New design of interdental rubber picks - does the archimedean screw design bring an improvement for experimental cleaning efficacy and force?

BACKGROUND: Up to date, interdental brushes (IDB) are the first choice for interdental cleaning because of their cleaning efficacy. Cylindrical ones must be selected individually according to the size/morphology of the interdental area (IDR), whereas conical ones cover a larger variability of IDR. However, there is a trend on the part of patients towards interdental rubber picks (IRP) which are in general conically shaped, and which seem to be linked with lower cleaning efficacy. A new IRP with an Archimedes´ screw design was developed to overcome this limitation. Therefore, the in vitro study aimed to measure the experimental cleaning efficacy (ECE) and force (ECF) during interdental use of IDBs versus the new IRP type. METHODS: Three IRPs with different tapers (PHB angled: 0.039, PHB straight S: 0.027, Vitis straight M: 0.045; all Flexipicks, Dentaid, Cerdanyola del Vallès, Spain) were compared to one IDB (Interprox micro PHD 0.9, Dentaid, Cerdanyola del Vallès, Spain). IDR were reproduced by a 3D-printer (Form2, Formlabs Sommerville, MA, USA) according to human teeth and matched to equivalent pairs (isosceles triangle, concave, convex) in three different diameters (1.0 mm,1.1 mm,1.3 mm). Covered with simulated biofilm, pre-/ post-brushing situations of IDR (standardized, computer-aided ten cycles) were photographed and quantified by digital image subtraction to calculate ECE [%]. ECF were registered with a load cell [N]. Statistically significant differences were detected using the Mann-Whitney-U-test and the Kruskal-Wallis-test with Bonferroni correction for multiple testing. RESULTS: Overall, the ECE (mean ± SD) was higher for IDB micro 0.9 (45.95 ± 11.34%, p < 0.001) compared to all IRPs (PHB angled: 25.37 ± 15.29%; PHB straight: 22.28 ± 16.75%; Vitis straight: 25.24 ± 12.21%; p ≤ 0.001), whereat best ECE was achieved in isosceles triangle IDR of 1.0-1.1 mm (IDB micro 0.9: 70.7 ± 7.7%; PHB angled S: 57.30 ± 4.43%; p < 0.001). The highest ECF occurred for Vitis straight M with 2.11 ± 0.46 N, while IDB micro 0.9 showed lowest ECF values (0.64 ± 0.14 N; p < 0.001). CONCLUSIONS: IRP with an Archimedes´ screw design and a higher taper were associated with advanced ECE but also higher ECF, nevertheless, ECE didn't reach the cleaning efficacy of conventional IDBs.

Powered or manual toothbrushes for people with disabilities - which is better?

DESIGN: A systematic review. AIM: Assess the effectiveness of manual toothbrushes (MTB) and powered toothbrushes (PTB) for people with physical or intellectual disabilities. DATA SOURCES AND STUDY SELECTION: The following data sources (MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE) were searched from the date of creation to February 2022 for papers which met the inclusion criteria. There were no language limitations set. The included studies were then hand-searched for relevant studies to be included. DATA EXTRACTION AND SYNTHESIS: Two reviewers screened the studies from the searches using Rayyan web application (Artificial-Intelligence search engine). Studies which met the inclusion criteria were selected. The studies were independently screened for the inclusion/exclusion criteria. Disagreement was resolved by discussion and consensus, or by a third party. Studies were then classified as low/moderate/high risk of bias. Analysis was performed on four subgroups; individual performing the brushing - (1) caregiver or (2) participant, main disability of the participant - (3) physical or (4) intellectual disability. Due to insufficient numerical data, a descriptive analysis was completed in place of the planned meta-analysis. RESULTS: In total, 16 publications were included within the results. There was no significant difference between manual or powered toothbrushing in both disability groups for the removal of plaque or gingival health. This applied to both self-brushing and caregiver brushing. CONCLUSIONS: There is no significant difference between powered and manual toothbrushes for effective oral hygiene maintence for people with physical or intellectual disabilities.

Color stability of bleached tooth enamel brushed with different stain-removing toothpastes.

