Waterpik Technologies DT400, D17511, 7500 User Manual

Disclosure Statement

• This course was designed, developed and produced by
Waterpik Technologies

• Waterpik Technologies manufactures and distributes
products addressed in this course

Course Objective

To provide the dental team with the information and
criteria needed to assist individuals in selecting a power
toothbrush appropriate to need

Learning Outcomes

• Discuss the clinical evidence from power toothbrush
research

• Identify which individuals will benefit from a power
toothbrush

• Recommend a power toothbrush appropriate to need

Introduction

Power brushes have been in existence for many years. In
the past, recommendations were often reserved for those
individuals with special needs. Today, with the wide vari­ety of products on the market, almost any individual can
benefit from a power brush.

1

A practice-based study that included 3,669 dental profes­sionals and 16,903 subjects demonstrates how typical den­tal office patients can benefit from a power brush. In the
study, power toothbrush use was considered by dental pro­fessionals to have a positive effect on the oral health of

80.5% of patients. Patients agreed, with 74% stating that

they thought the power brush resulted in better oral
hygiene. Ninety four percent (94%) of patients reported
that they would continue to use their power brush and
75% said they would recommend it to a friend.

2

Power brushes are good choices for many individuals.
They may be ideal devices for people who provide care to
the homebound or for those institutionalized or living in
a nursing home. In working with individuals, consider
those who present with any of the following as prime
candidates for using a power brush:

3,4

• Poor plaque (biofilm) control

• Gingivitis

• Periodontal maintenance

• Orthodontic appliances

• Implants

• Aesthetic restorations

• Crowns and bridges

• Physically challenged

• Gingival overgrowth

The Best Power Brush

A January 2003 systematic review5of power brushes by
the Cochrane Collaboration evaluated different types of
power brushes and tried to determine the superiority of
one type of brush over another. The reviewers evaluated
354 clinical trials published between 1964 and 2001. The
354 studies were reviewed for the following criteria:

5

• Study design had to be a randomized, controlled trial
comparing manual and power toothbrushes

• Comparisons between power brushes were excluded

• Crossover trials were eligible but not split mouth designs

• Subjects could not have a disability that would affect
toothbrushing; orthodontic appliances were allowed

• Brushing had to be unsupervised

• Combined interventions such as those with rinsing or
irrigating were excluded

• Study had to be a minimum of 28 days

• Outcomes measures had to include biofilm (plaque) and
gingivitis

From these standards, 29 studies fulfilled all inclusion cri­teria and had results that could be used for meta-analysis.
The total number of subjects in these trials was 2,547. Of
those, 239 or 9.4% were lost to follow-up.

5

The 29 trials were further categorized into groups based
on the mechanism of action. Six groups resulted. These
included:

5

• Side-to-side action with 8 studies

• Counter oscillation with 5 studies

• Rotation oscillation with 11 studies

• Circular with 3 studies

• Ultrasonic with 2 studies

• Unknown action with 0 studies

2

From the final review, the Cochrane group determined that
“Power toothbrushes with a rotational oscillation action
provided slightly better plaque removal and may provide
better protection against gum inflammation than manual
toothbrushes.”

5

The researchers discussed the weaknesses of their review
and noted:

5

• “One possible weakness of this review was the grouping
of toothbrushes by their modes of action.”

• “So many factors may influence the effectiveness of
toothbrushes including filament arrangement, orienta­tion, size, shape and flexibility, brush head size and
shape along with presence or absence and characteristics
of a timer that not all of them could be analyzed.”

• “None of the trials compared durability, reliability, and
cost of using manual versus powered brushes, it is
presently not possible to make a clear recommendation
on toothbrush superiority.”

In summary, the Cochrane review provides important
information on power toothbrushes, but is not without
flaws. Of consideration is that studies on older, obsolete
products with outdated technology were included in the
meta-analysis.

5

Many current power brushes with state­of-the-art technology have been able to show in well­designed scientific trials that they are superior to manual
brushes.

