title: Effect of brushing force and time on plaque removal using a powered toothbrush.
abstract: OBJECTIVE
  Primary objective - To determine the effect of varying brushing forces and brushing times upon the plaque-removing efficacy of a powered toothbrush. Secondary objective - to determine the optimum combination of brushing force and time for plaque removal.
  
  
  METHODS
  This randomised, single-blind, 16-cell, cross-over trial compared the efficacy of plaque removal of a powered toothbrush (PTB) used with four brushing forces (75, 150, 225 and 300 g) and over four brushing times (30, 60, 120 and 180 s). Twelve volunteers (18-30 years) were recruited and trained to use the Philips/Jordan Sensiflex 2000 PTB, which was modified so that specified forces and times could be recorded. Each subject was asked to abstain from all oral hygiene procedures for 24 hs prior to each brushing event, to allow plaque accumulation. Plaque was recorded using a modified Quigley & Hein index (PI) at six points per tooth before and after each episode of brushing, and the differences in the means (pre- to postbrushing) were compared. Three-way anova was undertaken to compare differences between plaque-removing efficacy for the 16 combinations of force and time. Subjects, brushing time and brushing force were used as fixed effects within the analysis.
  
  
  RESULTS
  All 12 subjects participating completed the 16 combinations of force and time over which plaque removal was assessed. Statistically significant differences in PI reductions were found between different brushing times and forces over all tooth surfaces (p<0.001). The interaction of varying brushing force and brushing time was significant for full mouth (FM) and interproximal (IP) sites (p<0.03). No statistical significance was demonstrated for smooth surface (SS) sites, nor was it detected for the interaction of subjects with brushing force or subjects with brushing time (p>0.05).
  
  
  CONCLUSIONS
  We conclude that brushing time and brushing force have significant effects upon the level of plaque removal by a PTB, and at 120 s brushing time the improvement in plaque removal with forces in excess of 150 g was negligible.
authors.affiliation: Restorative Dentistry, School of Dental Sciences, University of Newcastle upon Tyne, UK.
authors.forename: G I
authors.initials: GI
authors.lastname: McCracken
authors.forename: J
authors.initials: J
authors.lastname: Janssen
authors.forename: M
authors.initials: M
authors.lastname: Swan
authors.forename: N
authors.initials: N
authors.lastname: Steen
authors.forename: M
authors.initials: M
authors.lastname: de Jager
authors.forename: P A
authors.initials: PA
authors.lastname: Heasman
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D018592:Cross-Over Studies; D003773:Dental Plaque / Q000473:pathology / Q000628:therapy*; D003774:Dental Plaque Index; D011211:Electric Power Supplies; D004867:Equipment Design; D006801:Humans; D016037:Single-Blind Method; D013314:Stress, Mechanical; D013997:Time Factors; D014070:Tooth / Q000473:pathology; D014099:Toothbrushing / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome