A clinical evaluation of the plaque removal efficacy of five manual toothbrushes

J Clin Dent. 2010;21(1):8-12.


Objective: To assess and compare the plaque removal efficacy of five different Oral-B manual toothbrushes: CrossAction Pro-Health (CAPH), CrossAction (CA), Exceed (EX), Advantage 123 (ADV 123), and Indicator (IND).

Methods: This was a single-use, five-treatment, examiner-blind, randomized, five-period (visit) crossover study, with 10 different treatment sequences (groups) that determined the order in which the five toothbrushes were assigned at study visits. Three toothbrushes had an advanced CrissCross bristle design (CAPH, CA, EX), while two had more standard designs with straight bristles (ADV 123 and IND). At the first visit, subjects disclosed their plaque with disclosing solution, and an examiner performed a baseline plaque examination using the Rustogi, et al. Modification of the Navy Plaque Index (RMNPI). Subjects brushed for one minute with their assigned toothbrush under supervision, after which they again disclosed their plaque and were given a second plaque examination. The same procedure was followed for each of the visits in turn.

Results: All five manual toothbrushes showed a statistically significant (p < 0.0001) reduction in plaque from baseline for the whole mouth (84% to 93%), gingival margin (74% to 88%), and approximal surfaces (95% to 99%). For pair-wise treatment comparisons for all three plaque measures, CAPH, CA, and EX demonstrated statistically significantly better plaque removal than ADV 123 and IND (all p < 0.018). No other treatment comparisons were statistically significant.

Conclusion: All five manual toothbrushes showed highly effective plaque reduction for whole mouth, gingival margin, and approximal surfaces. Comparisons between brushes showed consistent advantages for CAPH, CA, and EX compared to ADV 123 and IND for all three plaque measures, indicating that advances in toothbrush design can further enhance plaque removal.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cross-Over Studies
  • Dental Plaque / prevention & control*
  • Dental Plaque Index
  • Equipment Design
  • Erythrosine
  • Female
  • Fluorescent Dyes
  • Gingiva / pathology
  • Humans
  • Male
  • Middle Aged
  • Single-Blind Method
  • Tooth / pathology
  • Toothbrushing / instrumentation*
  • Treatment Outcome
  • Young Adult


  • Fluorescent Dyes
  • Erythrosine