Interproximal access efficacy of three manual toothbrushes with extended, x-angled or flat multitufted bristles.

PURPOSE: This laboratory research study was conducted to evaluate three manual toothbrushes for their ability to remove artificial plaque from interproximal sites. MATERIALS AND METHODS: Interproximal access efficacy (IAE) was evaluated using a pressure-sensitive artificial plaque substrate placed around simulated anterior and posterior teeth with horizontal and vertical brushing motions. Efficacy was determined as the maximum width of artificial plaque removed from around the teeth. Testing was conducted on three manual toothbrushes with different bristle configurations coded as: Extended [Aquafresh Between Teeth (also marketed as Dr. Best Zwischenzahn)], X-angled (Oral-B CrossAction) and Flat multitufted (Oral-B Indicator). Twenty-four tests on each toothbrush design were conducted, and the results were statistically analysed using two-sample t-tests, assuming unequal variances. RESULTS: The individual mean IAE values on anterior and posterior tooth shapes with vertical and horizontal brushing were significantly (P < 0.001) higher for the toothbrush with extended bristles (Aquafresh Between Teeth) than for the other two toothbrush designs tested. When the data were combined to give an overall average, the IAE for the toothbrush with extended bristles (Aquafresh Between Teeth) was significantly (P < 0.001) higher than the IAE value for the toothbrushes containing x-angled (Oral-B CrossAction) or flat multitufted bristles (Oral-B Indicator). CONCLUSION: Based on the demonstrated predictability of the IAE assay for clinical interproximal plaque removal, the manual toothbrush with extended bristles should be an effective brush for cleansing the dental interproximal sites.

Laboratory assessment of the Sensodyne Mikro Aktiv extra soft toothbrush and the Oral-B indicator soft toothbrush.

OBJECTIVE: The objective of this laboratory study was to assess the Sensodyne Mikro Aktiv extra soft toothbrush, compared with the Oral-B Indicator soft toothbrush, for interproximal access efficacy (IAE). METHODS: Six toothbrushes of each product were tested four times, for a total of twenty-four tests on each toothbrush design. In the IAE assay, the tooth brushing technique involved independent evaluations of each toothbrush in a vertical or horizontal brushing motion, tooth shapes simulating anterior and posterior teeth, and a brushing weight of 250 g. The brushing apparatus was set to brush for 15 seconds at two strokes per second with a 50 mm stroke. All readings were measured with 3x magnification by a single investigator. RESULTS: The mean IAE value on anterior tooth shapes, with vertical and horizontal brushing, was significantly (p < 0.001) higher for the Sensodyne Mikro Aktiv toothbrush than for the Oral-B Indicator toothbrush. When the IAE values were combined to give an overall brushing average, the Sensodyne Mikro Aktiv toothbrush was significantly (p < 0.001) higher compared to the Oral-B Indicator toothbrush. CONCLUSION: The Sensodyne Mikro Aktiv toothbrush has demonstrated superiority to the Oral-B Indicator toothbrush for access into interproximal areas using this laboratory methodology.

Development of the Evolve toothbrush: laboratory evaluations of gingival margin cleaning and subgingival access.

OBJECTIVE: The Evolve toothbrush has been developed with three heads that adjust to the tooth shape with brushing. With the exertion of gentle pressure on the center head against the tooth cusps, the two outer heads bend and conform to the tooth anatomy at the gingival areas around each tooth. In preliminary clinical observations, decreased plaque and improved gingival appearance was observed after one and two weeks of unsupervised product use. The purpose of this laboratory research was to evaluate the ability of the Evolve toothbrush bristles to remove artificial plaque deposits at and around the gingival margin (Gingival Margin Cleaning, GMC), and to gain access into and remove artificial plaque deposits from under the gingival margin (Subgingival Access, SA) using standardized, published methods. METHODOLOGY: In the first two laboratory studies conducted, two toothbrush products, the new Evolve and the standard American Dental Association toothbrush (ADA) were evaluated for GMC and SA. In the third assay, three toothbrushes, the Evolve, Oral-B CrossAction, and the Sonicare Elite, were evaluated for SA. Each toothbrush product group was evaluated for 24 assessments using clinical tooth brushing motions on posterior tooth shapes under wet brushing conditions. RESULTS: In all laboratory tests conducted, the Evolve toothbrush had significantly (p < 0.001) greater efficacy compared to the other toothbrushes tested. CONCLUSION: The Evolve toothbrush warrants further clinical evaluations as it is believed these future findings will further substantiate those of the initial testing, and demonstrate the Evolve's ability to help improve oral and overall health.