OBJECTIVE: The effects of four toothpastes on the color stability of in-office bleached tooth specimens were determined. MATERIALS AND METHODS: We evaluated an experimental toothpaste (EXP) and three commercially available toothpastes: Colgate Optic White (OPW), Aquafresh White & Protect (AWP), and Crest 3D White (CDW). OPW, AWP, and CDW contained inorganic abrasives, whereas EXP and AWP contained sodium polyphosphate. Forty-eight randomly selected human-extracted maxillary central incisors were bleached and brushed twice daily over 30 days. We analyzed the final color difference (ΔE*ab, ΔE00 , ΔWID ), arithmetic average surface roughness (Ra) of the enamel measured on days 0 and 30, and scanning electron microscopy images of enamel surfaces and toothpastes. ΔE*ab, ΔE00 , ΔWID , and Ra were analyzed using one-way analysis of variance and Tukey's test (α = 0.05). RESULTS: ΔE*ab and ΔE00 values were significantly lower after toothbrushing with EXP, OPW, and CDW than with AWP. OPW induced the greatest positive ΔWID . Ra was significantly increased by OPW and CDW, but slightly increased by AWP, with cube-like particles, and EXP, with no particle-like structures. CONCLUSIONS: Only EXP stabilized the color of bleached teeth without increasing the enamel surface roughness. Sodium polyphosphate with approximately 10 phosphate groups was effective at removing stains. CLINICAL SIGNIFICANCE: The effect of toothpaste on the color stability of bleached teeth depends on the constituting abrasives and chemical components. Polyphosphoric acid has different stain-removal effects depending on its degree of polymerization. Additionally, although certain types of abrasives may be effective for color stability, they also increase the surface roughness of the enamel.

An updated systematic review on toothbrush contamination: An overlooked oral health concern among general population.

OBJECTIVES: The present systematic review was conducted to give an overview of toothbrush contamination among the general population and the factors affecting toothbrush contamination with an evidence-based approach. DATA/SOURCES: Medline (Pub Med), CINAHL Plus, Cochrane Library and Dentistry and Oral Health Sciences Source were searched for the results after applying the search strategy from January 2012 to May 2022, following inclusion and exclusion criteria. The data were collected using a self-made data collection form on study characteristics, population attributes and the main features, including the study's outcomes. The methodological quality of the included studies was independently evaluated based on the Joanna Briggs Institute's (JBI) critical appraisal checklist for cross-sectional studies and the Risk of Biasness Tool-1 (Rob-1) for randomized controlled trials (RCTs). A descriptive analysis of the included studies was done using SWiM guidelines. The impact of charcoal and non-charcoal brushes on toothbrush disinfection was quantitatively analysed using a forest plot. STUDY SELECTION: Of the 687 studies screened by title and abstract, 27 articles were selected for full-text evaluation using the EndNote reference program (Ver. X9.2). From these, 15 qualified and were included in the systematic review. Among the selected studies, eight were RCTs, six were cross-sectional studies, and the remaining one was an in vitro experimental study. CONCLUSIONS: The toothbrush becomes contaminated even after its first usage, and the contamination level rises with continued use. There are a number of factors that lead to the contamination of brushes, such as increased humidity brought on by a plastic cover or a toilet setting. Charcoal brushes show significant efficacy as compared to regular bristles in reducing toothbrush contamination; however, more RCTs are needed to further assess its efficacy. Nevertheless, rinsing with chlorhexidine mouthwash after daily brushing shows favourable results.

Promoting regular parental supervised toothbrushing: An additive intervention design adopting the Health Action Process Approach.

The study aimed to test the efficacy of the core elements of the Health Action Process Approach (HAPA) in an intervention among parents to promote regular supervised toothbrushing of preschool-aged children. The pre-registered study (https://osf.io/fyzh3/) tested the effects of an intervention employing information provision, behavioural instruction, implementation intention and mental imagery techniques, adopting a randomised controlled design in a sample of Australian parents of preschoolers (N = 254). The intervention used an additive design with four conditions-education, self-efficacy, planning and action control-progressively layered to show the cumulative impact of incorporating self-efficacy, planning and action control strategies with a foundational education component. The intervention was delivered online, and participants completed self-report measures of parental supervised toothbrushing and HAPA-based social cognition constructs pre-intervention and 4 weeks post-intervention. Although no significant intervention effects on behaviour were observed, mixed-model analyses of variance (ANOVAs) revealed an increase in intention and task self-efficacy within the action control condition and an increase in action planning in both the action control and planning conditions from pre-intervention to follow-up. Despite no anticipated changes in behaviour, these findings endorse the use of theory- and evidence-based behaviour change strategies to inspire change in HAPA-based determinants of parental supervised toothbrushing: intention, action planning and task self-efficacy.

