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	ABSTRACT

TOP ABSTRACT MATERIALS AND METHODS RESULTS DISCUSSION CONCLUSION REFERENCES

 
Background. The greater effectiveness of the power toothbrush compared with a manual toothbrush is well-documented. Despite this, acceptance by dental professionals is still low.

Methods. This general practice study evaluated the effectiveness of a power toothbrush (Braun Oral-B Ultra Plaque Remover, Braun GmbH) in 16,903 patients, based on the clinical opinions of dental professionals in regard to patients’ changing oral health status. In addition, a survey assessed the attitudes of dental professionals and patients toward the power toothbrush.

Results. The power toothbrush was considered by dental professionals to have had a positive effect on the oral health of 80.5 percent of their patients; the noticeable benefits with respect to a number of clinical criteria included plaque removal and improved gingival condition. Most patients in the study (88.9 percent) reported that they would continue using the power toothbrush once the study was completed. At the end of the study, many more dentists and hygienists considered the power toothbrush to be the most effective way of brushing, and almost 70 percent said that they would now be more likely to recommend a power toothbrush to their patients.

Conclusions. The power toothbrush improved the oral health of patients in this practice-based study, and the number of dental professionals who said they would recommend a power toothbrush increased markedly during the study.

Clinical Implications. Enabling dental professionals to evaluate the effect of a power toothbrush reinforces the findings from controlled clinical studies and increases their awareness of its potential to improve oral hygiene.

Since their introduction in the 1960s, power toothbrushes have been significantly improved, and today’s power toothbrushes are both highly effective and reliable. Their efficacy in comparison with that of the manual toothbrush has been evaluated in a large number of well-designed short- and long-term controlled clinical studies carried out by academic institutions and contract research companies specializing in dental research. These studies consistently have shown the power toothbrush to be superior, with results demonstrating greater plaque removal and, as a consequence, more improvement in gingival condition than that achieved with a manual toothbrush alone.^1–5

In addition to being highly effective, power toothbrushes have been shown to be well-received by patients and have the potential to improve compliance. Stålnacke and colleagues⁶ showed improved compliance with a power toothbrush, as did Hellstadius and colleagues,⁷ who demonstrated improved maintenance of plaque control in a group of patients with periodontal disease who were noted for their poor compliance with manual toothbrushing. Thus, power toothbrushes can have two clinically important benefits over manual toothbrushes. First, they are more effective at plaque removal, presumably because they confer on the patient a better brushing technique, and, second, they encourage better compliance with brushing. However, despite these clinically proven benefits, relatively few dental professionals recommend the use of a power toothbrush to their general patient population.¹

The fact that dental professionals do not wholeheartedly embrace the power toothbrush suggests that either the clinical data now available are not reaching them, or they are not convinced by the results of controlled clinical studies, which may not reflect the clinical situation as it applies to general practices. Therefore, practice-based studies^8,9 are needed to establish that the findings from controlled clinical trials apply to general practice settings.

This study involving a large patient base was designed to evaluate the potential of the Braun Oral-B Ultra Plaque Remover (Braun GmbH) to improve oral hygiene and to investigate the attitudes of dental professionals and their patients toward this power toothbrush.

	MATERIALS AND METHODS

TOP ABSTRACT MATERIALS AND METHODS RESULTS DISCUSSION CONCLUSION REFERENCES

 
The power toothbrush (Figure 1) evaluated in this study has an oscillating/rotating action with a frequency of 3,800 oscillating rotations per minute. The brush head is cup-shaped and has a diameter of 13 millimeters.

View larger version (80K): [in this window] [in a new window]   Figure 1. The Braun Oral-B Ultra Plaque Remover (Braun GmbH).

 
Study population. Dentists and hygienists in the United States were selected from Braun Oral-B databases and asked if they would participate in the study, which involved distributing power toothbrushes to selected patients. The dental professionals instructed their patients in the use of the power toothbrush; they then monitored the clinical status of patients for approximately eight months. A total of 3,669 dental professionals agreed to participate and were included in the study, resulting in an overall study population of more than 80,000 patients.

Patient inclusion criteria included having a consistent recall history; a need to improve manual brushing practices or poor oral hygiene despite the use of an alternative power brush; interest in using a power toothbrush; and sufficient motivation to comply with a continued preventive oral care regimen.

Study design. The study was divided into two phases. In the first phase, the dentist or hygienist made a subjective clinical evaluation of the patient’s oral health, before and after changing to the power toothbrush. Data were collected using a patient evaluation form that asked a number of questions designed to establish if use of the power toothbrush had resulted in any change in clinical status and whether the patient was satisfied with the toothbrush. The questionnaire was completed at the first recall appointment after the patient was given the power toothbrush.