Laboratory interproximal access efficacy and gingival margin cleaning of the elmex SENSITIVE SOFT, EXTRA SOFT and ADA reference toothbrushes.

OBJECTIVE: The purpose of these laboratory studies was to evaluate three toothbrushes for their ability to remove artificial plaque deposits at interproximal sites and along the gingival margin of simulated anterior and posterior teeth, using horizontal and vertical brushing motions. METHODOLOGY: Three toothbrushes were evaluated: elmex SENSITIVE SOFT; elmex SENSITIVE EXTRA SOFT; and the ADA reference. Twenty-four tests on each toothbrush group were conducted, and results were statistically analyzed using ANOVA and the post hoc Tukey test. RESULTS: In both the interproximal access efficacy and gingival margin cleaning assays, the elmex SENSITIVE EXTRA SOFT and SENSITIVE SOFT toothbrushes were statistically superior (p < 0.001) to the ADA reference toothbrush. CONCLUSION: The elmex SENSITIVE SOFT and EXTRA SOFT toothbrushes are predicted to offer excellent plaque removal efficacy interproximal areas and along the gingival margin of both anterior and posterior teeth.

Three laboratory assessments of a new triple-head toothbrush and the Oral-B 40 toothbrush.

OBJECTIVE: The objective of this series of laboratory studies was to assess a new triple-head toothbrush, the DR BEST FreiKopf, compared to the Oral-B 40 toothbrush, for interproximal access efficacy (IAE), gingival margin cleaning (GMC), and subgingival access (SA) as measures of toothbrush efficacy. METHODOLOGY: In each procedure, six toothbrushes of each product were tested four times for a total of twenty-four tests on each toothbrush design. In the IAE assay, the tooth brushing technique involved independent evaluations of each toothbrush in a vertical or horizontal brushing motion, tooth shapes simulating anterior and posterior teeth, and a brushing weight of 250 g. The brushing apparatus was set to brush 15 seconds at two strokes per second with a 50 mm stroke. In the GMC assay, the tooth brushing technique involved independent evaluations of each toothbrush in a horizontal brushing motion, tooth shapes simulating posterior teeth, and a brushing weight of 500 g. Simulated gingivae were prepared from self-curing dental acrylic. The brushing apparatus was set to brush for 60 seconds at two strokes per second with a 15 mm stroke. In the SA evaluations, the tooth shapes simulating posterior teeth were used, as well as a brushing weight of 500 g for 60 seconds at two strokes per second with a 15 mm stroke. All readings were measured with 3x magnification by one investigator. RESULTS: The mean IAE value on anterior and posterior tooth shapes, with vertical and horizontal brushing, and overall, was significantly (p < 0.001) higher for the triple-head toothbrush than for the Oral-B 40 toothbrush. In the GMC assay, the triple-head toothbrush had a significantly (p < 0.001) superior mean value compared to the Oral-B 40 product tested. In the SA study, the triple-head toothbrush was significantly (p < 0.001) superior compared to the Oral-B 40 toothbrush product tested. CONCLUSIONS: The triple-head toothbrush has demonstrated superiority to a traditional flat-head toothbrush for access into interproximal areas, and for removing deposits from the gingival margin, as well as below the gumline, in these laboratory assays.

Comparing the Dr. SEDOC and ADA toothbrushes in three independent laboratory procedures.

OBJECTIVE: The purpose of this research was to compare the Dr. SEDOC toothbrush, tufted with super-tapered bristles, to the ADA standard toothbrush in three laboratory procedures designed to evaluate 1) the cleaning ability of toothbrush bristles at the gingival margin (GMC), 2) interproximal access efficacy (IAE) and plaque removal efficacy, or 3) subgingival access (SA) into, and removal of artificial plaque deposits from under the gingival margin. METHODOLOGY: Efficacy was tested using three published laboratory methods, with pressure-sensitive paper placed around simulated teeth, at a brushing pressure of 250 or 500 g, with horizontal or vertical brushing motions. Twenty-four tests on each toothbrush design were conducted, and results were statistically analyzed using ANOVA. RESULTS: In all three assays, the Dr. SEDOC toothbrush had a significantly superior (p < 0.001) efficacy mean value compared to the ADA toothbrush. CONCLUSION: The Dr. SEDOC toothbrush, with super-tapered bristles, offers the potential for improved cleaning and plaque removal compared to the ADA standard control toothbrush.

Laboratory evaluations of two toothbrushes for removal of artificial plaque above, around and below the gingival margin.

