This item is factory sealed and boxed to ensure product hygiene. This particular brand is as good as the GUM or Butler brands. Excellent quality and ease of use. This "standard" size is exactly what was needed for Pura requirements. (The packaging says other sizes are available: 'Wide' and 'Narrow'.) We are very happy with our purchase and have saved money by purchasing four packs of 10 (40 nozzles total) of this one bought suppliers. Our periodontist told us that a brush head can be rinsed thoroughly and used multiple times in a day. Consult your dentist for a specific recommendation.
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