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Background: Poor oral hygiene in patients with tracheal intubation will increase the occurrence of dental plaque and mucosal inflammation, resulting in oral barrier dysfunction. This study aimed to design and evaluate a novel double-lumen endotracheal tube (DETT) and explore its role in infection control, particularly its effects on the oral microenvironment and ventilator-associated pneumonia (VAP)., Methods: This was a prospective, non-blinded, randomized parallel-controlled trial conducted from July 2024 to September 2024. A total of 115 patients who had been intubated for more than 3 days in a tertiary hospital ICU were enrolled and randomly assigned to either the DETT group (n = 58) or the conventional endotracheal tube (ETT) group (n = 57). Both groups received the same oral care protocols. The DETT group was intubated with the double-lumen endotracheal tube, which included a built-in bite block, while the ETT group used a standard endotracheal tube with a bite block. The primary outcome was the incidence of VAP, while secondary outcomes included oral bacterial colony counts, biofilm formation, BOAS oral health scores, and plaque index., Results: Compared to the ETT group, the DETT group showed a significant reduction in VAP incidence (χ²=4.382, p < 0.05). The DETT group also had significantly lower oral bacterial colony counts (Z=-7.362, P < 0.05) and biofilm formation (χ²=5.472, p < 0.05), as well as better BOAS scores (Z=-2.774, p < 0.05). However, there were no significant differences between the two groups in pathogenic bacterial presence or plaque index (p > 0.05)., Conclusions: The novel double-lumen endotracheal tube effectively reduces the total bacterial load in the oral cavity, inhibits biofilm formation, and lowers the incidence of VAP. It also improves oral function and hygiene, contributing to infection control, and holds significant clinical value., Competing Interests: Declarations. Ethics approval and consent to participate: The trial was approved by the Human Ethics Research Committee of the Affiliated Hospital of Jiaxing University (LS2021-KY-201-02). Consent for publication: We adhered to ethical guidelines by obtaining approval from the Human Ethics Research Committee of the Affiliated Hospital of Jiaxing University (LS2021-KY-201-02). All participants were given a detailed explanation of the study’s objectives and signed informed consent forms before enrollment, ensuring voluntary participation and confidentiality. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: A toothbrush device that telemonitors toothbrushing is a technologically advanced solution providing personalized feedback on toothbrushing habits and oral hygiene. These devices integrate smartphone apps to enhance oral health compliance through dental professional feedback., Objective: This 6-month prospective randomized controlled trial aimed to compare the clinical effectiveness, defined as improved oral hygiene measured by plaque reduction and halitosis control, of an interactive telemonitoring toothbrush (ITT), an oscillating-rotating power toothbrush (ORT), and a manual toothbrush (MT)., Methods: Participants were recruited offline from the Department of Advanced General Dentistry at Yonsei University Dental Hospital, South Korea. A total of 150 participants were randomly assigned to 3 groups (50 participants each): (1) an ITT connected to a smartphone app providing real-time feedback and weekly dental professional reviews, (2) an ORT with smartphone-based guidance requiring participants to send weekly brushing records via screenshots, and (3) an MT with a brushing diary for review. Data collection occurred in clinical settings. Primary outcomes included plaque reduction measured using the Simple Hygiene Score (SHS), while secondary outcomes included plaque reduction measured using the Turesky modification of the Quigley-Hein plaque index (QHI), reductions in halitosis, and changes in oral microbiota. All outcomes were assessed at baseline and 1 month, 3 months, and 6 months., Results: A total of 150 participants completed the study. Over 6 months, the SHS increased in the MT group (mean 3.16, SD 4.86 to mean 5.66, SD 5.20) but significantly decreased in the ITT group (mean 3.47, SD 5.50 to mean 2.27, SD 3.82; P=.004). Similarly, QHI decreased more in the ITT group (mean 1.79, SD 0.72 to mean 0.85, SD 0.63) than in the ORT (P<.001) and MT (P<.001) groups. Regarding microbiota, there were no significant differences in high-risk periodontal microbiota or the ratio of caries-risk to anticaries microbiota between the ITT and ORT groups. However, in the MT group, the ratio of caries-risk microbiota was significantly higher at the 3-month (P<.001) and 6-month (P=.005) recalls than at baseline and at the 3-month (P=.048) and 6-month (P=.03) recalls than at the 1-month recall. Poststudy questionnaires indicated that 45 of 50 ITT participants (92%) and 37 of 50 ORT participants (76%) reported improved brushing ability. The most effective feature in the ITT group was brushing training, while participants in the ORT group cited the brushing guide as most useful (P<.001). Satisfaction scores were higher in the ORT group (mean 7.90, SD 1.21) than in the ITT group (mean 7.15, SD 1.66; P=.004). The number of brushing events decreased significantly in the ORT group (P=.02), while brushing duration increased in the MT group (P=.01)., Conclusions: ITTs enable better oral hygiene management than MTs through dental professional feedback. However, further studies are needed to optimize feedback intervals and improve long-term adherence., Trial Registration: Clinical Research Information Service (CRIS), Republic of Korea, KCT0009094; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26110&search&#95;page=L., (©Jaeyeon Kim, Yiseul Choi, Yoolbin Song, Wonse Park. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 10.02.2025.)

Aims: To evaluate and compare the efficacy of manual toothbrush, audio-tactile performance (ATP) method, and musical toothbrush on plaque control and oral hygiene maintenance in visually impaired children., Methods and Results: The current observational study included 60 visually impaired children aged 9-16 years who were randomly divided into 3 groups, each with 20 children receiving oral hygiene instructions in different modes: Group 1 (Control) manual toothbrush, Group 2 (ATP) audio-tactile performance method with a manual toothbrush, and Group 3 musical toothbrush. Both manual (groups 1 and 2) and musical toothbrushes (Group 3) were changed after 3 months for better efficiency. Oral hygiene index simplified (OHI-S) and Rustogi Modified Navy Plaque Index (RMNPI) plaque scores were recorded at baseline, at the end of 1, 3, and 6 months. The collected data were statistically analysed using SPSS version 21. The intra- and inter-group comparisons were analysed using one-way ANOVA, and the multiple group comparisons were analysed using the Tukey HSD test. In intragroup comparisons from baseline to 6 months, both OHI-S and RMNPI plaque scores were reduced for group 3, only OHI-S plaque scores were reduced for group 2. Intergroup comparisons revealed a statistically high significant difference in OHI-S plaque scores from baseline to 6 months and RMNPI plaque scores from 1 to 6 months., Conclusion: The motivation and education with musical toothbrushes and audio-tactile performance (ATP) method could aid in the improvement of oral hygiene maintenance of visually impaired children., Competing Interests: Declarations. Conflict of interest: The author A declares that he has no conflict of interest. The author B declares that he has no conflict of interest and the author C declares that he has no conflict of interest. The author D declares that he has no conflict of interest. Ethical approval: This study has been performed in accordance with the Declaration of Helsinki and was approved by the Institutional ethical committee (Protocol/IRB/24/2015–16). Informed written consent was taken from all the parents/caretakers of the selected children who participated in the study., (© 2024. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

