A Meta-analysis Comparing Toothbrush Technologies on Gingivitis and Plaque.

BACKGROUND: Research continues to show an association between oral health and systemic health, further stressing the importance of effective daily plaque removal via toothbrushing to maintain periodontal health and overall well-being. This investigation was undertaken to compare the efficacy of oscillating-rotating, sonic, and manual toothbrushes in reducing gingivitis and plaque in randomised controlled trials (RCTs) with up to 6 months' follow-up. METHODS: This meta-analysis was conducted from a single database (Procter & Gamble Oral Care Clinical Archive) including RCTs from 2007 to 2022. Three authors independently assessed study eligibility. Disagreements concerning selected studies were resolved by discussion with an expert colleague. Direct and indirect treatment comparisons along with transition rates to gingival health were calculated using participant-level data. Transition-to-health time was calculated using data from all time points. Subregion analyses evaluated number of bleeding sites and plaque reduction. RESULTS: This meta-analysis included 21 gingivitis RCTs and 25 plaque RCTs. Relative to manual and sonic brushes, oscillating-rotating brushes had a higher percentage of participants who transitioned to gingival health (72% vs 21% and 54%; P < .001). Compared with manual and sonic brushes, respectively, oscillating-rotating brushes demonstrated greater bleeding site reductions (by 52% and 29%; P < .001) and superior plaque reductions (by 19% and 5%; P < .001). Oscillating-rotating brushes provided faster transitions to health than sonic brushes and showed greater efficacy across subregions. The most advanced oscillating-rotating brush demonstrated statistically significantly greater efficacy compared with traditional oscillating-rotating, manual, and sonic brushes when analysed separately. Risk of bias was deemed low for all studies. CONCLUSIONS: Oscillating-rotating toothbrushes offer superior results for transition to health, gingivitis, and plaque reduction compared with manual and sonic brushes. The most advanced oscillating-rotating model offers enhanced efficacy vs traditional models.

Brushing Behavior Changes and Plaque Removal with an Electric Toothbrush: A clinical trial.

Purpose To evaluate changes in toothbrushing behavior and plaque removal performance with usage of a next generation oscillating-rotating electric toothbrush (NG-OR).Methods This exploratory clinical study had a two-treatment, three-period, single-group, sequential design. Generally healthy adults with a screening whole mouth mean Turesky modified Quigley-Hein Plaque Index (TQHPI) score of at least 1.75 on a 0-5 scale and who were primarily OR brush users were enrolled. Participants used each OR toothbrush in A-B-B order, where a currently marketed OR brush with a traditional mechanical drive system (T-OR) was used in period A and the NG-OR brush with a linear magnetic drive was used in period B. At Visit 1, qualifying participants brushed on-site with T-OR. After a 48h washout, participants returned for Visit 2 and brushed on-site with NG-OR. Participants then used NG-OR for 1 week, twice daily, at home and returned for Visit 3 to brush on-site with NG-OR again. For all on-site brushings, participants were instructed to brush for 2min without interactive features. Each toothbrush was tagged with a transmitter chip connected to a Motion Tracking System to record movements of the toothbrush and participant using infrared light transmission to determine Isochronicity (brushing time uniformly distributed across the dentition). Plaque was measured using TQHPI. Primary variables were Isochronicity and TQHPl whole mouth mean plaque reduction (pre-brushing minus post brushing).Results Overall, 41 participants enrolled and received treatment; 40 completed the trial. NG-OR showed significantly greater Isochronicity after a single brushing (p=0.043) and after a 1-week at-home use (p=0.001) versus T-OR. NG-OR showed 41% greater whole mouth plaque removal than T-OR (p<0.001) after a single brushing. Plaque reduction by region/surface was consistent with whole mouth results.Conclusion The NG-OR brush showed greater brushing uniformity and plaque removal versus the T-OR brush.

Brushing behaviour changes and plaque removal with an electric toothbrush: A clinical trial.

