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Concept: Toothbrush


BACKGROUND: Dental caries among young children are a global problem. Scant attention is paid towards primary teeth, leading to high prevalence of dental caries. There are only few studies done in Sri Lanka, addressing oral hygiene among preschool children. Scientific evidence is in need to persuade authorities to establish a programme promoting oral hygiene among preschool children. METHODS: A descriptive cross sectional study was conducted in Ragama Medical officer of Health area. Consecutive children between 2 – 5 years of age, attending child welfare clinics were recruited for the study. Practices related to dental hygiene and socio-economic characteristics were obtained using an interviewer administered questionnaire. Mouth was examined for evidence of dental caries. Data collection and examination were done by two doctors who were trained for this purpose. The data were analysed using SSPS version 16. RESULTS: Total of 410 children were included. None had a routine visits to a dentist. Practices related to tooth brushing were satisfactory. Prevalence of dental caries gradually increased with age to reach 68.8% by 5 years. Mean total decayed-extracted-filled (deft) score for the whole sample was 1.41 and Significant caries index (SIC) was 4.09. Decayed tooth were the main contributor for the deft score and Care index was only 1.55. Girls had a significantly higher prevalence of caries than boys. CONCLUSIONS: Dental care provided for Sri Lankan preschool children appears to be unsatisfactory as prevalence of dental caries among this cohort of preschool children was very high. There is an urgent need to improve dental care facilities for Sri Lankan preschool children.

Concepts: Teeth, Dental caries, Sri Lanka, Dental plaque, Oral hygiene, Dental floss, Halitosis, Toothbrush


Triclosan (TCS), a broad-spectrum antimicrobial, is used in commercial toothpastes with reported dental benefits. Our studies on 22 popular manual toothbrushes in the U.S. showed that common toothbrush head components can accumulate substantial amounts of TCS after brushing with TCS-formulated toothpastes (TCS-TPs). After simulated 3-month brushing with a commercial best-selling TCS-TP, over one third of the adults' toothbrushes showed a cumulative TCS uptake of 21-37.5 mg, equivalent to 7-12.5 doses of the TCS used per brushing. Similar results were observed on children’s toothbrushes with small pea-size heads. Elastomer components were found to be the main contributor while both nylon bristles and elastomers could act as absorptive sinks for TCS during brushing. Studies on six different TCS-TPs containing 0.3 wt% TCS showed similar profiles of TCS accumulation. The absorbed TCS was gradually released into toothpaste slurries after switching to TCS-free alternatives. Release of TCS, which typically measured at a fraction (<75%) of the standard dose using the TCS-TPs, continued for over 2 weeks and occurred most rapidly in peroxide-containing "whitening" toothpastes, followed by alkaline and surfactant-rich toothpastes. The accumulating effect was not exclusive to TCS but was commonly observed on several chemicals identified in TCS-TPs and a range of regular toothpastes.

Concepts: Polymer, Nylon, Oral hygiene, Thermoplastic, Toothpaste, Dental floss, Toothbrush, Triclosan


The use of a toothbrush has a limited ability to control the dental biofilm in interproximal areas. Therefore, specialized devices, such as dental floss, may be useful for these specific areas.

Concepts: Randomized controlled trial, Biofilm, Dental plaque, Dental equipment, Oral hygiene, Dental floss, Toothbrush, Floss pick


The aim was to compare the efficacy of the electric versus the manual toothbrush in terms of the oral hygiene achieved by patients wearing rapid palatal expanders (RPEs).

