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This study aimed to compare the effectiveness of microcurrent-emitting toothbrushes (MCTs) and ordinary toothbrushes in reducing the dental plaque index (PI) and dental caries activity among orthodontic patients. The evaluation was performed using a crossover study design involving 22 orthodontic patients randomly assigned to the MCT or ordinary toothbrush groups. The participants used the designated toothbrush for 4 weeks and had a 1-week wash-out time before crossover to the other toothbrush. PI (Attin’s index) and dental caries activity were measured at baseline and at the end of each 4-week period. Additionally, patients completed questionnaires to assess patient satisfaction for “freshness in mouth” and “cleansing degree.” The results showed that the MCT group had a significant reduction in PI (p = 0.009), whereas the ordinary toothbrush group did not (p = 0.595). There was no significant difference in the dental caries activity between the two groups (p > 0.05). Patient satisfaction assessment revealed that 65% patients in the MCT group had more than “fair” experience of freshness, in contrast to 50% of patients in the ordinary toothbrush group. Satisfaction with cleansing degree was similar in both groups. Overall, these findings suggest that MCTs are more effective in reducing dental PI than ordinary toothbrushes.

A toothbrush device that telemonitors toothbrushing is a technologically advanced solution providing personalized feedback on toothbrushing habits and oral hygiene. These devices integrate smartphone apps to enhance oral health compliance through dental professional feedback. This 6-month prospective randomized controlled trial aimed to compare the clinical effectiveness, defined as improved oral hygiene measured by plaque reduction and halitosis control, of an interactive telemonitoring toothbrush (ITT), an oscillating-rotating power toothbrush (ORT), and a manual toothbrush (MT). Participants were recruited offline from the Department of Advanced General Dentistry at Yonsei University Dental Hospital, South Korea. A total of 150 participants were randomly assigned to 3 groups (50 participants each): (1) an ITT connected to a smartphone app providing real-time feedback and weekly dental professional reviews, (2) an ORT with smartphone-based guidance requiring participants to send weekly brushing records via screenshots, and (3) an MT with a brushing diary for review. Data collection occurred in clinical settings. Primary outcomes included plaque reduction measured using the Simple Hygiene Score (SHS), while secondary outcomes included plaque reduction measured using the Turesky modification of the Quigley-Hein plaque index (QHI), reductions in halitosis, and changes in oral microbiota. All outcomes were assessed at baseline and 1 month, 3 months, and 6 months. A total of 150 participants completed the study. Over 6 months, the SHS increased in the MT group (mean 3.16, SD 4.86 to mean 5.66, SD 5.20) but significantly decreased in the ITT group (mean 3.47, SD 5.50 to mean 2.27, SD 3.82; P=.004). Similarly, QHI decreased more in the ITT group (mean 1.79, SD 0.72 to mean 0.85, SD 0.63) than in the ORT (P<.001) and MT (P<.001) groups. Regarding microbiota, there were no significant differences in high-risk periodontal microbiota or the ratio of caries-risk to anticaries microbiota between the ITT and ORT groups. However, in the MT group, the ratio of caries-risk microbiota was significantly higher at the 3-month (P<.001) and 6-month (P=.005) recalls than at baseline and at the 3-month (P=.048) and 6-month (P=.03) recalls than at the 1-month recall. Poststudy questionnaires indicated that 45 of 50 ITT participants (92%) and 37 of 50 ORT participants (76%) reported improved brushing ability. The most effective feature in the ITT group was brushing training, while participants in the ORT group cited the brushing guide as most useful (P<.001). Satisfaction scores were higher in the ORT group (mean 7.90, SD 1.21) than in the ITT group (mean 7.15, SD 1.66; P=.004). The number of brushing events decreased significantly in the ORT group (P=.02), while brushing duration increased in the MT group (P=.01). ITTs enable better oral hygiene management than MTs through dental professional feedback. However, further studies are needed to optimize feedback intervals and improve long-term adherence. Clinical Research Information Service (CRIS), Republic of Korea, KCT0009094; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26110&search_page=L.

