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Objectives: To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5,000 individuals was fluoridated. In 2014, CWF in Israel stopped. Method and materials: Data on 12-year-old children from all areas in Israel from the national cross-sectional epidemiological survey conducted in 2011 to 2012 were stratified by city water fluoridation and by city and school socioeconomic status. Two dependent variables were defined: (1) DMFT index of caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov classification of fluorosis. Results: Data from 2,181 12-year-olds were analyzed. The average DMFT was 1.17 ± 1.72, and 49% were caries-free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs 0.98 in fluoridated cities) and there were more caries-free children in fluoridated cities (56.4% vs 40.6% in nonfluoridated). DMFT was higher in cities with lower socioeconomic status than high socioeconomic status (1.29 vs 1.05, respectively, P < .001) and there were fewer caries-free children in low socioeconomic status cities (44.5% vs 53.0% in high socioeconomic status cities, P < .0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in the Thylstrup-Fejerskov index), had questionable to mild fluorosis (9.3%). Conclusions: CWF is a cheap, simple method of dental health protection that reaches all socioeconomic levels, and cessation of water fluoridation reduced the health of Israel's children. Clinical significance: Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities. [ABSTRACT FROM AUTHOR]

Objectives: To describe the planning stage and the first year of “Smiles,” an innovative, inclusive oral health promotion program among preschool children, ages 3 to 5, encompassing the enhancement of daily toothbrushing skills, engagement of teaching staff and parents, and integration of a supportive environment of supervised toothbrushing in kindergartens. Method and materials: The major components of the first year of the program included workshops with the teaching staff, working sessions with the preschool children, and workshops with the parents. Program participation, program cooperation, program satisfaction, and kindergarten teachers, kindergarten parents, and dental hygienists’ attitudes towards this component of the program were recorded and evaluated. Minor components of the first year of the program included assimilation and integration of daily supervised toothbrushing in some of the kindergartens. Program participation, kindergarten teachers, kindergarten teachers’ assistants, and kindergarten parents’ attitudes towards this component of the program were recorded and evaluated. Results: In total, 180 kindergartens, in nine locations across Israel, including 5,311 preschool children, their parents, and teaching staff, took part in the first year of the program. High levels of participation (80% and above), cooperation (9.55 to 9.78) and satisfaction (9.62 to 9.81) were recorded in the first year of the program. Kindergarten teachers, parents, and dental hygienists expressed high levels of support for continuing the program beyond its first year (9.86 to 10.00). Regarding the daily supervised toothbrushing model in the kindergartens, high levels of satisfaction (9.50 to 9.75) and willingness to continue the program (9.50–10.00) were recorded among kindergarten teachers, assistants, and parents. Conclusion: The “Smiles” program serves as an example of successful collaboration between many partners and stakeholders from different organizations, sectors, and government ministries, local authorities, kindergarten management and staff, parents, and the most important partners, the preschool children. Its adherence to the basic principles of health promotion, and its professional adjustment to early childhood with positive atmosphere of happiness, joy, and shared warmth, contributed to the success of the program. [ABSTRACT FROM AUTHOR]

The relationship between ethnicity and chronic pain has been studied worldwide. The population of Israel includes two main ethnic groups, 75% Jews and 21% Arabs. The purpose of this study was to compare orofacial chronic pain characteristics and treatment outcomes between Jewish and Arab Israeli citizens. Two hundred patients admitted to the Orofacial Pain Clinic at Hebrew University–Hadassah School of Dental Medicine between 2017 and 2022 were selected randomly for this historical cohort study. Our cohort included 159 (79.5%) Jews and 41 (20.5%) Arabs. Twenty-six pain-related variables were compared of which only two differed significantly between the two groups, awakening due to pain and mean muscle sensitivity; both indicators were higher in the Arab group (p < 0.05). No differences were found in any of the other variables such as diagnosis, pain severity, onset, and treatment outcome. This minimal difference may be explained by the equal accessibility to medical services for all citizens, and the diversity of our staff that includes Jew as well as Arab service providers. These factors minimize or even eliminate racial bias, language, and cultural barriers, and is reflected in the minor differences in orofacial pain characteristics found between the two main ethnic groups in Israel. [ABSTRACT FROM AUTHOR]

