Measuring success in toothbrush design - an opinion and debate of the concepts

Toothbrushes date back nearly 1000 years, although the forerunners of today's brushes were developed in the 1930s. Ideally toothbrushes should be designed to promote optimum plaque removal with minimum adverse effects to the hard and soft tissues. Unlike the development of other oral hygiene products, notably toothpaste and mouthrinses, there appears to have been no debate of how best to evaluate the safety and efficacy of toothbrushes except perhaps in respect of filament stiffness. Even here there has been little consideration of the interplay of toothbrushes with toothpaste for safety and efficacy, a factor complicated by the multi-factorial aetiology of tooth wear and gingival recession. This review considers present and possible future laboratory and clinical methodologies whereby toothbrushes could be assessed for safety and efficacy. To date, for the most part, studies have concentrated on brush comparisons. This approach cannot be criticised since studies, in the main, have conformed with scientific guidelines. However, it has achieved little except to emphasise that the major variable to safety and more particularly efficacy is the brusher and not the brush. A proposal is pat forward that minimum standards for toothbrush safety and efficacy based on laboratory and clinical experiments be considered.