Brush head wear, subject-perceived and laboratory cleaning performance of two oscillating-rotating electric toothbrush heads over 3 months.

PURPOSE: To evaluate the progression of wear and the effect of wear on subject-perceived and laboratory cleaning efficacy of two oscillating-rotating electric brush heads, Oral-B Precision Clean (PC) and a store brand Easyflex (SB) brush head, after 4, 6, 8 and 13 weeks of use. METHODS: This research consisted of three phases: (1) Subject questionnaires--A crossover, single-blinded study was conducted among healthy adults who were regular users of Oral-B oscillating-rotating electric toothbrushes. Subjects were recruited from a general population and randomized based on age and gender into one of four cohorts reflecting the time period of use for each product: 4, 6, 8 or 13 weeks. After brushing with their first product (either PC or SB) for the designated period of time, subjects completed a questionnaire evaluating the brush head on 17 attributes related to perceived cleaning performance, brush head condition (i.e., durability) and brush head feel (i.e., gentleness). Subjects then used the second test product for the same period of time and completed the same questionnaire. (2) Wear index investigation--At the end of each time period, subjects' worn brush head pairs were evaluated by an independent, blinded investigator to determine the wear index score. (3) Robot testing--To analyze the laboratory cleaning efficacy of worn refills in the laboratory, a representative sample of 12 subject brush head pairs for each of the four cohorts were evaluated (96 brush heads in total). To analyze the laboratory cleaning efficacy for PC at Week 13 with SB at Week 4, a separate set of 20 subjects (40 brush heads in total) were evaluated. A robot was used to brush standard typodonts (Frasaco A3) covered with plaque substitute with the worn brush head for 2 minutes under standardized, controlled conditions simulating human brushing behavior. A 3D laser scan system was used to measure the area still covered with plaque substitute at different dental sites. RESULTS: Subject questionnaire--267 subjects completed study questionnaires. Statistically significant superior ratings (P < 0.05) were obtained with the PC brush head compared to the SB brush head for virtually all attributes at all four time periods (16/17 attributes for Weeks 4, 6 and 8 and 17/17 at Week 13). Highly significant advantages (P < 0.0001) were seen for 'overall rating', 'overall cleaning' and 'ready to replace brush head' attributes. Wear Index-- A total of 486 brush head samples (243 pairs) were analyzed for wear. At all four time periods, PC brush heads had a statistically significantly lower (P < 0.0005) mean wear index than SB brush heads. Robot Test--136 brush heads were analyzed using a laboratory (robot) test to investigate cleaning efficacy. Directionally higher laboratory cleaning for PC versus SB was observed for all dental sites (35/35) for all time periods. Comparing PC at Week 13 with SB at Week 4 showed statistically significant differences (P < 0.05) in favor of PC for the majority of dental sites and time periods (23/35).

Clinical evaluations of plaque removal efficacy: an advanced rotating-oscillating power toothbrush versus a sonic toothbrush.

OBJECTIVE: To evaluate the safety and plaque removal efficacy of an advanced rotating-oscillating power toothbrush relative to a sonic toothbrush with either a standard or compact brush head. METHODOLOGY: Two studies used a randomized, examiner-blind, two-treatment, crossover design. In Study 1, subjects were instructed to use their first randomly assigned toothbrush for five to seven days and then, after abstaining from all oral hygiene for 24 hours, were assessed with the Rustogi, et al. Modified Navy Plaque Index. They then brushed for two minutes and post-brushing plaque scores were recorded. Subjects were assigned to the alternate toothbrush and the procedures were repeated. In Study 2, subjects alternated using both brushes for approximately 10 days, then had four study visits three to four days apart (some variability based on patient scheduling). In Study 1, Oral-B Triumph with a FlossAction brush head and Sonicare Elite 7300 with a full-size, standard head were compared in a two-treatment, two-period crossover study. Study 2 compared Oral-B Triumph with a FlossAction brush head and Sonicare Elite 7300 with a compact head in a two-treatment, four-period crossover study. RESULTS: Fifty subjects completed Study 1 and 48 completed Study 2. All brushes were found to be safe and significantly reduced plaque after a single brushing. In Study 1, Oral-B Triumph was statistically significantly (p < 0.001) more effective in plaque removal than Sonicare Elite 7300 with the full-size brush head: whole mouth = 24% better, marginal = 31% better, approximal = 21% better. In Study 2, Oral-B Triumph was statistically significantly (p < 0.001) more effective than Sonicare Elite 7300 with the compact brush head: whole mouth = 12.2% better, marginal = 14.6% better, approximal = 12% better. CONCLUSION: Oral-B Triumph with its rotation-oscillation action was significantly more effective in single-use plaque removal than Sonicare Elite 7300 with its side-to-side sonic action when fitted with either a standard or a compact brush head.