This study aimed to investigate whether interdental brush shape influences cleaning efficacy, by comparing a waist-shaped interdental brush (W-IDB) with a cylindrical IDB (C-IDB); both provided with the same bristle texture. Cleaning efficacy of differently shaped IDBs was measured in proximal surfaces of teeth in a split-mouth cross-over design. Twenty-eight patients abolished oral hygiene for 4 d. Line angle plaque area was scanned with an intraoral camera after use of disclosing dye in baseline and after IDB application and analyzed planimetrically. Additionally, bacterial load in the IDBs was analyzed after usage by colony forming units (cfu). A Wilcoxon signed-rank test with continuity correction was used to compare the results of the waist-shaped and the cylindrically-shaped IDBs. The waist-shaped IDBs cleaned significantly better than their cylindrically-shaped counterparts (area cleaned: 23.1% vs. 18.3%), when applied at same interdental spaces (p < 0.001). However, no significant differences were found in comparison of bacterial load on the IDBs (median cfu counts: 2.3E9 vs. 2.7E9, p = 0.93). Irrespective of bristle texture or size, IDB shape have impact on cleaning efficacy. Waist-shaped IDBs are more effective in cleaning of the line angle area than cylindrically-shaped IDBs.

Background Children’s oral health continues to be a key issue, with dental caries remaining one of the most prevalent non-communicable diseases. One of the main ways to prevent dental caries is to carry out adequate toothbrushing with fluoridated toothpaste. Connected or ‘smart’ toothbrushes can provide real-time feedback on brushing behaviour to individuals or be used to provide feedback to groups for example within a school setting. This study aimed to identify the engagement level of school children with a smart, connected toothbrush, explore brushing frequency, timing, coverage, and duration during the research period, and compare data to observed changes over time. Methods Data on brushing behaviour were obtained from a feasibility cluster randomised controlled trial exploring smart, connected toothbrush use in a school-based brushing programme. Participants, aged 8–11 with access to a smart device, were recruited from six primary schools located in deprived areas of Manchester, England. Randomisation at the school level allocated participants to receive either a smart, connected toothbrush and text message intervention (intervention group) or the smart, connected toothbrush only (control group). Results Of the 409 participants provided with a smart, connected toothbrush, 289 (71%) connected and used the device during the study. Of those who engaged with the connected devices, participants brushed at least twice a day on 48.2% of the days they brushed. On completed questionnaires, 78.8% of parents indicated their children brushed their teeth twice a day. Brushing frequency appeared to decrease over the weekends, particularly on weekend mornings. Conclusions The results from this feasibility trial suggest that toothbrushing habits remain a fundamental area of importance, with a substantial proportion of children not brushing according to recommendations. Not all children connected or consistently used their devices during the study. Twice-daily brushing was infrequently recorded. Consideration must be given to the potential omission of brushing sessions, as the data may miss out sessions until the user syncs the brush with the app. Further research is needed to identify how frequency of brushing, particularly at the weekends, could be improved. Registration The study was retrospectively registered at ISRCTN, registration number ISRCTN77803149 on 28/12/2023.

Aims To evaluate and compare the efficacy of manual toothbrush, audio-tactile performance (ATP) method, and musical toothbrush on plaque control and oral hygiene maintenance in visually impaired children. Methods and results The current observational study included 60 visually impaired children aged 9–16 years who were randomly divided into 3 groups, each with 20 children receiving oral hygiene instructions in different modes: Group 1 (Control) manual toothbrush, Group 2 (ATP) audio-tactile performance method with a manual toothbrush, and Group 3 musical toothbrush. Both manual (groups 1 and 2) and musical toothbrushes (Group 3) were changed after 3 months for better efficiency. Oral hygiene index simplified (OHI-S) and Rustogi Modified Navy Plaque Index (RMNPI) plaque scores were recorded at baseline, at the end of 1, 3, and 6 months. The collected data were statistically analysed using SPSS version 21. The intra- and inter-group comparisons were analysed using one-way ANOVA, and the multiple group comparisons were analysed using the Tukey HSD test. In intragroup comparisons from baseline to 6 months, both OHI-S and RMNPI plaque scores were reduced for group 3, only OHI-S plaque scores were reduced for group 2. Intergroup comparisons revealed a statistically high significant difference in OHI-S plaque scores from baseline to 6 months and RMNPI plaque scores from 1 to 6 months. Conclusion The motivation and education with musical toothbrushes and audio-tactile performance (ATP) method could aid in the improvement of oral hygiene maintenance of visually impaired children.

