Power brushing

Preventive Dentistry Power brushing Background.—Power brushing is designed to remove as much plaque as possible, especially from areas that are relatively inaccessible. The brushing-induced turbulence produced during power brushing drives fluid dynamic forces into interproximal spaces, removing the biofilm from these areas. Power brushes offer anti-plaque and anti-gingivitis benefits and help in the management of gingivitis. Dental plaque biofilms are an important contributor to periodontal disease development, with bacteria in subgingival biofilms influencing the environment in which they live as well as host inflammatory responses. Environmental stresses and genetics can add to the adverse effects. A biological systems model has been proposed to provide a classification of periodontal disease that takes into account bleeding on probing (BOP) and pocket depth (PD) scores linked to inflammatory, immune, and microbiological parameters in distinct biological phenotypes. The five conditions in this system were defined by shallow or deep PDs combined with low or high BOP scores to create clinical categories that are more homogeneous in terms of the biology of the biofilm–gingival interface (BGI) and represent the full spectrum of periodontal disease. The potential benefits of power brushing for patients in the five BGI categories were investigated. BGI Categories.—The BGI classifications are as follows: BGI-H, which is biofilm–gingival interface-healthy and represents a periodontally healthy group; BGI-G, which is BGI-gingivitis, representing naturally occurring gingivitis but without significant pocketing; P1, or mild periodontitis, which is treated and/or stable periodontitis; P2, or moderate periodontitis, which represents a common range of moderate to severe periodontitis; and P3, severe periodontitis, representing the most severe periodontal disease. Rather than a continuous gradient of disease expression, these categories represent varying biological conditions of the periodontium with specific clinical manifestations. Methods.—The 175 healthy adults were divided into the five BGI groups, then underwent a prophylaxis treatment that did not include subgingival debridement. Subjects then received two acrylic stents to place over the right maxillary and mandibular posterior sextants and were told to abstain from brushing, flossing, or using interdental aids and mouthwash on these areas. The goal was to produce experimental biofilm overgrowth in the two

sextants over a 3-week period. All subjects also received written and verbal oral hygiene instructions and were monitored for safety weekly. After 21 days, the stents were discontinued and subjects were randomly assigned to use either a manual toothbrush or a powered toothbrush for the next 4 weeks (resolution phase), with the goal of restoring a normal full-mouth oral hygiene. At the end of the study, all subjects underwent standard prophylaxis with scaling and root planing. The results of the brushing efforts were measured and compared between BGI groups. In addition, saliva was collected 14 days before the study began and on days 0, 7, 14, 21, 35, and 49. The local levels of inflammatory biomarkers were determined from the salivary samples, including interleukin 1b (IL-1b), IL-8, IL-Ira, monocytic chemotactic protein-1, matrix-metalloproteinase-1 (MMp-1), MMP-3, MMP-8, MMP-9, tissue inhibitor of metalloproteinase-1 (TIMP-1), TIMP-2, TIMP-3, TIMP-4, and neutrophil gelatinase-associated lipocalin. Subgingival plaque samples were collected 14 days before the study began and on days 0, 21, and 49 and analyzed quantitatively and qualitatively for the presence of periodontal pathogens. Results.—All groups showed significantly greater reductions in BOP, gingival index (GI), PD, and periodontal index (PI) with the power brush compared to the manual brush. The clinical signs of inflammation were reduced more effectively by the power brush than by the manual brush for shallow pockets and for patients with deep pockets. The BGI groups with deep PDs showed a significantly greater reduction in PI, GI, BOP, and PD compared to manual brushing, but no change in clinical attachment level (CAL). Power brushing was also associated with a significant reduction in IL-1b levels. It achieved a 24% greater reduction in concentration levels of IL-1b compared to manual brushing. None of the other salivary inflammatory mediator levels were affected by the two types of brushing. Changes were also seen in the composition of the biofilm. Manual brushing tended to reduce the bacterial families compared to power brushing but the difference was not statistically significant. Discussion.—Power brushing for 4 weeks after creating a substantial subgingival biofilm was able to improve all

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clinical indices except CAL across a range of persons with periodontal disease. Significant changes were also noted in the levels of IL-1b, a marker of the body’s inflammatory response.

Clinical Significance.—Better understanding how biological status can be altered to produce clinical and subclinical changes in persons with preexisting periodontal disease should lead to improved methods of managing these patients. Power brushing was better than manual brushing for reducing BOP and GI in persons with shallow and deep pocket depths and significantly reduced salivary IL-1b levels.

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Dental Abstracts

These insights should help us in designing oral care interventions that will positively influence oral health status.

Aspiras MB, Barros SP, Moss KL, et al: Clinical and subclinical effects of power brushing following experimental induction of biofilm overgrowth in subjects representing a spectrum of periodontal disease. J Clin Periodontol 40:1118-1125, 2013 Reprints available from MB Aspiras, Philips Oral Healthcare – Dental & Scientific Affairs, 22100 Bothell Everett Hwy, MS 201, Bothell, Washington 98021; e-mail: [email protected]