Tapered toothbrush filaments in relation to gingival abrasion, removal of plaque and treatment of gingivitis.

OBJECTIVES: To compare a tapered filament toothbrush (TFTB) to a control toothbrush (ADA) in their potential to cause gingival abrasion and improve the gingival condition following a period of experimental gingivitis. METHODS: Thirty-two subjects refrained from brushing mandibular teeth for 21 days. During a subsequent 4-week treatment phase, the left or right side of the mouth was brushed with either the TFTB or ADA as randomly allocated. Gingival abrasion, plaque and gingival bleeding were assessed. RESULTS: During the treatment phase gingival abrasion showed a trend to be lower with the TFTB than the ADA, which was significant at the 2-week assessment. The mean plaque scores changed from 2.98 (day 21) to 1.59 for the TFTB and from 3.00 (day 21) to 1.31 for the ADA. The mean bleeding scores changed from 1.86 (day 21) to 1.35 for the TFTB and from 1.85 (day 21) to 1.20 for the ADA. Plaque and bleeding scores were significantly lower with the ADA. CONCLUSIONS: Both toothbrushes improved gingival health and effectively removed plaque. Although there was a tendency towards fewer sites with gingival abrasion with the TFTB brush, it was less effective than the ADA in the removal of plaque biofilm and reduction of bleeding. Subjects considered the TFTB to be more pleasant to use.

[Tooth brushing and gingival abrasion]. / Tandenpoetsen en gingivalaesies.

It has been known for some time that tooth brushing can have unwanted effects on the gingiva and hard dental tissues. The aim of this study is to evaluate two factors that may be of influence on the incidence of gingival abrasion during tooth brushing. The first factor being the possible influence of feedback through oral sensory perception and the second the possible abrasive effects of dentifrice. From the sensory feedback experiment it became clear that a significantly greater number of abrasions occurred when the test subjects would brush their own teeth than when they would have their teeth brushed by a dental hygienist. From the dentifrice experiment it became clear that the use of dentifrice has no significant effect on the occurrence of gingival lesions.

An oscillating/pulsating electric toothbrush versus a high-frequency electric toothbrush in the treatment of gingivitis.

OBJECTIVES: The objective of this study was to compare the effect of an oscillating/pulsating power toothbrush (Oral-B ProfessionalCare 7000; PC 7000) and a high-frequency power toothbrush (Philips Sonicare Elite; SE) on the reversal of experimental gingivitis. METHODS: The study had a randomised, examiner-blind, split-mouth design. After dental prophylaxis, subjects refrained from brushing mandibular teeth for 21 days to allow development of gingivitis. During a 4-week treatment phase, the right or left side of the mouth was brushed with either the PC 7000 or the SE toothbrush as randomly allocated. Plaque and gingivitis were assessed at baseline (Day 0), after 21 days of no oral hygiene, and after 1, 2 and 4 weeks of brushing twice daily. Gingival abrasion was assessed at Day 0 and after 1, 2 and 4 weeks of product use. RESULTS: Of 38 enrolled subjects, 35 provided evaluable data. The experimentally induced gingivitis (EIG) phase resulted in higher bleeding and plaque scores as compared to Day 0. During the treatment phase, plaque and bleeding scores were significantly lower with the PC 7000 than the SE toothbrush. After 4 weeks of use, the mean plaque scores changed from 2.78 (Day 21 of EIG phase) to 0.70 for the PC 7000 and from 2.67 (Day 21) to 0.88 for the SE. The mean bleeding scores changed from 1.86 (Day 21) to 1.24 for the PC 7000 and from 1.88 (Day 21) to 1.42 for the SE. No major differences were found between brushes with regard to gingival abrasion. CONCLUSIONS: The oscillating/pulsating power toothbrush (Oral-B ProfessionalCare 7000) was more effective than the high-frequency power toothbrush (Philips Sonicare Elite) at plaque removal and improvement of gingival condition, with no greater potential for causing gingival abrasion.

Approximal brush head used on a powered toothbrush.