Background: An Oral irrigator, known as a dental waterjet (DWJ), is an adjunctive oral hygiene tool to remove dental plaque. The aim of this study was to systematically evaluate the effectiveness of oral irrigators on orthodontic patients' oral hygiene and periodontal status., Methods: A comprehensive search was undertaken in five electronic databases (PubMed, EMBASE, Web of Science, Scopus, and Cochrane) up to 1 May 2024. Clinical trials comparing DWJ with other adjunctive tools or no adjunctive in healthy orthodontic patients were included. The outcome was periodontal health condition measured by periodontal indexes. The risk of bias of the included studies was assessed using the Cochrane risk of bias tool. Random- effects meta- analyses of mean differences (MD) with their 95% confidence intervals (CI) were conducted and the overall quality of evidence was evaluated by GRADE approach., Results: Seven trials were included in the meta-analysis (Two with low, and others with unclear risk of bias). There was no statistically significant difference between automatic toothbrush (ATB) with DWJ and ATB alone in the gingival index (GI) (MD = 0.00; 95% CI -0.17- 0.18) (low quality of evidence). No statistically significant differences were found between (ATB + DWJ) and manual toothbrush (MTB) alone in the GI (MD= -0.11; 95% CI -0.31- 0.09) (very low quality of evidence). Also, no significant difference was detected between the two groups in the Plaque index (PI) (MD= -0.12; 95% CI -0.36- 0.11) (very low quality of evidence). There was no statistically significant difference between (MTB + DWJ) and MTB alone in the GI (MD= -0.06; 95% CI -0.16- 0.03) (very low quality of evidence). No statistically significant differences were revealed between the two groups in the PI (MD= -0.33; 95% CI -0.97- 0.32) (very low quality of evidence). No statistically significant improvements were found between these two groups in bleeding index (BI) (MD= -0.05; 95% CI - 0.12 - 0.01) (low quality of evidence)., Conclusions: Adding DWJ to either manual or automatic toothbrushes did not significantly enhance oral health of orthodontic patients. Orthodontists could recommend their patients to use either of these toothbrushes with or without DWJ. Further clinical trials are needed., Trial Registration Number: The protocol of this study was registered on PROSPERO with the ID # CRD42023465849., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: Silicone mouth swabs have emerged as a promising alternative to gauze, sponge brushes, and soft-bristled toothbrushes, offering a balance between gentle cleaning and effectiveness. The flexibility and softness of silicone make it a suitable material for safely cleaning the sensitive oral tissues of elderly patients. This study aims to determine the optimal hardness level of silicone that maximises cleaning effectiveness while minimising the risk of trauma to oral tissues., Materials and Methods: A pseudo-plaque was created by mixing 6.0 g of Thicken Up Clear food additive with 12.0 ml of water and food colouring, which was then spread onto a NISSIN dentoform silicone rubber sheet (simulated soft tissue) with a thickness of 2.0 mm. Silicone heads with different hardness levels - 20, 30, 40, 50, and 60 Shore A - were attached to a V.P.2000 tooth brushing machine, operating at 75 rounds per minute with a force of 1.96 N. Each swab was used to brush the surface 25 times (n = 16 for each group)., Results: A one-way analysis of variance (ANOVA) revealed a statistically significant difference in pseudo-plaque removal among the five hardness levels, with an F-value of 106.161 (degrees of freedom = 4, 75, p 0.001). The Games-Howell pairwise comparison test showed that all five silicone hardness levels differed significantly from each other in their effectiveness in removing pseudo-plaque (p 0.05). No visible simulated soft tissue damage was observed before and after brushing, as inspected with a stereomicroscope in all experiments., Conclusion: The silicone oral swab with a hardness level of 60 Shore A was found to maximise pseudo-plaque removal in vitro. This finding is crucial for the development of specialised oral hygiene tools tailored to the needs of the elderly population, thereby enhancing oral health and overall well-being.

Aim: Treatment of periodontitis, a chronic inflammatory disease driven by biofilm dysbiosis, remains challenging due to patients' poor performance and adherence to the necessary oral hygiene procedures. Novel, artificial intelligence-enabled multimodal-sensing toothbrushes (AI-MST) can guide patients' oral hygiene practices in real-time and transmit valuable data to clinicians, thus enabling effective remote monitoring and guidance. The aim of this trial was to assess the effect of such a system as an adjunct to clinical practice guideline-conform treatment., Materials and Methods: This was a single-centre, double-blind, standard-of-care controlled, randomized, parallel-group, superiority trial. Male and female adults with generalized Stage II/III periodontitis were recruited at the Shanghai Ninth People's Hospital, China. Subjects received a standard-of-care oral hygiene regimen or a technology-enabled, theory-based digital intervention consisting of an AI-MST and targeted doctor's guidance by remote micromessaging. Additionally, both groups received guideline-conform periodontal treatment. The primary outcome was the resolution of inflamed periodontal pockets (≥4 mm with bleeding on probing) at 6 months. The intention-to-treat (ITT) analysis included all subjects who received the allocated treatment and at least one follow-up., Results: One hundred patients were randomized and treated (50 tests/controls) between 1 February and 30 November 2022. Forty-eight tests (19 females) and 47 controls (16 females) were analysed in the ITT population. At 6 months, the proportion of inflamed periodontal pockets decreased from 80.7% (95% confidence interval [CI] 76.5-84.8) to 52.3% (47.7-57.0) in the control group, and from 81.4% (77.1-85.6) to 44.4% (39.9-48.9) in the test group. The inter-group difference was 7.9% (1.6-14.6, p < .05). Test subjects achieved better levels of oral hygiene (p < .001). No significant adverse events were observed., Conclusions: The tested digital health intervention significantly improved the outcome of periodontal therapy by enhancing the adherence and performance of self-performed oral hygiene. The model breaks the traditional model of oral health care and has the potential to improve efficiency and reduce costs (NCT05137392)., (© 2024 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Design: The study was designed as a single-blinded, parallel, randomized controlled trial to compare the effectiveness of the Salvadora persica toothbrush (MTB), Salvadora persica chewing stick (MCS), and a standard toothbrush (STB) in controlling plaque and gingivitis. A total of 78 participants were randomly divided into three groups and instructed to use their assigned oral hygiene tool in a standardized manner for three., Case Selection: Participants were non-dental students and staff of Universiti Kebangsaan Malaysia, Kuala Lumpur Campus, selected through convenience sampling. They met specific inclusion criteria, such as being systemically healthy, having ≥20 teeth, and having a Basic Periodontal Examination score of 0, 1, or 2, with no periodontal pockets greater than 5.5 mm., Data Analysis: Clinical outcomes were measured using the Plaque Index (PI) and Periodontal Inflamed Surface Area (PISA) at baseline, one-, and three-weeks post-intervention. Data analysis was performed using mixed-model analysis of variance for continuous variables and Fisher's exact test for categorical variables., Results: All three groups showed significant improvements in plaque levels and severity of gingivitis from baseline to three weeks post-intervention. The MCS group demonstrated a significant improvement in mean PISA values of the anterior teeth compared to the MTB and STB groups. However, there was no significant difference in plaque level reduction or overall gingivitis severity among the three groups. This indicates that when used correctly, Salvadora persica toothbrushes and chewing sticks are as effective as standard toothbrushes in plaque control and gingival health., Conclusions: The study concludes that both Salvadora persica toothbrushes and chewing sticks can serve as effective alternatives to the standard toothbrush for plaque control and gingival health. This showcases the beneficial anti-plaque and anti-gingivitis properties of Salvadora persica. However, the effectiveness of these oral hygiene tools is contingent upon the correct usage techniques., (© 2024. The Author(s).)

BACKGROUND Regularly removing dental plaque is key to good oral hygiene and gingival health promotion. This study aimed to compare the effects of using soft and medium toothbrushes using the plaque index (PI), gingival index (GI), and bleeding on probing (BOP) index. MATERIAL AND METHODS A randomized parallel-group study design was used. Sixty-four participants were randomly assigned to 2 similar intervention groups (medium and soft toothbrush groups). The PI, GI, and BOP indexes were used. The median and median difference of PI, GI, and BOP were calculated. SPSS was used for data entry and analysis. Wilcoxon and Mann-Whitney U tests were used for data analysis. RESULTS The median scores of GI, PI, and BOP significantly decreased from 1.8, 1.7, and 2.0, respectively, before using medium toothbrushes to 0.0, 0.1, and 0.0, respectively, after using medium toothbrushes (all P<0.0001). Similarly, the median scores of GI, PI, and BOP significantly decreased from 2.0, 1.7, and 2.0, respectively, before using soft toothbrushes to 1.1, 0.9, and 1.0, respectively, after using soft toothbrushes (P<0.0001). The median differences in GI, PI, and BOP scores among those using medium toothbrushes were higher than the median differences among those using soft toothbrushes [(1.8 vs 0.9), (1.6 vs 0.8), and (2.0 vs 1.0), respectively]. These differences were statistically significant (P<0.0001). CONCLUSIONS This study concludes that medium and soft toothbrushes were effective in removing plaque and controlling gingivitis. Medium toothbrushes were more effective than soft toothbrushes in achieving these outcomes.