OBJECTIVE: To evaluate changes in toothbrushing behaviour and plaque removal performance with usage of a next generation oscillating-rotating electric toothbrush (NG-OR). METHODS: This exploratory clinical study had a two-treatment, three-period, single-group, sequential design. Generally healthy adults with a screening whole mouth mean Turesky modified Quigley-Hein Plaque Index (TQHPI) score of at least 1.75 on a 0-5 scale and who were primarily OR brush users were enrolled. Participants used each OR toothbrush in A-B-B order, where a currently marketed OR brush with a traditional mechanical drive system (T-OR) was used in period A, and the NG-OR brush with a linear magnetic drive was used in period B. At Visit 1, qualifying participants brushed on-site with T-OR. After a 48 h washout, participants returned for Visit 2 and brushed on-site with NG-OR. Participants then used NG-OR for 1 week, twice daily, at home and returned for Visit 3 to brush on-site with NG-OR again. For all on-site brushings, participants were instructed to brush for 2 min without interactive features. Each toothbrush was tagged with a transmitter chip connected to a Motion Tracking System to record movements of the toothbrush and participant using infrared light transmission to determine Isochronicity (brushing time uniformly distributed across the dentition). Plaque was measured using TQHPI. Primary variables were Isochronicity and TQHPl whole mouth mean plaque reduction (pre-brushing minus post-brushing). RESULTS: Overall, 41 participants enrolled and received treatment; 40 completed the trial. NG-OR showed significantly greater Isochronicity after a single brushing (p = 0.043) and after a 1-week at-home use (p = 0.001) versus T-OR. NG-OR showed 41% greater whole mouth plaque removal than T-OR (p < 0.001) after a single brushing. Plaque reduction by region/surface was consistent with whole mouth results. CONCLUSION: The NG-OR brush showed greater brushing uniformity and plaque removal versus the T-OR brush.

Gingival health effects with an oscillating-rotating electric toothbrush with micro-vibrations and a novel brush head designed for stain control: Results from a 12-week randomized controlled trial.

PURPOSE: To evaluate the reduction of plaque and gingivitis by an oscillating-rotating (O-R) smart-connected electric rechargeable toothbrush with micro-vibrations used with a novel brush head designed for stain control versus a manual toothbrush. METHODS: 100 adult subjects with evidence of gingivitis and plaque were enrolled in this single-center, examiner-blind, two-treatment, parallel-group, controlled trial. Subjects were randomized to either the O-R toothbrush used in whitening mode (Oral-B iO with Radiant White brush head) or the manual toothbrush (Oral-B Indicator). Subjects brushed twice daily with their assigned toothbrush and a standard sodium fluoride dentifrice. At baseline, week 1, and week 12, gingivitis was assessed with the Modified Gingival Index (MGI) and the Gingival Bleeding Index (GBI), and plaque was assessed with the Rustogi Modification of the Navy Plaque Index (RMNPI). Gingival case status was classified as " healthy" (< 10% bleeding sites) or "not healthy" (≤ 10% bleeding sites) according to the standard of the American Academy of Periodontology and the European Federation of Periodontology. RESULTS: All 100 subjects who were randomized to treatment completed the study. At baseline, the gingival case status for all subjects was classified as "not healthy". By week 12, 86% of subjects in the O-R brush group had transitioned to a " healthy" case status, in contrast to 20% of subjects in the manual toothbrush group (P< 0.001). The reduction in the adjusted mean number of bleeding sites from baseline was greater for the O-R brush group than for the manual brush group [at week 12, by 24.5 (74.6%) vs. by 7.8 (23.7%), respectively; P< 0.001]. Reductions for adjusted mean MGI and GBI scores were likewise statistically significantly greater for the O-R brush group relative to those of the manual brush group (P< 0.001). The O-R brush also provided greater relative reductions in adjusted mean whole mouth, gingival margin and approximal RMNPI scores at week 12 (P< 0.001), and plaque was similarly reduced in the lingual and buccal subregions (P< 0.001). Significant between-group plaque reductions favoring the O-R brush were observed for all regions as early as first use (P< 0.001). CLINICAL SIGNIFICANCE: The results of this 12-week study support the recommendation of the O-R toothbrush with micro-vibrations, used in whitening mode with a novel brush head designed for stain control, so patients motivated by esthetic desires can personalize their brushing experience without compromising cleaning and gingival health efficacy.

A 12-Week Randomized Controlled Trial Comparing a Novel Electric Toothbrush With an Extra Gentle Brush Head to a Manual Toothbrush for Plaque and Gingivitis Reduction.

