JICDRO is a UGC approved journal (Journal no. 63927)

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ARTICLE
Year : 2009  |  Volume : 1  |  Issue : 2  |  Page : 1-6

Clinical evaluation of a newly designed orthodontic tooth brush - A clinical study


1 Professor, Department of Periodontics, C.S.M. Medical University, Lucknow, India
2 Professor & H.O.D., Department of Orthodontics, Maulana Azad Dental College, New Delhi, India
3 Professor & H.O.D., Department of Orthodontics, Ram Dental College, Hospital & Research Center, Kanpur, India
4 Assistant Professor, Department of Periodontics, C.S.M. Medical University, Lucknow, India

Date of Web Publication4-Mar-2011

Correspondence Address:
C S Saimbi
Professor, Department of Periodontics, C.S.M. Medical University, Lucknow
India
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Source of Support: None, Conflict of Interest: None


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   Abstract 

In this study, a clinical trial was conducted with a newly designed orthodontic tooth brush, on ten subjects having fixed orthodontic appliances. In this newly designed tooth brush, the bristles of anterior portion of the head of the tooth brush are elongated and tapered towards the tip of the bristles and rest of the bristles are shorter than the anterior bristles. The inner bristles are further shorter than outer bristles row, providing a groove in the center of the brush. This groove is designed to engage the brackets. The elevated anterior bristles portion of the brush gets engaged in interproximal areas and cleans these areas.
In this study, the newly designed orthodontic tooth brush is compared with an ordinary tooth brush. Results of this study show that the newly designed orthodontic tooth brush is superior in its cleaning efficiency as compared to the ordinary tooth brush. The results show that plaque removing capacity of orthodontic tooth brush is nearly 95-99%.


How to cite this article:
Saimbi C S, Thulika J, Mehrotra A K, Shalini K. Clinical evaluation of a newly designed orthodontic tooth brush - A clinical study. J Int Clin Dent Res Organ 2009;1:1-6

How to cite this URL:
Saimbi C S, Thulika J, Mehrotra A K, Shalini K. Clinical evaluation of a newly designed orthodontic tooth brush - A clinical study. J Int Clin Dent Res Organ [serial online] 2009 [cited 2019 Oct 22];1:1-6. Available from: http://www.jicdro.org/text.asp?2009/1/2/1/77270


   Introduction Top


Maintenance of good oral hygiene has always been a problem in the normal dentition because of the inaccessible areas on the tooth surfaces where plaque and calculus are frequently deposited, leading to various periodontal problems. In patients undergoing fixed orthodontic appliance therapy, the situation becomes more grave as the fabrication of the bands, attachments like brackets, tubes, cleats, hooks and wires create new retentive areas where food is lodged frequently. These are artificially created retentive spaces near the gingival margin which do not have self cleansing properties, so most food particles and debris are deposited in interdental areas and between the marginal gingiva and around the band. These areas are most important as periodontal problems start from the interproximal areas [2] .

Several mechanical aids and chemical agents [3] are used to check the inflammation from the interproximal areas. But these measures are not very effective in maintaining the good oral hygiene of these areas. In fixed orthodontic appliance bearing patients, maintenance of oral hygiene is more difficult. Many different designs of orthodontic tooth brushes are available for maintaining the proper dental health of fixed orthodontic patients but none of the available orthodontic tooth brushes achieve optimal oral hygiene. Keeping in mind this lacuna, in the present study a new orthodontic tooth brush is designed.


   Materials and Method Top


A new orthodontic tooth brush was designed to improve the oral hygiene status of the patients undergoing orthodontic treatment with fixed appliances. The design of this new tooth brush was as under.

Design Of The Tooth Brush

  1. Bristles of middle two rows of a conventional tooth brush (soft) were cut in one plane, 3 mm shorter than the peripheral ones. Only seven posterior tufts were incorporated. In this way a rectangular box type groove was formed [Figure 1].
    Figure 1: A box type groove for the placement of orthodontic braces while brushing

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  2. Seven posterior tufts of peripheral rows were also cut short by 1 mm, so that it remained only 2 mm longer than the 2 central rows.
  3. Tip of the brush comprising of 3 anterior rows of 4 tufts each was cut in such a circular fashion that the bristles of middle two rows on second line were longest. Other bristles of the peripheral rows went on decreasing in height till they were 2 mm shorter than the longest central bristles [Figure 2].
Figure 2: The toe of the brush having pyramidal shape of cleaning the interproximal spaces

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   Clinical Trials Top


Ten subjects (both male and female in the age group of 14-22 years) undergoing treatment with upper and lower edgewise appliance were enrolled from Department of Orthodontics, King George's University of Dental Sciences, Lucknow, India for the clinical trials with this newly designed tooth brash. Only those subjects were selected for this study who did not have severe gingivitis and periodontal disease prior to commencement of orthodontic treatment.

This study was conducted in two phases. In phase I, plaque removing efficacy of ordinary tooth brush was observed. In phase II, the effect of newly designed orthodontic tooth brush was studied.

At the beginning of Phase I clinical trial, the dentition of all subjects were made plaque free by thorough oral prophylaxis. After achieving zero plaque score all the subjects were instructed to abstain from tooth brushing and use of any other mechanical and chemical oral cleansing aid for 3 consecutive days (72 hours).

