15 January 2020

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Prevention of plaque and gingivitis: manual or powered brushing?

Giulia Palandrani

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It is widely known that the presence of high levels of plaque cause gingivitis. Powered toothbrushes are now generally regarded to be more efficacious than manual toothbrushes in removing plaque and maintaining or improving the gingival condition.  
The objective of this study was to evaluate the effect of an oscillating/rotating/pulsating powered toothbrush on plaque and gingivitis prevention over a 9‐months period.      

MATERIALS AND METHODS    
A total of 122 subjects ≥18 years of age in good general health and with at least five teeth per quadrant and no pockets ≥5 mm were included.   At baseline,after a preexperimental phase of 3 weeks, with the aim to motivate and to improve the level of their gingival health, the subjects were randomly assigned to one of three groups: manual brushing with no interdental cleaning (MB), manual brushing and floss (MBF), or powered brushing and no interdental cleaning (PB).  
Clinical parameters  
Gingival condition was assessed using the bleeding on marginal probing (BOMP) index; the absence or presence of bleeding was scored within 30 seconds of probing on a scale of 0 to 2 (0 = non‐bleeding; 1 = pinprick bleeding; 2 = excess bleeding).   Staining of teeth at the vestibular sides was scored according to the Gründemann Modification of the Staining Index (GMSI)   Plaque was assessed using the modified Quigley and Hein plaque index (QHPI); the absence or presence of plaque was recorded on a six‐point scale (0 to 5; 0 = no plaque, and 5 = plaque covered more than two‐thirds of the tooth surface).  Gingival abrasion lesions were scored (GAS) according to the method described by Van der Weijden and Versteeg. The greatest diameter of the lesion was recorded using a peridomtal probe placed across the long axis of the lesion.   Clinical examinations were performed at day 0, baseline, 10 weeks, 6 months, and 9 months. At the baseline, 10‐week, and 6‐month appointments, all subjects received a new brush head or toothbrush and floss.    

RESULTS  
Bleeding scores at the final visit for the MB group was 0.65 and for the MBF and PB groups was 0.58 and 0.57, respectively. No significant difference among groups could be detected at this point.   At the final visit at 9 months, the overall plaque scores were lower for all regimens. The MB group had a score of 1.57, and MBF and PB groups had scores of 1.44 and 1.16, respectively. Significant differences between the PB group and the other two groups were detected (P = 0.002).   No Gingival abrasion lesions were reported in the present study, and there were no statistically significant differences in GAS scores among groups. The data showed that all regimens were safe.     The recorded brushing time at 6 months was 129.5 seconds for the PB group, 121.6 seconds for the MBF group, and 111.3 seconds for the MB group. This resulted in a statistically significant difference between the PB and MB groups (P = 0.006).       

CONCLUSIONS
All regimens maintained lower levels of plaque and bleeding compared to the intake levels at day 0.
However, the powered toothbrush maintained lower plaque levels for 9 months more effectively and maintained an improved gingival condition for ≥6 months compared to the manual toothbrush with or without the use of floss.      

For additional informations:  Comparison of the Use of Different Modes of Mechanical Oral Hygiene in Prevention of Plaque and Gingivitis