A novel oscillating-rotating power toothbrush with SmartGuide: designed for enhanced performance and compliance.

AIM: The aim of this article is to provide a review of common power toothbrush technologies with a focus on the oscillating-rotating motion used in a novel toothbrush; describe features to drive compliance such as the "SmartGuide" innovation; and finally recommend steps to motivate patients to adopt a power toothbrush as part of their home care regimen. BACKGROUND: Contemporary power toothbrushes are available with various modes of actions, bristle designs, and features. Clinical research shows these factors can impact the effectiveness of a toothbrush by altering its ability to remove plaque, particularly in areas that are difficult to access. An independent systematic review of power toothbrush technologies showed toothbrushes with a rotation-oscillation motion provided significant advantages over manual toothbrushes for plaque removal and gingivitis reduction. No other powered toothbrush technology showed results as consistently superior to manual toothbrushes. CONCLUSIONS: Recently, an advanced oscillating-rotating toothbrush was introduced, the Oral-B Triumph with SmartGuide (Procter & Gamble, Cincinnati, OH, USA), using clinically proven oscillating-rotating technology and incorporating a unique wireless remote display to drive good brushing technique and increase brushing time. This type of innovation in power toothbrush technology provides dental professionals and consumers with additional home care tools to help improve oral health. In recommending any power toothbrush, dental professionals should reinforce the benefits to patients in a way that addresses their values, use experiential learning tools to ensure they understand how to use the brush, explain the desired outcomes, and gain their commitment to comply with the recommendation.

The Oral-B CrossAction manual toothbrush: a 5-year literature review.

The design of the modern conventional manual toothbrush can be attributed to Dr. Robert Hutson, a Californian periodontist, who in the early 1950s developed the multitufted, flattrimmed, end-rounded nylon filament brush that became known as the Oral-B manual toothbrush. The trademark Oral-B emphasized that this was an oral brush, designed to clean all parts of the oral cavity, not merely a toothbrush. Flat-trimmed conventional toothbrushes based on the original Oral-B design have good plaque-removing capability when used carefully. However, limitations in terms of patients" brushing technique and brushing time necessitated a radical change in bristle pattern to improve performance, especially at approximal sites and along the gumline. RATIONALE FOR PRODUCT DEVELOPMENT: Detailed studies of the tooth-brushing process, using advanced scientific and ergonomic research methods, led to new toothbrush designs intended to maximize the efficacy of brushing efforts. These studies showed that the point of greatest interproximal penetration occurs when the direction of brushing changes; bristles angle back into the interproximal space, moving down and back up the adjoining approximal surface. These mechanics were further optimized on the basis of standardized evaluations of brush-design characteristics, including combinations of tuft lengths, insertion angles and tuft layout. With conventional vertical bristles these improvements yield limited benefits because only a few bristles are correctly positioned at the interproximal junction when the brush changes direction. Ultimately, a design with bristle tufts arranged at 16 masculine from vertical along the horizontal brush head axis was identified, in which the maximum number of bristles operated at the optimum angle throughout the brushing cycle. This design was significantly more effective (p < 0.001) than others in terms of penetration (by 9.6%) and cleaning effectiveness per brush stroke (by 15.5%). EFFECTIVENESS: This discovery paved the way for a new toothbrush design with a unique patented array of tufts, which became known as the Oral-B CrossAction brush. This design was selected for extensive independent studies designed to evaluate plaque removal at the gingival margins and in the approximal areas and longer-term control of gingivitis, relative to current standard designs. In a series of studies (published in 2000), 14 single-brushing comparisons and 2 longer-term studies demonstrated the consistent superiority of the Oral-B CrossAction brush over the equivalent commercial standards. Since then, several additional studies have contributed further positive performance data for the CrossAction brush. Two of the studies demonstrated that plaque removal by this brush was superior to that of 15 other manual toothbrushes, and further investigations contributed similarly positive data. Longer-term data have confirmed superior CrossAction performance and the long-term benefits of improved efficacy, particularly for gingivitis. DISCUSSION: Novel approaches to toothbrush design have produced a toothbrush that, when tested in a large number of clinical studies, has consistently met or exceeded established standards of efficacy. The literature contains a wealth of performance data on various toothbrush designs, but none of these designs shows the year-on-year consistency and reproducibility of the Oral-B CrossAction.