Objective: Advances in mobile technology are helping with health management practices, and smart toothbrushes provide proper dental care by collecting and analyzing users' toothbrushing data. The purpose of this study is to assess the effect of a telemonitoring device on oral hygiene management in individuals with intellectual or developmental disabilities and its role in promoting oral health., Materials and Methods: Participants were split into two groups: one initially using the telemonitoring device (telemonitoring device/manual toothbrush) and the other using it later (manual toothbrush/telemonitoring device), with a one-month washout period. The study compared plaque index, halitosis, changes in oral microbiota, and guardian questionnaire responses between the groups., Results: In period 1, the QHI index score significantly decreased from 1.93 to 0.83 in the group using the remote monitoring device, compared to an increase from 1.75 to 2.01 in the manual toothbrush group. Additionally, toothbrushing frequency, time, and cooperation increased by 0.82 ± 0.60, 0.82 ± 1.16, and 1.09 ± 0.94, respectively, with initial telemonitoring device use. However, these measures decreased by -1.45 ± 0.68, -1.09 ± 0.70, and - 1.00 ± 1.00 after switching to a manual toothbrush, and decreased by -0.64 ± 0.67, -0.27 ± 1.19, and 0.09 ± 0.94 overall, respectively. However, there were no significant differences in oral microbiota between the groups at these different time points., Conclusions: The study shows that telemonitoring devices effectively reduce plaque index and improve toothbrushing frequency, time, and cooperation. However, these benefits decrease after switching to a manual toothbrush. Follow-up is needed to assess satisfaction and compliance with telemonitoring device use., Clinical Relevance: Using telemonitoring devices in the oral health management of individuals with intellectual and developmental disabilities can improve their oral health quality., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Our study aimed to evaluate the long-term concordance and acceptance when using powered devices for everyday oral hygiene routine and gingival health in patients showing papillary bleeding., Patients and Methods: Thirty-one participants were recruited at the dental clinic of the University Hospital of Cologne, Germany, over a 6-week duration. At baseline, a standard dental check-up was performed, including oral hygiene indices and documentation of oral hygiene devices used. The study consisted of two consecutive phases: the first (motivational trial) was designed to prove the effectiveness and safety of a microdroplet device and a powered toothbrush compared to dental floss and a manual toothbrush over a period of 4 weeks. The second (observational) phase began with all participants receiving the powered oral homecare devices. Participants were able to use their oral hygiene measures of choice over an unsupervised period of 1 year. All participants were then rescheduled for a routine dental check-up, where oral hygiene indices and oral hygiene devices used were reevaluated., Results: After 1 year, 93.3% of participants stated they performed interdental cleaning on a regular basis (baseline 60.0%). The percentage using a powered toothbrush increased from 41.9% (baseline) to 90.0% after 1 year. Oral hygiene parameters had improved after both the motivational trial and observational phases compared to baseline (papillary bleeding index p = .000; Rustogi Modified Navy Plaque Index p < .05; Quigley-Hein Index p = .000)., Conclusion: In the long term, participants preferred using powered oral hygiene devices over the gold standard dental floss and manual toothbrush. Improved oral hygiene parameters after 1 year may indicate implementation of newly acquired oral-hygiene skills during the 4-week instruction phase., (© 2024. The Author(s).)

Background: Orthodontic treatment presents challenges with plaque accumulation around brackets, archwires, and elastics, leading to retained plaque and gingival inflammation. Conventional toothbrushing may not be enough, requiring additional oral hygiene aids like interproximal brushes, dental flosses, and water flossers. Limited research exists on comparing water flossing and interdental flossing in orthodontic patients. Therefore, this study aims to assess their effectiveness in maintaining oral hygiene during active orthodontic treatment., Methods: A single-blind, randomized, parallel clinical study recruited orthodontic patients with full-mouth brackets and archwires. Thirty participants were randomly assigned to either water jet flossing or interdental flossing groups. All participants were instructed to brush twice daily with a provided toothbrush and toothpaste and use the assigned intervention once daily at night. Clinical measures, including the Gingival Bleeding Index (BI), Plaque Index (PI), and Gingival Index (GI), were recorded at baseline and day 14. Descriptive statistics and statistical tests were performed using SPSS software., Results: The water jet flossing group demonstrated a slightly higher, albeit non-significant, benefit in plaque removal (median difference of 6.79%%, P = 0.279) and bleeding reduction (median difference of 5.21%%, P = 0.172) compared to the interdental flossing group after two weeks. Both groups showed significant reductions in gingival bleeding index and plaque index from baseline to the 2-week follow-up. The interdental flossing group had median mean percentage differences of 16.13%% (plaque index) and 23.57% (gingival bleeding index), while the water jet flossing group had median percentage differences of 21.87% (plaque index) and 32.29% (gingival bleeding index). No significant changes in gingival index grades were observed in either group., Conclusion: Both water jet flossing and interdental flossing were effective in reducing plaque accumulation and gingival bleeding among orthodontic patients. While no significant differences were found between the two methods, water jet flossing showed a potential advantage. Further research is needed to validate its effectiveness, assess long-term impact, and understand its benefits for orthodontic patients., (© 2024. The Author(s).)

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., (© 2024. The Author(s), under exclusive licence to British Dental Association.)

The objective of this study was to evaluate the effect of different interdental oral cleaning modalities on gingivitis and plaque following a 6-week period of home use. This was a randomized, four-arm, parallel design clinical trial. Study subjects were manual toothbrush (MTB) users with moderate to severe gingivitis, aged 18 to 65 years. Subjects were required at baseline to have a gingival bleeding score of ≥1 on at least 50 gingival sites per the Gingival Bleeding Index (GBI) and to have an overall plaque score of ≥0.6 per the Rustogi Modified Navy Plaque Index (RMNPI) following a 3- to 6-hour plaque accumulation period. Subjects were randomly assigned to use one of four oral care cleaning modalities: (1) NON group: MTB alone, (2) FLS group: MTB plus string floss, (3) IDB group: MTB plus an interdental brush, or (4) CPF group: MTB plus the Philips® Sonicare® Cordless Power Flosser with the Quad Stream nozzle. Efficacy measures (Modified Gingival Index [MGI], GBI, and RMNPI) and safety were assessed at baseline, 2 weeks, and 6 weeks. The primary efficacy endpoint was the reduction in gingival inflammation from baseline to week 6 as measured by the MGI. Of the 372 subjects randomized in the study, 364 completed a post-baseline MGI evaluation and were included in the analyses. The adjusted mean percent reduction in gingival inflammation from baseline to week 6 was -2.10% for the NON group, 2.82% for the FLS group, 2.60% for the IDB group, and 29.10% for the CPF group. Pairwise comparisons indicated that the CPF group was statistically significantly different from the NON, FLS, and IDB groups (.0001). In conclusion, adjunctive use of the Philips Sonicare Cordless Power Flosser with the Quad Stream nozzle and an MTB showed statistically better results in term of reducing gingival inflammation following 6 weeks of home use when compared to an MTB alone, an MTB used with string floss, and an MTB used with an interdental brush.

The study objective was to evaluate the effect of two different interdental oral cleaning modalities on gingivitis and plaque following a 4-week period of home use. This was a randomized, parallel, single-blinded study. Subjects were routine manual toothbrush (MTB) users with moderate to severe gingivitis, aged 18 to 65 years. Subjects were required at baseline to have a gingival bleeding score of ≥1 on at least 50 gingival sites per the Gingival Bleeding Index (GBI) and to have an overall plaque score of ≥0.6 per the Rustogi Modified Navy Plaque Index (RMNPI) following a 3- to 6-hour plaque accumulation period. Subjects were randomly assigned to one of three groups based on the oral care cleaning modalities: (1) NON group: MTB alone, (2) IDB group: MTB plus an interdental brush, or (3) MPF group: MTB plus a Philips® Sonicare® Power Flosser with the Quad Stream nozzle. All subjects used the MTB with fluoride toothpaste. Efficacy measures (Modified Gingival Index [MGI], GBI, and RMNPI) and safety were assessed at baseline, 2 weeks, and 4 weeks. The primary efficacy endpoint was the reduction in gingival inflammation from baseline to week 4 as measured by the MGI. A total of 189 subjects were randomized and 186 completed the study. The adjusted mean percent reduction in gingival inflammation from baseline to week 4 was 2.80% for the NON group, 11.32% for the IDB group, and 20.87% for the MPF group. The differences between the MPF group and the NON and IDB groups were statistically significant (.0001). In conclusion, use of the MTB with the Philips Sonicare Power Flosser showed statistically significant benefits compared to an MTB alone and an MTB used with an interdental brush in reducing gingival inflammation following 4 weeks of home use.

Objectives: The present proof-of-principle study assessed whether daily use of a power-driven water flosser (Sonicare AirFloss; SAF) leads to bacterial colonization in the nozzle and/or the device, resulting in contaminated water-jet., Material and Methods: In five participants, saliva samples at baseline and water-jet samples of devices used daily with bottled water for 3 weeks (test) were collected. Additionally, water-jet samples from devices used daily with bottled water extra-orally for 3 weeks (positive control) and from brand new devices (negative control), as well as samples from newly opened and 1- and 3-week opened water bottles were collected. Colony forming units (CFU) were recorded after 48 h culturing and 20 oral pathogens were assessed by polymerase chain reaction-based analysis., Results: Distinct inter-individual differences regarding the number of detected bacteria were observed; water-jet samples of test devices included both aerobic and anaerobic bacterial species, with some similarities to the saliva sample of the user. Water-jet samples from positive control devices showed limited number of aerobic and anaerobic bacterial species, while the samples from negative control devices did not show any bacterial species. Very few aerobic bacteria were detected only in the 3-week-old bottled water samples, while samples of newly and 1-week opened water bottles did not show any bacterial growth., Conclusions: The present proof-of-principle study showed that daily use of a power-driven water flosser for 3 weeks resulted in bacterial colonization in the nozzle and/or device with both aerobic and anaerobic, not only oral, species, that are transmitted via the water-jet., (© 2021 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

