N. A. M. Rosema

The efficacy of powered toothbrushes following a brushing exercise: a systematic review

AIM The primary objective was to determine, based on the available published evidence, the efficacy of powered toothbrushing following a brushing exercise and secondary to what magnitude this effect is dependent on the plaque index score, power supply and mode of action. MATERIAL AND METHODS The PubMed-MEDLINE and Cochrane CENTRAL databases were searched through and up to August 2014 to identify appropriate studies. The outcome measurement was the weighted mean (WM) percentage plaque score reduction of a full-mouth assessment following subject brushing. RESULTS The search yielded 2420 titles and abstracts. Ultimately, 58 articles with 146 brushing exercises as separate legs were selected. The overall effect of a powered brushing exercise provides a 46% WM plaque score reduction. One hundred and six experiments provided data as assessed according to the Quigley and Hein plaque index. The WM reduction from baseline in plaque scores was 36%. A WM plaque score reduction of 65% was observed in 39 experiments using the Navy plaque index. Subanalysis on power supply and mode of action showed WM plaque score reductions ranging from 33% up to 71% depending on plaque index score. CONCLUSION The efficacy in plaque removal following a brushing exercise using a powered toothbrush provides a WM plaque score reduction of 46% on average, with a range of 36-65% dependent on the index scale to score plaque. The available evidence indicates that the power supply (rechargeable or replaceable battery), mode of action, as well as brushing duration and type of instructions are factors which contribute to the variation in the observed efficacy.

Plaque-removing efficacy of new and used manual toothbrushes – a professional brushing study

OBJECTIVES The present study assessed whether 3-month-old used manual toothbrushes are less effective in reducing plaque scores compared with new toothbrushes with or without the use of dentifrice. MATERIAL AND METHODS The present study was performed employing a single-use, examiner-blinded, professional brushing model. Four brushing modalities were randomly allocated to one of four quadrants, that is, 3-month-old used toothbrushes and new toothbrushes both with and without the use of dentifrice. Prebrushing and post-brushing plaque scores (Quigley Hein plaque index) and gingival abrasion (GA) scores were obtained. A dental hygienist performed the professional brushing procedure. The 3-month-old used toothbrushes were assessed for wear. RESULTS No significant differences were observed among the treatments with regard to the prebrushing scores. The post-brushing plaque scores ranged from 1.59 for the new brush with dentifrice to 1.76 for the old brush with dentifrice. There was a significant difference (P = 0.036) among the four treatments regarding the old brush with dentifrice, which removed less plaque than the other treatment modalities. Regarding GA scores, no significant differences were observed. With regard to toothbrush wear after 3 months of use, the scores varied widely among the individually evaluated brushes. CONCLUSION The present study did not show a clinically relevant difference in plaque score reductions following a 2-minute brushing exercise among 3-month-old used and new manual toothbrushes. However, the wear rate of the brushes seemed to be the determining factor in loss of efficacy, rather than the age of the toothbrush. Furthermore, dentifrice did not show an additional effect on instant plaque removal.

Plaque Removal by Young Children Using Old and New Toothbrushes

There is inconclusive evidence about the relationship between toothbrush wear and plaque removal. This randomized cross-over clinical trial aimed to validate or invalidate non-inferiority in the plaque-removal efficacy of old vs. new toothbrushes in the hands of 7- and 8-year-old children. The lower limit for non-inferiority was set a priori as a difference in plaque score < 15%. Children (n = 101) brushed, in the first session, with either their 14-month-old toothbrush or a new one, and in the second session vice versa. The mean Quigley-Hein plaque score, before and after children brushed with old brushes, was 2.9 and 2.4, and with new brushes 2.8 and 2.1. The plaque score after they brushed with the new toothbrush was 10.9% lower (p < 0.001) than after they brushed with the old toothbrush. The confidence interval of 7.6%–13.9% was within the acceptance band (< 15%), and non-inferiority of old toothbrushes in the hands of these children was validated.

Gingival abrasion and recession in manual and oscillating-rotating power brush users

Objective To assess gingival recession (GR) in manual and power toothbrush users and evaluate the relationship between GR and gingival abrasion scores (GA). Methods This was an observational (cross-sectional), single-centre, examiner-blind study involving a single-brushing exercise, with 181 young adult participants: 90 manual brush users and 91 oscillating–rotating power brush users. Participants were assessed for GR and GA as primary response variables. Secondary response variables were the level of gingival inflammation, plaque score reduction and brushing duration. Pearson correlation was used to describe the relationship between number of recession sites and number of abrasions. Prebrushing (baseline) and post-brushing GA and plaque scores were assessed and differences analysed using paired tests. Two-sample t-test was used to analyse group differences; ancova was used for analyses of post-brushing changes with baseline as covariate. Results Overall, 97.8% of the study population had at least one site of ≥1 mm of gingival recession. For the manual group, this percentage was 98.9%, and for the power group, this percentage was 96.7% (P = 0.621). Post-brushing, the power group showed a significantly smaller GA increase than the manual group (P = 0.004); however, there was no significant correlation between number of recession sites and number of abrasions for either group (P ≥ 0.327). Conclusions Little gingival recession was observed in either toothbrush user group; the observed GR levels were comparable. Lower post-brushing gingival abrasion levels were seen in the power group. There was no correlation between gingival abrasion as a result of brushing and the observed gingival recession following use of either toothbrush.

