004, Milanovich et al. 2005. ...
Establish total protein concentration and total bacterial load as quantitative measures of residual interproximal plaque (IPP) in a clinical model designed to evaluate oral hygiene interventions.
This clinical model was a randomized, examiner and laboratory technician-blinded, parallel-design study whereby levels of residual IPP were compared for subjects using a manual toothbrush or a toothbrush+floss. Differences between interventions were compared after 7 and 21 days of use. Protein concentration was measured using 3-(4-carboxybenzoyl) quinoline-2-carboxaldehyde in a fluorescence microplate format and bacterial load was assessed by quantitative real-time PCR with universal primers specific for 16S rRNA and detected by SYBR Green. ancova was used to assess the statistical significance of the differences between interventions while clinical relevance was evaluated by a statistical model described by Man-Son-Hing et al. 2002.
Ninety-three subjects completed the study. Significant differences between interventions, using both outcome measures, were observed after 7 and 21 days. The difference between interventions by total protein concentration were further determined to be clinically relevant.
Only total protein concentration provided both statistically significant and clinically relevant differences between two clinically distinct oral hygiene interventions in this clinical model for evaluating IPP.
The effective cleaning of interdental spaces using toothbrushes is a challenge. The aim of the present in vitro study was to evaluate on the one hand the interdental cleaning efficiency and on the other hand the gingival injury potential of an electric single-headed sonic toothbrush (Water-pik) and two single-tufted manual toothbrushes (Curaprox1009; Lactona Interdental Brush). Brushes were evaluated using a brushing device. Test dental casts (maxillary sextants) consisting of black teeth coated with white paint were brushed using standardized horizontal movements. Thereafter, black (i.e. cleaned) areas were measured planimetrically. The soft tissue injury potential was evaluated using front segments of porcine mandibles. In the same brushing device, test brushes were moved over the gingiva. Before and after each treatment, the porcine mucosa was stained with a plaque disclosing agent to visualize injured areas, which could then be measured planimetrically as well. These evaluations were each made after 15, 30, 60, and 120 seconds of brushing. The statistical analysis was performed using non-parametric Mann-Whitney tests, and the level of significance was set at 5%. The best cleaning performance of 46% across all interdental spaces assessed was found with the electric sonic toothbrush (Waterpik), while the performances of the manual brushes from Lactona and Curaprox were 14.8% and 5%, respectively. At each point of evaluation, the gingiva was injured most markedly by the powered sonic toothbrush (Waterpik), followed by the manual Curaprox brush. The smallest damage of the porcine gingiva was produced by the manual Lactona brush. When comparing the manual toothbrushes, the Lactona product revealed a better cleaning performance combined with a smaller injury potential than the Curaprox brush. Thus, the prophylactic goal to achieve high degrees of cleaning while producing minimal damage is important and should have priority when evaluating and selecting toothbrushes.
Background:
Good oral hygiene is thought to be important for oral health. This review is to determine the effectiveness of flossing in addition to toothbrushing for preventing gum disease and dental caries in adults.
Objectives:
To assess the effects of flossing in addition to toothbrushing, as compared with toothbrushing alone, in the management of periodontal diseases and dental caries in adults.
Search methods:
We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 17 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4), MEDLINE via OVID (1950 to 17 October 2011), EMBASE via OVID (1980 to 17 October 2011), CINAHL via EBSCO (1980 to 17 October 2011), LILACS via BIREME (1982 to 17 October 2011), ZETOC Conference Proceedings (1980 to 17 October 2011), Web of Science Conference Proceedings (1990 to 17 October 2011), Clinicaltrials.gov (to 17 October 2011) and the metaRegister of Controlled Clinical Trials (to 17 October 2011). We imposed no restrictions regarding language or date of publication. We contacted manufacturers of dental floss to identify trials.
Selection criteria:
We included randomised controlled trials conducted comparing toothbrushing and flossing with only toothbrushing, in adults.
Data collection and analysis:
Two review authors independently assessed risk of bias for the included studies and extracted data. We contacted trial authors for further details where these were unclear. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using random-effects models. We examined potential sources of heterogeneity, along with sensitivity analyses omitting trials at high risk of bias.
