Table of Contents      
ORIGINAL RESEARCH
Year : 2018  |  Volume : 10  |  Issue : 1  |  Page : 12-16

Efficacy of oscillating – Rotating toothbrush (Oral –B) on periodontal health - A 4 week controlled clinical and microbiologic study


1 Department of Dentistry, Max Super Speciality Hospital, New Delhi, India
2 Department of Interventional Cardiology, Max Super Speciality Hospital, New Delhi, India

Date of Web Publication6-Jul-2018

Correspondence Address:
Dr. Sangeeta Dhir
1079, Sector 17, Faridabad, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_32_17

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   Abstract 


Aims: The aim of this study was to compare the efficacy of a powered toothbrush and manual toothbrush on the periodontal and microbial parameters. Settings and Design: This was a 4-week investigator-blinded, single-center, parallel group study. Subjects and Methods: A total of 120 participants were selected and assigned to one of the two toothbrush groups: study group (power toothbrush – Oral-B® CrissCross®) and control group (Oral-B® manual toothbrush). At baseline, gingival status, plaque, and bleeding on probing levels were recorded for the plaque index, gingival index, and bleeding index, respectively. Evaluation of the intraoral soft tissue for safety and clinical parameters was done for plaque, gingival status, and bleeding scores prior to the start of the study (i.e. baseline) and on the 28th day of the study. Statistical Analysis: Two-tailed statistical analyses were performed with a significance level set at P ≤ 0.05 and calculated using SPSS software. Changes in the clinical parameters (plaque index, gingival index, and bleeding index) were calculated using paired t-test. Comparisons between the powered and manual toothbrushes were performed using unpaired t-test. Analysis of categorized data (questionnaire) was done by Fisher's exact test. Results: Clinical parameters were recorded at baseline and on the 28th day. Reduction in plaque, gingival, and bleeding indexes for powered toothbrush was 89%, 85%, and 93% and for manual toothbrush it was 68%, 75%, 72% respectively. A significant reduction was observed in the plaque scores before and after brushing with both the manual and electric brushes. There was no clinically significant soft-tissue abrasion noticed in either of the groups. Preference analysis showed an increased preference for the electric toothbrush over the manual toothbrush. Conclusions: This study concluded that the oscillating-rotating technology as incorporated in the electric toothbrush had statistically significant results over the manual toothbrush and was found to be a safe and effective toothbrush for long-term use.

Keywords: Electric toothbrush, oscillating-rotating brush, periodontal health, powered brush


How to cite this article:
Dhir S, Kumar V. Efficacy of oscillating – Rotating toothbrush (Oral –B) on periodontal health - A 4 week controlled clinical and microbiologic study. J Int Clin Dent Res Organ 2018;10:12-6

How to cite this URL:
Dhir S, Kumar V. Efficacy of oscillating – Rotating toothbrush (Oral –B) on periodontal health - A 4 week controlled clinical and microbiologic study. J Int Clin Dent Res Organ [serial online] 2018 [cited 2018 Sep 20];10:12-6. Available from: http://www.jicdro.org/text.asp?2018/10/1/12/236095




   Introduction Top


Prevention has become the cornerstone of the modern dental practice, and plaque control (i.e., good effective personal oral hygiene) is the basic password to the meaningful practice of preventive dentistry. Intraoral cleaning devices have been a part of the human civilization since several years, and a strong correlation exists between the severity of the gingivitis and periodontitis and accumulation of dental plaque.[1] Toothbrush has been cited as the most effective and safest therapeutic device to remove plaque.[2] From numerous studies, it appeared that efficient plaque removal depended less on any specific method/type of brush than on an individual having an effective technique.[3] The conventional toothbrushes with their vertical bristles remove plaque from flat, accessible surfaces but are less effective at the gingival margins and in approximal areas, where the accumulation of plaque encourages gingivitis and deterioration of periodontal health. This proved an important stimulus for the development of the electric toothbrush which aimed to provide good technique independent of user's ability and manual dexterity. Fredrick Tronberg, a Swedish watchmaker, in 1885 designed the first mechanical toothbrush. The actual marketing of these brushes began in the 1960s.