OBJECTIVE: This study compared the gingivitis and plaque reduction efficacy of a novel smart-connected oscillating-rotating (O-R) electric toothbrush with micro-vibrations, used in Sensitive mode with an extra gentle ("sensitive") brush head, to the efficacy of a soft manual toothbrush. METHODS: This was a 12-week, examiner-blind, two-treatment, parallel-group clinical trial with 100 adult subjects (N = 100) having evidence of gingivitis and plaque at baseline. Subjects were randomly assigned to use either the O-R electric rechargeable toothbrush (Oral-B iO with Oral-B Gentle Care brush head) or the soft manual toothbrush (Oral-B Indicator). Gingivitis was assessed with the modified gingival index (MGI) and the gingival bleeding index (GBI). Plaque was assessed with the Rustogi modification of the navy plaque index (RMNPI). Patients were classified as having a "healthy" or "not healthy" gingival case status according to the criteria of the American Academy of Periodontology and the European Federation of Periodontology. Efficacy assessments and oral soft-tissue examinations were conducted before brushing at baseline, week 1, and week 12. The baseline assessment included both pre- and post-brushing plaque evaluations to evaluate single-use plaque removal efficacy. RESULTS: All 100 subjects completed the trial. Subjects had a mean age of 49.1 years; 72% were females. The O-R brush group had a significantly higher percentage of subjects who transitioned from "not healthy" to "healthy" gingival case status than did the manual brush group. Plaque reduction for the O-R brush group was also significantly greater (P ≤ .009) than for the manual brush group for whole mouth, gingival margin, and interproximal region, from day 1 (single use) through 12 weeks. Both brushes were well tolerated. CONCLUSION: The novel O-R toothbrush with micro-vibrations used in Sensitive mode with an extra gentle brush head provided significantly greater gingivitis and plaque reduction than did a manual toothbrush over 12 weeks.

A Global, In-Market Evaluation of Toothbrushing Behaviour and Self-assessed Gingival Bleeding with Use of App Data from an Interactive Electric Toothbrush.

PURPOSE: To determine if an interactive electric toothbrush and smartphone application (app) can reduce self-reported gingival bleeding and promote better brushing behaviour based on global, in-market usage data. MATERIALS AND METHODS: Anonymised data were collected worldwide between July 2020 and January 2021 from users of interactive oscillating-rotating electric toothbrushes and app (Oral-B Genius, GeniusX and iO). Self-reported gingival bleeding and brushing behaviour data captured via the app were sent to Google Firebase and Google BigQuery to aid processing and analysis. RESULTS: Data from 16.7 million brushing sessions were analysed. 439,481 new users responded at least once to the app question: 'Do you have gum bleeding?' Of users answering the question over their first two weeks of app use (153,201), the proportion reporting bleeding decreased statistically significantly from week 1 to 2 (28.8% to 17.1%, p < 0.0001). Of users answering the question over each of the first five weeks (43,060) a further statistically significant decrease in those reporting bleeding was seen in each consecutive week, with the week-5 rate being 12.7% (p < 0.0001 vs any previous week). Decreases in duration of excessive pressure (i.e. > 2.5 N - 3.0 N depending on the handle) decreased the proportion of self-reported gingival bleeding (p < 0.0001). Users brushed longer and with less overpressure (p < 0.0001) with vs without live feedback from the app, and showed 94.4% average coverage with live feedback. CONCLUSION: The interactive oscillating-rotating electric toothbrushes and app, particularly with live feedback, promote good brushing behaviour. Self-reported gingival bleeding occurred less frequently the longer the system was used.

Anti-gingivitis and Anti-plaque Efficacy of an Oral Hygiene System: Results From a 12-Week Randomized Controlled Trial.

The objective of this study was to compare the antigingivitis and antiplaque efficacy of an oral hygiene system versus a control regimen. This was a single-center, randomized, examiner-blind, two-treatment, 12-week parallel group study in adults with evidence of gingivitis and plaque. Eligible subjects were stratified by baseline gingivitis and plaque scores, number of bleeding sites, and tobacco use and randomized to one of two treatment groups: (1) oral hygiene system (test group) involving a novel smart-connected Oral-B® iO oscillating-rotating (O-R) electric toothbrush, 0.454 percent stabilized stannous fluoride (SnF2) dentifrice, 0.07 percent cetylpyridinium chloride (CPC) rinse, and floss, or (2) control regimen involving a manual toothbrush and 0.243 percent sodium fluoride dentifrice. Gingivitis (modified gingival index, gingival bleeding index) and plaque (Rustogi modification of the navy plaque index) were assessed at Baseline, Week 1, and Week 12.

Clinical Parameters and Oral Fluid Biomarkers in Gingivitis Subjects using an Electric Toothbrush with Irrigator vs a Manual Toothbrush Alone over 8 Weeks: A Randomised Controlled Clinical Trial.

