Introduction

Plaque-induced gingivitis continues to be prevalent among children, adolescents, and adults worldwide.^1-3  The prevalence of gingivitis in adults exceeds 75% and in some populations approaches 100%.⁴  The importance of prevention, early diagnosis, and treatment of gingivitis in adults to prevent progression into advanced periodontal diseases is emphasized in the dental literature.⁵  The role of dental bacterial plaque in the development of these diseases has been established in many studies.^6-8  The best approach to manage periodontal diseases is prevention, followed by early detection and treatment.  The prevention of periodontal diseases is targeted at the control of dental plaque.⁹  Prevention may be achieved by conscientious daily brushing and flossing to remove plaque that forms each day before inflammation occurs.¹⁰  Mechanical plaque removal with a manual toothbrush remains the primary method of maintaining good oral hygiene and the most affordable method for the majority of the population.^{11, 12}  The toothbrush has been reported to be the most effective home care device for plaque removal.¹³  (Click here for "How to Brush” pdf.)   In addition, dental floss has been reported to be an important part of oral hygiene.^14-17  Flossing removes plaque from between the teeth and under the gumline-areas where a toothbrush cannot reach.  These are the parts of the teeth where decay and periodontal disease often start.

The removal of interproximal plaque is considered to be important for the maintenance of gingival health and prevention of periodontal disease.  Unfortunately, most conventional manual toothbrushes are not designed to effectively remove interproximal plaque and, therefore, patients need to resort to additional products such as floss and interdental brushes for interproximal cleaning.  Reports in the literature have consistently demonstrated manual toothbrushes with advanced features such as tapered filaments deliver superior plaque removal in specific anatomical areas including interproximal sites compared to American Dental Association (ADA) manual reference toothbrushes.  A recent clinical study has demonstrated a newly developed manual toothbrush with tapered filaments (Meridol, GABA International, CH-Munchenstein) was superior to the ADA reference brush in plaque removal.  At proximal surfaces, the plaque scores were reduced for a Meridol toothbrush from 2.02±0.49 to 1.11±0.43 (p<0.001) and for the ADA reference brush from 2.01±0.52 to 1.20±0.45 (p<0.001).  The relative plaque reductions at proximal surfaces were 44.2±18.8% for the Meridol toothbrush and 40.5±15.9% for the ADA reference brush.¹⁸  Moreover, a study by Sharma et al. investigated the efficacy of a novel angled-bristled toothbrush (Oral-B CrossAction Vitalizer toothbrush) in comparison with three established brushes.  They have shown each tested toothbrush significantly (P=0.0001) reduced plaque levels after a single brushing.  However, in all three studies the CrossAction Vitalizer was significantly (P=0.0001) more effective than the comparator brushes in plaque removal from the whole mouth, the gingival margin, and interproximal surfaces.¹⁹  The use of dental floss and interproximal brushes has been shown to add additional benefits, in terms of plaque reduction, when they are associated with conventional manual brushes.  A review article by Sicilia et al. have indicated techniques of interproximal oral hygiene, fundamentally the use of dental floss and interproximal brushes, appear to add additional benefits, in terms of plaque reduction, when they are associated with conventional manual brushes. The authors also indicated further long-term studies are necessary to confirm their efficacy in the reduction of gingival bleeding or inflammation.  They suggested the choice of the type of technique must be made in relation to the characteristics of the patient:  dental floss could be indicated in individuals with closed interdental spaces and inter-proximal brushes in periodontal patients or in those with open embrasures.²⁰  The main problem with all interdental cleaning is, however, patient ability and motivation.  Patients are known to find flossing difficult, especially where there are tight contact points; therefore, interdental cleaning may not readily become an established part of daily oral hygiene.²¹  For that reason, patients may want to look for other advanced toothbrushes that maximize the removal of plaque in particular from interproximal areas.

There is a divergent body of scientific evidence reporting the relative effectiveness of different toothbrush designs for removing plaque.  The current study was designed to compare the plaque removal efficacy of a prototype manual Deep Clean toothbrush (Figure 1) versus an ADA manual toothbrush (Figure 2) and the ADA manual toothbrush in conjunction with floss.

Figure 1.  Prototype Deep Clean Active Clean toothbrush.

Figure 2.  ADA reference manual toothbrush.

	Page 2 of 13
Citation Number: Vol. 6, No. 3, Page 002