Association Between Daily Toothbrushing and Hospital-Acquired Pneumonia: A Systematic Review and Meta-Analysis.

Importance: Hospital-acquired pneumonia (HAP) is the most common and morbid health care-associated infection, but limited data on effective prevention strategies are available. Objective: To determine whether daily toothbrushing is associated with lower rates of HAP and other patient-relevant outcomes. Data Sources: A search of PubMed, Embase, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and 3 trial registries was performed from inception through March 9, 2023. Study Selection: Randomized clinical trials of hospitalized adults comparing daily oral care with toothbrushing vs regimens without toothbrushing. Data Extraction and Synthesis: Data extraction and risk of bias assessments were performed in duplicate. Meta-analysis was performed using random-effects models. Main Outcomes and Measures: The primary outcome of this systematic review and meta-analysis was HAP. Secondary outcomes included hospital and intensive care unit (ICU) mortality, duration of mechanical ventilation, ICU and hospital lengths of stay, and use of antibiotics. Subgroups included patients who received invasive mechanical ventilation vs those who did not, toothbrushing twice daily vs more frequently, toothbrushing provided by dental professionals vs general nursing staff, electric vs manual toothbrushing, and studies at low vs high risk of bias. Results: A total of 15 trials met inclusion criteria, including 10 742 patients (2033 in the ICU and 8709 in non-ICU departments; effective population size was 2786 after shrinking the population to account for 1 cluster randomized trial in non-ICU patients). Toothbrushing was associated with significantly lower risk for HAP (risk ratio [RR], 0.67 [95% CI, 0.56-0.81]) and ICU mortality (RR, 0.81 [95% CI, 0.69-0.95]). Reduction in pneumonia incidence was significant for patients receiving invasive mechanical ventilation (RR, 0.68 [95% CI, 0.57-0.82) but not for patients who were not receiving invasive mechanical ventilation (RR, 0.32 [95% CI, 0.05-2.02]). Toothbrushing for patients in the ICU was associated with fewer days of mechanical ventilation (mean difference, -1.24 [95% CI, -2.42 to -0.06] days) and a shorter ICU length of stay (mean difference, -1.78 [95% CI, -2.85 to -0.70] days). Brushing twice a day vs more frequent intervals was associated with similar effect estimates. Results were consistent in a sensitivity analysis restricted to 7 studies at low risk of bias (1367 patients). Non-ICU hospital length of stay and use of antibiotics were not associated with toothbrushing. Conclusions: The findings of this systematic review and meta-analysis suggest that daily toothbrushing may be associated with significantly lower rates of HAP, particularly in patients receiving mechanical ventilation, lower rates of ICU mortality, shorter duration of mechanical ventilation, and shorter ICU length of stay. Policies and programs encouraging more widespread and consistent toothbrushing are warranted.

Effect of whitening toothpastes on the surface roughness and microhardness of human teeth-an in vitro study.

OBJECTIVE: To determine the effect of whitening toothpastes on the surface roughness and microhardness of human teeth. METHODOLOGY: Surface roughness was estimated using the Talysurf instrument, and microhardness was estimated using the Vickers hardness tester before and after the application of whitening toothpastes on mounted extracted human teeth. RESULTS: In the activated charcoal group, there was a reduction in the surface roughness from 1.21 at baseline to 1.09 at 1 month and a further reduction to 1.02 at 3 months, which was found to be statistically significant. However, no statistically significant difference in surface roughness was found in the other toothpaste groups. With respect to microhardness, all 4 whitening toothpastes showed a statistically significant reduction in microhardness after 3 months of brushing. However, the reduction was significantly higher in group 2 and in group 4 compared to the others. CONCLUSION: This study showed that whitening toothpaste containing activated charcoal significantly reduced the surface roughness, whereas toothpastes with blue covarine and toothpastes containing activated charcoal significantly reduced the microhardness of the tooth. CLINICAL RELEVANCE: This study emphasizes the need for healthcare professionals to be aware of the potential disadvantages of whitening toothpastes and make evidence-based decisions when recommending the product to patients.

Impact of school for future parents and first preventive examination in the first year of life on oral habits.