OBJECTIVE: Two toothbrushes were evaluated with a laboratory method for the ability to remove artificial plaque deposits around interproximal sites (interproximal access efficacy, IAE) at the gingival margin (gingival margin cleaning, GMC), and below simulated gingivae (subgingival access, SA) using clinical toothbrushing motions under wet brushing conditions. METHODOLOGY: The toothbrushes tested were Meridol or an ADA reference standard. The Meridol toothbrush has a flat profile and contains double-tapered filaments. The ADA reference standard also has a flat profile, with traditional end-rounded bristles. Both toothbrushes have a soft texture. Six toothbrushes of each design were evaluated four times for a total of 24 assessments. RESULTS: The Meridol toothbrush had significantly (p < 0.001) higher mean IAE, GMC and SA values compared to the ADA reference standard toothbrush tested. CONCLUSION: From these results, the Meridol toothbrush with tapered bristles is more likely to be effective in clinical studies on plaque removal compared to other manual toothbrushes with rounded bristles in a flat head design, that are similar to the ADA reference standard toothbrush.

Laboratory evaluations of elmex inter X toothbrushes for interproximal access efficacy and posterior tooth surface cleaning.

Laboratory methods have been developed to evaluate the ability of toothbrush bristles to remove artificial plaque deposits at interproximal sites (Interproximal Access Efficacy; IAE) and on distal tooth surfaces (Posterior Tooth Surface Cleaning; PTSC). In the testing performed for this study, six toothbrushes were evaluated. These were: elmex inter X Sensitive; elmex inter X Sensitive Short Head; elmex inter X medium; elmex inter X Medium Short Head; Oral-B Cross Action 40 medium; and the ADA reference standard toothbrush. Six toothbrushes of each design were tested four times under wet brushing conditions in all assays. In the IAE studies, toothbrushing was conducted using a vertical or horizontal brushing motion, simulated anterior or posterior teeth, and a brushing weight of 250 g. The bristles were placed at a 90 degree angle to the tooth surface, and brushing was performed for 15 seconds at two strokes per second with 50 mm strokes. IAE was recorded as the maximum width of simulated plaque deposit removed. For the PTSC evaluations, a horizontal brushing motion was used on posterior tooth shapes, with a 250 g brushing pressure for ten seconds. PTSC was determined as the maximum measurement of artificial plaque deposit removed from the mid-facial area to the maximum post-distal area of the most posterior simulated tooth shape. All data were assessed with ANOVA and the post hoc Tukey test. In the individual IAE tests, with vertical or horizontal brushing on anterior and posterior simulated teeth, and on overall IAE mean values, the four elmex inter X toothbrushes were significantly higher (p < 0.01-0.001) than the ADA reference standard and the Oral-B Cross Action 40 toothbrushes. The mean PTSC values for all toothbrushes were significantly higher (p < 0.01-0.001) compared to the ADA Reference Standard toothbrush mean PTSC. All elmex inter X brushes were statistically significantly higher (p < 0.01-0.001) compared to the Oral-B Cross Action 40 product. The elmex inter X Medium had a significantly higher (p < 0.05-0.001) PTSC compared to the PTSC mean values of the other elmex inter X products tested.

Laboratory evaluations of a toothbrush with diamond-shaped filaments for stiffness and efficacy.

The purpose of these studies was to evaluate four toothbrushes with a similar flat profile for stiffness and efficacy in removing artificial plaque deposits from interproximal areas, or depth of removal from broad tooth surfaces, and to relate these findings to bristle stiffness. The test toothbrush had 5-mil diameter, elongated diamond-shaped bristles (D). Three toothbrushes contained 5-mil (5), 6-mil (6), or 7-mil (7) diameter round bristles. Stiffness studies were performed using the ISO 8627 method. In the efficacy studies, toothbrushing was conducted with a vertical or horizontal brushing motion on simulated anterior or posterior teeth using a brushing weight of 250 g. The bristles were placed at a 90 degrees angle to the tooth surface, and brushing was performed for 15 seconds at two strokes per second with 50 mm strokes. Each of the toothbrush designs was tested 24 times. Interproximal access efficacy (IAE) was recorded as the maximum width of simulated plaque deposit removed. Depth of deposit removal (DDR) was determined using a color comparative scale, where 0 = no deposit change and 4 = maximum removal. The averages of wet and dry stiffness measurements were found to be 7 > D > 6 > 5; all values were in the range accepted as soft texture. The means for total IAE were ranked D > 5 > 6 > 7, and total DDR mean rankings were D > 7 > 6 > 5. For the round bristles, stiffness was inversely related to IAE and paralleled the DDR rankings. Using ANOVA, the D and 5-mil toothbrushes had significantly higher (p < 0.05) IAE means compared to the 6- or 7-mil products. The D toothbrush had significantly higher (p < 0.05) DDR means than the 5-mil product. The diamond-shaped bristles in these flat profile products resulted in improved depth of deposit removal compared to the same design with 5-mil round bristles.

