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.

[A paradigmatic change in the management of caries in children: 'Gewoon Gaaf']. / Een omslag in cariësbehandeling bij kinderen: 'Gewoon Gaaf'.

This is a position paper about 'Gewoon Gaaf' ['Just Smooth'], a paradigmatic change in the management of caries in children with a special focus onprevention. Caries is now considered a disease related to behaviour. Behavioural changes are essential in the prevention of caries because only patient's self care can keep caries under control. It is the task of the oral care provider to alert parents and child to their own influence on the development of caries and particularly on how to keep this process under control. Evaluations have revealed that the traditional form of preventive care has hardly improvedoral health. In contrast, various studies have shown the good results of the 'Gewoon Gaaf' approach. Moreover it fits in well with the public debate, which puts more and more attention on efficiency and transparency in the care.

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.

[Oral health care volunteering in developing countries 2. Providing care effectively]. / Mondzorgvrijwilligerswerk in ontwikkelingslanden 2. Effectief zorgverlenen.

Oral health care volunteering in developing countries based on the traditional Western model does not contribute to sustainable improvement and has, presumably, negative consequences for the local health care system. The oral health care can and should be delivered more efficacious. To achieve efficacious and sustainable results, the 'Basis package of oral care' of the World Health Organization offers a good manual. In addition, the Dutch branch of Dental Health International can support non-governmental organizations in establishing volunteering oral health care delivery programmes in order to improve the preventive care, the accessibility of care, the working conditions of the local oral health care providers, and the medical hygiene.

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.

[Caries: diagnostics, monitoring and guidance in good oral health behaviour. A reorientation]. / Cariës: diagnostiek, monitoren en begeleiden naar goed mondzorggedrag. Een heroriëntatie.

Caries is a dynamic process which can develop either progressively or regressively under the all-determining influence of oral health behaviour. Management of caries therefore involves first of all: diagnostics, monitoring and preventive care and treatment which result in good oral health behaviour. The oral care provider should recognize all phases ofprogression of the caries process, and should be able to differentiate the symptoms which indicate an active or inactive process. A well maintained patient dossier is necessary to monitor this process over time. Following this procedure, the oral care provider is in a position to guide the patient with relevant information in order to achieve the final objective, good oral health.

[An index for untreated severe caries]. / Een index voor onbehandelde ernstige cariës.

Hardly any data are available on the clinical consequences of untreated severe caries, because there is no method to quantify the prevalence of oral conditions resulting from untreated caries. In the Philippines, an index was developed which records for (the location of) each tooth whether caries has reached the dental pulp, whether ulceration is present in the surrounding soft tissues due to sharp edges of fragments of a tooth lost due to caries, or whether a fistula or abscess is present. By adding the index to the existing Decayed Missing Filled Tooth index, insight is provided on the extent and the consequences of untreated caries and research may be carried out on its possible impact on the general health and wellbeing of national populations.

The effect of chlorhexidine varnish on root caries: a systematic review.

OBJECTIVE: The aim of this study was to systematically review the present literature on the effect of chlorhexidine varnish (CHX-V) on root caries. MATERIALS AND METHODS: The MEDLINE-PubMed, the Cochrane-CENTRAL and EMBASE databases were searched through December 2010 to identify any appropriate studies. Root caries incidence and root caries activity were selected as outcome variables. RESULTS: An independent screening of the unique titles and abstracts of 24 MEDLINE-PubMed, 14 Cochrane-CENTRAL and 18 EMBASE papers resulted in 6 publications that met the eligibility criteria. Data extraction provided no conclusive evidence that the application of CHX-V is effective in patients when regular professional oral prophylaxis is performed. If effective, the 40% CHX-V was found to provide a benefit over a control or fluoride varnish. CHX-V at lower concentrations (1 and 10%) may provide protection against root caries in high-risk patients (such as geriatric and xerostomia patients) in the absence of regular professional oral prophylaxis. CONCLUSION: Within the limitations of this review, it may be concluded that in the absence of regular professional tooth cleaning and oral hygiene instructions, CHX-V may provide a beneficial effect in patients in need of special care. The strength of this recommendation is graded as 'weak'.