Pregnancy is an ideal time to promote the primary prevention of early childhood caries. It is crucial to have a child's first dental examination in the first year of life. The aim of this study was to find out how the School for future parents and the child's first dental examination affect children's oral habits. A specialist pediatric dentist was involved in the implementation of the School for future parents and the courses and on timely care for the good oral health of the child. We examined all one- and two-year-olds whose parents responded positively to a dental examination for their child. During the first examination, we considered attendance at the School, how the parents booked the dental examination, what the child drinks when thirsty, how many times a day they brush their children's teeth and toothpaste use. During the second examination, we considered what the child drinks when thirsty, how many times a day the parents brush their children's teeth and toothpaste use. The results showed that participants in the School were more likely to book their children's first preventive, consultative dental examination (p < 0.001), brush their children's teeth, and use toothpaste (p < 0.001) than parents who did not attend the school. However, there was no difference between the two groups regarding what parents gave their children to drink when they were thirsty (p = 0.69). In the child's second year, all the parents used toothpaste, brushed their children's teeth more often, and their children drank sweet drinks more often than before the first examination (p < 0.001). We have succeeded in raising awareness of good oral habits among parents and children (the frequency of brushing children's teeth and the using toothpaste), but not changed the behavior in the type of drinking against thirst.

Environmental impact of the supervised toothbrushing programme amongst children in Scotland.

OBJECTIVES: To understand the environmental impact of providing a nationwide supervised toothbrushing programme (Childsmile) for 5-year-old children in Scotland. METHODS: A life cycle assessment was conducted to assess the annual environmental effects of the supervised toothbrushing programme in early years childcare, as well as each dental procedure (dental restoration under local anaesthesia (LA), single tooth extraction under LA, and multiple teeth extraction under general anaesthesia) spanning from 2001/02 to 2009/10. The expected savings in annual carbon dioxide equivalent (CO2e) emissions for all combined dental treatments in subsequent years were calculated compared to those in 2001/02. RESULTS: An overall decrease in CO2e emissions was evident in the Childsmile programme and across all dental procedures. The estimated reduction in emissions across all procedures varied from 102.5 tonnes in 2002/03 to 461.1 tonnes in 2009/10 when compared to 2001/02. Within three years, the expected emissions savings from all combined dental procedures surpassed the emissions generated by implementing the Childsmile programme. CONCLUSIONS: Over time, there was a significant reduction in annual CO2e emissions for all combined dental treatments in children. In the eighth year of the Childsmile, emissions savings were more than 4.5 times greater than the emissions generated during its implementation. CLINICAL SIGNIFICANCE: The study highlights the importance of educating public by individual dentists about the environmental impact of caries prevention programmes and paediatric dental treatments as this may influence patient choice. It also encourages commissioners of community dental programmes to support the implementation of supervised toothbrushing programmes in early years childcare.

Development and evaluation of the "Toothbrushing Timer with Information on Toothbrushes" application: A prospective cohort pilot study.

OBJECTIVES: For people, it is challenging to be conscious of the appropriate toothbrushing time to maintain good oral health in daily life. The aim of this study was to preliminarily examine the utility of an application (app) that combines a toothbrushing timer and information on toothbrushes. MATERIALS AND METHODS: We developed the "Toothbrushing Timer with Information on Toothbrushes" app to help users ensure appropriate toothbrushing time and learn about the beneficial characteristics of toothbrushes. A total of 18 participants were registered for the study. At baseline (T0) and after 1 month (T1) of app usage, study participants answered a digital questionnaire that comprised three questions on oral health practice, self-efficacy in oral hygiene, and quality of life related to oral health (Oral Health Impact Profile-14 [OHIP-14]). RESULTS: Five participants were excluded from the analysis as they did not answer the digital questionnaire. Finally, 13 participants completed the survey with a follow-up of 1 month. The 13 participants were grouped into health professionals (n = 8) and non-health professionals (n = 5). The total scores for oral health practice and self-efficacy related to oral hygiene increased after a month of app usage in health professional and non-health professional groups. However, there were no significant differences between T0 and T1 in either group. The total score of OHIP-14 was lower at T1 than at T0 in both groups. Therefore, participants showed better oral health practice, self-efficacy in oral hygiene, and quality of life related to oral health at T1 compared with that at T0. CONCLUSIONS: Our app showed positive results for the users and is useful in maintaining and promoting oral health awareness and practice. However, our pilot study lacks sufficient power and did not yield significant differences. Therefore, high-quality clinical trials with larger sample sizes are warranted for further improvement and evaluation.

