Efficacy of Ultrasonic, Electric and Manual Toothbrushes in Patients with Fixed Orthodontic Appliances

Evaluation of dental plaque reduction using microcurrent-emitting toothbrushes in orthodontic patients: a randomized, double-blind, crossover clinical trial

This study aimed to compare the effectiveness of microcurrent-emitting toothbrushes (MCTs) and ordinary toothbrushes in reducing the dental plaque index (PI) and dental caries activity among orthodontic patients. The evaluation was performed using a crossover study design involving 22 orthodontic patients randomly assigned to the MCT or ordinary toothbrush groups. The participants used the designated toothbrush for 4 weeks and had a 1-week wash-out time before crossover to the other toothbrush. PI (Attin's index) and dental caries activity were measured at baseline and at the end of each 4-week period. Additionally, patients completed questionnaires to assess patient satisfaction for "freshness in mouth" and "cleansing degree." The results showed that the MCT group had a significant reduction in PI (p = 0.009), whereas the ordinary toothbrush group did not (p = 0.595). There was no significant difference in the dental caries activity between the two groups (p > 0.05). Patient satisfaction assessment revealed that 65% patients in the MCT group had more than "fair" experience of freshness, in contrast to 50% of patients in the ordinary toothbrush group. Satisfaction with cleansing degree was similar in both groups. Overall, these findings suggest that MCTs are more effective in reducing dental PI than ordinary toothbrushes.

Cleaning performance of electric toothbrushes around brackets applying different brushing forces: an in-vitro study

Throughout treatment with fixed orthodontic appliances, effective plaque control is crucial to maintaining dental health. This in-vitro study evaluated the cleaning performance of eleven different brush heads of seven electric toothbrushes (oscillating-rotating and sonic motions) and varying brushing forces around orthodontic brackets. Six Mini Diamond® Twin brackets were placed on black-stained front teeth. Teeth were coated with white titanium oxide and brushed in a machine six times for one minute with two different brushing forces (1 N and 1.5 N). Eleven different brush heads were evaluated (either oscillating-rotating or sonic movements). The teeth were scanned and planimetrically evaluated after brushing. Three detailed plaque areas (DPAs) were created: proximal (< 1 mm to bracket), mid-tier (1-2 mm to bracket), and distant (> 2 mm to bracket). The proportion of contaminated proximal, mid-tier, and distant surfaces (white regions) in relation to the respective DPA was calculated. Independent of brushing forces, places with a higher distance (> 2 mm) to the orthodontic bracket had the least amount of residual contamination, followed by areas with a minor (1-2 mm) and proximal distance (< 1 mm). In all of the brushes tested and for both estimated brushing forces, the region with the highest residual contamination was the proximal area. The brush heads of the Paro® Sonic toothbrush left the least amount of residual contamination. The cleaning performance of electric toothbrushes around brackets on upper incisors varied across the brushes examined. The proximal area has the most residual contamination. Furthermore, 9 out of 11 toothbrushes cleaned more successfully with 1.5 N than with 1 N brushing force.

The effectiveness of low-level laser therapy and low-intensity pulsed ultrasound in reducing pain induced by orthodontic separation: a randomized controlled trial

BACKGROUND

The low-level laser therapy (LLLT) and low-intensity pulsed ultrasound (LIPUS) have been recently applied to control pain during orthodontic treatment.

OBJECTIVE

To evaluate and compare the effectiveness of LLLT and LIPUS in reducing pain induced by orthodontic separation.

STUDY DESIGN

A single-blinded randomized controlled trial.

METHODS

One hundred and fifty patients were randomly assigned into three groups; LLLT group, LIPUS group, and control group. After 5 min from the separators' placement, the first dose of the laser or the ultrasound was applied, the second dose was applied after 24 h, and the third dose was applied after 48 h on both maxillary and mandibular first molars. The exposure of laser was for 20 s at each point (maxillary and mandibular first molars), with an 810-nm aluminum-gallium-arsenide (AlGaAs) diode laser on continuous mode. The output power set at 150 mW, the energy density of 4 J/cm2, and a laser spot diameter of 7 mm were applied. Whereas the frequency of ultrasonic toothbrush was 1.6 MHz; and average output intensity was 0.2 W/cm2. The application was for 20 min (5 min on each first molar). The control group received the separators without another intervention. A Visual Analog Scale (VAS 100 mm) was used to assess pain intensity at several time intervals during the first four days after the separators' placement.

RESULTS

A total of 145 patients were assessed. There was a significant difference in pain perception among the three groups after 5 min (P = .002). The maximum pain level was reached after 24 h. However, the laser group and the ultrasound group showed a statistically significant decrease in pain scores compared to the control group at all the assessment time points (P < .001). Whereas there was no difference between the laser group and the ultrasound group in reducing the pain scores (P > .05).

CONCLUSIONS

The LLLT and the LIPUS effectively reduce the separation pain when applied in multiple doses without differences between them.

TRIAL REGISTRATION

This trial was registered with the German Clinical Trials Register (DRKS). ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID= DRKS00029991). Date of registration: 26/08/2022.

