Comparison of three different brush designs in orthodontic patients

Not yet recruiting

Conditions: oral hygiene maintenance in patients with fixed orthodontic appliances(braces).

Registration Number: CTRI/2021/07/034947

Lead Sponsor: SGT University

Brief Summary: Bacteria present in dental plaque are recognized asthe principal cause of caries and periodontal disease. Therefore, preventionand treatment of these two diseases are mainly based on dental plaque removal.Professional scaling and oral prophylaxis are the most effective methods toreduce pathogenic organisms and also for plaque removal. However, personal oralhygiene, using a toothbrush and dental floss daily, is very crucial forsatisfactory maintenance. Those patients who are undergoing orthodontictreatment have greater difficulty in maintaining oral hygiene. Orthodonticbands, brackets and wires are hindrances to brushing and flossing, frequentlyfacilitating accumulation of plaque to jeopardize gingival health.Thereis a significant increase in *Streptococcus mutans* and lactobacilli afterthe bonding of fixed appliances. Orthodontic treatment can increaseinflammation, bleeding, and enlargement of the gingiva as well as increasingprobing pocket depth.

Enamel demineralization after fixed orthodontictherapy can occur in up to 50% of patients. Enamel demineralization is causedby organic acids produced mainly by mutans streptococci (MS), which are knownto be the prime causative organism of dental caries. S mutans is the most frequentlyisolated from human oral cavities and have been implicated as the maincausative organisms of dental caries.Extensive plaque accumulationis associated with bonded orthodontic brackets , and a fixed appliance withorthodontic brackets causes specific changes in the oral environment, such asdecreased pH and increased plaque accumulation.The bacterialadhesion to orthodontic brackets can be the primary step leading to pathogenicplaque formation and enamel demineralization around orthodontic brackets,because the adhering bacteria continue to grow on the tooth surfaces near thebrackets. Therefore, information on the prevalence of S *mutans* inorthodontic treatment is helpful for identifying patients at risk of developingenamel demineralization and for planning caries-prevention programs duringorthodontic treatment.

Many clinical indices,instrumental examinations ,and laboratory tests are available now a days inorder to study and define periodontal condition. Among them ,clinical indicesremain the most commonly used criteria for an ordinary evaluation, due to theirviability.Various indices used for gingival and periodontal healthevaluation are gingival bleeding index, plaque index, interdental pressureindex, papillary bleeding index and Ortho-plaque index.Asstreptococcus mutans are considered as the main pathogens in initiation ofdental caries,the assessment of plaque accumulation and prevalence of white spot lesions around thebrackets can be done by counting the coloniesof *streptococcus mutans*.

Various aids tomaintain oral hygiene in orthodontic treatment include manual toothbrushes,dental floss, inter dental toothbrushes, three headed toothbrushes, poweredtoothbrushes ,sonic and ultrasonic toothbrushes. Initially, manual toothbrusheswere commonly advised for the patients with orthodontic treatment. Because ofshortcomings of manual toothbrushes in plaque removal, poweredtoothbrushes have been evaluated across a broad array of population groups andstudy designs and have demonstrated similar or significantly greater plaqueremoval compared with standard manual toothbrushes.

Among various typesof powered toothbrushes, existing evidence suggested that rotation-oscillation,ionic, and ultrasonic brushes performed better than manual toothbrushes inplaque reduction.They have been shown to remove significantlygreater in vitro *Streptococcus mutans* biofilm fromhydroxyapatite surfaces without bristle contacts compared withrotation-oscillation toothbrushes.Home careproducts to remove plaque, particularly in difficult-to access areas, is key toimproving patient compliance and avoiding disease. Beyond their clinicallyproven efficacy in removing plaque, power toothbrushes can enhance patientmotivation, leading to increased tooth brushing frequency and duration. The use ofelectric toothbrushes can offer better fluoride distribution throughout themouth .

Thefirst ultrasonic toothbrushwas patented in USA in the year 1992 byRobert T. Bock. Ultrasonictoothbrushes mainly diï¬€er from conventional electrical toothbrushes in their higheroperating frequency (>20 kHz) .The used frequency range is not audible forthe human ear and may be beneï¬cial since hydrodynamic forces (such as ï¬‚ow rateof the dental ï¬‚uid and the formation of bubbles) are signiï¬cantly increased.Still, the exact relation between the energy transfer from the brush to thebioï¬lm and the contribution of acoustic waves to bioï¬lm removal remain unclear.The ultrasound moves thebristles on the brush at a high speed and pressure. The toothbrush head vibratescausing the bristles to rotate. Because of this movement and speed, and as thetoothbrush is moved over the surface of the teeth, the toothbrush scrubs andeliminates more plaque than a normal toothbrush would. This means that theymove the brush head at such a rapid rate, that they are able to turbulentlymove particles of water and air in a gentle and effective enough way to easily cleanbetween teeth and below the gum line. Ultrasound projected into the slurrycauses the expansion of the bubbles and contact lead to dislodgement of theplaque bacteria adhering to the tooth surfacesStudies have evenshown that ultrasonic toothbrushes still provide superior **plaqueremoval** even when they are held up to 4mm away from the toothâ€™ssurface. The handle of the brush is large enough to grip safely, and the headof the device can be changed easily with simple instructions. The onlyrestriction for use is in patients with pacemakers because of the ultrasonictransducer’s ability to adversely affect pacemaker function.

A number of studies showed that ultrasonictoothbrushes could reduce more dental plaque but there isinsufficient data to show the streptococcus count in patients using differenttypes of brushes. Hence the present study is designed to compare the efficacyof manual, electric and ultrasonic toothbrushes in the patients undergoingfixed orthodontic treatment by quantifying *streptococcus mutans* in plaque in the Department of Orthodontics and Dentofacial Orthopaedics,Faculty of Dental Sciences,SGT University,Budhera ,Gurugram.

Detailed Description: Not available

Recruitment & Eligibility

Status: Not Yet Recruiting

Sex: All

Target Recruitment: 90

Inclusion Criteria

1.Age group: 12 to 18.
2.Patients having at least 20 teeth which are either bonded/banded with fixed orthodontic appliance.
3.Have not taken any antibiotics since 1month.
4.Non smoker patients.

Exclusion Criteria

1.Patient with periodontal disease or loss of attachment.
2.Any systematic or local disease affecting the periodontium.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
The aim of this study is to compare the effectiveness of Manual, electric and Ultrasonic Toothbrushes in fixed orthodontic treatment by quantifying the Streptococcus mutans bacteria in plaque.	Clinical evaluations to be done at baseline and further at 1,3 and 6 months.

Secondary Outcome Measures

Name	Time	Method
The secondary aim of the study is to compare the efficacy of manual, electric and ultrasonic toothbrush in fixed orthodontic patients by comparing the changes in orthodontic plaque index and gingival index.	Clinical evaluations to be done at baseline and further at 1,3 and 6 months.

Trial Locations

Locations (1): SGT university
🇮🇳
Gurgaon, HARYANA, India
SGT university
🇮🇳Gurgaon, HARYANA, India
Shikha
Principal investigator
8570848597
ahlawatshikha1408@gmail.com