Main results:
Twelve trials were included in this review, with a total of 582 participants in flossing plus toothbrushing (intervention) groups and 501 participants in toothbrushing (control) groups. All included trials reported the outcomes of plaque and gingivitis. Seven of the included trials were assessed as at unclear risk of bias and five were at high risk of bias.Flossing plus toothbrushing showed a statistically significant benefit compared to toothbrushing in reducing gingivitis at the three time points studied, the SMD being -0.36 (95% CI -0.66 to -0.05) at 1 month, SMD -0.41 (95% CI -0.68 to -0.14) at 3 months and SMD -0.72 (95% CI -1.09 to -0.35) at 6 months. The 1-month estimate translates to a 0.13 point reduction on a 0 to 3 point scale for Loe-Silness gingivitis index, and the 3 and 6 month results translate to 0.20 and 0.09 reductions on the same scale.Overall there is weak, very unreliable evidence which suggests that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 or 3 months.None of the included trials reported data for the outcomes of caries, calculus, clinical attachment loss, or quality of life. There was some inconsistent reporting of adverse effects.
Authors' conclusions:
There is some evidence from twelve studies that flossing in addition to toothbrushing reduces gingivitis compared to toothbrushing alone. There is weak, very unreliable evidence from 10 studies that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 and 3 months. No studies reported the effectiveness of flossing plus toothbrushing for preventing dental caries.
Le point de contact interdentaire est une région clef de l'équilibre des relationsinter et intra-arcades. La préservation de son intégrité et sa restauration conforme au cahier des charges requis est un impératif opératoire.Nombre de pathologies mettent en péril ce point de contact interdentaire, de lacarie à la maladie parodontale, ou bien encore certaines parafonctions à type debruxisme.Cette étude liste les instruments, les matériaux et autant de procédures quipermettent la reconstitution matérielle et le retour à un état physiologiquement sain du point de contact interdentaire.De la matrice circonférentielle métallique aux coins interdentaires translucides,de l'amalgame aux inlays en céramique, la palette des solutions est large. Leur examen nous amène à une synthèse concernant leurs indications et leursperformances respectives.
Zusammenfassung Die effektive Reinigung der Interdentalräume mit Zahnbürsten ist eine Herausforderung. Ziel der vorliegenden In-vitro-Studie war es, die Reinigungseffizienz und gleichzeitig das Gingivaverletzungspotenzial einer elektrischen Schallzahnbürste mit Singlekopf (Waterpik) und zweier Einbüschelbürsten (Curaprox 1009; Lactona Interdental Brush) fur den Interdentalbereich zu untersuchen. Die Bürsten wurden in einer Bürstmaschine evaluiert, indem Testmodelle (Oberkiefersextanten), bei welchen schwarze Modellzähne weiß beschichtet wurden, mit standardisierten horizontalen Bewegungen bearbeitet wurden. Danach wurden die schwarzen (d.h. gereinigten) Flächen planimetrisch erfasst. Das Verletzungspotenzial wurde anhand des Frontsegments von Schweineunterkiefern untersucht. Die Testbürsten wurden wiederum mit der Bürstmaschine über die Gingiva geführt. Vor und nach jeder Behandlung wurde die Schweinegingiva mit einem Plaquerevelator gefärbt. Damit wurden verletzte Gingivastellen/-flächen sichtbar gemacht und vermessen. Die Evaluationen fanden nach jeweils 15, 30, 60 und 120 Sekunden Bürstdauer statt. Die beste Reinigungsleistung über alle gemessenen Interdentalräume zeigte die elektrische Schallzahnbürste mit 46 %, während die Reinigungsleistung der Einbüschelbürste von Lactona 14,8 % betrug und die der Einbüschelbürste von Curaprox 5 %. Die Gingiva wurde zu jedem Untersuchungszeitpunkt am deutlichsten von der elektrischen Schallzahnbürste mit Singlekopf (Waterpik) verletzt, gefolgt von der Einbüschelbürste von Curaprox. Die geringsten Verletzungen der Schweine-gingiva wurden von der Einbüschelbürste von Lactona verursacht. Im Vergleich zwischen den Handzahnbürsten zeigte die letztgenannte Bürste eine besser Reinigungswirkung in Kombination mit einem kleineren Verletzungspotenzial. Das Ziel, einen möglichst hohen Sauberkeitsgrad zu erreichen und dabei wenig Schaden anzurichten, ist also wichtig und sollte bei der Evaluation und Wahl von Zahnbürsten im Vordergrund stehen. Summary The effective cleaning of interdental spaces using toothbrushes is a challenge. The aim of the present in vitro study was to evaluate on the one hand the interdental cleaning efficiency and on the other hand the