Concepts: Toothbrush


Objectives To assess the methods of toothbrushing recommended for both adults and children by dental associations, toothpaste and toothbrush companies and professional sources such as in dental textbooks and by experts. Secondly, to compare the advice by source and whether recommendations differed for adults and for children.Methods Examination of online material on methods of toothbrushing from dental associations, toothpaste and toothbrush companies and associated organisations providing professional advice; as well as from dental texts.Results There was a wide diversity between recommendations on toothbrushing techniques, how often people should brush their teeth and for how long. The most common method recommended was the Modified Bass technique, by 19. Eleven recommended the Bass technique, ten recommended the Fones technique and five recommended the Scrub technique. The methods recommended by companies, mainly toothpaste companies, differed from those of dental associations, as did advice in dental textbooks and research-based sources. There was a wide difference in the toothbrushing methods recommended for adults and for children.Conclusions The unacceptably large diversity in recommendations on what toothbrushing method to use should concern the dental profession. Higher grades of evidence of effectiveness of toothbrushing techniques are required to inform professional bodies that develop guidelines on toothbrushing.

Concepts: Professional, Teeth, Dental plaque, Oral hygiene, Toothpaste, Toothbrush, Tooth brushing, Bass Rock


Dental caries in young children is a major public health problem impacting on the child and their family in terms of pain, infection and substantial financial burden on healthcare funders. In the UK, national guidance on the prevention of dental caries advises parents to supervise their child’s brushing with fluoride toothpaste until age 7. However, there is a dearth of evidence-based interventions to encourage this practice in parents. The current study used intervention mapping (IM) to develop a home-based parental-supervised toothbrushing intervention to reduce dental caries in young children.

Concepts: Health care, Public health, Health, Dental caries, Oral hygiene, The Child, Fluoride therapy, Toothbrush


Data sourcesElectronic databases searched were Cochrane Oral Health’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline Ovid, Embassy Ovid, LILACS BIREME Virtual Health Library, CINAHL EBSCO, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan Fang Database and VIP Database and the World Health Organisation International Clinical Trials Registry Platform for ongoing trials. No restrictions on language or date of publication.Study selectionRandomised controlled trials (RCTs) were included evaluating OHC in the form of mouthwashes, swabs or toothbrushing or in combination in critically ill patients receiving mechanical ventilation.Data extraction and synthesisTwo reviewers carried out data extraction independently. Study authors were contacted for additional information. Random-effects meta-analyses were performed where data could be pooled.ResultsThirty-eight RCTs (6,016 participants) were included. Five trials (13%) were assessed at low risk of bias, 26 studies (68%) high and seven studies (18%) of unclear risk of bias. There were four main comparisons; chlorhexidine (CHX mouthrinse or gel) versus placebo/usual care, toothbrushing versus no toothbrushing, powered versus manual toothbrushing and comparisons of oral care solutions.Evidence from 18 RCTs (2451 participants, 86% adults) shows that CHX mouthrinse or gel, as part of OHC, reduces the risk of VAP compared to placebo or usual care from 25% to about 19% (RR 0.74, 95% confidence intervals (CI) 0.61 to 0.89, P = 0.002, heterogeneity I2 = 31%). Number needed to treat (NNT) = 17 (95% CI 10 to 33).There is no evidence of a difference between CHX and placebo/usual care for the outcomes of mortality (RR 1.09, 95% CI 0.96 to 1.23, P = 0.18, I2 = 0%, 15 RCTs, 2163 participants, moderate quality evidence), duration of mechanical ventilation (MD -0.09 days, 95% CI -1.73 to 1.55 days, P = 0.91, I2 = 36%, five RCTs, 800 participants, low quality evidence) or duration of intensive care unit (ICU) stay (MD 0.21 days, 95% CI -1.48 to 1.89 days, P = 0.81, I2 = 9%, six RCTs, 833 participants, moderate quality evidence). There is insufficient evidence to determine the effect of CHX on duration of systemic antibiotics, oral health indices, caregivers' preferences or cost. Only two studies reported any adverse effects, and these were mild with similar frequency in CHX and control groups.The effect of toothbrushing (± antiseptics) is uncertain on the outcomes of VAP (RR 0.69, 95% CI 0.44 to 1.09, P = 0.11, I2 = 64%, five RCTs, 889 participants, very low quality evidence) and mortality (RR 0.87, 95% CI 0.70 to 1.09, P = 0.24, I2 = 0%, five RCTs, 889 participants, low quality evidence) compared to OHC without toothbrushing (± antiseptics).There is insufficient evidence to determine whether toothbrushing affects duration of mechanical ventilation, duration of ICU stay, use of systemic antibiotics, oral health indices, adverse effects, caregivers' preferences or cost.Only one trial (78 participants) compared use of a powered toothbrush with a manual toothbrush, providing insufficient evidence to determine the effect on any of the outcomes of this review.Fifteen trials compared various other oral care solutions. There is very weak evidence that povidone iodine mouthrinse is more effective than saline/placebo (RR 0.69, 95% CI 0.50 to 0.95, P = 0.02, I2 = 74%, three studies, 356 participants, high risk of bias) and that saline rinse is more effective than saline swab (RR 0.47, 95% CI 0.37 to 0.62, P <0.001, I2 = 84%, four studies, 488 participants, high risk of bias) in reducing VAP. Due to variation in comparisons and outcomes among trials, there is insufficient evidence concerning the effects of other oral care solutions.ConclusionsThe results from high quality evidence found that oral hygiene care (OHC), including chlorhexidine mouthwash or gel, reduces the risk of developing ventilator-associated pneumonia in critically ill patients from 25% to about 19%. However, there is no evidence of a difference in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay.There is no evidence that OHC including both antiseptics and toothbrushing is different from OHC with antiseptics alone, and some weak evidence to suggest that povidone iodine mouthrinse is more effective than saline/placebo, and saline rinse is more effective than saline swab in reducing VAP. There is insufficient evidence to determine whether powered toothbrushing or other oral care solutions are effective in reducing VAP. There is also insufficient evidence to determine whether any of the interventions evaluated in the studies are associated with adverse effects.

