Sandhya P Naik et al 10.5005/jp-journals-10024-2229 ORIGINAL RESEARCH Effectiveness of Different Bristle Designs of Toothbrushes and Periodontal Status among Fixed Orthodontic Patients: A Double-blind Crossover Design 1Sandhya P Naik, 2Sameer Punathil, 3Praveena Shetty, 4Ipsita Jayanti, 5Md Jalaluddin, 6Anisha Avijeeta ABSTRACT Results: In both phase 1 and 2 of this RCT, toothbrush with crisscross bristles exhibited maximum plaque reduction among Aim: The aim of the present study was to evaluate the effec- the three different bristle design toothbrushes following 30 days tiveness of different bristle designs of toothbrushes and the (p = 0.312 ± 0.102 and 0.280 ± 0.110, respectively), which was periodontal status among patients undergoing fixed orthodontic statistically significant. treatment. Conclusion: It was concluded that all the three designs of This randomized controlled trial Materials and methods: toothbrushes were effective in removing plaque in patients (RCT) consisted of 45 adolescents (comprising 20 males and with fixed orthodontic appliances. But among the three different 25 females) undergoing fixed orthodontic treatment. The study toothbrushes, toothbrush with crisscross bristles showed the participants were randomly allocated to three groups, each highest mean plaque reduction. group being assigned a locally available toothbrush with a particular design of toothbrush bristle. In the first test phase, Clinical significance: Plaque accumulation around the orth- group I study participants were allocated to toothbrush with flat odontic brackets and gingival margins is quite common among bristles, group II study subjects were allocated to toothbrush with the fixed orthodontic patients, who encounter difficulty in main- zigzag bristles, and group III study participants were allocated to taining good oral hygiene. Specially designed toothbrushes are toothbrush with crisscross bristles. The study participants were very essential for effective plaque removal among the patients recalled after 4 weeks to check the effectiveness of the allocated undergoing fixed orthodontic treatment. toothbrushes. A washout period of 1 week was maintained to Keywords: Bristles, Crossover design, Fixed orthodontic appli- ensure that there was no carryover effect of the different bristle ances, Plaque. designs. In the second test phase, each patient used the oppo- site toothbrush bristle design (group I: toothbrush with zigzag How to cite this article: Naik SP, Punathil S, Shetty P, Jayanti I, bristles, group II: toothbrush with crisscross bristles, and group Jalaluddin M, Avijeeta A. Effectiveness of Different Bristle III: toothbrush with flat bristles). Plaque scores were measured Designs of Toothbrushes and Periodontal Status among using Turesky–Gilmore–Glickman modification of Quigley-Hein Fixed Orthodontic Patients: A Double-blind Crossover Design. plaque index (PI). J Contemp Dent Pract 2018;19(2):150-155. Source of support: Nil 1Department of Public Health Dentistry, Government Dental Conflict of interest: None College and Hospital, Mumbai, Maharashtra, India 2Department of Pedodontics, Sree Anjaneya Institute of Dental INTRODUCTION Sciences, Kozhikode, Kerala, India The oral diseases most frequently occurring in human- 3Department of Orthodontics and Dentofacial Orthopedics Srinivas Institute of Dental Sciences, Mangaluru, Karnataka kind are dental caries and periodontal disease, and the India causative factor of both is dental plaque. Personal and 4-6Department of Periodontology, Kalinga Institute of Dental professional oral hygiene practices are the procedures Sciences, Bhubaneswar, Odisha, India directed at the removal of dental plaque. Toothbrush is Corresponding Author: Sandhya P Naik, Department of Public one of the most commonly used adjuncts for maintaining Health Dentistry, Government Dental College and Hospital oral hygiene.1 Mumbai, Maharashtra, India, Phone: +919156388888, e-mail: During orthodontic treatment, oral hygiene measures [email protected] that are directed toward the removal of dental plaque 150 JCDP Effectiveness of Different Bristle Designs of Toothbrushes around the brackets and orthodontic appliances need to The participants using chemical plaque control measures become more effective. Plaque accumulation around the and those taking drugs that could affect the state of gin- fixed orthodontic appliances can be challenging for effec- gival tissues, including corticosteroids and nonsteroidal tive toothbrushing and can interfere with the mechanical antiinflammatory drugs, were excluded from the study. cleaning action of mastication. As the duration of orth- odontic treatment is long, routine oral hygiene measures Sample Size Determination for the orthodontic patient including professional