A comparative study of two powered toothbrushes and one manual toothbrush in young adults.

The aim of this 3-group, 3-treatment, single-blind, parallel group study was to evaluate and compare the efficacies of the Philips/Jordan HP735 powered toothbrush, the Braun/Oral-B D7 powered toothbrush, and the Oral-B Advantage B35 manual toothbrush in young adults (18-25 years). Full mouth mean (SD) modified Turesky Plaque Index (PI) and the Löe & Silness Gingival Index (GI) were recorded at baseline. After 24 hours abstinence from oral hygiene, the PI was recorded and each subject was given one of the test brushes with detailed instructions for use. Each subject then brushed under supervision for 90 seconds, during which time mean (SD) toothbrushing forces (TBF) were recorded. PIs were recorded immediately after brushing, and the subjects were then discharged for 6 weeks to use the allocated toothbrush at home. After 6 weeks, PI, GI and TBF were again recorded. There were no significant differences (ANOVA) for PI and GI between groups at baseline, or for PI following brushing at 24 hours. After 6 weeks, the powered brushes produced lower mean PI (SD) scores than the manual brushes, but the differences were significant only at interproximal sites. Mean GI scores for the HP735 group were similar at baseline and at 6 weeks, although for the other brushes the GI scores actually increased over this period. Mean (SD) TBF (grams/force) at baseline and 6 weeks, respectively, for the brushes were; HP735 233 (205), D7 159 (58), B35 279 (122) (p = 0.026): HP735 194 (86), D7 141 (57), B35 297 (113) (p = 0.0001). The within-group variability for the HP735 TBF reduced considerably over 6 weeks, which is possibly because of the click-force threshold feature of this brush.

A comparative study of the Philips HP 735, Braun/Oral B D7 and the Oral B 35 Advantage toothbrushes.

The aim of this 3-group, 3-treatment, single-blind, parallel group study was to evaluate and compare the efficacies of the Philips/Jordan HP 735 powered toothbrush, the Braun/Oral B D7 powered toothbrush and the Oral B Advantage B35 manual toothbrush in a cohort of 75 young adults (18-25 years). Following an appointment for screening, full mouth mean (+/-sd) modified Turesky plaque index (PI) and Löe & Silness gingival index (GI) were recorded at baseline. After 24 h abstinence from all oral hygiene measures, PI was recorded and each subject was given one of the test brushes with detailed instructions for use. The subject then brushed under supervision for 90 s, during which time mean (+/-sd) toothbrushing forces (TBF) were recorded. PI were recorded immediately after supervised brushing and the subjects were then discharged for 6 weeks to use the allocated toothbrush at home. After 6 weeks, PI, GI and TBF were again recorded. Comparisons between the brushing groups for all parameters, at baseline, 24 h and 6 weeks were tested using ANCOVA. There were no significant differences for PI and GI between groups at baseline, or for PI following supervised brushing at 24 h. After 6 weeks subjects using the powered brushes had lower mean PI (+/-sd) scores than those using manual brushes but the differences were significant only at interproximal sites; HP 735 1.44 (0.52), D7 1.44 (0.53), B35 1.75 (0.51) (p=0.05). At 6 weeks, mean (+/-sd) GI were; HP 735 1.49 (0.21), D7 1.61 (0.21), B35 1.64 (0.22) (p=0.033). Mean GI scores for the HP 735 group were similar at baseline and at 6 weeks although for the other brushes, the GI scores actually increased over this period. Mean (+/-sd) TBF (grammes/force) at baseline and 6 weeks respectively for the brushes were; HP 735 233 (205), D7 159 (58), B35 279 (122) (p=0.026): HP 735 194 (86), D7 141 (57), B35 297 (113) (p=0.0001). The within-group variability for the HP 735 TBF reduced considerably over 6 weeks, a likely consequence of the click-force threshold feature of this brush.

Toothbrushing forces in children with fixed orthodontic appliances.

