This experimental study compared the cleaning efficiency of a newly designed silicone mouth swab with that of the MouthEze (MC3), a specialized oral hygiene tool designed for gentle mouth cleaning. The study involved simulating brushing using a silicone mouth swab attached to a brushing simulator to remove pseudo-plaque from a silicone rubber sheet under both wet and dry conditions. The samples used in this study included a set of silicone mouth swabs (either a newly designed silicone mouth swab or the MC3) and silicone rubber sheets. The sample size was calculated using G*Power version 3.1. With an effect size of f = 0.8, a power of test 0.8, and an alpha level of 0.05, the required sample size was determined to be 42. However, for this study, a total of 48 samples were used, divided into 4 groups, with 12 samples in each group. The effectiveness of each tool was evaluated by analyzing and calculating the area of pseudo-plaque removed after brushing.
Silicone mouth swab
The MouthEze (MC3, Oral Care Innovations LTD., United Kingdom) is a specialized oral hygiene tool designed for gentle and effective cleaning of the mouth, particularly for individuals who face challenges using traditional toothbrushes. It is widely used in elderly care, hospitals, and by caregivers for patients with limited dexterity, cognitive impairments, or other conditions that make routine oral hygiene difficult. The MC3 features a silicone head, specifically engineered to be soft and gentle on the delicate tissues of the mouth. The silicone material is less abrasive than traditional bristles, thereby reducing the risk of trauma to sensitive areas such as the gums, tongue, and oral mucosa. The MC3’s straight bristles are designed to clean surfaces effectively without causing irritation (Fig. 1 Left).
Our team developed a newly designed silicone mouth swab as a modification of the MC3. These modifications focused on optimizing the shape and length of the silicone head (Fig. 1 Right). The new design was tailored with straight and threaded brushing bristles to better access different areas of the mouth, including hard-to-reach spots like the back of the oral vestibule and underneath the tongue. The length of the swab head was increased to ensure it could reach all necessary areas while maintaining control and precision. The silicone used in the new swab is medical-grade, chosen for its comfort and flexibility. A durometer of 20 Shore A was selected, providing the ideal balance between softness and firmness. This level of softness ensures that the silicone was gentle enough to avoid causing trauma to delicate oral tissues, such as the buccal mucosa, oral vestibule, and palate, while also providing sufficient firmness to effectively remove food debris and microbial biofilm. This balance was expected to allow the mouth swab to perform its cleaning function effectively without compromising comfort, based on the softness and flexibility of the medical-grade silicone. However, since this study was in vitro, direct assessment of patient comfort was not conducted. Future studies could explore patient-reported outcomes related to comfort when using this new swab.
The newly designed silicone mouth swab (Left), and a MouthEze (MC3, Oral Care Innovations LTD., United Kingdom) (Right).
Brushing simulation
The V.P.2000 tooth brushing machine (Warren Tech, NY, USA) was used in this study. The V.P.2000 is a specialized laboratory device used to simulate the mechanical action of brushing in controlled experimental settings. It is designed to provide consistent and repeatable brushing conditions for testing the abrasion resistance, cleaning efficiency, and durability of dental materials and oral hygiene tools15,16. The machine can operate at various speeds, typically ranging from 75 to 150 rotations per minute (rpm). The V.P.2000 is equipped with a system to apply specific weights, usually in the range of 50 to 150 g, to mimic the pressure exerted during brushing. In addition, research by Annette Wiegand and colleagues compared the force exerted during manual brushing to that of electric brushing. They found that manual brushing typically exerts an average force of 1.6 ± 0.3 Newtons17. Based on these findings, our study used a weight of 150 g on the V.P.2000 toothbrushing machine to simulate realistic brushing conditions. The V.P.2000 typically simulates a back-and-forth brushing motion, which is common in manual toothbrushing. The machine is commonly used to test the wear resistance of dental materials, such as sealants, fillings, and crowns, by simulating prolonged exposure to brushing. Researchers used the V.P.2000 to assess the effectiveness of different toothbrushes, swabs, and other oral hygiene tools in removing plaque or simulated biofilm from dental surfaces. The machine provided a standardized environment for testing, ensuring that results are not influenced by variations in brushing technique or force, which can occur with manual testing.