Objective Advances in mobile technology are helping with health management practices, and smart toothbrushes provide proper dental care by collecting and analyzing users’ toothbrushing data. The purpose of this study is to assess the effect of a telemonitoring device on oral hygiene management in individuals with intellectual or developmental disabilities and its role in promoting oral health. Materials and methods Participants were split into two groups: one initially using the telemonitoring device (telemonitoring device/manual toothbrush) and the other using it later (manual toothbrush/telemonitoring device), with a one-month washout period. The study compared plaque index, halitosis, changes in oral microbiota, and guardian questionnaire responses between the groups. Results In period 1, the QHI index score significantly decreased from 1.93 to 0.83 in the group using the remote monitoring device, compared to an increase from 1.75 to 2.01 in the manual toothbrush group. Additionally, toothbrushing frequency, time, and cooperation increased by 0.82 ± 0.60, 0.82 ± 1.16, and 1.09 ± 0.94, respectively, with initial telemonitoring device use. However, these measures decreased by -1.45 ± 0.68, -1.09 ± 0.70, and − 1.00 ± 1.00 after switching to a manual toothbrush, and decreased by -0.64 ± 0.67, -0.27 ± 1.19, and 0.09 ± 0.94 overall, respectively. However, there were no significant differences in oral microbiota between the groups at these different time points. Conclusions The study shows that telemonitoring devices effectively reduce plaque index and improve toothbrushing frequency, time, and cooperation. However, these benefits decrease after switching to a manual toothbrush. Follow-up is needed to assess satisfaction and compliance with telemonitoring device use. Clinical relevance Using telemonitoring devices in the oral health management of individuals with intellectual and developmental disabilities can improve their oral health quality.

Connected toothbrushes, where an electric toothbrush connects wirelessly to a smartphone app that provides feedback and guidance to the user, can improve clinical indicators of oral health. However, the impact of the connected brush on user perceptions of brushing skills, behaviors, “everyday” oral health (e.g., breath odor, how clean teeth feel), and user perceptions of the smartphone app are also important. In this study, a novel PRO measure – the Everyday Oral Health and Brushing (EOHAB) Questionnaire – was implemented to capture these important views. The EOHAB was administered in: (1) a randomized controlled clinical trial (RCT; N  = 80) comparing a connected toothbrush to an unconnected electric brush over 6 weeks and (2) a single-arm study ( N  = 159), where participants used an electric brush alone for 1 week and then a connected brush for 3–4 weeks. EOHAB scores addressing perceptions of brushing behaviors/skills, oral health, and the usefulness and ease of use of the app were calculated. Impression of change items that directly asked users about changes in their perceptions were scored separately. In the single-arm study, perceptions of brushing skills and behaviors were very positive prior to using the unconnected or connected brush and then became incrementally more positive after using the electric brush alone and then the connected brush before decreasing at the last assessment interval. In both studies, cross-sectional correlations between the EOHAB scores and objective measures of brushing behavior and clinical measures were close to zero. Increased brushing duration and coverage over time were observed when participants reported improved perceptions on impression of change items and positive ratings of app utility, but not other EOHAB scores. In the RCT, the connected brush significantly improved several impression of change items, but not other EOHAB items asking about current perspectives. In sum, use of a connected toothbrush was associated with improved brushing and oral health perceptions when EOHAB questions asked directly about changes since starting use of the toothbrush. Brushing metrics improved as views on the app became more positive. Although not uniform, the results support previous studies indicating that connected brush systems can improve patient-reported outcomes.

