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Clinical Evaluation of an Ionic Toothbrush in the Removal of Established Plaqne and Reduction of Gingivitis

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Clinical Evaluation of an Ionic Toothbrush in the Removal of Established Plaqne and Reduction of Gingivitis Perio(dontics Clinical evaluation of an ionic toothbrush in the removal of established plaqne and reduction of gingivitis Ronald L, Van Swol*/Donald E. Van Scotter**/Jeffrey J. Pucher***/Andrew R. Dentino' Abstract The clinical effectiveness of a manual Ionic toothbrush in the removal of dental plaque and the reduction of gingivitis was evaluated. A double-blind study evaluated the effect of a small, imperceptible electric current on established dental plaque and gingivitis during loothbrushing. Sixty--four adults completed the study. Gingivitis and plaque scores were determined at baseline and after 3 and 6 months. The baseline indices of the nvo groups were well balanced. At each exainlnaiion, the participants were instructed how to hold the toothbrush properly arid retninded to change brush heads every 4 weeks. Statistically significant iinprovemems in Loe Gingival Index scores were observed from baseline to 6 months between the control and test groups and within the test group. The Quigley-Hein Plaque Index scores also showed a significant improvement from baseline ¡o 6 months between the control and test groups and within Ihe test group. (Quintessence Int ¡996:27:389-394:) Clinical relevance hygiene today is specifically directed toward plaque control.' Today, toothbrushing is the most widely By using the ionic toothbrush conscientiously on a practiced method of oral hygiene and has a very high daily basis, the compliant patient can remove degree of social acceptability.- It bas been shown that, significantly more plaque tban with other tooth- in industrialized countries, 80% to 90% ofthe popula- brushes, reducing the risk of gingival inflammation tion brush their teeth one or two times a day.^''* It has and caries. been fiirtber sbown that the toothbrushing practiced by the majority of these people is unsatisfactory, if the goal is plaque controi. An average daily brushing of approximately 2 minutes' duration will remove only half the accumulated plaque, leaving the other half to Introduction promote rapid regrowth." This finding was supported For many years, people have used various methods for by another study, in whicb it was sbown that the cleaning their teeth. The most primitive method was average person, by brushing, removes only about 50ÏS the use of various types of wooden stick. The mahi of the plaque present on his or her teeth.^ reason for tooth cleaning in years past was the removal In an effort to increase the amount of plaque of food particles that caused oral discomfort, while oral removed at each brushing, toothbrushes of different sizes and shapes and made of various materials have been developed. Brushes with soft bristles, multitufted * Professor and Director. Division of Periodontics, Marquette Uruver- heads, and end-rounded filaments have been intro- sity, School of Dentistry, Milwaukee. Wisconsin. duced. In addition, many electric-powered tooth- ** Adjunct Professor. Division of Peri o don lies. Marquette University, School of Dentistry, Milwaukee, Wisconsin. brushes have been developed. Generally, the manual and electric toothbrusbes are equaUy effective in •"• Assistant Professor. Division of Periodontics. Marquene tjniversity, School of Dentistry, Milwaukee. Wisconsin. removal of bacterial plaque.' In spite of all tbis activity Reprint requests; Dr Ronald L. Van Swol, Division of Periodontics, in improving toothbrush type and design, most people Marquette University, Sctiool of Dentistry, PO Box lS8t, Milwaukee, still remove oniy about 50% ofthe plaque present when Wisconsin 532O1-IS81. Quintessence International Volume 27, Number 6/1996 389 Van Swol et al they brush their teeth,^ The development of a tooth- Method and materiais bmsh that would allow the average person to remove Adult male and female subjeets were selected from the more plaque from his or her teeth on a daily basis is faculty, staff, and general patients at Marquette Univer- highly desirable. sity, School of Dentistry. All potential subjects were In an effort to achieve better plaque removal, a thoroughly screened, and those who participated were manual ionic action toothbrush was developed. The required to meet the following qualifications: purpose of this study in humans was to evaluate the effectiveness of the hyG ionic toothbrush (Hukuba 1. They completed a Confidential Health Question- Dental) in removing dental plaque and reducing naire. gingivitis. 