AIM: This study was designed to test whether the approximal efficacy of a powered toothbrush (Braun Oral-B 3D Plaque Remover) can be improved when a pointed-shaped brush head (PBH) specifically designed for these approximal areas is used as compared with the standard cup-shaped brush head (CBH). MATERIAL AND METHODS: Forty non-dental students were included. They all received the powered toothbrush and two different brush heads (CBH+PBH). Instructions were given to use each brush head twice every day (2 min. with the CBH followed by 1 min. with the PBH). Two weeks later they received an appointment for the first experiment (Exp 1), prior to which they abstained from all oral hygiene procedures for 48 h. Plaque was assessed at 6 sites/tooth. Next, the dental hygienist brushed for 2 min. (30 s/quadrant) with the CBH. Plaque was scored again. Subsequently, the dental hygienist brushed the approximal areas for another minute: in two randomly selected contra-lateral quadrants for 30 s with the CBH and in the opposing quadrants for 30 s with the PBH. The next approximal plaque was scored a third time. After 2-3 weeks, Exp 2 was carried out comparable to Exp 1; only this time the panelists brushed themselves. RESULTS: Exp 1 showed approximal plaque scores at the baseline of 1.70 and 1.72 and at post-brushing 0.21 and 0.26 for the CBH + PBH and CBH only, respectively (p<0.05). The additional increase in approximal plaque reduction after 30 s of brushing with PBH was 22% and for the CBH 19% (p<0.05). Exp 2 showed approximal plaque scores at baseline of 1.76 and 1.74 and post-brushing of 0.21 and 0.24 for the CBH+PBH and the CBH, respectively. The additional approximal plaque reduction of 30 s brushing with PBH was 19% and 18% with the CBH (no significant difference). DISCUSSION/CONCLUSION: An additional 1 min. showed minor differences (1-3%) between brush heads. The effect of the 1 min. extra brushing (+/-18%) itself was much larger. It seems therefore beneficial to advise the patient to brush longer. A second different brush head may stimulate to do so.

Brushing with and without dentifrice on gingival abrasion.

OBJECTIVES: This study was designed to evaluate two factors possibly influencing incidence of gingival abrasion during toothbrushing: (1) the abrasiveness of a dentifrice and (2) the possible influence of feedback of oral sensory perception. MATERIAL AND METHODS: For this purpose, two separate, single blind, randomized clinical experiments were performed. The two groups of subjects were requested not to brush their teeth 48 h, prior to the experiments. After staining with disclosing solution gingival abrasion sites were recorded as small (< or =5 mm) and large (>5 mm), both before and after brushing. The dentifrice experiment was a split-mouth design, including 36 subjects, brushing their teeth in two randomly selected contra-lateral quadrants, either with or without dentifrice, whereas the remaining two quadrants were brushed, using the alternative choice. The sensory perception feedback experiment was a full-mouth design, including 43 subjects and two separate brushing exercises with use of dentifrice. The first brushing-exercise was performed by a dental hygienist, excluding the feedback of oral sensory perception of the brusher. After a 4 weeks period of familiarization to the manual toothbrush, subjects brushed themselves in the same random order as the hygienist, using a fresh brush, thus including oral sensory perception. RESULTS: In the dentifrice experiment, the increment of small abrasion sites was 5.86 for brushing with and 5.75 without dentifrice. There was no statistically significant difference between brushing with and without dentifrice. Both with and without dentifrice, more small abrasions were found vestibular, (3.78 and 4.22, respectively) as compared with lingual (2.22 and 1.42, respectively) (p=0.027, p<0.001). In the sensory perception feedback experiment, the increment in small gingival abrasion sites was larger for the subjects brushing themselves (8.86) as compared with the professional brushing (2.94, p <0.0001). Subjects caused more abrasion on the vestibular surfaces (6.28) as compared with the lingual (0.60, p=0.0001), where the professional did not show this difference (vestibular: 1.88, lingual: 1.30, p=0. 1388). CONCLUSIONS: No statistically significant difference in the incidence of gingival abrasion was found between brushing with dentifrice or without dentifrice. Neither did oral sensory perception seem to affect the incidence of gingival abrasion.

