The Evaluation of the Effectiveness of Conventional and Pulsating Toothbrushes on Oral Health of Healthy and Mentally Disabled Pediatric Patients

Ages between 7-12 (mean age 11.14±1.08), 31 healthy (17 girls, 14 boys) and 31 educable mentally disabled (12 girls, 19 boys) (special education school students), a total of 62 children were included in the study, following the ethics committee approval (REF: 29601).

Patient selection The children in the experimental group were educable mental disabled children (special education school students) and the control group systemically healthy children (primary school students). The children participating in the study were required not to use antibiotics, not to have received an additional plaque control application in the previous 5 months, to have at least 20 teeth in their mouths and not to receive orthodontic treatment, to have an intelligence level close to the average for disabled children, and to be capable of brushing on their own. Children in the study group were informed not to perform different oral hygiene practices such as mouthwash and dental floss during the study.

A preliminary meeting was held with the children's parents and they were informed verbally and in writing about the content of the study. For this purpose, a voluntary consent form was signed, including the content of the study, duration of participation, potential risks and problems, possible benefits for the patient, address, and telephone information of the parent and the child. One-on-one interviews were held with the children's parents, questions were asked about their general health conditions, and records were taken.

Clinical Evaluation Oral and dental examinations of children were performed with the help of a mirror and probe according to the World Health Organization criteria. If any surface of the tooth became visible in the mouth, the tooth was considered erupted. If both primary and permanent teeth were in the same tooth space at the same time, permanent teeth were included in the evaluation. DMFT values for permanent teeth and dft values for primary teeth were calculated according to the DMFT index (Decayed, Missing, and Filled Teeth Index). To determine oral hygiene, G&V Simplified Oral Hygiene Index [G&V OHI-S (Green and Vermillion Oral Hygiene Index-Simplified,1964)], Modified Sulcus Bleeding Index (MOD-SBI) and Aproximal Plaque Index (API) were used. The amount of plaque was measured by staining method from different surfaces of six teeth, two from the anterior area and four from the posterior area. At the beginning of each experimental period, children were instructed not to brush their teeth for 24 hours. Bleeding status was evaluated by applying the Modified Sulcus Bleeding Index within the clinical examination before brushing on the test day and control appointments. The plaque was stained with Mira-2-tone plaque staining solution pre and post-brushing during each examination period, and the stained plaque was shown to the child.

Each child was taught individually how to brush using the Bass Technique, first on the model and then in front of the mirror. Children were instructed to brush themselves for 2 minutes twice a day, after breakfast and in the evening before going to bed. Families were informed with written documents to follow up the brushing. To ensure the accuracy of the brushing time, 2-minute hourglasses were given to all children at the beginning of the study, and the families of disabled children were specifically warned to monitor the time. Cards prepared to mark brushings were sent to families. During the study, toothpaste was sent to the children for brushing with a single type of toothpaste (Ipana Complete 7 Care System Night-Procter & Gamble).