Abstract Background Evidence from Western countries indicates that there are fundamental discrepancies between self-perceived illness of immigrants and the provision of health care, according to the Western bio-medical health service model. These need to be understood in the planning and implementation stages of public health care programs for new immigrants. The objectives of the present study were to investigate self-perceived versus clinically diagnosed dental and periodontal health status among immigrants from Ethiopia. Methods During 2004–2005, dental and periodontal health status was recorded among 340 Ethiopian immigrants, utilizing the DMFT and CPI indices. Additionally, participants were interviewed using a questionnaire which included perceived dental and periodontal health status. Sensitivity and specificity levels of this perception were calculated and compared with the published scientific literature. Results Regarding dental caries, according to the three operational cut-off points, sensitivity ranged from 70% to 81%, and specificity ranged from 56% to 67%. Regarding periodontal status, 75% of the subjects clinically diagnosed with periodontal pockets self-perceived a "bad" health status of gums (sensitivity) and 54% of the subjects diagnosed without periodontal pockets, reported a "good" health status of gums (specificity). These indications of perception levels were higher than a previous study conducted among native born Israelis. Conclusion Minority ethnic groups should not be prejudicially regarded as less knowledgeable. This is illustrated by the unexpected high level of oral health status perception in the present population. Oral health promotion initiatives among immigrants should be based upon optimal descriptive data in order to accomplish the inherent social commitment to these diverse populations.

Abstract Background Dental epidemiology has indicated that immigrants and minority ethnic groups should be regarded as high risk populations on the verge of oral health deterioration. The objectives of this study were to measure the changing pattern of dental caries, periodontal health status and tooth cleaning behaviour among a cohort of Ethiopian immigrants to Israel between the years 1999–2005. Methods Increment of dental caries and periodontal health status was recorded among a cohort of 672 Ethiopian immigrants, utilizing the DMFT and CPI indices. Data were gathered during 1999–2000 and five years later, during 2004–2005. Participants were asked about their oral hygiene habits in Ethiopia and in Israel five years since their immigration. Results Regarding dental caries, at baseline 70.1% of the examinees were caries-free, as compared to 57.3% after five years. DMFT had increased from 1.48 to 2.31. For periodontal health status, at baseline, 94.7% demonstrated no periodontal pockets (CPI scores 0–2) and 5.3% revealed periodontal pockets (CPI scores 3&4), compared to 75.6% and 24.4%, respectively after five years. At baseline, 74% reported cleaning their teeth exclusively utilizing chewing and cleaning sticks common in Ethiopia. After five years, 97% reported cleaning their teeth exclusively utilizing toothbrushes. Conclusion The deterioration in the oral health status, especially the alarming and significant worsening of periodontal health status, among this immigrant group, emphasizes the need for health promotion and maintenance among immigrants and minority groups in changing societies. An "acclimatizing and integrating" model of oral health promotion among minority and immigrant groups is suggested.

Abstract Background Preventive dentistry has traditionally emphasized improvement of oral hygiene. School-based programs, often delivered by dental hygienists or other health educators, are usually limited to dental knowledge provision. The present study focused on promotion of health behavior. The objectives were to evaluate the effect of a pragmatic educational program on tooth brushing skills of young schoolchildren. Methods The population consisted of 196 first grade children in Jerusalem. One dentist interviewed the children and evaluated base-line brushing skills, applying simple visual index, based on dividing the dentition to eight different segments. a trained hygienist then educated the children, emphasizing brushing skills. A simple "scrubbing" brushing method was taught for all dental surfaces. Four months later a second examination was conducted, applying same evaluation methods. Results At base-line 92% of the children had brushed the labial surfaces of front teeth, but only 8% brushed the inner surfaces of posterior teeth. Only 32% brushed occlusal surfaces. These levels significantly increased after four months: 98% now brushed the labial surfaces; 43% brushed inner surfaces of posterior teeth, 87% brushed occlusal surfaces (p < 0.001). The average number of dental "areas" brushed had increased (among the eight areas recorded) from 2.8 to 5.7 (p < 0.0001). Conclusion This method of behavioural instruction emphasized improvement of personal manual skills specifically for those areas of the dentition which demand most efforts in oral hygiene promotion. These results are of practical help in improving future health education programs by the health promotion team.