Correlations between two plaque indices in assessment of toothbrush effectiveness.

BACKGROUND: The Rustogi et al. Modified Navy (RMNPI) and Turesky et al Modification of the Quigley Hein (TQHPI) plaque indices are commonly used to measure plaque removal. This study evaluated the possible correlations of both indices using data relative to a single use assessment of plaque removal using commercially available toothbrushes. METHODS: Single use crossover study designs have been previously reported. Disclosed plaque was scored pre- and post-brushing using both the RMNPI and the TQHPI. Sixty subjects, with an initial mean RMNPI score of 0.6 or greater, were enrolled and completed the study. No minimum score was required for TQHPI. After the initial scoring, the order for each index was randomized so that each subject was scored with either RMNPI followed by TQHPI or vice versa. Two manual toothbrushes [Oral-B CrossAction (CA) and Colgate Navigator (NA)] and one battery-powered brush (Crest SpinBrush Pro) (SBP) were evaluated in the trial. One examiner performed all clinical measurements. Pearson correlations were performed on whole mouth, buccal, and lingual plaque scores for the CA toothbrush. RESULTS: Strong positive correlations were found between the two plaque indices for pre- and post-brushing scores for the whole mouth and on lingual and buccal surfaces, where Pearson correlation coefficients ranged between 0.963 and 0.995. There was no correlation between the pre-brushing plaque score and the amount of plaque removed by brushing indicating that higher plaque levels before brushing do not necessarily predict that greater amounts of plaque will be removed during toothbrushing. Each toothbrush was found to be safe and significantly reduced plaque levels after a single brushing (t-test, p=0.0001). Significantly greater plaque reductions were found with the CA than the NA and SBP toothbrushes at whole mouth, lingual, and approximal surfaces for both indices (analysis of variance (ANOVA), p < or = 0.0002 for all comparisons). CONCLUSIONS: Strong positive correlations were found between two plaque indices (the RMNPI and TQHPI) for pre- and post-brushing scores at whole mouth, lingual, and buccal surfaces as assessed using data from a single use assessment of plaque removal. Efficacy data from this study demonstrated the CA toothbrush provided superior cleaning when compared to the NA manual toothbrush and SBP battery toothbrush. CLINICAL IMPLICATIONS: Two commonly used indices for assessing plaque removal in clinical studies are RMNPI and TQHPI. However, each index differs in the way plaque is scored. This study used both indices to assess comparative toothbrush efficacy and showed a strong correlation between indices for both pre- and post- brushing plaque scores. The result suggests that both indices demonstrate sufficient sensitivity to differentiate toothbrush efficacy.

Plaque removal efficacy and safety of the next generation of manual toothbrush with angled bristle technology: results from three comparative clinical studies.

