New studies on estimated and actual toothbrushing times and dentifrice use.

Toothbrushing is the most widely recommended and practiced method of dental home care. While there is considerable information available in the literature on the time spent brushing the teeth, there is minimal information relating actual brushing time with the time patients estimate they normally brush. This paper reports in detail a study conducted in Switzerland in the 1980's, and supplements this information using the same protocol with two different Swiss populations conducted in the 1990's. In the early Swiss study, on volunteers registering at a dental clinic, the mean actual toothbrushing time was approximately 68 seconds. In the two recent studies, conducted with Swiss army soldiers or three groups of inhabitants in a town near Zurich, the actual toothbrushing means were 83.5 and 72.8 seconds, respectively. In the three studies conducted, the time subjects estimated they had brushed ranged between 134.1 to 148.1 seconds. In all studies, the difference between actual and estimated times was significantly different (p < 0.01). The amount of toothpaste used during toothbrushing was evaluated in two of the studies. In both evaluations, the amount of dentifrice used was approximately 1 gram. Dental professionals should be aware that there is a consistent difference in the time that patients believe they brush, and the time they actually spend brushing.

Impact of improved toothbrushes on dental diseases. I.

This review consists of a short history of toothbrush efficacy trials plus recent literature on test methods of newer brush designs. Effects of handle size, bristle trim arrangement and size, brush head design, and brushing methods are considered. Methods for detecting and measuring plaque, particularly on critical surfaces, are reviewed, as are the influence of brushing time, method, and exerted force. Testing protocols, including plaque indices, tooth selection, and subject compliance, can produce large differences in results. Testing conditions must be carefully selected and controlled to obtain reproducible results.

Impact of improved toothbrushes on dental diseases. II.

The new generation of manual and powered toothbrushes that have been tested in recent years exhibit better plaque removal than do older brushes. Differences are most significant when individuals have been instructed in proper brushing technique. Comparisons of powered and manual brushes show the clear superiority of newer powered brushes, but there is no such effect with older powered brushes, which stop when force is applied. Newer powered brushes reduce gingivitis and gingival abrasions. In a limited 18-month trial, a powered oscillating toothbrush improved existing periodontal conditions, thus effecting a considerable savings in treatment costs. At present, under optimal conditions, improved designs of both manual and powered toothbrushes, which do not stop or break down in use, produce more significant plaque removal in critical sites. Long-term trials are needed to confirm these results.

A Review of Laboratory Methods to Determine Toothbrush Safety and Efficacy.

Laboratory toothbrush evaluations have focused on three primary areas: hardness, efficacy and end-rounding. There is an accepted ISO standard for toothbrush texture, to categorize products from extra soft to extra firm. New toothbrush designs, with changes in bristle tufting, alignments, and lengths, yield reproducible results in the ISO procedure. New research has focused on a mathematical model that predicts stiffness, which overestimates in the 25-30% range. Efficacy testing has focused on the ability of toothbrush bristles to achieve interproximal penetration or access between and around artificial teeth or simulated tooth models. The majority of methods reviewed use "cleaning" or removal of deposited materials adherent to dentoform teeth. One test procedure uses deposition of ink from toothbrush bristles onto dentoform tooth surfaces. Many different approaches have been used over the years to evaluate efficacy. One method used since 1979 in several laboratories, and 3 methods developed in 1993 and 1994 are compared in detail for similarities and differences in testing performance criteria. Two of these procedures have been predictive of clinical plaque removal efficacy testing. Lack of bristle end-rounding was recognized in the 1930s and was related to gingival tissue damage. A revival of interest in end-rounding has occurred since the mid-80s using SEM and definitions and drawings of acceptable endings. The primary use of the new procedure has been to determine the % of acceptable and/or highest degree of end-roundness for the various toothbrush brands studied. No clinical gingival safety studies have been located related to these new laboratory end-rounded methods.

The effect of two toothpastes on plaque and gingival inflamation.

In this study on 60 adult subjects, the effective of Parodontax, a dentifrice containing herbal ingredients and sodium bicarbonate abrasive, was compared to a non-marketed new toothpaste containing herbal ingredients and calcium hydrogen phosphate as the abrasive. Plaque, gingivitis and gingival bleeding parameters were scored. The periodontal probe bleeding index of Ainamo and Bay was modified to score slight and moderate bleeding. In this first four-week period all subjects used the new toothpaste. After this period the new toothpaste produced a significant decrease (p<0.01) in gingivitis and bleeding on probing, but no effect on plaque was observed. During the second period of eight weeks the subjects were randomly divided into two groups, one using Parodontax and the other group continuing with the new toothpaste. The study design was a double-blind procedure. At the end of the 12-week study period the plaque index showed no changes in both groups. The gingivitis and bleeding indices decreased significantly (p<0.001) by 40% in both groups compared to the baseline examination.

Effects of blunt scaling on periodontal status and subgingival microorganisms. A pilot study.

