See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/12445881

An Evaluation of the Efficacy of a Curved Bristle and Conventional

Toothbrush. A Comparative Clinical Study

Article  in  Journal of Periodontology · June 2000

DOI: 10.1902/jop.2000.71.5.785 · Source: PubMed

CITATIONS READS

12 163

1 author:

Vijay Chava
Narayana Dental College and Hospital
43 PUBLICATIONS   311 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Vijay Chava on 03 June 2015.

The user has requested enhancement of the downloaded file.

9138_IPC_AAP_553180 6/1/00 9:39 AM Page 785

J Periodontol • May 2000

An Evaluation of the Efficacy of a Curved

Bristle and Conventional Toothbrush. A
Comparative Clinical Study*
Vijay K. Chava

Background: The aim of this study was to determine the

plaque-removing ability of a curved bristle toothbrush compared
to a conventional, straight bristle, manual toothbrush.
Methods: The study group consisted of 100 volunteers 16 to
24 years of age from a professional engineering college. A four-
week post-prophylaxis, parallel, longitudinal, double-blind clin-
ical study was conducted; all volunteers were instructed in spe-

T
he effect of plaque on the peri-
cific oral hygiene techniques. Plaque was assessed at baseline odontium plays a vital role in the
and at the end of 1, 2, 3, and 4 weeks using the Quigley-Hein initiation and progression of peri-
plaque index after disclosing with erythrosin red. Gingival sta- odontal diseases. The bacterial plaque
tus was assessed at baseline and at the end of 1, 2, 3 and 4 initiates an inflammatory process in the
weeks by using the gingival index of Löe and Silness. supporting structures of the tooth, and if
Results: Comparative assessment showed a mean of 2.11 ± allowed to continue, ultimately may lead
0.086 mm for group 1 and 2.37 ± 0.216 mm for group 2, indi- to the loss of teeth.1-3 To overcome this,
cating a significant difference between the plaque-removing effi- toothbrushing with a dentifrice is the sole
cacy of the curved bristle and straight bristle toothbrush. method of oral hygiene practiced by
Conclusions: The curved bristle toothbrush was significantly many people. Many clinical studies
more effective in removing plaque overall than the conventional clearly indicate that the major deposits of
toothbrush. J Periodontol 2000;71:785-789. plaque form in stagnation areas such as
KEY WORDS the approximal areas, gingival margins,
and defects in the teeth.4-10 These areas
Clinical trials; dental plaque/prevention and control;
are protected from the natural cleaning
toothbrushing/instrumentation; dental plaque index.
mechanisms of oral tissues.4-6 Thus,
emphasis must be placed on the effec-
*Department of Periodontics, S.D.M. College of Dental Sciences & Hospital, Dharwad, India.
tiveness and efficiency of plaque removal
devices used to facilitate oral hygiene in
these elusive areas.
Electrical toothbrushes have been
extensively investigated, and several stud-
ies failed to show much benefit from man-
ual and powered toothbrushes.11-14 How-
ever, a few well-controlled clinical trials
have compared the effectiveness of var-
ious manual toothbrushes.4,7,15 The
results of these trials have been incon-
clusive, but there has been a strong indi-
cation that all brushes are least effective
on the lingual aspects of lower molars
and that a correct preset angulation of
the brush head improves plaque control
in such areas.6,16 Previous studies have
shown that curved bristle toothbrushes
were more effective in removing plaque
when used in assisted brushing8 and in
handicapped children.17,18 The most

785
9138_IPC_AAP_553180 6/1/00 9:39 AM Page 786

Efficacy of Curved and Conventional Toothbrushes Volume 71 • Number 5

recent study to evaluate the efficacy of a curved bris-

tle toothbrush found it to be efficient when used by a
trained care provider.9 The aim of this study therefore
was to investigate in adult subjects whether the curved
bristle toothbrush was more efficient in removing
plaque than the conventional toothbrush.
MATERIALS AND METHODS
One hundred (100) engineering students volunteered
for the study. Their average age was 20 years, with a
range of 16 to 24 years. All the subjects who were
selected satisfied the following criteria: 1) no clinical
gingival inflammation; 2) no adverse restorations; 3)
no dental caries; 4) no history of antibiotics or oral
antiseptic therapy; 5) no supplemental plaque control
aids over the previous 6 months; 6) a minimum of 24
teeth with no interposed edentulous spaces or loss of
interdental contacts; and 7) no adverse habits (smok-
ing, pan chewing, etc.).
Brushes
The two brushes used in the study were an experi-
mental curved bristle toothbrush† and a conventional
toothbrush; i.e., one with a slender head with 3 rows
of bristles‡ (Fig. 1). The experimental brush head mea-
sured 30 mm long by 12 mm wide and contained 20
tufts in 3 rows; 14 tufts were located on the lateral
aspects with 25 inwardly curved monofilaments and 6
tufts in a short central row of 3.15 mm long bristles
each with a diameter of 0.23 mm (Fig. 2). The head Figure 1.
of the control brush was slender, measuring 20 mm by Overall view of the two toothbrushes. Left: Curved bristle toothbrush;
6 mm, with a 0.21 mm filament diameter. right: conventional toothbrush.

