Faculty Bibliography

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.

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.

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.

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.

PURPOSE: To compare the safety and efficacy of a manual toothbrush and a battery-operated power toothbrush in two separate studies, one utilizing a single-use design and the other a 3-month parallel-group design. MATERIALS AND METHODS: The toothbrushes compared in the two studies were the Oral-B CrossAction manual toothbrush and the Colgate Actibrush battery-operated power toothbrush. The single-use study, which used a single-blind, cross-over design, involved 71 healthy subjects, who were instructed to abstain from oral hygiene for 23-25 hours prior to brushing with each of the two toothbrushes. Plaque was measured using the Proximal Marginal Index (PMI) pre- and post-brushing. The 3-month parallel-group study involved a total of 113 subjects who had plaque (PMI), gingivitis and bleeding (Loe and Silness) scored at baseline and after 1 and 3 months of product use. RESULTS: In both studies, the two toothbrushes were found to be safe. In the single-use study, significantly greater amounts of plaque were removed by the CrossAction manual toothbrush than by the Actibrush for the whole mouth as well as for marginal and approximal sites (P < 0.001). In the 3-month study, significantly greater plaque reduction was achieved with the CrossAction brush, the advantage being significant at 1 month for all sites except lingual sites (P < 0.05). At 3 months, there were consistent numerical advantages in favor of the CrossAction at all sites except lingual sites. Reductions in gingivitis were found to be similar with both toothbrushes.

PURPOSE: To evaluate the cleaning efficacy of three battery-operated, non-rechargeable, oscillating/rotating power toothbrushes, using a robot system to simulate normal clinical toothbrush use. MATERIALS AND METHODS: The study compared the cleaning efficacy of the new Braun Oral-B D4/EB4 with the Actibrush and the Dr. Best Powerclean in two independent experiments. Plaque substitute was applied to the artificial teeth of typodonts, which were cleaned by the robot system for a total of 2 minutes at a brushing force of 1.95 N. The remaining plaque substitute on buccal + lingual/palatal and occlusal surfaces, as well as gingival margin and interproximal sites, was measured using a computerized vision system. RESULTS: The new D4/EB4 was found to remove more plaque substitute than the Actibrush at all sites, and for all surfaces, lingual surfaces and occlusal surfaces the difference in favor of the D4/EB4 was statistically significant (P < 0.05). In comparison with the Powerclean toothbrush, the D4/EB4 was significantly more effective at all sites (P < 0.001). These results indicate that not all battery-operated oscillating/rotating power toothbrushes have equal efficacy with respect to plaque removal and that, in this series of laboratory experiments, the Braun Oral-B D4/EB4 was more effective than the Actibrush and the Dr. Best Powerclean.

PURPOSE: To compare the safety and efficacy of two battery-operated, non-rechargeable power toothbrushes, the Braun Oral-B Battery toothbrush (D4) and the Colgate Actibrush. MATERIALS AND METHODS: This was a randomized, single-blind, parallel-group study carried out over a 3-month period. A total of 114 subjects from a general population, who met the inclusion criteria of the study and who had whole mouth plaque scores of > or = 1.5 and gingivitis scores of > or = 1.2, participated in the study. Subjects were given either the D4 or the Colgate Actibrush with the manufacturers' instructions, and were asked to brush their teeth at home twice each day. At baseline and after 1 and 3 months, subjects were examined for oral hard and soft tissue health, after which they were assessed for gingivitis (Modified Gingival Index), bleeding (Gingival Bleeding Index), and plaque (Modified Quigley-Hein Plaque Index). Prior to each assessment, subjects refrained from all oral hygiene procedures for a period of 12-18 hours. RESULTS: No evidence was found of significant oral soft or hard tissue trauma, and both brushes were considered to be safe when used according to the manufacturers' instructions. In the D4 group, whole mouth, marginal and approximal plaque scores were significantly reduced from baseline (P < 0.05) after both 1 and 3 months by 7-12%, whereas, in the Actibrush group, plaque scores remained relatively unchanged from baseline throughout the study. Furthermore, comparisons between the toothbrush groups showed that whole mouth, marginal and approximal plaque scores for the D4 were significantly lower than those for the Actibrush at both the 1- and 3-month assessments. Modified Gingival Index scores after 3 months were significantly reduced from baseline in both groups by 7-8%. Similarly, percentages of bleeding sites were significantly lower by 12-15%. There were no significant differences between the groups with respect to gingivitis scores.

