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ORIGINAL ARTICLE
Year : 2014  |  Volume : 12  |  Issue : 1  |  Page : 9-12

Cleaning ability of toothbrush with or without the use of dentifrice on debris and plaque removal in hostel inmates aged 20-24 years


1 Department of Public Health Dentistry, S.G.T. Dental College, Hospital and Research Institute, Gurgaon, Haryana, India
2 Department of Public Health Dentistry, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India

Date of Web Publication18-Aug-2014

Correspondence Address:
Sachin Chand
Department of Public Health Dentistry, S.G.T Dental College, Hospital and Research Institute, Near Sultanpur Lake, Budhera, Gurgaon 123 505, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.138899

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  Abstract 

Objectives: The aim was to find the cleaning ability of the toothbrush with or without the use of dentifrice in removal of debris and plaque in hostel inmates aged 20-24 years. Materials and Methods: A randomized clinical trial was carried out on 30 undergraduate students of K.D. Dental College and Hospital. The debris and plaque scores were recorded using debris index-simplified and plaque index respectively. The subjects were divided into three groups. After recording the baseline scores, the study groups were instructed to follow the modified bass method for the period of 10 days and then follow-up scores were recorded. Paired 't'- test and one-way ANOVA test was used to compare the mean baseline and mean follow-up scores. Results: The difference in mean debris scores at baseline and follow-up for Group II (P = 0.000) and Group III (P = 0.005) was found to be statistically significant. However, for Group I (P = 0.153), this difference was not significant. The difference in mean plaque scores at baseline and follow-up in all the three groups was statistically significant. When the mean differences in debris and plaque scores of the three groups were compared, it was found to be statistically significant for Group I and Group II and Group I and Group III, however, it was not significant for Groups II and III. Conclusion: The present study showed that the cleaning ability of the toothbrush with dentifrice was more effective in the removal of debris and plaque than the cleaning ability of the toothbrush without dentifrice.

Keywords: Cleaning ability, debris, dentifrice, plaque, toothbrush


How to cite this article:
Chand S, Solanki J. Cleaning ability of toothbrush with or without the use of dentifrice on debris and plaque removal in hostel inmates aged 20-24 years. J Indian Assoc Public Health Dent 2014;12:9-12

How to cite this URL:
Chand S, Solanki J. Cleaning ability of toothbrush with or without the use of dentifrice on debris and plaque removal in hostel inmates aged 20-24 years. J Indian Assoc Public Health Dent [serial online] 2014 [cited 2019 Oct 16];12:9-12. Available from: http://www.jiaphd.org/text.asp?2014/12/1/9/138899


  Introduction Top


The importance of oral hygiene has been known for centuries. [1] It is well established that the dental plaque is an essential etiological factor for many common dental diseases like dental caries and periodontal disorders. Thus, effective plaque control is one of the most common measures for the maintenance of the oral health in order to prevent the onset and progression of dental diseases. Although self-cleansing mechanisms such as saliva and detersive factors may eliminate loosely attached debris, they do not adequately remove dental plaque. Therefore, regular proper oral hygiene is a prerequisite for proper debris and plaque removal and prevention of common dental diseases. [2] Plaque control includes the usage of mechanical procedures as well as chemical agents, which retard plaque formation. Mechanical plaque control methods include tooth brushing and interdental cleaning aids like dental floss, toothpicks, interdental brushes, etc., Chemical plaque control is used as an adjunct to mechanical means and various chemicals used for this purpose include triclosan, sanguinarine and chlorhexidine gluconate, etc.

Toothbrushes are the most widely used as an oral hygiene aids for the maintenance of oral health. People brush their teeth for many reasons like to feel fresh and confident, to have a nice smile, to avoid bad breath and to avoid dental diseases. [3] The first toothbrush is thought to have been invented in China in 1000 AD and had an ivory handle and bristles made from a horse's mane. Toothbrushes were first mass-produced by William Addis of Clerkenwald, England. H.N. Wadsworth patented the first American toothbrush, and companies began to mass produce toothbrushes in America around 1885. Nylon replaced the natural bristles in modern brushes in 1938. [4]

Although toothbrushes are essential for dental plaque control, other auxiliary products like dentifrices are available to potentiate the action of toothbrushes. [5] In 1892, Dr. Washington Sheffield of New London, Connecticut, manufactured dentifrice called "Dr. Sheffield's Creme Dentifrice" into a collapsible tube following which Colgate and Company Dental Cream was introduced in 1896. [6] Dentifrices are considered agents with antibacterial potential which could have a beneficial effect on plaque control and disease prevention. It is thus suggested that by using toothbrushes and dentifrice, it would be possible to get a combination of chemical and mechanical action in the toothbrushing. However, the cost of dentifrices can prove to be an inhibiting factor in oral hygiene maintenance practices for low-income populations. Therefore, an evaluation of its real importance also deserves attention. [5]