The objective of this study was to investigate the influence of daily feeding of an oral care chew on the composition of canine supragingival plaque microbiota. Twelve beagle dogs were recruited to the randomized cross-over study. The dogs were fed one of two dietary regimes, both consisting of a commercially available wet and dry diet mix, either with or without daily supplementation with an oral care chew. After each 28-day test phase, supragingival plaque samples were collected and processed via Illumina sequencing to determine the microbiota composition. A comparative analysis of bacterial species associated with health and periodontal disease, identified from prior clinical studies, revealed differences between the dietary regimes. Consumption of the daily oral care chew, resulted in a significant increase in proportion of 6 health associated taxa but only 3 disease associated taxa compared to no chew. In contrast, 8 disease and 1 health associated taxa showed increased proportions for no chew versus the oral care chew. Daily feeding of the oral care chew tested in this study has therefore been shown to increase the proportion of health associated bacteria, over bacteria associated with periodontal disease, in supragingival plaque compared to no chew. By influencing plaque microbiota towards a bias for health associated bacteria, feeding of the oral care chew provides a means to reduce the prevalence of bacterial species shown to be associated with periodontal disease in dogs., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

This study aimed to investigate whether interdental brush shape influences cleaning efficacy, by comparing a waist-shaped interdental brush (W-IDB) with a cylindrical IDB (C-IDB); both provided with the same bristle texture. Cleaning efficacy of differently shaped IDBs was measured in proximal surfaces of teeth in a split-mouth cross-over design. Twenty-eight patients abolished oral hygiene for 4 d. Line angle plaque area was scanned with an intraoral camera after use of disclosing dye in baseline and after IDB application and analyzed planimetrically. Additionally, bacterial load in the IDBs was analyzed after usage by colony forming units (cfu). A Wilcoxon signed-rank test with continuity correction was used to compare the results of the waist-shaped and the cylindrically-shaped IDBs. The waist-shaped IDBs cleaned significantly better than their cylindrically-shaped counterparts (area cleaned: 23.1% vs. 18.3%), when applied at same interdental spaces (p < 0.001). However, no significant differences were found in comparison of bacterial load on the IDBs (median cfu counts: 2.3E9 vs. 2.7E9, p = 0.93). Irrespective of bristle texture or size, IDB shape have impact on cleaning efficacy. Waist-shaped IDBs are more effective in cleaning of the line angle area than cylindrically-shaped IDBs.

Background: The purpose of this study was to evaluate the mitigating effect of the use of interdental brushes on periodontal health inequality., Methods: This study was based on the data acquired in the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI; 2013-2015). A total of 17,583 participants (7,633 males and 9,950 females)) aged 19 years or older completed the KNHANES VI between 2013 and 2015. Multivariable logistic regression analysis was performed using socioeconomic characteristics (sex, age, level of education, individual income), personal health practice (smoking, toothbrushing, dental flossing, interdental brushing, dental clinic visiting), systematic medical factors (diabetes mellitus, hypercholesterolemia, hypertension, obesity) and the community periodontal index. We confirmed differences in the prevalence of periodontal disease with the use of an interdental brushes stratified according to individual income., Results: Three logistic regression models adjusted for covariates hierarchically. In all models, individuals who used an interdental brush were not significantly different from individuals who did not use an interdental brush. The adjusted odds ratio (OR) for interdental brushing was 0.918 with a 95% confidence intervals (CIs) of 0.797-1.057. When periodontal disease was the outcome of the model, the lowest income group had 1.266 (95% CIs 1.066 to 1.502) times the odds of having periodontal disease than the highest income group. In interdental brush nonusers, the lowest income group had 1.276 (95% CI 1.061-1.533) times the odds of having periodontal diseases than the highest income group. However, in the interdental brush users, there were no significant differences in periodontal disease prevalence among income groups., Conclusions: The results suggest that the use of interdental brushes could alleviate periodontal health inequality.

Introduction: Periodontal therapy disrupts the biofilm harbouring calculus that triggers inflammation. The explorer is primarily used for calculus detection, and the ultrasonic instrument is primarily used for calculus removal. The efficiency in dental hygiene care may improve if the ultrasonic instrument could be used in both calculus detection and removal., Purpose: The purpose of this study was to validate the effectiveness of calculus detection between the Thinsert® ultrasonic insert and the 11/12 explorer., Methods: Upon IRB approval, this validation study involved three dental hygiene faculty from the Ohio State University Dental Hygiene Program and 30 patient participants from the Ohio State University community. Using both instruments, calculus was evaluated on Ramfjord index teeth and on four possible surfaces per tooth. Data were analysed to evaluate for interrater reliability, intrarater reliability, sensitivity, and specificity., Results: For interrater reliability, the average measure of intraclass coefficient (ICC) value was 0.782 with a 95% confidence interval (CI) of 0.749-0.810 (F (1439, 2878)  = 4.852, P < 0.01). For intrarater reliability, mean Kappa averages were in the full agreement range (κ = 0.726, n = 2160, P < 0.01). When using the Thinsert® for calculus detection, the sensitivity was 75%, specificity was 97%, PPV was 81%, and NPV was 94%., Conclusion: Since calculus evaluation was comparable when using the ODU 11/12 explorer and the Thinsert®, efforts can be focused on developing the tactile sensitivity when using the Thinsert® ultrasonic instrument in the assessment, treatment, and maintenance of periodontal disease and the support of oral health. The efficiency in dental hygiene care may improve by using the Thinsert® ultrasonic instrument in both the detection and removal of calculus., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The tongue is one of the primary sources of halitosis. The manual or mechanical removal of biofilm is known to decrease oral malodor., Objective: To evaluate a new tongue hygiene technique hereby referred to as "the X technique" and its effects on both halitosis and the number of microorganisms based on microbiological parameters and diagnostic features of the breath., Material and Methods: The study included thirty patients divided into a control group (patients without systematized guidelines of lingual hygiene, but who performed the mechanical cleaning of tongue dorsum, each in its own way), the 3R group (instructed to perform the movements of the X technique for 3 repetitions at each brushing), and the 6R group (instructed to perform 6 repetitions of the technique at each brushing). After two weeks, a new data collection was performed., Results: Patients in the 6R group presented the lowest score on the organoleptic assessment scale at the second consultation, followed by the 3R group and the controls. Regarding the self-perception of breath by the method of Visual Analog Scale (VAS), the control group did not perceive improvements in oral malodor; the results of the 3R group and the 6R group were similar., Conclusion: These results indicate that the X technique improves both measurements and perceptions of halitosis. Microbiological analyses revealed greatest reduction in the 6R group. The findings show that the X technique reduces both organoleptic scores and the number of bacterial colonies, and improves users' perceptions of their breath.

Purpose: To evaluate oral and dermal tolerance following use and user acceptability of an experimental denture-cleansing wipe. An exploratory objective was to develop a method to assess denture wipe effectiveness in removing debris from denture surfaces., Materials and Methods: This was a single-center, randomized, controlled, parallel-group, examiner-blind study in participants with ≥1 full/partial denture. Participants were randomized to clean their dentures with the denture wipe (n = 76) or water (n = 76) up to 4 times per day for 14 days. Tolerability was assessed by treatment-emergent adverse events (TEAEs), oral soft tissue examination, and lead hand dermatological assessment. Acceptability was assessed by questionnaire. The feasibility of a methodology to assess the efficacy of the wipe at removing food particles was also evaluated through determination of the mass of chewed peanut particles that the wipe removed after a single use (n = 31)., Results: The proportion of participants experiencing oral TEAEs by day 14 was 0.039% with the denture wipe (lip injury [n = 1], mouth injury [n = 2]) and 0.013% with the water rinse (coated tongue [n = 1]). There were no dermal TEAEs and no TEAE-related study withdrawals. Skin irritation scores with the denture wipe remained unchanged from baseline. Comparing before vs. after cleaning with the denture wipe, a higher proportion of participants rated their dentures as feeling extremely/very fresh (28.9% pre-/85.5% post-cleaning), feeling extremely/very clean (34.2%/86.8%) and looking extremely/very clean (43.5%/85.5%). More denture-wipe group participants than water-rinse group participants were extremely/very satisfied with the amount of debris removed from their dentures (88.1% vs 72.4%). The methodology used to assess the weight of peanut particles captured from the wipes/dentures appeared to be a feasible investigation technique., Conclusions: The denture wipe was generally well-tolerated and had good user acceptability. The methodology for assessing the mass of peanut particles removed by denture wipes was successful., (© 2018 The Authors. Journal of Prosthodontics published by Wiley Periodicals, Inc. on behalf of American College of Prosthodontists.)