Brushing Techniques
Curved bristle toothbrush. The brush is applied in an
occlusal/incisal direction to hug the tooth. The curved
bristles thus engage the labial and lingual aspects of
the tooth and are directed at an approximately 45°
angle; the middle row occupies the occlusal areas. The
brush is activated with very short horizontal strokes.
No vertical motion is used so that the brushing tech-
nique is similar to the Modified Bass technique. The
terminal ends of the curved bristle resemble the shape
of a curet. It is directly applied to the junctional epithe-
lium unlike the straight bristles, which can easily punc-
ture the epithelial lining.
The curved ends of the bristles rotate on their axis
under slight pressure and slip into the depth of the sul-
cus, so that during back-and-forth movement of the
handle, the shank of the bristles twist and sweep the
plaque out from the gingival areas (Fig. 3).
Conventional toothbrushes. The Modified Bass tech-
nique was used, in which the brush is applied at a 45°
angle to the long axis of the tooth and directed into the
gingival sulcus. A small back-and-forth motion is per-
formed, without disengaging the bristle ends from the
sulcus.
Plaque Measurement
After thorough oral prophylaxis and polishing, plaque
was disclosed with erythrosin red§ and assessed on
the buccal, lingual, and interproximal surfaces of all
teeth excluding third molars, according to the plaque
index of Quigley and Hein.19 Plaque scores were then
reviewed and recorded at 1, 2, 3, and 4 weeks.
Gingival index. In each patient, gingival inflam-
mation was clinically assessed at 6 sites (mesiobuc-
cal, buccal, distobuccal, mesiolingual, lingual, and
distolingual) on Ramfjord teeth numbers20 16, 21, 24,
36, 41, and 44. Scores were then reviewed at 1, 2,
3, and 4 weeks using the Löe and Silness gingival
index.21 The investigator’s reproducibility was tested
prior to the trial by examining plaque scores in 50
subjects twice with an interval of 15 minutes between
examinations and calculated by expressing the per-
centage of duplicated scores. This was found to be
98%.
† Collis curve, Collis Curve Inc., Minneapolis, MN.
‡ Plakoff-3 , ICPA, Mumbai, India.
§ Plaksee, ICPA.

786
9138_IPC_AAP_553180 6/1/00 9:39 AM Page 787

J Periodontol • May 2000 Chava

Figure 3.
Working principle of curved bristle toothbrush and straight bristle
toothbrush.

RESULTS
Figure 2. All subjects completed the study. Results showed that
View and diagrammatic presentation of the experimental brush. the experimental brush was significantly more effec-
tive in removing plaque than the conventional brush.
Table 1 shows a comparison of means and stan-
Criteria for Grouping dard deviations between groups 1 and 2 and reveals
The subjects were divided into two groups of 50 statistical significance at a 1% level.
depending on the toothbrush assigned: group 1, curved Table 2 shows a comparison of means and stan-
bristle toothbrushes; and group 2, conventional, slen- dard deviations in the anterior and posterior teeth within
der head toothbrushes. the groups and demonstrates statistical significance.
Trial Design When means and standard deviations in the two groups
The subjects were informed about the project, and writ- and at different weeks were compared, there was a
ten consent for participation was obtained. The study
was a 4-week post-prophylaxis, parallel, longitudinal,  Colgate, Colgate Palmolive Ind. Ltd, Mumbai, India.
double-blind design. At the time of the initial exami-
nation, the subjects randomly picked toothbrushes (by
lottery method) that were numbered from 1 to 100 Table 1.
and individually packed in brown covers along with Comparison of Mean Plaque Values
printed instruction forms by a third person (statisti-
Between the Groups
cian); the coded numbers marked on the covers were
recorded. All the participants in the study were pro-
Groups Mean S.D. S.E. z Score P Value
vided with a common toothpaste and were asked to
follow the instructions. Plaque was assessed at the end 1 2.11 0.086 0.0329 7.9077 <0.01*
of 1, 2, 3, and 4 weeks. After 4 weeks, the findings
2 2.37 0.216
obtained were subjected to statistical analysis by using
z test. *Significant.

