Successful endoscopic removal of a swallowed toothbrush, a therapeutic challenge. A case report / Extracción endoscópica exitosa de un cepillo de dientes, un reto terapéutico. Reporte de caso

Abstract Introduction: Toothbrush swallowing, whether voluntary or accidental, is a rare event and must be handled as an emergency, because these foreign bodies, due to their length and hardness, are not expected to pass completely through the digestive tract and may cause serious complications. Case presentation: A 22-year-old woman with an eating disorder (bulimia nervosa) involuntarily swallowed a toothbrush while inducing vomiting. Unfortunately, after the initial assessment in the emergency department, and due to the lack of symptoms, her psychiatric history, and the fact the toothbrush was not observed in imaging studies, she was discharged. Due to the patient's insistence that she was telling the truth, she was referred to a secondary healthcare institution by her treating physician, where the successful endoscopic extraction of the toothbrush was performed 36 hours after it was swallowed. The procedure was carried out with the patient under sedation and by experts in digestive extraction who used an overtube, foreign body forceps, and polypectomy loops. Conclusion: Cases of toothbrush swallowing are rarely reported and occur mainly in people with mental illnesses, such as eating disorders involving self-induced vomiting. Therefore, in these cases, physicians should always believe what these patients say, even in the absence of symptoms and imaging findings, as this enables their timely referral to a digestive service to confirm whether the toothbrush was swallowed or not and to perform the endoscopic extraction as soon as possible, since it can cause serious complications due to its characteristics.

Resumen Introducción. La ingesta de cepillos de dientes, voluntaria o accidental, es una situación poco frecuente que requiere ser tratada como una emergencia, pues por su longitud y dureza, no se espera que estos cuerpos extraños tengan un tránsito completo por el tracto digestivo, lo que puede causar graves complicaciones. Presentación del caso. Mujer de 22 años con trastorno alimentario (bulimia nerviosa) quien al inducirse vomito ingirió involuntariamente un cepillo de dientes. Lamentablemente, después de la valoración inicial en el servicio de urgencias, debido a que no presentaba síntomas, a su antecedente psiquiátrico y a la no identificación del cepillo en estudios de imagen, fue dada de alta. Ante la insistencia de la paciente de decir la verdad, fue remitida por su médico tratante a una institución de salud de segundo nivel, donde, a las 36 horas de la ingesta, se realizó la extracción endoscópica exitosa del cepillo. El procedimiento fue realizado bajo sedación por expertos en extracción digestiva usando un sobretubo, pinzas para cuerpos extraños y asas de polipectomía. Conclusión. Los casos de ingesta de cepillos de dientes son raramente reportados y ocurren principalmente en personas con trastornos psiquiátricos como desórdenes alimentarios que involucran la inducción de vómito. Por tanto, en estos casos siempre se debe creer la versión del paciente, incluso en ausencia de síntomas y hallazgos imagenológicos, pues esto posibilita una remisión oportuna al servicio digestivo para confirmar la ingesta y realizar la extracción endoscópica lo más pronto posible, ya que, por sus características, pueden causar graves complicaciones.

Efectividad del cepillo dental eléctrico versus manual para la remoción de biofilm en pacientes con síndrome de Down / Effectiveness of electric versus manual toothbrush for biofilm removal in patients with Down syndrome

Introducción: La salud oral en pacientes con síndrome de Down (SD) es un reto, ya que las alteraciones en la motricidad ocasionadas por la discapacidad intelectual (DI) hacen que tareas como la remoción del biofilm oral o placa dentobacteriana (PDB) con el cepillado sea deficiente. La efectividad de los cepillos eléctricos (CE) comparada con los manuales (CM) en afectados con SD sigue siendo un tema debatible ya que no se ha encontrado una homogeneidad de resultados. Es conveniente mayor investigación sobre el tema, debido a que el SD es considerada la alteración cromosómica más frecuente y la causa principal de DI en el mundo. Objetivo: Conocer la efectividad del CE en comparación con el CM para la remoción de PDB en pacientes mexicanos con SD de entre seis y 14 años. Material y métodos: Estudio transversal experimental, con emparejamiento de sujetos con SD de ambos géneros según la edad (seis a 14 años), asignando el cepillo a utilizar (grupo 1 CM o grupo 2 CE). Se realizó educación dental y método de cepillado con la técnica de Fones, así como control de PDB antes y después el efectuado por medio del índice de O'Leary durante tres días. Se analizaron los resultados utilizando estadística descriptiva e inferencial (prueba de normalidad Lilliefors, prueba t para variables independientes y dependientes). Se aceptó un análisis de significancia p < 0.05. Resultados: La utilización de la t para muestras independientes presentó una mejoría en incremento de dicho marcador de O'Leary en el conjunto total en los tres días de seguimiento respectivamente (t = 6.9, p < 0.00002; t = 8.4, p < 0.00000; y t = 9.5, p < 0.00000). Al comparar por prueba t aplicada a muestras dependientes el índice de O'Leary basal versus cada una de las evaluaciones de seguimiento también se observaron diferencias significativas en los dos conjuntos (grupo 1: p = 0.003, p = 0.0006 y p = 0.0017; grupo 2: p = 0.007, p = 0.0006 y p = 0.0002). Conclusión: La instrucción dental y motivación del paciente fueron determinantes hacia el buen desempeño del cepillado de los dientes y remoción de placa en el par de colectivos, es decir, la reafirmación de la técnica de Fones incrementa gradualmente la mejoría de la forma de uso del cepillo en niños con SD. Ambos métodos con CM y con CE fueron efectivos a fin de remover significativamente la placa, observándose una mayor mejoría en el grupo con CE, sugiriendo que éste disminuye la dificultad de la higiene bucal en personas con SD. Esta línea de investigación es importante en el beneficio de la condición oral de esta población (AU)