PURPOSE: To investigate the safety and efficacy of a novel angled-bristled toothbrush in comparison with three established brushes. METHODS: The Oral-B CrossAction Vitalizer toothbrush was compared with two manual toothbrushes, the Oral-B CrossAction and Oral-B Advantage, and the battery-operated Crest SpinBrush Pro brush in three independent single-use, examiner-blind, crossover studies. In each study, over 50 healthy subjects from a normal population brushed with their randomly assigned toothbrush for 1 minute without instruction. Subjects returned after a 1-week washout period and brushed with the alternate toothbrush. At each visit, oral hard and soft tissues and plaque were examined before and after brushing. Plaque was evaluated using the Rustogi Modified Navy Plaque Index. RESULTS: Each tested toothbrush significantly (P=0.0001) reduced plaque levels after a single brushing. However, in all three studies, the CrossAction Vitalizer was significantly (P=0.0001) more effective than the comparator brushes in plaque removal from the whole mouth, the gingival margin and approximal surfaces. All toothbrushes were found to be safe with no evidence of oral hard or soft tissue trauma.

A 30-day clinical comparison of a novel interdental cleaning device and dental floss in the reduction of plaque and gingivitis.

OBJECTIVE: To compare the safety and efficacy of a novel battery-operated interdental cleaning device (Oral-B Hummingbird) [ID], fitted with either a flossette or pick attachment, versus hand-held dental floss in the reduction of plaque and gingivitis when combined with manual tooth brushing over a 30-day period. METHODOLOGY: This randomized, examiner blind, parallel group study assessed three treatment groups: ID/flossette (ID/F), ID/pick (ID/P), and unwaxed manual dental floss. All groups used the same soft manual toothbrush and toothpaste. The 84 subjects were stratified to treatment groups based on initial whole mouth mean plaque scores, gingivitis scores, and gender. Subjects were instructed to brush twice daily and use their assigned interdental method once daily in the evening before brushing. Gingivitis, gingival bleeding, and plaque were evaluated at baseline and Day 30. RESULTS: A total of 78 subjects completed all aspects of the study and were included in the analyses. There was no significant difference between treatment groups in baseline plaque, gingivitis, and bleeding scores. After 30 days, statistically significant reductions from baseline gingivitis and bleeding scores were found for all groups (p < 0.0001), but there were no significant statistical differences among groups. Whole mouth and approximal plaque scores were significantly reduced from baseline in the manual floss and ID/F groups after 30 days of product use, with no significant difference between groups. Plaque reduction for both the manual floss and ID/F groups was significantly greater than the ID/P group. All interdental cleaning methods were safe as used in the study, with no evidence of oral hard or soft tissue trauma. CONCLUSION: The Oral-B Hummingbird was safe and effective in reducing approximal plaque and gingival inflammation, and provides a useful alternative device for interdental cleaning.

Plaque removal efficacy of a novel tooth wipe.

OBJECTIVE: This study was designed to evaluate the safety and plaque removal efficacy of a tooth wipe (Oral-B Brush-Ups) using a manual toothbrush as a control. METHODOLOGY: Twenty-five healthy subjects from a general population were enrolled in this randomized, single-use, crossover study. After 23-25 hours of no oral hygiene, oral hard and soft tissues were examined, and disclosed plaque was scored using the Turesky, et al. modification of the Quigley Hein Plaque Index. Subjects used their randomly assigned product for a timed period of one minute without instruction, after which hard and soft tissues and plaque scores were reassessed. Subjects returned to the clinic after a one-week washout period, and the clinical procedures were repeated before and after use of the alternate product. All clinical measurements were made by one examiner who was masked to treatment sequence. RESULTS: Both the tooth wipe and toothbrush were found to be safe, and significantly reduced plaque levels from whole mouth, facial, and lingual surfaces (p < 0.0001). The toothbrush removed significantly greater plaque than the tooth wipe (p < 0.0001) on whole mouth surfaces (49% vs. 29%), facial surfaces (71% vs. 44%), and lingual surfaces (25% vs. 13%). CONCLUSION: The tooth wipe provides an effective method of plaque removal when tooth brushing is not practical.

The effect of two power toothbrushes on calculus and stain formation.