Aim: To evaluate the effectiveness of plaque removal of an experimental chewable brush in comparison with a manual brush in children between age 9 and 13 years., Method: This single blinded randomised controlled study included a total of 60 healthy children between age 9 and 13 years that fulfilled the selection criteria. Selected children were randomly assigned to manual toothbrush group (MT) and chewable toothbrush group (CT). Children were instructed to use the respective toothbrushes under supervision. Effectiveness of plaque removal was evaluated by recording Turesky's modification of Quigley-Hein index scores (TMQHI) before and after brushing on single use. Difference in the pre-brushing and post-brushing plaque scores between the groups were statistically compared by using Mann-Whitney U test., Results: TMQHI plaque scores of selected children for the MT and CT groups was found to be statistically similar before using the toothbrush (p = 0.072). Difference between overall plaque reduction scores were found to be 1.0 for MT and 1.13 for CT, which did not reveal statistical significance (p = 0.308). In order to evaluate efficiency of chewable toothbrush, TMQHI scores for buccal and lingual scores were analysed separately, and found no statistical significance in plaque removal on either surfaces (p = 0.944 for buccal, p = 0.080 for lingual)., Conclusions: Chewable toothbrush was found to be as effective in total plaque removal as manual tooth brushing in the children between age 9 and 13 years. The chewable brush may be an appropriate oral hygiene adjunct for school children spending a considerable amount of time out of home.

Objective: This in-vitro study aimed to develop a technique to measure the frictional forces and determine the frictional coefficient (μ) associated with the rubbing of dental floss against teeth. Incorrect flossing technique and the etiology of grooves at the cementoenamel junction (CEJ) of proximal area of teeth has long been a controversial topic. We hypothesized that the μ between teeth surfaces and dental floss is affected by contact angulation., Materials and Methods: Tests were conducted using two different types of dental floss (waxed and unwaxed nylon) on different surfaces (enamel, dentine, smooth and rough glass rods) under different moisture conditions (dry and wet). The μ generated by performing C-shape flossing was measured, using the Capstan equation, at constant load (100g) over different flossing contact sliding angulations. In addition, the surface characteristics of intact and used nylon flosses were compared using a scanning electron microscope (SEM)., Results: The mean μ was highest with a smooth glass rod (0.42±0.11), followed by rough glass rods (0.30±0.07), dry enamel (0.27±0.08), wet enamel (0.23±0.06), then dentine (0.18±0.04). Moreover, higher μ was associated with waxed floss when used against dry enamel, smooth and rough glass rods (P<0.001). At different moisture conditions, waxed floss demonstrated greater μ with dry surfaces (P<0.03). No association was found between μ and dental floss contact angulation. Both floss types showed deterioration after usage; although waxed type exhibited markedly greater deterioration when used on dry surfaces. In conclusion, the magnitude of the μ was found to be influenced by surface roughness, moisture condition, and independent of the contact angulation area during sliding of dental floss., Significance: It is important to consider the potential side effects of frictional forces on both tooth surface and dental floss during clinical application., (Copyright © 2018. Published by Elsevier Inc.)

Objective: To compare the effect of a single-tufted toothbrush combined or not with a conventional toothbrush to control dental biofilm in healthy orthodontic patients., Materials and Methods: Twenty orthodontic patients were randomly assigned to receive three different treatments: Group 1-conventional toothbrush; Group 2-single-tufted toothbrush and Group 3-combination of single-tufted and conventional toothbrushes. Stained plaque index (SPI), visible plaque index (VPI) and gingival bleeding index (GBI) were recorded. The data were analysed by Kolmogorov-Smirnov test. Wilcoxon test was used for intragroup comparison and Friedman test for the intergroup comparison (α = 5%)., Results: Intragroup analysis showed that VPI and SPI significantly decreased (P < 0.05) after 72 hour in Group 3. Anterior and posterior teeth did not show any significant statistical differences after 72 hour (P > 0.05), but VPI values in the labial surfaces were different to Group 3 (P < 0.05) in comparison with the other groups after 72 hour. Group 3 showed a statistically significant reduction (P < 0.05) for SPI in the interproximal surfaces when compared with Group 1., Conclusion: The combination of single-tufted and conventional toothbrushes was effective for controlling dental biofilm formation in orthodontic patients., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To evaluate and compare the efficacy of customized toothbrushes in maintenance of oral hygiene and gingival health with that of conventional toothbrushes in children with cerebral palsy., Methods: Thirty patients with cerebral palsy in the age group of 6 to 18 years were randomly divided into two groups-group I (normal toothbrush) and group II (customized toothbrush). Common oral hygiene instructions were given to both the groups. Before beginning the study, plaque index (PI) and modified gingival index (MGI) were recorded, following which patients were made to practice their routine twice a day brushing with either normal toothbrush or custom-made toothbrush for 3 weeks. At the end of 3 weeks, PI and MGI were rerecorded. The subjects belonging to group II were also made to perform muscle exercises using the modified brush head., Results: Significantly high percentage drop between the pre- and post-PI as well as MGI (31.55% and 30.23%, respectively) was observed in the custom-made toothbrush group, while the percentage drop of only 8.34% (PI) and 14.51% (MGI) was seen in the normal toothbrush group., Conclusions: Custom-made tooth brushes increased the efficiency of maintaining oral hygiene and gingival health of individuals with cerebral palsy., (© 2018 Special Care Dentistry Association and Wiley Periodicals, Inc.)

Background and Aim: To develop evidence-based answers to a series of questions in relation to toothbrushing using a modified Delphi consensus approach. Oral hygiene and especially toothbrushing have been a fundamental part of the efforts to prevent caries and gingivitis. The questions discussed involved the frequency and duration of brushing, the effectiveness and safety of powered brushes and the recommendations for children and orthodontic patients., Review Results: The Delphi panel agreed that twice daily brushing for 2 minutes and a systematic pattern is advised. Moreover, it was concluded that evidence suggests that power brushes are safe and more effective in the short and long-term compared to manual brushes in terms of plaque removal and gingivitis reduction. For children and orthodontic patients, the likelihood of enhancing compliance/convenience with use of a power brush was highlighted., Conclusion: Toothbrushing constitutes a fundamental part of the efforts to prevent caries and gingivitis., Clinical Significance: Twice daily brushing for 2 minutes and a systematic pattern is advised. Power brushes are safe and could provide benefits, for adults, children and orthodontic patients.

Patients with serious gingivitis or periodontal diseases suffer from receding gums. Brushing teeth with a toothbrush may result in bleeding gums and new wounds, which increases the difficulty of removing facultative anaerobes from gum pockets, to decrease the damage inflicted on gums, this study proposed a cleaning device that can generate and emit oxygen microbubbles for eliminating facultative anaerobes in the mouth cavity. In this study, the authors conducted simulations with a denture to investigate the efficacy of using this method to remove facultative anaerobes. In this research for the optimal device design, several variables were manipulated including rotation speeds of the bubble generator, different nozzle diameters, and different numbers of nozzle holes. The results revealed that the device is effective in removing facultative anaerobes; moreover, of all design variables, the number of nozzle holes was the factor having the largest effect on anaerobe removal, as it influenced the flow volume and oxygen content of the discharge: the greater the number of nozzles, the greater the flow volume, oxygen content, and efficacy of anaerobe removal.

Objectives: To determine the efficacy of 4 different oral hygiene regimens involving adjunctive interdental cleaning devices in unsupervised young subjects with intact interdental papilla., Material and Methods: Sixty periodontally healthy subjects were randomly allocated to 4 groups following different oral hygiene regimens (T-7): use of manual toothbrush alone; manual toothbrush plus dental floss; manual toothbrush plus interdental brushes; and manual toothbrush plus rubber interdental picks. Oral hygiene instructions (OHI) were given. One week after (T0), professional supragingival scaling and polishing was performed, and subjects were then reseen every 2 weeks (T14 and T28). At T-7, T0, T14 and T28, full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS) and angulated bleeding index (AngBI) were taken., Results: During the first week (T-7/T0 unclean phase), FMPS decreased significantly in all groups except the group using dental floss. At T28, a significant decrease in FMPS (P < .001, all groups) and FMBS (P < .05, all groups except the group using flossing P < .001) was noted. Interdental FMPS showed significantly lower values in subjects treated with interdental brushes or rubber interdental picks vs toothbrushing alone (P < .05). The use of interdental picks was associated with reduced interdental FMBS when compared to flossing (P < .05)., Conclusion: In young subjects, with no interdental attachment loss, toothbrushing or toothbrushing and adjunctive interdental cleaning devices such as dental floss, interdental brushes or interdental rubber picks can significantly reduce both plaque and gingival inflammation. Use of interdental brushes or rubber picks reduces more interdental plaque in comparison with toothbrushing alone., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: This study deals with management of a group of elderly patients with a history of leprosy and hand deformities by a multidisciplinary team of dentists and occupational therapists. Assistive technology devices have been developed to allow such patients to obtain independence in oral self-care and can be a cost-effective approach to improving oral care in this population. The objective of this study was to describe the development of assistive devices to facilitate daily oral hygiene in older people with enduring leprosy-related impairments., Methodology: Case study realized among elders with a history of leprosy residents in a former isolation colony in Betim, Minas Gerais, Brazil. The elders were evaluated for dependence on others for denture hygiene and mouthwash using the Daily Oral Hygiene Activity Index (ADOH). Those deemed partially or completely dependent on others were eligible for an intervention based on assistive technology. We adopted a personalized approach to each case, taking into account medical history, physical impairment and living environment. Six months after the intervention, the participants were assessed again using the ADOH and an unstructured interview about use of the devices., Principal Findings: Assistive devices for denture hygiene and mouthwash were developed for 16 elders. These devices facilitated oral hygiene in most patients and there was no worsening in any of the cases. Patients' report suggested they were satisfied with the devices provided., Conclusions: This study demonstrated that assistive devices can facilitate oral hygiene activities in leprosy patients. It also reinforces the importance of using a multidisciplinary team for the rehabilitation of these patients., Competing Interests: The authors have declared that no competing interests exist.

