Efficacy+of+Toothbrushes+&+Interproximal+Aids

1. There is no one superior design for a manual toothbrush; the efficacy of the toothbrush depends on the patient. MW19 With all of the different designs of toothbrushes including different sized heads, various handle designs, angled brushes and different bristle configurations patients may have a difficult time choosing one that's right for them. Carranza's Clinical Periodontology asserts that plaque removal is comparable among the different designs of manual toothbrush, and that patients' techniques and perceptions of the toothbrushes are more important factors in the efficacy of the toothbrush. If the patient likes a particular toothbrush, it is likely that they will use it more regularly than one they do not like, so encouraging patient preferences can be important to patient compliance. As health care providers and educators, it is a good idea to show your patients different options so they can choose something that they feel works for them. This is a great way to individualize patient care, and take the opportunity to find out how you can motivate your patients by involving them in the process.

**2. Powered toothbrushes remove plaque as well as, if not slightly better than, manual toothbrushes. RK 7** As we know plaque is the major etiology of periodontal disease, because of this it is our job to increase patient understanding and compliance to daily plaque removal. By maintaining current knowledge on the efficacy of different toothbrushes and inter-dental aids, dental hygienists will be able to provide their patients with individualized aids that are specific to each case.

Toothbrushes range in size and design, in addition to the length, hardness, and arrangement of bristles. When recommending a toothbrush to a patient a clinician should consider each individual patients periodontal status, as well as when and where they brush, how much time they spend brushing, and their brushing technique.

A study conducted by oral health clinical services compared the use of a powered toothbrush to a manual toothbrush by measuring each participant’s plaque index. The study consisted of 126 subjects whose plaque index was initially measured after refraining from their regular oral hygiene routine for 24 hours. They were then separated into two equal separate groups based off their initial plaque findings. They were then instructed to brush their teeth for one minute with their assigned toothbrush (manual or power) upon completion; their plaque index was then re-measured. The study’s results showed that the subjects using the power toothbrush had a 42.1% greater plaque reduction than the subjects using the manual toothbrush after a single use. This study supports the greater efficacy for the removal of plaque with the use of a powered toothbrush.

According to Carranza, a powered toothbrush removes slightly more plaque than a manual toothbrush; however it does not improve the amount of gingival inflammation beyond what is achieved with a manual toothbrush. Patients who are good candidates for a power toothbrush are those who are poor brushers, have poor dexterity, children, and caregivers of individuals who are unable to brush on their own. The benefits of power toothbrushes are that they are durable, their handles are designed for patient comfort, and their convenient due to built in timers. The disadvantage is that they can cost up to $200.

References

Nathoo, S, Wachs, G, Petrone, D, Proskin, H, & Kemp, J. (2003). Comparison of plaque removal efficacy of a battery-powered toothbrush and a manual toothbrush: a single-use clinical study in new jersey. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed

There are several different tooth brushing techniques that have been designed to remove plaque. However often times the Bass brushing technique is recommended to patients. The advantages of the Bass brushing technique is that the method is easy to master. The method used is short, back and fourth motions. Patient's find this easy to demonstrate because it is similar to the scrubbing that most patients perform. Another advantage to the Bass brushing technique is that it also focus on the cervical and interproximal portions of the teeth, which is where plaque accumulates first.
 * 3. The bass brushing technique has advantages over other brushing techniques. GE 6**

**4. Using the** toothbrush and interproximal aide is the most dependable way of achieving oral health benefits. AP12
Not only is toothbrushing extremely important but the use of an oral hygiene aide is also. Plaque growth not only occurs within hours but the majority begins forming in the interproximal regions where it is difficult to reach with the toothbrush.

