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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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ORIGINAL ARTICLE
Year : 2011  |  Volume : 29  |  Issue : 3  |  Page : 235-238
 

Plaque removal efficacy of powered and manual toothbrushes under supervised and unsupervised conditions: A comparative clinical study


1 Department of Pedodontics, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
2 Department of Pedodontics, DAV(C) Dental College and Hospital, Yamunanagar, Haryana, India
3 Department of Pedodontics, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India

Date of Web Publication10-Oct-2011

Correspondence Address:
S Kallar
13, Inder Nagar, Opposite Verka Milk Plant, Ferozepur Road, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.85832

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   Abstract 

The present study was undertaken to determine and compare the efficacy of manual and powered toothbrushes under supervised and unsupervised conditions in 200 school-going children between 6 and 13 years of age. Two hundred school-going children aged between 6 and 13 years were selected. Children were randomly divided into two groups of 100 in each. Group 1 children were given manual brushes, while group 2 children were given powered brushes. The groups were further divided into two subgroups, with supervised brushing in subgroup A and unsupervised brushing in subgroup B. At 3, 6, 9 and 12 weeks, plaque was recorded according to Turseky-Gilmore-Glickman modification of Quingley Hein index and oral hygiene performance index. Data were statistically analyzed. Both brushes significantly reduced the plaque accumulation, though to different degrees. Powered brushes showed significant plaque reduction as compared to the manual brushes. Supervised group of both brushes showed a greater plaque reduction.


Keywords: Index, manual toothbrushes, plaque, powered toothbrushes


How to cite this article:
Kallar S, Pandit I K, Srivastava N, Gugnani N. Plaque removal efficacy of powered and manual toothbrushes under supervised and unsupervised conditions: A comparative clinical study. J Indian Soc Pedod Prev Dent 2011;29:235-8

How to cite this URL:
Kallar S, Pandit I K, Srivastava N, Gugnani N. Plaque removal efficacy of powered and manual toothbrushes under supervised and unsupervised conditions: A comparative clinical study. J Indian Soc Pedod Prev Dent [serial online] 2011 [cited 2017 Aug 23];29:235-8. Available from: http://www.jisppd.com/text.asp?2011/29/3/235/85832



   Introduction Top


Dental plaque is defined as soft deposits that form a biofilm adhering to the tooth surface in the oral cavity, including removable and fixed restorations. [1] Dental plaque has been considered a direct cause of gingival and periodontal diseases. Plaque is also capable of reducing the pH at the surface of enamel to the levels that can cause dissolution of the hydroxyapatite crystals and initiates caries.

Good plaque control facilitates good gingival and periodontal health, prevents tooth decay and preserves oral health for a lifetime. [1]

Plaque control can be achieved by either mechanical or chemical means. However, mechanical plaque control remains the mainstay for prevention of dental diseases, with chemotherapeutic agents acting as an adjunct to it. The mechanical methods of plaque removal are tooth brushing, flossing, and use of interdental cleansing devices, while the various chemical methods include the use of mouthrinses, dentifrices, enzymes, and antimicrobial mouthwashes.

Various designs of toothbrushes have been recommended to enhance mechanical removal of dental plaque. Two types of brushes are widely used, manual and powered toothbrush.

In spite of brushing being the most accepted method of plaque removal, still its efficacy depends on the type of brush, method of brushing, ideal time to brush, individual having an effective technique of brushing and time taken to achieve a fast learning curve in effective handling of the toothbrush under supervision. [2]

Aims and objectives

To determine the efficacy of powered and manual toothbrushes.

To compare the efficacy of manual and powered brushes under supervised and unsupervised conditions.


   Materials and Methods Top


Two hundred school-going children of age group between 6 and 13 years were selected for the study. They were randomly divided into two groups comprising 100 students each according to the brush used. Each group was further subdivided into two subgroups which comprised 50 students each; one group was supervised for brushing while the other group was left unsupervised.

