Safety and Clinical Evaluation of a Sonic Tongue Brush

Abstract

Background: Tongue coating consists of oral bacteria, desquamated epithelium, blood cells, and food residues and is involved in periodontal disease, halitosis, and aspiration pneumonia. Recently, a tongue brush with sonic vibration was developed to clean the tongue. This comparative study examined the extent of tongue coating, its effects on the tongue, bacterial count particularly on the posterior dorsum of the tongue, and the degree of pain using a manual tongue brush and the newly developed sonic tongue brush.

Materials and methods: Patients' extent of tongue coating and the quantity of bacteria were analysed before and after brushing with a sonic or manual nylon tongue brush. Moreover, the impressions of the dorsum linguae were obtained before and after brushing to establish models that were observed under a stereo microscope to evaluate tongue trauma. Pain caused during the use of these brushes was evaluated based on the numerical rating scale (NRS).

Results: The extent of tongue coating and number of bacteria decreased in both the sonic and manual nylon brush groups after tongue cleaning; however, no significant differences were noted. Tongue trauma evaluation revealed that the tongue surface was significantly scratched in the manual brush group compared with the sonic brush group. NRS-based pain evaluation revealed no significant differences.

Conclusions: The sonic brush was equally effective in removing tongue coating and bacteria compared with the manual brush. As the sonic brush does not cause tongue trauma, it may be considered a safe and effective cleaning tool of the tongue.

Keywords: Bacterial testing; Tongue brush; Tongue cleaning; Tongue coating; Tongue injury.

Fig. 1

Flowchart of the study design.

Fig. 2

Tongue brushes used in this study. A, Toothbrush (Sonicare FLEXCare®, Philips) and ultrasonic tongue brush attachment (Sonicare TongueCare+, Philips). B, Manual tongue brush (Hi-Zac Tongue Brash, BEE BLAND MEDICO DENTAL, Osaka).

Fig. 3

The extent of tongue coating before and after manual or sonic brushing was evaluated based on Kojima's grading. Tongue coating significantly decreased in both sonic and manual brush groups (P > .01). However, no significant differences were noted between the 2 groups.

Fig. 4

Dorsum linguae models were established and evaluated before and after brushing under a stereo microscope at 50× magnification. A, Damage to the tongue surface. Multiple longitudinal lines (arrows) were noted on the tongue surface after brushing in the manual brush group. In addition, lingual papillae were morphologically unclear after brushing. However, almost no damage was noted on the tongue surface after brushing in the sonic brush group, with the maintenance of lingual papillae. B, The number of injuries on the dorsum linguae after manual or sonic brushing. This number was significantly lower in the sonic brush group than in the manual brush group (P > 0.05). C, Changes in the tongue surface. Lingual papillae on the tongue surface were morphologically unclear in the manual brush group. Almost no damage was noted on the tongue surface in the sonic brush group, with the maintenance of lingual papillae.

Fig. 5

A, Bacterial count after brushing. The bacterial count after brushing significantly decreased compared with that before brushing in both groups. However, no significant intergroup differences in bacterial count were noted. B, The degree of pain during brushing was evaluated based on the numerical rating scale. No significant differences were noted after brushing between the sonic and manual brush groups.