Evidence from large cohort studies has demonstrated that high standards of oral hygiene will ensure the stability of periodontal tissue support . It is generally recommended that patients brush their teeth at least twice daily, not only to remove plaque but also to apply ﬂuoride through the use of dentifrice to prevent caries. In 1780, the Englishman William Addis manufactured a toothbrush. Nylon ﬁlaments were introduced in 1938. However, there is still insufﬁcientevidence that one speciﬁc toothbrush design is superior to another.
In 1986, an international workshop on oral hygiene concluded that, up to that
time, neither powered nor manual toothbrushes had been found to remove more plaque, regardless of the brushing method . At the 1996 World Workshop in Periodontics, it was carefully concluded that the limited evidence suggested that electric brushes provide additional beneﬁt compared to manual brushes .
However, rotation ⁄ oscillation-powered brushes signiﬁcantly reduced both short- and long-term plaque and gingivitis. However, rotation ⁄ oscillation-powered brushes signiﬁcantly reduced both short- and long-term plaque and gingivitis.
For many decades, abrasive systems such as
calcium carbonate, alumina and dicalcium phosphate have been used. Today, most dentifrices contain silica. Although more expensive, silica can be
combined with ﬂuoride salts and is very versatile.
plaque removal is associated minimally with abrasives, which is another action attributed to the toothbrush.
However, insufﬁcient evidence exists on the role of detergent in the plaqueremoving effectiveness of dentifrices, sodium ﬂuoride, sodium monoﬂuorophosphate, amine ﬂuoride or stannous ﬂuoride.
There has been increased research interest inagents such as bisbiguanide, triclosan, sanguinarine, quaternary ammonium chloride compounds and
Although very effective when used as a mouth rinse, chlorhexidine has demonstrated limited efﬁcacy when included in dentifrices, as it can be inactivated by ﬂavor and detergent.
Triclosan is used in many oral care products because it exhibits antibacterial as well as antifungal and antiviral properties.
Triclosan alone has moderate anti-plaque properties , and has shown anti-inﬂammatory effects on gingival tissues . Daily use of a triclosan ⁄ copolymer dentifrice may have some effect on periodontitis progression.
The data show that both triclosan ⁄ zinc citrate and triclosan ⁄ copolymer have signiﬁcant, albeit small, positive effects on plaque reduction and gingivitis.
Pyrophosphates, ﬂavorings and detergents, especially sodium lauryl
sulfate, which are present in most commercially available dentifrices, have been implicated as causative factors in certain oral hypersensitive reactions such as aphthous ulcers, stomatitis, cheilitis, burning sensations and oral mucosal desquamation.
Practical efﬁcacy is also inﬂuenced by the acceptability of the method to patients and therefore their compliance.
The majority of these studies showed that there was no beneﬁt of ﬂossing on plaque or clinical parameters of gingivitis.
However, a routine recommendation to use ﬂoss is notsupported by scientiﬁc evidence as established by Berchier et al. In their comprehensive literature search and critical analysis. However, common sense arguments are the lowest level of scientiﬁc evidence. The fact that dental ﬂoss has no additional effect on toothbrushing is apparent from more than one review. Found that ﬂossing was only effective in reducing the risk of interproximal caries when applied professionally. Round toothpicks are too thick and too blunt to reach the lingual half of the tooth when trying to angle them, while the curved surface of the toothpick provides only point contact with the tooth surface. Rectangular woodsticks are also designed inappropriately for interdental cleaning as they are too pliable to be able to clean lingually . However, triangular woodsticks seem to have the correct shape to ﬁt the interdentalspace.
Woodsticks can only be used effectively where sufﬁcient interdental space is available. Woodsticks have the advantage of being easy to use and can be
used throughout the day without the need for a bathroom or mirror .
When used on healthy dentition, woodsticks depress the gingivae by up to 2 mm and therefore clean part of the subgingival area.
Within the limitations of the search and selection strategy of the review. Concluded that, as an adjunct to toothbrushing, interdental brushes remove more dental plaque than ﬂossing. Therefore, patients require interdental brushes of various sizes.
They suggested that mechanical depression of the interdental papilla is induced by interdental brushes, which in turn causes recession of the marginal gingival. This, together with good plaque removal, could be the reason for the reduction in pocket depth.
Various hypotheses have been put forward by the authors to explain the results. One of the hypotheses is that, when patients with gingivitis perform supragingival irrigation on a daily basis, the population of key pathogens (and their associated pathogenic effects) may be altered, reducing gingival inﬂammation . There is also the possibility that water pulsations may alter the speciﬁc host–microbe interaction in the subgingival environment and that inﬂammation is reduced independent of plaque removal . Another possibility is that the beneﬁcial activity of the oral irrigator is at least partly due to removal of food deposits and other debris, ﬂushing away of loosely adherent plaque, removal of bacterial cells, interference with plaque maturation and stimulation of immune responses. Other explanations include mechanical stimulation of the gingival.
Concluded that use of an oral irrigator as an adjunct to toothbrushing does not have a beneﬁcial effect on reducing plaque scores. However, there is evidence that suggests a positive tendency toward improved gingival health when using an oral irrigator as an adjunct to toothbrushing as opposed to regular oral hygiene (i.e. selfperformed oral hygiene without any speciﬁc instruction).
Based on the available literature, it can be concluded that a single oral hygiene instruction has a small positive effect that will last 6 months or more. Further research should establish the effect of repeated oral hygiene instructions. Toothbrushing using a manual toothbrush is effective to the extent that it results in reduction of the plaque scores by approximately half. Using an oscillating ⁄ rotating toothbrush, additional efﬁcacy can be obtained. In studies ‡3 months in duration, a 7% increase in plaque reduction and a 17% increase in gingivitis reduction were observed for electric toothbrushing relative to manual toothbrushing.
With respect to interdental cleaning, the best available data suggest the use of interdental brushes. These brushes should therefore be the ﬁrst choice in patients with open interdental spaces. Meta-analysis showed superiority of the interdental brush to ﬂoss with respect to plaque removal. A dentifrice is usually used in combination with toothbrushing. To enhance the mechanical action of the toothbrush, abrasive ingredients have been added to dentifrices. Research has shown that these do not contribute to the instant cleaning effect, however, data on stannous ﬂuoride and triclosan support use of these products.
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