In the second phase of the study, 600 dental professionals and 900 patients were randomly selected and contacted by telephone. A trained interviewer asked each subject a series of questions designed to evaluate his or her attitude toward the power toothbrush and its clinical effectiveness. Data were collected from dental professionals after approximately eight months and from patients after approximately 10 months.

Because of the uncontrolled study design and subjective nature of the data, only descriptive statistical analyses were carried out.

	RESULTS

TOP ABSTRACT MATERIALS AND METHODS RESULTS DISCUSSION CONCLUSION REFERENCES

 
Clinical evaluation. Evaluation forms for 16,903 patients were available for analysis eight months after the start of the study. The table shows baseline demographic characteristics of this group of patients. The majority of patients had been using a manual toothbrush, approximately one-half brushed two or more times per day and nearly three-fourths had good-to-excellent oral health.

View this table: [in this window] [in a new window]   TABLE BASELINE DEMOGRAPHIC CHARACTERISTICS OF THE PATIENT GROUP (N = 16,903).

 
At the first recall appointment for patients after they began using the power toothbrush (that is, after approximately six months of product use), change in oral health status was evaluated by the dental professional and classified on a five-point scale (from considerably improved to considerably worse). Figure 2 shows that the oral health of the majority of patients (80.5 percent) improved somewhat or considerably, while the oral health of only 1.2 percent of patients was considered to have become somewhat worse or considerably worse.

View larger version (38K): [in this window] [in a new window]   Figure 2. Dental professionals’ evaluation of changes in their patients’ oral health status after switching to the power toothbrush (Braun Oral-B Ultra Plaque Remover, Braun GmbH). An opinion regarding oral health status was not provided for approximately 3.9 percent of the patients (N = 16,903).

 
Clinical characteristics. Dental professionals were asked to specify, from a list of clinical characteristics, the changes that had been observed in patients in whom oral health had improved. Better cleaning along the gingival margin was reported for 57.8 percent of patients, improved gingival condition for 40.1 percent, better cleaning of lingual anterior surfaces for 34.5 percent, better cleaning of posterior surfaces for 33.3 percent, less calculus for 29.9 percent and less staining for 13.5 percent of patients. Other, unprompted, comments about the clinical condition of less than 1 percent of the patient population included better approximal cleaning, less tooth sensitivity and decreased pocket depths.

When completing the evaluation forms, the dental professionals asked patients how satisfied they were with the power toothbrush and whether they intended to continue using the product (Figure 3). When asked if they would continue to use the power toothbrush, 88.9 percent of patients responded that they would, compared with 3.7 percent who responded that they would not. Five percent were not sure and 2.5 percent gave no answer.

View larger version (35K): [in this window] [in a new window]   Figure 3. Patients’ satisfaction with the power toothbrush (Braun Oral-B Ultra Plaque Remover, Braun GmbH). Approximately 1.4 percent of patients did not provide an opinion (N = 16,903).

 
Professional telephone survey. Of the 3,669 dental professionals who participated in the patient evaluation phase of the investigation, 600 were randomly selected and contacted by telephone after approximately eight weeks. From this group, 420 completed a second telephone questionnaire after eight months.

With respect to their patients’ oral health, more than 90 percent of dental professionals reported that it had been either somewhat or considerably improved by changing to the power toothbrush. Improvements were seen in cleaning along the gingival margin, at posterior surfaces and at lingual anterior surfaces. In addition, more than 90 percent of the dental professionals noted that gingival condition had improved and the level of calculus and staining had decreased. Nearly 70 percent of the dental professionals said they would now be more likely to recommend a power toothbrush to their patients. At the beginning of the study, they recommended use of a power toothbrush a mean of 2.5 times per week; this figure increased to more than seven times per week when they were contacted after eight months.

At baseline and after eight months, dental professionals were asked which method of toothbrushing they considered to be most effective: manual or power-assisted. As shown in Figure 4, after eight months, the percentage of dental professionals who considered the power toothbrush to be most effective had increased from 37.6 percent to 62.5 percent.

View larger version (47K): [in this window] [in a new window]   Figure 4. The method of toothbrushing considered to be most effective by dental professionals eight months after the study began (n = 282).

 
Patient telephone survey. From among the patients involved in the study, 900 were randomly selected and contacted by telephone approximately four weeks after the study began. Of these, 600 were again contacted after about 10 months.