Aim: The aim of this study was a comparison of the handling and acceptance of two kinds of interdental brushes (interdental brush with a handle [HB] and a newly invented interdental cleaning device [NB])., Methods and Materials: In a randomized crossover trial, 40 test subjects with an average number of 23.5 interdental areas were examined. At two appointments with a "washout" period of one week, the volunteers tried out both cleaning tools (HB and NB). They were asked to clean as many interdental spaces as possible. The percentage of spaces, which could be reached, is the IRI (Interdental Reachability Index). Furthermore, subjective impressions were determined., Results: The average IRI using HB was 64% compared to 80% using of NB (P<.001); 62.5% of the volunteers found the cleaning with HB painful and 15% the cleaning with NB. The subjective feeling after cleaning was 1.75 with NB compared to 2.2 with HB (P=.015), grading the feeling, from 1 for "very good" to 5 for "poor." The acceptance of regular interdental hygiene was rated 1.95 in the case of the NB and 2.85 in the case of the HB. After both appointments, the test subjects declared that they would use the NB 3.05 times and the HB 1.78 times a week., Conclusion: This study shows that the test subjects reached more interdental spaces with NB than with the HB. NB can improve the usage of interdental brushes. Regarding subjective comfort, participants also favoured NB over HB., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To compare in a randomized clinical trial the efficacy of a high-velocity microdroplet device for interdental cleaning vs dental floss at reducing plaque and gingivitis., Methods: Sixty participants with an irregular interdental home cleaning regime were randomly assigned to use either a microdroplet device (n=40, test) or dental floss (n=20, control) for 4 weeks. At baseline and reassessment, the papilla bleeding index, the modified proximal plaque index and the amount of gingival crevicular fluid (GCF) were recorded. At the second appointment, participants completed a questionnaire regarding their assigned interdental cleaning option. The process quality of this investigator-initiated trial was ensured by independent scientific observers and media representatives., Results: Improvement in the interdental cleaning routine reduced gingivitis in both groups (P<.05). The microdroplet device was more effective at reducing plaque (P=.003). The GCF amount remained the same in both groups. Comfort of use was greater with the microdroplet device. However, self-reported effectiveness was superior with dental floss. About 85% of participants using the microdroplet device said they would continue daily use., Conclusion: Improving the interdental cleaning routine with the microdroplet device or dental floss reduced gingivitis and plaque in both groups. Acceptance regarding comfort of use was higher with the microdroplet device. Dental floss remained the first choice for narrow interdental spaces, yet the microdroplet device offers an effective and well-accepted alternative for patients who fail the proper flossing routine., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To examine the effect of tongue cleaning with a tongue scraper (TS) or toothbrush (TB) in patients with periodontitis., Background: The tongue is a possible reservoir for bacterial (re)colonization of the periodontal tissues in patients with periodontitis. To date, it is not known what the influence of tongue cleaning is on the tongue coating of patients with periodontitis., Material and Methods: Eighteen systemically healthy, untreated moderate to severe adult patients with periodontitis with some degree of tongue coating were randomly assigned to the use of a TS or TB for cleaning the tongue. Microbial load of the saliva and tongue dorsum, amount of tongue coating and patient perception about tongue cleaning were studied at baseline and 2 weeks later., Results: Two weeks of tongue cleaning with either a TB or a TS, did not influence the microbiological counts, neither in the saliva, nor in the tongue coating, even though tongue coating was significantly less. The patients themselves experienced no differences in breath odour or taste sensation after 2 weeks of tongue cleaning; however, they felt that their tongue was cleaner at the end of the study compared to baseline. No differences could be detected between the uses of a TS vs a TB., Conclusion: In patients with periodontitis, tongue cleaning does not influence the bacterial load in the saliva or on the tongue dorsum., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The aim of this randomized-controlled, single-blinded study was to compare the effects of mechanical tooth cleaning (MTC) and ultrasonic debridement (UD) on oral hygiene status in healthy young adults. Thirty-seven participants (mean age: 20.3±0.62 years) were divided into 3 groups after pre-examination: group A, receiving MTC; B, receiving MTC+UD using a universal insert (UDUI); and C, receiving MTC+UD using a probe-shaped insert (UDPI). All participants were required to abstain from oral hygiene for 24 hours after the allocated intervention, after which they were examined. A masked examiner determined the Quigley-Hein plaque index (PlI) and Silness and Löe gingival index (GI) scores before the interventions and after 24 hours of non-brushing. A significant increase in the PlI score was observed in group A (p<0.001) in comparison with that in group B (A: 0.311±0.26; B: -0.01±0.33; C: 0.13±0.27; p<0.05). A significant decrease in the GI score was observed in groups B and C (p<0.05), and the change in this score in group C significantly differed from that in group A or B (A: -0.04±0.25; B: -0.13±0.17; C: -0.33±0.2; p<0.05). Only MTC was insufficient to prevent plaque formation over a 24-hour period of non-brushing and decrease the GI score. Ultrasonic debridement was more effective in preventing plaque formation and decreasing the GI score, regardless of the type of insert used. The present results suggest that UD should be included as an important procedure in the provision of professional oral prophylaxis and that UDPI is as efficient for cleaning as UDUI.

Purpose: To demonstrate the effectiveness of the cavitating jet in removing biofilms from the rough surface of 3-dimensional structures., Materials and Methods: The optimal nozzle dimensions and injection conditions were identified by cavitation impact measurements. Biofilm was grown intraorally for 72 hours by 4 volunteers. The stained fixtures were assigned to different experimental groups. One comparison was performed between the cavitating jet and the water jet at 60 seconds. Additional comparisons were conducted among the time course experiments at 30, 60, and 180 seconds. After injection, the residual plaque biofilm (RPB) area was measured using a digital microscope., Results: The total RPB of the cavitating jet was significantly lower than that of the water jet. Although there were no significant differences between the total RPB at 30 and 60 seconds, a significant difference was detected between 60 and 180 seconds. The RPB on the root sector was significantly lower than that on the crest sector at 60 and 180 seconds., Conclusion: The cavitating jet can effectively clean the biofilm formed on the rough surface of the implant screw, especially on the root sector.

Aims: To assess the efficacy of rhamnolipid (mixture of monorhamnolipid and dirhamnolipid congeners), purified monorhamnolipid, dirhamnolipid and lactonic sophorolipid biosurfactants against pathogens important for oral hygiene., Methods and Results: Acquired and produced biosurfactants were fully characterized to allow the antimicrobial activity to be assigned to the biosurfactant congeners. Antimicrobial activity was assessed using the resazurin-aided microdilution method. Mixed rhamnolipid JBR425 (MR) and lactonic sophorolipids (LSLs) demonstrated the lowest minimum inhibitory concentration (MIC) which ranged between 100 and 400 μg ml -1 against Streptococcus mutans, Streptococcus oralis, Actinomyces naeslundii, Neisseria mucosa and Streptococcus sanguinis. Combining these biosurfactants with standard antimicrobial agents namely chlorhexidine, sodium lauryl sulphate, tetracycline HCl and ciprofloxacin showed a dramatic drop in the MIC values. In addition, in vitro studies demonstrated the biosurfactants' ability to prevent and disrupt oral pathogens biofilms. The increased permeability of microorganisms treated with biosurfactant, as shown using bisbenzimide dye, in part explains the inhibition effect., Conclusion: The results demonstrate that rhamnolipids and LSLs have the ability to inhibit oral pathogens both in planktonic and oral biofilm states., Significance and Impact of the Study: The findings indicate the potential value of biosurfactants for both oral hygiene and the pharmaceutical industries since there is a serious need to reduce the reliance on synthetic antimicrobials and antibiotics., (© 2017 The Society for Applied Microbiology.)

