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Effect of Sonic and Mechanical Toothbrushes on Subgingival Microbial Flora: a Comparative in Vivo Scanning Electron Microscopy Study of 8 Subjects

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Effect of Sonic and Mechanical Toothbrushes on Subgingival Microbial Flora: a Comparative in Vivo Scanning Electron Microscopy Study of 8 Subjects Isa ni Research Effect of sonic and mechanical toothbrushes on subgingival microbial flora: A comparative in vivo scanning electron microscopy study of 8 subjects Karen B, Williams, MS, RDHVCharles M, Cobb, DDS, PhDVHeidi J. Taylor, MS, Alan R. Brown, DDSVKimberly Krust Bray, MS, Objedives; The purpose of this initial study was to evaluafe fhe effects of bcfii a sonic and a mechanical focfhbrush versus fhe effects of no freatment on depth of subgingival penetrafion of epifhelial and footh- assooiafed bacferia. Method and materials: Eight adult subjects exhibiting advanced chronic pericdontitis with at leasf 3 single-rocfed feeth thaf were in separate sextanfs wiffi facial pockefs a 4 mm and s 8 mm and fhaf required exfraction consfituted the expérimentai sample. Teeth were either subjected to 15 sec- onds of brushing wifh a mechanical toothbrush or a sonic tocfhbrush or leff untreated. The tesf toofh and fhe associafed soft fissue wall of the periodonfai pocket were removed as a single unit. Samples were processed and coded for blind examinafion by scanning elecfron microsoopy. Distribufionai and morpho- logic characferisfics of dominanf bacteria wifh specific emphasis on spirochetes were evaluafed for boffi epithelial- and foofh-associafed plaque. Results: No differences were found in morphotypes or disfribu- fional and aggregafional characteristics of epifhelial-associafed microbes in the f- to 3-mm subgingival zone befween fhe mechanical and sonic tocf h bru s h-freated groups and the control group. Both toothbrush groups featured disrupfion of microbes fhat extended up to 1 mm subgingivally. Roof surfaces on the sonic-treated samples appeared plaque-free at low magnificafion; however, af 4,70Dx, afhin layer of mixed morphofypes and intact spirochefes was found supragingivally and slighfly subgingivally. In compar- ison, mechanical brush samples feafured incompletely removed plaque, bofh supragingivally and subgingi- vally, wifh intact spirochetes presenf on subgingival root surfaces. Conclusion: Results suggest similar effecfs for bcfh sonic and mechanical toothbrushes on epifhelial- and footh-as so dated bacferial plaque in periodontal pockets and adjacenf root surfaces fhaf extend up to 1 mm subgingivally. Furfher, the pres- ence of infact subgingival spirochefes suggesfs limifed exposure fo acousfical or mechanical energy from fhe foofhbrushes evaluafed, (Quintessence int2001:32:147-154) Key words: mechanical, scanning microscopy, sonic, spirochefes, subgingival microflora, toofhbrush lthough host response may be responsible for the CLINICAL RELEVANCE: The present study compares Atissue degradation associated with inflammatory the abilify of sonic and mechanical toothbrushes fo dis- periodontal disease, plaque remains the primary initia- rupf subgingival plaque af increasing depths within perio- tor or trigger,'"^ The most common form of periodon- dontal pockefs by examining fhe pockef soft tissue wall tal disease, chronic periodontitis, has been reported to and fhe associafed roof surface in 8 subjects. affect over 30% oí the adult population, with severe disease reported in T>/(i to 13% of adults,'''-* Periodontal therapy is directed toward the reduc- 'Direcfor of Ciinical and ApplieO Research, Scfiool of Denfistry, University tion and subsequent control of pathogenic bacterial of Missouri—Kansas City, Kansas City, Missouri. species. In order for periodontal therapy to be effec- ^Department of Periodonlics, School of Denfistry, University ot Missouri- Kansas City, Kansas City, Missouri. tive, a long-term commitment to oral hygiene is required of the patient.^-'' Currently, the principal ^Formerly, Deparfment of Dental Hygiene, School of Dentisfry, University ot Missouri—Kansas City, Kansas City, Missouri; presentiy, US Civii Service, means for the prevention and control of periodontal Vicenza, Itaiy, disease involves the systematic and efficient removal of 'Cral and Maxilloiacia! Surgery, School of Denfisfry, Universify of supragingival and suhgingival plaque hy oral hygiene, Missouri—Kansas Cify, Kansas City, Missouri, through mechanical and/or chemical means,''-'' ^Division ol Oenfai Hygiene, School of Denfisfry, University ot Missouri- While toothbrushing remains the single most Kansas Cify, Kansas City, Missouri. widely practiced personal plaque control method, Reprint requesfs; Or Charies M, Cobb, Departmenl of Periodontics, Sohool of Dentistry, Universify of Missouri—Kansas City, 650 East 25th there remains some controversy and a lack of defini- Streef, Kansas City, Missouri 6410B, E-mail; [email protected] tive evidence to clearly demonstrate the superiority of Quinfessence International 147 • Wiilianis et al any one toothbrush design or mode of action.'