[Caries in children and quality of life]. / Cariës bij kinderen en levenskwaliteit.

Caries is the most prevalent oral disease in children. The majority of caries in toddlers remains untreated, with toothaches as a consequence. Although toothache is an important determinant of the quality of life, prevalence data on toothaches hardly exist. Research results indicate that children's quality of life improves after caries treatment. The question remains which type of treatment is preferable. To address this question, evidence from randomized controlled clinical trials on various treatment methods is needed.

Safety and efficacy of two manual toothbrushes.

OBJECTIVE: The purpose of this study was to test the efficacy and safety of a newly designed multi-level manual toothbrush (Profit-Haije-Brush) compared with a control flat-trimmed manual reference toothbrush from the American Dental Association (ADA). MATERIAL AND METHODS: For this study, 36 healthy subjects without previous experience in the use of the Profit-Haije-Brush (PHB) were selected. Subjects were given a period of 2 weeks to become familiar with both types of brushes and were instructed to use them on alternate days for 2 min twice daily. Prior to their visit, subjects refrained from all oral hygiene procedures for 48 h. Prebrushing plaque and gingival abrasion scores were assessed. Subsequently, two randomly chosen contra-lateral quadrants were brushed with one of both brushes and the other two quadrants with the alternate brush. Subjects were supervised during their 2-min brushing exercise. After brushing, plaque and gingival abrasion were re-assessed. A questionnaire was filled out to investigate the subjects' attitudes towards both brushes. RESULTS: The overall mean prebrushing PI was 2.47 for the PHB and 2.44 for the ADA. The reduction in PI was 1.32 and 1.23 respectively (P < 0.05). With regard to gingival abrasion the overall mean prebrushing scores were 4.57 (PHB) and 5.34 (ADA). Post-brushing scores were 13.49 and 13.77 for the PHB and ADA respectively. CONCLUSION: Statistically, the multi-level PHB was significantly more efficacious than the flat-trimmed ADA. However, the difference is clinically considered small and the amount of remaining plaque was not significantly different between brushes. No greater potential to cause gingival abrasion to the oral tissues was observed.

[Paradigm shift in dentistry for children: from restorative to preventive treatment of caries]. / Paradigmaverschuiving in de kindertandheelkunde: van restauratieve naar preventieve behandeling.

First, the development of dental health care for children in the Netherlands is discussed. Caries prevalence among children has declined sharply. The present situation, however, makes clear that the majority of carious cavities in the temporary dentition remain untreated. This has led to the conclusion that the level of restorative care has to increase. On the basis of new insights in cariology gained in recent decades, the authors of this article argue for abandoning the old paradigm of restorative treatment in favour of prevention in the treatment of caries.

[Regular and careful brushing with fluoride toothpaste is the basis of prevention]. / Regelmatig en zorgvuldig poetsen met fluoridetandpasta is de basis van preventie.

For the dental care of parents and children, people in the Netherlands rely especially on the advice of the Ivory Cross. The basis of this advice is plaque removal with fluoride toothpaste. When this offers insufficient protection, one usually finds irregular and careless dental hygiene. Information and instruction concerning daily and careful dental hygiene should receive the highest priority of dental care professionals. If a patient's own dental care cannot be brought up to standard or if this cannot be done immediately, then (temporary) support can be provided by dental professionals in the form of preventive treatment. Doing this, however, without improving the self care of patients has to be regarded an inadequate treatment modality.

Effect of 40% chlorhexidine varnish on mutans streptococci counts in pits and fissures of permanent first molars.

OBJECTIVES: This study aimed to test the following hypotheses: (1) a carry-over effect of EC40 does not occur in a split-mouth model, (2) two consecutive applications of EC40 varnish with an interval of 3 months per year has a better inhibiting effect on mutans streptococci in pit and fissure plaque of permanent first molars of 6-7-year olds than a repeated application at each 6 months and (3) EC40 exerts an inhibiting effect on mutans streptococci for at least a 6-month duration. METHODS: Using a split-mouth design, test molars received EC40 on fissures and pits and control molars remained without treatment. One group of test molars received EC40 at baseline, 6, 12 and 18 months and another group at baseline, 3, 12 and 15 months. Plaque samples were taken from pits and fissures of test and control molars at baseline, 6, 9, 12 and 24 months. A mixed ANOVA model was used to analyze the data. RESULTS: The first hypothesis was accepted, the second rejected and the third accepted. CONCLUSIONS: Twice a year EC40 application on pits and fissures of permanent first molars of 6-7-year-old children can significantly reduce mutans streptococci numbers for a 6-month period, but the reductions were small.

