N.A.M. Rosema

The efficacy of manual toothbrushes following a brushing exercise: a systematic review: How effective are manual toothbrushes?

AIM To determine the efficacy of manual tooth brushing with respect to toothbrush design and brushing duration. MATERIAL AND METHODS The PubMed-MEDLINE and Cochrane CENTRAL were searched through October 2010 to identify appropriate studies. The outcome measurement was dental plaque removal following subject brushing. RESULTS The search yielded 2119 titles and abstracts. Ultimately, 59 papers with 212 brushing exercises as separate legs of the experiments and meeting the eligibility criteria were selected. Overall, a brushing exercise provides a 42% (21) plaque score reduction (95% CI: 41.23; 42.03). Of the brushing studies providing data as assessed according to the Quigley and Hein plaque index, the weighted mean reduction from baseline in plaque scores was 30% (95% CI: 26.79; 33.21). A weighted mean plaque score reduction of 53% (95% CI: 49.51; 56.49) was observed in the experiments using the Navy plaque index. Subanalysis between the different bristle tuft configurations illustrated variation in plaque removal ability (24-61%). The angled bristle design numerically showed the highest mean plaque reduction with either index. A subanalysis of brushing duration revealed after 1 min, a mean reduction of 27% and after 2 min, 41%. CONCLUSION The efficacy in plaque removal following a brushing exercise is a reduction from baseline plaque scores of 42% on average, with a variation of 30-53% dependent on the plaque index used. The available evidence indicates that bristle tuft arrangement (flat trim, multilevel, angled) and brushing duration are factors that contribute to the variation in observed efficacy.

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.

Evaluation of two soft manual toothbrushes with different filament designs in relation to gingival abrasion and plaque removing efficacy

OBJECTIVES To evaluate the effect of two soft manual toothbrushes with different filament and brush head designs in relation to gingival abrasion and plaque removing efficacy to the in relation flat trimmed manual reference toothbrush of the American Dental Association (ADA). METHODS The study had a randomized single use cross-over model (n = 76) with three sessions whereby all brushes were used by each subject. Subjects were asked to abstain from all oral hygiene procedures for 48 h. They brushed according to split-mouth design. Pre- and post-brushing plaque and gingival abrasion were assessed. RESULTS The Sensodyne Sensitive (SENS) was more abrasive than the ADA (P < 0.001) while the Oral-B Sensitive Advantage (OBSA) was less abrasive than the SENS (P < 0.001). There was no statistically significant difference between the OBSA and the ADA (P = 0.319). All three brushes showed statistically significant reductions (49-56%) in plaque versus baseline. Compared to the ADA and the SENS, the OBSA had a smaller percentage of plaque removal (56% versus 49%, P <or= 0.001; and 50% versus 52%, P = 0.028). CONCLUSIONS The present study which compared two soft toothbrushes showed that the OBSA caused less gingival abrasion compared to the SENS-brush with a marginal loss (2%) of efficacy.

Effects of sugar-free chewing gum sweetened with xylitol or maltitol on the development of gingivitis and plaque: a randomized clinical trial

OBJECTIVE The objective of this study was to test the effect of sugar-free chewing gum sweetened with xylitol or maltitol compared to the use of a gum base or no gum on gingivitis and plaque scores under both brushing and non-brushing circumstances. METHODS The design of the study was a four-group, double-blinded, randomized controlled study with a 3-week duration. In each group, the participants did not brush the teeth in the lower jaw designated to develop experimental gingivitis, while maintaining normal oral hygiene procedures in the upper jaw. After professional dental prophylaxis, the participants were allocated into one of four groups (xylitol, maltitol, gum base or no gum). Chewing gum was used five times a day for 10 min. RESULTS 220 participants completed the study and provided evaluable data. The increase in bleeding on marginal probing (BOMP) and plaque scores (PS) in the non-brushed (lower) jaw with experimental gingivitis was significant in all groups (P < 0.001). As compared to the gum base, the increase in BOMP in the xylitol and maltitol group was significantly lower. In the brushed upper jaw, no significant changes for BOMP were observed from the baseline to the end point of the study, and there were no significant differences in BOMP and PS between the groups. CONCLUSION In circumstances where regular brushing is performed, no effect of chewing gum was observed on bleeding and plaque scores. In the absence of brushing, chewing xylitol or maltitol gum provided a significant inhibitory effect on gingivitis scores compared to chewing gum base. The difference when compared to the group not using gum was not significant.