gingival injury potential of an electric single-headed sonic toothbrush (Waterpik) and two single-tufted manual toothbrushes (Curaprox 1009; Lactona Interdental Brush). Brushes were evaluated using a brushing device. Test dental casts (maxillary sextants) consisting of black teeth coated with white paint were brushed using standardized horizontal movements. Thereafter, black (i.e. cleaned) areas were measured planimetrically. The soft tissue injury potential was evaluated using front segments of porcine mandibles. In the same brushing device, test brushes were moved over the gingiva. Before and after each treatment, the porcine mucosa was stained with a plaque disclosing agent to visualize injured areas, which could then be measured planimetrically as well. These evaluations were each made after 15, 30, 60, and 120 seconds of brushing. The statistical analysis was performed using non-parametric Mann-Whitney tests, and the level of significance was set at 5 %. The best cleaning performance of 46% across all interdental spaces assessed was found with the electric sonic toothbrush (Waterpik), while the performances of the manual brushes from Lactona and Curaprox were 14.8 % and 5 %, respectively. At each point of evaluation, the gingiva was injured most markedly by the powered sonic toothbrush (Waterpik), followed by the manual Curaprox brush. The smallest damage of the porcine gingiva was produced by the manual Lactona brush. When comparing the manual toothbrushes, the Lactona product revealed a better cleaning performance combined with a smaller injury potential than the Curaprox brush. Thus, the prophylactic goal to achieve high degrees of cleaning while producing minimal damage is important and should have priority when evaluating and selecting toothbrushes.
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.
La mayoría de los estudios cruzados con dentífrico fluoretado (DF) de concentración estándar (1.000-1.500ppmF) han empíricamente utilizado un periodo de wash-out de 7 días para eliminar el efecto residual del tratamiento. Para DF de alta concentración (5.000ppmF) este periodo es desconocido y sería necesario un tiempo mayor para la remoción de fluoruro (F) de la saliva. Este estudio verificó si menos de 7 días sería suficiente para eliminar el F residual de la saliva después de uso DF de 5.000ppm F.
The effective cleaning of interdental spaces using toothbrushes is a challenge. The aim of the present in vitro study was to evaluate on the one hand the interdental cleaning efficiency and on the other hand the gingival injury potential of an electric single-headed sonic toothbrush (Water-pik) and two single-tufted manual toothbrushes (Curaprox 1009; Lactona Interdental Brush). Brushes were evaluated using a brushing device. Test dental casts (maxillary sextants) consisting of black teeth coated with white paint were brushed using standardized horizontal movements. Thereafter, black (i.e. cleaned) areas were measured planimetrically. The soft tissue injury potential was evaluated using front segments of porcine mandibles. In the same brushing device, test brushes were moved over the gingiva. Before and after each treatment, the porcine mucosa was stained with a plaque disclosing agent to visualize injured areas, which could then be measured planimetrically as well. These evaluations were each made after 15, 30, 60, and 120 seconds of brushing. The statistical analysis was performed using non-parametric Mann-Whitney tests, and the level of significance was set at 5%. The best cleaning performance of 46% across all interdental spaces assessed was found with the electric sonic toothbrush (Waterpik), while the performances of the manual brushes from Lactona and Curaprox were 14.8% and 5%, respectively. At each point of evaluation, the gingiva was injured most markedly by the powered sonic toothbrush (Waterpik), followed by the manual Curaprox brush. The smallest damage of the porcine gingiva was produced by the manual Lactona brush. When comparing the manual toothbrushes, the Lactona product revealed a better cleaning performance combined with a smaller injury potential than the Curaprox brush. Thus, the prophylactic goal to achieve high degrees of cleaning while producing minimal damage is important and should have priority when evaluating and selecting toothbrushes.
IN BRIEF
This review focuses on the relationship between diabetes and periodontal infection and potential mechanisms involved in local and systemic disease progression. In addition, various oral complications of diabetes are discussed, along with recommendations for management, treatment, and proper referral.