Powered toothbrushes were presumed to be of much use for the special population; however, the technology innovation has rendered the new power brushes with greater efficacy and patient-pleasing features that enhance compliance. An Oral-B ® toothbrush, with oscillating-rotating (O-R) brush head, is marketed as Oral-B ® CrossAction (Procter & Gamble, Cincinnati, OH, USA). The power brush head design has an outer circular row inclined at +16° and an inner circular row inclined at −16°. The angulation of the filaments is for both the forward (clockwise) and backward (counterclockwise) motions of the O-R handle. This arrangement of the bristles allows the angled bristles for coupled short movements with a high number of directional turning points at a high frequency to optimize the removal of plaque. In addition, it also gives an effective application of shear forces for plaque disruption and removal. In this study, we hypothesize that powered toothbrushes help in improving the gingival health. The objective of the study was to compare the efficacy of powered (O-R) toothbrush over manual toothbrush in reducing the plaque and gingivitis scores over a 4-week period.


   Subjects and Methods Top


A 4-week investigator-blinded, single-center, parallel group study was conducted with 120 recruited participants, based on the selection criteria, in the average age group of 25–40 years (proportionate ratio of males and females). The study was carried out in accordance with the guidelines of Helsinki declaration of 1975, as revised in 2000. The study protocol was approved by the Institutional Ethics Committee, Max Super Speciality Hospital, New Delhi, India (reference: RS/MSSH/SKT-2/CARD/IEC/14-29). Written informed consent was taken from all the recruited participants. The study was registered with the Clinical Trials Registry of India. All recruited participants were healthy, with minimum 14 natural teeth and no evidence of gross neglect, extensive caries, or periodontal disease. At the baseline visit, participants were given an oral soft-tissue examination followed by an assessment of Turesky modification of Quigley Hein Plaque index (Vladimir)[4] with a minimum score of 1–2. Participants were excluded if they had received dental prophylaxis within 1 month prior to the start of the study and had serious medical condition, for example, diabetes, infectious diseases, cardiac pacemakers, pregnancy, or any physical condition limiting manual dexterity. The recruited participants were also instructed to abide by the study criteria of not participating in any other oral care study, to refrain from using nonstudy oral hygiene products for the duration of the study.

Powered sample size was determined with α = 0.05, using a two-sided test. The total sample size of 120 with 60 participants per group was estimated to provide 90% power difference between the two groups. Qualified participants were stratified according to their baseline plaque score of 1–2 (Ainamo and Bay, 1975)[5] [Turesky et al., 1970),[6] gingival index (Lobene et al., 1986)[7] and bleeding index. Plaque samples were collected for microbial assessments. Following oral prophylaxis, the co-investigator randomly assigned the participants to one of the two groups: Group 1: the O-R powered brush with angled crisscross bristles (Oral-B ® Professional Care 1000 with Oral-B ® CrossAction brush head (EB50) and a standard anticavity fluoride dentifrice (Colgate, Palmolive) and Group 2: the Oral-B ® manual toothbrush and the same anticavity fluoride dentifrice. Randomization for the participants was done with the flip of a coin (heads and tails). The co-investigator assigned toothbrush and the dentifrice to the participants with the instructions on oral hygiene and product usage (in accordance with the manufacturer's instructions). Verbal and written instructions were provided to all participants for brushing, that is, 2 min twice daily with their assigned products. The participants were scheduled to return for the 28th day (±2 days) assessments (clinical and microbiological). Before the scheduled visits, participants were asked to refrain from brushing for 12–14 h prior to their appointment and to bring their assigned products with them. At week 4 visit, all participants were asked to fill the preference questionnaire form. The safety assessment of the two brushing methods was done by visual examination of the soft and hard tissues at the baseline and at the end of the study.

Microbiological assessment

For collection of plaque sample, teeth were isolated with cotton rolls; supragingival plaque was carefully removed with a sterile scaler to prevent the contamination of the samples with saliva or supragingival plaque. For collection of plaque samples, paper point #20 taper (Dentsply, Maillefer, Ballaigues, Switzerland) was inserted slowly with a sterile dental tweezer into the sulcus till tissue resistance was met. The paper point was left for 20 s and was carefully removed without touching the adjacent unrelated tissues. The collected sample was suspended in 0.3 ml of 0.9% sterile sodium chloride (NaCl) solution for microbiological examination. Blood agar culture media was prepared by mixing a proportion of 4 g/100 ml of distilled water, boiled, and cooled at 45°C. Plaque samples were mixed with sodium citrate and transferred to the culture plates with sterile platinum loop. Agar plates were then incubated at 37°C for 48–72 h. Digital colony counter (CP 600 Plus, Phoenix, Araraquara, Brazil) was used to count the microbial colonies (colony-forming units [CFUs]/ml).