Systematic Review and Meta Analysis of the Relative Effect on Plaque Index among Pediatric Patients Using Powered (Electric) versus Manual Toothbrushes

Although many randomized controlled trials (RCT) have evaluated the efficacy of powered or electric toothbrushes compared with manual or traditional toothbrushes to remove biofilm and plaque, only one systematic review has been published for pediatric patients. The primary objective of this study was to perform a systematic review and meta analysis for this population. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, N = 321 studies were initially identified. Three independent, blinded abstract reviews were completed resulting in a total of n = 38/322 or 11.8% for the final analysis (n = 27 non-orthodontic, n = 11 orthodontic studies). Meta analysis of these outcome data have revealed a strong reduction in plaque index scores among pediatric patients using electric toothbrushes of approximately 17.2% for non-orthodontic patients and 13.9% for orthodontic patients. These results provide strong clinical evidence for recommending electric toothbrushing to pediatric patients, as well as those patients undergoing orthodontic therapy and treatment.

Role of the general dental practitioner in managing the risks of orthodontic treatment

The aim of this article is to outline the potential risks in orthodontic treatment and the general dental practitioner's role in reducing and managing such risks. The success of orthodontic treatment largely depends on patient understanding of the risk/benefit implications of the orthodontic treatment and all of the potential consequences involved in such treatment. A perfect blend of good case selection, sound clinical judgement and, more importantly, a patient's clear understanding of the potential risks involved and the treatment implications help minimise and manage potential hazards that occur during the course of the treatment.

Changes in Distribution of Dental Biofilm after Insertion of Fixed Orthodontic Appliances

Good oral hygiene is an important factor in oral and general health, especially in orthodontic patients, because fixed appliances might impede effective oral hygiene and thus increase the risks of tooth decay, periodontal disease and general health complications. This study investigated the impact of fixed orthodontic appliances on the distribution of dental biofilm in teenagers. Supragingival plaque was assessed at T0, T1 and T2. The distribution of the biofilm was analyzed. Approximal Plaque Index (API) and Bonded Bracket Index (BBI) were used to measure the presence of dental plaque. After insertion of the fixed appliance, the dental plaque indices values in the orthodontically treated group were significantly higher (p < 0.05) than in the control group. Fixed orthodontic appliances caused significant changes in the distribution of the biofilm. This was characterized by the change of location of the dental plaque. In the orthodontic group, we observed an increase in the amount of the supragingival plaque on the vestibular surface of the teeth.

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.

How effective are three methods of teaching oral hygiene for adolescents undergoing orthodontic treatment? The MAHO protocol: an RCT comparing visual, auditory and kinesthetic methods

Background

Fixed orthodontic appliances hamper oral hygiene procedures. The consequences are gingivitis and white spot lesions. Fifty to 70% of patients treated with braces encounter these problems. Their care in the USA represents an annual cost of five hundred million dollars. Initial education and motivation for oral hygiene depend on two categories of factors: firstly, practical prophylactic measures (instruments and medication, professional care) and secondly, the educational component: choice of communication technique, frequency, and nature of hygiene instructions. This trial aims to study this last component. Its main objective is to compare three methods’ effectiveness of oral hygiene education in adolescent patients treated with braces in terms of biofilm (plaque) control. The secondary objectives are the evaluation of these methods’ effectiveness regarding gingival inflammation and the maintenance of hygiene during the first 6 months of treatment.

Methods

This study is a prospective randomized controlled trial of superiority. It evaluates the effectiveness of three hygiene education techniques. A total of 90 patients from the University Hospital Center of Rennes will be randomized into 3 parallel groups with a 1:1:1 ratio. Each will benefit from a different educational method: oral and/or practical. The main outcome will be the average plaque index for each group after 6 months of treatment. Additional outcomes will be the average gingival index for each group and the plaque and gingival indices over 6 months.

Discussion

The effectiveness of preventive procedures for optimizing oral hygiene during orthodontics is based on ambiguous literature. As a result, it is difficult to draw conclusions and to translate them into everyday practice. Sixty-eight percent of the orthodontists support the development of guidelines for education. The aim of this study is to standardize methods of oral hygiene education during orthodontic fixed treatment. The purpose of this study would be to provide practitioners with a concrete education program through guidelines dedicated to the method having the best results.

Trial registration

ClinicalTrials.gov NCT04444154. Registered on 22 June 2020. SI CNRIPH ID 8011N° 20.04.27.58337. Registered on 29 July 2020

The Efficacy of Powered Oscillating Heads vs. Powered Sonic Action Heads Toothbrushes to Maintain Periodontal and Peri-Implant Health: A Narrative Review

Objectives: To compare the efficacy of rotating-oscillating heads (ORHs) VS sonic action heads (SAHs) powered toothbrushes on plaque accumulation and gingival inflammation. Methods: An electronic (MEDLINE, Embase, Inspec, PQ SciTech and BIOSIS) and a complementary manual search were made to detect eligible studies. RCTs meeting the following criteria were included: final timepoint longer than 15 days; year of publication after 2000; patients without orthodontic appliances or severe systemic/psychiatric diseases. Studies comparing two or more different types of sonic/roto-oscillating toothbrushes were excluded. Selection of articles, extraction of data, and assessment of quality were made independently by several reviewers. Results: 12 trials (1433 participants) were included. The differences between ORHs and SAHs toothbrushes were expressed as weighted mean differences (WMD) and 95% confidence intervals (CI). The heterogeneity of data was evaluated. Concerning Plaque Index, both toothbrushes obtained comparable results. Six trials of up to 3 months and at an unclear risk of bias provided significant outcomes in terms of gingival inflammation in favor of ORHs toothbrush. Evidence resulting from three trials of up to 6 months and at a high/low risk of bias stated SAHs toothbrush superiority in gingival inflammation. Conclusions: Both ORHs and SAHs toothbrushes improved the outcomes measured from the baseline. In most of the good quality trials included, SAHs toothbrush showed statistical better long-term results. Due to the shortage of investigations, no further accurate conclusions can be outlined with reference to the superiority of a specific powered toothbrush over the other.

