A review of the clinical efficacy of the Oral-B oscillating/rotating power toothbrush and the Philips Sonicare toothbrush in normal subject populations.

Plaque removal by a toothbrush results from a physical scrubbing of bristles on the tooth surface that removes adherent plaque bacteria. Because of the frequency of brush head motion, some power toothbrushes generally remove plaque more effectively than a manual brush. One power toothbrush, Philips Sonicare, claims also to remove plaque as a result of dynamic fluid activity. This effect has been shown in laboratory studies but clinical evidence is currently lacking. This review evaluated the data from well-controlled clinical studies carried out in normal subjects from a general population comparing the Sonicare toothbrushes with the Oral-B oscillating/rotating power toothbrush technology. It focuses on plaque removal from approximal surfaces where it is difficult for toothbrush bristles to reach, as it is here that any dynamic fluid effect should be most apparent. Results from the review found no evidence to support a greater efficacy for the Sonicare toothbrushes either generally or at approximal surfaces. Data revealed that the oscillating/rotating toothbrush was more effective than the Sonicare toothbrushes with respect to plaque removal. It is possible that factors associated with the clinical situation such as damping resulting from bristle contact with the tooth surface and the high viscosity of saliva and dentifrice may counteract dynamic fluid activity in vivo. This review indicates that dynamic fluid activity beyond the reach of bristles as demonstrated in the laboratory is yet unproven in the clinical situation.

A practice-based study of a power toothbrush: assessment of effectiveness and acceptance.

BACKGROUND: The greater effectiveness of the power toothbrush compared with a manual toothbrush is well-documented. Despite this, acceptance by dental professionals is still low. METHODS: This general practice study evaluated the effectiveness of a power toothbrush (Braun Oral-B Ultra Plaque Remover, Braun GmbH) in 16,903 patients, based on the clinical opinions of dental professionals in regard to patients' changing oral health status. In addition, a survey assessed the attitudes of dental professionals and patients toward the power toothbrush. RESULTS: The power toothbrush was considered by dental professionals to have had a positive effect on the oral health of 80.5 percent of their patients; the noticeable benefits with respect to a number of clinical criteria included plaque removal and improved gingival condition. Most patients in the study (88.9 percent) reported that they would continue using the power toothbrush once the study was completed. At the end of the study, many more dentists and hygienists considered the power toothbrush to be the most effective way of brushing, and almost 70 percent said that they would now be more likely to recommend a power toothbrush to their patients. CONCLUSIONS: The power toothbrush improved the oral health of patients in this practice-based study, and the number of dental professionals who said they would recommend a power toothbrush increased markedly during the study. CLINICAL IMPLICATIONS: Enabling dental professionals to evaluate the effect of a power toothbrush reinforces the findings from controlled clinical studies and increases their awareness of its potential to improve oral hygiene.

Electric toothbrush use. Attitudes and experience among dental practitioners in Germany.

PURPOSE: To evaluate the attitudes and experience of electric toothbrush use among dental practitioners in Germany. MATERIALS AND METHODS: A telephone survey of 399 dentists was conducted. RESULTS: Many dentists in Germany (41%) thought that between half and 70% of their patients do not clean their teeth correctly, and that this is the result of either poor brushing technique or insufficient brushing time coupled with insufficient visits to the dentist. Most dentists surveyed (61%) would recommend an electric toothbrush to their patients in order to improve oral hygiene control, and of these, 82% would recommend the Braun Oral-B Plaque Remover. When these dentists were asked if there had been any change in tooth and gum condition among those patients who switched from using a manual toothbrush to the Braun Oral-B Plaque Remover, 73% said that they had observed an improvement. None of the dentists interviewed had noted any deterioration. These views of German dentists are in agreement with laboratory and clinical studies that have shown an advantage for the Braun Oral-B Plaque Remover over a manual toothbrush. The results indicate that clinical trial results are a relevant way of assessing toothbrush performance, and that results may be extrapolated to normal home use.

An overview of established interdental cleaning methods.

The removal of interproximal plaque is considered to be important for the maintenance of gingival health, prevention of periodontal disease and the reduction of caries. Unfortunately, the toothbrush is relatively ineffective at removing interproximal plaque, and therefore patients need to resort to additional techniques. Floss, woodsticks, rubber tips and interdental brushes currently represent the primary methods available for interproximal cleaning. No one method suits all patients and it is difficult for any of these methods to access the posterior dentition. Floss is the most widely used method of interdental cleaning and the American Dental Association reports that up to 80% of interdental plaque may be removed by this method, resulting in a significantly reduced incidence of caries and prevention of periodontal disease. The main problem with all interdental cleaning is, however, patient ability and motivation. Patients are known to find flossing difficult, especially where there are tight contact points, and therefore interdental cleaning does not readily become an established part of daily oral hygiene. As such, there is a need for new techniques/devices to be developed that will make interdental cleaning easier and improve patient motivation. Results of clinical and laboratory studies have indicated that the Braun Oral-B Interclean (ID2) is a safe and effective device for the reduction of interproximal plaque and the control of gingivitis. In addition, the ID2 was preferred by the majority of volunteers to conventional floss.