As very few studies regarding dentists' professional burnout have been published, we provide an updated review and recommendations with regards to the published dental literature of this phenomenon, which is relevant to the general dental community around the world. Professional burnout has been found to be prevalent among dentists and dental students. The challenge lies in early recognition and developing intervention programs specifically for the dental profession. Attention to realistic career expectation and the type of dentist one prefers to be, attention to practice management skills and the stressfulness of work, as well as longitudinal monitoring of newly qualified dentists on burnout development are recommended. Learning about professional burnout and its potentially serious consequences, as well as increasing knowledge about how to prevent and treat it are crucial. It is not only a caregiver problem, but also a public health problem. [ABSTRACT FROM AUTHOR]

Abstract Background Clinical (normative) and subjective (self-assessment) evaluation of caries and periodontal diseases have been reported to demonstrate a significant disparity. The dental public health team is obligated to recognize and understand this gap. The objectives of the study were to investigate the practical values of using questionnaires (self–perceived assessment) as compared to clinical examinations (normative assessment) and to evaluate the implications of the results in understanding the public's perception of oral health. Methods The investigation was performed on 4920, 21 year-old Israeli adults upon release from compulsory military service between 1996 and 1998. Participants were asked to fill in a questionnaire inquiring how they would rate their personal dental and periodontal health levels. Clinical examinations, employing the DMFT and CPITN indices, were performed to determine normative oral health status. Perceived and normative assessments were compared for sensitivity, specificity, positive and negative predictive values and overall proportions using the clinical examinations as a gold standard. Results The sensitivity (disease perception) for dental status was found to be 0.34, while the specificity (health perception) was found to be 0.83. The positive predictive value for perceived dental status was found to be 0.68, whereas the negative predictive value was found to be 0.54. The sensitivity for perceived periodontal status was found to be 0.28, while the specificity was found to be 0.83. The positive predictive value for perceived periodontal status was found to be 0.05, whereas the negative predictive value was found to be 0.97. Regarding the overall proportions, a large discrepancy was found between self–assessment and professional assessment for both dental and periodontal health status. Conclusions Self-assessment questionnaires were of low value in evaluating oral health status both in the individual and public levels, though perception levels of health were higher than that of disease. Findings reflects a low level of awareness of the public that may influence care-seeking behavior and highlight the importance of oral health promotion and the crucial need for public health action.

Objective: To assess the impact of media exposure on oral health outcomes among Jewish adults in Jerusalem, Israel, by means of a conceptual hierarchical model. Method and Materials: A cross-sectional study was conducted using a stratified sample of 254 adults 35 to 44 years (mean age, 38.63 years) in Jerusalem, Israel. Media exposure was operationally categorized by type and frequency. Behavioral data included toothbrushing, dental attendance, oral hygiene aids use, plaque level, sugar consumption, and smoking. Clinical outcomes were assessed according to the decayed/missing/filled teeth (DMFT) index and the Community Periodontal Index (CPI). Results were analyzed by chi-square test, independent test, one-way ANOVA, and linear and multiple logistic regression models. Results: A total of 254 examinees consisted of 127 men and 127 mean (married couples). High type and high frequency of media exposure, as compared with other modes, revealed statistically significant higher caries experience (DMFT, 13.10), higher level of untreated decay (D, 1.67), and lower periodontal health (CPI [0], 0.39). A conceptual hierarchical regression model identified that the relationship described was mediated by sociodemographic determinants (education) and behavioral determinants (dental attendance and plaque level). Conclusion: Media exposure should be observed by community health program planners and general practitioners to examine the type and frequency of the messages. They also need to react on time to balanced bad advertising and add a good message at the community. This pragmatic approach could lead to better use of the media and improve oral health behavior and outcomes. [ABSTRACT FROM AUTHOR]