Comparative in vitro study of the cleaning efficacy of AirFloss ultra and I-Prox Sulcus brushes in an orthodontic phantom model

Preventing biofilm-related risks such as gingivitis and white spot lesions during orthodontic treatments is very challenging. The cleaning efficiencies of AirFloss Ultra and I-Prox P sulcus brushes were evaluated using an orthodontic phantom model. After attaching brackets onto black-coated maxillary KaVo teeth, a plaque substitute was applied. The evaluated tooth surfaces were divided into two areas. Cleaning was performed with an AirFloss Ultra with two (A-2) or four (A-4) sprays or an I-Prox P for two (I-2) or four (I-4) seconds. Images before and after cleaning were digitally subtracted, and the percentage of fully cleaned surfaces was determined (Adobe Photoshop CS5, ImageJ). Statistical analysis was performed by ANOVA and post hoc tests with Bonferroni correction (SPSS 25, p < 0.05). The mean values of total cleaning efficacy were 26.87% for I-2, 43.73% for I-4, 34.93%, for A-2 and 56.78% for A-4. The efficacy was significantly higher for A-4 than for A-2, I-4, and I-2. There were significant differences between the four groups. Repeated cleaning led to an improved result. Within the study limitations, the AirFloss Ultra with four sprays proved to be more efficient than the sulcus brush I-Prox P for cleaning.

Powered toothbrushes for plaque control in fixed orthodontic patients: a network meta-analysis

BACKGROUND

Orthodontic patients are at greater risk due to the inability to clean around the components directly bonded to teeth. Hence, the aim of the present network meta-analysis is to compare the utility of powered toothbrushes in plaque control in patients with orthodontic brackets compared with manual tooth brushing.

METHODOLOGY

Necessary data were extracted and analysed for Risk of Bias. Heterogeneity was assessed using Chi-square and I² tests. Random effects model was used for both direct and mixed treatment comparisons. Standardized mean difference with 95% confidence interval was the effect estimate for plaque and bleeding scores and mean difference for pocket depth. Inconsistencies between the direct and indirect estimates were evaluated by H-statistics. GRADE approach was used to assess the quality of evidence.

RESULTS

Pooled results from 14 studies showed significantly higher plaque scores in patients using manual toothbrushes. Pooled results from 13 studies showed significant higher bleeding scores as well with manual brushes. There was a significant reduction in pocket depth with electric toothbrushes.

CONCLUSION

Powered toothbrushes are a promising alternative for plaque control in patients with fixed orthodontic brackets. Stronger evidence can be established with addition of long-term clinical trials based on the recommendations.

Assessment of cooperation and compliance in adult patients at three stages of orthodontic treatment at a tertiary care hospital: A cross-sectional study

OBJECTIVE

The study was conducted to assess cooperation and compliance in adult orthodontic patients during the leveling and alignment, space closure/molar correction and finishing stages of orthodontic treatment.

MATERIALS AND METHODS

This cross-sectional study was conducted on adult patients undergoing fixed orthodontic mechanotherapy in a tertiary care hospital. Patient cooperation was assessed during orthodontic treatment stages using Orthodontic Patient Cooperation Scale (OPCS) and compliance by Clinical Compliance Evaluation (CCE) form. A sample size of 38 subjects was included for each stage of treatment; therefore, a total of 114 subjects were recruited for the study. Shapiro-Wilk test identified that the data were normally distributed. One way ANOVA was used to evaluate the percentage cooperation and compliance among three stages. Pair-wise comparisons among the three stages were performed using Post hoc Tukey test. Simple and multiple linear regression analysis were carried out to see the factors associated with cooperation and compliance.

RESULTS

A statistically significant difference was seen for scores of patient cooperation and compliance using CCE (P=0.01); however, the results of the OPCS were non-significant among the three stages of treatment (P=0.16). There was a significant difference in patient cooperation and compliance between space closure/molar correction and finishing stage (P=0.01). A highly significant decline in oral hygiene was found with the progression of orthodontic treatment, from space closure/molar correction to the finishing stage of treatment (P<0.001).

CONCLUSIONS

Improvement in the cooperation and compliance levels for adult orthodontic patients was observed during the space closure/molar correction stage, which then showed a decline as the treatment progressed. Maintenance of oral hygiene was gradually reduced with the progression of orthodontic treatment.

