Australasian Dentist Magazine March April 2021

Category 48 Australasian Dentist Introduction Mechanical removal of bacterial plaque is the most efficient method to control conditions such as dental caries, gingivitis, and for prevention of progressive periodontal disease [Mandel, 1966; Theilade et al., 1966]. However, it has been reported that daily brushing only partially removes plaque deposits [Warren et al., 1998]. Regular plaque removal with a manual toothbrush represents the most frequently used method of oral hygiene in Western society. Whenused correctly and for a sufficient period of time, the manual toothbrush efficiently removes supragingival plaque [Pizzo et al., 2010; Saxer and Yankell, 1997]. Dental caries, an oral health problem strictly related to inefficient plaque removal, is influenced by several variables: social status, geographical area, and age [Campus et al., 2007]. In most individuals plaque scores are reduced approximately by 50% during manual toothbrushing [Pizzo et al., 2010]. Current data suggests that a simplification of home dental hygiene procedures might be useful. To improve plaque removal different designs of manual and powered toothbrushes were introduced over the past 40 years [Kiche et al., 2002; McInnes et al., 1992]. According to Terezhalmy et al. [2005], the powered toothbrushes were found to deliver greater plaque removal by 42.4% and 28.2% compared to the control manual toothbrushes; Lazarescu et al. [2003] have shown that, after 3 weeks of use, the powered brush was significantly more efficient than the manual brush in the group of subjects unfamiliar with electric devices. In recent literature, four main types of powered toothbrushes are available, based on their mechanism of action: side to side, counter-oscillation, rotationoscillation, circular [Heanue et al., 2003; Robinson et al., 2005]. Is a new sonic toothbrush more effective in plaque removal than a manual toothbrush? By D. Re*, G. Augusti*, D. Battaglia*, A.B. Giannì**, D. Augusti* * Division of Oral Rehabilitation Istituto Stomatologico Italiano, University of Milan, Italy ** Maxillo-Facial and Odontostomatology Unit Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, Milan. Abstract Aim Powered or manual toothbrushes are daily used instrument in the Western area for the control and removal of bacterial biofilm. Among powered toothbrushes, sonic technology has shown to produce fluid turbulent activity that might assist in plaque removal; however, limited knowledge is available invivo. The objectives of this study were to compare the plaque removal efficacy of two different toothbrushes in a population not familiar with sonic technology, and to collect and analyse data regarding oral hygiene habits. The null-hypothesis was that a sonic toothbrush is able to remove a superior amount of plaque compared to the manual type. Materials and methods Forty young adult patients were enrolled in the study. A single-cohort crossover clinical trial was designed. For each patient, three appointments were scheduled: the first (T0) was used for oral care education and explanations of toothbrushes techniques, for a preliminary professional hygiene session, and for delivery of a questionnaire; at one week (T1), plaque evaluation was performed (Turesky modification of the Quigley and Hein index) at baseline and after asking patients to brush with the randomly selected manual or sonic device. At the last appointment (week 3, T2), the same plaque evaluations of T1 were repeated asking patients to brush with the other toothbrush. Entire mouth indexes were calculated and mean reductions in whole mouth plaque scores were obtained (pre-brushing minus post-brushing values) for the two tested toothbrushes. Multiple ANOVA tests (p=0.05) were used 1) to compare plaque levels between male and female subjects at baseline and post-brushing, regardless the type of toothbrush, and 2) to differentiate between mean reductions in whole mouth plaque scores according to the type of toothbrush (manual versus sonic). The study population was subjected to descriptive statistical analysis; potential relationships between socio- demographic variables and obtained plaque scores were evaluated (Mann-Whitney and Kruskal-Wallis tests). Results Full-mouth plaque levels were reduced at post-brushing sessions, regardless the device, by approximately 62% (p<0.0001). Mean plaque index reductions for manual and sonic toothbrush were of 1.05 ± 0.22 and 1.19 ± 0.37, respectively. A statistically significant difference was found between the two devices (p=0.0342). The powered sonic toothbrush removed about 10%more plaque than the manual type. From the collected questionnaire financial data, willingness to pay (WTP) values expressing economic efforts of patients for the purchase of toothbrushes were of € 4.83 ± 3.86 and of € 54.75 ± 36, for the manual and sonic devices, respectively. Conclusion Within the limitations of the study, in subjects without any previous experience of a similar technology, the single use of the sonic toothbrush showed a significantly greater plaque reduction compared to the manual traditional toothbrush (nullhypothesis accepted). Keywords Efficacy, In-vivo clinical trial, Oral habits, Plaque removal, Sonic toothbrush. clinical