It is well accepted that regular oral hygiene is the key to oral health of patients and the toothbrush remains the centerpiece of it. The goal in toothbrush design typically focuses on providing maximum plaque removal capability while ensuring gentleness to both hard and soft tissues. Design of effective brushes thus requires understanding of oral anatomy, brush cleaning mechanics/tribology and also ergonomic considerations. However, an often overlooked feature in effective brush design includes consideration of brushing techniques and habits preferred by patients.
For example, the development of multifilament tufting patterns with high degrees of end rounding permitted Oral-B, the global leader in toothbrush design, to develop the first high efficiency manual brushes in the early 1960’s. These flat trimmed toothbrushes revealed their best efficacy when used in brushing patterns associated with modified Bass techniques and a vertical brushing motion. Later, Oral-B further maximized manual brushing efficacy by the development of criss-cross tufting patterns – so called ‘CrossAction’ -- in a manual brush design. Importantly, the development of this complex tufting design was influenced by consumer habits – including the back and forth brushing technique that many consumers employ. A recent systematic review of manual toothbrush plaque removal efficacy illustrates the importance of considering consumer usage patterns in brush design, as toothbrushes with angled bristle tufts like CrossAction provided the highest mean plaque score reduction while flat-trim toothbrushes had the lowest mean reduction.1 Oral-B was thus a pioneer in the development of an improved efficacy manual brush by adapting the brush head design to patient usage habits.
The development of power toothbrushes in the 1960’s represented a key milestone for dentists and patients – with electromechanical energy increasing the number of cleaning strokes which could be applied within a finite period of toothbrushing. In their original designs, power toothbrushes tended to reinforce the brushing patterns of consumers with up and down or side to side brushing patterns. Later more advanced designs were focused quite differently – in fact mimicking cleansing actions associated with professional cleaning. The most successful mimicry of professional cleaning in a power brush was developed by Oral B/Braun with oscillating-rotating technology in the early 1990’s. Oscillating-rotating brushing motions simulated the tooth-by-tooth polishing actions that dental professionals use in applying prophylaxis cups in handpieces. In addition, both efficacy and ergonomic ease of use were enhanced by applying reversing oscillations during cleaning to increase patient control compared to continuous circular brushed pattern. The reversing directions of the brush motions coincidentally increased brushing efficiency in plaque removal – building on learnings from the mechanical effects in CrossAction manual designs.
The oscillating-rotating design by Oral-B represented a major step forward in brush efficacy for patients and dentists. In 2011, an independent Cochrane Collaboration report concluded that oscillating-rotating power toothbrushes reduced plaque and gingivitis more effectively than a manual toothbrush in the short and long-term; no other powered designs were consistently superior to manual toothbrushes.2 This conclusion was derived from their systematic review and meta-analysis of 50 clinical studies involving approximately 4,300 subjects in both short and longer-term trials.
Given their clinical success, patients are continuously encouraged by their dentists to consider power options such as oscillating-rotating toothbrushes, which are difficult to match in terms of cleaning efficiency (plaque removed for time spent). Regardless of the proven benefits, and the dental professional’s admonition, many adults have still not taken advantage of the effective cleaning potential of power brushes and still use manual brushes. Research shows that these consumers favor the traditional larger size and shape of a manual toothbrush, larger amount of toothpaste applied and the ability to brush several teeth at once. Most importantly, many of these patients still prefer a “back and forth” brushing technique. Oral-B solved this paradox by the development of Deep Sweep. This unique multi-directional power toothbrush with triple zone cleaning technology, marketed as Oral-B Deep Sweep (or Oral-B TriZone in other regions), is characterized by its unique, multi-directional movement derived from the three distinct brush zones:
Zone 1: The power tip for hard-to-reach back teeth
Zone 2: The manual-like stationary bristles for thorough cleaning directed by the manual action of the user
Zone 3: The wide sweeping-pulsating bristles for interdental cleaning
Collectively, these brushing zones permit patients to obtain superior plaque cleaning and gingivitis efficacy relative to manual3,4 and sonic controls5,6 in a platform matching the brush usage patterns preferred by many patients. Comparative clinical research demonstrated the superior efficacy of the new multi-directional brush in plaque and gingivitis reduction relative to control brushes, even in the hard-to-reach interdental spaces and marginal areas. In an 8-week study, the Oral-B DeepSweep with the SmartGuide produced significantly greater reductions in gingivitis (30%), bleeding (29%) and (44%) plaque relative to pre-treatment versus a premium sonic power toothbrush.6
Patients formerly preferring a manual brush have enthusiastically embraced the novel multi-directional power brush in both consumer and clinical trials.
The following publications provide more information on the Oral-B DeepSweep multi-directional power toothbrush with triple zone cleaning technology:
Mielczarek A, Klukowska M, Kaiser E, Stoerkel U, Mandl C, Walters P, Warren P. A novel power toothbrush with multi-directional, triple zone cleaning technology. Am J Dent 2012; 25 (Spec Iss A): 3A-9A.
Klukowska M, Grender JM, Timm H. A single-brushing study to compare plaque removal efficacy of a new power brush to an ADA reference manual toothbrush. Am J Dent 2012;25 (Spec Iss A): 10A-13A.
Sharma NC, Klukowska M, Mielczarek A, Grender JM, Qaqish J. A 4-week clinical comparison of a novel multi-directional power brush to a manual toothbrush in the reduction of gingivitis and plaque. Am J Dent 2012;25 (Spec Iss A): 14A-20A.
Goyal CR, Klukowska M, Grender JM, Cunningham P, Qaqish J. Evaluation of a new multi-directional power toothbrush versus a marketed sonic toothbrush on plaque and gingivitis efficacy. Am J Dent 2012;25 (Spec Iss A): 21A-26A.
Klukowska M, Grender J, Goyal CR, Qaqish J, Biesbrock AR. 8-week evaluation of anti-plaque and anti-gingivitis benefits of a unique multi-directional power toothbrush versus a sonic control toothbrush. Am J Dent 2012;25 (Spec Iss A): 27A-32A.
1Slot DE, et al. Int J Dent Hyg 2012;10:187-197.
2Yacoob M, et al. British Society for Oral and Dental Research, September 2011: Abstract 106.
3Klukowska M, et al. Am J Dent 2012;25 (Spec Iss A): 10A-13A.
4Sharma NC, et al. Am J Dent 2012;25 (Spec Iss A): 14A-20A.
5Goyal CR, et al. Am J Dent 2012;25 (Spec Iss A): 21A-26A.
6Klukowska M, et al. Am J Dent 2012;25 (Spec Iss A): 27A-32A.