Statistical analysis

The study outcome variables as evaluated were changes in the mean clinical and microbiological parameters from baseline to the end of 4 weeks. All statistical analyses were two tailed with a significance level set at P ≤ 0.05 and calculated using SPSS software. Changes in the clinical parameters, that is, plaque, gingival, and bleeding indexes were calculated using paired t-test. Comparisons between the powered and manual toothbrushes were done using unpaired t-test. Analysis of categorized data (questionnaire) was done by Fisher's exact test.


   Results Top


The study participants comprised 65 (54.1%) males and 55 (45.8%) females. At baseline, the mean plaque, gingival, and bleeding indexes for powered brush were 2.72 ± 0.31, 2.46 ± 0.41, and 31.2 ± 20.8 and for manual brush were 2.76 ± 0.81, 2.51 ± 0.1, and 30.6 ± 17.2, respectively. On the 28th day (±2 days), the following clinical parameters were assessed: plaque, gingival, and bleeding indexes were 0.18 ± 0.21, 1.03 ± 0.01, and 1.52 ± 1.0 for powered brush and 1.61 ± 0.05, 1.85 ± 0.02, and 3.73 ± 3.2 for manual toothbrush, respectively. Statistically significant reduction in clinical parameters was observed with O-R brush when compared with manual brush (P< 0.001) [Table 1]. Percentage reduction for both the brushes on the clinical parameters (plaque, gingival, and bleeding indexes) was 89%, 85%, and 93% for powered brush, whereas it was 68%, 75%, and 72% for the manual brush, respectively [Table 2] and [Graph 1].
Table 1: Comparison of plaque index, gingival index, and bleeding index on the 28th day

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Table 2: Percentage reduction in plaque, gingival, and bleeding indexes between oscillating-rotating and manual brush at 4 weeks

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Baseline CFU units for powered and manual brushes were 179 ± 0.67 and 171 ± 0.72, respectively. Percentage reduction for the CFUs for electric brush was 51%, and for manual brush, it was 35%. Comparatively, powered brush presented a statistically significant reduction in the microbial count (P< 0.001) [Table 3] and [Graph 2]. Analysis of the questionnaire revealed that 81% preferred powered brush, whereas 19% preferred manual brush. There were no adverse events (soft- or hard-tissue trauma) observed in this study [Graph 3].
Table 3: Mean score in colony-forming units from baseline to the 28th dayMean CFUPercenta

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   Discussion Top


Toothbrushing has a key role in maintaining good oral hygiene, and it depends on a number of factors which include knowledge, manual dexterity, and motivation. Powered brushes simulate the manual motion of toothbrushes with lateral and rotary movements of the brush head.[8] Clinical studies with manual toothbrush have shown that most patients do not develop good brushing technique or do not brush for a required period of time, i.e., 1–2 min.[1],[4]

In this study, an advanced cross action O-R powered brush was compared to the manual toothbrush for its efficacy on the microbial levels and the corresponding impact on the periodontal parameters of health for a 4-week period. Plaque evaluations included assessments of whole mouth plaque assessment. Gingivitis reductions were evaluated using the noninvasive index of evaluating the gingival health, and the number of bleeding sites was assessed with probing. For all the three measures, the O-R power brush offered statistically significant benefits compared to the manual toothbrush (P< 0.001). Results of the comparative assessment between the two brushes presented a statistically significant reduction of 89% in plaque index, 85% in gingival index, and 93% in bleeding scores. The manual brush presented reduction of 68% in plaque index, 75% in gingival index, and 72% in bleeding scores. CFU percentage reduction was 51% for O-R brush and 35% for manual brush.

The result of this study corroborates with that of published studies. An 8-week clinical study comparing O-R brush with sonic brush revealed statistically significant results for O-R brush. Whole mouth, gingival margin, and approximal plaque reductions were 27.7%, 46.8%, and 29.3% greater, respectively, compared with that of the sonic brush, while the reductions in gingivitis, gingival bleeding, and the number of bleeding sites were 34.6%, 36.4%, and 36.1% greater, respectively, for the O-R brush than that for the sonic brush (P< 0.001). This study did not report any adverse events for either brush.[8] A 6-week clinical trial with the O-R brush showed a significant reduction in whole mouth and interproximal plaque.[9] A comparative study of O-R brush to sonic brush showed significantly greater reductions in plaque and gingivitis levels as compared to the sonic brush. Both brushes produced statistically significant mean whole mouth plaque reductions compared to baseline.[10] A comparative study of manual brush with the powered brush revealed a 7.9% significantly superior mean whole mouth plaque reduction relative to the manual brush control.[11]

