The aim of this study was to evaluate the plaque removal efficacy of four different brush heads for a sonic toothbrush: standard and mini brush heads of Inter Care, and the standard and mini brush heads of Diamond Clean. This study was concluded as an investigator-blinded, four-brush crossover design study. Nineteen dentists with clinically healthy gingiva and without restorative materials in the teeth or prosthetic teeth participated in the study. Prior to the experiment, the subjects received a professional prophylaxis regime and were requested to refrain from brushing their teeth for 48hours. Assessment was carried out using the modified O'Leary's plaque control record (6 sites per tooth) at the baseline and after each brushing interval by one blinded investigator. The PCR score at the baseline was 100% at baseline in all subjects. The results showed no statistically significant differences in the PCR scores among the four brush heads. However, the medium value of interproximal differed among the groups. The plaque removal rate was higher in the IS and IM groups than in the DS and DM groups.

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Measurement of the occlusal force is important for estimating the risk of periodontal destruction, because an excessive occlusal force accelerates periodontal destruction in patients with periodontitis. Very few dentists assess the occlusal force in clinical practice, because an expensive device is needed for its measurement. The aim of the present study was to determine whether the occlusal force can be estimated based on the morphological characteristics of the face in young adults of the same age group with a similar number of teeth. Dental students (n = 100) of Kyushu Dental University participated in the present study (60 men and 40 women; age 23.1±2.99 years). The students were asked to bite pressure-sensitive films, and the bitten films were analyzed using Occuluser^® FDP707 (GC Corp. JAPAN) in order to measure the occlusal force. The facial photographs of all the students were obtained with a digital camera, and the photographs were incorporated into a computer for software assessment (ImageJ, NIH, USA). The total head height, zygomatic diameter, width of the lower jaw, area of the face, and gonial angle were measured in the incorporated images. The occlusal force was significantly higher in the male students than in the female students. Furthermore, the total head height and area of the face were significantly higher in the male students, whereas no significant differences in the zygomatic diameter, width of the lower jaw and gonial angle were observed between the male and female students. Multiple regression analysis was performed using the following two parameters as explanatory variables: total head height/zygomatic diameter and width of the lower jaw/zygomatic diameter. The occlusal force was significantly influenced by one of the measured parameters (width of the lower jaw/zygomatic diameter) and the sex of the subject, with a coefficient of determination of 0.25. These results suggest that the occlusal force can be partly estimated based on the morphological characteristics of the face and the sex in young adults.

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This is a case report of a patient in whom recovery of gingival recession was obtained with the use of a proper brushing technique, without any need for periodontal surgery. A 26-year-old female patient presented with the chief complaint of pain induced by cold water in the lower right posterior region of the mouth. Periodontal examination and x-ray revealed dental caries around the lower right molars. The pocket depth in the region of the right upper molars was 4.0 mm. Although the patient had gingival recession at 13, 14 and 23, and a festoon gingiva (McCall's festoon) was recognized, her occlusal style was group function and the occlusion was stable. Based on the periodontal disease classification proposed by the Japanese Society of Periodontology, this patient was diagnosed as having generalized mild chronic periodontitis with gingival recession of the anterior maxillary region. As a poor brushing technique was thought to be the cause of the gingival recession, the patient was given instructions on oral hygiene, especially focusing on a proper brushing technique, so as to achieve a satisfactory gingival condition and plaque control. After 15 years, the gingival recession gradually recovered on the side of the wedge-shaped defect. At 18 years after the first treatment, the creeping gingival attachment was found to totally cover the wedge-shaped defect. However, it was difficult to keep good condition of subgingival region by brushing, and the onset of gingivitis was recognized around the marginal gingiva. Brushing towards the apical region was advised for improving the gingival level on the side of the wedge-shaped defect. After 25 years, the gingival condition of the patient remains satisfactory and the oral environment healthy. This case report emphasizes that improper tooth brushing can cause gingival recession. With appropriate diagnosis, provision of instructions on the proper technique for brushing may be expected to yield successful and exceedingly predictable results in the treatment of gingival recession.

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