Laboratory interproximal access efficacy of two toothbrushes with cross-angulated bristling.

Interproximal access efficacy (IAE) has been evaluated in a laboratory method using pressure-sensitive paper placed around simulated anterior and posterior teeth, using horizontal or vertical brushing motions. The two toothbrushes evaluated in this study were the Oral-B Cross Action Medium 40 and the Dr. Best X-Activ Mittel. Twenty-four tests on each toothbrush design were conducted, and results were statistically analyzed using ANOVA. In all of the individual evaluations, using either vertical or horizontal brushing motions on either anterior or posterior simulated teeth, the Dr. Best X-Activ Mittel toothbrush was significantly (p < 0.001) more effective than the Oral-B Cross Action Medium 40 in achieving IAE. When individual IAE data from the vertical, horizontal, anterior and posterior assessments were combined to assess overall IAE, the Dr. Best X-Activ Mittel toothbrush had a significantly (p < 0.001) higher mean value than the Oral-B Cross Action Medium 40 mean value.

Laboratory evaluation of two bi-level toothbrush products for subgingival access and gingival margin cleaning.

Recent technological advances have enabled the production of split or feathered endings of individual toothbrush filaments. The purpose of this laboratory study was to compare a bi-level manual toothbrush containing standard end-rounded bristles with the same shaped toothbrush containing feathered filaments, 3 mm deep, on the outer raised bi-level rows to achieve subgingival access (SA) and remove artificial plaque at the gingival margin, or gingival margin cleaning (GMC). Simulated gingivae were prepared with a 0.2 mm space between the gingivae and tooth surface. The toothbrushes were aligned with the papillae at the gingival margin, and were tested using wet brushing conditions for 60 seconds at two strokes per second with a 15 mm stroke. Four toothbrushes of each type were evaluated four times, for a total of 16 assays per design. The SA maximum depth was recorded on pressure-sensitive paper under the simulated gingivae, and the length of gingival margin cleaning was recorded as the GMC efficacy. Readings were performed with 3x magnification by one investigator. In these laboratory assays, the bi-level toothbrush with feathered outer-row bristles significantly (p < 0.001) increased the ability of the bristles to achieve SA by 35.7% and GMC efficacy by 54.5% compared to an identical bi-level toothbrush with end-rounded bristles.

Influences of directed research and clinical observations on the development of a tartar control whitening dentifrice.

Early literature described the benefits of cleaning the mouth and teeth to prevent tartar accumulation and tooth loss. For more than a century, the need for meticulous tooth scaling and regular brushing to maintain oral health has been recorded. More recently, because of innovative research into the chemical and biological activity of saliva, dentifrices have been formulated which specifically interrupt the mineralization of plaque and food debris to stain and calculus. Proof of efficacy of these dentifrices are obtained with well-designed clinical tests which quantify stain and calculus by using reliable scoring systems.

A six-week clinical efficacy study of four commercially available dentifrices for the removal of extrinsic tooth stain.

The objective of this double-blind clinical study was to compare the efficacy for extrinsic tooth stain removal of four commercially available dentifrices: Colgate Tartar Control with Baking Soda & Peroxide Fluoride Toothpaste; Aquafresh Advanced Whitening Toothpaste with Fluoride; Rembrandt Tartar Control Low Abrasion Fluoride Whitening Toothpaste; and Crest Regular Fluoride Toothpaste. Following a baseline examination for extrinsic tooth stain on the anterior six mandibular and maxillary teeth, qualifying adult male and female subjects from the Philadelphia, Pennsylvania area were randomized into four treatment groups which were balanced for age, gender, tobacco habits, and level of extrinsic tooth stain. Subjects were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned dentifrice using a soft-bristled toothbrush. Examinations for extrinsic tooth stain were repeated after six weeks' use of the study dentifrices. One hundred eighty (180) subjects complied with the protocol, and completed the entire study. At the six-week examination, subjects assigned to the Colgate Tartar Control with Baking Soda & Peroxide Fluoride Toothpaste treatment group exhibited statistically lower levels of extrinsic tooth stain area and extrinsic tooth stain intensity than did those subjects assigned to the Crest Regular Fluoride treatment group. Subjects assigned to the Aquafresh Advanced Whitening treatment group exhibited significantly lower levels of extrinsic tooth stain area than did those assigned the Crest Regular Fluoride group. No other significant differences among the four study dentifrices were noted. Thus, the results of this double-blind clinical study support the conclusion that Colgate Tartar Control with Baking Soda & Peroxide Fluoride Toothpaste provides significantly greater control of extrinsic tooth stain than does Crest Regular Fluoride, a sodium fluoride/silica dentifrice.

