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An in Vitro Evaluation of Electric Toothbrushes

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An in Vitro Evaluation of Electric Toothbrushes Preventive Dentistry An in vitro evaluation of electric toothbrushes B. S. Khambay*/A. D. Walmsley^* Fotir cotnmercially avaiiable electric toothbrushes (Sonieare, Braun Electric Toothbrush, Interplak, and Blend-a-Dent) »ere assessed both for their operating characteristics and their ability to retnove a 'food debris " medium. The Sonieare and Blend-a-Dent have a lateral vibrator)' action, while the Interplak and Braun produce a rotary movement of the brush head. The vibratory action of the Sonieare was susceptible to loading. All devices produced both stable-pulsating cavitation and acoustic tnicrostreaming that was demonstrated in vitro using a suspension of particles in water Their effectiveness in removing a food debris medium was assessed with and without water Three of the brushes (Sonieare, Braun, and Blend-a- Dent) were simitar in their abllit}- to remove the placjue, and all were superior to the Interplak: its streaming forces removed no food debris. The results indicated that the Blend-a-Dent was the most effective brush design in vitro, although the differences between Blend-a-Dent and Sonieare were not statistically significant. (Quintessence Int 1995:26:841-848.) Introduction The early designs of electric toothbrushes generated a transverse {side-to-side) movement, and this motion Electric toothbrushes have become established as an is stih prominent in those presently avaiiable. Other effective alternative to manual methods of tooth- variations include rotation of small individual tufts and brushing. The mode of action of these brushes is a rotary longitudinal movement of the brush head. designed to simulate manual methods and as such is Reports on the effectiveness of a toothbrush with a attractive to the population as an easy and simple rotational movement suggest that it may be superior in method of brushing teeth. The use of electric tooth- removing interdental plaque in vivo,"'^ with differ- brushes has a particular advantage in controlling ences in efficiency between different designs and plaque accumulation in patients with low compliance manufacturers of eleetric toothbrush.'- Such differ- to dental treatment.' Some reports have indicated that ences may be related to the operating characteristics of electric toothbrushes are superior to manual ones in these brushes. terms of removing plaque and improving gingival The mechanism of electric toothbrushes may be health.^-^ Other longitudinal and randomized control superior to that of conventional toothbrushing, per- clinical studies, however, have not conclusively proved haps because of a superior scrubbing action resulting any differences in the efficacy of plaque removal from rapid vibration of tbe brusb bead. It is possible to between manual and electric toothbrushing.''"' One speculate that the vibratory action of the electric area in which electric toothbrushes are considered to toothbrush will move fiuid between the teeth and into be inferior to manual brushing is in their ability to the gingival crevice, thus dislodging and possibly remove plaque from the interproximai and Iinguai disrupting plaque colonies. Research has shown that tooth surfaces.^''" plaque bacteria may be affected by sonic energy'' as a possible result of both cavitation and acoustic micro- ' Research Associaie, University of Birmingham. School of Denlislrv. streaming forces. It is unliliely that cavitation is the Birmingham. England. predominant mechanism for disrupting the plaque, ** Senior Lecturer in Restorative Dentistry. University of Birmingham, however, because the low-powered battery-operated School of Dentistry, Birmingham, England. devices do not generate enough energy to produce Reprint reqjcsts: Dr A. D. Walitisley, Senior Lecturer in Restorative transient cavitation; if it does occur, cavitation will be Dentistry, University of Birmingham. School of Dentistry, St. Chad's Queensway. Birmingham B4 6NN, Engiand. stabie, resulting in gentle puisation of bubbles.'^''^ Intgmqtinnai VolLime-2fi. Number 12/1995 841 Preventive Dentistry Fig 1 The four brushes used in the study: (clockwise from top) Braun, Biend-a-Dent, interpiak, and Sonicare. Table 1 Arrangement ofthe bristles on the four electric toothbrushes used in the study Electric toothbrush Head design/bristle arrangement Sonicare Large rectangular brush head Plastic guard around the head Alternating arrangement of long and short bristles Braun Small circular brush head BrisUes arranged in a concentric pattern, with an outer, middle, and irmer row Outer bristles larger than inner bristles Interpiak Large head with 10 separate tufts Bristles tapered within each tuft Blend-a-Dent Medium-sized rectangular brush head Bristles arranged