Dental Plaque Removal by Ultrasonic Toothbrushes

With the variety of toothbrushes on the market, the question arises, which toothbrush is best suited to maintain oral health? This thematic review focuses first on plaque formation mechanisms and then on the plaque removal effectiveness of ultrasonic toothbrushes and their potential in preventing oral diseases like periodontitis, gingivitis, and caries. We overviewed the physical effects that occurred during brushing and tried to address the question of whether ultrasonic toothbrushes effectively reduced the microbial burden by increasing the hydrodynamic forces. The results of published studies show that electric toothbrushes, which combine ultrasonic and sonic (or acoustic and mechanic) actions, may have the most promising effect on good oral health. Existing ultrasonic/sonic toothbrush models do not significantly differ regarding the removal of dental biofilm and the reduction of gingival inflammation compared with other electrically powered toothbrushes, whereas the manual toothbrushes show a lower effectiveness.

Prevention and caries risk management in teenage and orthodontic patients

As patients progress from childhood through to teenage years, they progress through periods of high caries risk as they undergo changes in lifestyle and oral microflora. Removable or fixed orthodontic treatment also alters the oral microflora and can dramatically increase caries risk. This paper outlines ways to identify the transition to higher caries risk, and practical ways to lower the risk of hard tissue loss from dental caries during orthodontic treatment across the teenage years, including tooth surface protection, optimised use of mechanical and chemical plaque control, and appropriate delivery of remineralising agents over time.

The Microflora Diversity and Profiles in Dental Plaque Biofilms on Brackets and Tooth Surfaces of Orthodontic Patients

Objective: Fixed orthodontic appliances may influence the oral environment through accumulation of plaque, decreased plaque pH, and increased gingival inflammation. These changes in the oral cavity can potentially lead to periodontal disease, demineralization, and other infectious diseases.

Materials and Methods: To investigate the changes in biofilm throughout the initial 2 weeks, we placed a stainless steel bracket on the upper second premolar and collected plaque samples on the bracket and on the tooth surface at different time points (0, 24, 48 h and 1 and 2 weeks) and plated on tryptic soy agar blood agar plate, and kept at 37°C in an anaerobic chamber for 5 days to determine the CFUs of bacteria. At the end of 2 weeks, we removed the bracket and elastomeric module, and we isolated genomic DNA from the bacterial biofilm for identification of bacteria by 16S rRNA PCR analysis. We also analyzed the morphology of biofilm on the bracket by scanning electron microscope.

Results: Our results show that the bacterial biofilm was significantly increased on the bracket in all the subjects, whereas on the tooth surface, the CFUs were not significantly increased. PCR assay showed that biofilm on orthodontic brackets from all subjects showed colonization by Streptococcus gordonii, Porphyromonas gingivalis and Streptococcus mutans were observed on some of the subjects after 48 h, whereas Aggregatibacter actinomycetemcomitans biofilm was observed in all the time points except 24 h.

Conclusion: This study demonstrated that both periodontal and cariogenic bacterial biofilms were formed on the bracket as early as 24 h.

Oral cleanliness in daily users of powered vs. manual toothbrushes - a cross-sectional study

Background

Toothbrushing is a daily routine. Still, when adults are asked to manually perform oral hygiene to the best of their abilities, a considerable amount of plaque persists. Little is known about the performance of people who use a powered toothbrush. The present study thus analysed whether the capability to achieve oral cleanliness is better in people for whom powered toothbrushing is a daily routine.

Methods

University students, who either performed powered (N = 55) or manual (N = 60) toothbrushing for more than 6 months on a daily basis were asked to clean their teeth to the best of their abilities by their own device. Plaque was assessed prior to and immediately after brushing. Furthermore, gingival bleeding, recessions, periodontal pocket depths and dental status were assessed. Oral hygiene performance was video-taped and analyzed with respect to brushing duration, sites of brushing and application of interproximal cleaning devices.

Results

No differences between groups were found with respect to plaque before and after brushing, clinical parameters and overall brushing duration (all p > 0.05, all d < 0.156). After brushing, plaque persisted at approximately 40% of the sections adjacent to the gingival margin in both groups.

Conclusions

No advantage of daily powered toothbrushing as compared to daily manual toothbrushing was seen with respect to oral hygiene or clinical parameters. The capability to achieve oral cleanliness was low, irrespective of the type of toothbrush under consideration. Additional effort is thus needed to improve this capability.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0790-9) contains supplementary material, which is available to authorized users.

Evaluation of Changes in Cariogenic Bacteria in a Young Moroccan Population with Fixed Orthodontic Appliances

Fixed orthodontic appliances hinder the maintenance of proper oral hygiene and result in dental plaque accumulation. Many studies report that qualitative changes in the dental flora occur after initiating the orthodontic treatment, but there is a paucity of literature on the same topic among Moroccan orthodontic patients. The aim of this study was to evaluate the changes of the oral microbial flora during the orthodontic treatment period of a young Moroccan population. Materials and Methods. Dental plaque samples of 18 patients, who were randomly selected before the placement of orthodontic appliances, were collected to isolate and identify the bacterial species involved using classical bacteriological methods for species' culture and identification. The reading was recorded at T0 before placement of the device. New samples were taken again one month later and then three months afterwards, where the readings were recorded as T1 and T2, respectively. The culture was made via Columbia Agar with 5% sheep blood, Todd Hewitt Broth, and Schaedler medium containing vitamin K3. Bacterial species were identified using API-20 Strep for Streptococci and API-20 A for anaerobic bacteria. The phoenix system was used for identification. Results. After three months of orthodontic treatment, the increase in the frequency of Streptococcus sobrinus and Streptococcus mitis were significant (0.01 and 0.02, respectively) as well as for Lactobacillus (0.03). No significant difference was recorded for other bacterial species. Conclusion. There is a significant qualitative change in oral microorganisms after three months of orthodontic treatment, especially for bacteria that are incriminated in caries formation.