Adjunctive effect of a water-cooled Nd:YAG laser in the treatment of chronic periodontitis

OBJECTIVES To test whether use of a water-cooled Nd:YAG laser adjunctive to supra- and subgingival debridement (SRP) with hand and ultrasonic instruments results in greater clinical improvement than SRP alone. Another objective was to investigate the reduction in the number of microorganisms. METHODS This study was an examiner-blind, randomized and controlled clinical trial using a split-mouth design. Nineteen subjects with moderate-to-severe generalized periodontitis were selected. Immediately following SRP in two randomly chosen contra-lateral quadrants, all pockets 4 mm were additionally treated with the Nd:YAG laser (1064 nm, 6 W, 400 mJ). Clinical assessments (Plaque index, bleeding on pocket probing, probing pocket depth) were performed pre-treatment and at 3 months post-treatment. In each quadrant, one site was sampled for microbiological evaluation at pre-treatment, immediately post-instrumentation and 3 months post-treatment. RESULTS At the 3-month visit, the clinical parameters had significantly improved for both regimens. No significant differences between treatment modalities were observed for any of the clinical parameters at any time. Immediately following instrumentation, the total colony forming units for both groups were significantly reduced as compared with pre-instrumentation. No significant differences between treatment modalities were observed. CONCLUSIONS Three months after SRP, no additional advantage was achieved with the additional use of the Nd:YAG laser. Microbiological findings reflect these clinical results.

Adjunctive effect of a water-cooled Nd

OBJECTIVES To test whether use of a water-cooled Nd:YAG laser adjunctive to supra- and subgingival debridement (SRP) with hand and ultrasonic instruments results in greater clinical improvement than SRP alone. Another objective was to investigate the reduction in the number of microorganisms. METHODS This study was an examiner-blind, randomized and controlled clinical trial using a split-mouth design. Nineteen subjects with moderate-to-severe generalized periodontitis were selected. Immediately following SRP in two randomly chosen contra-lateral quadrants, all pockets 4 mm were additionally treated with the Nd:YAG laser (1064 nm, 6 W, 400 mJ). Clinical assessments (Plaque index, bleeding on pocket probing, probing pocket depth) were performed pre-treatment and at 3 months post-treatment. In each quadrant, one site was sampled for microbiological evaluation at pre-treatment, immediately post-instrumentation and 3 months post-treatment. RESULTS At the 3-month visit, the clinical parameters had significantly improved for both regimens. No significant differences between treatment modalities were observed for any of the clinical parameters at any time. Immediately following instrumentation, the total colony forming units for both groups were significantly reduced as compared with pre-instrumentation. No significant differences between treatment modalities were observed. CONCLUSIONS Three months after SRP, no additional advantage was achieved with the additional use of the Nd:YAG laser. Microbiological findings reflect these clinical results.

Adjunctive effect of a water-cooled Nd:YAG laser in the treatment of chronic periodontitis: Adjunctive effect of the Nd:YAG laser to SRP

OBJECTIVES To test whether use of a water-cooled Nd:YAG laser adjunctive to supra- and subgingival debridement (SRP) with hand and ultrasonic instruments results in greater clinical improvement than SRP alone. Another objective was to investigate the reduction in the number of microorganisms. METHODS This study was an examiner-blind, randomized and controlled clinical trial using a split-mouth design. Nineteen subjects with moderate-to-severe generalized periodontitis were selected. Immediately following SRP in two randomly chosen contra-lateral quadrants, all pockets 4 mm were additionally treated with the Nd:YAG laser (1064 nm, 6 W, 400 mJ). Clinical assessments (Plaque index, bleeding on pocket probing, probing pocket depth) were performed pre-treatment and at 3 months post-treatment. In each quadrant, one site was sampled for microbiological evaluation at pre-treatment, immediately post-instrumentation and 3 months post-treatment. RESULTS At the 3-month visit, the clinical parameters had significantly improved for both regimens. No significant differences between treatment modalities were observed for any of the clinical parameters at any time. Immediately following instrumentation, the total colony forming units for both groups were significantly reduced as compared with pre-instrumentation. No significant differences between treatment modalities were observed. CONCLUSIONS Three months after SRP, no additional advantage was achieved with the additional use of the Nd:YAG laser. Microbiological findings reflect these clinical results.