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Oral hygiene for physically and mentally handicapped children residing in institutions is dependent on the quality of care given by auxiliaries (nurses, attendants, and volunteer workers). Auxiliaries can be taught and motivated to perform plaque control techniques necessary to care for the institutionalized child’s oral health.

Jean Frazier has completed an interesting and informative examination of the roadblocks to good oral health practice by patients that are imposed by the mass media of this country.

Dr. Chambers presents his evidence in support of the hypothesis that the number of Americans susceptible to prevention by the control of plaque in their homes is limited because this habit is inconsistent with their style of living.

Using strain gauges, the method to be described measures the lateral force required to produce a standard deflection of toothbrush tufts. A deflector bar which remains stationary is attached to a cantilever which is stressed by the pressure of the brush moving across the deflector bar. The resulting strain is measured by using strain gauges which are connected via a Wheatstone bridge to an oscilloscope. Movements of the oscilloscope beam represent changes in the force exerted by the brush and are photographed on moving film. The effects on stiffness of changes in the rate of strain, length, diameter, wetness and temperature of nylon were investigated separately, and a standard test was devised which could assist in more accurate labelling of toothbrushes.

An ultrasonic motor drives the small head of a recently developed toothbrush. In two preliminary experiments, participating patients, including a mentally retarded individual, were able to remove plaque from their teeth effectively and efficiently. The effectiveness of the ultrasonic toothbrush is shown with use of pictures of the oral health status of a patient before a prophylaxis, after she had used the ultrasonic device for two weeks, and then after she had brushed with a hand toothbrush for two weeks.

The purpose of the studies described in this report was to evaluate the efficiency of a reciprocating motion toothbrush as an instrument for cleaning the teeth. These studies were initiated during the early stages of the development of the device; therefore, they reflect both pro­ gressive engineering improvements and the accumulation of information showing that the danger of hard tissue abrasion and soft tissue laceration was not an im­ portant consideration with this device. The two main criteria that could be used to judge efficiency were speed of cleaning and thoroughness of cleaning. From a practical standpoint, however, speed per se is not a reliable measure of efficiency because the factor of pleasure cannot be disregarded. For example, if the use of a power device encouraged the subject to brush longer than he ordinarily did with a hand brush and this factor alone resulted in an improved state of oral hygiene, the application of power to the toothbrush would be justified. Since early studies with the electric device re­ vealed that important pleasurable fea­ tures were associated with its use, the criterion of thoroughness of cleaning in­ dependent of time was adopted as the main measure of cleaning efficiency.

This investigation was supported by Research Grant D-646(C3) from the National Institute of Dental Re­ search, U .S . Public Health Service. *Research Fellow in periodontology, Tufts University School of Dental Medicine. fAssistant professor of periodontology, Tufts Uni­ versity School of Dental Medicine. {Research professor of oral pathology; professor and chairman, department of periodontology, Tufts Univer­ sity School of Dental Medicine.

1. T o cause tissues supporting the teeth to return to a state of health. After suc­ cessful treatment the gingival tissues should be a pale coral pink with a firm, well-stippled “ orange peel” surface and should be resistant and insensitive to trauma. The teeth should be firmly held in position and there should be no sup­ puration. To accomplish this objective, all forms of local irritants must be re­ moved or corrected. 2. T o perform all. dental operations which will help maintain supporting tis­ sues in a healthy condition. T o accom­ plish this, the treatment should include occlusal equilibration, correction of im­ proper contact areas, contouring of poor dental restorations, and perhaps a gingivectomy to reduce pockets that are so deep that the patient cannot maintain oral health. 3. When necessary, to correct the diet and all systemic conditions which tend to interfere with the health of the oral tis­ sue. 4. T o teach patients the importance of and the technics for maintaining the supporting tissues of the teeth in a healthy condition by adequate home care. 5. To convince patients of the impor­ tance of regular and frequent follow-up examinations. Any treatment for periodontitis cannot be considered successful if, after a few weeks, the gingival tissue returns to an inflammatory condition with the support­ ing tissues tender and hyperemic and the teeth bathed in suppuration. Adequate treatment must include procedures which will maintain health for months and, with periodic help from a dentist, for years. Maintenance of health depends al­ most entirely upon removal or correction of the causes of disease. If supragingival calculus is not completely removed, if food impaction continues, if diet is in­ adequate, or if any local or systemic factor which lowers the resistance of the periodontium remains uncorrected, healthy oral structures cannot be main­ tained. Even if all known etiologic factors are removed but oral care is then neg­ lected by the patient, in a few months the oral condition will be unsatisfactory. Most periodontists agree that proper toothbrush technic is an effective, simple and inexpensive aid in maintaining the oral cleanliness so essential to oral health. This paper is limited to a discussion of the use of a toothbrush in periodontitis, which is an important part of the fourth principle mentioned above.