Dentaltown November 2013 - (Page 94)

hygiene and prevention perio reports continued from page 93 Dry Brushing Mandibular Lingual Surfaces First Manual Toothbrushing Removes Less than 50 Percent of Plaque Toothbrushing is generally accepted as the most common practice to reduce oral plaque biofilm. Despite the introduction of a variety of toothbrush designs and bristle configurations, no one toothbrush design has been found to be superior for plaque removal. Personal preference for one brush over another is how people decide which brush to use. Enthusiastic brushing is not however synonymous with effective plaque removal. Most people are able to remove approximately 50 percent of plaque with a one-minute brushing. This means people are generally not very good toothbrushers and live their lives with considerable plaque on their teeth. A systematic review was needed to determine the effectiveness of manual toothbrushing. Researchers at University of Amsterdam in the Netherlands evaluated all available studies to determine the effect of manual toothbrushing on plaque removal. A total of 59 papers with 212 brushing experiments were evaluated. A total of 10,806 subjects participated in these studies. The outcome analyzed from each of these studies was the percentage of reduction in plaque from before to after the brushing exercise. Overall, the manual toothbrush provides a 42 percent reduction in plaque scores. The reduction is 30 percent when the Quigley and Hein plaque index is used and 50 percent when the Navy plaque index is used. Sub-analysis revealed that various bristle designs reduced plaque scores 24 to 61 percent. Toothbrushing time also impacted plaque removal. For studies brushing for one minute, the mean plaque reduction was 27 percent and increased to 41 percent with two minutes of brushing. Standard toothbrushing instructions focus on bristle placement and toothbrush movement, not where to start brushing. Mandibular lingual surfaces have the highest levels of both calculus and gingivitis, but this area is often the last to be brushed, if at all. Many clinicians followed their common sense instincts and recommended that patients brush mandibular lingual surfaces first. Individuals reported success with this approach, but no research was available to confirm these findings. To test this theory, 29 dental hygienists were invited to participate in a pilot study to measure the effects of lingual brushing first on calculus and bleeding. They invited patients with heavy lingual calculus to participate in the study. Since all were busy clinicians, data collection was limited to mandibular lingual surfaces, measuring calculus and bleeding upon probing. A total of 126 patients participated in the study. Dental hygienists instructed the patients to begin brushing on the lingual surfaces of the mandibular arch. They were told to brush dry, no water and no toothpaste. They followed their regular brushing technique, brushing until all the teeth in the mouth felt clean and tasted clean. At that point, they rinsed their toothbrush, added toothpaste and brushed again to deliver the toothpaste to the tooth surfaces. They were seen again at six months. Analysis of the data revealed a 55 percent reduction in bleeding on the mandibular lingual surfaces and a 58 percent reduction in calculus. When analyzing data from just the mandibular anterior teeth, the reduction in calculus was 63 percent. Patients reported brushing longer and more evenly throughout their mouths. Clinical Implications: Teach patients to dry brush mandibular lingual surfaces first to achieve longer time brushing and more thorough plaque removal. n O'Hehir, T., Suvan, J.: Dry Brushing Lingual Surfaces First. JADA 129:614, 1998. Clinical Implications: Toothbrushing doesn't remove as much plaque as you might expect. n Slot, D., Wiggelinkhuizen, L., Rosema, N., Van der Weijden, G.: The Efficacy of Manual Toothbrush Following a Brushing Exercise: A Systematic Review. Int J Dent Hygiene 10: 187-197, 2012. 94 NOVEMBER 2013 » dentaltown.com http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown November 2013

Dentaltown.com Highlights
Howard Speaks: Not Getting it Done? Hire a Consultant
Professional Courtesy: Painful Advertising
Continuing Education Update
Second Opinion: The Role of Teamwork in the Third Era of Medicine
Deprogrammed Open Bite Can Help with Veneers
Bruxism Worse with Splint
Corporate Profile: Burbank Dental Laboratory
Product Profile: Eaglesoft 17
Debunking the Social Stigma of Stress
The Personal Side of Stress
In Your Face: Facing the Realities of Stress in Dentistry
When Tragedy Strikes: How to Prepare for and Recover from a Natural Disaster
The Latex Problem: It’s More Complicated Than You Think
Why Dentists Require Specific Exercise
How Much Money Can You Make When You’re Dead?
Denture Stabilizations with Small-diameter Implants
You Should Know: CrownMen
Product Profile: Synergy
Product Profile: NuSmiles ZR
Continuing Education: The New Evolution of Chariside CAD/CAM Technology
Ad Index
In This Issue: Dry Brush Inside Bottom Teeth First
Perio Reports
Dentally Incorrect
101 Ways to Reduce Stress
Achieving Goal Congruency

Dentaltown November 2013