At the end of this period, the total plaque deposit was disclosed by Bismarck brown disclosing solution and scored by the Turesky-Gilmore-Glickman Modification of The Quigley and Hein plaque index[4].This scored plaque served as base line for the clinical trial. Before starting the experimental trial all the subjects' dentition were made plaque free and they were supplied ordinary soft tooth brush. They were advised to brush their teeth once a day in the morning after waking up for three days. After three days experimental plaque was disclosed and scored by the above method. This was the plaque which could not be removed in the phase I study.

In Phase II clinical trial, the newly designed orthodontic tooth brush was used after one week of the phase I study. Before starting the experiment with the newly designed orthodontic brush, all the subjects' dentition were made plaque free and they were supplied with the newly designed orthodontic tooth brush for brushing for 3 days. They were advised to brush in their own technique once a day in the morning and on the 4th day experimental plaque was scored by the above method. This left over plaque could not be removed with newly designed orthodontic tooth brush.


   Statistical Analysis Top


The mean score of the base line plaque and the experimental plaque of each subject was calculated for both the phases. % plaque removing efficacy of both the brushes in each subjects was calculated. The mean plaque scores of individual subjects were used to evaluate the effectiveness of both the brashes in removing plaque. The t-test was used to evaluate the difference in effectiveness of ordinary tooth brash Vs the newly designed orthodontic tooth brash.


   Results Top


Mean baseline plaque scores and experimental plaque scores of ordinary tooth brash and newly designed orthodontic tooth brash is shown in [Table 1]. Base line plaque score of all the ten subjects of phase I and phase 11 is almost the same but the mean experimental plaque score with newly designed orthodontic tooth brash was very low ranging from 0.02 to 0.13, whereas mean experimental plaque score after brushing with ordinary tooth brush was much higher than the phase II experimental plaque ranging from 0.73 to 1.67.

Percentage plaque removal by both the brushes is also depicted in [Table 1]. Better result was achieved with orthodontic tooth brush which is 99% percent in most of the patients. Plaque removing efficacy of ordinary tooth brush was much lower, ranging from 64.47% to 78.86%. There was no evidence of dislodgement of fixed appliance and any soft tissue injury with phase I and II brushes. The superior cleansing effect of newly designed orthodontic brush is demonstrated. Data of both the phases were analyzed statistically and t-test was performed on the mean average of all the subject plaque index [Table 2]. Phase I plaque index was treated as control and phase II plaque index as experimental plaque. Statistical analysis showed highly significant difference in plaque reduction at the 0.001 level.
Table 1: Baseline and Mean Plague Scores of Ordinary Toothbrush and Newly Designed Tooth brush

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Table 2: Comparison of Mean Plague Inhibitory Effect in Phase I and II

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   Discussion Top


Oral hygiene is greatly complicated for patients following the placement of a full-banded orthodontic appliance. In the present study, significantly lower plaque scores were demonstrated for the newly designed tooth brush as compared to the ordinary tooth brush.

The configuration of the bristles in the new brush was done in such a manner that it had a better cleaning ability especially in the interdental space and the area around the band and bracket. The middle two rows were cut 2 mm short of the peripheral bristles so as to form a rectangular box type groove. The tooth brush could snugly fit over the bracket and other accessories and the food debris could be removed simultaneously from the bracket and the adjacent tooth surfaces both cervically and incisally. If the bristles of the middle two rows were not reduced in height, the peripheral bristles would also not come in proper contact with the tooth surface.

The toe region of the tooth brush was designed in a pyramidal fashion. The bristles of the middle two rows on the second line remained longest of all the bristles on the brush as the posterior peripheral ones were also reduced in height by 1 mm. During placement of the brush the longest bristles of the toe are engaged in the interproximal space, brackets are engaged in the homogenous rectangular groove and the peripheral bristles of the posterior part came in contact with the incisal and cervical part of the teeth and band [Figure 3].
Figure 3: The placement of newly designed orthodontic toothbrush in the patient mouth

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Thus, the lower plaque scores by using the newly designed tooth brush could be attributed to the better adaptation of the bristles on to the orthodontic appliances and tooth surface, thereby increasing the cleaning ability of the new brush.

Although gingival inflammation was not scored, there appeared to be a general improvement of gingival health with the experimental brush. This would be consistent with the result as plaque is decreased, so is inflammation.


   Conclusions Top


The following conclusions were drawn from the present study.

  • The newly designed orthodontic tooth brush was found to be superior in its cleaning efficiency when compared to the ordinary toothbrush.
  • The mean change in the plaque inhibitory effect was found to be highly significant between the two groups.


 
   References Top

1.Bay, I; Kardel, K.M.; Skaugaard, M. Quantitive evaluation of the plaque-removing ability of different types oftooth brushes. J Peridontol 1967; 38:526-533.  Back to cited text no. 1
    
2.Carranza, F.A. : Glickman's Clinical Periodontology 9th ed., W.B.Saunders Co., Philadelphiya,1990.  Back to cited text no. 2
    
3.Newburn ,E: Chemical and mechanical removal of plaque: Comp Continue Educ. Dentis . Suppl. 1985;6:110-116.  Back to cited text no. 3
    
4.Turesky, S., Gilmore, N .D. and Glickman, I: Reduced plaque formation by the chloromethyl analogue of victanine. J Periodontal 1970; 41:41.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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  In this article
    Abstract
    Introduction
    Materials and Method
    Clinical Trials
    Statistical Analysis
    Results
    Discussion
    Conclusions
    References
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