Effect of Different Cleaning Regimes on Biofilm Formation of Acrylic-Based Removable Orthodontic Appliance: A Randomized Clinical Trial.

Objectives: This study aimed to evaluate the effects of different cleaning regimes of acrylic-based removable orthodontic appliances on bacterial biofilm formation and whether the surface modification, i.e., polished acrylic fitting surface, reduces biofilm formation. Materials and Methods: This double-blind, parallel, randomized clinical trial involved thirty-nine orthodontic patients indicated for removable orthodontic appliances. The patients were allocated into three groups according to the cleaning method: brushing with a denture brush and chlorhexidine (CHX) toothpaste, Lacalut cleaning tablet, and a combination of both cleaning methods. Each patient wore an upper removable appliance containing eight wells fitted with eight detachable acrylic tiles (four polished and four unpolished) for seven days. Five types of oral microbiota were evaluated using selective growth media and biochemical tests. The biofilm cleaning efficacy was assessed using the colony-forming unit (CFU) and scanning electron microscopy (SEM). Statistical Analysis. Data from the CFU using different cleansing regimes were compared, following log transformation, using one-way analysis of variance (ANOVA). The polished and unpolished tiles were compared for biofilm formation on each cleansing method using an independent t-test. Results: There was no significant difference among the three cleaning methods on the polished or unpolished tiles. However, in polished tiles, streptococci were significantly reduced in all cleaning methods, whereas staphylococci and Staphylococcus aureus were markedly decreased in brushing and combination cleaning methods. However, the total number of anaerobic bacteria was significantly reduced in polished tiles using the combination method only. Conclusions: Polishing the fitting surface of an acrylic-based orthodontic appliance reduced the tested bacterial biofilm formation and may enhance cleaning efficiency. Brushing and combination methods showed superior cleaning effects compared to cleaning tablets. This trial is registered with NCT05707221.

Tooth brushing with fluoridated toothpaste and associated factors among Chinese adolescents: a nationwide cross-sectional study.

BACKGROUND: Tooth brushing with fluoridated toothpaste has become the most important way to provide the anti-caries effect of fluoride around the world. China has promoted the use of fluoridated toothpaste since 1989. However, there are few studies on the national profile of use of fluoridated toothpaste and related factors in Chinese adolescents. We carried out this study to investigate oral hygiene behaviours, especially the status of tooth brushing with fluoridated toothpaste and its correlates among adolescents, based on data from the latest Nation Oral Health Survey in mainland China. METHODS: This cross-sectional study recruited 118,601 participants aged 12-15 years using multistage stratified sampling. Questionnaires were completed by students at school. Data employed in analyses were extracted from the questionnaire, including information on tooth brushing, fluoridated toothpaste, dental floss, sociodemographic factors, fluoride knowledge and attitude towards regular dental check-ups. A binary logistic regression was performed to compute the odds ratios (OR). Tooth brushing twice daily with fluoridated toothpaste was the dependent variable. Sociodemographic factors, fluoride knowledge, attitude towards regular dental check-ups, dental visit experience and perceived oral health were the independent variables. P < 0.05 was considered statistically significant. RESULTS: A total of 32.6% of participants brushed their teeth twice daily, 7.4% used fluoridated toothpaste, and 3.9% cleaned their teeth twice daily with fluoridated toothpaste. The logistic regression showed the probability of twice-a-day tooth brushing with fluoridated toothpaste was higher among these groups: females (OR: 1.141; 95%CI: 1.072-1.214), 15-year-olds (OR: 1.786; 95%CI: 1.634-1.952), from urban areas (OR: 1.389; 95%CI: 1.288-1.497), without siblings (OR: 1.351; 95%CI: 1.259-1.450), with an educated father (OR: 1. 605; 95%CI: 1.442-1.788) and mother (OR: 1.706; 95%CI: 1.530-1.903), having dental visit experiences (OR: 1.702; 95%CI: 1.589-1.823), rating one's oral health as good (OR: 2.341; 95%CI: 2.083-2.631), having fluoride knowledge (OR: 4.345; 95%CI: 4.034-4.678) and having a positive attitude towards regular dental check-ups (OR: 1.589; 95%CI: 1.460-1.729). CONCLUSIONS: The oral hygiene behaviours of Chinese adolescents were undesirable. Twice daily tooth brushing with fluoridated toothpaste was significantly associated with sociodemographic factors, fluoride knowledge, and attitudes towards regular dental check-ups.