Purpose: The purpose of this retrospective study was to provide practice-based evidence to determine if the consistency of dental hygiene therapy, despite utilizing instrumentation literature that has proven to cause alterations to implant surfaces, affects peri-implant health or survival., Materials and Methods: The study sample comprised patients with implant-supported full-arch fixed dental prostheses who were distributed into two groups. The consistent hygiene group patients had dental hygiene therapy at a minimum biannually and were exposed to at least three dental hygiene instrument materials. The inconsistent hygiene group patients had dental hygiene therapy at a minimum once every 3 to 10 years and were exposed to at least three dental hygiene instrument materials. Years of survival free of soft tissue pathology and/or implant failure were estimated. Continuous features were summarized with medians, interquartile ranges (IQRs), and ranges; categorical features were summarized with frequency counts and percentages., Results: Among 48 patients in the consistent hygiene group, 11 patients experienced soft tissue pathology or implant failure at a median of 11.3 years; among 99 patients in the inconsistent hygiene group, 17 patients experienced soft tissue pathology or implant failure at a median of 4.8 years. The survival free of soft tissue pathology or implant failure rate at 5 years was 94% for the consistent hygiene group and 91% for the inconsistent hygiene group. The survival free of soft tissue pathology or implant failure rate at 20 years was 70% for the consistent hygiene group and 79% for the inconsistent hygiene group (P = .91)., Conclusion: Although no statistical differences were found between the groups, this practice-based evidence suggests more consistent dental hygiene therapy increases the median in years in which soft tissue pathology or implant failure is present.

Background: poor oral health is common among older people dependent on supportive care and it affects their quality of life. Cognitive impairment and functional dependency may increase the risk of compromised daily oral hygiene., Aim: to investigate the effectiveness of a tailored preventive oral health intervention among home care clients aged 75 years or over., Patients and Methods: the intervention group comprised 151 patients (84.4 ± 5.6 years) and the control group 118 patients (84.7 ± 5.2 years). An interview and a clinical examination were carried out before a tailored intervention of oral and denture hygiene. The participants in both groups were re-interviewed and re-examined after 6 months., Results: the intervention significantly reduced the number of plaque covered teeth and improved denture hygiene. In addition, functional ability and cognitive function were significantly associated with better oral hygiene., Conclusions: the intervention had a positive effect on oral hygiene, however the number of teeth with plaque remained high, even after the intervention. Multiple approaches based on individual needs are required to improve the oral health of vulnerable older adults, including integrating dental preventive care into daily care plan carried out by home care nurses., (© The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: journals.permissions@oup.com)

Introduction: Dental caries and periodontal diseases are all induced by oral biofilm (dental plaque). This study was conducted to evaluate if fluoride-impregnated miswak is as effective in plaque removal and fluoride release as toothbrushing with fluoride toothpaste., Materials and Methods: This single-blind, randomized, crossover study was conducted at the Department of Cariology, University of Gothenburg, Gothenburg, Sweden, from February 2010 to January 2011. Fifteen healthy subjects participated in this study. The participants were instructed to use the following: (1) 0.5% NaF-impregnated miswak, (2) nonfluoridated miswak, (3) toothbrush with nonfluoride toothpaste, and (4) toothbrush with 1450 ppm fluoride toothpaste. Each method was used twice a day for 1 week after which plaque amount and fluoride concentration in resting saliva were measured. There was a 1-week washout period between each method., Results: No significant difference between miswak and tooth-brushing was found regarding plaque removal on buccal and lingual surfaces. A somewhat higher fluoride concentration in resting saliva was found after using impregnated miswak when compared with toothbrushing with fluoride toothpaste (p < 0.05)., Conclusion: Miswak and toothbrushing showed the same plaque removing effect on buccal and lingual surfaces. Miswak impregnated with 0.5% NaF resulted in a higher concentration of fluoride in saliva than brushing with 1450 ppm fluoride toothpaste., Clinical Significance: Miswak impregnated with 0.5% NaF and toothbrushing results in comparable plaque removal and about the same fluoride concentration in saliva even it was somewhat higher for impregnated miswak.

Dental hygienists are often faced with patients wearing lingual orthodontic therapy, as ultrasonic instrumentation (UI) is crucial for oral health. As the application of external forces can lead to premature bonding failure, the aim of this study was to evaluate the effect of UI on shear bond strength (SBS) and on adhesive remnant index (ARI) of different lingual orthodontic brackets. 200 bovine incisors were divided into 10 groups. Four different lingual (STB, Ormco; TTR, Rocky Mountain Orthodontics; Idea, Leone; 2D, Forestadent) and vestibular control (Victory, 3M) brackets were bonded. UI was performed in half of specimens, whereas the other half did not receive any treatment. All groups were tested with a universal testing machine. SBS and ARI values were recorded. Statistical analysis was performed (significance: P = 0.05). TTR, Idea, and 2D lingual brackets significantly lowered SBS after UI, whereas for other braces no effect was recorded. Appliances with lower mesh area significantly reduced their adhesion capacity after UI. Moreover groups subjected to UI showed higher ARI scores than controls. UI lowered SBS of lingual appliances of small dimensions so particular care should be posed avoiding prolonged instrumentation around bracket base during plaque removal. Moreover, UI influenced also ARI scores.

The aim of this study was to compare the efficacy in supragingival plaque removal of two soft-bristle toothbrushes. Seventy volunteers were allocated randomly to the Colgate Slim Soft or Curaprox CS5460 toothbrush grourps. At baseline appointment, volunteers underwent plaque examination using the Rustogi Modification of the Navy Plaque Index. Under supervision, they then brushed their teeth for 1minute with their assigned toothbrushes and the plaque examination was repeated. Volunteers performed daily oral hygiene with their assigned toothbrush and a regular dentifrice provided by the researchers for 7 days. The baseline experimental procedures were then repeated. Separate analyses of variance were performed for the whole-mouth, interproximal, and gumline plaque scores (p < 0.05). No difference in baseline pre-brushing scores was found between groups. After a single toothbrushing, the mean plaque score was significantly reduced in both groups (p < 0.05), with greater reduction of whole-mouth and interproximal plaque scores observed in the SlimSoft group compared with the Curaprox group (p < 0.05). After 7 days, the SlimSoft group showed greater reduction of the whole-mouth and interproximal plaque scores compared with the Curaprox group (p < 0.05). In conclusion, the SlimSoft toothbrush presented greater efficacy in supragingival plaque removal than did the Curaprox CS5460 toothbrush, as reflected by whole-mouth and interproximal plaque scores.

Introduction: Various types of oral hygiene measures have been practiced by different populations around the world, as there is difference in the oral hygiene products including toothpicks and toothpowders. Miswak or tooth cleaning stick, for mechanical tooth cleaning, can be traced back at least to pre-Islamic times. Currently, many of the world populations still use chewing sticks as the single method for tooth brushing. The present study was done to study the incidence and prevalence of caries among Miswak and non-Miswak users., Materials and Methods: The study was done consisting of 120 cases and 120 control group (60 boys and 60 girls in each group) from the secondary school. The materials used were light, explorer, mirror, gloves, upper and lower teeth models, Miswak, and common toothbrush. After the recording of the primary data, Miswak was given to case group and the students were trained to use it on the teeth models. After 2 years, the examination of the teeth was done using the same method as before start of the study and by the same investigators. All the data were recorded, tabulated, and analyzed with the help of Statistical Package for the Social Sciences (SPSS) statistics version 17 using Student's t-test., Results: From the 240 participants, only 211 had continued the study for the total period of time. Out of these, 111 were from the study group and 100 from the control group. On comparison of the decayed-missing-filled (DMF) index scores of the study and control groups, before and after completion of the study, had also shown that the caries index was increased and the difference was found to be statistically significant., Conclusion: From the study, it can be concluded that the study group using Miswak had less number of caries incidence than the control group of non-Miswak., Clinical Significance: Miswak can be used as teeth cleaning aid in day-to-day life as it can reduce the caries incidence.

Medically compromised patients attending the dental clinic at the Toronto Rehabilitation Institute have considerable gingival inflammation and breath odor. The objective of this study was to evaluate the effect of toothbrushing on the periodontal status of these patients and to determine if there were any additional benefit in combining brushing with an application of an antibiotic rinse. During the first 7 days of the study, the teeth of 11 participants were brushed twice a day by a dental hygienist using a soft-bristle suction toothbrush without toothpaste. Soft interproximal brushes were used to clean interproximal surfaces from the facial aspect. During the second week, facial and interproximal cleaning were repeated in the same patients, but the toothbrush and interproximal brush were dipped in 10-mL of a solution consisting of water and 40 mg/mL of metronidazole with nystatin. Each patient underwent an oral examination and biofilm sampling at baseline, after brushing without toothpaste (week 1), and after brushing with antibiotic solution (week 2). After week 1, tissues improved substantially, and there was a notable change in the biofilm on the teeth. The addition of an antibiotic solution increased healing and resulted in a further decrease in oral biofilm. Medically compromised patients would benefit considerably from a treatment regimen of antibiotic solution to decrease oral infection followed by a daily oral care program of brushing and interdental cleaning to maintain healthy oral tissues.

