A comparative evaluation of commercially available pediatric toothbrushes in India Abstract Objective: Methods: Results: Conclusions: Key words:

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1 Original Article A comparative evaluation of commercially available pediatric toothbrushes in India Rinku Mathur,* Shailendra Jain, Sudhir Meena, Mohd Parvez *Assistant Professor, Dept. of Pediatric & Preventive Dentistry, Govt. Dental College, Jaipur, India. Private Practitioner, Assistant professor, Dept. of Prosthodontics & Implantology, Govt. Dental College, Jaipur, India. Abstract Objective: To evaluate the design and dimensions of Indian and Chinese pediatric toothbrushes commercially available in India and compare them with the standard specifications for pediatric toothbrushes. Methods: The present study involved 16 Indian and 14 Chinese pediatric toothbrushes which were evaluated for length and width of head of the toothbrushes, number of bristles, number of rows and diameter of the bristles. Moreover, both the Indian and Chinese pediatric tooth brushes were compared with length and height of head, number of rows, number of tufts per row and bristle diameter of standard specifications for pediatric toothbrush. Results: The width and height of the Indian tooth brushes were significantly less than the Chinese while the number of bristles per tuft in Indian tooth brushes (15.12±17.97) was approximately half of the Chinese (39.14±6.35) variants. In contrast, the head of the Indian (5.14±0.45) tooth brushes was significantly greater than their Chinese (4.72±0.47) counterparts. Chinese tooth brushes differed significantly from standard values in length, height, rows, tufts per rows and also bristle diameter. The length and height of head in Chinese toothbrushes was significantly lower while the number of rows and bristle diameter was significantly greater than the standard values. Indian toothbrushes differed from standard values only in height of the head, number of tufts per row and bristle diameter. Conclusions: Indian and Chinese toothbrushes differed significantly for most of the dimensions. Furthermore, both the Indian and Chinese variants did not conform to the standard dimensions of pediatric tooth brushes Key words: Design; Dimension; Pediatric toothbrush; Standard specifications. Author for correspondence: Dr. Rinku Mathur, A-87, Manu Path Shyam Nagar, Jaipur, India. Tel: rinkumathur@gmail.com

2 Introduction Tooth brushing is fundamental to meaningful practice of preventive dentistry. Mechanical method is one of the most widely used and accepted method of plaque control. Till date, tooth brushing remains by far the most popular, time tested mechanical method of personal oral hygiene and plays a pivotal in the defense against plaque and gingivitis (1). Eventually use of a scientifically designed toothbrush is critical in upholding the oral hygiene. This fact is all the more relevant in context of children. With universal use of tooth brushes and changing Indian economy, it is worthy to examine the tooth brushes available in the market and evolve the recommendations to regulate their marketing. The bristle toothbrush appeared about the year 1600 in China, was first patented in America in 1857 and has undergone little change. Generally, toothbrushes vary in size and design as well as in length, hardness and arrangement of bristles (2). Some toothbrush manufacturers claim superiority of design for factors such as minor modifications of bristle placement, length and stiffness (3). In addition many features such as use of neon colors of familiar cartoon caricatures are designed to attract the attention of pediatric purchasers. Unknown to most users, the toothbrush is a mechanical device regulated under the Food, Drug and Cosmetic Act (FD& C Act 1992) (4). The code of Federal Regulations defined a manual toothbrush as a device, composed of a shaft with either natural or synthetic bristles at one end; intended to remove adherent plaque and food debris from the teeth to reduce tooth decay. Over the years toothbrushes have undergone changes in all possible ways. They vary in size, design, length, hardness and length of the bristles. Although the American Dental Association (ADA) does not evaluate and classify manual toothbrush, certain recommendations have been made. Desirable characteristics of a toothbrush are (Wilkins 1983) (5) - Conforms to individual s requirements in size, shape and texture. - Be easily and efficiently manipulated. - Be readily cleaned and aerated, impervious to moisture. - Be durable and inexpensive. - Have prime functional property of flexibility, softness and diameter of bristles or filaments and strength, rigidity and lightness in the handle. - Be designed for utility efficiently and cleanliness. Because of the great variety in shapes, size, textures and other characteristics, the consumer must become familiar with the available products as plaque removal depends on the design of toothbrush in addition to the technique used (6). The objective of the current study was to evaluate the design and dimensions of Indian and Chinese pediatric toothbrushes commercially available in India and compare them with the standard specifications for pediatric toothbrushes. Material and methods This randomized, single blind study was carried at the facilities of Research Testing Laboratories (REEL) Jaipur, involving 30 pediatric toothbrushes from both Indian and Chinese manufacturers. Kimmelman and Tassman have stipulated the specifications for pediatric toothbrushes as illustrated in table 1 (7) All possible varieties of toothbrushes available in the Indian market were collected. Out of 30 varieties, 16 were 14