Effect of a single-tufted toothbrush on the control of dental biofilm in orthodontic patients: A randomized clinical trial

OBJECTIVE

To compare the effect of a single-tufted toothbrush combined or not with a conventional toothbrush to control dental biofilm in healthy orthodontic patients.

MATERIALS AND METHODS

Twenty orthodontic patients were randomly assigned to receive three different treatments: Group 1-conventional toothbrush; Group 2-single-tufted toothbrush and Group 3-combination of single-tufted and conventional toothbrushes. Stained plaque index (SPI), visible plaque index (VPI) and gingival bleeding index (GBI) were recorded. The data were analysed by Kolmogorov-Smirnov test. Wilcoxon test was used for intragroup comparison and Friedman test for the intergroup comparison (α = 5%).

RESULTS

Intragroup analysis showed that VPI and SPI significantly decreased (P < 0.05) after 72 hour in Group 3. Anterior and posterior teeth did not show any significant statistical differences after 72 hour (P > 0.05), but VPI values in the labial surfaces were different to Group 3 (P < 0.05) in comparison with the other groups after 72 hour. Group 3 showed a statistically significant reduction (P < 0.05) for SPI in the interproximal surfaces when compared with Group 1.

CONCLUSION

The combination of single-tufted and conventional toothbrushes was effective for controlling dental biofilm formation in orthodontic patients.

Antimicrobial action of chlorhexidine digluconate in self-ligating and conventional metal brackets infected with Streptococcus mutans biofilm

Objectives

The objectives of this study were to assess the adherence of Streptococcus mutans biofilms grown over conventional ligature (CL) or self-ligating (SL) metal brackets and their bacterial viability after 0.12% chlorhexidine (CHX) digluconate treatment.

Materials and methods

The sample consisted of 48 metallic orthodontic brackets divided randomly into two groups: CL (n=24) and SL brackets (n=24). S. mutans biofilms were grown over the bracket surface (96 h) and treated with CHX (positive control) or 0.9% phosphate-buffered saline (PBS) (negative control) for 1 min each. Quantitative analysis was assessed by colony-forming units, and fluorescence microscopy was performed aiming to illustrate the outcomes. The tests were done in triplicate at three different times (n=9). Data were analyzed using ANOVA and Tukey test (P<0.05).

Results

There were significant differences in brackets’ biofilm formation, being CL largely colonized compared with SL, which was observed by colony-forming unit counting (P<0.05) and microcopy images. Significant reduction in the viability of S. mutans was found in both brackets treated with CHX compared to PBS (P<0.05).

Conclusion

The antimicrobial activities of CHX were similar for CL and SL brackets (P>0.05). In conclusion, a lower colonization was achieved in SL brackets and S. mutans biofilms were susceptible to CHX treatment to both studied brackets.

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.

Evaluation of changes in Streptococcus mutans colonies in microflora of the Indian population with fixed orthodontics appliances

BACKGROUND

Orthodontic therapy has oral ecological changes causing increased numbers of mutans streptococci in saliva and plaque. The purpose of this study was to estimate counts and colonization pattern of Streptococcus mutans after application of fixed orthodontic appliances.

MATERIALS AND METHODS

Plaque samples of randomly selected sixty patients were collected before placement of orthodontic appliances from buccal and labial aspects of the anterior teeth and four first molars and readings were recorded as T0. After placement of appliances (0.22 MBT preadjusted Gemini), i.e., 2(nd) and 3(rd) month, the plaque samples were collected again from same site and readings were recorded as T1 and T2, respectively. Counts of S. mutans in these patients were determined by using DM Strips (Orion Diagnostic, Espoo, Finland). Kruskal-Wallis test and Mann-Whitney U-test were used to find out significant differences between different time interval for Dentocult score for S. mutans in orthodontic patients (P < 0.001).

RESULTS

Prior to the treatment, 46 patients (76%) showed mild and 14 patients (24%) showed moderate colonization of S. mutans. After treatment, the severity of colonization increased showing fifty patients (84%) moderate and six patients (10%) showing severe colonization of S. mutans at T1, which further increased in severity at T2 with 54 patients (90%) showing severe colonization with S. mutans.

CONCLUSION

Results showed that fixed orthodontic appliance increases colonization of S. mutans during orthodontic treatment.

Impact of Orthodontic Treatment on Periodontal Tissues: A Narrative Review of Multidisciplinary Literature

The aim of this review is to describe the most commonly observed changes in periodontium caused by orthodontic treatment in order to facilitate specialists' collaboration and communication. An electronic database search was carried out using PubMed abstract and citation database and bibliographic material was then used in order to find other appropriate sources. Soft and hard periodontal tissues changes during orthodontic treatment and maintenance of the patients are discussed in order to provide an exhaustive picture of the possible interactions between these two interwoven disciplines.