At 3, 6, 9 and 12 weeks, plaque was recorded according to Turseky-Gilmore-Glickman modification of Quingley Hein index and oral hygiene performance index. Data were statistically analyzed.


   Observations and Results Top


The results are shown in [Table 1],[Table 2],[Table 3],[Table 4],[Table 5],[Table 6].
Table 1: Mean values of reduction in plaque score from baseline to 12 weeks (for powered group)

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Table 2: Mean values of reduction in plaque score from baseline to 12 weeks (for manual group)

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Table 3: Mean values of reduction in plaque score from baseline to 12 weeks (for powered supervised group)

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Table 4: Mean values of reduction in plaque score from baseline to 12 weeks (for powered unsupervised group)

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Table 5: Mean values of reduction in plaque score from baseline to 12 weeks (for manual supervised group)

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Table 6: Mean values of reduction in plaque score from baseline to 12 weeks (for manual unsupervised group)

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The [Table 1] shows the mean plaque reduction score with Turseky-Gilmore-Glickman modification of Quingley Hein plaque index (S) for powered group to be 1.03 ± 0.1269. Similarly, with Silness and Loe Plaque index (P), it was 0.82 ± 0.1011, and with patient's oral hygiene performance index, it was 1.53 ± 0.2072.

The [Table 2] shows the mean plaque reduction score with Turseky-Gilmore-Glickman modification of Quingley Hein plaque index (S) for manual group to be 0.67 ± 0.0853. Similarly, with Silness and Loe Plaque index, it was 0.54 ± 0.0957, and with patient's oral hygiene performance index, it was 0.99 ± 0.211.

The [Table 3] shows the mean plaque reduction score with Turseky-Gilmore-Glickman modification of Quingley Hein index (S) for powered supervised group to be 1.14 ± 0.0530. With Silness and Loe plaque index (P), it was 0.9 ± 0.0512. Similarly, with patient's oral hygiene performance index (H), it was 1.68 ± 0.0131.

The [Table 4] shows that the mean plaque reduction for powered unsupervised group was 0.920 ± 0.0697 using Turseky-Gilmore-Glickman modification of Quingley Hein index (S). Similarly, the mean plaque score at baseline using Silness and Loe plaque index (P) was 0.73 ± 0.0578, and with patient's oral hygiene performance index, the mean plaque reduction was 1.38 ± 0.1781.

The [Table 5] shows the mean reduction scores with Turseky-Gilmore-Glickman modification of Quingley Hein plaque index (S) for manual supervised group to be 0.73 ± 0.0317. Similarly, with Silness and Loe plaque index (P), it was 0.6 ± 0.0558, and with patient's oral hygiene performance index (H), the mean plaque reduction was 1.12 ± 0.1658.

The [Table 6] shows the mean reduction scores with Turseky-Gilmore-Glickman modification of Quingley Hein plaque index (S) for manual supervised group to be 0.60 ± 0.0677. Similarly, with Silness and Loe plaque index (P), it was 0.47 ± 0.0837, and with patient's oral hygiene performance index (H), the mean plaque reduction was 0.87 ± 0.1741.


   Discussion Top


Numerous clinical studies have shown a direct relationship between oral hygiene status, the quality of plaque, and the prevalence and severity of periodontal diseases. [3]

Plaque control is the removal of dental plaque on a regular basis and the prevention of its accumulation on the teeth and adjacent gingival surfaces. It is a critical component of dental practice, permitting long-term success of periodontal and dental care. [1]

Plaque control can be achieved by either mechanical or by chemical means. However, according to Weijden, mechanical plaque removal remains the mainstay for prevention of dental diseases, with chemotherapeutic agents acting as an adjunct to it. [3]

Mechanical plaque control is done by daily cleaning with toothbrush and other oral hygiene aids. Tooth brushing is an effective means of removing plaque, thereby preventing gingivitis and, to some extent, controlling dental caries. [4]

Various designs of toothbrushes have now been recommended to enhance the mechanical removal of dental plaque. The high prevalence and severity of dental diseases indicates that tooth brushing, as a basis of prevention, is inadequately performed (Lilenthal, Amerena and Gregory 1965; Alexander 1970).