Technology has greatly influenced all phases of the dental hygiene process of care. Chairside diagnostic tools and self-monitoring devices improve early detection of lesions and previously undetected oral/systemic diseases, facilitate assessment of systemic health status, and support patient engagement in self-care. Collectively, improved patient assessment reduces risks for medical emergencies and promotes patient safety. Technological advances enable better visualization of hard and soft tissues during the assessment phase, aid decision-making with planning and delivery of appropriate oral care interventions, and facilitate evaluation of patient outcomes related to dental hygiene treatment. Additional research is needed to support the benefits of patient-centered technologies designed to affect behavioral change.

Purpose: The purpose of this study was to determine the extent of ultrasonic scaling instrumentation instruction in dental hygiene programs in the U.S. Currently, there is no publication available defining a consensus of instruction for ultrasonic instrumentation., Methods: Exempt status was received from the West Virginia University Institutional Review Board. A survey was developed with dental hygiene administrators and faculty, based on assumptions and a list of questions to be answered. The survey was tested for validity and revised after feedback from additional faculty. The instrument was 64 questions divided into demographics, curriculum and equipment. Most questions included a text box for additional comments. An email survey was sent to all directors of accredited dental hygiene programs in the U.S. (n=323). The final possible number of respondents was n=301. Results were collected in aggregate through the Secure Online Environment (SOLE). Results were transferred to an Excel spreadsheet for statistical analysis., Results: After 3 emails, the response rate was 45% (n=136). No significant differences in methods of instruction were found between associate and baccalaureate degree granting programs. Eighty-nine percent of programs introduce hand scaling prior to ultrasonic scaling instruction. Students in 96% of the programs were required to administer pre-procedural mouth rinse intended to reduce the amount of bacteria. The magnetostrictive ultrasonic scaler is widely used in dental hygiene instruction. A variety of inserts/ tips were available although a universal or straight insert/tip was most common. Calculus, not inflammation, was the primary criterion for ultrasonic scaler use., Conclusion: The results of this study demonstrate that ultrasonic instrumentation is an integral component of the clinical curriculum and the majority of the dental hygiene programs prescribe to similar teaching methods. Programs could benefit from incorporating current scientific research findings of using site specific inserts to perform periodontal debridement based on thorough biofilm removal measured by resolution of inflammation., (Copyright © 2016 The American Dental Hygienists’ Association.)

Objectives: We conducted a large household survey in 2013 to determine the current status of oral health practices and use of oral health services in the Kingdom of Saudi Arabia (KSA)., Methods: The Saudi Health Information Survey is a national multistage survey of individuals ≥ 15 years of age. We used a backward elimination multivariate logistic regression model to measure the association between having been to a dental clinic during the last year, and sex, age, marital status, education, time since last routine medical examination, history of diagnosis with a cardiovascular chronic condition, brushing or flossing teeth and use of Miswak (a chewing stick)., Results: Between April and June 2013, 10,735 participants completed the survey (89.4% of the households contacted). An estimated 1.5 million (11.5%) and 6.3 million (48.6%) Saudi Arabian people, ≥ 15 years of age, had visited a dental clinic for a routine check-up and for a complaint during the last year, respectively. In total, 16.3%, 85.0% and 52% of Saudi Arabian people never brush their teeth, never floss their teeth or never use Miswak, respectively. The probability of visiting a dental clinic increased with education, among individuals who brushed or flossed their teeth and who used Miswak., Conclusions: Oral hygiene practices are not common among Saudi Arabian people, and use of health care for prevention of oral disease is limited. Hence, the need for oral health promotion is pressing. The KSA Ministry of Health should develop and implement programmes, through its primary health clinics, to increase the awareness of the importance of good oral health., (© 2016 The Authors. International Dental Journal published by John Wiley & Sons Ltd on behalf of World Dental Federation.)

Background: The removal of dental plaque plays an essential role in the maintenance of oral health. Numerous powered and manual toothbrushes were manufactured to achieve this goal, but even up to this day different opinions and research results have been revealed to assess the priority of the mentioned devices., Aim: Comparison of powered and manual toothbrushes on the basis of periodontal parameters and safety., Materials and Methods: Electronic search of the databases of MEDLINE and EMBASE (until May 2014) was carried out with the help of keywords in order to find relevant trials. The inclusion criteria were as follows: randomised controlled clinical trials, adult population, the presence of at least 15 permanent teeth. Split-mouth trials and interventions carried out by dental professionals, were excluded. Primary outcomes were the changes of plaque and gingival indices, while secondary outcomes were probing pocket depth (PPD), safety and quality assessment. The effect-size of the interventions was expressed by the standardised mean difference (SMD) with 95% confidence interval (CI). Random-effects models were performed., Results: Electronic search resulted in 173 hits. 21 trials with the total number of 1500 subjects were then eligible for the meta-analysis. Both toothbrushes were safe, without considerable side effects on soft or hard tissues. Powered toothbrushes seemed to be generally more effective in removing plaque (-9%), reducing gingivitis (-6%) and preventing calculus formation. The SMDs for plaque and gingival indices were -0,40 (95% Cl: -0,95 to -0,16) and -0,29 (95% Cl: -0,56 to -0,03) respectively, in favour of the powered devices. There was no significant difference in changes of PPD. By further dividing the powered toothbrushes according to their mode of action, the plaque removal effect of the rotation oscillation (plus three dimensional), side to side sonic and ultrasonic toothbrushes seemed to be significantly better, than their manual ones, while the counter oscillation and the ionic toothbrushes did not perform better. Quality assessment and sensitivity analysis revealed various types of bias up to a certain extent. Consequently, no trial was found to be eligible for the highest quality criteria., Conclusions: The investigated rotation oscillation and vibrating toothbrushes appeared to be statistically more effective than their manual counterparts, although there is little known about its clinical relevance. The advantage of the electric toothbrushes disappears in case of adequately instructed and motivated patients that highlights the importance of individualised oral hygiene education. The design of the trials shows high heterogeneity, therefore their clinical implications should be handled carefully.

The prevalence of dental caries has been decreasing among kindergarten children in Shanghai, China, over recent years, although it still remains at an unacceptably high level. The purpose of this study was to identify which factors were important in providing oral health guidance and achieving further improvement in the oral health status of kindergarten children in urban China. A survey was conducted on dental caries in 128 Japanese and 368 Chinese kindergarten children and a questionnaire given to their parents/guardians on each child's lifestyle and dietary habits from birth to the present. Correlations between responses to each questionnaire item and the status of dental caries were statistically analyzed. The dft index score (p=0.0016), prevalence of dental caries (p=0.0002), and percentages of children with decayed (untreated caries-affected) teeth (p<0.0001) were significantly higher in the Chinese than in the Japanese children. Many differences were observed in lifestyle factors between the two groups. The percentage of parents failing to control the child's snacking habits between meals was higher in China, and weaning was significantly delayed in China compared with in Japan. These lifestyle factors were considered to be associated closely with the high risk of dental caries in Chinese kindergarten children. These findings indicate that oral health guidance for kindergarten children in Shanghai, China, should focus on control of dietary habits, including control of inter-meal snacking, and breastfeeding practices. The results of this study may help improve the status of dental caries among Chinese children.

Objective: The aim of this study was to record preventive oral health care planned by dental therapists and oral health therapists (therapists) for patients with poor oral hygiene undergoing orthodontic treatment., Materials and Methods: A cross-sectional survey, using a clinical vignette of a patient with poor oral hygiene undergoing therapy with a fixed appliance, was undertaken to record the preventive care offered to this individual by therapists working across 15 Local Health Districts (LHDs). This orthodontic vignette was inserted between two dental caries-related vignettes. Data were coded and descriptive statistics were used to report the findings., Results: One-hundred and seventeen therapists returned questionnaires (giving a response rate of 64.6%), of whom 82.0% (n = 95) completed the orthodontic vignette. Adopting motivational interviewing techniques to facilitate communication with the patient and their parent was recommended by 88.4% (n = 84) respondents, 98.0% (n = 93) offered oral-hygiene instruction, 70.5% (n = 67) recorded plaque levels and used disclosing solution and 60.0% (n = 57) offered dietary advice. Products recommended for use at home included fluoride toothpaste [1,450 ppm F (80.0%; n = 76) and 5,000 ppm F (59.0%; n = 24)] and casein phosphopeptide amorphous phosphates plus fluoride (CPP-ACPF) paste (33.3%; n = 32). Less than 20% offered fissure sealants., Conclusion: Preventive advice and care was offered inconsistently by therapists in this study. To ensure that all therapists adopt a scientifically based approach to prevention, LHD clinical directors should implement continuous professional education programmes for therapists to improve patient's health outcomes., (© 2015 FDI World Dental Federation.)