To assess feasibility, acceptability, and early efficacy of monetary incentive-based interventions on fostering oral hygiene in young children measured with a Bluetooth-enabled toothbrush and smartphone application. A stratified, parallel-group, three-arm individually randomized controlled pilot trial. Two Los Angeles area Early Head Start (EHS) sites. 36 parent-child dyads enrolled in an EHS home visit program for 0-3 year olds. Eligible dyads, within strata and permuted blocks, were randomized in equal allocation to one of three groups: waitlist (delayed monetary incentive) control group, fixed monetary incentive package, or lottery monetary incentive package. The intervention lasted 8 weeks. Primary outcomes were a) toothbrushing performance: mean number of Bluetooth-recorded half-day episodes per week when the child's teeth were brushed, and b) dental visit by the 2-month follow-up among children with no prior dental visit. The a priori milestone of 20% more frequent toothbrushing identified the intervention for a subsequent trial. Feasibility and acceptability measures were also assessed, including frequency of parents syncing the Bluetooth-enabled toothbrush to the smartphone application and plaque measurement from digital photographs. Digital monitoring of toothbrushing was feasible. Mean number of weekly toothbrushing episodes over 8 weeks was 3.9 in the control group, 4.1 in the fixed incentive group, and 6.0 in the lottery incentive group. The lottery group had 53% more frequent toothbrushing than the control group and 47% more frequent toothbrushing than the fixed group. Exploratory analyses showed effects concentrated among children ≤24 months. Follow-up dental visit attendance was similar across groups. iPhone 7 more reliably captured evaluable images than Photomed Cannon G16. Trial protocol and outcome measures were deemed feasible and acceptable. Results informed the study protocol for a fully powered trial of lottery incentives versus a delayed control using the smart toothbrush and remote digital incentive program administration. ClinicalTrials.gov identifier NCT03862443.

Objectives People with intellectual disabilities often have poor oral hygiene and depend on carers’ support. We aimed to investigate, whether automatic toothbrushes could benefit people with Down syndrome (DS). Materials and methods In a randomized, single-blinded cross-over study we compared the cleansing efficacy of a horse-shoe shaped automatic toothbrush with that of rotating-oscillating toothbrushing in unassisted domestic use over four weeks by persons with DS. Rustogi Modified Navy Plaque Index (RMNPI) and Gingival Bleeding Index (GBI) were assessed before and after each intervention period. Wilcoxon Signed-Rank Test was used for statistical analysis. Results Fifteen participants (mean age 31 ± 8.33 years) finished the study. There were no statistically significant differences in RMNPI between the two brushing modalities after four weeks of unassisted home use, neither in full mouth (Y-brush®: median 59.2%; range 24.8 – 76.7; rotating-oscillating toothbrush: 54.6%; 6.4 – 71.3) ( p  = 0.484) nor in subgroup analyses. RMNPI was statistically significantly higher after four weeks of automated brushing than baseline. There was no statistically significant difference for full-mouth GBI between the two brushing modalities. Conclusions Both, oscillating-rotating and automated toothbrushing resulted in unsatisfactory plaque control after unassisted use by people with DS. Clinical relevance Further studies should investigate the impact of caregivers’ assistance with auto-cleaning devices to persons with disabilities on plaque removal efficacy. Customization of mouthpieces and simplification of handling modalities might effect a higher cleansing capacity and should be future goals for automatic brushing device manufacturers.

Objectives This study aimed to compare the cleansing efficacy of the Oral-B ® iO™ electric toothbrush incorporating oscillating-rotating technology with microvibrations - with a traditional oscillating-rotating toothbrush. Materials and methods Thirty adult participants were randomly assigned to use the iO™ electric toothbrush with the brush head iO™ Ultimate Clean or the traditional oscillating-rotating toothbrush Oral-B ® Genius ® with the Cross-Action brush head. Oral hygiene indices (Rustogi Modified Navy Plaque Index and Gingival Bleeding Index) were assessed before and after 28 days of home use of the assigned product. Participants were instructed to refrain from interdental hygiene during the study period. After a 2-week washout period, the clinical investigation was repeated in a crossover design. Results All 30 participants completed the study with no dropouts. After 28 days of use, the iO™ showed statistically significantly lower plaque levels than the conventional oscillating-rotating toothbrush (25.09% vs. 30.60%, p  = 0.029). This difference was particularly noticeable in marginal and approximal areas. There were no significant distinctions in gingival bleeding indices. Conclusions The Oral-B ® iO™ electric toothbrush displayed enhanced plaque removal efficiency compared to a conventional oscillating-rotating technology. Clinical relevance This study highlights the potential benefits of advanced toothbrush technologies for plaque reduction and encourages further research.