Australasian Dentist Magazine March April 2021

Category Australasian Dentist 51 number of subjects (3/40) reported to use an electric (rotating-oscillating) device; additional aids (like mouthwashes or dental floss) for optimisation of home oral hygiene procedures were also moderately adopted by approximately 50% of patients. Despite the studied population (young adults with a mean age of 24 years) being supposedly familiar with current internet technologies, very low consideration for online shopping in order to buy a toothbrush was recorded, stores and pharmacies, followed by direct purchase from the family dentist, were preferred. Assigned mean WTP values for manual and sonic tested toothbrushes were of € 4.83 ± 3.86 and of € 54.75 ± 36, respectively. For a professional hygiene session the mean economic effort declared by patients was € 77.6 ± 25, with no significant difference (p>0.05) detected between male (76.39 ± 30) and female (78.64 ± 22) subjects. Discussion The process of maintaining good oral hygiene depends on the ability and motivation of individual patients [Ferrazzano et al., 2008]; it is helped by the use of an efficient modern toothbrush [Claydon and Addy, 1996]. Both manual and power toothbrushes have increased the ability to remove plaque, although the effectiveness of manual toothbrush is still limited by manual dexterity and skill of the user [Heasman, 2001]. Power toothbrushes have partially overcome this limitation with the added advantage of simplifying the brushing technique and increasing the motivation to brush regularly. The aimof our study was to investigate data collection within a cross-over design of clinical trial using efficacy of plaque removal as the primary outcome measure. There are a number of advantages in using crossover design clinical trials: the subjects act as their own controls; moreover, an increase in efficiency and precision is obtained and the sample size is usually lower than for comparable parallel group design [McCracken et al., 2004; McCracken et al., 2005; Piantadosi, 1997]. Reports in the literature have consistently demonstrated that powered toothbrushes with rotation- oscillation mechanisms deliver superior plaque removal compared to manual toothbrushes. The efficacy of sonic toothbrushes has been demonstrated in several clinical and in vitro studies [Stanford et al., 1997; Zimmer et al., 2000] and may be explained by the fluid dynamic activity. The authors showed in their in vitro study that the Sonicare could remove 56- 78% of plaque from enamel specimens at a distance of 3 mm between the dental surface and bristles [Stanford et al., 1997]. This clinical trial was clinically designed to assess the efficacy of brushing alone, in the absence of additional cleaning tools such as flossing. Results from the present study showed that the tested sonic device was safe and effective in removing plaque from whole mouth compared to the manual toothbrush: a significant additional 10% reduction was found for subjects without any previous use or familiarisation with the sonic technology. Based on our results, the correct use of an electric brush do not seem to be more difficult at first trial compared to a manual toothbrush; as demonstrated by Lazarescu et al. [2003], after providing proper instructions, subjects rapidly developed an effective brushing technique with a short learning curve. Our study model did not consider a minimum plaque index score as an inclusion criterion and we reported a mean baseline PI value of 1.82. This is in accordance with the demographic analysis: regular dental checkups and in- office professional hygiene sessions were reported by the majority of patients. Our data showed an overall extremely positive attitude of the population towards oral care and prevention. For these reasons, it would be inappropriate to extrapolate the results of this study to make any assumptions regarding tooth brushing efficacy in the general population (that may shows different/higher plaque levels) [McCracken et al., 2005]. The obtained financial information revealed that patients established higher mean WTP values for the sonic brush compared with the traditional brush (54.75 vs. 4.83); however, the estimated price for the power device was lower than its current commercial value. This study did not compare long-term use or clinical outcomes such as bleeding and gingivitis. Power toothbrush studies showing significant reduction in plaque have also shown significant reduction in periodontal indexes [Zimmer et al., 2000]. Considering the present research, we did not evaluate residual plaque levels at proximal surfaces after brushing: however, other studies have found the ability of power brushes to reduce plaque levels also in difficult-to-reach tooth areas [Sharma et al., 2006]. Additional studies measuring long- term use and clinical outcomes are needed for this new sonic toothbrush; claimed advantages beyond plaque removal efficacy, like abrasion features or the effects on dentin sensitivity, should be further investigated. Conclusion The tested null-hypothesis has been accepted. In subjects without any previous experience of a similar technology, the single use of the sonic toothbrush showed significant greater reduction in plaque compared to the manual traditional toothbrush. u Email gapmagazines@optusnet.com.au for the references to this article. E-mail: davide.augusti@unimi.it Fig. 3 Baseline (A) and post-brushing (B) recordings of plaque index by gender (F: Female; M: Male). Fig. 4 Plaque index reductions for the tested manual and sonic toothbrushes. clinical