12 February 2024

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Non-carious cervical lesions and impact of toothbrush head and toothpaste abrasiveness

Lara Figini

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Non-carious cervical lesions (NCCL) result from the loss of tooth structure at the level of the cementum-cementum junction caused by various wear processes unrelated to dental caries.

Their prevalence in individuals aged 18 years and older is high, 68.5%, in various levels of severity. NCCLs are mostly probably caused by excessive abrasion due to the toothbrush, due to the mechanical action exerted by the toothbrush and toothpaste on the teeth.

Toothbrushes can have different shapes, head sizes, surface structures, lengths and hardness of the filaments. In addition to toothbrush-related factors, the level of abrasiveness of toothpaste may aggravate the progression of NCCL.

Materials and methods

In an in vitro study, published soon in the Journal of Dentistry, the authors studied the effect of toothbrush head configuration and toothpaste abrasiveness on the development of simulated non-carious cervical lesions (NCCL) in vitro. Various extracted premolars were randomly assigned into 15 groups (of 16 teeth each) depending on the configuration of the toothbrush head used (flat cut, wavy, cross-angled/multi-level/with additional gums, crossed-angle/multi-level/head flexible, feathery) and depending on the abrasiveness of the toothpaste used (low/medium/high).

The teeth were mounted on acrylic blocks, where their roots were partially covered with acrylic resin, leaving 2 mm of root surfaces exposed. Tooth brushing was simulated for 35,000 and 65,000 sends. Samples were analyzed using filometry to measure tooth volume loss (mm3) and lesion morphology. Data were analyzed using ANOVA with pairwise comparisons and Kruskal-Wallis tests.

Results

The two-way interaction between toothbrush head configuration and toothpaste abrasiveness was significant. After 35,000 sends, the flat-cut and cross-angle/multi-level/additional gum toothbrushes caused the highest abrasion when combined with highly abrasive toothpastes, while the cross-angle/multi-level/flexible brush head showed the lowest abrasion. less when associated with less abrasive toothpastes.

After 65,000 visits, greater tooth loss was observed for all toothbrushes when combined with highly abrasive toothpastes. Flat-cut toothbrushes caused the most tooth loss. Tooth loss rates were lower for the cross-angled/multilevel/flexible brush head combined with low-abrasive toothpaste than for other toothbrushes except feathered and wavy.

Flat lesions (mean internal angle±standard deviation: 146.2°±16.8) were mainly associated with low-abrasive toothpastes, while wedge-shaped lesions (85.8°±18.8) were found to be more frequently associated with medium and high abrasive toothpastes.

Conclusions

From the data of this study, which must be confirmed in other similar works, it can be concluded that the development, progression and morphology of simulated NCCLs are conditioned both by the configuration of the toothbrush head and by the abrasiveness of the toothpaste.