PURPOSE: To compare the safety and efficacy with respect to the control of calculus and stain of two power toothbrushes. MATERIALS AND METHODS: This was a cross-over study involving a total of 81 subjects from a general population who used, in a randomized sequence, the Braun Oral-B 3D Excel (D17) and the Sonicare toothbrush with a conventional dentifrice, and a manual brush with a tartar control dentifrice. The manual toothbrush with tartar control dentifrice served as a positive control with respect to control of calculus. Following 9 weeks of manual brush use with a conventional, non-abrasive dentifrice, each test brush was used for a period of 9 weeks, after which subjects switched to the next brush in the sequence. Calculus was scored using the Volpe-Manhold Calculus Index and stain using the Lobene Stain Index. RESULTS: All three brushes were found to be safe as used in the study. All three toothbrushes significantly reduced the levels of calculus as compared to the control period. Reduction from baseline in the rate of calculus formation was greatest in the D17 group (63%), followed by the manual brush with tartar control dentifrice (60%) and Sonicare (44%). Both the D17 and the manual brush were significantly more effective than Sonicare (P< 0.001). The D17 was also more effective at controlling stain formation than either Sonicare or the manual brush with tartar control dentifrice at the gingival margin, the difference from Sonicare being statistically significant for all analyses (P< 0.0001). It is concluded that the D17 is significantly more effective in reducing both the rate of calculus and stain formation than the Sonicare toothbrush.

A clinical study of plaque removal with an advanced rechargeable power toothbrush and a battery-operated device.

PURPOSE: To compare the safety and efficacy of two recently introduced modern power toothbrushes with different characteristics. MATERIALS AND METHODS: This was a single-blind, randomized, crossover study which compared the ability of two power toothbrushes to remove plaque during a 2-minute brushing period. The two brushes were the Braun Oral-B 3D Excel (D17), a rechargeable toothbrush with an oscillating/rotating/pulsating action and the Colgate Actibrush, a battery-operated device with an oscillating/rotating action. Seventy-four healthy subjects from a general population who met the inclusion/exclusion criteria used the two brushes on alternate days for a period of familiarization before returning to the test facility. At this visit, subjects with a whole mouth mean Proximal/Marginal Plaque Index of > or = 2.20 after 23-25 hours of no oral hygiene were randomly assigned to one of two treatment sequences, D17/Actibrush and Actibrush/D17, balanced for age and gender. Subjects brushed with their assigned toothbrush after which post-brushing plaque scores were recorded. After a 2-week washout phase subjects returned to the test facility and brushed with the alternate toothbrush as described. Data from the two visits were pooled, after which plaque removal efficacies were compared. Change from prebrushing treatment means were compared using ANOVA with models appropriate for the crossover design. RESULTS: Both toothbrushes were found to be safe and both significantly reduced plaque levels (P < or = 0.0001), but the D17 was significantly more effective than the Actibrush for the whole mouth and for approximal sites. Plaque reductions for the D17 were 46.5%, 55.2% and 42.9% for whole mouth, marginal and approximal sites, respectively while reductions for the Actibrush for the whole mouth, marginal, and approximal sites, were 41.5%, 52.5% and 36.8% respectively. It is concluded that the Braun Oral-B D17 may offer advantages in terms of plaque removal over the battery-powered Actibrush, particularly at hard to reach approximal sites.

A practice based study of a children's power toothbrush: efficacy and acceptance.

Power toothbrushes can offer significant advantages over a manual toothbrush both with respect to plaque removal and compliance. Most studies have, however, been carried out with adult toothbrushes in adult populations. Less is known about the efficacy of children's power toothbrushes, although it is likely that similar advantages will be demonstrated. This practice based study used the Debris Index (DI) component of the Simplified Oral Hygiene Index to compare baseline oral hygiene with results after 2 months of using the Braun Oral-B Kids' Power Toothbrush (D10). The study involved 13 dental offices and a total of 154 children aged 4 to 9 years. For all sites (facial and lingual), using the D10 for 2 months resulted in an approximately 40% reduction in the DI. Questionnaires completed by the parents or guardians, the children, and the dentists indicated a very favorable response to the power toothbrush. Both parents and children preferred the D10 to a manual toothbrush and most said they would continue to use it. The fact that children found the D10 fun to use may well aid compliance. Dentists thought that the D10 was effective and, at the end of the study, most said that they would now recommend a power toothbrush. It is concluded from the results of this practice based study that the D10 can help to reduce plaque levels in a population of children who previously relied on a manual toothbrush. The fact that the D10 is appealing to children and fun to use should aid compliance with long-term oral hygiene.