PURPOSE: To compare clinical outcomes and oral fluid biomarkers in gingivitis subjects using an electric toothbrush/irrigator combination (test) or a manual toothbrush alone (control) over 8 weeks. MATERIALS AND METHODS: Subjects were randomly assigned to two groups of n = 30. In both groups, toothbrushing was performed twice daily at home and no additional interdental cleaning aids were allowed. Plaque Index (PLI), Gingival Index (GI), whole saliva (WS), and gingival crevicular fluid (GCF) samples were collected at weeks 2, 4, and 8. RESULTS: Subjects' mean age was 23 years and 52% were female. Overall baseline means were 1.31 for PLI, 1.07 for GI, and 34.9 for number of bleeding sites. At every follow-up visit, both groups differed statistically significantly (p < 0.001) from baseline for all clinical parameters. The test group demonstrated statistically significantly (p < 0.001) greater reductions in GI vs the control group by 18% at week 2, 17% at week 4 and 24% at week 8. The test group also demonstrated statistically significantly (p < 0.002) greater reductions in the number of bleeding sites vs the control group by 33% at week 2, 34% at week 4 and 43% at week 8. Between-group comparisons for both WS and GCF revealed numerical trends for decreased levels of interleukin (IL)-1ß in GCF after 4 and 8 weeks, but these were not statistically significant. CONCLUSION: In subjects using the electric toothbrush/irrigator combination, increased clinical improvements may be found accompanied by similarly improved trends for oral fluid biomarkers such as IL-1ß.

A 6-month randomized controlled trial evaluating a novel smart-connected oscillating-rotating toothbrush versus a smart-connected sonic toothbrush for the reduction of plaque and gingivitis.

PURPOSE: This 6-month study compared the effects of a smart-connected oscillating-rotating (O-R) electric rechargeable toothbrush with micro-vibrations with those of a marketed smart-connected sonic rechargeable toothbrush for the reduction of gingivitis and plaque. METHODS: In this single-center, examiner-blind, two-treatment, open-label, parallel-group, randomized study, 110 adult subjects with evidence of gingivitis and plaque were randomized to use either the O-R brush (Oral-B iO) or the sonic brush (Philips Sonicare DiamondClean). Both groups were instructed to brush twice daily with a standard sodium fluoride dentifrice. Gingivitis and plaque were assessed at baseline, week 1, and week 24 using the Modified Gingival Index (MGI), Gingival Bleeding Index (GBI), and the Rustogi Modification of the Navy Plaque Index (RMNPI). Designation of gingivitis case status as "healthy" or " not healthy" was made according to the World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. RESULTS: A significantly greater percentage of subjects in the O-R brush group versus the sonic brush group transitioned from " not healthy" to " healthy" gingivitis case status at week 24 (96.4% vs. 81.8%; P= 0.029). The O-R toothbrush produced a significantly greater reduction in adjusted mean MGI score, adjusted mean GBI score, and adjusted mean number of bleeding sites than did the sonic brush (week 24, by 32.6% for MGI score, by 23.7% for GBI score, and by 26.1% for number of bleeding sites, P< 0.001). After a single use on day 1, plaque removal was statistically significantly greater for the O-R brush compared to the sonic brush (P< 0.001); by week 24, the O-R brush demonstrated greater reductions in whole mouth plaque (24.6%), gingival margin plaque (61.9%) and approximal region plaque 25.8% (P≤ 0.007 for all) compared to the sonic brush. CLINICAL SIGNIFICANCE: This 6-month study provides evidence supporting use of a smart-connected O-R electric toothbrush with micro-vibrations for plaque removal and gingivitis reductions, resulting in transitions to a healthy gingival state.

Handheld optical coherence tomography for clinical assessment of dental plaque and gingiva.

SIGNIFICANCE: Optical coherence tomography (OCT) offers high spatial resolution and contrast for imaging intraoral structures, yet few studies have investigated its clinical feasibility for dental plaque and gingiva imaging in vivo. Furthermore, the accessibility is often limited to anterior teeth due to bulky imaging systems and probes. AIM: A custom-designed, handheld probe-based, spectral-domain OCT system with an interchangeable attachment was developed to assess dental plaque and gingival health in a clinical setting. APPROACH: Healthy volunteers and subjects with gingivitis and sufficient plaque were recruited. The handheld OCT system was operated by trained dental hygienists to acquire images of dental plaque and gingiva at various locations and after one-week use of oral hygiene products. RESULTS: The handheld OCT can access premolars, first molars, and lingual sides of teeth to visualize the plaque distribution. OCT intensity-based texture analysis revealed lower intensity from selected sites in subjects with gingivitis. The distribution of the dental plaque after one-week use of the oral hygiene products was compared, showing the capability of OCT as a longitudinal tracking tool. CONCLUSIONS: OCT has a strong potential to display and assess dental plaque and gingiva in a clinical setting. Meanwhile, technological challenges remain to perform systematic longitudinal tracking and comparative analyses.

An 8-week randomized controlled trial comparing the effect of a novel oscillating-rotating toothbrush versus a manual toothbrush on plaque and gingivitis.