2. They signed an informed consent form that was approved by the Institutional Review Board at Marquette University. Principies of the Ionic Action Mechanism 3. They were dental piaque formers, as demonstrated by a elinical examination. A basic understanding ofthe ionic action mechanism is essential. The use of devices with ionic action in the 4. They were not taking any medication or using oral cavity is not a new concept. The terms ionto- mouthwashes that could have an inhibitory effect phoresis, electmphoretic. and electmionlzinghave heen on formation of dental plaque. used synonymously in dentistry for many years,^"" 5. They had a minimum of 20 natural teeth. Ionic activity was a concept originally developed for 6. They agreed to return for periodic examinations at Che desensitization of natural teeth. Pratt'' patented 3 and 6 tnontiis following the recording of baseline the idea in 1889. data. The mechanism for the ionie aetion is due to a change in the polarity ofthe teeth. Teeth are normally The Intent of this study was to emoll 65 to 70 negatively charged and plaque is positively charged. patients who met these criteria. Three examiners were Opposite charges attract and bond to each other. trained by the principal investigator in the clitiical Plaque, therefore, is attaehed to the tooth surface by indices to be used and were tested for intraexaminer ionic bonding.'^ and interexaminer reliability. A high level of reliabihty was achieved. The hyG toothbrush has a 3-V lithium battery The Loe Gingival index'^ was used to evaluate located under the metal band on the handle. The gingival inflammation. The gingivai tissues were battery is similar to a watch battery and just as safe. The divided into two gingival scoring units, namely the toothbrush bristles are negatively charged through the labial/buccal and lingual/palatal surfaces. Criteria for metal rod within the brush head. When the metal band scoring were as follows: 0 - normal gingiva; 1 - mild on the toothbrush handle is held with moistened inflammation—slight change in color and slight edema, fmgers, the positively charged ions are transferred to but no bleeding on probing; 2 = moderate inflamma- the teeth during brushing. The tooth polarity changes tion—redness, edema, and some glazing, but no from negative to positive. The positively charged tooth bleeding on probing; and 3 = severe inñammation- ions repel the positively charged plaque ions. The marked redness, edema, and bleeding on probing. positively charged plaque ions are then attracted to the negatively charged bristles ofthe hyG toothbrush. This The Quigley-Hein Plaque Index '* was used to assess important ionic exchange, along with the normal disclosed plaque on the labiai/buecal and lingual/ mechanical action of the bristles on the toolh and palatal tooth surfaces; 0 = no plaque; 1 = separate gingival surfaces, may enhance plaque removal. flecks of plaque at the cervical margin ofthe tooth; 2 = a thin continuous band of plaque (up to 1 mm) at the Contact of moist fingers with the metal band on the cervical margin ofthe tooth; 3 - a band of plaque wider hyG toothbrush handle is essential to maximize ionic than 1 mm but covering less than one third of the transfer of plaque molecules between the teeth and the crown ofthe tooth; 4 = plaque covering at least one toothbrush bristles. Laboratory studies have shown third but less tlian two thirds ofthe crown ofthe tooth; that the actual current circulation from the 3-V lithium and 5 = plaque covering two thirds or more of the battery is 1.5 V at the teeth when the brush is held with crown ofthe tooth. moistened fingers. The current is only 0.8 V when the Seventy-one subjects were selected for the study. brush is held with dry fingers.'"" Each received a complete-mouth gingivai exatnina- 390 Quintessence International Volume 27, Number 6/199e Van Swol et al tion. After each tooth area was scored according to the Gingival Index, subjects were given a liquid disclosing solution and instructed to rinse for 15 seconds. Plaque scores were then determined and recorded. The subjects were given a prepackaged and coded hyG ionic action toothbrush (Fig 1 ), The toothbrushes were received evenly divided (36 of each) between those that had active batteries and those that had inactive batteries. Each packet had a code number that was recorded for the subject at the time of delivery Neither the researchers nor the subjects knew whether their toothbrush contained an active or inactive battery. Written instructions were given, and the subjects were shown how to hold the toothbntsh properiy so that their moist fingers touched the metal band during toothbrushing. Subjects were told to brush at least twice daily using their usual technique and dentifrice. They were lltrther advised not to use any oral rinses that could affect plaque inhibition during the course of Fig 1 Electronic toothbrush evaitja- the study Additional toothbrush heads with soft ted Metai pad (arrow), or terminai, multitufted 0.18 diameter nylon bristles were dis- must iiave linger or palm contact. pensed. Subjects were instructed to change brush heads every 4 weeks. They were then scheduled for an appointment for the next scoring session, approxi- mately 3 months from the date of the Initial exam- ination. Table ! Demographic data of subjects At the 3-month examination, the gingival inflam- mation scores were determined and recorded. Each Group A Group B subject was given disclosing solution, and the plaque (test) (control) accumulations were scored and recorded. During the No, 34 30 course of the examination, the subjects were observed Female-male ratio 30:4 25:5 to assure the safety of the toothbrush assigned to them.
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