An evaluation of renal function in workers occupationally exposed to mercury vapour.

The renal function of a population of workers occupationally exposed to mercury in the chlor-alkali industry has been examined and compared to that of a population of workers with no occupational exposure to mercury. Measurement of specific urinary proteins and enzymes have been carried out on each individual on three separate occasions and have been complemented by blood plasma measurements at the final visit. Under the conditions of exposure to mercury sustained in this study, there is no evidence of an increased prevalence of renal dysfunction as indicated by enzyme and protein measurements. The urinary concentration of the low molecular weight protein, beta 2-microglobulin, is significantly lower in the mercury-exposed group than in the control group. In contrast to recently published literature, no relationship is seen between urinary mercury concentration and the appearance of high molecular weight protein in urine. A small increase in the prevalence of higher activities of the urinary enzyme N-acetyl-beta-glucosaminidase and gamma glutamyl transferase is observed when the urinary mercury concentration exceeds 100 micrograms/g creatinine. A small increase in the prevalence of raised urinary N-acetyl-beta-glucosaminidase activity is observed when the duration of exposure to mercury exceeds ten years. The pattern of proteinuria has been characterised in a total of sixteen individuals from both populations; a low molecular weight proteinuria is seen in three individuals from the control group whilst a high molecular weight proteinuria is seen in the remainder (seven in the control and six in the mercury group).

The use of beta-thromboglobulin to detect platelet damage by therapeutic ultrasound in vivo.

Three sequential blood samples were drawn from arms of adult human volunteers by means of a cannula technique, and the plasma levels of beta-thromboglobulin (beta-TG an index of platelet damage) were measured. Ultrasound (0.75 MHz, continuous wave; spatially averaged intensity 0.34 to 0.5 W/cm-2) was applied to the blood vessels while the second sample of each series was being taken. No elevation of beta-TG was detected, indicating that under these conditions ultrasonic irradiation had not damaged an appreciable number of platelets. There was, however, an indication of decreased platelet sensitivity following insonation; and it is postulated that this may be the result of either increased production or secretion of the potent endothelial platelet inhibitor, prostacyclin, or both.

Release of beta-thromboglobulin from human platelets by therapeutic intensities of ultrasound.

The effects of therapeutic intensities of ultrasound on human platelets in whole blood were investigated by monitoring the release of the platelet specific protein beta-thromboglobulin (beta-TG). More beta-TG was released as the intensity of the ultrasound was increased and also as the driving frequency was decreased from 3.0 to 0.75 MHz. Some beta-TG was released at spatially-averaged intensities as low as 0.6 W/cm2 at 0.75 MHz, a value significantly lower than that observed for the onset of aggregation of platelet rich plasma (obtained from the same volunteer) in the same exposure system. Liberation of beta-TG by ultrasound was diminished but not abolished in the presence of inhibitors which rendered the platelets functionally inert. Our data suggests that beta-TG is liberated in two ways, firstly as a result of platelet disruption by cavitation, and subsequently by potent aggregating agents, liberated in parallel with beta-TG, inducing the physiological release reaction in adjacent platelets. The low therapeutic intensities and short exposure times (30 s or less) necessary to liberate beta-TG from normal human platelets in vitro, suggests that patients with abnormally sensitive platelets and/or 'hypercoagulable state' could be at risk if subjected to high therapeutic intensities of ultrasound.

The investigation of collagen induced platelet aggregation by the screen filtration pressure technique.

A modification of the screen filtration pressure technique has been developed to allow platelet response to collagen to be measured. Using a commercial collagen suspension this method has been found to be both simple to perform and to give highly reproducible results. Changes in platelet response to collagen after administration of acetylsalicyclic acid were clearly detected and this suggests that collagen screen filtration pressure may provide a sensitive method for evaluating the effect of platelet release inhibiting drugs.

The role of membrane bound complement in the aggregation of mammalian platelets by collagen.

Platelets from dogs decomplemented with purified Cobra Venom Factor (CVF) lose the ability to aggregate in response to collagen stimulation. In vitro in man, dog and rabbit, and in vivo in the dog, CVF abolishes the collagen response of platelets, the effect being dose-related. Resuspension of CVF inactivated platelets in plasma containing complement resulted in a total return of sensitivity to collagen. Examination of CVF inactivated platelets with the electron microscope failed to show any marked difference from control platelets. Serotonin granules were still present and the platelets retained a discoid appearance. Incubation of platelets with antibodies to C1, C3 and C5 resulted in inhibition of the collagen response: this effect was dose-related. Light microscopy indicated that DVF does not affect the adhesion of platelets to collagen but appears to prevent subsequent aggregation. It is suggested that the complement system is involved in the induction of the platelet release reaction by collagen, and that inhibition by CVF and anticomplement antibodies is the result of a blocking of the release reaction.