Plaque removal by professional electric toothbrushing compared with professional polishing.

OBJECTIVES: This parallel examiner blind study was designed to compare the results of professional brushing with an electric toothbrush (ETB, Braun Oral-B 3D Excel) to a professional polish session. MATERIAL AND METHODS: For this study, 90 non-dental students were selected. All received a single oral prophylaxis where plaque and calculus were removed and the teeth were polished so that all subjects started with equally clean teeth. Approximately 4 weeks later the subjects received a new appointment prior to which they were asked to abstain from oral hygiene procedures for at least 48 h. At baseline the examiner (M.P.) evaluated the amount of dental plaque (Sillness & Löe) at six surfaces of each tooth. Subsequently, in the absence of this examiner, the subject's teeth were brushed or polished by a dental hygienist (Y.I.J.). Three groups were formed; the subjects in Group 1 received 10 min of polishing with a rubber cup/point using dentifrice as abrasive paste, in Group 2 subjects were brushed for 2 min with an ETB and dentifrice by the hygienist and in Group 3 brushing for 10 min was performed with an ETB and dentifrice. Care was taken to call upon the examiner always >10 min after her leaving the room so that she was unaware of the treatment. Electric brushing was carried out carefully following the contour of the teeth and turning the brush head separately in the direction of the mesial and distal aspect of each tooth in each approximal space. After finishing with the brushing/polishing, the examiner re-evaluated the amount of remaining dental plaque. RESULTS: The baseline plaque levels in Groups 1-3 were 1.54, 1.62 and 1.55, respectively. The reduction in plaque scores in Group 1 was 94.8% (+/-4.0), for Group 2 94.2% (+/-4.7) and for Group 3 99.4% (+/-0.5). The results in Group 3 were significantly better than in Groups 1 and 2. Explorative analysis revealed that these differences were due to a higher plaque removal from the approximal surfaces and molars. CONCLUSION: Two minutes of professional brushing with an ETB was as effective as 10 min of professional polishing. Whereas 10 min with an ETB was even more effective.

High and low brushing force in relation to efficacy and gingival abrasion.

OBJECTIVES: Does a high brushing force induce more gingival abrasion than a low (regular) brushing force? Furthermore, what is the effect of a low or high force on the efficacy? METHODS: Thirty-five non-dental students were selected. All received an appointment prior to which they abstained from oral hygiene for at least 48 h. At baseline the teeth and surrounding tissues were disclosed using Mira-2-Tone disclosing solution. Next, the examiner (PAV) evaluated the number of sites with gingival abrasion and the amount of dental plaque (Quigley & Hein) at 6 surfaces of each tooth. In the absence of this examiner, the subject's teeth were brushed by a hygienist (MP) using the Braun/Oral-B-D17 oscillating rotating toothbrush. Brushing was performed in two randomly selected contra-lateral quadrants for 60 s with either a low force (+/-1.5 N) or high force (+/-3.5 N) and in the opposing quadrants for 60 s with the alternative force. Visual feedback was given to control force. The brush was moved from the distal tooth to the central incisor perpendicular to the tooth surface with an angle of approximately 10-15 degrees towards the gingival margin. Next, the number of sites with abrasion and the remaining plaque were assessed again. RESULTS: The overall baseline gingival abrasion scores were 3.1 and 3.2 sites for high and low force, respectively, and increased to 5.0 and 5.9 sites respectively after brushing. There was no significant difference with respect to incidence of abrasion. At baseline, 48 h. plaque levels were 2.2. The reduction in plaque scores with the low force was 60% and with the high force 56%. This difference was significant. CONCLUSION: With the oscillating rotating power toothbrush (Braun/Oral-B D17) the use of high force (+/-3.5 N) is less efficacious as compared to a regular low force (+/-1.5 N) while the incidence of gingival abrasion sites was comparable.

Plaque removal with a novel manual toothbrush (X-Active) and the Braun Oral-B 3D Plaque Remover.

