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Clinical studies

BROXO® toothbrush compared with its main competitors

In vitro testing of the effectiveness of the BROXO® brush and its competitors separate fact from fiction and highlight the advantages confered by 50+ years of experience, clinical studies and scientific development.

The most important quality of an electro-mechanical brush is its brushing/massaging efficacy. The superiority of the BROXO® brush is repeatedly proven through a trustworthy "in vitro" trial. The trial is performed by coasting artificial jawbones with a product similar to dental plaque and to brush them with the help of the testing device that holds the device, with pre-determined conditions of fixation time and movements. The test consists in noting the clealiness of the teeth, interdental spaces and gums.

Cleanliness of the gum era is an apt indicator of massaging efficiency.

Braun Plak Control, Hapika, Interplak, Sensonic, Sonicare, Ultrasonex and BROXO® brush.

We have chosen a trial methodology which has been adopted by NF under reference S 91404 and will become adopted by AFNOR and the European Union of Dental Associations.

This trial consists in applying an electric toothbrush with well determined load, time and movement conditions, over cylinders of 10 mm of diameter, representing the geometry of teeth and interdental spaces. Over each of these cylinders is placed a piece of sensitive paper of the same kind as the one normally used in the graphic registration devices. The paper is black an coated with white titanium.

Examination of the black print left on the white background by the electric toothbrush under test on the sensitive paper allows us to determine the brushing effect and to define its efficacy both quantitatively (by looking at the black surface) and qualitatively (by looking at the intensity of the blackness itself).

The penetration in interdental spaces, which are the most important areas, can also be appreciated by the detailed examination of the imprint left on the paper.

The interpretation of these results are made by computer through Adobe Photoshop. The image of the imprint is first scanned in RGB color and then converted to grayscale. Then, the contrast is totally suppressed to obtain a single kind of gray level numbered from 0 to 255.

The ranges of values the paper can provide is from a minimum of 199 (lighter) to a maximum value of 71 (darker).
The interpretation of the results is thus without errors, precise, trustworthy and repeatable.

During this comparative test the result obtained are resumed in Attachment A - "Recapitulation of the Result on sensitive paper 31.10.1995". Concerning this "Recapitulation of result" here are some remarks and interpretations.

The "Efficiency Scaled from 0 to 255" given for the loads of 150, 200 and 250g with the average value, corresponds to the numbers given by the computer.

For example, looking at the measurement sheet of the BROXO® brush 120v/60hz in attachment B, numbered values are given from 0% standard of brushing (71), to the 100% standard (199), as well as for each brushing imprint (from 151 to 180) done over 3 cylinders, each corresponding to a different load. The average is calculated for each load (175-162-154) and also for the 3 different loads (164).

There is such a measurement sheet for each electric toothbrush tested, and for each one with 0% standard and 100% standard of brushing.

The "Efficacy in % from 71 to 199" is the "Efficacy Scaled from 0 to 255" compared to the paper limits from 71 to 199, which correspond respectively to 100% and 0% of brushing.

These values seem to be weak but this is due to the fact that the brushing print was examined when compared with a control surface of 4 cm2, which is relatively wide.

In the following column of the "Recapitulation of results" we have compared "Efficacy in % from 71 to 199" admitting that 100% corresponds to the Broxodent®/Periobrush. By using this method numbers are easier to understand.

Thus, once again we can observe that the BROXO® brush has a better brushing efficacy. Even if expressed with other numbers, it is interesting to remark that this new trial described at the beginning, made by coating the jawbones.

The superiority of the BROXO® brush is still more worthy of notice by the visual exam of the imprint then by reading the numbers in Attachment A.

As a first conclusion we can see that only Interplak bears a comparison with the BROXO® brush, Sonicare and even more neatly Sensonic are distinctively inferior and finally, qualified as inadequate follow Braun Plak Control, Hapika and Ultrasonex, this last being practically worthless.

These differences are even more accentuated when examined in detail and by considering the brushing done in the area of the interdental spaces where the BROXO® brush is particularly efficient, contrarily to Sonicare, Sensonic, Braun Plak Control and even more to Haprika and UltraSonex.

We have considered giving more importance to the difficult access areas such as the interdental spaces, if compared to the other areas easily attained ( by example teeth surface) but finally we renounced, to simplify measurements and interpretations.

Without going back to the large number of clinical studies made on the subject, we must not forget that brushing does not only have as functions to clean teeth, eliminate dental plaque and remaining food, but also, and mainly, to massage gums and favor the blood circulation at the capillary level as well as to improve the keratinisation of the gum's texture. To comply with all these requirements an automatic toothbrush must not only be efficient but also be agreeable to use (user's friendly) and do not create traumatism.