Introduction: Oral health in patients having Down syndrome (DS) is a challenge since the changes in motor skills caused by intellectual disability (ID) deteriorate tasks such as the removal of biofilm or dental plaque (DP) with brushing. The effectiveness of electric toothbrushes (ET) compared to manual toothbrushes (MT) in DS patients remains debatable since no homogeneity of results has been found. Further research on the subject is advisable as DS is considered the most frequent chromosomal alteration and the leading cause of ID in the world. Objective: To know the effectiveness of the ET in contrast to the MT for the removal of DP in Mexican DS patients between six and 14 years old. Material and methods: Experimental cross-sectional study, with the pairing of DS subjects of both genders according to age (six to 14 years), assigning the brush to be used (group 1 MT or group 2 ET). Dental education and brushing were performed employing the Fones technique and DP control before and after brushing employing the O'Leary index for three days. The results were analyzed using descriptive and inferential statistics (Lilliefors normality test, t-test for independent and dependent variables). A significance test p < 0.05 was accepted. Results: The t-test for independent samples showed an improvement in the increase of the O'Leary index in the complete group in the three days of follow-up respectively (t = 6.9, p < 0.00002; t = 8.4, p < 0.00000; and t = 9.5, p < 0.00000). When comparing by t-test for dependent samples the baseline O'Leary index versus each of the follow-up evaluations, significant differences were also observed in both groups (group 1: p = 0.003, p = 0.0006 and p = 0.0017; group 2: p = 0.007, p = 0.0006 and p = 0.0002). Conclusion: The dental education and motivation of the patient were decisive for the good performance of tooth brushing and removal of the plaque in both groups. The reaffirmation of the Fones technique gradually increases the improvement of the brushing technique in DS children. Both brushings using MT and ET were effective in removing the biofilm significantly. However, a greater improvement was observed in the group with ET, suggesting that it reduces their difficulty with tooth brushing. This line of research is important to benefit the oral condition of this population (AU)

Effectiveness of electric toothbrush as vibration method on orthodontic tooth movement: a split-mouth study

Abstract Objective: To investigate the effects of application of vibratory stimuli, using an electric toothbrush, on the rate of orthodontic tooth movement during maxillary canine retraction. Methods: A split-mouth study was conducted in 28 subjects (mean age = 20.8 years; ranging from 18 to 24 years) whose bilateral maxillary first premolars were extracted with subsequent canine retraction. On the Vibration side, light force (100 g) was applied to the canine for 90 days, in combination with vibratory stimuli provided by an electric toothbrush; only orthodontic force was applied to the canine on the non-vibration side. Amount of canine movement was measured monthly. Related to electronic toothbrush usage, a diary was provided to each patient for recording discomfort during experimental period, having 100-mm visual analogue scale (VAS). The paired t-test was used to assess the differences in amount of tooth movement between canines of the vibration and non-vibration sides. Results: The amount of tooth movement was similar for canines on the vibration side and on the non-vibration side (mean 0.81 ± 0.10 mm and 0.82 ± 0.11 mm, respectively, p> 0.05). Plaque accumulation was minimal in any subject throughout the study. No subject reported discomfort as a result of using the electric toothbrush. Conclusions: This study demonstrates that application of vibratory stimuli using an electric toothbrush, in combination with light orthodontic force, do not accelerate orthodontic tooth movement.