Objective: Dental implants and peri-implant tissue are susceptible to disease conditions that may lead to implant loss. The objective of the present study was to describe teeth and implant surroundings as well as clinical health indices and oral microbiologic parameters. Method and Materials: A group of 83 adults (42 men and 41 women) were enrolled in the study. Clinical assessments of dental implants and contralateral natural teeth included dental plaque, gingival inflammation, and bleeding on probing. Microbiologic assessments included bacterial culture, light and phase contrast microscopy, and DNA probe hybridization for a panel of 14 target microorganisms. Clinical and microbiologic data were compared by paired t test and ANOVA. P < .05 was considered statistically significant. Results: The Plaque Index for the implants was 1.85 ± 0.47, whereas the score for natural teeth was significantly higher, 2.15 ± 0.52. Compared to the samples obtained from the dental implants, the samples from natural teeth demonstrated significantly higher total bacterial cell numbers (P < .05). Consistent with the clinical measures of dental plaque, significantly higher numbers of oral bacteria, including aerobic and anaerobic bacteria, were found in dental plaque samples from teeth (aerobic 5.648 ± 0.512, anaerobic 6.243 ± 0.535, P < .0001) compared to implants (aerobic 5.430 ± 0.541, anaerobic 5.917 ± 0.523, P < .0001). In addition, there were significantly higher numbers of anaerobic (6.243 ± 0.535 and 5.917 ± 0.523, P < .0001) than aerobic (5.648 ± 0.512 and 5.430 ± 0.541, P < .008) bacteria for samples from teeth and implants, respectively. Conclusion: Clinical and microbiologic analyses provide consistent findings that suggest differences in quantity of plaque and bacterial species between teeth and dental implants. For long-term treatment success, the importance of plaque control and oral hygiene of both periodontal and dental implant therapy is emphasized. [ABSTRACT FROM AUTHOR]

Background: Evidence from Western countries indicates that there are fundamental discrepancies between self-perceived illness of immigrants and the provision of health care, according to the Western bio-medical health service model. These need to be understood in the planning and implementation stages of public health care programs for new immigrants. The objectives of the present study were to investigate self-perceived versus clinically diagnosed dental and periodontal health status among immigrants from Ethiopia. Methods: During 2004-2005, dental and periodontal health status was recorded among 340 Ethiopian immigrants, utilizing the DMFT and CPI indices. Additionally, participants were interviewed using a questionnaire which included perceived dental and periodontal health status. Sensitivity and specificity levels of this perception were calculated and compared with the published scientific literature. Results: Regarding dental caries, according to the three operational cut-off points, sensitivity ranged from 70% to 81%, and specificity ranged from 56% to 67%. Regarding periodontal status, 75% of the subjects clinically diagnosed with periodontal pockets self-perceived a "bad" health status of gums (sensitivity) and 54% of the subjects diagnosed without periodontal pockets, reported a "good" health status of gums (specificity). These indications of perception levels were higher than a previous study conducted among native born Israelis. Conclusion: Minority ethnic groups should not be prejudicially regarded as less knowledgeable. This is illustrated by the unexpected high level of oral health status perception in the present population. Oral health promotion initiatives among immigrants should be based upon optimal descriptive data in order to accomplish the inherent social commitment to these diverse populations. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5000 individuals was fluoridated. In 2014 CWF in Israel stopped., Methods: Data on 12-year-old children from all areas in Israel from the national crosssectional epidemiological survey conducted in 2011-2012 were stratified by city water fluoridation and by city and school socio-economic status (SES). Two dependent variables were defined: (1) DMFT index -caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov (TF) classification of fluorosis., Results: Data from 2181, 12-year-olds was analyzed. the average DMFT was 1.17&#43;1.72 and 49% were caries free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs. 0.98 in fluoridated cities) and there were more caries free children 56.4% in fluoridated cities vs. 40.6% in non-fluoridated. DMFT was higher in cities with lower SES than high SES (1.29 vs. 1.05 respectively, p<0.001) and there were less caries free children in low SES (44.5% vs. 53% in high SES cities, p<0.0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in TF index), had questionable to mild fluorosis (9.3%)., Conclusions: CWF is a cheap, simple method of dental health protection that reaches all socio-economic levels and cessation of water fluoridation reduced the health of Israel's children., Clinical Significance: Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities.

Objectives: To assess gingivitis and gingival bleeding following the consumption of Aged Garlic Extract versus placebo for a period of four months., Methods: A randomized, controlled, examiner-blind, two-treatment parallel group study was conducted. Participants were stratified and randomly assigned equally to a regimen group using Aged Garlic Extract (AGE) or a control group, based on gender, age, baseline number of bleeding sites, and gingival health status. Assessment was performed at baseline and at one, two, three, and four months. Clinical assessment was conducted by three experienced calibrated examiners., Results: One hundred and fifty-one participants followed the inclusion criteria; 50.3% males, with an average age of 32.7 ± 8.2 years. Only 134 subjects completed the four-month study (11.3% attrition rate). A statistically significant decrease of the Modified Gingival Index and Gingival Bleeding Index scores was shown for the AGE compared to the placebo group, both between and within groups (p < 0.001)., Conclusions: This research demonstrated that daily consumption of AGE benefits oral health by reducing gingival inflammation and gingival bleeding, as compared to a placebo control., Competing Interests: The authors have no financial interest in the product or in the company sponsoring this study., (Copyright© by the YES Group, Inc.)