A clinical investigation into the effect of toothbrush wear on efficacy.

It is generally recommended that toothbrushes should be replaced after three-months' use in order to maintain efficacy. This clinical investigation employed a single-use, cross-over study and a three-month parallel-group study to investigate the effect of toothbrush wear on plaque and gingival health. Toothbrushes were artificially worn using a laboratory wear machine to simulate three months of clinical toothbrush use. Results from the single-use study showed that both the new and the worn toothbrushes significantly reduced whole mouth, marginal and approximal plaque scores from pre- to post-brushing (p < 0.0001). The new brush was, however, significantly more effective than the worn brush, demonstrating 13.4%, 11.0%, and 17.0% greater plaque reduction for whole mouth, marginal and approximal sites, respectively (p < 0.0001). Results from the three-month study confirmed this finding, with significant differences in plaque reduction (p < 0.0001) between the new and worn toothbrushes at 6 and 12 weeks for all sites. A significant difference (p < 0.0001) between the groups was also found for mean whole mouth gingivitis scores; this difference favoring the new brush at both 6 and 12 weeks. Examination of hard and soft oral tissues revealed no significant difference between the new and the worn brushes with respect to safety. It is concluded that a worn toothbrush is less effective than a new toothbrush for plaque removal and control of gingivitis.

An investigation into the effect of three months' clinical wear on toothbrush efficacy: results from two independent studies.

OBJECTIVE: Limited evidence has suggested that a worn toothbrush may be significantly less effective than a new brush with respect to plaque removal. Two independent studies, one with a manual toothbrush and one with a powered toothbrush, were undertaken to compared the ability of these toothbrushes as new and after three months' use to remove plaque. METHODOLOGY: Subjects from a general population were given either an Oral-B CrossAction manual toothbrush (Study 1) or a Braun Oral-B Battery (D4) toothbrush (Study 2). They were instructed to use their respective toothbrushes twice per day for a period of three months. After this time, those subjects meeting the studies' respective inclusion criteria entered the single-use, cross-over phase of the two studies. Both studies involved disclosing the teeth prior to measuring plaque. In Study 1, plaque was recorded using the Proximal Marginal Plaque Index and subjects brushed for one minute, by random assignment, with either a new or a worn toothbrush. In Study 2, plaque was measured using the Modified Quigley-Hein Plaque Index and subjects brushed for two minutes with either new or used brush heads, by random assignment. After a period of approximately one week, subjects returned to the test facilities and brushed with the alternate brush. RESULTS: Study 1 showed that both the new and the worn CrossAction toothbrushes significantly reduced plaque scores (p < 0.0001). A comparison of the two toothbrushes revealed no significant difference for whole-mouth plaque scores; however, at approximal sites the new toothbrush was significantly more effective than the worn brush (p = 0.033). In Study 2, as in Study 1, brushing with either a new or a worn brush head significantly reduced plaque scores (p < 0.0001). A comparison of the efficacies of the new and worn D4 toothbrushes revealed a non-significant tendency for the new brush head to remove more plaque than the worn brush head. However, when plaque removal was assessed for subjects using brush heads with the most extreme wear, i.e., scores of 3 or 4 (n = 15), a significant difference (p < 0.05) between new and worn brush heads was observed for the whole-mouth and approximal surfaces. CONCLUSION: The results from these two studies provide further data in support of the hypothesis that a worn toothbrush is less efficient with respect to plaque removal than a new brush. Patients should therefore be encouraged to replace their toothbrush regularly before bristle wear becomes excessive.