Resumo Objetivo: investigar os efeitos da aplicação de estímulo vibratório, usando escova elétrica, sobre a taxa de movimentação dentária ortodôntica durante a retração dos caninos superiores. Métodos: um estudo de boca-dividida foi realizado em 28 pacientes (idade média de 20,8 anos, variando entre 18 e 24 anos) cujos dois primeiros pré-molares superiores foram extraídos, com subsequente retração dos caninos. No lado Com Vibração, uma força leve (100g) foi aplicada no canino durante 90 dias, em combinação com o estímulo vibratório gerado por uma escova de dentes elétrica; enquanto os caninos do lado Sem Vibração foram submetidos apenas à aplicação da força ortodôntica. A quantidade de movimentação dos caninos foi aferida mensalmente. Quanto ao uso da escova de dentes elétrica, diários foram fornecidos aos pacientes para que esses anotassem, em Escalas Visuais Analógicas (EVA) de 100 mm, o desconforto sentido durante o período experimental. O teste t pareado foi utilizado para avaliar as diferenças na quantidade de movimentação dos caninos nos lados Com Vibração e Sem Vibração. Resultados: os valores da movimentação dentária foram semelhantes nos lados Com Vibração e Sem Vibração (médias de 0,81 ± 0,10 mm e 0,82 ± 0,11 mm, respectivamente, p> 0,05). O acúmulo de placa dentária nos pacientes dessa amostra foi mínimo, ao longo de todo o estudo. Nenhum paciente relatou desconforto durante o uso da escova elétrica. Conclusões: o presente estudo demonstrou que a aplicação de estímulo vibratório usando uma escova elétrica, associada a forças ortodônticas leves, não foi capaz de acelerar a movimentação dentária ortodôntica.

Effectiveness of musical toothbrush on oral debris and gingival bleeding among 6–10-year-old children: A randomized controlled trial

Context: Motivation serves to be an integral part of health promotion to children at the learning phase of their life. Aim: Evaluation of the effectiveness of musical toothbrush over regular toothbrush in the debris and gingival bleeding scores among children. Settings and Design: This was a single-blinded parallel, randomized controlled trial conducted among 6–10-year-old schoolchildren in Chennai. Methods: One hundred participants with allocation ratio of 1:1 were assigned to musical and regular toothbrush group by simple randomization. After baseline evaluation (T0) of Debris Index-Simplified (DI-S) and Gingival Bleeding Index (GBI), outcome variables were assessed for a period of 3 months (T1, T2, and T3). Statistical Analysis Used: Friedman test and Mann–Whitney statistical test were used to compare the outcome variables within and across the two groups. Results: Thirty-two boys and 68 girls (mean age: 8.53 years) participated in the study. Statistically significant difference was seen in DI-S score among musical toothbrush group (mean: 0.50 [T3] and GBI score: 8.18% [T3]) when compared to regular toothbrush group (mean: 1.59 [T3] and GBI score: 23.54 [T3]) at the end of the 3rd month. Conclusion: Although both the musical and regular toothbrushes effectively reduced the DI-S and GBI scores, former showed effective change among children when compared to the latter.

Comparison of tooth brushing with traditional miswak in maintenance of oral hygiene

Background: Chewing sticks were used throughout the ancient times many communities till date. Many people in today’s modern days still have maintained this practice of oral hygiene due to reasons like cost, customs and religious reasons and accessibility. The miswak, obtained from the twigs of the Salvadora persica tree, may be beneficial due to its mechanical cleaning. The aim of the present study was to compare the oral hygiene status and gingival conditions following the use of conventional tooth brushing and miswak over a period 100 days. Materials and methods: The study was conducted in a madrasa in outskirts of Jammu and Kashmir. Out of the total 154 subjects, a total of 148 subjects who were voluntarily willing to participate in the study were selected. Out of these subjects 72 subjects were using miswak (Group I), 76 subjects were using tooth brush and tooth paste (Group II) as an oral hygiene aid. All of these subjects were evaluated for Gingival and Plaque status on 50th and 100th day following oral prophylaxis. Results: Both Group I showed a significant difference (p≤0.05), at 50th and 100th day in their mean plaque scores. The mean gingival scores recorded for subjects using only miswak and those subjects using both miswak as well as tooth brush and tooth paste increased from 50th day to 100th day and showed a statistical difference between the two means in group I. Conclusion: The results of the present study suggest that miswak can be used as an effective adjunct for oral hygiene maintenance along with toothbrush and tooth paste as it is readily available and inexpensive.