At the four-week interview, 95 percent of patients reported that they were using the power toothbrush at least once a day. At the 10-month interview, this figure had decreased only slightly to 89 percent.

With respect to their oral hygiene status, patients agreed with the subjective clinical evaluation made by the dental professionals. Seventy-four percent of patients thought that use of the power toothbrush had resulted in their oral hygiene being either somewhat better or much better than that when they had been using only a manual toothbrush.

Ninety-four percent of patients reported that they would probably or definitely continue to use the power toothbrush, and 75 percent reported that they would recommend the power toothbrush to a friend.

	DISCUSSION

TOP ABSTRACT MATERIALS AND METHODS RESULTS DISCUSSION CONCLUSION REFERENCES

 
In contrast to nearly every other study carried out with power toothbrushes, this investigation was practice-based and involved a large number of patients (N = 16,903). Of these, 16,172 used a manual toothbrush and 687 used an alternative power toothbrush. The study involved 3,669 dental professionals, who monitored the effect of the power toothbrush on their patients’ oral hygiene.

Because of the number of patients involved, a large amount of data was generated; however, these data were of a subjective nature because it was impossible to calibrate the examiners with respect to scoring specific plaque and gingival indexes. Despite this, we consider the results of the study to be of particular value because they reflect the normal method of oral hygiene appraisal used by dental professionals at recall appointments—namely, an overall subjective evaluation of clinical status. Such a study is in agreement with the views of Mjör and Wilson,^8,9 who commented that observations from the real-world environment of dental practice are important in interpreting research data.

Results from this practice-based study showed that 80.5 percent of patients benefited from switching to the power toothbrush, with dental professionals judging their oral health status to have improved somewhat or considerably compared with their baseline status. This was true despite the fact that approximately three-fourths of the patients had been judged to have good, very good or excellent standards of oral hygiene at the beginning of the study. The patients themselves endorsed this view, with 74 percent reporting their oral health to be somewhat better or much better than it had been when they were using only a manual toothbrush.

One other practice-based investigation of the power tooth-brush has been reported. In that study, a telephone survey was used to evaluate the opinions of dental practitioners in Germany with respect to the effect that power toothbrush use had on the oral health of their patients.¹⁰ Consistent with our own findings, 73 percent of respondents indicated that use of a power toothbrush (Braun Oral-B Plaque Remover) had resulted in improvement in the condition of their patients’ teeth and gingivae. Thus, findings from this practice-based study, as well as ours, appear to confirm the results from controlled clinical studies, which have shown that power toothbrushes,^1,2,4,5 including the one evaluated in our study,^3,11 are more effective than manual toothbrushes.

Results from this practice-based study showed that 80.5 percent of patients benefited from switching to the power toothbrush.

Our results show that when dental professionals have direct experience with a power toothbrush, their perception of its value to patients changes. By the end of the study, those favoring power toothbrushes had increased from 37.6 to 62.5 percent and those who were undecided had decreased from 46.6 to 22.7 percent. Although this study resulted in a change in practice with respect to recommending use of the power toothbrush, it remains to be seen whether the results will help to convince the general population of dental professionals of the benefits of power toothbrushing.

	CONCLUSION

TOP ABSTRACT MATERIALS AND METHODS RESULTS DISCUSSION CONCLUSION REFERENCES

 
The superior effectiveness of power toothbrushes that has been shown in controlled clinical studies may also be exhibited in a general practice setting. In this practice-based study, we found that direct experience with a power toothbrush convinced the majority of dental professionals of its clinical benefits and resulted in an increased level of recommendation to their patients.

	FOOTNOTES

Ms. Ray is national manager of Professional Education, Oral-B Laboratories, Belmont, Calif.

Ms. Cugini is manager, Clinical Research Oral Care, Braun GmbH, Kronberg, Germany.

Dr. Chater is a medical communications consultant, Staffordshire, England.

This study was funded by Braun Oral-B. Braun GmbH, Kronberg, Germany, is the manufacturer of the Braun Oral-B Ultra Plaque Remover.

The authors thank Merrill Research & Associates, San Mateo, Calif., for compilation of data from evaluation questionnaires; Research Data Inc., Framingham, Mass., for conducting the telephone interviews; and MaryAnn Connelly McCabe, Oral-B Laboratories, Belmont, Calif., for her contributions to this project.

	REFERENCES

TOP ABSTRACT MATERIALS AND METHODS RESULTS DISCUSSION CONCLUSION REFERENCES

 

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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by WARREN, P. R. Articles by CHATER, B. V. Search for Related Content PubMed PubMed Citation Articles by WARREN, P. R. Articles by CHATER, B. V.