**5. Although there is different types of floss available, not one single floss has been proven to be more effective than the other. MC#3**
====There is many varieties of floss available, and patients are able to choose from waxed, nylon, yarn, nonbonded, or powered floss. Factors that influence the patients choice include tight contacts and dexterity. One study demonstrated that the use of a powered flosser after manual tooth brushing had the best outcome in plaque reduction when compared to three traditional flosses. Other studies have showen this device to be safe and effective, but no better at plaque removal than finger flossing. The clinician needs to be able to assess the patient's needs and recommend the most appropriate floosing aid for the patient. The patients compliance, motivation, and technique will have the best outcome in plaque control. ==== ===6.Brushing and flossing is often not the most effective way for the patient to clean interdental spaces and the clinician should introduce types of interdental aids until one is found that the patient will use, such as a toothpick. KT4=== The wooden tip, or toothpick, is an item that can be commonly found and may already be used by some patients. These tips easily access the buccal surfaces, but placed on a handle can reach other surfaces more easily. It is very helpful for cleaning furcation areas that flossing and standard brushes are unable to reach. Patient compliance has the possability to increase when the patient feels they are able to do the task requested of them and are comfortable with the interdental aid. Instruct the patient to trace along the gingival margin from the buccal and lingual aspect as well as into interproximal spaces. If a furcation is present demonstrate how to use the toothpick in this area. Some disadvantages are that the patient may blunt the interdental papilla and posterior as well as lingual areas maybe difficult to reach.

Power toothbrushes come in many different sizes with many different types of brush rotations. The power toothbrushes that are utilizing oscillating/pulsating power move the toothbrush bristles in a repeated back and forth movement with pulsations included in this movement. The high frequency power toothbrushes utilize fast vibrations in their bristle movement. Although both these toothbrush types are utilizing power as a source of their movement the action is somewhat different. Therefore, studies have shown that power toothbrushes that use an oscillating/pulsating(oral-b) motion do remove more plaque than a power toothbrush that operates on a high frequency (Sonicare).
 * 7. Efficacy of power toothbrush with oscillating/pulsating vs. a high frequency toothbrush LM #11**

Many factors play a role in choosing the right tool for plaque removal. Oral conditions such as interproximal concavities make it difficult for floss to reach these areas therefore it is recommended that consideration for plaque removal be recommeded on the patients current oral condition. Teppe brushes have the ability to reach concavities that floss or a normal toothbrush can't reach.
 * 8. Interproximal brushes with toothbrushing remove more plaque than toothbrush alone and toothbrush and floss. SR14**

Since patients with moderate and severe periodontal disease are ADA III and ADA IV, respectively, these patients would have 5-6 mm below CEJ and 3-4 mm attachment loss or more than 6 mm from the CEJ and 5-6 mm attachment loss that dental floss cannot thoroughly clean these areas alone. In these cases, recesssion, furcations, and root surfaces concavities are also significant and clinically observed. According to Carranza, interproximal cleaning aids that can be handled with ease and simplicity and adapted better on the different surfaces such as the interproximal brushes are recommended when access is available.
 * 9. Interproximal brushes remove more interproximal plaque and easier to use than dental floss in patients with moderate and severe periodontal disease. LL #9.**

The most important aspect of the dental hyienists duties is to educate the patients in order to obtain optimal oral health. Without educating the patient about proper use of the toothbrush and interdental aids the efficacy of the product can not be accurately demonstrated.
 * 10. The efficacy of toothbrushes and interdental aids is dependent on patient education. MT #18**

Plaque as we know is the causative agent of periodontal disease and therefore needs to be removed regularly. It is up to the patient to take responisbility of their oral health and develop or practice habits of daily oral hygiene, however it is the dental hygienist's responisiblity to get them there through research, education and motivatation.
 * 11. Optimal oral health cannot be achieved without good plaque removal habits of the patient. TL #8**

Floss should be used in all interproximal areas that have scalloped gingiva. The floss should be wrapped around the tooth an inserted into the sulcus. This can be accomplished either with a floss-aide or with fingers alone. Interdental aids, no matter which is the preference, should be used on all tooth surfaces that the toothbrush and floss cannot adequately reach, such as large embrasures and furcations.
 * 12. All patients require the regular use of a toothbrush, either manual or electric, at least once a day. The brushing method should emphasize access to the gingival margins of all accessible tooth surfaces and extension as far onto the proximal surfaces as possible. CE5**