787
9138_IPC_AAP_553180 6/1/00 9:39 AM Page 788

Efficacy of Curved and Conventional Toothbrushes Volume 71 • Number 5

Table 2. DISCUSSION
Comparison of Mean Plaque Values One hundred (100) subjects who participated in the
study exhibited great variations in their ability to clean
Between the Groups in Anterior and their teeth and were presumably dependent on man-
Posterior Teeth ual dexterity, motivation, and ability to follow instruc-
tions. As in the study by Gibson et al.,6 the mean
Teeth Groups Mean S.D. S.E. z Score P Value plaque scores of all teeth except third molars for each
Anterior 1 2.085 0.095 0.0275 5.6281 <0.01* individual, for each visit, were assessed. This provided
2 2.24 0.17 more sensitive and accurate evaluation of brushing
Posterior 1 2.12 0.079 0.0318 9.7698 <0.01* effectiveness compared with methods used in other
2 2.43 0.210 studies such as Bay et al.16 and Scopp et al.,4 where
only certain designated teeth were assessed. In addi-
*Significant.
tion, unlike some studies, Bay et al.16 utilized a stan-
dardized 3-minute brushing time. Shorter periods have
progressive reduction in plaque scores. It was found to been found to be inadequate.10
be statistically significant at a 1% level when compar- The effectiveness of a curved bristle toothbrush
ison was made between weeks 1 and 2, 1 and 3, and shown in this study may, in part, be due to the brush-
1 and 4 between the two groups. ing time being effectively reduced or to prolonged con-
Table 3 shows the baseline scores between groups tact duration of the brush and teeth, compared to tech-
1 and 2, which were not significant. However, weeks niques used with the conventional brush. However, it
2 and 4 demonstrated significance at the 5% level, and may also be attributed to the curvature of the bristles,
no significance was found between weeks 2 and 3 and which allows entry into sulcular areas with a drawing
3 and 4 in group 1. action. Because of the softness of the curved bristles,
No significance was noticed between weeks 2 and 3, any resistance theoretically causes the bristles to bend
2 and 4, and 3 and 4 in group 2 as shown in Table 4. back on themselves. Other studies using curved bris-
When comparison of means and standard devia- tle brushes8,9,17,18 found them to be effective in chil-
tions in labial, palatal/lingual areas, and interproximal dren and when used by home care providers.
areas in both the arches was done, statistical signifi- The results of the current study strongly indicate
cance was seen between groups 1 and 2 as shown in that the experimental brush is more effective on the
Table 5. lingual and interproximal aspects of lower molars.
Table 6 shows gingival scores, with no significant dif- It may be due to better adaptation of the correctly
ference at baseline and at different weeks. angulated bristles reaching the protected areas. This
is in contrast with results of previous trials6,16 indi-
Table 3. cating that brushes were least effective on lingual
Comparison of Mean Plaque Values and aspects of lower molars. According to Cohen,22 trial
periods of 3 weeks are advisable if a brush is to be
Standard Deviation at Baseline Between tested accurately. The findings of this study support
the Groups this view showing the trend towards progressively
reduced plaque scores with the curved bristle brush
Groups Mean S.D. S.E. t Value P Value during the third and fourth weeks of the trial. This
1 2.99 0.2706 0.1438 0.1968 >0.05* contrasts with the results of a previous trial,4 where
an experimental toothbrush was found to produce
2 2.9617 0.1737 lowest plaque scores in the first week. One expla-
*Not significant. nation may be that patients tend to revert to the
technique they are most comfortable with. In the
Table 4. present study, the questionnaires revealed that
90% of the subjects found the curved bristle
Mean Plaque Values and Standard Deviation brushes more comfortable to use. In conclusion,
in Different Weeks and Different Groups this study has shown that a curved bristle tooth-
brush is comparatively more effective in remov-
Week 1 Week 2 Week 3 Week 4 ing plaque than a conventional toothbrush.
Groups Mean SD Mean SD Mean SD Mean SD ACKNOWLEDGMENTS
1 1.96 0.0894 2.13 0.1304 2.16 0.1049 2.11 0.086 The author thanks Dr. Srinath L. Thakur, Dr. K.V.V.
Prasad, and Mr. S.B. Javali for their help during the
2 2.22 0.1923 2.41 0.2775 2.38 0.2098 2.37 0.216
study.