Clinical and microbiological effects of 3 periodontal treatments were investigated: (i) scaling and root planing with sharp instruments combined with pocket flushing, (ii) scaling with blunt plastic curettes and pocket flushing, and (iii) pocket flushing alone. Clinically comparable, randomized sites of 8 patients with progressive adult periodontitis were treated 4 times in intervals of approximately 4 months. Prior to each re-treatment and at the end of the study all sites were clinically monitored and the subgingival microflora was examined. Results showed that all treatments were effective in reducing pocket depths and the subgingival microflora, while attachment levels remained unchanged. At individual sites treatment responses were of considerable heterogeneity. In general, clinically improving sites had strongly reduced and sites loosing > or = 3 mm of attachment high residual bacterial cell numbers. Sites with intermediate residual subgingival plaque levels showed quite variable clinical responses. This preliminary study suggests that weakly abrasive procedures could be very valuable for the initial treatment of periodontal lesions. This hypothesis should be further tested in comprehensive clinical trials.

Periodontal conditions in Swiss Army recruits.

The purpose of the present study was to assess the oral hygiene and periodontal conditions of a young male population representative for Switzerland. 757 Swiss Army recruits were examined for their oral health status including the assessment of Plaque Index (PlI), Retention Index (RI) and Sulcus Bleeding Index (SBI) as well as Probing Depth (PD) and Loss of Probing Attachment (LA). All the teeth of the right maxillary and mandibular dental arch were evaluated on four aspects. One recruit yielded a status of juvenile periodontitis and was excluded from further analysis. 2.3% of the teeth had been lost, mainly as a result of orthodontic therapy. Mean PlI and SBI for all 756 recruits approximated 0.6, while the mean RI was around 0.1. The mean PD was 2.3 mm, and the mean LA of 0.9 mm was measured. PD and LA were slightly higher on proximal than on buccal or oral aspects. Site specific analysis for all parameters are presented. Since only 0.4% of the recruits showed probing depths of greater than or equal to 5 mm and only 1% of the subjects showed LA greater than or equal to 4 mm on any surfaces it may be concluded that severe signs of chronic adult periodontitis are absent in 99% of young male Swiss citizens.

[Conventional surgical furcation therapy. Closed and open scaling]. / Konventionelle chirurgische Furkationstherapie. Geschlossenes und offenes Scaling.

Epidemiological studies in the sixties indicated that in patients older than 45 years periodontal disease was the major cause of tooth-loss, particularly in molars. However, improved prevention and enhanced dental awareness have now reduced both the incidence of periodontal disease and tooth-loss. Unfortunately, periodontal disease and tooth-loss still progress rapidly in a small group of patients. The currently used diagnostic parameters do not allow the early identification of this small group. Despite controlled periodontal treatment, loss of molars has remained twice as high as overall tooth loss. When all patients are divided into different perio-subgroups, molar loss tends to identify patients with a high periodontal risk. This conclusion can be drawn from the fact that furcation treatment is usually clinically successful, although calculus removal is insufficient. Early diagnosis of molar furcation involvement may help identify the small group of patients in which periodontitis may develop. The local morphological patterns may also contribute to rapid progression of the disease resulting eventually in loss of the molars. In such cases resective therapy is proposed instead of the usual open or closed scaling procedures.

[Periodontal diseases]. / Parodontale Erkrankungen.

Research into pathogenesis and therapy of periodontal diseases have advanced considerably over the last 15 years. Basic research has disclosed anatomic and morphologic "weak spots" in the periodontium at the marginal gingiva and the interdental space. Approximately 70 microorganisms were isolated, among them many gram negative anaerobic bacteria. Products of these bacteria comprise of enzymes which destroy the periodontal connective tissue and interfere with immunologic mechanisms. Based on this knowledge several diseases are differentiated. A correct diagnosis contributes to a favorable therapy, such that the common periodontitis of adults (PA) responds well to treatment and the other periodontitis-forms are amenable to stabilisation if the patient cooperates. For the general practitioner the particular risks are elucidated. Already an examination for periodontitis and more so local treatment induces a bacteremia in every patient. Dentists and referring physicians should envisage preventive measures in patients at risk.

[Fluoride retention and clearance after rinsing with fluoridated mouthwashes]. / Fluoridretention und-clearence nach Spülungen mit fluoridierten Mundwässern.

Oral fluoride clearance and oral fluoride retention were studied in 12 adult volunteers. 5 different mouthrinses were used. The test agents, in part available on the market, includes two Candida mouthrinses containing 1508 and 330 ppm F, respectively, Act containing 308 ppm F, a zinc fluoride-hexetidine (ZH) combination containing 287 ppm F, and an amine fluoride 297/SnF2 (AmF/SnF2) combination containing 241 ppm F. The volunteers rinsed with 10 ml of the above solutions for 30 s each. The oral fluoride concentration was reduced to 1 ppm 99 min after rinsing with Candida original. With the AmF/SnF2 solution, the oral fluoride concentration remained above 1 ppm for 39 min, and for about 20 min after rinsing with Candida reduced, ZH and Act. With both Candida original and ZH significant fluoride levels in the oral fluid were still found after 3 h, while with AmF/SnF2 and Act significant fluoride levels lasted for 2 h. A specific clearance value was determined for each mouthrinse, reflecting the ability of the agent to remain attached to the oral structures. The AmF/SnF2-rinse had a rapid clearance value. About 9 to 17% of the fluoride brought into the oral cavity were not expectorated. For the mouthrinses containing 0.05% NaF the retention was about 0.4 mg F. This value is considered to be harmless. Mouthrinses used after the application of a monofluorophosphate-dentifrice helped to increase the relatively low oral fluid fluoride level. Rinsing with the test agents after brushing with the amine fluoride dentifrice (Elmex) produced no significantly increased fluoride levels. In-between meals eliminated the oral fluoride concentration rapidly.