PURPOSE: To compare a novel oscillating-rotating (O-R) electric rechargeable toothbrush with micro-vibrations (Oral-B iO) to a manual brush for gingivitis and plaque reduction. METHODS: Adult subjects with gingivitis and plaque were randomized to use either the O-R or the manual toothbrush with standard fluoride dentifrice twice daily. Efficacy was assessed at baseline, week 1, and week 8 using the Rustogi Modification of the Navy Plaque Index (RMNPI), Modified Gingival Index (MGI), and Gingival Bleeding Index (GBI). Gingivitis status ('healthy'/'not healthy') was also assessed, per the American Academy of Periodontology/European Federation of Periodontology criteria. RESULTS: One hundred and ten subjects were enrolled and completed the randomized controlled trial. The baseline mean number (SD) of bleeding sites for all subjects was 32.11 (16.703). At week 8, 82% of subjects using the O-R toothbrush were categorized as 'healthy' (<10% bleeding sites), versus 24% of subjects using the manual brush (P < 0.001). Subjects using the O-R toothbrush showed statistically significantly greater reductions (P < 0.001) in the number of bleeding sites, GBI scores and MGI scores versus those using a manual toothbrush as early as 1 week and throughout the 8-week study. The O-R toothbrush also provided statistically significantly greater reductions (P < 0.001) in all plaque measures, including sub-regions, versus the manual toothbrush after a single brushing and at weeks 1 and 8. CONCLUSIONS: The novel O-R electric toothbrush with micro-vibrations provided statistically significantly greater plaque and gingivitis reductions versus a manual toothbrush, with performance benefits demonstrated after a single brushing and continuing throughout the 8-week study.

Randomized controlled trial assessing plaque removal of an oscillating-rotating electric toothbrush with micro-vibrations.

OBJECTIVE: The objective was to assess plaque removal potential of a newly designed oscillating-rotating (O-R) electric rechargeable toothbrush with micro-vibrations compared to a manual toothbrush. METHODS: This was a randomized single-brushing, two-treatment, examiner-blind, replicate-use, four-period crossover design study, conducted with three cohorts of nine subjects each, with all subjects using each toothbrush twice. Test toothbrushes included a new O-R rechargeable electric toothbrush with micro-vibrations (Oral-B iO prototype) and a manual American Dental Association (ADA) reference toothbrush. On each of the four study visits, subjects refrained from oral hygiene for 12 hours prior. At each visit, subjects received a pre-brushing plaque examination, brushed with their assigned toothbrush and a marketed fluoride dentifrice and then received a post-brushing plaque examination. Plaque was assessed using the expanded Turesky Modified Quigley-Hein Plaque Index. Treatment comparison analyses were two-sided and carried out at the 5% significance level. RESULTS: All 27 randomized subjects (mean age = 42.0 years) completed the trial. Both brushes produced significant plaque reductions versus baseline (P < 0.001). The O-R electric brush provided statistically significantly greater plaque reductions in all regions compared to the regular manual toothbrush, with a between-treatment difference of 0.929 for whole mouth plaque, 0.965 for proximal plaque, 1.029 for lingual plaque and 0.815 for facial plaque (P < 0.001 for all comparisons). Additionally, use of the novel O-R brush yielded greater brushing evenness/consistency when comparing the facial and lingual mean plaque removal differences relative to manual brushing (P = 0.001). Both brushes were well-tolerated. CONCLUSION: The novel O-R toothbrush with micro-vibrations produced significantly greater plaque reductions compared to the manual toothbrush.

Introducing the Oral-B iO electric toothbrush: next generation oscillating-rotating technology.

PURPOSE: A novel oscillating-rotating electric toothbrush (Oral-B iO) has been developed with a linear magnetic drive, resulting in oscillation-rotations with micro-vibrations. The mechanism directs motor energy directly to the bristle tips. The brush also has a redesigned round brush head and smart pressure sensor to enhance plaque removal and encourage proper brushing technique. METHODS: The plaque removal and gingival health effects of this new electric toothbrush technology were evaluated in three randomized controlled studies summarized in this supplement, including an 8-week trial versus a manual toothbrush, an 8-week trial versus a premium sonic toothbrush, and a single-brushing, repetitive-use study versus a manual toothbrush. RESULTS: Outcomes from these studies demonstrate statistically significantly greater plaque removal and gingival health improvements for the Oral-B iO toothbrush technology versus manual and sonic toothbrush controls. Plaque removal advantages demonstrated in the replicate-use single-brushing trial resulted in significant gingival health benefits as evidenced in the longer-term trials. In addition, gingivitis case status assessments based on the American Academy of Periodontology (AAP) and European Federation of Periodontology (EFP) guidelines show that over 80% of subjects using the Oral-B iO transitioned from 'gingivitis' (≥10% bleeding sites) at baseline to 'generally healthy' (<10% bleeding sites) at week 8 in both longer-term clinical trials, versus 24% in the manual toothbrush group and 53% in the sonic toothbrush group. CONCLUSIONS: This uniquely designed oscillating-rotating electric toothbrush with a linear magnetic drive delivers significantly greater plaque removal and gingival health benefits with additional features to improve brushing experience and clinical outcomes.