1,2,3,4,6,10,11,12

Individual Recommendations

Once clinical efficacy has been established, when recom­mending a power brush, individual preferences can play a
significant role in product acceptance. In fact, studies have
shown that when individuals play a more assertive role in
healthcare decisions, compliance and satisfaction
increase.

6

Therefore, it is unlikely that all the individuals
in a practice will like or benefit from the same type of
power toothbrush. Importantly, the individual oral health
needs along with personal preferences should influence
the brush recommendation.

1,3,6

There are a large number of power brushes on the market
with a wide array of features, which can influence acceptance
of the product. To help individuals find the product right
for them, there are multiple features to consider.

• Timer: Essential for those who need to extend
brushing time

• Handle size: Should be of adequate size and feel
comfortable

• Brush head motion and configuration: Size is important
as is dexterity

• Lifestyle: Frequent travelers may prefer a battery­operated unit

• Disposability: This generally means that neither the bat­tery nor the brush head can be replaced. Products gen­erally last around 3 months - the same as a manual
toothbrush and often cost the same. May be a good
gateway product

• Affordability: With multiple products in a wide range of
prices, there is a power brush to fit anyone’s budget

Brushing Recommendations

Some individuals may think that once they use a power
brush, they no longer have to make any effort when
brushing. Therefore, it is important to continue empha­sizing how often and long to brush. Studies have shown
that good biofilm removal takes time, and those who
brush longer tend to remove more biofilm.

8,9

It is important to explain to first time users that power
brushes have a unique or different sound and sensation
than manual brushes. It may take some time to get
adjusted to a new product. Additionally, some products
may enhance the foaming action of the toothpaste and
this may initially be overwhelming. See Figure 1. Advise
individuals not to use an excessive amount of toothpaste
and not to turn the unit on until they have placed the
brush head in their mouth.

3

Figure 1

4

While the thoroughness of brushing is dependent on the
nature of the user, power brushes may help simplify the
brushing process. The individual will still need to prop­erly angle the brush in the mouth, but once in place, the
brush head motion will do all the work. Since a power
brush generates more strokes per minute than a manual
brush, the individual may remove more biofilm in the
same amount of brushing time.

3

Because there are different types of units available, be
sure to review the manufacturer’s complete instruction
guide PRIOR to recommending or demonstrating the
product. Recommending and instructing is easier if you

have read all instructions and tried the product yourself.

Oral Health Outcomes

A toothbrush is the most frequently used self-care device.
Yet the ability to effectively remove biofilm with a tooth­brush varies from person to person. For the last several
years, power toothbrushes have become an integral rec­ommendation to improve biofilm control. There is a
growing body of evidence on products currently available,
which show when compared to a manual toothbrush,
many power toothbrushes are:

1,2,3,4,6,10,11,12

• Superior at removing biofilm

• Effective at reducing gingivitis

• Likely to enhance stain removal

• As safe as a manual brush for soft and hard tissue

• Well-liked and even preferred by individuals

Waterpik®Power Toothbrushes

Waterpik Technologies entered the power toothbrush
market more than thirty years ago. From the original
Touch-Tronic

®

toothbrush to today’s SynchroSonic™ Plus

advanced action sonic plaque removal system, Waterpik

®

rechargeable power brushes remove biofilm and reduce
bleeding better than a manual toothbrush.

15,16,18

Vibe®Electric Toothbrush

The Vibe®toothbrush is quiet and small enough to take
everywhere. See Figure 2. Up to 15,000 brush strokes per
minute clean better than a manual toothbrush.

19

Features include:

• Gentle side-to-side
vibrating brushing
action

• Ergonomically designed
for ease and comfort

• Disposable, like a
manual brush. No
need to replace batter­ies or brush heads

• Internal battery lasts
up to six months

• Includes a handy travel
brush cover

• Available in four colors

SenSonic®High
Performance Sonic Plaque Remover

The SenSonic®tooth­brush is a brush with
state-of-the-art sonic
technology producing
30,000 gentle brush
strokes per minute. See
Figure 3. It has a soft,
compact, contoured
brush head design, elec­tronic feedback system
that automatically adjusts
speed to maintain peak
performance, a power
indicator light, and a
dishwasher safe, easy to
clean storage carousel.