Subgingival access and artificial plaque removal by a sonic cleaning device.

A sonic subgingival cleaning device (soniPick Sonic Interdental Plaque Remover) has recently been marketed with three bristle tips varying in size lengths and bundle diameters. The purpose of this study was to evaluate the ability of these bristle tips to remove subgingival artificial plaque deposits in a laboratory method used for toothbrushes. The laboratory method has been modified for testing the sonic device, to simulate the directions for using the product at home. The dimensions (length x bundle width) of three tips tested were: 0.007" x 0.040"; 0.007" x 0.062"; and 0.009" x 0.062". The tips used with the sonic device were placed on the tooth surface at a 20 degrees angle according to directions, and inserted 3 mm under simulated gingivae. The device was turned on and the tip was moved in a maximum 10 mm stroke for 15 seconds with the brushing machine. For control purposes, a flat, multi-tufted, ADA-accepted manual toothbrush (Oral-B P35) was also tested. The manual toothbrush was tested using the standard methods for evaluating toothbrushes, i.e., with the bristle tips placed at the gingival margin, then brushed at a 45 degrees angle at 250 g weight, using 15 mm strokes for 60 seconds. The depth of subgingival deposit removal was recorded as the maximum depth of the artificial plaque deposit removed from the pressure-sensitive paper under the simulated gingivae over anterior- or posterior-shaped teeth. In the assays conducted, the three bristle tips on the sonic device removed artificial plaque deposits under the simulated gingival at depths of 1.9-2.7 mm. The manual toothbrush had a mean subgingival cleaning depth of 0.6 mm. Differences between the three bristle tips used with the sonic device and the manual toothbrush were significant (p < 0.001 ANOVA). In this laboratory assay, all 3 bristle tips provided with the sonic cleaning device maintained access into and subsequent removal of artificial plaque from the subgingival space.

Laboratory evaluation of the reach tooth & gum care toothbrush and three additional manual toothbrushes for subgingival access.

A new laboratory procedure has been developed to evaluate subgingival access efficacy (SAE) of toothbrush bristles using clinical toothbrushing motions and pressure-sensitive paper placed around simulated tooth shapes and gingival tissues under wet brushing conditions. Subgingival access is determined by measuring the maximum distance of the bristle marks from the brushing stroke on the pressure-sensitive paper under the simulated gingival tissues. Four manual toothbrushes (Reach Tooth & Gum Care, Colgate Total Design, Mentadent and Oral-B Advantage) with differing designs, bristle feathering or outside row dimensions were evaluated. Each toothbrush design was evaluated for 28 assessments on anterior and posterior tooth shapes. On overall assessments for subgingival access, the Reach Tooth & Gum Care toothbrush was significantly (p < 0.05-0.001) superior to the other three commercially available toothbrushes tested.

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.

Laboratory evaluations of three dentifrices with polishing or brushing.

The purpose of this study was to determine the depth of deposit removal of three dentifrices using a dental felt polishing tip or an Oral-B P 35 toothbrush. The dentifrices were compared using a laboratory method which simulates clinical tooth polishing or toothbrushing procedures, and utilizes a pressure-sensitive paper that records the depth of deposit removal. Each polishing time was conducted for five seconds; toothbrushing time was 15 seconds. Both polishing and toothbrushing were performed at a weight of 250 grams. Depth of Deposit Removal (DDR) was recorded using a 0-4 scale from a comparative color chart. The dentifrices evaluated were Arm & Hammer Dental Care, Colgate Regular, and Crest Regular. Twenty-four replicates of each dentifrice, tested undiluted, were performed. Results indicated that dentifrice efficacy was ranked numerically as Arm & Hammer Dental Care > Colgate Regular > Crest Regular. In all of the assays the Arm & Hammer Dental Care dentifrice had significantly (p < 0.01-0.001) higher DDR mean values compared to the Colgate Regular and Crest Regular dentifrices. The Colgate Regular dentifrice was significantly (p < 0.01-0.001) superior to the Crest Regular dentifrice in the assays conducted.

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.