The Effectiveness of Two Manual Slim Bristles Toothbrushes among Fixed Orthodontic Appliance Patients / Jurnal Sains Kesihatan Malaysia

@#This research aimed to evaluate the oral hygiene status in fixed orthodontic appliance patients when using two different slim bristles toothbrushes and to assess patients’ toothbrush perception. Twenty six fixed orthodontic appliance patients participated in the six weeks prospective, crossover clinical trial. All patients used two different slim bristles toothbrushes (Toothbrush A and Toothbrush B) for two weeks each with a washout period in between. Gingival health and plaque value were assessed based on Lӧe & Silness Gingival Index and Silness & Lӧe Plaque Index at baseline, week 2, week 4 (washout) and week 6. At the end of the trial, patients’ toothbrush perception was assessed through questionnaire. All data were analysed using SPSS version 22. The mean age of the patients was 21.5 ± 4.3 years, with female predominant (n= 17, 65.4%). More than half were Malay (n= 15, 57.7%) and had tertiary education (n=14, 53.8%). Patients could achieve good oral hygiene when using Toothbrush A (65.4%) and Toothbrush B (69.2%). However, the occurrence of gingivitis was significantly higher when using Toothbrush A (OR=1.889, 95% CI=1.207-2.957, p value < 0.05). Toothbrush B was felt to clean better (n= 14, 53.8%) while Toothbrush A was perceived to be easier to use (n=14, 53.8%). Both toothbrushes maintained patients’ oral hygiene status. However, when using Toothbrush B, oral health status was better as it significantly reduced gingivitis occurrence compared to Toothbrush A. As for the toothbrush perception, most patients preferred Toothbrush A to be taken home.

Clinical evaluation of toothbrushing effects of the manual toothbrush with the bristles made of 3 different materials / 实用口腔医学杂志

Objective: To compare the effects of ordinary nylon toothbrush,bamboo fiber toothbrush and silicone rubber toothbrush. Methods: 30 and 156 college students were respectively included by the enrolment criterion and were respectively divided into 3 groups. Tooth brushes with the same specification and with the 3 materials were respectively used in the 3 goups with the same methods. Plaque index(PI) (n = 10) was examined before and 1 month after use of the brushes; gingival index(GI) was examined(n = 52) before,1 and 3 month after use of the brushes. Results: 1 month after use of the brushes full mouth PI removal rate(n = 10) and GI reduction(n = 52) were not statistically different among the 3 group(between each 2 groups,P＞ 0. 05). 3 months after use of the brushes GI reduction of the silicone rubber toothbrush group was more than that of ordinary nylon toothbrush and bamboo charcoal toothbrush groups(P ＜ 0. 05). Conclusion: Plaque removal efficiency of the 3 kinds of toothbrush is similar. The silicone rubber toothbrush is more effective for gigiva health than ordinary nylon toothbrush and bamboo charcoal toothbrush.

Effectiveness of T-shaped toothbrush in children: A pilot study

@#Dental caries and gingivitis are common oral health problems affecting schoolchildren worldwide. Effective tooth brushing in children is fundamental in preventing dental caries and gingivitis and maintaining good oral health. Children routinely present with unsatisfactory oral hygiene due to poor compliance and poor dexterity in tooth brushing. The purpose of the present study was to evaluate the effectiveness of a novel T-shaped toothbrush in plaque removal and gingival health among children and to obtain feedback regarding its use. Nineteen participants aged 8-10 years who fulfilled the criteria enrolled in this study. The children were taught the proper technique of using the new toothbrush and instructed to use it for a period of 2 weeks. The plaque scores and gingival scores were measured at baseline and after 2 weeks. They were asked to complete a questionnaire regarding the use of the toothbrush after 2 weeks. Statistical analysis was performed using t-test. There was a statistically significant (p <0.05) reduction in mean (SD) plaque scores from baseline 1.96 (0.85) to 1.51 (0.75), after 2 weeks. Similarly, mean (SD) gingival scores reduced significantly from 0.20 (0.11) to 0.13 (0.08) over the two-week period. Overall, majority of participants (68% to 89%) gave positive feedback in all aspects regarding the use of T-shaped toothbrush, although 63.2% of them reported having difficulties to handle the T-shaped toothbrush initially. The T-shaped toothbrush can effectively improve oral hygiene in children with acceptable plaque removal and adequate gingival health in children.

A Comparative Evaluation Of Alternative Disinfectants To Decontaminate Tooth Brush

This study aimed to evaluate the effectiveness of alternative methods for toothbrush disinfection. Methods - 50 children of age grp 6-12yrs were included in the study. The new toothbrushes were given to children and were asked to brush in the morning and nigh for 1week under the supervision of parents. 2% chlorhexidine, 100% and 50% synthetic vinegar, 25% eucalyptus oil were tested. The head of both morning and night toothbrush were covered with sterile gauze and immediately transferred to microbiology department for microbial decontamination efficacy testing. Results :All disinfectant solutions used had equal antimicobial action for tooth brush disinfection. No difference in colonies or antimicrobial efficacy was seen between different disinfectants and morning and night toothbrush. Conclusion- These agents can be cost-effective, easily accessible, and comparatively effective for toothbrush disinfection. Because these agents are nontoxic, cost-effective and easily accessible, they may be appropriate for household use.