Gingivitis and plaque scores of 8- to 11-year-old Burmese children following participation in a 2-year school-based toothbrushing programme

AIM The present study assessed whether gingivitis and plaque scores of 8- to 11-year-old school children who participated in a SBTB programme for 2 years were lower than those of children who did not participate in the programme. MATERIAL AND METHODS The present study was performed using an examiner-blind, parallel group design and was performed in Burma (Myanmar) in 2006. Three of the five schools where daily SBTB programmes took place after lunch and which were performed under teacher supervision were randomly selected; three non-participating schools (non-SBTB) from the same area were assigned as controls. Twenty-five children per school were examined for gingivitis (bleeding on marginal probing) and plaque (Quigley & Hein). RESULTS In total, 150 8- to 11-year-old children participated, with 75 children in either group. The test group (SBTB) exhibited an overall mean bleeding score of 0.76. For the control group (non-SBTB), this score was 0.83. With respect to the overall mean plaque scores, the test group exhibited a score of 2.93, whereas the control group exhibited a score of 2.91. No statistically significant differences between the test and the control group were observed. CONCLUSION The present study did not reveal a statistically significant effect of daily SBTB programmes in 8- to 11-year-old school children with respect to gingivitis and plaque scores.

Parotid gland swelling following mouthrinse use

BACKGROUND Unilateral or bilateral swelling of the parotid gland is a reported side effect of rinsing the mouth with chlorhexidine. Although the incidence rate is extremely low, there have been several case reports on this topic and the authors of these reports have suggested several explanations for the mechanism of this complication. METHODS In this report, two cases of parotid gland swelling are discussed. Both patients developed unilateral parotid swelling following the use of a mouthwash, case 1 after using a chlorhexidine mouthwash following flap surgery and case 2 after using a hexetidine mouthwash in an approved clinical trial that was testing different mouthwashes. RESULTS In both of the cases, differential diagnoses were made to explain the cause of the parotid swelling. However, discontinuing use of the product resulted in an eventual complete resolution of symptoms in both patients. CONCLUSIONS Swelling of the parotid gland following use of a mouthwash has previously been reported, although previous reports found this side effect only in patients who used chlorhexidine mouthwashes. This complication has therefore been informally linked to chlorhexidine. The present case report questions this hypothesis and suggests that parotid gland swelling may not be related to the type of mouthwash used, but may instead be a consequence of the rinsing action itself.

The influence of a hydrogen peroxide and glycerol containing mouthrinse on plaque accumulation: a 3-day non-brushing model

AIM To evaluate the inhibition of plaque growth by an experimental mouthrinse (BioXyl) based on hydrogen peroxide/glycerol. DESIGN It was a double-blind, randomized study involving 40 volunteers in good general health. At the start of the trial, all participants received a dental prophylaxis to remove all plaque deposits. During the next 3 days subjects refrained from any mechanical oral hygiene procedure, except for the allocated mouthrinse being either the hydrogen peroxide (H(2)O(2); 0.013% H(2)O(2)/0.004% glycerol) or the placebo without H(2)O(2). At the third day of appointment, plaque levels were assessed at six sites per tooth. RESULTS The test group had a mean overall plaque score of 2.66 and the placebo group of 2.70. The difference in plaque scores between the two groups was not statistically significant. CONCLUSIONS The results of this pilot study showed that there was no statistically significant difference between the H(2)O(2)/glycerol group and the placebo group with respect to plaque inhibition within this study design.

Effectiveness of various interventions on maintenance of gingival health during 1 year – a randomized clinical trial

BACKGROUND Rinsing with the combined use of an oxygenating-agent (OA) and chlorhexidine (CHX) in addition to mechanical oral hygiene could improve and/or maintain good gingival health over a long period. METHODS This study had an examiner-blinded, randomized, six-group parallel design consisting of two-phases: a 3-week treatment phase and a subsequent 12-month experimental phase. A total of 267 subjects in good general health (≥18 years), without periodontitis, with at least five teeth per quadrant, and with moderate to advanced gingivitis were enrolled. A 3-week treatment phase was initiated to improve gingival health. Subjects were assigned to one of the six groups: two basic oral hygiene groups (Control I & II), one professional oral hygiene instruction group (OHI), one professional prophylaxis group (PP), an OA&CHX rinse group and a group receiving a combination of all regimens (COMBI group), being OHI + PP + OA&CHX. Dental plaque, gingival bleeding and staining assessments were performed at the start of the treatment phase, at baseline and at 4, 7, 10, and 12 months. RESULTS There was a significant reduction in dental plaque-scores for the OA&CHX and COMBI-group (0.51 [SD = 0.37], 0.38 [SD = 0.33] respectively) and a significant reduction in gingivitis scores for the OA&CHX and COMBI group (6.9% [SD = 14.0], 13.4% [SD = 13.4] respectively) from the start of the treatment phase to baseline. No clinically relevant changes were observed for the other four groups. After baseline, bleeding and plaque-scores increased back to a non-significant level between groups, and this level remained throughout the study. CONCLUSION OA&CHX and COMBI-group showed a clinically relevant improvement after the treatment phase in terms of dental plaque and gingival bleeding levels. At the 4-month clinical assessment, there was no longer a significant difference between groups.