3 Indian and 14 were Chinese. These were randomly coded from 1 to 30. Each toothbrush was evaluated for the length, width and height of its head. In addition, number of tufts per row, number of bristles in each tuft and diameter of each bristle was assessed. Table 1: Specifications for pediatric toothbrushes proposed by Kimmelman and Tassman Length 25 mm Height 9 mm Rows 3 tufts per row 11 Diameter of bristles 4 Soft mm Medium mm Hard 0.30 mm The length, width and height of the head of the toothbrushes were measured using Vernier calipers. The number rows and number of bristles was counted under magnified Compact Fluorescent Light source. Bristles were counted by extracting the tuft and counting each manually. The recommended method for measuring smaller diameter wires in technical science is optical interference method using monochromatic light source but in this study profile projector was used which is basically for measuring the dimensions of rubber components. This equipment has 3 magnifications i.e. 5X, 20X and 50X; it has a display screen which shows the profile of the component being projected and a totally digital recording with a least count of 0.001mm. SPSS, 15.0 was used for statistical analysis. A p value of <0.05 was considered as statistically significant. Unpaired t test was used to evaluate the significance in differences for dimensions between the Indian and Chinese tooth brushes. Furthermore, one sample t test was executed to assess the difference in dimensions of Indian and Chinese variants from the standard values. Results A total of 30 pediatric toothbrushes were evaluated out of which 16 were Indian and 14 were Chinese. Table 2 demonstrates that length, number of rows and tufts per row did not differ significantly between the Indian and Chinese tooth brushes. It was observed that the width and height of the Indian tooth brushes were significantly less than the Chinese while the numbers of bristles per tuft in Indian tooth brushes (15.12±17.97 was approximately half of the Chinese (39.14±6.35) variants. In contrast, the head of the Indian (5.14±0.45) tooth brushes was significantly greater than their Chinese (4.72±0.47) counterparts. Table 2: Design and dimensions of Indian and Chinese toothbrushes Component Indian Chinese (Mean±SD) (Mean±SD) n= 16 n=14 Length (Head) 24.68± ±1.30 Width (Head)* 10.03± ±1.38 Height (Head)* 5.14± ±0.47 Rows 3.12± ±0.64 Tufts/ rows 7.31± ±0.91 Bristles/ tuft* 15.12± ±6.35 Bristle diameter* 0.17± ±0.02 *Unpaired t test, p<0.05 Both Indian and Chinese were compared with the standard specifications (table 3). Chinese tooth brushes differed significantly from standard values in length, height, rows, tufts per rows and also bristle diameter. The length and height of head in Chinese toothbrushes was significantly lower while the number of rows and bristle diameter was significantly greater than the standard values. Indian toothbrushes differed from standard values only in 15

4 height of the head, number of tufts per row and bristle diameter. Table 3: Comparison of Indian and Chinese toothbrushes with standard specifications Component Standard Values Indian Mean±SD n= 16 Chinese (Mean±SD) n=14 Length (Head) 25mm 24.68± ±1.30* Height (Head) 9mm 5.14±0.45* 4.72±0.47* Rows ± ±0.64* Tufts/ rows ±1.31* 7.92±0.91* Bristle diameter 0.19mm 0.17±0.04* 0.20±0.02* *One sample t test, significantly different (p<0.05) from standard values Height of the tooth brush head in Indian (5.14±0.45) and Chinese (4.72±0.47) types of toothbrushes was approximately half of the standard values (9mm). Discussion Toothbrush design and study design are important criteria for toothbrush studies. The toothbrush head size, the bristles and their array are among the many aspects that have been explored. Studies on toothbrushes reported that improved plaque removal can be achieved with modifications in the design of the conventional toothbrush such as correct angulations of the brush head, design of the toothbrush, bristle layer and diameter, material used and also the manual dexterity of the patients (8). Nylon bristles have a uniform diameter and predictable firmness. The firmness of a bristle depends on three factorsmaterials, diameter and length. Since bristles are made of nylon, the diameter of the bristle becomes the critical determinant of texture. The usual range of diameters of pediatric toothbrushes is from 0.16 to 0.30 mm (9). Based on the hardness or stiffness, toothbrushes are classified as soft, medium and hard. Various studies have been conducted regarding the specifications of adult toothbrushes and their plaque removal efficacy. However, there are very few studies that have investigated pediatric tooth brushes. None of the toothbrush brands of the present study have exhibited the required standards (7) for the pediatric toothbrushes. Data from the present study showed that most of the dimensions of Chinese brand tooth brushes were significantly different from Indian brands. Furthermore, both the Chinese and Indian variants did not conform to the standard values. Although manual dexterity plays an important role in plaque removal by tooth brushes, the significance of design of the tooth brushes cannot be ignored. The present study results demonstrate the need for regulating the dimensions of toothbrushes that are freely available in the market in India. There was no attempt done in the present study to assess the plaque removal efficacy of the Chinese and Indian brands of toothbrushes. Further clinical studies are recommended in order to evaluate the plaque removal efficacy and gingival health maintenance by both the brands. Conclusions Indian and Chinese toothbrushes differed significantly for most of the dimensions. Furthermore, both the Indian and Chinese variants did not conform to the standard dimensions of pediatric tooth brushes. References 1. Loe H, Theilade E, Jensen SB. Experimental gingivitis in man, J Periodontol. 1965;36: Silverstone LM, Featherstone MJ. A Scanning electron microscope study of the end rounding bristles in eight 16

5 toothbrush types. Quintessence Int. 1988;19: Newman MG, Takei H, Klokkevold PR, Carranza FA. Carranza's clinical periodontology, 10 th ed. Elsevier: Philadelphia; 2011; p Ciancio SG. Non-Surgical periodontal therapy. Periodontol ;9: Wilkins EM. Clinical practice of dental hygienist, 4th ed. Lea and Febiger;1983; Bastiaan RJ. The cleaning efficiency of different toothbrushes in children, J Clin Periodontol. 1986; 13: Kimmelman BB. Research in designs of children s toothbrushes, J Dent Child. 1960;27 : Park KK, Matis BA, Christen AG. Choosing an effective toothbrush, Clin Prev Dent. 1985;7: Mc Donald RE, Avery DR, Dean JA. Dentistry for the child and adolescent. 8th ed. St. Louis: Mosby; 2007; p