The electric toothbrush amplitude of movement must be wide enough to assure the brushing of all teeth's and gums' surfaces in a relatively short time (of more or less 1 minute) that the user usually grants to his dental hygiene.

Ultrasonex bases its marketing strategy on the use of the ultrasonic frequency which is the case with its 1,6 MHz. But, in fact, because of its weak power, the efficacy of the device is practically non-existing. The imprint made on sensitive paper is identical, whenever the device is working or not.

Hapika even if of very efficacy because of its small size and the weak power supplied by its batteries, it has at the least the capacity of improving the brushing of a manual toothbrush.

Sensonic and Sonicare use in excess the word "sonic" in their publicity as their frequency of 30.000 movements per minute only represents 250 cycles per second (while Ultra-Sonex has 1,6 millions of cycles per second).

The BROXO® brush works on a frequency of 60 cycles per second considered as the best one for efficacy and comfort. A frequency of 250 cycles per second is too high as it determines (at an equal power) a too weak amplitude of movement, as well as being uncomfortable to the user by the fact that it becomes ticklish and makes a piercing noise.

These inconveniences are particularly felt whenever a hard part of the brush stem touches a tooth, which of course will happen, sooner or later when teeth are being brushed. The Sensonic and Sonicare conceptors tried to reduce the problem by creating brush stems made of two or more pieces, but without really solving it. On the contrary, these adopted solutions have arisen another problem, the one of proliferation of bacteria in the brush stem's areas which are pratically impossible to desinfect or clean properly.

The marketing idea advanced both by Sensonic and Sonicare that the creation of foam cavitation help the elimination of dental plaque deserves to be rectified. This phenomenon is not linked to the frequency as they pretend, but to the speed of the bristle's movements. This has always happened with the Broxodent®/Periobrush as its speed of bristle's movements is about the same as the ones of the Sensonic and the Sonicare (2 to 6 m/s). A very sophisticated study has proved it very recently.

Interplak and Braun Plak Control, even if they have special brushing movements, compared to all the others, as they rotate, are part of the big family of devices with constant angle and torque. Only the frequency falls when a load is applied on the brush stem.

Both their systems are helped only by cheap mechanical solutions but the brushes may creates traumatisms on gums when too strong loads are applied, as the torque and its amplitude will not decrease. This is particularly the case with Interplak that has a relatively important power. Also concerning the Interplak, a major defect must be mentioned, related to the mechanical conception of the brush stem itself. So that each tuff may have a rotating movement with the help of a rack and pinion the bristles which will be in contact with the mouth, will also be in touch with the cavities needed for this type of mechanism.

So, even if there are small holes and Interplak enclosed in the packaging user's instructions for the cleaning of the brush stems, in the cleaning itself is perfectly impossible and there is a high risk of bacteria proliferation as well as of pathogenic germs, viruses, "candida albicans", etc. There is also a great possibility that the mechanism becomes greasy, but the bad smell and mainly the risks of infection are even more important. It must be noted that the Interplak brush stem, that must be replaced periodically, thus wastable, is composed of nearly 20 different pieces.

Coming back to the problem of the load applied on the toothbrush, once again BROXO® brush has an unparalleled behavior. Because of its patented, electro-mechanic system its motor assures a self-regulation of the brushing energy.

With an optimum constant frequency, at the first stage of load accepted by the gums, the amplitude of the movement remains always constant, thus not being influenced by this load.

But, if the load becomes too strong, the amplitude diminishes automatically and progressively till it becomes, if necessary, of no significance, to avoid all traumatisms of the gums. This behaviour repeats itself at the energy levels, 1, 2 and 3 of the BROXO® brush and permits a treatment adapted to all kind of gum's conditions until they are completely healed.

There are also other important qualities with which the BROXO® brush complies:

Absolute water tightness of the device.

Guaranteed electric security by the use of an extra-low tension (14 V).

No need of batteries nor accumulators which solve the problems of polluting destruction of replacements, by avoiding them, as well as the ones of the poor liability, limitation and variation of the power during usage.

Unequalled long life because only one piece of the motor is in motion and it transmits power directly to the brush stem. To prove it there is the fact that the same BROXO® brush devices put on life trial of continuous working in February 1994, are still perfectly functioning today, representing more than 15,000 hours of continuous functioning, as well as more than 5 billions of brushing movements.

SWISS HEALTHCARE SOLUTIONS S.A.. -Geneva; October 31, 1995.

Pierre J. Jousson - R&D Engineer / Translation into English AD.