Comparison of Effectiveness of Manual Orthodontic, Powered and Sonic Toothbrushes on Oral Hygiene of Fixed Orthodontic Patients

Introduction: Maintenance of good oral hygiene is important for patients undergoing fixed orthodontic treatment.

Aim: The aim of this study was to evaluate the effectiveness of a manual orthodontic toothbrush, powered toothbrush with oscillating head and sonic toothbrush in controlling plaque, gingivitis and interdental bleeding in patients undergoing fixed orthodontic treatment, and to compare their relative efficacy.

Materials and methods: Sixty subjects, who were to receive orthodontic treatment with both upper and lower fixed appliances, were randomly divided into three study groups, with 20 patients in each group. Groups I to III were given manual orthodontic, powered and sonic toothbrushes, respectively. Plaque index (PI), gingival index (GI) and interdental bleeding index were scored to assess the level of plaque accumulation, gingival health and interdental bleeding at baseline; 4 and 8 weeks recall visits after fixed appliance bonding. Paired t-tests and one-way analysis of variance (ANOVA) tests were used for intragroup and intergroup comparisons. The level of statistical significance was set at p < 0.05.

Results: This study showed that a significant reduction in all the three indices scores was found from baseline to 4 and 8 weeks in group III. On intergroup comparison, no statistically significant differences were detected between the three groups for any of the parameters assessed.

Conclusion: On intragroup comparison, sonic brushes performed superiorly in reducing gingivitis, plaque and interdental bleeding as compared to the manual orthodontic and powered brushes. On intergroup comparison, the relative comparative effectiveness was found to be similar for all the three brushes.

How to cite this article: Sharma R, Trehan M, Sharma S, Jharwal V, Rathore N. Comparison of Effectiveness of Manual Orthodontic, Powered and Sonic Toothbrushes on Oral Hygiene of Fixed Orthodontic Patients. Int J Clin Pediatr Dent 2015;8(3):181-189.

Combined effects of repeated oral hygiene motivation and type of toothbrush on orthodontic patients: a blind randomized clinical trial

OBJECTIVE

To investigate the effects on plaque index (PI) scores of manual or electric toothbrush with or without repeated oral hygiene instructions (OHI) and motivation on patients wearing fixed orthodontic appliances.

MATERIALS AND METHODS

One month after the orthodontic fixed appliance bonding on both arches, 60 patients were randomly assigned to four groups; groups E1 (n  =  15) and E2 (n  =  15) received a powered rotating-oscillating toothbrush, and groups M1 (n  =  15) and M2 (n  =  15) received a manual toothbrush. Groups E1 and M1 received OHI and motivation at baseline (T0) and after 4, 8, 12, 16, and 20 weeks (T4, T8, T12, T16, and T20, respectively) by a Registered Dental Hygienist; groups E2 and M2 received OHI and motivation only at baseline. At each time point a blinded examiner scored plaque of all teeth using the modified Quigley-Hein PI.

RESULTS

In all groups the PI score decreased significantly over time, and there were differences among groups at T8, T12, T16, and T20. At T8, PI scores of group E1 were lower than those of group E2, and at T12, T16, and T20, PI scores of groups M1 and E1 were lower compared to those of groups M2 and E2. A linear mixed model showed that the effect of repeated OHI and motivation during time was statistically significant, independently from the use of manual or electric toothbrush.

CONCLUSIONS

The present results showed that repeated OHI and motivation are crucial in reducing PI score in orthodontic patients, independent of the type of toothbrush used.

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.

Orthodontic-periodontics interdisciplinary approach

In this present era, when a significant number of patients seeking orthodontic treatment are adults, importance of multidisciplinary treatment approach cannot be overemphasized. Higher susceptibility of plaque accumulation in patients undergoing orthodontic treatment makes involvement of periodontist almost unavoidable. Also, orthodontic treatment frequently results in undesirable periodontal changes which require immediate attention. More recently, orthodontics has been used as an adjunct to periodontics to increase connective tissue support and alveolar bone height. The purpose of this article is to review the adverse effects of orthodontic treatment on the periodontal tissues and to discuss the mutually beneficial relationship shared between the two specialties.

Quantifying plaque during orthodontic treatment:

OBJECTIVE

To evaluate the literature on different methods of scoring plaque in patients with fixed orthodontic appliances.

MATERIALS AND METHODS

A systematic electronic and hand search using MEDLINE and PubMed was conducted.

RESULTS

Most orthodontic trials have used the original Silness and Löe plaque index. Indices vary in several potentially important aspects. Only two papers have reported reproducibility of methods of plaque scoring in orthodontic patients.

CONCLUSION

Some plaque indices are inappropriate for orthodontic patients. Newer digital planimetric methods are promising if more complex. There is a need to further assess the reproducibility and practicability of the advocated methods.

Empirical evaluation of age groups and age-subgroup analyses in pediatric randomized trials and pediatric meta-analyses

BACKGROUND

An important step toward improvement of the conduct of pediatric clinical research is the standardization of the ages of children to be included in pediatric trials and the optimal age-subgroups to be analyzed.