788
9138_IPC_AAP_553180 6/1/00 9:39 AM Page 789

J Periodontol • May 2000 Chava

Table 5. uation of plaque removal with a double headed

toothbrush. J Clin Periodontol 1988; 15:94-98.
Comparison of Mean Plaque Values in Upper 7. Agerholm DMF. A clinical trial to evaluate plaque
Labial and Palatal, Lower Labial and Lingual, removal with a double headed toothbrush. Br
Dent J 1991;170:411-413.
and Interproximal Areas in the Two Groups 8. Shory NL, Mitchell GE, Jamison HC. A study of
the effectiveness of two types of toothbrushes for
. z removal of oral accumulations. J Am Dent Assoc
Areas Groups Mean S.D Score P Value Significance 1987;115:717-720.
9. Kambu PP, Levy SM. An evaluation of the effec-
Upper labial 1 55.26 10.88 1.6843 <0.05 Yes tiveness of four mechanical plaque removal
2 59.92 16.4 devices when used by a trained care provider. J
Spec Care Dent 1993;13:9-13.
Upper palatal 1 57.58 6.95 1.4775 >0.05 No 10. Frandsen A, Barbano J, Soumi J, Chang J,
2 60.14 10.09 Houston R. A comparison of the effectiveness of
Charters, Scrub, and Roll methods of tooth
Upper interproximal 1 55.9 12.43 2.4901 <0.05 Yes brushing in removing plaque. J Dent Res Scand
2 62.14 8.18 1972;80:267-271.
11. Walsh M, Heckman B, Leggott P, Armitage G,
Lower labial 1 56.9 12.43 1.1295 >0.05 No Robertson PB. Comparison of manual and power
2 59.63 11.73 tooth brushing with and without adjunctive oral
irrigation, for controlling plaque and gingivitis.
Lower lingual 1 65.42 12.24 5.1396 <0.01 Yes J Clin Periodontol 1989;16:419-427.
2 81.02 17.63 12. Ainamo J, Hormia M, Kakaunisaho K, Sorsa T,
Suomalainen K. Effect of manual versus pow-
Lower interproximal 1 54.26 10.88 3.5664 <0.01 Yes ered toothbrushes. J Dent Res 1991;70(Spec.
2 64.48 14.69 Issue):557(Abstr. 2329).
13. van der Weijden GA, Danser M, Nijboer A, Tim-
mermann MF, van der Velden U. The plaque
Table 6. removing efficacy of a reciproque rotating tooth-
brush. J Dent Res 1991;70(Spec. Issue):557
Mean Gingival Score and Standard (Abstr. 2328).
14. Stoltze K, Bay L. Comparison of a manual and a new
Deviation in Different Weeks and electric toothbrush for controlling plaque and gingivitis.
Different Groups J Clin Periodontol 1994;21:86-90.
15. Zimmer S, Didner B, Roulet JF. Clinical study on the
Baseline Week 1 Week 2 Week 3 Week 4 plaque removing ability of a new triple headed tooth-
brush. J Clin Periodontol 1999;26:281-285.
Mean Mean Mean Mean Mean 16. Bay I, Kardel KK, Skougard MR. Quantitative evalua-
Groups (SD) (SD) (SD) (SD) (SD) tion of the plaque removing ability of different types of
toothbrushes. J Periodontol 1967;38:526-533.
1 2.13 1.75 1.00 0.73 0.53 17. Avey Karen D. Give your teeth a hug: A simplified brush-
(0.13) (0.10) (0.07) (0.07) (0.11) ing technique for children. J Dent Child 1984;51:371-373.
18. Williams NJ, Schuman NJ. The curved bristle tooth-
2 2.16 1.80 1.08 0.78 0.43 brush: An aid for handicapped population. J Dent Child
1988;55:291-293.
(0.10) (0.06) (0.09) (0.12) (0.08) 19. Quigley GA, Hein JW. A comparative cleaning efficiency
of manual and power brushing. J Am Dent Assoc 1962;
65:26-29.
20. Ramfjord SP. The periodontal disease index (PDI). J Peri-
REFERENCES odontol 1967;38:602-610.
1. Arnim S. Thoughts concerning cause, pathogenesis, 21. Löe H, Silness J. Periodontal disease in pregnancy. 1.
treatment and prevention of disease. J Periodontol Prevalence and severity. Acta Odontol Scand 1963;21:
1958;29:217-223. 533-551.
2. Ash MM, Githin BN, Smith WA. Correlation between 22. Cohen MM. A pilot study testing the plaque removing
plaque and gingivitis. J Periodontol 1964;35:424-429. ability of newly invented toothbrush. J Periodontol 1973;
3. Ellison SA. Oral bacteria and periodontal disease. J Dent 44:183-187.
Res 1970;49:198-202.
4. Scopp IW, Cohen G, Cancro LP, Bolston S. Clinical eval- Send reprint requests to: Dr. Vijay Kumar Chava, Depart-
uation of a newly designed contoured toothbrush. J Peri- ment of Periodontics, S.D.M. College of Dental Sciences &
odontol 1976;47:87-90. Hospital, Sattur, Dharwad-580 009, Karnataka, India. Fax:
5. Critchley P. Dental plaque, oral disease and plaque con- 91-836-447612; e-mail: chava7@hotmail.com
trol. J Ind Dent Assoc 1978;50:43-49.
6. Gibson MT, Joyston-Bechal S, Smales FC. Clinical eval- Accepted for publication November 15, 1999.

789

View publication stats