A better toothbrush? ADA unconvinced

Every year millions of toothbrushes go out of commission, splayed, flattened, mildewed, rejected. And twice a year, the average dental patient hears yet another lecture from his dentist about brushing more thoroughly. The convergence of these two factors means a huge market for any company that can prove its toothbrush is better than the competition ... or even just better than the average.

The latest salvo in the toothbrush wars comes from GABA, a Swiss subsidiary of Colgate-Palmolive, courtesy of a study published in the July issue of the Journal of Dentistry (Vol. 35:7, pp. 614-622). Researchers from the University of Rochester in New York write that the company's cross-angled soft bristle design fights gum disease better than the American Dental Association's (ADA) standard brush.

The study found that patients who switched to the GABA's elmex Sensitive Extra Soft or elmex Sensitive Soft brushes reduced their plaque and gingivitis by about 12 percent over 30 days. Patients who switched to a new ADA standard brush achieved no improvement.

"I think this could be a great design, especially for patients who have tooth sensitivity, or for older patients who have receding gums," said Yan-Fang Ren, DDS, PhD, MPH, an assistant professor who led the GABA-funded study.

But Clifford Whall, Ph.D., the ADA's director of product acceptance, isn't impressed. "We haven’t seen sufficient evidence to convince us that any one brush is better than another brush," he said.

To put the elmex toothbrushes to the test, Dr. Ren and his colleagues divided 84 people with mild gingivitis into three roughly equal groups. Group 1 used the elmex Sensitive Extra Soft, group 2 used the elmex Sensitive Soft and group 3 used the ADA standard toothbrush.

The patients were rated for gingivitis on the Silness Loe scale of 0 to 3, where 0 is no inflammation and 3 is severe inflammation. At the beginning of the study, all the patients had an average score of about 1.25. After 30 days, the elmex Sensitive Extra Soft group dropped to 1.11, the elmex Sensitive Soft group fell to 1.10, and the ADA standard group saw no improvement.

The Quigley Hein plaque index (modified by Turesky) ranges from 0 to 5, where 0 is no plaque and 5 is plaque covering two-thirds or more of the crown of the tooth. At the start of the study, plaque scores hovered around 2.45 for all the groups. After 30 days, the elmex Senstive Extra Soft score dropped to 2.10 while the elmex Sensitive Soft score fell to 2.17. Once again, the ADA standard group experienced no significant improvement.

The differences between the ADA brush and the elmex brushes were statistically significant, but the differences between the two elmex brushes were not.

Dr. Ren attributed the success of the elmex brushes to the tapered shape of the bristles and the positioning of some tufts at a slight angle, which he said helped with interproximal cleaning. He noted that these two brushes wore evenly, while the ADA brush wore out only in the middle columns, suggesting that more of the elmex bristles touched the teeth.

This "cross-bristle" design isn't exactly new, said Salim Nathoo, D.D.S., an assistant clinical professor at the University of Medicine and Dentistry of New Jersey, who has conducted similar research for toothbrush companies. "It has been shown to have advantages," he said.

But dentists shouldn't focus too much on toothbrush design, he said. "Rather than recommending things, [dentists] should educate the patients about brushing technique."

In fact, brushing technique is the key reason that the ADA isn't impressed by studies like this one, said Dr. Whall. The patients in the elmex study were instructed to brush "in their usual manner." Previous research suggests that most people brush much less than the two minutes the ADA recommends. "We want to see the products used properly," Dr. Whall said.

The ADA doesn't particularly recommend any brand of brush, he added. Instead, it sets standards. Any brush that meets those standards can wear the ADA's Seal of Acceptance.

Dr. Ren acknowledged that brushing technique is more important than brush design, though he argued that the softness of the elmex brush might be particularly suitable for people with sensitivity due to receding gums.

The bottom line? As Dr. Ren himself acknowledged, "Any soft brush is fine if used properly."

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