Objective: Colgate Total toothpaste has been demonstrated to be highly effective in plaque and gingivitis control. The effect of triclosan on root caries and on the survival of dental crowns (fixed dental prosthetic treatment) has not been evaluated. In order to examine these important variables, a randomized controlled clinical trial was conducted comparing Colgate Total toothpaste with triclosan, and an identical fluoride toothpaste without triclosan., Methods: Adult subjects were randomly assigned to a test group using Colgate Total plus Whitening toothpaste with triclosan, and a control group using Colgate sodium fluoride toothpaste without triclosan. By the end of the study, following three years of product use, an evaluation was performed to compare baseline data to the three-year data for root caries and dental crown survival. Clinical root caries was evaluated by the Katz RCI- Root Caries Index. Within-treatment analysis for each dentifrice was conducted using a paired t-test. Between-treatment analysis was performed using Analysis of Covariance (ANCOVA). For fixed dental prosthetic treatment evaluation, dental crowns were dichotomized for success and failure at the end of the study. Within-treatment analysis for each dentifrice was conducted using a paired t-test. Between-treatment analysis was performed using the Bonferroni test., Results: One-thousand, three-hundred, and fifty-seven subjects (1,357) completed the study. Regarding root caries, at termination of the study the Colgate Total group presented a mean score of 1.14 +/- 1.75 and a +5.6% change from baseline, while the sodium fluoride toothpaste presented a mean of 1.25 +/- 1.88 and a +43.2% change from baseline (p < 0.001). The adjusted mean root caries increment was 0.07 +/- 0.03 for the Colgate Total group, and 0.38 +/- 0.03 for the sodium fluoride toothpaste group (p < 0.001). Regarding crowns, at termination of the study the Colgate Total group presented a mean score of 5.38 +/- 3.70 and a +1.1% change from baseline, while the sodium fluoride toothpaste without triclosan presented a mean of 5.75 +/- 3.86 and a +3.8% change from baseline (p < 0.001). The mean (adjusted for multiple comparisons) dental crowns failure increment was 0.09 +/- 0.03 for the Colgate Total group, and 0.31 +/- 0.02 for the sodium fluoride toothpaste group (p < 0.001)., Conclusion: A comparison between the two study groups revealed a statistically significant difference for root caries and dental crown failure scores, both favoring the triclosan toothpaste (Colgate Total). The significantly lower root caries and observed dental crown failure scores among the Colgate Total toothpaste users indicate an effect of the triclosan and the copolymer system. These results are important and could provide a strong and valuable public health measure.

Objective: The elmex SENSITIVE extra soft toothbrush, with soft conical filaments designed for plaque removal specifically in the cervical area and interdental spaces, and gentleness for hypersensitive teeth with exposed dentine, was evaluated for plaque removal effectiveness, safety, and subjective satisfaction., Methods: One-hundred and seven healthy adults participated in the clinical trial designed according to American Dental Association (ADA) guidelines, and were randomly divided into a test group (N = 54) using the elmex brush, and a control group (N = 53) using the ADA reference brush. Subjects were chosen with gingival recession resulting in exposed dental necks and reported sensitivity, and were given a pre-study cleaning by a hygienist. Clinical examinations included the Rustogi plaque index (before and after brushing), and an examination for any soft lesion adverse effects, at baseline, 30, and 60 days. A subjective questionnaire, measuring satisfaction, sensitivity, and painless brushing, was administered at 30 and 60 days. An ANCOVA model, with baseline level as the covariate, was employed for testing clinical differences between groups at one and two months. The Mann-Whitney test measured differences in the satisfaction questionnaires., Results: The total plaque index, after brushing and at one and two months, demonstrated a significantly higher mean level for the control compared to the test group (3.05 vs. 2.16; p = 0.001 and 3.47 vs. 2.56; p = 0.0003, respectively). Similar significant differences were detected for plaque levels at the gingival margin and the proximal dental surfaces, after brushing at one and two months. No significant differences were found pre-brushing at any of the measurement points. Most subjective assessments of the two brushes at one and two months revealed significant differences in favor of the test brush., Conclusion: These results indicate an effective toothbrush for promoting oral health, and patient acceptance of a toothbrush with soft conical filaments intended specifically for sensitive teeth.