^"^i^ mechanical toothbrushes versus no treatment on depth Many individuals do not achieve tbe level of cleaning of subgingivai penetration and on aggregation cbarac- required for periodontal bealtb as evidenced by tbe teristics of epitbelial- and tootb-associated bacteria in levels of gingivitis and periodontal disease found in 8 subjects witb advanced cbronic periodontitis. tbe population.^'-^'^ A variety of electrically powered toothbrusbes has been developed to assist individuals in removing dental plaque. Short-term studies are METHOD AND MATERIALS divided on tbe issue of superiority wben it comes to tbe comparison of electric tootbbrushes^""^^ with their A total of 8 subjects over tbe age of 18 in good general manual counterparts.^^"" bealth were selected from the available pool of In the last decade, new toothbrushes that generate patients at the University of Missouri-Kansas City acoustical energy have been developed. Sonic tootb- School of Dentistry. Subjects were selected based on brusbes use a bigh frequency bristle motion, in addi- tbeir scheduled treatment of multiple extractlotis for tion to their scrubbing or plaque-removing activity, to advanced chronic periodontitis. All participants pre- create dynamic fluid activity.^^ Various in vitro studies sented with a minimum of 3 nonfurcated teeth in sep- suggest the sonic tootbbrusb bas tbe potential to lift arate sextants with poeket depths of £ 4 mm and £ 8 and disperse plaque bacteria up to 4 mm beyond tbe mm on facial surfaces of teeth scheduled for extrac- pbysical reach of the bristle tips tbrougb tbe genera- tion. Prior to enrollment, subjects completed a med- tion of acoustical energy.'^""'" ical bistory form and were excluded from tbe study for Sonic toothbrusbes utilize solid state electronic a history of diabetes, blood dyscrasia, liver and kidney microcircuitry and an electromagnetic driver to disease, immunosuppression, bepatitis B or C, HIV achieve rapid bristle movement tbat produces mild infection, anticoagulant tberapy or cbronic use of cavitation in fluid as well as fluid streaming.-" •'^ Bristles non-steroid al anti-inflammatory medications, vibrate at 250 or 260 Hz (depending on tbe sonic rbeumatic fever, beart defects, and implant prostbesis brush), creating mild cavitation and bubble activity, or any other conditions necessitating propbylactic and move at 500 to 520 brusb strokes per second. In antibiotic therapy. In addition, subjects were excluded tbeory, attached plaque is removed not only by tbe for a bistory of antibiotic tberapy in tbe previous 3 direct action of tbe bristles, but also by tbe eftect of tbe montbs, evidence of oral/esophageal candidiasis, and vibrations carried in oral fluids. Tbis process is referred use of a sonic tootbbrush or any periodontal instru- to as acoustic microstreaming. Acoustic microstream- mentation in the previous 6 months. Tbe study was ing is characterized by the production of bydro- approved by the University of Missouri-Kansas City dynamic sbear stresses (bubble activity) and is tbought Institutional Review Board for Human Research, and to lift and disperse plaque from tbe teetb.^^-^*''"''*^ qualified subjects signed an informed consent form No clinical studies have demonstrated this "beyond prior to treatment. tbe bristles" effect In vivo; bowever, previous in vitro Premolars, canines and/or incisors from different studies bave shown acoustic energy is capable of dam- sextants scheduled for extraction due to advanced aging adherent bacteria on bydroxyapatite-coated chronic periodontitis were selected. All specimens disks.^^-'ä Tbe clinical relevance of these laboratory were free of cervical caries lesions, damage to dentinal results remains questionable due to tbe dynamics of surfaces, and periapicai or periodontal abscesses. brushing in the oral eavity. The ability of sonic vibra- The study was conducted as a 1-faetor within sub- tions to transmit througb a medium of crevicular fluid ject design. Subjects contributed at least 1 tooth to and into tbe subgingivai environment remains each treatment cell. Only one treatment was randomly unproven. Bristle contact with tbe oral soft and hard assigned per sextant to prevent overlapping treatment tissues may dampen tbe effects of sonic vibrations. effects. In some circumstances where multiple teeth Additionally, it can be hypothesized that pre-existing met entry criteria and were adjaeent in the mouth, 2 plaque accumulations, particularly if heavy, as well as samples were enrolled in the sonic and mechanical the viscosity of saliva may alter acoustical transmis- toothbrush group. All teeth were obtained from sion and potential effectiveness. patients with planned treatment of multiple extractions The in vivo effectiveness of sonic toothbrusbes to due to advanced chronic periodontal disease.
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