Several clinical trials
have been conducted on the SenSonic

®

toothbrush
including studies that show its ability to alter bacteria,
reduce biofilm, stain, and gingivitis, and equivalency to
the Sonicare

®

toothbrush.

13,14,15,16,17

Ability to alter bacteria

• Blanco and co-workers showed that exposure to the

sonic frequency generated by the SenSonic

®

toothbrush

severely disrupted the structural integrity of the

periodontal pathogen, T denticola (spirochetes).

13

Figure 2

Figure 3

5

• MacNeill et al found that sonic energy from the
SenSonic

®

toothbrush severely shortened and/or removed
fimbriae from the cell walls of A viscosus. The researchers
observed that these study findings were consistent with
previous studies on other sonic brushes that have exam­ined the effect of sonic energy on bacteria.

14

Biofilm, stain, gingivitis reductions

• Barnes and others demonstrated that the SenSonic

®

toothbrush showed statistically significant reductions in
both biofilm and gingivitis after four weeks use.

15

• Hefferren showed that the SenSonic®toothbrush is
effective at reducing both existing stain (of one year’s
duration) and that induced by diet - after just one
minute of brushing.

17

Comparison to Sonicare®toothbrush

• Zimmer and co-workers compared a manual brush to the
SenSonic

®

toothbrush and Sonicare®toothbrush and
found both sonic brushes were more effective in removing
biofilm and reducing gingivitis than the manual tooth­brush.

16

The chart below highlights the percent reduc-

tions from baseline for each of the brushes in the study:

*Both the SenSonic

®

toothbrush and the Sonicare®tooth-

brush reduced bleeding to nearly the same level, 0.06 and

0.07 respectively. However, the Sonicare

®

toothbrush

started with a higher baseline reading than the SenSonic

®

toothbrush, 0.56 versus 0.35 respectively.

16

SynchroSonic™ Plus Advanced Action Sonic Plaque Remover

The SyncroSonic™ Plus toothbrush is the first affordable,
dual motor sonic plaque removal system. See Figure 4.
With 40,000 brush strokes per minute, this dual motor
design creates a unique multi-directional bristle action.
The ergonomic angled design allows for better access to
posterior teeth. In addition to brush heads, the system
comes with a tongue cleaner and polishing attachment.
The SynchroSonic™ Plus toothbrush is clinically proven
superior to a manual toothbrush.

18

In a randomized clinical
trial by Barnes et al, the
SynchroSonic™Plus tooth­brush was significantly
more effective at reducing
biofilm and gingival bleed­ing than a manual tooth­brush. There was no evi­dence of hard or soft tissue
abrasion from the use of the
SynchroSonic™ Plus
toothbrush.

18

The chart
below highlights the clinical
outcomes from the study.

*Statistically significant

18

A synopsis and comparison of other high-speed power
brushes is included in the chart on page 6.

When you recommend products, it is beneficial to know
where they can be purchased along with an estimated cost.
Having this information will enhance credibility and
increase compliance with your recommendation.
Alternatively, products can be purchased at professional
discounts for dispensing in the office.

Conclusion

Po wer toothbrushes are safe and effective devices for many
people. According to Maria Perno Goldie, RDH, MS,
international speaker and author,

“No longer are power toothbrushes

considered only for special needs clients, but

rather the logical choice for all adult and

child clients. Cost is no longer an issue

because prices of deluxe models are lower

than ever, and low-cost battery operated

portable toothbrushes are now available.”

1

Figure 4

Percent Reductions from Baseline18.