Keeping all the above mentioned points in view, the present study was undertaken to find the cleaning ability of the toothbrush with or without the use of dentifrices in removal of debris and plaque with the following objectives:

  • To assess the cleaning ability of toothbrush with dentifrices in removal of debris and plaque
  • To assess the cleaning ability of toothbrush without dentifrices in removal of debris and plaque
  • To compare the cleaning ability of toothbrush with or without dentifrice in removal of debris and plaque.



  Materials and Methods Top


Sampling

A total of 105 hostel inmates was chosen as the study population, of which 67 agreed voluntarily to participate in the study. Based on the inclusion and exclusion criteria, 30 subjects were randomly chosen for the clinical trial. Literature from the previous study was analysed for sample size estimation. [5] Undergraduate third and final year male students in the age group of 20-24 years were selected mainly because of the convenience factor.

Inclusion criteria

  • Subjects who gave informed consent
  • Subjects in the age group of 20-24 years
  • Subjects are staying in the hostel for the period of more than 1 year.


Exclusion criteria

  • Subjects who did not give inform consent
  • Subjects using tobacco and alcohol in any form
  • Subjects are suffering from any systemic illness that have oral manifestations
  • Subjects on the antibiotics in the period of last 15 days.


All the subjects were asked not to eat food or snacks except hostel food to rule out the dietary influence on debris and plaque.

Ethical clearance and informed consent

Ethical clearance for the study was obtained from the Institutional Ethical Committee before the start of the study, and the purpose of the study was explained prior to the collection of data to each participant and their consent was obtained.

Study design

The 30 subjects selected for study were randomly divided into three groups:

  • Group I: 10 subjects
  • Group II: 10 subjects
  • Group III: 10 subjects.


Recording of baseline scores

  • The baseline plaque and debris scores were recorded for each study group before brushing using the debris index-simplified [7] and plaque index [8]
  • The clinical examination was carried out by a single trained examiner (k > 0.82).


Clinical intervention

After recording the baseline scores the study groups instructed to follow the brushing regimen (modified bass method) for the period of 10 days as follows:

  • Group I - was given new toothbrush and dentifrice
  • Group II - was instructed to use only new toothbrush but without dentifrice
  • Group III - was instructed to use their routine oral hygiene measures.


Recording of final scores

  • During the intervention period, the subjects were instructed to brush their teeth once in the morning before breakfast
  • After the intervention period of 10 days debris and plaque scores were recorded in the morning before the brushing in the same manner as the baseline scores.


Statistical analysis

The statistical analyses were carried out using  SPSS version 11.5 for windows (SPSS Inc., 233 South Wacker Drive, 11 th Floor, Chicago, IL 60606-6412). Paired't'- test was used to compare the mean baseline and mean follow-up scores for debris and plaque in each group. One-way ANOVA was used to compare the mean debris and mean plaque scores between the three groups. P < 0.05 was considered to be statistically significant at confidence interval of 95%.


  Results Top


The present study was carried out on 30 undergraduate subjects residing in the hostel of K.D. Dental College and Hospital with the mean age of 22 ± 1.5 years. The subjects were divided into three groups - Group I using the dentifrice and toothbrush (n = 10), Group II using only toothbrush (n = 10), Group III using their routine oral hygiene measures (n = 10). Debris Index - Simplified (debris component of Simplified Oral Hygiene Index) and Plaque Index were used to record the debris and plaque at baseline and follow-up in all the three groups.

The mean debris score at baseline for Group I was 1.16 (standard deviation [SD] = 0.22), Group II was 0.92 (SD = 0.26) and Group III was 1.22 (SD = 0.53) and the mean debris score at follow-up for Group I was 1.09 (SD = 0.15), Group II was 1.40 (SD = 0.30), Group III was 1.62 (SD = 0.32). The mean plaque score at baseline for Group I was 0.93 (SD = 0.24), Group II was 0.77 (SD = 0.19), Group III was 1.04 (SD = 0.45) and the mean plaque score at follow-up for Group I was 0.83 (SD = 0.20), Group II was 1.11 (SD = 0.27), Group III was 1.35 (SD = 0.29).