OBJECTIVES: The study was designed to test the efficacy in plaque removal of three toothbrushes: two manual brushes, the Butler GUM 311 and the Dr Best X-Active, and one electric toothbrush the Braun Oral-B 3D Plaque Remover (3D). METHOD: The study was a split-mouth, single-blind, randomized clinical study consisting of three identical experiments testing three combinations of toothbrushes (experiment 1: 3D versus Butler; experiment 2: 3D versus Dr Best; experiment 3: Butler versus Dr Best), in which the teeth of the panellists were brushed by a dental hygienist. In a fourth experiment, the panellists brushed their own teeth (3D versus Dr Best). Thirty-five subjects participated in the study and received a professional prophylaxis prior to the first experiment. They were requested to refrain from brushing their teeth for 48 h prior to each experiment. Plaque was assessed according to the Silness & Löe plaque index at six sites per tooth. Next, the dental hygienist (experiments 1-3) or the panellist (experiment 4) brushed for 60 s with their first assigned brush in two randomly selected contralateral quadrants. Brushing was repeated (60 s) with the second brush in the opposing two contralateral quadrants. Prior to experiment 4, panellists were given two thorough hands-on professional instructions in the use of the 3D and the Dr Best toothbrushes. RESULTS: In experiment 1, the 3D showed a mean plaque reduction of 72% compared to 63% with the Butler (P<0.01). In experiment 2, the 3D showed a mean plaque reduction of 79% and the Dr Best 76% (P<0.05). In experiment 3, the Butler showed a mean plaque reduction of 81% and the Dr Best 85% (P=0.01). In the hands of the panellists (experiment 4), the 3D showed a mean plaque reduction of 88% and the Dr Best 84% (P<0.05). CONCLUSIONS: A 5-week training period with repeated hands-on instruction gives panellists the skill to perform brushing with efficacy comparable to that of professional brushing. In agreement with a previous study, the 3D was more effective than a flat-trimmed manual toothbrush (Van der Weijden et al. 1994). Brushing with the criss-cross resulted in small statistical differences with the 3D and the flat-trimmed manual toothbrush. The clinical relevance of these statistically significant results should be the subject of a longitudinal study.

Increased release of IL-12p70 by monocytes after periodontal therapy.

OBJECTIVES: It has been suggested that periodontal inflammation may result in an altered immune response. The peripheral immune capacity in periodontitis patients can be investigated using lipopolysaccharide (LPS)-stimulated whole blood cell cultures (WBCC), known to reflect the behavior of monocytes in particular. A previous study in our laboratory revealed that monocytes in the stimulated cultures from periodontitis patients behaved functionally different compared with controls. The present study investigated whether this different response of periodontitis patients' monocytes is intrinsic or acquired. MATERIAL AND METHODS: The release of inflammatory mediators was measured in Escherichia coli LPS-stimulated WBCC from 12 periodontitis patients before and after periodontal therapy. In addition, the total leukocyte and leukocyte differentiation counts were also determined in the patients before and after therapy. RESULTS: The levels of interleukin (IL)-12p70 in cell culture supernatants increased two times and those of prostaglandin E2 showed a trend towards reduction after therapy, whereas the levels of IL-1beta, IL-6, IL-8, IL-10, IL-12p40 and tumor necrosis factor-alpha did not change. The total number of white blood cells was decreased after periodontal therapy. CONCLUSIONS: After periodontal therapy, the functional phenotype of the peripheral blood monocytes from patients was reconstituted, resembling that of subjects without periodontitis.

A clinical comparison of three powered toothbrushes.