DENTAL GINGIVAL

BIOFILM INDEX BLEEDING INDEX

Manual toothbrush 5.4% 20%

SynchroSonic™ Plus toothbrush 9.7%* 32%*

Percent Reductions from Baseline

16

BIOFILM APPROXIMAL PAPILLARY

INDEX BIOFILM INDEX BLEEDING INDEX

Sonicare®toothbrush 48.3% 74.6% 87.5%*

SenSonic

®

toothbrush 52.5% 75.9% 82.9%*

Manual toothbrush 10% 17.4% 52.5%

6

*Information as of April 2003

Product Disclaimer

All power brushes are not equivalent when it comes to
brush head configuration, brush head motion, and
number and type of brush strokes per minute. Therefore,
expectations of similar clinical outcomes on products of
differing brands cannot be assumed.

References

1. Goldie MP. Power toothbrushing: An easy, effective
way to improve oral health. Contemporary Oral
Hygiene 2002; July/August: 28-33.

2. Warren PR et al. A practice-based study of a power
toothbrush: Assessment of effectiveness and accept­ance. JADA 2000; 131: 389-394.

3. Jahn C. Making patient-centered self-care recommen­dations: Automatic toothbrushes. J Practical Hyg 2001;
10(5): 38-39, 42.

4. Bowen D. An evidence-based review of power tooth­brushes. Compend Contin Educ Oral Hyg 2002; 9: 3-16.

5. Heanue M et al. Manual versus powered toothbrushing
for oral health (Cochrane Review) In: The Cochrane
Library, Issue 1, 2003. Oxford: Update Software.

6. Jahn CA. Automated oral hygiene self-care devices:
Making evidence-based choices to improve client
outcomes. J Dent Hyg 2001; 75: 171-186.

7. Larrabee JH. The changing role of the consumer in health
care quality. J Nurs Care Qual 1995; 9: 8-15.

8. Lang WP et al. Preventive behaviors as correlates of
periodontal health status. J Public Health Dent 1995;
55(1): 10-17.

9. Hawkins BF et al. Duration of toothbrushing for effec­tive plaque control. Quintessence Int 1986; 17: 361-365.

10. Walmsley AD. The electric toothbrush: A review.

B Dent J 1997; 182: 209-218.

11. Heasman PA et al. Power toothbrushes: A review of

clinical trials. J Clin Periodontol 1999; 26: 407-420.

12. Brothw ell DJ et al. An update of mechanical oral hygiene

practices: Evidence based recommendations for disease
prevention. Can Dent Assoc J 1998; 64(4): 295-304.

13. Blanco VL et al. In vitro effect of the SenSonic

®

toothbrush on Treponema denticola. J Clin
Periodontol 1997; 24: 318-323.

14. MacNeill S et al. Sonic and mechanical toothbrushes:

An in vitro study showing altered microbial surface
structures but lack of effect on viability. J Clin
Periodontol 1998; 25: 988-993.

15. Barnes C. A clinical evaluation of the effect on gin-

givitis and plaque reduction of the SenSonic

®

plaque
removal instrument. Abstract presented at ADHA
Annual Session, 1995.

16. Zimmer S et al. Clinical study of the effectiveness of
two sonic toothbrushes. J Clin Dent 1999; 11: 24-27.

17. Hefferren J et al. Assessment of the stain removal
cleaning power of the SenSonic

®

plaque removal

instrument in beagles. J Dent Res 1996; 75: 86.

18. Barnes C et al. A comparison of a Waterpik®dual
motor power toothbrush and a manual toothbrush in
affecting interproximal bleeding reduction and dental
biofilm accumulation. J Clin Dent 2003; 14: 49-52.

19. In-house data on file.

Product Comparison: High Speed Power Brushes*

SynchroSonic™ Plus Advanced Action Sonic Plaque Braun Oral B®3D Excel Pulsating Sonicare®Elite

Removal System - Model DT 400 Model - D17511 Model 7500

Parent company Waterpik Technologies Oral-B

®

Laboratories Philips Oral Healthcare, Inc

Brush stroke Randomized (sonic) Oscillation + in & out pulsation Sonic (back & forth)

