Introduction

Patients with fixed orthodontic appliances tend to have increased plaque accumulation, predisposing them towards gingival inflammation. Considering the critical role of dental biofilm in gingivitis, effective dental biofilm control is thus essential to improve oral hygiene in orthodontic patients. Appropriate selection of oral hygiene instruments may rightly motivate the orthodontic patients to maintain good oral hygiene. Orthodontic toothbrushes are generally preferred over other brushes for the effective cleaning that they offer. The impact of various toothbrushes on periodontal health in the long-term has not been studied. It has been hypothesized that single-tufted toothbrushes would offer more effective plaque removal and healing of gingival inflam­mation, compared to conventional toothbrushes.

Aim

To evaluate the effectiveness of different toothbrushes in reducing gingival inflammation and dental biofilm removal in gingivitis patients with fixed orthodontic appliances.

Patient Profile

• Patients undergoing fixed orthodon­tic treatment who came for regular dental visits and had at least 22 teeth (n=36; age: 18-35 years).

  Methods

  Study Design

• A single-blind, random­ized, controlled parallel group clinical trial.

  Treatment Strategy

• Patients were randomized as follows:
  • Conventional toothbrush (C-TB; n=12)
  • Orthodontic toothbrush (O-TB; n=12)
  • Single-tufted toothbrush (ST-TB; n=12)
• All study subjects received tailored oral hygiene instructions based on their assigned toothbrush type.

Assessments

The Turesky modification of the Quigley-Hein plaque index (TQHI), gingival index (GI), bleeding on probing (BOP), and probing pocket depth (PPD) were assessed at baseline and repeated in the first week, sixth week, and at third month.

Results

• The mean age of the study population was 23.14 years, patients in all the study groups experienced significant improvements in clinical parameters, as compared to baseline.
• At week 6, patients in the O-TB and ST-TB groups had significantly greater improvements in TQHI and BOP scores, compared to those in the C-TB group (p < 0.05) (Table 1).

• At the visit in third month, patients in the ST-TB group maintained significantly lower TQHI and BOP scores, on the contrary, the O-TB group’s scores were similar to those of the C-TB group (Table 1).
• Patients in the ST-TB and C-TB groups had significantly lower GI scores, compared to those in the O-TB group at all time points during the study (Table 1).

Table 1: Changes in the parameters during the study period

BOP: Bleeding on probing, C-TB: Conventional toothbrush, GI: Gingival index, O-TB: orthodontic toothbrush, PPD: probing pocket depth, ST-TB: single-tufted toothbrush, TQHI: Turesky modified Quigley Hein plaque index

• The effectiveness of ST-TB was significantly higher than that of other toothbrushes, but all toothbrushes demonstrated lower efficacy in the posterior region.

  Conclusions

• The ST-TB was more effective in reducing gingival inflammation over the period of three months. ST-TB had similar efficacy to the O-TB in terms of dental biofilm removal in patients with fixed orthodontic appliances.
• Further in-depth studies are warranted to validate these findings and to demonstrate the efficacy of this approach in maintaining periodontal tissue health in patients with fixed orthodontic appliances.