AIM: The purpose of the present study was to compare the ability of the Braun Oral-B 3D Excel power toothbrush (BPT), the Sonicare power toothbrush (SPT) and the Philips Sensiflex 2000 (HX 2550) power toothbrush (PPT) to control plaque and reduce experimentally induced gingivitis. MATERIALS AND METHODS: Two experiments were carried out in two different groups of subjects using a split-mouth design whereby the two halves of the mandible which had been allowed to develop gingivitis were brushed over a 4-week period with the test toothbrushes. Experiment 1 compared the BPT with the SPT (n = 35) and experiment 2 compared the BPT with the PPT (n = 32). The study used a run-in period of 2 weeks, which, together with the 3-week experimental gingivitis phase, represented the pretrial phase of the experiment. The purpose of this phase was two-fold: first, to enable the subjects to become acquainted with the two power brushes and for them to receive proper oral hygiene instruction, and, second, to develop a reasonable level of gingivitis on the mandible. Those subjects with at least 40% of sites exhibiting bleeding in each quadrant in the mandible at day 21 of the experimental gingivitis phase were allowed to continue with the trial. During the next 4 weeks (treatment phase) of each experiment, subjects were told to brush according to a split-mouth design, the right and left sides of the mouth being randomly allocated to a toothbrush. During this period, no rinsing with an antiseptic mouthwash or flossing was allowed and a standard toothpaste (Zendium(R)) was used. After 1, 2 and 4 weeks, the plaque index (Quigley & Hein) and the bleeding tendency on marginal probing were assessed in the mandible. RESULTS: Experiment 1 showed that the bleeding score was reduced from 1.63 to 1.12 at 4 weeks by the BPT and from 1.65 to 1.26 by the SPT. This reduction was more rapid and greater with the BPT (P < 0.05). The plaque index was reduced from 2.19 at day 21-1.03 at 4 weeks by the BPT, and from 2.18 to 1.20 by the SPT. The difference between the two toothbrushes was not significant. Experiment 2 showed that the bleeding score was reduced from 1.77 at day 21 to 1.07 at 4 weeks by the BPT and from 1.75 to 1.24 by the PPT. This reduction was more rapid and greater with the BPT (P < 0.05). There was no significant difference in plaque index at 4 weeks (BPT, 1.09; PPT, 0.95). Data from the questionnaire at the end of the study revealed that, in both experiments, most subjects preferred the BPT. CONCLUSIONS: The data from this study show that the design and action of the Braun Oral-B 3D Excel power toothbrush are more effective in resolving gingivitis than the Sonicare & the Philips Sensiflex 2000 power toothbrushes.

Effectiveness of an electrically active brush in the removal of overnight plaque and treatment of gingivitis.

OBJECTIVES: The purpose of the present study was to evaluate the effect of an electrically active toothbrush on established plaque and gingivitis in a 7-month clinical trial. MATERIAL AND METHODS: For this study, 66 volunteers (non-dental University students) were selected on the basis of having moderate gingival inflammation. At baseline, plaque (Quigley & Hein), bleeding upon marginal probing and the Modified Gingival index were assessed on the vestibular, mesio-vestibular, disto-vestibular and lingual surfaces at four sites per tooth. Subjects were randomly divided among two groups; one group brushed with a control brush (Butler GUM 309) while the other used the electrically active test brush. After 2 weeks, 4 weeks, 4 months and 7 months the clinical indices were again recorded. At each assessment the participants received a new brush head for the electrically active brush (test group) or a new manual control toothbrush (control group). RESULTS: All baseline indices appeared to be well balanced. A mean Quigley & Hein plaque score of 1.98 and 2.13 was found in the control and test group, respectively. Little change was observed from baseline to 7 months. The mean bleeding upon marginal probing score at baseline was 0.62 for the control group and 0.59 for the test group. Little to no improvement was observed for the manual brush, whereas an increase in bleeding was observed in the test group in the course of this study. The mean percent reduction in plaque after 1 min of brushing varied throughout the study between 36% and 46%. No difference between the brushes was observed at any time point during the 7-month test period. CONCLUSION: No beneficial effect could be shown for the 'electrically active design feature' compared to a regular manual toothbrush control.

Generalized cervical root resorption associated with periodontal disease.