A pseudo-plaque, created by mixing 6.0 g of Thicken Up Clear food additive with 12.0 ml of water and food coloring, was spread onto a NISSIN dentoform silicone rubber sheet (simulated soft tissue) with a thickness of 2.0 mm18. The MC3 silicone head (n = 12) and the new silicone head (n = 12) were attached to a V.P.2000 tooth brushing machine, operating at 75 rounds per minute with a force of 2.45 N, and each was used to brush the surface 25 times under both wet (n = 12) and dry (n = 12) conditions (Fig. 2). To assess the performance of the silicone mouth swab under different conditions, both wet and dry environments were simulated during the brushing experiments. For the wet condition, the surface of the silicone rubber sheet representing oral soft tissues (buccal mucosa, oral vestibule, and palate) was uniformly moistened using distilled water applied with a spray bottle. The surface was sprayed until a consistent thin layer of moisture was visible, simulating the natural moisture levels typically found in the oral cavity. For the dry condition, the silicone rubber sheet was carefully dried using sterile gauze to ensure the absence of any visible moisture. The drying process was repeated until the surface appeared matte and dry to the touch. This setup aimed to replicate situations where oral tissues are relatively dry, such as after periods of reduced salivation, commonly observed in elderly individuals or those with xerostomia.
The MC3 silicone head (Left) and the new silicone head (Right) were attached to a V.P.2000 tooth brushing machine.
Outcome measures and statistical analysis
The ImageJ program (1.54f version) was used to analyze and quantify the area where the pseudo-plaque was removed after brushing. ImageJ is an open-source image processing program widely used in scientific research for analyzing and measuring various types of images. Originally developed at the National Institutes of Health (NIH), ImageJ allows researchers to perform complex image analysis with high precision. The program is especially popular in fields like biology, medicine, and material science for tasks such as measuring areas, counting objects, and analyzing spatial distribution. In this study, ImageJ was used to analyze and measure the area where pseudo-plaque was removed after brushing under both wet and dry conditions. After brushing, the simulated soft tissue was photographed using a Canon digital camera (EOS M10, F4.0, 1/80 shutter speed, ISO 1600) (Fig. 3). ImageJ was employed to quantitatively assess the area of pseudo-plaque removed from the silicone rubber sheets during the brushing experiments under both wet and dry conditions. The areas of removed pseudo-plaque were analyzed using the following steps:
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The images were imported into the ImageJ program and converted to grayscale.
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The thresholding function was used to differentiate between areas of remaining pseudo-plaque and the cleaned areas.
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The ‘Analyze Particles’ tool was applied to measure the total area of plaque removed, expressed in square millimeters.
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The plaque removal per unit length of the swab head (cleaning efficiency) was also calculated by dividing the total cleaned area by the swab head length.
The use of ImageJ allowed for precise and consistent measurements of the plaque removal across different experimental conditions, providing an objective basis for comparing the effectiveness of the new silicone mouth swab and the MC3. The final result represented the quantified pseudo-plaque removal area (Fig. 4).
The simulated soft tissue was photographed after brushing.
The outcome measures in this study included the area where pseudo-plaque was removed and the pseudo-plaque removal per head length of the MC3 and new silicone mouth swab after brushing after brushing under both wet and dry conditions. A two-way analysis of variance (ANOVA) was conducted to assess differences in pseudo-plaque removal between groups. Statistical analysis was performed by IBM SPSS version 22 (SPSS Inc, Chicago, IL, USA, 2022). Values of p < 0.05 were considered statistically significant.
The ImageJ final result represents the quantified pseudo-plaque removal area (green).
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