Australasian Dentist Magazine March April 2021

Category Australasian Dentist 49 Deacon et al. [2010] reported in an extended systematic review that no definitive conclusions can be drawn regarding the superiority of one type of powered toothbrush over another. The safety of power toothbrushes has been clearly established, and daily use of a power toothbrush is at least as safe as a manual toothbrush. The use of a powered toothbrush, which employs a mechanical action instead of a manual one, reduces brushing force and the incidence of gingival bleeding because of gum damage [He et al., 2001; Boyd, 1997]. In addition, power toothbrushes have been shown to be well received and improve compliance in orthodontic patients [Silvestrini Biavati et al., 2010]. A particular type of electric toothbrush is based on sonic energy; McInnes et al. [1992] showed that plaque bacteria can be removed using this technology. Sonicare toothbrush operates at a frequency of 260 Hz: the brush head oscillation produces a bristle tip velocity that, when inserted in a fluid/air environment creates turbulent fluid and bubble activity and associated shear forces. There is evidence, in vitro, that fluid activity assists in removal of both plaque and stain [Khambay and Walmsley, 1995]. The aim of this study was to compare the plaque removing efficacy of two different toothbrushes in a population unfamiliar with sonic toothbrushes and to collect and analyse data regarding oral hygiene habits. The null hypothesis tested was that sonic toothbrush is able to remove a superior amount of plaque compared to the manual conventional toothbrush. Materials and methods Study population A total of 40 healthy young adults males and females (18 men and 22 woman; mean age, 24±3.5; range 18-32 years) volunteered to participate to this study. Screening and selection of subjects were performed randomly out of the patients of the Department of Oral Rehabilitation from the Istituto Stomatologico Italiano, University of Milan, Italy. A single investigator explained the objectives of the research; inclusion and exclusion criteria applied for all participants are reported in Table 1. Study design A single-cohort, crossover clinical trial [McCracken et al., 2005], single blind, 2 treatments, 3-week total observation time was conducted. The study was approved by the local ethics committee and complied with the requirements of the Declaration of Helsinki. Materials The Philips Sonicare DiamondClean 300 Series (Philips Oral Healthcare Inc., USA) toothbrush and the Butler Gum 409 Compact Soft (Sunstar America Inc., USA) manual brush were used. The BioRepair Plus (Coswell Farma, Italy) fluoride toothpaste was provided to all subjects during the whole test period. Plaque was disclosed using a Ivoclar Plaque Test indicator liquid (Fluorescin disodium salt < 1 wt.%, glycerine, distilled water) (Ivoclar Vivadent AG, Liechtenstein) in association with a LED light curing unit (Valo Cordeless, Ultradent products Inc., USA). Procedure For each patient enrolled in the study, 3 appointments were scheduled one week apart, using the following scheme: Baseline (T0); Week 1 (T1); Week 2 (T2). Baseline (T0) After a study description refresh, all subjects provided informed consent to participation. Two educational movies were shown individually to all participants; the first one illustrated the modified Bass technique for the manual toothbrush while the second explained the propermode of use for the sonic toothbrush (manufacturer’s usage instructions). No specific interdental cleaning aids were used. Patients were invited to replicate demonstrated movements on an oral model. Then a questionnaire was given to collect demographic data (gender, age), oral health and economical information, habits regarding oral hygiene (use of mouthwashes, floss, checkups, toothbrush knowledge and preferences). The form is reproduced in Figure 1. In the questionnaire, the strength or magnitude of preference for manual and TABLE 1 Inclusion and exclusion criteria applied for the selection of participants. sonic toothbrushes was recorded by means of a Willingness to Pay (WTP) analysis: this was performed by asking patients the maximum amount of money they would spend for a specific oral care device. The measurement of patient preferences by WTP index is frequently used in medicine since it might be helpful when dealing with decisions in health economics [Augusti et al., 2013]; this type of analysis is also considered important for an evaluation of patients’ perspectives regarding dental preventive measures (like hygiene procedures) or treatments. WTP was also elicited for an in-office professional hygiene session. The intraoral examination was followed by professional prophylaxis [Turesky et al., 1970]. The following appointment was planned at one week. Volunteers were asked to refrain from all oral hygiene measures 23–25 h prior to the appointment and to refrain from eating, drinking or smoking in the preceding 4 h. Week 1 (T1) At T1 and T2, participants received an oral examination of hard and soft tissues Fig 1 The questionnaire INCLUSION CRITERIA EXCLUSION CRITERIA Good general health Bad oral health: caries, periodontal diseases or oral lesions. Minimum of 24 natural teeth. A history of rheumatic fever, AIDS, leukemia, cirrhosis, sarcoidosis, diabetes mellitus, hepatitis, or any medical condition requiring consultation or drug therapy. Subjects that reported brushing Any physical condition that limits manual dexterity required for at least once daily. toothbrushing. Never used a sonic power A present history of medications that are likely to affect oral toothbrush before. health. Antibiotic usage during the two months preceding the study Fixed orthodontic appliances Removable dentures or extended fixed prosthesis clinical