The aim of this investigation was to determine whether toothbrushing forces are influenced by wearing fixed orthodontic appliances. Thirty children, (10 males, 20 females) with planned fixed appliance therapy and aged 10-15 years, were recruited to the study. No subject had previously worn an orthodontic appliance. At baseline, each subject brushed their teeth in their usual way, unsupervised. The toothbrush used was a purpose-designed electronic instrument that measured the force applied to the brush and transmitted force data by radio to a remote PC. After toothbrushing, subjects had orthodontic brackets fitted. Toothbrushing was repeated at 2 and 14 weeks after baseline, and brushing forces recorded. There were no significant differences between the measurements made at baseline and those made at 2 and 14 weeks. There were no differences between males and females in the forces used at any time point. It was concluded that toothbrushing forces are unaffected by placing fixed orthodontic appliances in children. The brushing forces recorded were comparable with those previously found by other investigators.

Flossing behaviour in English adolescents.

The aim of this study was to investigate the relation between flossing behaviour and other health, cleanliness and social behaviours in adolescents. Data from a survey of 41142, 12-16-year-old children from 244 secondary schools throughout England were analysed to obtain information about flossing frequency, dental attendance and recalled advice about flossing, and some general cleanliness and social behaviours. Subjects completed a questionnaire, anonymously, in class during normal school hours. Flossing frequency was found to change with age, its use becoming less frequent from age 12 through age 16 years. There was a significant relationship between flossing frequency and the time since the last dental attendance, the more recent attenders flossing more frequently. 6% of subjects recalled receiving advice about flossing at their last dental attendance and higher proportions of those who used floss recalled such advice, compared with non-flossers. Flossing frequency was also found to correlate positively with frequencies of washing hands after visiting the lavatory and bathing, and having a current friend of the opposite gender. There was only a small association between smoking habit and flossing, and only in school years 8 and 10: subjects most committed to smoking used floss slightly more frequently than those who did not smoke. Factor analysis showed evidence of gender differences in perceptions of flossing. Males equated use of floss with health-related behaviours while females associated flossing more with cleanliness behaviours. This finding is consistent with gender differences in toothbrushing behaviour reported in previous studies. The present study provides further insights into the history of dental flossing.

Self-concept and dental health behaviours in adolescents.

The purpose of this investigation was to examine the relation between some dental health behaviours and 2 measures of self-concept in adolescents. Data from a survey of 41142, 12-16-year-old children from 244 secondary schools throughout England were analysed to obtain information about their frequencies of toothbrushing, use of dental floss and dental attendance, and whether they recalled advice about toothbrushing, in relation to self-esteem and health locus of control (HLOC). Subjects completed a questionnaire, anonymously, in school class. The results showed a significant positive correlation (Spearman) between the frequencies of flossing and toothbrushing, in both sexes, and between social group and toothbrushing frequency, where brushing frequency increased as socio-economic status improved. Some association between use of floss and social group emerged, but this was smaller and less consistent than that observed with toothbrushing brushing frequency. Self-esteem was positively correlated with toothbrushing frequency at ages 12-15 years, while HLOC showed correlations at some ages but not others. Use of dental floss showed no relation to self-concept. Subjects with more favourable self-concept were more likely to make more frequent dental visits than those with a poorer self-view. There was a strong and consistent correlation between recalled advice about toothbrushing and lower self- esteem and external locus of control. The results are in agreement with our earlier reports and suggest that self-concept may play a significant role in mediating changes in dental health behaviour.

Motivation for dental hygiene in adolescents.

The aim of this study was to investigate the relation between some 'lifestyle' factors and motivation for toothbrushing in young people. Data from a questionnaire survey of 7770 children aged 14-15 years were analysed to obtain information about their main reason for toothbrushing, their toothbrushing frequency, smoking behaviour and social efficacy. In those who brushed their teeth less frequently, toothbrushing was performed more for cosmetic reasons, that is, having teeth that look and feel good and breath that smells fresh, in contrast to the avoidance of toothache and false teeth, which are health reasons. The more socially advantaged individuals were more inclined to brush their teeth to avoid toothache, and less for the sake of good appearance, compared with the more disadvantaged. Motivation for toothbrushing varied significantly with smoking behaviour, committed smokers were more inclined to brush for cosmetic reasons whereas those who had never smoked were more concerned to avoid dental problems. Similarly, those who had a current friend of opposite sex, and in males, those expressing confidence when meeting members of the opposite sex, brushed more for cosmetic reasons. In conclusion, different people perform their dental hygiene for quite different reasons. These findings need to be taken into account when instructing patients in personal dental care and formulating dental health messages.