METHODS

We set out to evaluate empirically the age ranges of children, and age-subgroup analyses thereof, reported in recent pediatric randomized clinical trials (RCTs) and meta-analyses. First, we screened 24 RCTs published in Pediatrics during the first 6 months of 2011; second, we screened 188 pediatric RCTs published in 2007 in the Cochrane Central Register of Controlled Trials; third, we screened 48 pediatric meta-analyses published in the Cochrane Database of Systematic Reviews in 2011. We extracted information on age ranges and age-subgroups considered and age-subgroup differences reported.

RESULTS

The age range of children in RCTs published in Pediatrics varied from 0.1 to 17.5 years (median age: 5; interquartile range: 1.8-10.2) and only 25% of those presented age-subgroup analyses. Large variability was also detected for age ranges in 188 RCTs from the Cochrane Central Register of Controlled Trials, and only 28 of those analyzed age-subgroups. Moreover, only 11 of 48 meta-analyses had age-subgroup analyses, and in 6 of those, only different studies were included. Furthermore, most of these observed differences were not beyond chance.

CONCLUSIONS

We observed large variability in the age ranges and age-subgroups of children included in recent pediatric trials and meta-analyses. Despite the limited available data, some age-subgroup differences were noted. The rationale for the selection of particular age-subgroups deserves further study.

Plaque levels of patients with fixed orthodontic appliances measured by digital plaque image analysis

INTRODUCTION

A digital plaque image analysis system was developed to objectively assess dental plaque formation and coverage in patients treated with fixed orthodontic appliances.

METHODS

The technique was used to assess plaque levels of 52 patients undergoing treatment with fixed appliances in the Department of Orthodontics at Johannes Gutenberg University in Mainz, Germany.

RESULTS

Plaque levels ranged from 5.1% to 85.3% of the analyzed tooth areas. About 37% of the patients had plaque levels over 50% of the dentition, but only 10% exhibited plaque levels below 15% of tooth coverage. The mean plaque coverage was 41.9% ± 18.8%. Plaque was mostly present along the gum line and around the orthodontic brackets and wires.

CONCLUSIONS

The digital plaque image analysis system might provide a convenient quantitative technique to assess oral hygiene in orthodontic patients with multi-bracket appliances. Plaque coverage in orthodontic patients is extremely high and is 2 to 3 times higher than levels observed in high plaque-forming adults without appliances participating in clinical studies of the digital plaque image analysis system. Improved hygiene, chemotherapeutic regimens, and compliance are necessary in these patients.

Adverse effects of orthodontic treatment: A clinical perspective

Orthodontic treatment is associated with a number of adverse effects, such as root resorption, pain, pulpal changes, periodontal disease, and temporomandibular dysfunction (TMD). Orthodontists should be aware of these effects and associated risk factors. Risk factors linked to root resorption include the duration of treatment, length, and shape of the root, trauma history, habits, and genetic predisposition.

Different powered toothbrushes for plaque control and gingival health

BACKGROUND

Powered brushes were first introduced commercially in the 1960s. A recent systematic review suggested the superiority of certain modes of powered over manual toothbrushing for plaque and gingivitis reduction. That review did not allow for direct comparison between different modes of powered toothbrush.

OBJECTIVES

To compare different modes of powered toothbrushing against each other for plaque reduction and the health of the gingivae. Other factors to be assessed were calculus and stain removal, cost, dependability and adverse effects.

SEARCH STRATEGY

The following databases were searched: Cochrane Oral Health Group's Trials Register (to 26 July 2010); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3); MEDLINE via OVID (1950 to 26 July 2010); EMBASE via OVID (1980 to 26 July 2010); CINAHL via EBSCO (1982 to 26 July 2010). There were no language restrictions.

SELECTION CRITERIA

Trials were considered for inclusion with the following criteria: random allocation of participants; no compromised manual dexterity; unsupervised powered toothbrushing for at least 4 weeks. The primary outcomes were the plaque and gingivitis scores after powered toothbrush use during trial period.

DATA COLLECTION AND ANALYSIS

Data extraction was performed independently and in duplicate. The authors of trials were contacted to provide missing data where possible. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using the random-effects model. Potential sources of heterogeneity were assessed.

MAIN RESULTS

The review included data from 15 trials with 1015 participants. Due to the dearth of trials assessing the same mode of action, no definitive conclusions can be stated regarding the superiority of one mode of powered toothbrush over any other. Only minor and transient side effects were reported. Cost, dependability were not reported.

AUTHORS' CONCLUSIONS

Further trials of good quality are required to establish if any mode of action has superiority over the other modes of action for powered toothbrushes.

Safety of oscillating-rotating powered brushes compared to manual toothbrushes: a systematic review

BACKGROUND

Oscillating-rotating power toothbrushes have been proven clinically efficacious. To our knowledge, a comprehensive review of all clinical and laboratory investigations solely comparing the safety of these toothbrushes to the standard of care (i.e., manual toothbrushes) has not been published. The aim of this systematic review is to examine the literature concerning the relative soft and/or hard tissue safety outcomes with the use of oscillating-rotating toothbrushes compared to manual toothbrushes.