UNLABELLED: BACKGROUND AND DESCRIPTION OF CASE: The etiology and pathogenesis of generalized cervical root resorptions is not well understood. In the present report, a case of severe cervical root resorption involving 24 anterior and posterior teeth is presented. The lesions developed within a period of 2 years after the patient had changed to an acid-enriched diet. They extended far into the coronal dentin and were associated with gingival inflammation and crestal bone resorption. However, no generalized clinical attachment loss had occurred. Culturing of subgingival plaque revealed the presence of several putative periodontal pathogens among which Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. Treatment consisted of mechanical debridement supported by systemic antibiotics (amoxycillin plus metronidazole) and dietary advice. RESULTS: Within 1 year after the onset of treatment, all resorptive lesions had repaired by ingrowth of a radio-opaque mineralized tissue. The crestal areas showed radiological evidence of bone repair. 3 years after the onset of therapy, one premolar was extracted and examined histologically. It appeared that irregularly-shaped masses of woven bone-like tissue had invaded into the domain of the resorbed coronal dentin and were bordered by thin layers of acellular cementum. CONCLUSION: It is concluded that, in this patient, the cervical resorptions were likely the result of an osteoclastic response extending into the roots because the root-protective role of the junctional epithelium did not develop. We hypothesize that this was due to the combined effects of a periodontopathogenic microflora and a dietary confounding factor.

Oscillating/rotating electric toothbrushes compared: plaque removal and gingival abrasion.

OBJECTIVES: This study was designed to test the efficacy in plaque removal and the potential for gingival abrasion of 3 electric toothbrushes. The established Braun Oral-B 'Ultra' plaque remover (D9), the Philips/Jordan HP 735, and the newly designed Braun Oral-B 3D Plaque Remover (3D). MATERIAL AND METHODS: This study was designed as a split-mouth, single blind, randomised clinical study consisting of 3 identical experiments with 3 combinations of toothbrushes (exp 1:3D-HP735, exp 2:D9-HP735, exp 3:D9-3D). 40 subjects were requested not to brush their teeth 48 h prior to each examination. At this visit, both the gums and teeth were disclosed for the assessment of baseline plaque and gingival abrasion. Abrasion sites were scored as small (< or = 5 mm) or large sites (> 5 mm). Plaque was assessed according to the Quigley & Hein index at 6 sites per tooth. The participants brushed 60 s with the 2 brushes, each brush in 2 randomly selected contra-lateral quadrants. RESULTS: The increase in number of small abrasions after brushing (exp. 1) was 1.2 versus 1.7 for 3D and HP735, respectively (ns); In exp. 2 the increase was 0.9 for both D9 and HP735. In exp. 3 the increase was 0.4 sites for both D9 and 3D. Comparison of the 3D and HP735 showed a mean plaque reduction of 67% and 54%, respectively (p<0.05); when the D9 and HP735 were compared, a mean plaque reduction of 70% and 58%, respectively, was found (p<0.05); a mean plaque reduction of 74% was found in the comparison of D9 and 3D. CONCLUSION: The results show that the potential gingival abrasion after brushing is comparable for all 3 electric toothbrushes. In addition the longer the subjects used the brushes the less abrasion occurred. Finally both 3D and D9 were more effective than the HP735 in removing plaque.

A comparison of the efficacy of a novel electric toothbrush and a manual toothbrush in the treatment of gingivitis.

PURPOSE: To compare the efficiency of a new electric toothbrush featuring a novel three-dimensional brush head action, with a manual toothbrush, in resolving gingivitis which had been allowed to develop in a group of subjects prior to the treatment phase of the study. MATERIALS AND METHODS: This was a randomized split-mouth study. A total of 35 healthy non-dental students refrained from any oral hygiene on the lower jaw for a period of 21 days in order to develop gingivitis. They then brushed one quadrant of the lower jaw with the Braun Oral-B 3D Plaque Remover and the other with a manual toothbrush for a period of 4 weeks. Plaque and gingivitis were evaluated at the start of the study, after the 21 days of no oral hygiene, and after 1, 2, 3 and 4 weeks of brushing twice a day. RESULTS: At the end of the study, the 3D was found to be significantly more effective at reducing bleeding on probing (P < 0.05) for all sites combined and all individual sites. Plaque removal was also significantly more effective with the 3D. Subjects in the study reported that they preferred the 3D to the manual toothbrush and said that it would encourage them to brush for longer. It is concluded that the new Braun Oral-B 3D Plaque Remover offers advantages over a manual toothbrush in terms of plaque control and improvement of gingival condition.