Toothbrushing schedule, motivation and 'lifestyle' behaviours in 7,770 young adolescents.

Data from a survey of 7,770 14-15-year-old children from 131 secondary schools throughout England were analysed to obtain information about the times of day they brushed their teeth, their motivation for toothbrushing, and some 'lifestyle' variables. In the 19 per cent of respondents who reported brushing their teeth once per day, 75 per cent did so in the morning before school; only 23 per cent reported brushing before going to bed at night. In this group there was a marked association between reported readership of broadsheet newspapers and reported time of brushing in the daily schedule. As reported newspaper readership changed towards the popular tabloids, the proportion of subjects who reported brushing only in the morning increased. Almost all those who claimed to brush two or three times per day reported brushing before bed. There were systematic differences in motivation for toothbrushing: those who reported brushing only once per day appeared to be motivated more by social reasons than by preventive dental health reasons. Among other factors, toothbrushing appeared to be influenced by getting up time, breakfast, and time of going to bed. The results demonstrate that toothbrushing habits are strongly influenced by an individual's lifestyle and social behaviour. Dental health advice needs to take into account this broad pattern of background factors.

Efficacy of dental health advice as an aid to reducing cigarette smoking.

Ninety-eight cigarette smokers attending the Newcastle upon Tyne Dental Hospital, wishing to reduce their tobacco consumption, received smoking reduction advice in combination with dental health instruction and periodontal care. Those advised against smoking showed a greater reduction (P < 0.001) in reported cigarette consumption during treatment and follow-up, compared with 38 control subjects who received dental health instruction but no advice against smoking. Fifty percent of intervention subjects reported reducing to half or less than half of their initial cigarette consumption, compared with 24% for controls. Eighty percent of those advised against smoking reported some reduction, against 29% for controls. The reported smoking cessation rate in the intervention group was 13.3%, compared with 5.3% in the control subjects. The results indicate that advice against smoking combined with dental health instruction and periodontal care can be an effective aid to reducing tobacco consumption.

Differential prediction of dental health behaviour by self-esteem and health locus of control in young adolescents.

A survey of 7770 schoolchildren, aged 14-15 years, from 131 secondary schools in England, was made in 1990 to obtain information about toothbrushing frequency, motivation for mouth care, frequency of dental visits, self-esteem and health locus of control (HLOC). The aim of the study was to compare self-esteem and HLOC as predictors of dental health behaviour. Subjects completed a questionnaire, anonymously, in class during normal school hours. The results showed significant associations (chi 2 test) between the 3 dental variables and self-esteem, in both sexes. Toothbrushing frequency and the proportions of subjects brushing to make their teeth feel clean increased with increasing self-esteem; recent and distant visits to the dentist were associated with low self-esteem. Only toothbrushing frequency showed any significant variation with HLOC. In males, this association showed more frequent toothbrushing with more internal HLOC, but in females, no consistent pattern emerged. HLOC scores showed markedly less correlation (Spearman) with frequencies of toothbrushing and dental visits compared with self-esteem scores. Significant positive correlations were observed between toothbrushing frequency and self-esteem in both sexes, and frequency of dental visits in males, but not in females. HLOC showed a significant positive correlation only with toothbrushing frequency in males. The correlation between toothbrushing frequency and self-esteem was significantly greater than that between brushing frequency and HLOC, in both sexes. The results suggest that self-esteem, which is a general construct, may have more potential for predicting dental health behaviour than the more specific health-related measure HLOC.

The immediate effects of smoking on gingival fluid flow.