Avaliação da eficácia das escovas convencionais e multifilamentadas: Um estudo randomizado cego controlado / Effectiveness of conventional and multifi lamentary toothbrushes: a randomized, blinded, controlled trial

Objetivo: comparar o efeito de escovas multifilamentadas com as escovas dentais convencionais, na formação do biofilme dental bacteriano na área dentogengival, em indivíduos saudáveis. Material e métodos: para a realização deste estudo de delineamento prospectivo, cruzado, cego e randomizado, foram selecionados 16 voluntários periodontalmente saudáveis, os quais inicialmente foram submetidos a uma adequação bucal. Após sete dias de adequação, os indivíduos foram aleatoriamente divididos em quatro grupos: A) escova multifilamentos nacional (Sanifill Infinite); B) escova multifilamentos importada (Curaprox); C) escova convencional 1 (Bitufo Class macia); e D) escova convencional 2 (Oral B Indicator ), utilizando o mesmo dentifrício para os quatro grupos. Os voluntários foram instruídos a usarem somente o método de higiene referente ao grupo a que foram designados, por um período de 14 dias, com intervalos (washout) de sete dias entre os períodos experimentais. Durante o washout, todos os indivíduos fizeram uso de escovas, dentifrícios e fio dental padronizados. Os seguintes parâmetros clínicos foram avaliados nos tempos 0 e 14 dias: índice de placa visível e corada (IPV e IPC) e índice de sangramento gengival (ISG). Resultados: após análise dos dados, não foram observadas diferenças estatísticas (p > 0,05), nem intragrupo e nem intergrupo, para todos os parâmetros analisados. Conclusão: escovas convencionais e multifilamentadas foram igualmente eficazes no controle do biofilme dental bacteriano, na área dentogengival.

Objective: to compare the effect of multifilament toothbrushes and the conventional ones relating it to the formation of dental bacterial biofilm in the dentogingival region in healthy individuals. Material and methods: to conduct this study in a prospective, crossed, blind and randomized outlining way, sixteen periodontal healthy volunteers were selected and initially submitted to an oral adjustment. After seven days of adjustment, the individuals were randomly divided into four groups: A) the national multifilament toothbrush (Sanifi ll Infi nite); B) the imported multifilament toothbrush (Curaprox); C) the conventional toothbrush 1 (Bitufo Class Macia); and D) the conventional toothbrush 2 (Oral B Indicator); the same toothpaste was utilized by the four groups. The volunteers were instructed to the usage of only one method of oral hygiene which is related to the group they were designed for a period of fourteen days, with intervals (washout) of seven days between the experimental periods. During the washout, all the individuals made use of the toothbrushes, toothpastes and standardized dental floss. The following clinical parameters were evaluated at 0 day and 14 days: visible plaque index and disclosed plaque index (VPI and DPI) and gingival bleeding index (GBI). Results: no statistically significant differences were observed (p > 0,05), neither with the intragroup nor the intergroup in all the parameters analyzed. Conclusion: conventional toothbrushes and the multifilamented ones were equally effective in controling dental bacterial biofilm in the dentogingival region.

Effectiveness of different mechanical bacterial plaque removal methods in patients with fixed orthodontic appliance: a systematic review/meta-analysis / Eficácia de diferentes métodos de remoção mecânica de placa bacteriana em pacientes com aparelho ortodontico fixo: revisão sistemática / meta-análise

The presence of fixed orthodontic appliances and its accessories tends to affect bacterial plaque removal, resulting in inadequate cleaning being performed by the patient. Thus, the aim of this systematic review and meta-analysis was to answer the following focal question: are the mechanical methods of oral cleaning effective for the reduction of bacterial dental plaque in patients with a fixed orthodontic appliance? A systematic search of the literature was conducted in the following databases: Scopus, PubMed, Cochrane, Web of Science, Embase, and Medline, in addition to Controlled Trials and Grey Literature, without limitations of language and year of publication. Furthermore, searches were also conducted in the reference lists of the articles selected. Included in the present review were clinical studies with patients undergoing therapy with fixed orthodontic appliances, which would, by means of comparison, evaluate the effectiveness of different mechanical bacterial plaque removal methods. The methodological quality of the articles included was evaluated in accordance with the methodological evaluation protocol, and was classified as high, moderate or low. In order to perform the meta-analysis, articles with high methodological quality were included. Analysis of subgroups was performed according to the type of intervention. The plaque index was defined as the continuous outcome variable, using the fixed effect when there was homogeneity among the articles, and the random effect in cases of heterogeneity. 1815 articles were found, of which only 23 fulfilled the eligibility criteria, with 17 being of high methodological quality and 6 of moderate quality. Of these, 18 included an analysis of the effectiveness of the conventional manual brush, 4 of the manual orthodontic brush,15 of electric brushes, 3 of interdental brushes, 1 of dental floss and 4 or oral irrigation devices, and 1 of Siwak. In the qualitative evaluation of the studies, the use of these mechanical control methods was shown to be effective, with exception of the use of Siwak, which presented an increase in bacterial plaque. Moreover, the results of the meta-analysis indicated a significant reduction of -0.98 (IC 95%) in the plaque index for the use of conventional manual brushes in the period of one month (p<0.001). There is a body of evidence that proves the effectiveness of mechanical bacterial plaque removal in patients using orthodontic appliances and accessories. The findings of the meta-analysis proved the effectiveness of the conventional manual brush. Further studies with better standardization of samples are required to strengthen the evidences.

