Introduction
Good oral hygiene is essential for preventing dental caries and gingivitis, the most common periodontal disease, and it is well acknowledged effective daily removal of plaque biofilm plays a central role in maintaining oral health.1-7 Of all the oral hygiene methods available, toothbrushing is the most commonly used. Some people use no other means of plaque removal.
Numerous short- and long-term comparative studies have explored the relative benefits of manual versus powered toothbrushes for the effective mechanical removal of plaque. Despite evidence that certain powered models, namely those with rotation-oscillation action, are consistently more effective than manual brushes in reducing plaque and gingivitis,8-9 the manual toothbrush is likely to remain in common use. Manual toothbrush manufacturers continue to address the need for improved cleaning efficiency by developing new models with design modifications aimed at achieving improved plaque removal, regardless of the variations and inconsistencies in brushing technique seen in manual toothbrush users in the general population.10,11
Clinical studies are crucial for establishing the relative merits of various models as they become available. Typically, both single-use and long-term studies are conducted to examine the proposed superiority of a new toothbrush, as seen for example with the introduction of the manual Oral-B® CrossAction® (Procter & Gamble, Cincinnati, OH, USA) design.12-15 Ideally, clinical data should be periodically reviewed to determine whether the advantages continue to be robust when further comparisons are made with both existing models and new designs as they appear on the market.16
A new Oral-B manual toothbrush, Exceed, incorporates modifications to an existing toothbrush design. These include a crisscross bristle pattern with angulated bristle tufts and a power tip. Another recent approach to manual toothbrush design is the Asian Colgate® 360°® (Colgate-Palmolive, New York, NY, USA). Features include multifunctional bristles, polishing cups, and a tongue cleaner.
The present study compared plaque removal following a single brushing with these two commercially available manual brushes in order to establish their relative advantages and used a four-period repeated single use crossover design to control for residual (carryover) effects. Two indices commonly used for assessing plaque removal are the Rustogi et al. Modified Navy Plaque Index (RMNPI)17 and the Turesky et al. Modified Quigley-Hein Plaque Index (TQHPI).18,19 Although these indices score plaque in different ways, there are strong positive correlations between them.20 If there is a real clinical advantage for plaque removal with one of the brushes in the present study, then this should be expressed regardless of which index is used.