METHODS

With the use of electronic databases of the National Library of Medicine (PubMed-MEDLINE), the Cochrane Central Register of Controlled Trials (Cochrane-CENTRAL), and the Excerpta Medical Database (EMBASE), a search of in vivo and in vitro trials through May 2010 was conducted to identify appropriate studies that evaluated the effects of an oscillating-rotating power toothbrush compared to a manual toothbrush with respect to soft and/or hard tissue safety. Eligible trials incorporated a safety evaluation as a primary or secondary outcome parameter (i.e., gingival recession, observed/reported adverse events, and hard tissue effects) or used a surrogate parameter (i.e., stained gingival abrasion and brushing force) to assess safety. Data extraction for the primary- and surrogate-measure safety studies, which included mean values and SDs when available, and a meta-analysis of the gingival recession data were performed.

RESULTS

Independent screening of the titles and abstracts of 697 PubMed-MEDLINE, 436 Cochrane-CENTRAL, and 664 EMBASE papers resulted in 35 publications that met the eligibility criteria. The mean change in gingival recession was not significantly different among toothbrush groups in the two selected trials with safety as a primary outcome (weighted mean difference: 0.03). A meta-analysis of the five trials that evaluated safety with a surrogate parameter was not possible; however, there were no significant between-group differences at the study end in any trial. A descriptive analysis of the 24 selected studies assessing safety as a secondary outcome revealed few brushing-related adverse events. The heterogeneity in objectives and methodology of the four in vitro trials that met the eligibility criteria precluded generalization of the results.

CONCLUSION

A large body of published research in the preceding 2 decades has consistently shown oscillating-rotating toothbrushes to be safe compared to manual toothbrushes, demonstrating that these power toothbrushes do not pose a clinically relevant concern to hard or soft tissues.

In vitro tooth cleaning efficacy of electric toothbrushes around brackets

This in vitro study assessed the cleaning efficacy of different electric toothbrushes around upper incisor brackets. Standard and Mini Diamond brackets were fixed on black-stained teeth. The teeth were coated with white titanium oxide and brushed in a machine twice for 1 minute each. Twelve different brush heads with either a wiping or an oscillating-rotating action were tested. After brushing, the teeth were scanned, the black surfaces were assessed planimetrically and a modified plaque index for orthodontic patients (PIOP) was introduced. Tooth areas, which were black again after brushing indicated tooth surface contact of the filaments and were expressed as a percentage of total area. The remaining white areas around the brackets indicated 'plaque-retentive' niches. Analysis of variance was used for individual comparison of the brush types. Bonferroni/Dunn adjustment was applied for multiple testing. The Sonicare toothbrush handle with the brush head 'Compact ProResults' (81.7 per cent) and the brush head 'Standard ProResults' (80.8 per cent), as well as the sonic Waterpik toothbrush SR 800E with the standard brush head (78.2 per cent), showed statistically significantly better cleaning efficacy than all others. The poorest cleaning efficacy was observed for the oscillating-rotating Braun Oral-B Professional Care with the brush head 'Ortho' (less than 50 per cent). The planimetric findings were in correspondence with the results of the PIOP assessment. Cleaning efficacy of electric toothbrushes around brackets on upper incisors was different between the tested brushes. The PIOP was practicable, effective, and easy to use, although it has to be verified in a clinical study.

Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances

INTRODUCTION

Effective self-care is difficult for people with orthodontic appliances because of the inherent design of brackets and archwires. It is not uncommon to have increases in plaque and gingivitis after placement of fixed appliances. The purpose of this study was to evaluate the effect of using a dental water jet (DWJ) with a specialized tip (orthodontic) on plaque and bleeding in adolescent orthodontic patients with fixed appliances.

METHODS

One hundred six subjects were enrolled in this single blind, parallel clinical study. They were randomly assigned to 1 of 3 treatment groups: group 1, once daily irrigation with a DWJ and orthodontic jet tip plus a manual toothbrush; group 2, once daily flossing (FL) plus a manual toothbrush; group 3, manual toothbrush (MT) only. Plaque index (PI) and bleeding index (BI) scores were recorded at baseline, and at 2 and 4 weeks.

RESULTS

All groups showed statistically significant reductions in PI (whole mouth and interproximal) at 2 and 4 weeks (P <.001). In group 1, the DWJ was statistically more effective at reducing whole-mouth and interproximal plaque than the methods in the other groups (P >.001) at both 2 and 4 weeks, whereas the FL protocol in group 2 was significantly more effective than the MT protocol in group 3 at 4 weeks (P =.025) for whole-mouth plaque and at 2 and 4 weeks (P = .011 and P = .028, respectively) for interproximal plaque. All groups showed statistically significant reductions in BI (whole mouth and interproximal) at 2 and 4 weeks (P <.001). The DWJ in group 1 was statistically more effective at reducing whole-mouth bleeding than the protocols of the other groups at 2 and 4 weeks (P <.001), and the FL was statistically more effective than the MT at both times (P <.001). Both the DWJ and the FL were significantly more effective than the MT at 2 weeks (P <.001 and P <.016, respectively) for interproximal bleeding, but there were no differences between the groups at 4 weeks.

CONCLUSIONS

A DWJ with a specialized orthodontic jet tip is effective for adolescents in fixed orthodontic appliances; it demonstrated beneficial results for the reduction of plaque and bleeding.