Utility technology in the assessment of the cut-off between a negative and a positive test in a caries prediction model.

The methodology for the assessment of a negative or positive test in caries prediction models has not received much attention. This study aims to explain how utility technology could be applied in a caries prediction model for the assessment of the cut-off between a negative and a positive test. In this study loss of utilities was assigned to false outcomes of the prediction test. A regression equation with past caries experience variables of 11-year-old children and caries increment in the 11- to 15-year forecast period as outcome was computed. The adjusted explained variance for caries increment was 0.45. Formulas were constructed for the loss of utilities for false-negative tests whereas false-positive tests were corrected with a fixed loss of utilities. Each 11-year-old child of the 252 children was screened at various points of the regression equation. Loss of utilities was calculated for each child on the basis of the validation criterion, the outcome of the test and the actual caries increment of the child. The point on the regression equation with the least loss of utilities for the whole group was taken as the cut-off between a negative and a positive test. If the validation criterion for the prediction period was set on no caries, the prediction model resulted in a sensitivity of 84% and a specificity of 73%. This prediction model has potential when caries incidence is low and resources limited.

Salivary mutans streptococci counts as indicators in caries risk assessment in 6-7-year-old Chinese children.

OBJECTIVES: This study aimed to determine whether salivary mutans streptococci (MS) counts in Chinese children had any value in the prediction of new caries in the permanent dentition in the age interval of 6.5-8.5 years. METHODS: Four hundred and thirty-three 6-7-year-old children participated in this 2-year longitudinal study. Salivary MS counts were obtained at baseline with the spatula method. Dentin and enamel caries was recorded at baseline and at the follow-up, 2 years later. Spearman's correlation coefficients were computed. Past caries experience variables at baseline were entered into a multiple regression model with caries increment of the permanent dentition as dependent variable. MS counts were subsequently entered into the model to assess the additional caries predictive value. RESULTS: Spearman's correlation coefficient for MS counts and caries experience of the primary dentition at baseline was 0.48 and for MS counts and caries increment in the permanent dentition 0.12. In the multiple regression model caries increment of the permanent dentition had an adjusted R2 of 0.17 when the past caries experience variables were entered. Adding MS counts in the regression model did not change the R2 value. CONCLUSIONS: Salivary MS counts did not add any caries predictive value when past caries experience variables were used as caries predictors in this Chinese child population.

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.

Caries-preventive effect of resin-based and glass ionomer sealants over time: a systematic review.

INTRODUCTION: The difference in preventing dentine lesion development between resin-based and glass ionomer sealant materials is unclear. Two recently published reviews were unable to conclude on the difference because the comparison was an exclusion criterion in one review and there were statistical shortcomings in the relevant papers in the other (Cochrane) review. OBJECTIVES: The aim of the present investigation was to carry out a systematic review on the caries-preventive effect of these two types of sealant materials under more liberal exclusion criteria concerning the statistical presentations in the publications. METHODS: Based on five exclusion criteria, the literature search in the electronic libraries PubMed and MEDLINE and the publications retrieved in the Cochrane review, revealed 12 eligible publications for analyses. A variety of glass ionomers and resin-based sealant materials had been applied in the included studies. Attributable risk (AR) was chosen rather than relative risk (RR), as used in the Cochrane review, because RR is very instable in a low caries population. RESULTS: There was no consistent pattern observed with respect to the caries-preventive effect of either resin-based or glass ionomer sealants. Therefore, it was impossible to calculate an overall AR. CONCLUSIONS: There is no evidence that either resin-based or glass ionomer sealant material is superior to the other in preventing dentine lesion development in pits and fissures over time.