Evaluation of an oscillating-rotating toothbrush with micro-vibrations versus a sonic toothbrush for the reduction of plaque and gingivitis: results from a randomized controlled trial.

PURPOSE: To compare a novel oscillating-rotating (O-R) electric rechargeable toothbrush with micro-vibrations to a marketed premium sonic toothbrush for reduction of gingivitis and plaque in an 8-week randomized controlled trial. METHODS: Adult subjects with evidence of gingivitis and plaque were randomized to use either the novel O-R brush (Oral-B iO) or the sonic brush with sodium fluoride dentifrice twice daily. Assessments at baseline and week 8 included the Rustogi Modification of the Navy Plaque Index (RMNPI), Modified Gingival Index (MGI), and Gingival Bleeding Index (GBI). Gingivitis status ('healthy'/'not healthy') was classified per the American Academy of Periodontology/European Federation of Periodontology criteria. RESULTS: Ninety subjects were randomized to treatment and completed the study. Subjects had a mean age of 49.2 years; 68 were females. At baseline, the mean number (standard deviation [SD]) of bleeding sites for all subjects was 32.8 (16.43). At week 8, the O-R brush group had a higher percentage of 'healthy' gingiva subjects than the sonic brush group (84% vs. 53% P = 0.003). In the between-group comparisons at week 8, the O-R brush group showed statistically significantly greater reductions (P < 0.001) compared to the sonic group for MGI, GBI, and number of bleeding sites. The O-R brush group also had statistically significantly greater plaque removal (P ≤ 0.011) than the sonic brush group for whole mouth plaque as well as plaque in the proximal regions and along the gingival margin. CONCLUSIONS: The novel O-R electric toothbrush with micro-vibrations provided greater plaque and gingivitis reductions than the marketed premium sonic toothbrush over 8 weeks.

The effects of oscillating-rotating electric toothbrushes on plaque and gingival health: A meta-analysis.

PURPOSE: To compare the effects of oscillating-rotating (O-R), sonic (side-to-side), and manual toothbrushes on plaque and gingival health after multiple uses in studies up to 3 months. METHODS: A meta-analysis was conducted on randomized clinical trials (RCTs) up to 3 months in duration to evaluate O-R electric toothbrush effectiveness regarding gingivitis reduction and plaque removal versus sonic and/or manual toothbrushes. To ensure access to subject-level data, this meta-analysis was limited to RCTs involving O-R toothbrushes from a single manufacturer conducted from 2007 to 2017 for which subject-level data were available and that satisfied criteria of duration, parallel design, examiner-graded, etc. For gingivitis studies, a one-step individual subject meta-analysis was used to assess direct and indirect treatment differences and to identify any subject-level covariates modifying treatment effects. In the two-step meta-analysis, individual participant data were first analyzed in each study independently using the last timepoint (up to 3 months), producing aggregate data for each study. Then forest plots were produced using these aggregate data with random-effects models. For plaque studies, the efficacy variables were standardized so direct comparisons could be generated using the 2-step meta-analysis. Network meta-analysis was performed to assess the indirect plaque comparisons. RESULTS: 16 parallel group RCTs with 2,145 subjects were identified assessing gingivitis via number of bleeding sites. In five and 11 gingivitis studies assessing O-R brushes versus manual and sonic brushes, respectively, a change in the average number of bleeding sites of -8.9 ( 95% CI: -15.9, -1.9) and -3.1 (95% CI: -3.8, -2.4) was observed (P ≤ 0.008). These reductions equate to a 50% and 28% bleeding benefit for O-R technology versus the respective controls. The sonic brush bleeding change versus manual was -5.9 (P = 0.062), a 34% bleeding benefit. Utilizing individual bleeding scores, subjects with localized or generalized gingivitis (≥ 10% bleeding sites) had 7.4 times better odds of transitioning to generally healthy (< 10% bleeding sites) after using an O-R brush versus manual. 20 parallel design RCTs with 2,551 subjects assessed plaque (TMQHI, RMNPI). In eight and 12 plaque RCTs assessing an O-R brush versus manual and sonic brushes, respectively, standardized changes in average plaque scores of -1.51 (95% CI: -2.17, -0.85) and -0.55 (95% CI: -0.82, -0.28) were observed (P< 0.001). These plaque reductions by O-R equate to a relative 20% and 4% greater benefit, respectively. The change for sonic versus manual was -0.93 ( 95% CI:-1.48, -0.38); (P < 0.001) which equates to a 12% plaque benefit. CLINICAL SIGNIFICANCE: This subject-level meta-analysis of studies up to 3 months provides sound evidence supporting recommendations for patients with various degrees of gingival bleeding to use oscillating-rotating electric toothbrushes over manual and sonic toothbrushes to improve plaque control and gingival health.