Concepts: Health care, Clinical trial, Pneumonia, Effect, Effectiveness, Oral hygiene, Mouthwash, Toothbrush


This study aims to investigate variables related to adherence to oral self-care in the Brazilian adult population. It is an exploratory study, using secondary data from a population-based survey on a representative sample of the adult population of the entire Brazilian territory (n=60202). The sample was selected using a multiple stage approach. The oral self-care indicator was defined by grouping the variables: periodicity of dentist appointments, use of dental floss, toothbrush and toothpaste, frequency of brushing and replacement of the toothbrush. The scores obtained from the indicator were categorized into adequate, partially adequate, and inadequate care. Statistical analysis consisted of dimensionality reduction, and oral self-care-related variables were submitted to logistic regression. The variables mostly related to inadequate or partially adequate oral self-care were: illiteracy (OR = 11.20, OR = 4.81), low educational level (OR = 3.50, OR = 1.96), negative oral health self-concept (OR=3.73, OR=1.74), absence of natural teeth (OR = 4.98, OR=2.60), edentulous lower arch (OR = 3.09; _____), number of missing upper teeth (OR=1.14, OR=1.05), absence of health insurance (OR=2.23, OR=2.07), sedentary lifestyle (OR=2.77, OR=1.51), and smoking (OR=2.18, OR=1.40). It was concluded that the individual’s level of education is one of the main factors for adherence to adequate oral self-care, followed by level of oral health self-concept and tooth loss. Likewise, lifestyle also bears a significant influence.

Concepts: Sample, Statistics, Teeth, Dental implant, Dentistry, Oral hygiene, Dental floss, Toothbrush


The type of used rotating-oscillating toothbrush was incorrectly assigned; correct used rotating-oscillating toothbrush is Pro1000 Precision Clean, Procter&Gamble GmbH, Schwalbach, Germany.

Concepts: Health care, Epidemiology, Clinical trial, Pharmaceutical industry, Clinical research, Nylon, Tooth enamel, Toothbrush


A 2-month randomized clinical trial (RCT) study comparing electric and manual toothbrushes used by residents in nursing homes showed significant reduction in plaque score for both groups. The aim of this follow up study was to study if the effect sustained in a longer perspective when toothbrushes were used according to resident’s own preference.

Concepts: Clinical trial, Randomized controlled trial, Pharmaceutical industry, Clinical research, Dental plaque, Oral hygiene, Dental floss, Toothbrush