Objective: The present study was designed to evaluate the health promotion effectiveness, especially at the gingival margin, and the subjective satisfaction of a new toothbrush with soft conical filaments., Methodology: Sixty-eight healthy adult subjects participated in the clinical trial and were randomly divided into a test group (meridol toothbrush) or control group (standard ADA reference toothbrush). Subjects were given oral hygiene instructions and a pre-study cleaning by a dental hygienist. Clinical examinations included the Gingival Index (GI), Bleeding Index (BLI), and Patient Hygiene Performance Index (PHP) for plaque levels (before and after brushing), and were conducted at baseline, 30, and 60 days. A self-administered satisfaction questionnaire was applied at 30 and 60 days. The statistical test employed for change within each test group was repeated measures ANOVA, and ANCOVA was employed for between-group analysis. For measures of satisfaction, Fisher's Exact test was applied when comparing the percentages of answers., Results: For the GI, the test group demonstrated a highly significant statistical decrease (from GI = 0.22 to GI = 0.13, p = 0.0004). The control group showed less of a decrease with statistical significance (GI = 0.21 to GI = 0.16, p = 0.05). For the BLI, the test group also demonstrated a highly significant statistical decrease (from BLI = 0.29 to BLI = 0.11, p = 0.0013), while the control group showed a very small decrease with no statistical significance (BLI = 0.24 to BLI = 0.17). The analyses of the PHP plaque levels after brushing showed significant and similar decreases for both groups over the study period (test group: p = 0.04, controls: p = 0.01). In an analysis of PHP before brushing, both brushes showed increases from baseline to day 30. This increase continued from day 30 to day 60 for the control group. For the test group, there was a significant decrease from day 30 to day 60 (PHP = 0.84 to PHP = 0.75, p = 0.037). For satisfaction, a significantly higher percentage of test subjects expressed that the brush was "pleasant to use" as compared to controls, both at 30 and 60 days (77% vs. 48%, p = 0.02, 80% vs. 54%, p = 0.04, respectively)., Conclusion: The initial increase in plaque levels (before brushing) in the test group, is explained as a possible "learning curve" effect of using this new and unconventional brush. It is suggested that the conical filaments clean the subgingival pockets and that this is of important gingival health potential. This subgingival cleansing might not be adequately detected by the PHP index. These results might indicate a gingival health promotion potential for this toothbrush with conical filaments.

Objective: This study was designed to assess a newly developed toothbrush for efficacy in plaque removal, reduction of gingivitis and soft tissue bleeding, and retardation of stain formation over 30 days., Methodology: Healthy adult subjects (N = 112) were admitted to the study, and randomly given a test toothbrush, (the elmex interX medium) or the control toothbrush, an ADA-Accepted flat-bristle profile toothbrush. Additionally, the subjects were randomly assigned to be given oral hygiene instruction, or no formal oral hygiene instruction. Examinations and assessments were performed at baseline, 15 and 30 days, and included gingivitis levels, stain levels, bleeding on probing, and plaque levels before and after brushing., Results: No significant statistical differences were found between the two toothbrushes on gingivitis, nor on the stain index; however, over the course of the study the gingivitis decreased significantly (p = 0.012) for the test toothbrush group. For the bleeding index, a significant statistical difference (p = 0.027) was found at 30 days favoring the test toothbrush. There was also a significant decrease for the test toothbrush on bleeding over time (p = 0.004). Following overnight plaque formation, the before-brushing plaque levels were significantly different in favor of the test toothbrush at 15 days (p = 0.002), and again at 30 days (p = 0.001). Immediately after brushing, there was a significant statistical difference (p = 0.015) favoring the test toothbrush at 30 days., Conclusion: These results clearly indicate improved plaque removal and reduction of bleeding and gingivitis for the new elmex interX medium toothbrush compared to the ADA-Accepted control toothbrush.