In this interview we talk to Doctor Ralf Adam, research fellow, clinical operations in oral care for Procter and Gamble/Oral-B.

Dr Ralf Adam loves electric toothbrushes. Although they’ve been around since Braun invented the Mayadent in the 60’s, today’s have come an awfully long way. 

A huge amount of research has gone into how they can change the behaviour of people, protecting their health and gums.

As Adam explains: “There is the device itself which is capable of doing some things, but what is at least as important is the person using the device so that it really comes to life and it fits the individual need and that is shown in the individual benefit.”

Certainly Procter and Gamble is one of the leaders in electronic toothbrushes, and has spent considerable time and money evaluating the benefits.It tested a thousand children in a study, some as young as three years old, and found that there was a six fold less likelihood of plaque and a 40% higher likelihood of being caries free.

Adam warms to his theme as he cites research in the German state of Pomerania. “They looked at manual toothbrushes versus power toothbrushes." And over 11 years, with several thousands of people, what they found is if you use a power toothbrush, you have a more than 20% higher likelihood of having less tooth loss versus manual brush users.

It isn’t just the brush, but also behaviour that is key, and changing that behaviour is vital.  He says: “if you look at toothbrushing instructions by the profession for the last 50 years, everyone will tell you it has been largely unsuccessful and not sustainable. Now this is what we are trying to address with using modern new technologies. Such as, for example, an app”.

So what does this app do?  Using it as you brush shows an increase of 21.6% in the time spent brushing and much more of the tooth surface is actually brushed, 94% in fact!

Of course, it must be pointed out that literally billions of people around the world use a manual toothbrush, and changing their behaviour and using apps will help. It needs to. Research shows that the average time spent brushing manually is just 46 seconds!

The app is also being used by a dentist doing a trial to analyse bleeding gums. Adam explains: “He uses this app in order to track whether his periodontal patients are bleeding while toothbrushing and when they are, which they shouldn’t be, he’s calling them into the office and has much better outcomes that way.” Moreover, the research, by Prof Maurizio Tonetti, was published in the Journal of Clinic Periodontology and showed that the usage of the app by patients to self-report their bleeding on brushing was actually a good predictor of bleeding on probing that would be observed clinically. This demonstrates that the use of smart toothbrushes and oral health apps has a big potential in improving oral and periodontal health.

Everyone is “appy” then!  “Oh yes”, says Dr. Ralf Adam: “Prevention is the thing.”

He also published some research last March at the International Association for Dental Research in Portland, Oregon, showing that brushing with an electric toothbrush extended the time a tooth was free from staining, thus prolonging the good work of the hygienist.

There are two other key factors that excite Dr Adam. One is the message that interdental brushing, or flossing, is a vital change in behaviour. The second is stannous fluoride in toothpaste which has been shown to reduce bleeding sites by 51% in group tests.

"It isn’t just the brush, but also behaviour that is key, and changing that behaviour is vital. He says: “if you look at toothbrushing instructions by the profession for the last 50 years, everyone will tell you it has been largely unsuccessful and not sustainable. Research shows that when manual toothbrush users switch to electric, they keep their old brushing habits, including missing lingual/palatal areas. We are trying to address this using modern new technologies such as an improved in-mouth use experience to enable patients to brush all areas evenly.  The International Journal of Dental Hygiene recently published a study of how people brush, and it shows improved plaque removal and evenness of brushing with next generation oscillating rotating toothbrushes. Brushing can be further improved via the use of app technology”.

Should there be standardisation in such things as interdental brush colours and sizes?  This is something Adam is keen on but hasn’t yet won the battle.

“This is a very hot topic. I'm also a member of the Oral Health group of the ISO norming organization and representative of German DIN, which is the norming organization in Germany.”  He admits though: “We did not succeed in order to get that normalization.”

Dr. Ralf Adam believes governments must also do more, and early!

“Paediatric dentistry is one thing where they should look into it and look into programs in order to establish and develop healthy oral behaviours in the widest sense.  I would re-establish things like effective school programs, you know that dentists are going back to schools.”

Dentists themselves though need to change behaviour, he thinks, to achieve better oral health.

“I mean the problem starts with dentistry. In my mind, if you look at the majority of dentistry, they are in treatment still; drill and fill. This is where they make money.”

Prevention has to be profitable!

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