Effects of ultrasonic, electric, and manual toothbrushes on subgingival plaque composition in orthodontically banded molars

Orthodontists' instructions for oral hygiene in patients with removable and fixed orthodontic appliances

INTRODUCTION

The aim of this questionnaire-based survey was to evaluate information on frequencies, instructions and products relating to oral hygiene (OH) in orthodontic practices.

METHODS

Using a computer-generated randomization list, 1000 orthodontists were selected and sent a questionnaire. The size and number of inhabitants of the federal states of Germany were considered. The federal states with the highest return rate (Baden-Wuerttemberg [BW], Bavaria [B], Hesse [H], Lower Saxony [LS], Nordrhein-Westphalia [NRW]) were considered and differences between the 16 federal states were divided into North, South, East and Central Germany.

RESULTS

The response rate of the questionnaires was 52.4%. The majority (53.8%) worked in one practice alone. Most (59.1%) have been orthodontists for 5-25 years. For vestibular multibracket appliances (MBA) in BW, B, H and LS over 90% recommended interdental brushes (IDB). In NRW 91.4% recommend fluoride gel. In B and H more than 80% chose electric toothbrush (ETB), in BW, LS and NRW more than 80% manual toothbrush (MTB). For lingual MBA (LMBA) in BW, H, LS and NRW with approximately 50% each fluoride gel, IDB and MTB were chosen. In B fluoride gel, IDB and ETB. For removable apparatus (RA), five federal states recommended MTB (>80%) and ETB (BW, B, H > 80%; NRW > 70%; LS > 60%).

CONCLUSION

Electric toothbrushes are recommended for the use with all appliances, only with removable appliances manual toothbrushes are favoured. For vestibular MBA it is strongly advised to use IDB additionally.

Powered Toothbrushes: An Opportunity for Biofilm and Gingival Inflammation Control

The present review aimed at a broad investigation on the potential of powered as compared to manual toothbrushes in different aspects of clinical dentistry. Studies evaluating plaque and gingival inflammatory parameters were included, as well as those that investigated adverse effects. Emphasis was given separately to adults, youngsters, special-needs patients, and those under fixed orthodontic therapy. In general, comparisons favored powered toothbrushes. In summary, approximately 68% of the included studies, in terms of plaque/gingival inflammation in adults, presented better results for powered toothbrushes. In children and special-needs populations, approximately 40% of the included studies favored powered toothbrushes for plaque/gingival inflammation, and none favored manual ones. In orthodontic individuals, 50% of the studies also demonstrated a better effect of powered toothbrushes on plaque and gingival inflammation. All included studies that assessed adverse events did not demonstrate a difference in these effects when comparing manual vs. powered toothbrushes. It is concluded that the use of powered toothbrushes is an opportunity to enhance patterns of plaque control and associated gingival inflammation.

A randomized, 3-month, parallel-group clinical trial to compare the efficacy of electric 3-dimensional toothbrushes vs manual toothbrushes in maintaining oral health in patients with fixed orthodontic appliances

INTRODUCTION

The aim of this single-blinded, parallel-group, randomized clinical trial was to compare the efficacy of electric 3-dimensional (3D) toothbrushes and manual toothbrushes in removing plaque and reducing gingival inflammation in orthodontic patients.

METHODS

Eighty adolescents with fixed orthodontic appliances in both arches were randomized at a 1:1 ratio, with an equal number of both sexes, in this examiner blinded, parallel clinical trial. Eligibility criteria included subjects aged between 12 and 16 years, good general health, nonextraction orthodontic treatment, and plaque-induced gingivitis, excluding patients with active caries or periodontitis, tooth agenesis, syndromes, disabilities, and craniofacial deformities, ≥2 cervical and/or proximal fillings, dental prostheses or dental implants, and subjects smoking or using antibiotics or medication predisposing to gingival enlargement. Patients were assigned to use either an electric 3D orthodontic toothbrush (Oral-B Pro-1000 with Oral-B Ortho head; Procter & Gamble, Cincinnati, Ohio) or a manual toothbrush (Oral-B Orthodontic brush; Procter & Gamble) and instructed to brush twice daily for 2 minutes. The main outcomes were: (1) plaque removal, assessed with the Modified Silness and Löe plaque index and the Modified Full Mouth Plaque Score, and (2) gingival inflammation reduction, assessed with the Modified Silness and Löe Gingival Index and the Modified Simplified Gingival Index. Measurements were taken at baseline, 1, 2, and 3 months. Randomization was achieved with 2 random sequences, one for each brush, written and sealed in opaque numbered envelopes. Blinding was possible for outcome assessment only.