The aim of the present study was to examine the immediate effect of smoking a cigarette on gingival crevice fluid (GCF) flow-rate. The study involved 17 healthy volunteers (6 male, 11 female) aged 19-57 years (mean 34.5 years) who regularly smoked cigarettes. All were periodontally healthy. GCF was collected at the mesio-buccal aspects of the right and left maxillary 2nd premolar teeth, using filter-paper strips left in place for 3 min. Samples were taken at baseline and subsequently at 10 min intervals for 70 min. Each subject sham smoked an unlit standard cigarette for 7 min after the 20 min recording, and smoked the same cigarette for 7 min to within 1 cm of the filter, following the 40 min recording. The results showed that following sham smoking (30 min recording) GCF volume increased by a mean of 16.7% (p = 0.057), and following smoking (50 min recording) GCF volume increased by a mean of 89.7%, over the previous recording (p < 0.0001). The increase following smoking was greater than that following sham smoking (p < 0.0001). Flow-rate returned to near resting levels within the experimental period. The results indicate that smoking produces a marked transient increase in GCF flow-rate, which might reflect changes in blood flow known to be produced by nicotine.

Self-esteem as a predictor of toothbrushing behaviour in young adolescents.

A survey of 4075 14-year-old children from secondary schools throughout England was made to obtain information about toothbrushing frequency, motivation for mouth care, and self-esteem. Subjects completed a questionnaire, anonymously, in class. Toothbrushing frequency was found to increase significantly with increasing self-esteem in males (P less than 0.0001) and females (P less than 0.05). However, there was no consistent variation with self-esteem in those brushing 3 or more times per day, in either sex. There was a significant variation in the main reason given for mouth care between the sexes (P less than 0.0001); proportionately more females (67%) than males (57%) gave cleanliness or cosmetic effect as the principal reason for mouth care. A variation was observed in the mean reason given for mouth care with self-esteem in females (P less than 0.05), but not in males. However, in both sexes, as self-esteem improved, there was a consistent increase in the proportions of individuals who brushed their teeth to make them feel clean. These findings suggest there may be a positive relationship between self-esteem and toothbrushing behaviour and motivation for mouth care in adolescents.

Effects of smoking on oral ecology. A review of the literature.

The smoking habit is associated with a variety of deleterious changes in the mouth. In this review, the toxicology of tobacco smoke and its effects on the saliva, oral commensal bacteria and fungi, and oral polymorphonuclear leukocytes, are described. Smoking increases salivary flow rate, but does not alter the composition of plaque or its rate of deposition. Smoking appears to enhance anaerobiosis in the oral cavity, and depress the activity of oral leukocytes. Additionally, tobacco smoke components may have a selective toxic effect on particular species of microbiota. Gingival fluid exudate is reduced in smokers, with the consequence that the carriage of leukocytes and immunoglobulins is likely to be diminished.

Bedtimes and family size in English schoolchildren.

Data from a survey of 3727 14-year-old children from 31 secondary schools in England in 1984-85 were analysed to obtain information about bedtimes and sleep duration in relation to the number of children in the family. Subjects completed a questionnaire, anonymously, in class. The modal bedtime was 22 30 and the modal time spent in bed was 9 h. Males went to bed later than females (P less than 0.05) but there was no significant difference between the sexes in the time they spent in bed. As the number of siblings increased bedtimes became later (P less than 0.05) and the time spent in bed markedly decreased (P less than 0.001). These results suggest that young adolescents from large families (4 or more children) may be more at risk from inadequate sleep than those in smaller families.

The effect of smoking on immediate post-extraction socket filling with blood and on the incidence of painful socket.

The effect of habitual smoking on post-extraction socket filling with blood and on the incidence of painful socket, was investigated. Data were collected from 2417 adult dental out-patients in whom 3541 extractions were performed under local anaesthesia. Post-operative socket filling with blood was significantly reduced in smokers, compared with non-smokers (p less than 0.01). There was a higher incidence of painful socket in heavy smokers (20 or more cigarettes per day), compared with nonsmokers (p less than 0.05). There was a significant relationship between immediate post-extraction socket blood level and the incidence of painful socket; sockets which showed poorer filling were more likely to develop painful socket (p less than 0.02). Smoking appeared to have an adverse effect upon the healing of extraction wounds.