Salivary fluoride concentrations following toothbrushing with experimental toothpaste containing surface pre-reacted glass-ionomer (S-PRG) filler.

BACKGROUND: Single-blind 9 case comparative studies were conducted to evaluate salivary fluoride concentrations following toothbrushing using experimental toothpaste containing surface pre-reacted glass-ionomer (S-PRG) fillers. Preliminary tests were conducted in order to determine the volume of usage as well as the concentrations (wt %) of S-PRG filler. Based on the results given these experiments, we compared the salivary fluoride concentrations following toothbrushing with 0.5 g of 4 different types of toothpastes: 5 wt % S-PRG filler, 1400 ppm F AmF (amine fluoride), 1500 ppm F NaF (sodium fluoride), and MFP (monofluorophosphate) containing toothpaste. METHODS: Of the 12 participants, 7 participated in the preliminary study and 8 in the main study. All participants brushed their teeth using the scrubbing method for 2 min. At first, 1.0 and 0.5 g of 20 wt % S-PRG filler toothpastes were used to compare, then followed by 0.5 g of 0 (control), 1, and 5 wt % S-PRG toothpastes, respectively. The participants spat out once and rinsed with 15 mL of distilled water for 5 s. Saliva was collected for 3 min each at different time intervals of 0 (baseline), 5, 10, 15, 30, 60, 120, and 180 min after the rinsing. Fluoride concentrations were determined using a fluoride electrode, and the area under the salivary clearance - time curve (AUC: ppm‧min) of each toothpaste was calculated as the salivary fluoride retention. The main study was then conducted to evaluate the salivary fluoride concentrations as well as the AUC value using 0.5 g of 5 wt % S-PRG filler toothpaste, followed by NaF, MFP, and AmF toothpastes. RESULTS: Since there were no statistical differences between using 1.0 and 0.5 g of 20 wt % S-PRG toothpastes in salivary fluoride concentrations as well as the AUC value throughout the 180 min measurement, the volume was set as 0.5 g for the following studies. Concentrations of 5 and 20 wt % S-PRG toothpastes retained 0.09 ppm F or more in saliva even after 180 min. No statistical differences were seen in the salivary fluoride concentrations at any time intervals as well as the AUC value between 5 and 20 wt % S-PRG toothpastes. Based on these results, the concentration of 5 wt % S-PRG toothpaste was used for the main comparative study. MFP toothpaste resulted in by far the lowest salivary fluoride concentrations (0.06 ppm F at 180 min) and the AUC value (24.6 ppm‧min), whereas 5 wt % S-PRG toothpaste (0.15 ppm F at 180 min, 92.3 ppm‧min) displayed retention on par with AmF toothpaste which appeared to result in higher values (0.17 ppm F at 180 min, 103 ppm‧min), compared to NaF toothpaste (0.12 ppm F at 180 min, 49.3 ppm‧min). CONCLUSIONS: The salivary fluoride concentrations following toothbrushing with 0.5 g of 5 wt % S-PRG filler containing toothpaste showed retention similar to the best performing 1400 ppm F AmF toothpaste even 180 min after toothbrushing.

Comparative evaluation of "Tell-Tell-Tell," "Ask-Tell-Ask," and "Teach back" communication techniques on oral health education among 12-13-year-old children - An educational intervention trial.

Background: Effective communication with children can improve their understanding and aid in complying with oral hygiene instructions. Aim: The aim is to compare the retentiveness of oral hygiene instructions in children educated using three communication techniques. Methodology: One hundred and twenty children in the age range of 12-13 years were included in the study. Baseline awareness of oral hygiene maintenance was assessed using a questionnaire. Twenty children were randomly assigned to each group: Tell-Tell-Tell, Ask-Tell-Ask, Teach-back, and information provided. Knowledge was reassessed after a week; data were tabulated and assessed statistically. Results: There were no statistically significant differences in the baseline data among the groups (P > 0.05). Regardless of the group, there was an improvement in knowledge regarding the frequency and timing of brushing as well as the cause of dental caries after the intervention. However, children in Ask-Tell-Ask and Teach back showed significant improvement over Tell-Tell-Tell (P ≤ 0.01). Conclusion: Communication strategies, such as Ask-Tell-Ask and Teach back, which have a strategy to involve children, have been shown to be superior over Tell-Tell-Tell.