It is assumed that removing plaque (a layer of bacteria in an organic matrix which forms on the teeth) will help prevent gum disease (gingivitis) and tooth decay (dental caries). Gum disease, which appears as red, bleeding gums, may eventually contribute to tooth loss. Untreated tooth decay may also result in tooth loss. Toothbrushing removes some plaque, but cannot reach in-between the teeth, where gum disease and tooth decay are common. This review looks at the added benefit of dental flossing, in people who brush their teeth regularly, for preventing gum disease and tooth decay. Twelve trials were included in this review which reported data on two outcomes (dental plaque and gum disease). Trials were of poor quality and conclusions must be viewed as unreliable. The review showed that people who brush and floss regularly have less gum bleeding compared to toothbrushing alone. There was weak, very unreliable evidence of a possible small reduction in plaque. There was no information on other measurements such as tooth decay because the trials were not long enough and detecting early stage decay between teeth is difficult.
To investigate in vitro the use of ultrasound in a power toothbrush to aid in the removal of dental plaque biofilm without bristle contact.
Dental plaque was modeled using Streptococcus mutans biofilm adherent to hydroxyapatite disks. Treatment arms included positive and negative controls, disks with and without biofilm, respectively. Power toothbrush modes of action tested included a toothbrush with sonic and ultrasonic action (ULT), the same toothbrush with only sonic action (ULN), a sonic toothbrush (SON) and a rotating/oscillating toothbrush (OSC). The active element of the toothbrushes (bristles or point of ultrasound emission) was immersed in toothpaste slurry and held 3 mm away from the disk surface. Treatment included activation of the toothbrush mode of action for 5 seconds. Control disks were exposed to the same fluid environment but not exposed to a power toothbrush. After treatment, biofilm present on the disks was stained using a red dental plaque disclosing solution. Photographs were then taken and the presence of biofilm assessed using digital image analysis. For each disk a normalized pixel volume, related to the presence of biofilm corrected for lighting, was determined. Statistical testing was done with a one-way ANOVA and a Bonferroni post hoc test.
Normalized pixel volumes (mean +/- standard deviation) were 0.428 (0.010) for the negative control and 1.022 (0.040) for the positive control. Normalized pixel volumes for the power toothbrush modes of action were 0.641 (0.075) for ULT, 0.972 (0.027) for ULN, 0.921 (0.010) for SON and 0.955 (0.025) for OSC. Statistical analysis showed a significant treatment effect (P<0.001). All power toothbrush modes of action exhibited some biofilm removal without bristle contact in this in vitro assay. Of the modes of action tested, the combined sonic and ultrasonic mode of action (ULT) removed the greatest amount of biofilm from the disk surfaces. The same toothbrush when tested with (ULT) and without (ULN) ultrasound showed a greater amount of biofilm removed when ultrasound was present.
The aim of this study was to assess systematically the adjunctive effect of both flossing and toothbrushing versus toothbrushing alone on plaque and gingivitis.
The MEDLINE and Cochrane Central register of Controlled Trials (CENTRAL) databases were searched through December 2007 to identify appropriate studies. The variables of plaque and gingivitis were selected as outcomes.
Independent screening of titles and abstracts of 1166 MEDLINE-Pubmed and 187 Cochrane papers resulted in 11 publications that met the eligibility criteria. Mean values and SD were collected by data extraction. Descriptive comparisons are presented for brushing alone or brushing and flossing. A greater part of the studies did not show a benefit for floss on plaque and clinical parameters of gingivitis. A meta-analysis was performed for the plaque index and gingival index.
The dental professional should determine, on an individual patient basis, whether high-quality flossing is an achievable goal. In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence.
In an in-vitro experimental set-up, we tested the efficacy of different electric toothbrushes in cleaning teeth with a multibracket appliance.
The efficacy of three sonic and four rotating toothbrushes were compared; the brushes removed artificial plaque from plastic teeth. The amount of removed plaque substitute was determined via a comparative photo-analysis with one picture of the teeth before and one picture after the brushing cycle. Two views of the tooth segment were chosen: one vestibular view and one apical view of the areas behind the bracket wings. All tests were carried out with water, elmex and Pearls and Dents as brushing media.
The data showed greater brushing efficacy when Pearls and Dents toothpaste was used. The Sonicare toothbrush was the most efficient. The Sonicmax and rotating Oral-B ProfessionalCare 7000 were also very efficacious. On average, all the other toothbrushes performed less well. All toothbrushes were capable of brushing the undercut areas behind the bracket wings, with plaque removal being the greatest when the Sonicare toothbrush was used together with Pearls and Dents.
The best electric toothbrushes did not demonstrate good tooth cleaning. Longer brushing times, mastery of the proper brushing technique, and/or special toothbrush heads are absolutely necessary.
ResearchGate has not been able to resolve any references for this publication.