tooth The formula used to calculate sample size was: cleaning and home care instructions must be given with 2 2 a lot of consideration. Z12−α / n= 2 Effective home-plaque-control measures are very con- d n is the required sample size; Z is a constant; its ducive for maintaining a functional dentition throughout 1–α/2 value for a two-sided test is 1.96 for 95%; d is absolute life. These include toothbrushing by manual or electric precision 20% = 0.2. toothbrush combined with interdental cleaning. It is well As calculated from the above formula, 45 participants known that there is a positive correlation between the were randomly allocated to three different types of locally degree of plaque accumulation and gingival disease. The available toothbrushes with varied toothbrush bristle role of plaque as a causative factor in the development designs groups (Flow Chart 1). of chronic inflammatory disease has been routinely con- 3 firmed in the scientific literature. Dental plaque causes Study Groups inflammatory process in the supporting structures of the teeth, which, if progressed, results in tooth loss.4 First test phase The most effective method of achieving good oral • Group I: Toothbrush with flat bristles health in most of the population is the daily usage of • Group II: Toothbrush with zigzag bristles 5 manual toothbrush. Since their first use by the Chinese • Group III: Toothbrush with crisscross bristles (Figs 1 in the late 16th century, toothbrushes have gone through and 2). changes in their basic structure. Various aspects, such as size, shape, bristle arrangement, texture and stiffness, Second test phase head design, angulations between head, shaft and handle • Group I: Toothbrush with zigzag bristles along with other features, as well as many other modifica- • Group II: Toothbrush with crisscross bristles tions have been made. • Group III: Toothbrush with flat bristles. In the present day, a very wide variety of toothbrushes are available in the market. This has led to a dilemma Methodology in the consumer’s mind with respect to efficacy of each This was a double-blind crossover study, where a 1-week toothbrush. In addition, factors such as cost, availability, washout period was given between the crossover phases advertising claims, family tradition, or personal habits to evaluate the effectiveness of the three bristle designs decide the type of toothbrush going to be used by a par- of toothbrushes among patients undergoing fixed orth- ticular person.6 Thus, the aim of the present study was odontic treatment. to evaluate the effectiveness of different bristle designs The examiner was trained and calibrated before the of toothbrushes and the periodontal status among fixed start of the study. Intraexaminer agreement for PI was orthodontic patients. calculated by repeat measurements that were done on 10 patients not participating in the study, within an inter- MATERIALS AND METHODS val of 1 hour. The Kappa coefficient for PI was found to This RCT was conducted on 45 adolescent participants be 0.7. All the participants were given a similar type of (20 males and 25 females) undergoing fixed orthodontic toothpaste. Toothbrushing technique instructions were treatment, whose ages varied between 15 and 18 years. given to the participants for the purpose of standardiza- Ethical approval along with informed consent was tion. Furthermore, instructions to brush twice daily for obtained from the participants before the study. Detailed 2 minutes (morning just after waking up and in the night information about the study design and procedure was before going to bed) were given to the participants, along explained to the participants. with directions to use the same toothbrush and toothpaste Patients with fully bonded fixed orthodontic appli- given to them. ances and without any systemic diseases, patients who Lottery method was used to randomly allocate all the had not taken any antibiotics or antiseptic mouthwashes patients to the study groups according to the different for 1 month before the study were included in the study. bristle designs of toothbrushes. Coding was done for The Journal of Contemporary Dental Practice, February 2018;19(2):150-155 151 Sandhya P Naik et al Flow Chart 1: Distribution of study participants Fig. 1: Front view of all the three toothbrushes Fig. 2: Side view of all the three toothbrushes each one of the toothbrushes. It was only at the end of the The second test phase was carried out in a similar way, study that the codes were decoded. In the first test phase, after a 1-week washout period to negate the carryover the toothbrushes that were allocated were in the order: effects of the different bristle designs. Toothbrush bristle • Group I: Toothbrush with flat bristles designs were alternated