longitudinally Longer bristles to the outer sides ofthe brush and shorter ones toward the center A physical phenomenon more likely to be encoun- those toothbrushes; and the effectiveness of such tered is acoustic microstreaming, and electric tooth- devices on the removal of a "food debris" medium. brushes may utilize such forces during use. The Sonicare brush works at a higher sonic frequency than Method and materials do others (ie, 250 Hz) and may accordingly produce more effective streaming forces. Such a toothbrash has Observations of brush head movement shown to be safe to use in the mouth, and it has been Four electric toothbrushes were selected for this suggested that its plaque-removal abilities are superior investigation (Fig 1): Sonicare (Optiva), Braun Elec- to those of manual brushing. "^ " There is evidence that tric Toothbrush, Interpiak (Bausch & Lomb), and the Sonicare generates fluid activity in vitro that assists Blend-a-Dent (Procter & Gamble). The arrangement in removal of both plaque'** and stain.'^ It is likely, how- of the bristles on each toothbrush head was different ever, that all devices produce acoustic microstreaming, (Table 1 ). and it is of value to determine whether or not acoustic The action of the toothbrushes was investigated streaming is effective. using a camera attached to a Videorecorder. The The aim of this study was to determine the operating movement of all four toothbrushes was measured at characteristics of four different commercially available xlO magnification. The toothbrush was clamped and electric toothbrushes; the physical forces generated by switched on, and a stroboscope was shined onto the 842 Quintessence International Volume 26, Number 12/1995 Preventive Dentistry vibrating head. The frequency of the strobe was the paper. This cut paper was weighed and then increased until it approached the frequency of the calibrated against the weight of a known area of paper \ibrating brush head, which had the effect of slowing (1 cm'). This test was repeated five titnes for each down the vibratory motion. The displacement ofthe electric toothbrush. head was observed, and the motion was measured with The contribution of streaming to plaque removal a standard calibrated slide placed adjacent to the was assessed by repeating the procedure but immersing vibrating head. The displacement amplitude of the the microscopic slide in water. The toothbrush was head was taken as half the peak-to-peak displacement fully immersed and positioned so that the bristles were ofthe vibrating brush.™ The translation ofthe rotatory I mm above the slide. The brush was operated for 10 motion ofthe Interplak and Braun was measured. The seconds and then removed to allow measurement of frequency of the strobe was gradually increased until the area of food debris removal. the brush appeared stationar>', and the strobe fre- quency was recorded. The load required to stop motion ofthe vibratory Results toothbrushes was measured by pressing the working instrument against a pan balance. The applied load was Basic moveinents increased until the brush movement was stopped and observed with the camera. The Sonicare brush exhibited a side-to-side motion with a rolling side-to side motion ofthe head. This Battery discharge time motion was greatest at the tip of the head and least toward the pari nearest to the handle (Fig 2a). The The fully charged instruments were worked con- Braun brush had a rotatory movement of the entire tinuously in air, and the time taken for the battery to head, alternating between clockwise and counter- completely discharge was recorded. clockwise, resulting in a quarier turn in each direction (Fig 2b). The head ofthe Interplak brush remained Acoustic microstreaining stationary while the bristies rotated about their long axis. The Interplak had an intricate internal mechan- Because it was the primary purpose of the study to ism to rotate all bristles in either a clockwise or measure streaming ftelds around each working tooth- counterclockwise action (Fig 2c}. The bristles tended brush in an open field, presence of acoustic micro- to separate during the rotary movement. The Blend-a- streaming fluids was measured and recorded with the Dent toothbrush exhibited a rolling action of the zoom camera and video system at ¡< 10 magnification, whole head, which was a combination of a transverse A Petri dish was filled with water, and zinc stéarate motion with some longitudinal movement (Fig 2d). particles were placed on the surface. The toothbrush was held in an adjustable clamp and positioned so that Three of the brush heads (Braun. Interplak, and the bristles were immersed approximately 1 mm into Blend-a-Dent) were unaffected by loads of up to 2 kg. the water. The toothbrush was activated, and the Loads of approximately 50 g applied to the Sonicare motion of the particles
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