RESULTS

Considerable variability was observed among patients in the values of all dependent variables. There was no difference between interventions over time for any of the outcomes, and the main effects for treatment and time were also not statistically significant. For Modified Silness and Löe plaque index, the interaction was 0.001 (95% confidence interval, -0.011 to 0.013; P = 0.89).

CONCLUSIONS

No difference in plaque removal efficacy and gingival inflammation reduction was found between the electric 3D and manual toothbrushes in adolescents with fixed orthodontic appliances. Therefore, orthodontists should focus on enhancing their patients' dental awareness and oral hygiene, along with professional prophylaxis and other oral hygiene aids, independently of the brush used.

REGISTRATION

This trial was registered at ClinicalTrials.gov (Identifier: NCT02699931).

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

Electric and manual toothbrushes and toothpastes for all participants were provided by Procter & Gamble (Oral-B). Miscellaneous costs were covered by the participating departments.

Blue light & chlorhexidine therapies on Streptococcus mutans biofilm and its regrowth on an in vitro orthodontic model

INTRODUCTION

Fixed orthodontic appliances create areas of stagnation for dental biofilms and make it difficult to clean the teeth; therefore, there is a risk of developing incipient caries lesions during the orthodontic treatment. The objective of this study is to determine if the combination of 2 different therapies, phototherapy by blue light (BL) and the antimicrobial 0.12% chlorhexidine (CHX) on enamel, orthodontic brackets, and elastics, would reduce or inhibit mature Streptococcus mutans biofilms and their regrowth on these substrates 24 hours after the application of the treatment; and if this treatment would interfere with bracket adhesion to the enamel.

METHODS

Biofilms of S. mutans UA159 were formed for 5-days over samples composed of a bovine enamel, orthodontic bracket, and orthodontic elastic. Then, the specimens were treated with 0.89% NaCl for 1 minute, BL for 12 minutes (72 J/cm²), 0.12% CHX for 1 minute, and BL for 12 minutes, followed by 0.12% CHX for 1 minute (BL+CHX). Biofilm was evaluated by colonies forming units and dry weight immediately after treatments and 24 hours after treatments (regrowth). The pH of the spent media was measured on the fifth and sixth days. Biofilm formation on the samples after the treatments and regrowth was visually evaluated by confocal laser scanning microscopy. Shear bond strength (SBS) between bracket and enamel was evaluated using a universal testing machine at a crosshead speed of 1 mm/min. After bonding, specimens were thermocycled (500× at 5-55°C), treated, and thermocycled again.

RESULTS

After 5 days of biofilm formation, BL+CHX significantly reduced the bacterial viability on enamel compared with NaCl (P = 0.004) and BL (P = 0.014). For bracket and elastic, all the treatments resulted in similar bacterial viability (P ≥0.081). In the regrowth, CHX and BL+CHX significantly reduced the bacterial viability in the enamel compared with the NaCl (P ≤0.015) and BL (P ≤0.013). For bracket, BL+CHX significantly reduced the bacterial viability compared with NaCl (P = 0.008) and BL (P = 0.009). For the elastic, BL+CHX eliminated the biofilms from the substrate. CHX and BL+CHX significantly reduced the bacterial viability 24 hours after treatment for all substrates (P ≤0.05). The media pH significantly increased when samples were treated with CHX and BL+CHX (P ≤0.001). Confocal laser scanning microscopy images visually showed an abundant quantity of red cells in the samples treated with BL+CHX. There was no difference in the SBS between the treatments (P ≥0.932).

CONCLUSIONS

The association between BL and CHX reduced S. mutans biofilm and its regrowth on an in vitro orthodontic model and did not influence the bonding strength between bracket and enamel.

Microbial Screening Reveals Oral Site-Specific Locations of the Periodontal Pathogen Selenomonas noxia

INTRODUCTION

Selenomonas noxia (SN) is an important periodontal pathogen, associated with gingivitis and periodontitis. Many studies have found associations between SN and indicators of poor health outcomes, such as smoking, low socioeconomic status and obesity. However, less is known about the prevalence of this organism and more specifically about other oral site-specific locations that may harbor this organism.

