Manual toothbrushes with hard bristles may remove plaque better than those with soft bristles but may also cause more soft-tissue trauma, according to researchers from Witten/Herdecke University and Heinrich-Heine University (Journal of Periodontology, August 19, 2010).
In a randomized controlled trial, 120 volunteers, ages 18-62 years, were separated into three groups with 40 subjects each. Each group used manual toothbrushes with hard, medium, or soft bristle stiffness. The participants were instructed to brush twice a day for two minutes each time. After the initial exam, clinical parameters for plaque removal, gingivitis, and soft-tissue damage were recorded again at four and eight weeks.
Primary outcome measures were the differences in Quigley-Hein index (QHI) and papillary bleeding index (PBI) compared to baseline; secondary outcome measures were the differences in modified approximal plaque index (MAPI) and the Danser gingival abrasion index (DI).
The researchers found that QHI and MAPI showed lower index scores in subjects using hard-bristled toothbrushes after eight weeks (p < 0.05 and p < 0.001, respectively). In contrast, subjects using toothbrushes with hard bristles demonstrated more gingival lesions (p < 0.01) and higher PBI scores after four and eight weeks (p < 0.001) compared to toothbrushes with soft or medium bristles.
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