Evaluation Of Plaque And Micro-Stain Removal Efficacy Of Charcoal-Infused Versus Conventional Tooth Brushes In Egyptian Adults: A Randomized Clinical Trial

Oral hygiene practices are essential for maintaining oral health and preventing a wide range of conditions, including dental plaque accumulation, halitosis, extrinsic staining, gingival inflammation, and periodontal diseases, all of which can significantly affect an individual's quality of life. Among these factors, dental plaque is considered the primary etiological agent in the development of both dental caries and periodontal disease. It contributes to disease progression by facilitating bacterial colonization, lowering the pH at the tooth surface, and promoting the demineralization of enamel through hydroxyapatite dissolution.

Toothbrushing with toothpaste remains the cornerstone of daily oral hygiene and the most widely accepted method for mechanical plaque control. Its effectiveness depends on multiple variables, including toothbrush design (such as bristle type and arrangement), brushing technique, frequency, and duration. In addition to plaque removal, toothbrushing also plays an important role in controlling extrinsic stains, thereby contributing to improved dental esthetics.

In recent years, charcoal-infused toothbrushes have been introduced as an alternative oral hygiene aid and have gained increasing popularity in the consumer market. These toothbrushes typically incorporate activated charcoal-often derived from binchotan charcoal-into nylon bristles. Activated charcoal is characterized by a highly porous structure and large surface area, which theoretically enhances its ability to adsorb organic compounds. Manufacturers claim that charcoal-infused toothbrushes offer multiple benefits, including antimicrobial activity, deodorizing effects, and improved stain removal. These effects are proposed to occur through mechanisms such as increasing oral pH, reducing bacterial load, and binding stain-causing chromogens on the tooth surface.

Despite these claims and widespread commercial promotion, the scientific evidence supporting the clinical effectiveness of charcoal-infused toothbrushes remains limited and inconclusive. Most available studies have focused on charcoal-containing dentifrices rather than toothbrushes, and clinical trials-particularly those involving adult populations-are scarce. Furthermore, existing data show inconsistent findings regarding their superiority over conventional toothbrushes in plaque control and whitening efficacy.

Therefore, the present randomized controlled clinical trial was designed to evaluate and compare the effectiveness of charcoal-infused toothbrushes versus conventional nylon toothbrushes in reducing dental plaque and removing extrinsic stains among Egyptian adults. Plaque accumulation was assessed using the Turesky and Gilmore modification of the Quigley-Hein Plaque Index, a validated and widely used clinical index. Stain removal efficacy was evaluated objectively using spectrophotometric color measurements (ΔE, ΔL*, Δb*) obtained with a Vita Easyshade device, allowing for precise and reproducible assessment of tooth color changes.