METHODS

Using an existing patient repository (n = 47) of DNA isolated from saliva and other oral sites (n = 235), including the dorsum of the tongue, lower lingual incisor, upper buccal molar and gingival crevicular fluid (GCF), molecular screening for SN was performed. Screening results were analyzed for associations between demographic variables (age, sex, race/ethnicity) and clinical information (body mass index or BMI, presence of orthodontic brackets, primary/mixed/permanent dentition).

RESULTS

qPCR screening revealed a total of n = 62/235 sites or 26.3% harboring SN with saliva and GCF (either alone or in combination with one or more sites) most often observed (Saliva, n = 23/27 or 85.18%, GCF, n = 14/27 or 51%). Analysis of site-specific data revealed most positive results were found among saliva and GCF alone or in combination, with fewer positive results observed among the tongue (33.3%), lower lingual incisor (29.6%), and upper buccal molar (25.9%). No significant associations were found between demographic or clinical variables and presence of SN at any site.

CONCLUSIONS

These results may be among the first to describe site-specific locations of S. noxia among various additional oral biofilm sites. These data may represent a significant advancement in our understanding of the sites and locations that harbor this organism, which may be important for our understanding of the prevalence and distribution of these organisms among patients of different ages undergoing different types of oral treatments, such as orthodontic treatment or therapy.

Comparison of the effects of ultrasound toothbrushes with different frequencies on oral hygiene: A randomized-controlled clinical trial

BACKGROUND

The purpose of this study was to examine whether high-frequency ultrasound toothbrushes have different effects on oral hygiene.

METHODS

Fifty first-year dental hygiene students were randomly divided into three groups using ultrasound toothbrushes with different frequencies (1.6, 3.2 and 4.8 MHz) twice a day (3-min sessions) for 8 weeks. Plaque index (PlI) and gingival index (GI) scores were assessed at 4 and 8 weeks.

RESULTS

Changes in GI scores from baseline to 8 weeks tended to differ among the groups (p = 0.0862). The GI was significantly lower in the 3.2 and 4.8 MHz groups at 8 weeks (3.2 MHz group: p < 0.01, 4.8 MHz group: p < 0.05). At 4 weeks, the GI was significantly lower in the 3.2 MHz group (p < 0.05) and tended to be lower in the 4.8 MHz group (p = 0.07). The PlI was significantly lower in the 3.2 MHz group at 8 weeks (p < 0.01) and tended to be lower in the 1.6 and 4.8 MHz groups (1.6 MHz: p = 0.07, 4.8 MHz: p = 0.05). In addition, the PlI was significantly lower in the 4.8 MHz group at 4 weeks (p < 0.05). No significant differences in the changes in any measurements were observed among the groups.

CONCLUSIONS

The results of this study indicated that ultrasound toothbrushes with different frequencies probably have different effects on oral hygiene. However, it is difficult to conclude strongly that higher frequency ultrasound toothbrushes are more effective as there were some limitations.

Effect of chlorhexidine varnish on gingival growth in orthodontic patients: a randomized prospective split-mouth study

Introduction:

Fixed orthodontic appliances patients suffer limitations on the effective control of biofilm by mechanical methods, bringing the need of a coadjutant in the control of inflammation and oral health improvement.

Objective:

The aim of this prospective split-mouth blind study was to analyze the effect of a 40% chlorhexidine (CHX) varnish on gingival growth of patients with orthodontic fixed appliances. Methods: Healthy teenage patients with fixed orthodontic appliances and increased gingival volume were recruited (n = 30). Each individual was his own control, having in the maxilla one control side and one treatment side. An application of varnishes occurred on the vestibular area of the upper premolars and first molar crowns, on the control side (placebo varnish) and on the experimental side (EC40^(r) Biodentic CHX varnish). The varnishes and sides were randomly chosen and its identification and group was kept by a third party observer and it was not revealed to the researchers and participants until the end of study. In order to establish a baseline registration, digital photographs were taken by a trained photographer before varnish application at baseline (T₀), as well as 14 days (T₁₄) and 56 days (T₅₆) after the application. The gingival volume was calculated indirectly using the vestibular areas (mm²) of the upper second premolars' clinical crowns by RapidSketch^(r) software, at all study times. The data were analyzed using ANOVA and the Turkey-Krammer test.

Results:

It was observed, in the final sample of 30 individuals, that at T₀, the control and treatment groups were similar. At T₁₄ and T₅₆, a progressive reduction of the clinical crown area was seen in the control group, and an increase in the average area was detected in the experimental group (p < 0,05).

