Modern toothbrushes have various bristle tuft arrangements (e.g., flat-trim, multilevel, compound screening assay angled) that are designed [9] to enhance plaque removal from hard-to-reach areas of the dentition, particularly from interproximal areas.

The degree of hardness and stiffness of a toothbrush depends on the filament characteristics such as its material, diameter and length. Today many manufacturers vary the length or diameter of the filaments mounted in a single head. Toothbrushes with thinner filaments are softer while thicker filament diameters are stiffer and less flexible. The number of filaments per tuft also determines the hardness of a toothbrush, which in turn has an effect on the cleaning performance. Robertson and Wade [10] showed that subjects cleaned significantly better with medium and hard brushes than with a soft-bristled brush. Berdon et al. [11] found that a toothbrush with 0.18 mm diameter filaments was significantly less effective (P < 0.05) in cleaning than were five brushes with larger diameter filaments from the same manufacturer. Gibson and Wade [12] Sunitinib in vivo observed that a toothbrush with 0.2 mm diameter filaments tended to clean the marginal gingiva more effectively than another

with 0.18 mm diameter filaments. In a crossover study, Vowles and Wade [13] tested the differences between 0.13 mm and 0.28 mm filament diameters and found that plaque removal was significantly better (P < 0.001) with the thicker filaments when used with the roll technique for brushing the facial and interproximal areas. It appears, therefore, that filaments must have a degree of stiffness to dislodge plaque deposits. Designs are based on the premise that the majority of persons in any population use a simple horizontal brushing action. Over time, the design of the brush head has evolved

and multiple tufts of bristles, sometimes angled in different directions, are now used. Today, prospective users can readily find a toothbrush with a handle size appropriate to their hand size, and much emphasis has been placed on new ergonomic designs [14]. Toothbrush manufacturers have made great effort in considering many different aspects when designing new models to Buspirone HCl meet the challenge of enhancing plaque biofilm removal through improved tooth brushing efficacy. A few toothbrush manufacturers have also made the effort to evaluate tooth brushing efficacy. Product design changes can yield genuinely improved performance characteristics [15]. A major shortcoming of conventional flat-trim toothbrushes has been a ‘blocking effect’ of tight bristle tufts, preventing individual tufts from reaching interproximal areas. Multilevel toothbrushes have been developed with alternating rows of longer and shorter bristle tufts acting independently, uninfluenced by adjacent bristles during brushing. Once independent motion is achieved, the longer bristles can effectively reach farther between the teeth [16].