A presença de aparelhos ortodônticos fixos e seus acessórios tende a afetar a remoção da placa bacteriana, resultando em limpeza inadequada realizada pelo paciente. Assim, o objetivo desta revisão sistemática e metaanálise foi responder à seguinte questão norteadora: os métodos mecânicos de limpeza oral são eficazes para a redução da placa bacteriana dental em pacientes com aparelho ortodôntico fixo? Uma pesquisa sistemática da literatura foi realizada nas seguintes bases de dados: Scopus, PubMed, Cochrane, Web of Science, Embase e Medline, além de Ensaios Controlados e Literatura Cinzenta, sem limitações de idioma e ano de publicação. Além disso, as pesquisas também foram realizadas nas listas de referência dos artigos selecionados. Foram incluídos na presente revisão estudos clínicos realizados com pacientes submetidos à terapia com aparelhos ortodônticos fixos, os quais, por meio de comparação, avaliaram a eficácia de diferentes métodos mecânicos de remoção de placas bacterianas. A qualidade metodológica dos artigos incluídos foi avaliada de acordo com o protocolo de avaliação metodológica, e classificada como alta, moderada ou baixa. Para realização da metanálise, foram incluídos artigos de alta qualidade metodológica. A análise dos subgrupos foi realizada de acordo com o tipo de intervenção. O índice de placa foi definido como variável de desfecho contínuo, utilizando o efeito fixo quando houve homogeneidade entre os artigos e o efeito aleatório nos casos de heterogeneidade. 1815 artigos foram encontrados, dos quais apenas 23 preencheram os critérios de elegibilidade, sendo 17 de alta qualidade metodológica e 6 de qualidade moderada. Destes, 18 incluíram uma análise da eficácia da escova manual convencional, 4 da escova ortodôntica manual, 15 de escovas elétricas, 3 de escovas interdentais, 1 de fio dental e 4 de dispositivos de irrigação oral e 1 de Siwak. Na avaliação qualitativa dos estudos, a utilização destes métodos mecânicos de controle mostrou-se efetiva, com exceção do uso de Siwak, que apresentou aumento na placa bacteriana. Além disso, os resultados da meta-análise indicaram uma redução significativa de -0,98 (IC 95%) no índice de placa para o uso de escovas manuais convencionais no período de um mês (p <0,001). Existe um conjunto de provas que comprovam a eficácia da remoção de placas bacterianas mecânicas em pacientes que utilizam aparelhos e acessórios ortodônticos. Os resultados da metanálise provaram a eficácia da escova manual convencional. Outros estudos com melhor padronização de amostras são necessários para fortalecer as evidências.

A comparative analysis of micro-organism colonization of tooth-brushes in a public bath based on the storage technique / 대한구강보건학회지

OBJECTIVES: Bacterial colonization on toothbrushes can cause stomatitis and other oral diseases such as dental caries and periodontitis. In this study we tested 18 toothbrushes, of which six were left exposedto the air, six were stored in a plastic bag, and six in a toothbrush case. METHODS: ATP (RLU: relatively light unit) values measured by ATP Luminometer were compared with APC (CFU: colony forming unit) by swabbing culture method using 3M™ petrifilm™ aerobic count plates. RESULTS: Swabs from toothbrushes left exposed in the air developed an average of 651.67±261.94 CFU, while the “In plastic bag” and the “In toothbrush case” specimens developed 593.17±354.33 and 120.83±68.87 CFU, respectively. CONCLUSION: The best option is to rinse the toothbrush well with water and to keep them dry in a well-ventilated area in order to reduce the growth of bacteria in a public bath.