Conclusions:

The use of 40% CHX varnish decreases the gingival overgrowth in patients undergoing orthodontic treatment. Further studies are necessary to set the action time and frequency of application.

Effectiveness of a motionless ultrasonic toothbrush in reducing plaque and gingival inflammation in patients with fixed orthodontic appliances

OBJECTIVE

To compare the effectiveness of a motionless ultrasonic toothbrush to a manual toothbrush in reducing dental plaque, gingival inflammation, and mutans streptococci in patients with fixed orthodontic appliances.

MATERIALS AND METHODS

Twenty-five orthodontic patients were recruited to this crossover study. The patients were randomized into two groups starting with manual or motionless ultrasonic toothbrushes for 30 days. After a 30-day washout period, the patients switched to the other toothbrush type for 30 days. Plaque and gingival indices were evaluated by two calibrated-blinded examiners before and after each 30-day period of brushing. Salivary samples were also collected for quantification of mutans streptococci.

RESULTS

On the bracket side, the motionless ultrasonic toothbrush showed a significantly higher mean plaque index bracket score after 30-day usage than baseline (P = .049), while the manual toothbrush group showed no difference between the before and after brushing periods (P = .10). The changes in plaque index bracket score were significantly more favorable in the manual toothbrush group than in the ultrasonic toothbrush group (P = .04). In contrast, no difference was observed on the nonbracket side. There was no significant difference in the changes of gingival index or the numbers of mutans streptococci between the two groups.

CONCLUSION

Manual toothbrushing performed better than brushing with the motionless ultrasonic toothbrush in plaque removal on the bracket side in orthodontic patients. However, no difference was observed in terms of gingival status and the numbers of mutans streptococci.

Powered versus manual toothbrushing for oral health

BACKGROUND

Removing dental plaque may play a key role maintaining oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this. This is an update of a Cochrane review first published in 2003, and previously updated in 2005.

OBJECTIVES

To compare manual and powered toothbrushes in everyday use, by people of any age, in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 23 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE via OVID (1946 to 23 January 2014), EMBASE via OVID (1980 to 23 January 2014) and CINAHL via EBSCO (1980 to 23 January 2014). We searched the US National Institutes of Health Trials Register and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials of at least four weeks of unsupervised powered toothbrushing versus manual toothbrushing for oral health in children and adults.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by The Cochrane Collaboration. Random-effects models were used provided there were four or more studies included in the meta-analysis, otherwise fixed-effect models were used. Data were classed as short term (one to three months) and long term (greater than three months).

MAIN RESULTS

Fifty-six trials met the inclusion criteria; 51 trials involving 4624 participants provided data for meta-analysis. Five trials were at low risk of bias, five at high and 46 at unclear risk of bias.There is moderate quality evidence that powered toothbrushes provide a statistically significant benefit compared with manual toothbrushes with regard to the reduction of plaque in both the short term (standardised mean difference (SMD) -0.50 (95% confidence interval (CI) -0.70 to -0.31); 40 trials, n = 2871) and long term (SMD -0.47 (95% CI -0.82 to -0.11; 14 trials, n = 978). These results correspond to an 11% reduction in plaque for the Quigley Hein index (Turesky) in the short term and 21% reduction long term. Both meta-analyses showed high levels of heterogeneity (I(2) = 83% and 86% respectively) that was not explained by the different powered toothbrush type subgroups.With regard to gingivitis, there is moderate quality evidence that powered toothbrushes again provide a statistically significant benefit when compared with manual toothbrushes both in the short term (SMD -0.43 (95% CI -0.60 to -0.25); 44 trials, n = 3345) and long term (SMD -0.21 (95% CI -0.31 to -0.12); 16 trials, n = 1645). This corresponds to a 6% and 11% reduction in gingivitis for the Löe and Silness index respectively. Both meta-analyses showed high levels of heterogeneity (I(2) = 82% and 51% respectively) that was not explained by the different powered toothbrush type subgroups.The number of trials for each type of powered toothbrush varied: side to side (10 trials), counter oscillation (five trials), rotation oscillation (27 trials), circular (two trials), ultrasonic (seven trials), ionic (four trials) and unknown (five trials). The greatest body of evidence was for rotation oscillation brushes which demonstrated a statistically significant reduction in plaque and gingivitis at both time points.

AUTHORS' CONCLUSIONS

Powered toothbrushes reduce plaque and gingivitis more than manual toothbrushing in the short and long term. The clinical importance of these findings remains unclear. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and only temporary.