title: Cleaning efficacy and soft tissue trauma after use of manual toothbrushes with different bristle stiffness.
abstract: BACKGROUND
  The purpose of this study is to evaluate the efficacy of manual toothbrushes of the same type with different bristle stiffness concerning plaque removal, gingivitis development, and soft tissue trauma.
  
  
  METHODS
  In a randomized controlled trial, three groups with 40 subjects each used manual toothbrushes with either hard-, medium-, or soft-bristle stiffness. The at-home brushing time was set for 2 minutes, twice a day. Four and 8 weeks after the baseline examination, clinical parameters for plaque removal, gingivitis, and soft tissue damage were recorded again. Recruitment and examinations of the subjects were performed at the Department of Operative and Preventive Dentistry and Endodontics, Heinrich Heine University. A total of 120 volunteers (age range: 18 to 62 years) were recruited and stratified according to sex and age. Primary outcome measures were differences in the Quigley and Hein index (QHI) and papillary bleeding index (PBI) compared to baseline; secondary outcome measures were differences in the modified approximal plaque index (MAPI) and Danser gingival abrasion index.
  
  
  RESULTS
  The QHI and MAPI showed lower index scores in subjects who used hard-bristled toothbrushes after 8 weeks (P <0.05 and P <0.001, respectively). In contrast, subjects who used toothbrushes with hard bristles demonstrated more gingival lesions (P <0.01) and higher PBI scores after 4 and 8 weeks (P <0.001) compared to subjects who used soft- or medium-bristled toothbrushes.
  
  
  CONCLUSIONS
  Manual toothbrushes with hard bristles may better remove plaque, but may also cause more soft tissue trauma compared to brushes with softer bristles.
authors: Department of Operative and Preventive Dentistry, Faculty of Health, Witten/Herdecke University, Witten, Germany. stefan.zimmer@uni-wh.de
authors: Stefan
authors: S
authors: Zimmer
authors: Metin
authors: M
authors: Öztürk
authors: Claudia R
authors: CR
authors: Barthel
authors: Mozhgan
authors: M
authors: Bizhang
authors: Rainer A
authors: RA
authors: Jordan
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D003773:Dental Plaque / Q000517:prevention & control*; D003774:Dental Plaque Index; D004867:Equipment Design; D005260:Female; D005881:Gingiva / Q000293:injuries*; D005891:Gingivitis / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018583:Pliability; D012016:Reference Values; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D014099:Toothbrushing / Q000009:adverse effects / Q000295:instrumentation*; D016896:Treatment Outcome; D055815:Young Adult