Comparing Chewable and Manual Toothbrushes for Reducing Dental Plaque: A Pilot Study / 치위생과학회지

This study aimed to compare the effectiveness of chewable toothbrush and manual toothbrush and provide basic data for recommendation of the chewable toothbrush in specific groups and situations. A total of 20 subjects participated in this study (rolling method, 10; non-rolling method, 10). After professional prophylaxis, participants used the manual toothbrush to brush their teeth for 3 minutes. After a 7-day wash-out period, participants used the chewable toothbrush according to the manufacturer's instructions. Pre- and post-plaque indexing of the teeth was performed. The dental plaque index was assessed using the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI) for amount of plaque and Silness-Löe Plaque Index (SLPI) for plaque thickness. The difference between pre- and post-dental plaque index was analyzed using a paired t-test and the Wilcoxon signed-rank test. The Mann-Whitney U test was also used to compare the dental plaque index reduction rates. The dental plaque index differed significantly between the chewable toothbrush and the manual toothbrush. The TMQHPI reduction rate was significantly different between the rolling and non-rolling method groups for the manual toothbrush but not the chewable toothbrush. The difference in SLPI reduction rate between the rolling and non-rolling method groups was significant for the manual toothbrush but not for the chewable toothbrush. Differences in the dental plaque index reduction rates between the chewable and manual toothbrushes were not significant in the non-rolling method group. The results of this study showed higher reduction rates in dental plaque with manual toothbrush use than with chewable toothbrush use. However, the non-rolling method group did not show statistically significant differences according to toothbrush type. The present study showed that a chewable toothbrush can be an alternative to a manual toothbrush for individuals who have difficulty using the generally recommended rolling method.

Comparative Evaluation of Conventional Toothbrushing with Traditional Miswak for Oral Hygiene Maintainence in a Socially Disadvantaged Young Muslim Population.

Background: Chewing sticks were used throughout the Greek and Roman empires and by many communities till date. Many people do not use modern oral hygiene aids such as toothbrushes due to reasons like cost, customs and religious reasons and accessibility. The miswak, obtained from the twigs of the Salvadora persica tree, may be beneficial due to its mechanical cleaning. The aim of the present study was to assess and compare the oral hygiene status and gingival conditions following the use of conventional tooth brushing and miswak in socially disadvantaged subjects over a period 100 days. Methods: The study was conducted in an orphanage in Srinagar, Jammu and Kashmir. Out of the total 354 subjects, 180 subjects who were within this selected age group were followed and examined After acquiring the permission and the information to the subjects a total of 148 subjects, were voluntarily willing to participate in the study. Out of these subjects 72 subjects were using miswak (Group I), 46 subjects were using tooth brush and tooth paste (Group II) while 30 subjects (Group III) accepted that they were using both miswak as well as tooth paste and tooth brush as an oral hygiene aid. All of these subjects were evaluated for Gingival and Plaque status on 50th and 100th day following oral prophylaxis. The Mean, Standard Deviation, One way ANOVA test and Scheffe test were performed to reveal the statistical significance. Results: Both Group II and Group III showed a significant difference (p≤0.05), at 50th and 100th day in their mean plaque scores. The mean gingival scores recorded for subjects using only miswak and those subjects using both miswak as well as tooth brush and tooth paste increased from 50th day to 100th day and showed a statistical difference between the two means. Conclusion: The results of the present study suggest that miswak can be used as an effective adjunct for oral hygiene maintenance along with toothbrush and tooth paste as it is readily available and inexpensive.

The time interval of using electric toothbrush after the adhesion of two common luting cements / 实用口腔医学杂志

Objective:To explore the time interval of using electric toothbrush after the adhesion of zinc polycarboxylate cement (ZPC) and PanaviaTM F(PF) respectively.Methods:The facial surfaces of 60 premolars were exposed and embedded in self-curing resin with custom made cylinder-shaped molds.Then the facial surfaces were cut with a diamond saw and polished with waterproof polishing papers to create standardized dentin surfaces.30 co-cr ally test-pieces and 30 zirconia ceramic test-pieces (4.0 mm in diameter and 2.0 mm in height) were adhered on 30 dentin surfaces respectively with ZPC and PF.The samples of each kind were divided into 5 groups (n =6) and brushed with an electronic toothbrush for 30 seconds immedietly (group 1),12 h (group 2),24 h (group 3)and 48 h(group 4) after adhesion,respectively.The samples in group 5 without brush were the controls.Shear bond strength of the samples was measured and the fracture patterns were observed under steriomicroscope.Results:In the ZPC adhered samples the bond strength of group 1,2,3 was lower than that of group 4 and 5 (P ＜ 0.05),group 4 vs group 5,P ＞ 0.05.In the PF adhered simples the bond strenth of group 1 and 2 was lower than that of group 3,4 and 5 (P ＜ 0.05),group 3 or 4 vs group 5,P ＞ 0.05.The fracture patterns were mostly cement cohesive failure.Conclusion:The time intervals of using electric toothbrush after the adhesion of ZPC and PF are 48 h and 24 h respectively

Effects of Manual Toothbrushing on Gingival Recession in an Adult Population Sample in South of Chile / Efectos del Cepillado de Dientes Manual sobre la Recesión Gingival en una Muestra de Población Adulta en el Sur de Chile

The aim was to study the association between the presence of gingival recession (GR) and manual brushing features an adult population in southern Chile. A study on a probabilistic stratified random sample of 530 teeth with RG in 105 patients (75 women and 30 men), distributed in 3 age groups (18-34, 35-50 and 51-64 years), who used manual brushing the last 10 years were performed. Three examiners (k=0.87) evaluated the brush type, frequency and method of brushing. We recorded the GR depth and width as rated Miller's classification, sulcus or pocket depth, clinical attachment loss (CAL), tooth malposition and the presence or absence of gingival bleeding on probing. The GR were 28.68% class I, 35.47% class II, 29.24% Class III and 6.61% Class IV. First and second mandibular premolar showed the highest GR frequency. Combined brushing method and medium toothbrush type were the most used. Significant differences between GR and brushing frequency (p = 0.001); 64.1% of teeth relate GR to brushing frequency of 3 or more times daily. CAL of 3-4 mm was associated with GR (P=0.000), affecting 60.3% of teeth. In addition, gingival bleeding and tooth malposition were associated with a higher frequency of GR. Brushing frequency of 3 or more times daily is associated with the presence of RG.

El objetivo fue estudiar la asociación entre la presencia de recesiones gingivales (RG) y características del cepillado manual en una población de adultos del sur de Chile. Se realizó un estudio estratificado probabilístico sobre una muestra aleatoria de 530 dientes afectados con RG en 105 pacientes (75 mujeres y 30 hombres), distribuídos en 3 grupos etáreos (18-34, 35-50 y 51-64 años), quienes utilizaron cepillado manual los últimos 10 años. Tres examinadores (k=0,87) evaluaron el tipo de cepillo, frecuencia y método de cepillado. Se registró la profundidad y ancho de las RG según la clasificación de Miller, profundidad de surco o bolsa, pérdida de inserción clínica, malposición dentaria y presencia o ausencia de hemorragia gingival al sondaje. Las RG fueron clase I en 28,68%, clase II en 35,47%, clase III en 29,24% y clase IV en el 6.61%. La mayor frecuencia se observó en el primer y segundo premolar mandibular. El método de cepillado combinado y el cepillo medio fueron los más utilizados. Se observaron diferencias significativas entre RG y frecuencia de cepillado (p=0,001); el 64,1% de dientes con RG se relacionaron a una frecuencia de cepillado de 3 o más veces al día. La pérdida de inserción clínica entre 3-4 mm se asoció a RG (P=0,000), afectando el 60,3% de los dientes. Además, la hemorragia gingival y mal posición dentaria se asociaron a una mayor frecuencia de RG. Una frecuencia de cepillado de 3 o más veces al día se asocia a la presencia de RG.

Penetrating toothbrush injury in a child: an unusual presentation

We present an unusual case of a penetrating toothbrush injury in a 6-year old child. The injury was sustained due to a fall at home and resulted in accidental implantation of an adult toothbrush in the facial soft tissues. The toothbrush was removed under general anaesthesia without any complications. This case highlights a rare presentation involving extra oral penetration of a toothbrush which is not reported previously in the literature.

Molecular Identification of Bacterial Species Present on Toothbrushes

Toothbrushes play an essential role in oral hygiene. However, they can be significant in microbial transmission and can increase the risk of infection, since they can serve as a reservoir for microorganisms in healthy, oral-diseased and medically ill adults. This study was conducted to evaluate toothbrush contamination in six toothbrushes donated from four people. Two participants each supplied two toothbrushes - one used in the bathroom and one used in the workplace. The other two people each donated two toothbrushes used in the workplace. Polymerase chain reaction was used to construct a 16S rRNA clone library. Sequences of cloned DNA were compared with those from the reference organisms provided by GenBank. A total 120 clones, representing 20 clones for each toothbrush, were analyzed. They are composed of six pylum, 46 genera and 79 species. The most dominant species were Streptococcus oralis, Streptococcus parasanguinis and Haemophilus parainfluenzae. Enterobacter and Escherichia were recovered from toothbrushes used domestically. Toothbrushes used in the workplace did not contain Enterobacteria.

An unusual foreign body tooth brush in esophagus: a case report.

We report a rare case of accidental toothbrush swallowing by a normal adult which was successfully removed by rigid esophagoscope. A 25 year young man presented to casualty of KIMS, Hubli, with ingestion of toothbrush accidentally half an hour before. Patient’s general physical examination and systemic examination was normal. Oral cavity, oropharynx and indirect laryngoscopic findings were normal. An emergency upper GI Endoscopy was done and foreign body was confirmed to be present at 35 cm from upper incisor teeth. Foreign body was removed by rigid esophagoscope under GA. Otolaryngologist is the most common medical faculty consulted for management of aero digestive foreign bodies. Toothbrush swallowing in normal adults is a rare accident. Most of them are found in esophagus and spontaneous passage is unknown and hence the need for early removal.