The types of brushes are manual, powered, ionic and sonic brushes. For hand brushing (manual) to be effective, a certain degree of manual dexterity is required. A number of investigations showed that children are generally not capable of obtaining a sufficient oral hygiene level by manual brushing due to their underdeveloped motor skills, lack of knowledge about oral hygiene and effective brushing, less amount of time spent on brushing than recommended or a combination of these. [5] Hence ,ionic and powered brushes have been introduced to facilitate tooth cleaning and improve the oral hygiene of the patient.

According to Axelesson and Lindhe et al. (1981), meticulous plaque removal by patient under regular supervision results in a major reduction in dental diseases. [6]

Hence, the aim of the present study was to compare the efficacy of powered and manual brushing under supervised and unsupervised conditions. Those in the supervised group were given instructions for brushing and those in the unsupervised group were told to brush as before.

The efficacies of the two brushes were compared using Plaque index (modification by Loe 1967), Turseky-Gilmore-Glickman modification of Quingley Hein index and patient's oral hygiene performance index.

Both the brushes significantly reduced the plaque accumulation, though to different degrees. Similar results were obtained from the study conducted by Lazarescu et al., [2] Jongenelis, [7] Martin et al. (1987), Baab and Johnson, [8] and Preber et al. (1991).

The results of our study differ from those reported by William et al., [9] in which they compared the effectiveness of an electric brush and a regular hand brush in preventing or removing dental plaque and concluded that both brushes were equally effective in removing plaque.

In this study, the powered supervised group showed significantly more plaque reduction as compared to the manual group. The result probably can be attributed to a better understanding of hygiene requirement by the children, the use of better brushes than those used previously, and also to Hawthrone effect (because of participation in the study) (Ainamo et al. 1997).


   Conclusion Top


Both brushes significantly reduced the plaque accumulation, though to different degrees. The powered group showed significantly more plaque reduction as compared to the manual group. The supervised group of both manual and powered brushes showed a greater plaque reduction than the unsupervised group. The degree of efficacy of the two brushes in plaque reduction in decreasing order could be summarized as: powered supervised > powered unsupervised > manual supervised > manual unsupervised.

 
   References Top

1.Nikiforuk G. Understanding dental caries, prevention basic and clinical aspect, New York, Karger publication; 1985.  Back to cited text no. 1
    
2.Lazarescu D, Boccaneala S, Illiescu A, De Boever JA. Efficacy of plaque removal and learning effect of a powered and a manual toothbrush. J Clin Periodontol 2003;30:726-31.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Rugg -Gunn AJ, Macgregor ID. A survey of toothbrushing behaviour in children and young adults. J Periodontol Res 1978;13:282-9.  Back to cited text no. 3
    
4.Ainamo J, Xie Q, Ainamo A, Kallio P. Assessment of the effect of an oscillating /rotating electric toothbrush on oral health.A 12 month longitudinal study. J Clin Periodontol 1997;24:28-33.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Mentes A, Atukeren J. A study of manual toothbrushing skills in children aged 3-11 yrs. J Clin Pediatr Dent 2003;27:91-4.  Back to cited text no. 5
    
6.Newman MG, Takei HH, Carranza AF. Clinical Periodontology, 9 th ed. ,Philadelphia, Saunders Company; 2003.  Back to cited text no. 6
    
7.Jongenelis AP, Wiedemann W. A comparison of plaque removal effectiveness of an electric versus a manual toothbrush in children. ASDC J Dent Child 1997;64:176-82,165.  Back to cited text no. 7
[PUBMED]    
8.Baab DA, Johnson RH. The effect of a new electric toothbrush on supragingival plaque and gingivitis. J Periodontol 1989;60:336-41.  Back to cited text no. 8
[PUBMED]    
9.Williams AS, Ash M. A clinical evaluation of an electric toothbrush. J Periodontol 1964;35:127-36.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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