PURPOSE: To compare the safety and plaque removal efficacy of two angled-bristled toothbrushes. MATERIALS AND METHODS: The brushes were compared using a single-use, cross-over designed study, where healthy subjects from a normal population brushed their teeth with their assigned toothbrush for a timed 60 seconds. Pre- and post-brushing plaque levels were evaluated after disclosing, using the Proximal/Marginal Plaque Index. At the first visit, 100 subjects with a plaque index of > or = 2.20 after 23-25 hours of no oral hygiene were enrolled in the study. At the end of the study, data from 91 subjects were suitable for analysis. The two treatment sequence groups, X-Aktiv/CrossAction and CrossAction/X-Aktiv, were balanced for age and gender and, at each visit, pre-brushing plaque scores did not differ significantly between the two groups. Data from the two visits were pooled, after which plaque removal efficacies were compared. RESULTS: Both toothbrushes were found to be safe and both significantly reduced plaque levels (P< or = 0.0001), but the CrossAction was significantly more effective than the X-Aktiv for whole mouth and marginal sites, as well as the difficult-to-access approximal areas (P< or = 0.0008). For the whole mouth, the CrossAction was 11.8% more effective; for marginal sites the difference was 12.6%, and for approximal sites the difference was 11.4%. It is concluded that the Oral-B CrossAction toothbrush is significantly more effective with respect to plaque removal than the Dr. Best X-Aktiv.

PURPOSE: To evaluate and compare the oral hard and soft tissue safety and the plaque-removing efficacy of a children's power toothbrush (Braun Oral-B Kids' Power Toothbrush-D10) and a manual toothbrush in children from a general population. MATERIALS AND METHODS: Seventy children aged 6-11 yrs were enrolled into a single-blind, randomized, parallel-design study. At baseline, oral hard and soft tissues were evaluated and plaque was assessed on buccal and lingual surfaces of all fully erupted permanent and primary teeth using the Turesky Modification of the Quigley-Hein Plaque Index. Eligible subjects were randomized to use either a Braun Oral-B children's power toothbrush (D10) or a manual toothbrush for the duration of the study. Subjects were instructed to brush their teeth at home twice daily for 1 min each day for the 30-day study period. At baseline and after 15 and 30 days, plaque was assessed following 12-18 hrs of no oral hygiene. In addition, at each visit single-use plaque removal was evaluated after subjects had brushed their teeth for 1 min under supervision. Oral hard and soft tissues were assessed for safety before and after the supervised 1-min brushing at each visit. RESULTS: There were no pre-brushing oral hard and soft tissue abnormalities or post-brushing changes in oral tissues in either group. There were statistically significant reductions in mean plaque index for the whole mouth (P< 0.006), buccal surfaces (P < 0.0001) and anterior teeth (P< 0.008) from day 0 to day 30 in the D10 group, but not in the manual group. Greater mean changes in whole mouth plaque reduction were seen for the D10 group as compared to the manual group at days 15 and 30 (P< 0.05). Results from the single-use supervised brushing at each visit revealed that reductions in mean whole mouth plaque were statistically significant in both groups at each visit (P< 0.0001). There was statistically significantly greater plaque removal after a single brushing at day 0 in the D10 group compared with the manual group (P< 0.002), but the difference was not significant at days 15 and 30.

PURPOSE: To compare the safety and efficacy of two oscillating-rotating power toothbrushes, the rechargeable Braun Oral-B D8 and the battery-powered Colgate Actibrush. MATERIALS AND METHODS: This was a randomized, examiner-blind, parallel-group study, carried out over 3 months of product use, involving a total of 113 healthy subjects with a plaque score of > or = 1.5 and a gingivitis score of > or = 1.1. Subjects were given written and verbal instructions in the use of their respective power brushes and were told to brush twice per day. At baseline, hard and soft tissues were examined, and plaque scores and gingival scores were recorded after 12-18 hrs of no oral hygiene. Subjects returned after 3 months, at which time soft and hard tissues were re-examined and plaque and gingivitis scores were recorded. RESULTS: No evidence was found of soft or hard tissue trauma and both brushes were considered to be safe when used according to the manufacturers' instructions. After 3 months, whole mouth plaque scores had decreased by 7% in the D8 group but had increased by 4.3% in the Actibrush group. The decrease from baseline in the D8 group was statistically significant, but the increase in the Actibrush group was not. The difference between the two groups was statistically significant both for the whole mouth and all individual sites. Whole mouth gingivitis scores were also reduced significantly from baseline in both groups, by 22.5% in the D8 group and by 17.5% in the Actibrush group. For whole mouth scores and all individual sites (interproximal, buccal and lingual), the D8 was significantly more effective than the Actibrush.