Effects of professional toothbrushing among patients with gingivitis.

OBJECTIVES: This study aimed to evaluate the biological and clinical effect of professional toothbrushing on the periodontal health of patients with gingivitis. METHODS: We enrolled 21 university students with gingivitis in Jinju City in this study between April 24 and October 28, 2014. A dental hygienist performed a professional toothbrushing routine on the participants twice, once at baseline and after 3 months. Oral examinations were performed at baseline, 3, and 6 months to assess the periodontal health. The patient hygiene performance index, gingival bleeding rate, periodontal pocket depth, amount of gingival sulcus fluid, and number of bacterial colonies in the gingival sulcus (CFU/mL) were evaluated during the oral examination. RESULTS: The patient hygiene performance index, gingival bleeding rate, pocket depth, amount of gingival sulcus fluid, and CFU/mL within the gingival sulcus significantly decreased after professional toothbrushing (p < 0.05), indicating an improvement in the periodontal health. The patient hygiene performance index, gingival bleeding rate, pocket depth, amount of gingival sulcus fluid, and CFU/mL within the gingival sulcus decreased more among those whose pocket depth was 4-5 mm than among those whose PD was ≤3 mm (p < 0.05). CONCLUSIONS: Professional toothbrushing improved the periodontal health in patients with gingivitis in respect of both biological and clinical results.

Comparison of modified bass, rolling, and current toothbrushing techniques for the efficacy of plaque control - A randomized trial.

OBJECTS: This study aimed to compare the effectiveness of the modified Bass technique (MBT), the Rolling technique and the current brushing technique(CBT) for plaque removal and to assess the acceptability of the first two brushing techniques. METHODS: 180 participants were randomly assigned to PowerPoint-based training with a demonstration of either the MBT plus basic toothbrushing, the Rolling technique plus basic toothbrushing, or the basics of tooth brushing alone (CBT group). The participants were asked to brush their teeth based on what they had learned. The Turesky modification of the plaque index of Quigley & Hein (TQHI) and marginal plaque index (MPI) were assessed at the baseline examination and after 1, 2, and 4 weeks. Brushing sequence, brushing technique, and brushing duration were measured immediately after training and at each subsequent interview. RESULTS: After instruction (0 weeks), all groups showed a significant decrease in TQHI and MPI (p<0.001), followed by a gradual increase. There was no difference in the overall effect of plaque removal between the groups(p>0.05). MBT had a better effect on cervical plaque removal than the Rolling technique after 4 weeks (p<0.05). More participants in the Rolling group were able to fully master the brushing technique during the whole four weeks. CONCLUSIONS: There was no difference in the overall plaque removal effect among the three groups. The MBT was most effective in removing plaque at the cervical margin but more difficult to master. CLINICAL SIGNIFICANCE STATEMENT: This study was conducted to compare the teaching and plaque removal effects of two brushing techniques and to understand which method is better for plaque removal as well as adoption. This study provides a reference and basis for future clinical work and oral hygiene education.

Characterization of whitening toothpastes and their effect on the physical properties of bulk-fill composites.

To characterize activated charcoal and 2% hydrogen peroxide-based toothpastes and investigate their effects on roughness, color change, and gloss of bulk-fill composite resin. Composite resin specimens (Aura Bulk Fill, SDI) were subjected to 5,000 brushing cycles with regular toothpaste (Colgate Total 12, [RT]), activated charcoal toothpaste (Bianco Dental Carbon, [AC]), or hydrogen peroxide-containing toothpaste (Colgate Luminous White Advanced, [HP]), with or without coffee exposure. The pH, particle characterization by scanning electron microscopy (SEM), and weight% of solid particles in the toothpaste were assessed. Roughness (Ra) was evaluated using a surface profile-measuring device, color change (∆Eab/∆E00) by reflectance spectrophotometer, and gloss unit (GU) by glossmeter. Kruskal-Wallis, Dunn, Friedman, and Nemenyi tests were used, and the correlation coefficient test was performed between Ra and GU (α=0.05). RT presented a higher Ra after brushing and did not change after staining with coffee; moreover, the ∆Eab/∆E00 values were higher for RT than HP. Regarding gloss, AC and HP obtained higher values compared to RT. A significant negative correlation between gloss and Ra was found for RT exposed to coffee. All toothpastes had a neutral pH; however, RT had the largest percentage of solids by weight. SEM images showed particles of many sizes: irregular shape (RT), more regular particles (AC), and spherical clusters (HP). Although surface roughness, color change, and gloss may compromise the longevity of restorations, the whitening toothpastes tested did not promote more morphology changes than regular toothpastes.