Comparative assessment of plaque removal and motivation between a manual toothbrush and an interactive power toothbrush in adolescents with fixed orthodontic appliances: A single-center, examiner-blind randomized controlled trial.

INTRODUCTION: The objective of this 2-arm parallel trial was to determine the plaque removal efficacy (main outcome) and the motivation assessment (secondary outcome) comparing a manual versus an interactive power toothbrush in orthodontic patients. METHODS: Sixty adolescents with fixed orthodontic appliances in both arches were randomized in a 1:1 ratio in this parallel, randomized, examiner-blind controlled clinical trial. Eligibility criteria included at least 16 natural teeth, 1-6 "focus care areas," plaque score of ≥1.75, no severe caries, gingivitis and periodontitis, no dental prophylaxis, no smoking, no antibiotics, and no chlorhexidine mouth rinse. Subjects were to brush unsupervised with either an interactive power toothbrush (Oral-B Professional Care 6000, D36/EB20) with Bluetooth technology or a regular manual toothbrush (Oral-B Indicator 35 soft). Focus care areas were each brushed for 10 additional seconds. Plaque removal was assessed with the use of the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI) to determine change from baseline at 2 and 6 weeks. Supervised brushing at screening and post-treatment visits recorded actual brushing times. Subject-reported motivational aspects were recorded at screening and week 6. RESULTS: Fifty-nine subjects aged 13-17 years completed the study. The interactive power toothbrush provided significantly (P <0.001) greater plaque reduction versus the manual toothbrush at 2 and 6 weeks according to the whole-mouth TMQHPI. The treatment difference in adjusted mean plaque change from baseline was 0.777 (95% CI 0.614-0.940) at week 2 and 0.834 (0.686-0.981) at week 6. Mean reductions in the number of focus care areas were also significantly greater (P <0.001) in the power brush group at weeks 2 and 6. Brushing times increased significantly at weeks 2 and 6 (P ≤0.013) versus baseline in the interactive power brush group only. Subject-reported motivation was significantly increased in the interactive power brush group at week 6 versus screening (P ≤0.005). CONCLUSIONS: An interactive power toothbrush generated increased brushing times and significantly greater plaque removal versus a manual brush.

A 5-week randomized clinical evaluation of a novel electric toothbrush head with regular and tapered bristles versus a manual toothbrush for reduction of gingivitis and plaque.

OBJECTIVE: To evaluate the efficacy of an oscillating-rotating (O-R) electric rechargeable toothbrush with a novel round brush head comprised of regular and tapered bristles in reducing plaque and gingivitis versus a manual toothbrush. METHODS: This was a randomized, examiner-blind, parallel group, five-week study. Participants with mild-to-moderate plaque and gingivitis received an oral examination and were evaluated for baseline plaque (Rustogi Modified Navy Index), gingivitis (Modified Gingival Index) and gingival bleeding (Gingival Bleeding Index). Qualifying participants were randomly assigned to the novel Oral-B sensitive brush head (EB60) on an Oral-B Vitality O-R handle (D12) or an ADA manual toothbrush. Participants brushed twice daily with the assigned brush and a standard fluoride dentifrice for 5 weeks before returning for an oral examination and plaque and gingivitis evaluations. RESULTS: A total of 150 participants were randomized to treatment and completed the study (mean age = 45.7 years). Both brushes demonstrated a statistically significant reduction in number of bleeding sites versus baseline (P < 0.001). At Week 5, the number of bleeding sites was reduced from baseline by 11.15 (52.2%) for the O-R brush and 5.04 (23.6%) for the manual brush. The treatment difference was statistically significant (P < 0.001). Significant reductions versus baseline (P < 0.001) were also seen for both brushes for MGI, GBI and Rustogi plaque measures (whole mouth, gingival margin and proximal), but the O-R brush produced significantly greater reductions versus the manual brush (P < 0.001). CONCLUSION: The O-R handle and round brush head with tapered and regular bristles produced greater plaque and gingivitis reductions than the manual brush.

A comparative assessment of plaque removal and toothbrushing compliance between a manual and an interactive power toothbrush among adolescents: a single-center, single-blind randomized controlled trial.