A systematic review reported the clinical superiority of powered brushes on the plaque and gingivitis reduction when compared to that of manual brushes. This review showed a 21% reduction in plaque and 11% reduction in gingivitis at 3 months. This review also stated that the greatest body of evidence was in favor of O-R brushes which showed a statistically significant reduction in plaque and gingivitis at both short- and long-term duration.[12] Results of a randomized controlled trial comparing manual flat-trim toothbrush to the power toothbrush with distinct multidirectional cleaning action demonstrated statistically and clinically significantly greater levels of plaque removal and gingivitis reduction. The power toothbrush provided statistically significantly (P< 0.05) greater removal of plaque: whole mouth (131%), gumline (97.4%), and interproximal (220%), as well as reductions in gingivitis (400%) and gingivitis severity (320%) after 12 weeks of use.[13]


   Conclusions Top


Our study concluded that the oscillating-rotating Oral-B Crossaction powered toothbrush was effective and safe for long term use in maintaining the periodontal health.

Acknowledgment

The authors would like to convey their sincere thanks to Mr. DK Gupta for the statistical assessments and analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ray E, Thomas B, Wei S. Use of toothbrush in plaque control for children. In: Paediatric Dentistry-Scientific Foundations and Clinical Practice. USA: C.V. Mosby Company; 1982. p. 645.  Back to cited text no. 1
    
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Cancro LP, Fischman SL. The expected effect on oral health of dental plaque control through mechanical removal. Periodontol 2000 1995;8:60-74.  Back to cited text no. 2
    
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Saxer UP, Yankell SL. Impact of improved toothbrushes on dental diseases. I. Quintessence Int 1997;28:513-25.  Back to cited text no. 3
    
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Vladmir WS. Epidemiology of gingival and periodontal diseases. In: Clinical Periodontology, Carranza. 8th ed. Philadelphia, USA: W.B. Saunders; 1996. p. 61.  Back to cited text no. 4
    
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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. 5
    
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Turesky S, Gilmore ND, Glickman I. Reduced plaque formation by the chloromethyl analogue of victamine C. J Periodontol 1970;41:41-3.  Back to cited text no. 6
    
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Lobene RR, Weatherford T, Ross NM, Lamm RA, Menaker L. A modified gingival index for use in clinical trials. Clin Prev Dent 1986;8:3-6.  Back to cited text no. 7
    
8.
Ccahuana-Vasquez RA, Conde E, Grender JM, Cunningham P, Qaqish J, Goyal CR, et al. An eight-week clinical evaluation of an oscillating-rotating power toothbrush with a brush head utilizing angled bristles compared with a sonic toothbrush in the reduction of gingivitis and plaque. J Clin Dent 2015;26:80-5.  Back to cited text no. 8
    
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Klukowska M, Grender JM, Conde E, Milleman KR, Milleman JL. Plaque reduction efficacy of an oscillating-rotating power brush with a novel brush head utilizing angled bristle tufts. Compend Contin Educ Dent 2014;35:702-6.  Back to cited text no. 9
    
10.
Klukowska M, Grender JM, Conde E, Ccahuana-Vasquez RA, Ram Goyal C. A randomized clinical trial evaluating gingivitis and plaque reduction of an oscillating-rotating power brush with a new brush head with angled bristles versus a marketed sonic brush with self-adjusting technology. Am J Dent 2014;27:179-84.  Back to cited text no. 10
    
11.
Klukowska M, Grender JM, Timm H. A single-brushing study to compare plaque removal efficacy of a new power brush to an ADA reference manual toothbrush. Am J Dent 2012;25:10A-3A.  Back to cited text no. 11
    
12.
Yaacob M, Worthington HV, Deacon SA, Deery C, Walmsley AD, Robinson PG, et al. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev 2014;17:CD002281.  Back to cited text no. 12
    
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Gallob J, Mateo LR, Chaknis P, Morrison BM Jr., Panagakos F. Randomized controlled trial comparing a powered toothbrush with distinct multi-directional cleaning action to a manual flat trim toothbrush. Am J Dent 2015;28:351-6.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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