A Personalised 3D-Printed Dental Plaque Removal Mouthguard for Older Adults.

OBJECTIVES: The aim of the present study was to examine the plaque removal effectiveness of a personalised 3D-printed dental plaque removal mouthguard device in a clinical trial setting. METHODS: A personalised 3D-printed mouthguard was developed to clean dental plaque using micro-mist. A clinical trial was conducted to examine the plaque removal effectiveness of this device. The clinical trial recruited 55 participants (21 males and 34 females) with an average age of 68.4 years (range, 60-81 years). Dental plaque was dyed by plaque disclosing liquid (Ci). Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI) was used to evaluate the level and rate of plaque formation on the tooth surface. The TMQHPI was recorded and intraoral photos were taken before and after mouthguard cleaning. The plaque removal rate was calculated based on TMQHPI and intraoral photos (pixel-based method) before and after cleaning. RESULTS: The personalised 3D-printed micro-mist injection mouthguard can be effective in dental plaque removal on tooth and gingiva, and the effectiveness lies between that of a manual toothbrush and a mouth rinse. The newly proposed pixel-based method can be a practical, high sensitive tool to evaluate the level of plaque formation. CONCLUSIONS: Under the conditions of the present study, we conclude that the personalised 3D-printed micro-mist injection mouthguard can be useful in reducing dental plaque and may be especially suitable for older adults and disabled people.

Mirror, mirror on the wall-is toothbrushing instruction via a three-dimensional motion-tracked system the fairest of them all?

AIMS: To assess the efficacy of a smart toothbrush and mirror (STM) system which provided computer-assisted toothbrushing instruction versus conventional verbal toothbrushing instruction (TBI) amongst a group of 6-12-year-old children. DESIGN: This randomised controlled trial comprised South Korean school children who were randomly allocated to one of two arms - the STM (n = 21) or the conventional TBI arm (n = 21). The STM system used identical brushes as the TBI group, but with the brush employing three-dimensional motion tracking systems alongside a mirror with an inbuilt computer to guide the user. Modified Quigley-Hein plaque indexes were taken at baseline, immediately after STM/TBI, and then at 1 week and 1 month. RESULTS: Overall, there was a statistically significant reduction in the average whole-mouth plaque scores for both groups, 40.50% and 40.57% for the STM group and TBI group respectively. There was no statistical significance that either arm was more effective in reducing plaque scores than the other. Both groups demonstrated time to be a statistically significant factor in reducing plaque indices. CONCLUSION: There is no conclusive evidence that the STM system offers any benefits in terms of plaque control over conventional TBI in this study.

Effects of brushing duration on the efficacy of dental plaque removal: An in vitro study.

INTRODUCTION: This study was performed to evaluate the effects of varying brushing times on the dental plaque-removal efficacy of a power toothbrush to determine the optimal length of time required to brush the teeth. METHODS: A typodont with 32 teeth was divided into four quadrants and further divided into four zones each (two teeth per zone). Using a robotic arm, toothbrushing was performed over eight different brushing times (0, 60, 120, 180, 240, 300, 360, and 420 s) to remove the artificial plaque applied on the labial surface of the teeth in occlusion. Photographs were taken every 60 s from each zone of the typodont. The images obtained were processed using ImageJ software to measure the percentage of remaining plaque. Data were analysed with factorial ANOVA, least squares regression analysis, and post hoc Tukey tests. RESULTS: Plaque removal significantly increased with brushing time across the brushing intervals studied (p < 0.05). Efficient plaque removal was achieved after 240 s of brushing. There was no significant difference in plaque accumulations between the maxillary and mandibular arch (p = 0.19) and the right and left areas after each time interval (p = 0.49). CONCLUSION: Brushing duration is negatively correlated with the remaining plaque for a given toothbrush. Two minutes of brushing is not sufficient for significant plaque removal. Considering the limitations of this in vitro study, clinical studies are needed in order to change brushing recommendations to 240 s.