Brush stroke per minute 40,000 40,000 pulsations 31,000

7,600 oscillations

Speeds 2 2 2

Timer 2 minute 2 minute 2 minute

30 second quadrant alert Yes No Yes

Brush heads/accessories 2 brush heads 1 brush head 1 brush head

1 tongue cleaner

1 polisher

Promotional price $24.99 $29.95 $39.99

Direct professional pricing Yes Yes Yes

Clinically proven better than
a manual brush at reducing:

• Plaque • Yes • Yes • Yes

• Gingivitis/bleeding • Yes • Yes • No

• Stain • No • Yes • No

PN 20007016-ART

© 2003 Water Pik, Inc. FN 20007016ART-F AA

7

Post Test for Course #03-03

Power Brushes: An Effective Alternative

1. What features may influence individual preference for a power brush?

a) Timer
b) Handle size
c) Brush head configuration
d) All of the above

2. Which type of individual would NOT be a candidate for a power brush?

a) Orthodontic
b) Periodontal maintenance
c) Edentulous
d) Physically challenged

3. When compared to a manual toothbrush, the SynchroSonic™ Plus power toothbrush:

a) Was better at removing biofilm but not at reducing gingivitis
b) Was better at reducing gingivitis but not at removing biofilm
c) Equal to the manual brush in biofilm removal and gingivitis reduction
d) Better than the manual brush at biofilm removal and gingivitis reduction

4. When the SenSonic

®

toothbrush and Sonicare®toothbrush were compared to a manual toothbrush, what were

the results?

a) The SenSonic

®

toothbrush was superior in all measures to the Sonicare®toothbrush and the manual toothbrush

b) The Sonicare

®

toothbrush was superior in all measures to the SenSonic®toothbrush and the manual toothbrush

c) The SenSonic

®

toothbrush and Sonicare®toothbrush were both superior to the manual toothbrush

d) The manual toothbrush was superior to both the SenSonic

®

toothbrush and Sonicare®toothbrush

5. Which statement is true about the power toothbrush review by the Cochrane Collaboration?

a) One weakness of the study was grouping by modes of action
b) 92 studies were included in the meta-analysis
c) Randomized clinical trials were excluded
d) Studies need to be a minimum of 6 months for inclusion

Obtaining Continuing Education Credits

Waterpik Technologies is designated as an Approved
PACE Program Provider by the Academy of General
Dentistry. The formal continuing education programs of
this provider are accepted by the AGD for Fellowship,
Mastership, and membership maintenance credits.
Approval does not imply acceptance by a state or provin­cial board of dentistry. The current term of approval
extends from 04-05-1998-05-31-2006.

Credits: 1 hour

If you have questions about CE requirements in your state
or province, please consult your regulatory board.

Directions

• Fill out the Waterpik CE Registration F orm and Answ er
Sheet.

• Answers should be logged on the answer sheet. Please
make a copy of the post test and your answer sheet to
retain for your records.

• Only one original answer sheet per individual will be
accepted. PHOTOCOPIES ARE NOT VALID.

• Answers left blank will be graded as incorrect.

• Please fill out the course evaluation portion.

• Submit your answer sheet via mail to:

Carol Jahn, RDH, MS
Educational Programs Manager
Waterpik Technologies
1730 East Prospect Road
Fort Collins, CO 80553

Scoring

In order to receive credit, you must answer correctly 4
questions out of 5.

Results

Will be mailed in 6 – 8 weeks.

Questions

Please contact Carol Jahn, Education Programs Manager,
at 1.800.525.2020 x 8565 or via email at
[e-mail].

CE Registration Form and Answer Sheet

Course #03-03: Power Brushes: An Effective
Alternative

Name: ______________________________________
Credentials: __________________________________
Street Address: ________________________________
City:________________________________________
State: ________________ Zip:__________________
Daytime Phone: ______________________________
Email: ______________________________________

Answer Sheet - Please circle the correct
answer for each question.

1. a b c d

2. a b c d

3. a b c d

4. a b c d

5. a b c d

Course Evaluation – Circle your response:
1 = lowest, 5 = highest

Course objectives were met

12345

Content was useful

12345

Questions were relevant

12345

Rate the course overall

12345