BACKGROUND: Many adolescents have poor plaque control and sub-optimal toothbrushing behavior. Therefore, we compared the efficacy of an interactive power toothbrush (IPT) to a manual toothbrush (MT) for reducing dental plaque and improving toothbrushing compliance. METHODS: In this randomized, parallel single-blind clinical study, adolescents brushed twice daily with either a MT (Oral-B® Indicator soft manual toothbrush) or an IPT (Oral-B® ProfessionalCare 6000 with Bluetooth). Subjects brushed for 2 min, plus an additional 10 s for each 'Focus Care Area'. At screening and Week 2, afternoon pre-brushing plaque was assessed via the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI), and supervised brushing duration was measured. RESULTS: Sixty subjects were randomized; 98% completed. At Week 2, the mean reduction in whole mouth plaque relative to baseline was 34% (p < 0.001) for the IPT versus 1.7% (p = 0.231) for the MT. For Focus Care Areas, the IPT yielded a 38.1% mean TMQHPI reduction (p < 0.001) versus 6.2% for the MT (p < 0.001). Mean brushing time versus baseline increased 34 s in the IPT group (p < 0.001) while remaining flat in the MT group (p = 1.0). CONCLUSIONS: Over 2 weeks, adolescents using an IPT experienced superior plaque reduction and increased overall brushing time versus those using a MT. TRIAL REGISTRATION: This trial was retrospectively registered ( ISRCTN10112852 ) on the 18th, June 2018.

Newborn infant skin: physiology, development, and care.

Infant skin is critical to the newborn child's transition from the womb environment to the journey to self-sufficiency. This review provides an integrative perspective on the skin development in full term and premature infants. There is a particular focus on the role of vernix caseosa and on the implications of skin development for epidermal penetration of exogenous compounds. Healthy full-term newborn skin is well-developed and functional at birth, with a thick epidermis and well-formed stratum corneum (SC) layers. Transepidermal water loss is very low at birth, equal to, or lower than adults, indicating a highly effective skin barrier. Vernix facilitates SC development in full-term infants through a variety of mechanisms including physical protection from amniotic fluid and enzymes, antimicrobial effects, skin surface pH lowering, provision of lipids, and hydration. Premature infants, particularly those of very low birth weight, have a poor skin barrier with few cornified layers and deficient dermal proteins. They are at increased risk for skin damage, increased permeability to exogenous agents and infection. The SC barrier develops rapidly after birth but complete maturation requires weeks to months. The best methods for caring for infant skin, particularly in the diaper region, are described and related to these developmental changes.

Brush head composition, wear profile, and cleaning efficacy: an assessment of three electric brush heads using in vitro methods.

OBJECTIVE: The objective of this research was to evaluate a current store brand (SB) brush head for composition/physical characteristics, Wear Index (WI), and cleaning efficacy versus the previous SB brush head refill design (SB control) and the Oral-B Precision Clean brush head (positive control, PC). METHODS: This research consisted of three parts: 1) Analytical analysis using Fourier Transform Infrared (FT-IR) spectrometry to evaluate the chemical composition of the current SB brush head bristles relative to the SB control. In addition, physical parameters such as bristle count and diameter were determined. 2) Wear Index (WI) investigation to determine the Wear Index scores of in vitro-aged brush heads at four weeks (one month) and 13 weeks (three months) by a trained investigator. To "age" the brush heads, a robot system was used as a new alternative in vitro method to simulate aging by consumer use. 3) Robot testing to determine the cleaning performance of in vitro-aged brush heads, comparing one month-aged current SB brush heads with the SB control (one and three months-aged) and the PC brush heads (three months-aged) in a standardized fashion. RESULTS: 1) FT-IR analysis revealed that the chemical composition of the current and control SB refill brush heads is identical. In terms of physical parameters, the current SB brush head has 12% more bristles and a slightly oval brush head compared to the round brush head of the SB control. 2) Wear Index analysis showed there was no difference in the one month-aged current SB brush head versus the one month-aged SB control (1.67 vs. 1.50, p = 0.65) or versus the three months-aged PC brush head (1.67 vs. 1.50, p = 0.65). The one month-aged current SB brush head demonstrated statistically significantly less wear than the three months-aged SB control (1.67 vs. 2.67, p = 0.01). 3) Analysis of cleaning efficacy shows that the one month-aged current SB brush head had improved cleaning performance over the one month-aged SB control brush head (p < 0.05), despite no statistically significant difference in wear. Both the one month-aged current and control SB brush heads showed statistically significantly lower cleaning performance compared to the three months-aged PC brush heads (p < 0.01). CONCLUSION: While the current SB brush head showed improved cleaning over the SB control, it demonstrated significantly lower durability and cleaning in comparison to the PC brush head. Dental professionals should be aware of these differences, both in durability and in cleaning performance, when recommending brush heads to their patients.