When paired 't'- test was used to compare the baseline and follow-up scores for debris and plaque in each group, it was found that the difference in mean debris scores at baseline and follow-up for Group II (P = 0.000) and Group III (P = 0.005) was statistically significant. However, the difference in mean debris scores at baseline and follow-up for Group I (P = 0.153) was not statistically significant. It was also found that the difference in mean plaque scores at baseline and follow-up in all the three groups was statistically significant (Group I (P = 0.006), Group II [P = 0.000], Group III [P = 0.004] [Table 1]).
Table 1: Comparison of baseline and follow-up score for debris and plaque in each group


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When one-way ANOVA test was used to compare the mean difference of debris (difference between baseline and follow-up score) and mean difference of plaque scores (difference between the baseline and follow-up score) between the three groups, it was found to be statistically significant [Table 2]. Following significance in one-way ANOVA test, post-hoc Tukey's test was employed. When the mean difference in debris score of Group I and mean difference in debris score of Group II was compared, a statistically significant difference (P = 0.000) was found. Similarly, when the mean difference in debris score of Group I and mean difference in debris score of Group III was compared a statistically significant difference (P = 0.004) was found. However, when mean difference in debris score of Group II and mean difference in debris score of Group III was compared, no statistically significant difference (P = 0.128) was found [Table 3].
Table 2: Comparison of mean debris and mean plaque scores between the 3 groups


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Table 3: Post-hoc Tukey's test


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When the mean difference in plaque score of Group I and mean difference in plaque score of Group II was compared, a statistically significant difference (P = 0.000) was found. Similarly, when the mean difference in plaque scores of Group I and mean difference in plaque score of Group III was compared a statistically significant difference (P = 0.006) was found. However, when mean difference in plaque score of Group II and mean difference in plaque score of Group III was compared, no statistically significant difference (P = 0.198) was found [Table 3].


  Discussion Top


The present study was a randomized clinical trial aimed to analyze the cleaning ability of the toothbrush with or without the use of dentifrice on removal of debris and plaque. The results of the present study showed that there was a significant reduction in mean debris and mean plaque scores after 10 days in the subjects using toothbrush with dentifrice, that is, Group I. However, an increase in the mean debris and mean plaque scores was found in the subjects using toothbrush without dentifrice irrespective of whether the toothbrush used or using routine oral hygiene measures, that is, Group II and Group III respectively. Similar results were obtained in the study conducted by De la Rosa et al. who found 27% less plaque accumulation in the subjects who used toothbrush with dentifrice when compared to those who used toothbrush without dentifrice. [9] Furthermore, although the pure and simple use of a toothbrush can ideally lead to the reduction of dental plaque to clinically acceptable levels, its use should be encouraged even under nonideal conditions since it is fundamental as a motivational agent for an adequate oral health care. [10]

The decrease in mean debris and mean plaque score in the subjects might be attributed to the presence of detergent substances and abrasives in the formulation of dentifrices. [5] The detergent substances and abrasives help in the removal of debris and plaque by increasing the abrasiveness of the toothbrush and softening of the debris and plaque, which together enhances the cleaning ability of toothbrush. [11]

However, in a study conducted by Parizotto et al. in 2003, it was found that dentifrices do not have a prominent role on the mechanical removal of debris and plaque. [5] The study conducted by Paraskevas et al. concluded that the use of dentifrice does not contribute to the instant mechanical plaque removal during manual toothbrushing. [12] It seemed that the mechanical action provided by the toothbrush was the main factor in the plaque-removing process. [13],[14]

It is thus suggested that by using toothbrushes and dentifrice, it would be possible to get a combination of chemical and mechanical action in the oral peophylaxis. [15] Such action would be related to the presence of detergent substances in the formulation of dentifrices, more commonly represented by sodium lauryl sulfate, [16] which help the removal of plaque by increasing friction in the location and by protecting against the rapid recolonization of the dental surface by the residual presence of adherent microorganisms. [11]

The present study had certain limitations like short duration for which the study was conducted, and the subjects were instructed to take only hostel diet, but they can't be monitored as they move out from the hostel for their personal work, might have influenced the study results. As the study population was a captive population restricted to hostel inmates of the dental institute, the results obtained were specific. Hence, the results cannot be generalized to the whole population for which further study is recommended taking a larger sample selected from a cross-section of the population.


  Conclusion Top


It was found from the study that the cleaning ability of a toothbrush with dentifrice was more effective in the removal of debris and plaque than the cleaning ability of the toothbrush without dentifrice.

 
  References Top

1.Hioe KP, van der Weijden GA. The effectiveness of self-performed mechanical plaque control with triclosan containing dentifrices. Int J Dent Hyg 2005;3:192-204.  Back to cited text no. 1
    
2.van der Weijden GA, Hioe KP. A systematic review of the effectiveness of self-performed mechanical plaque removal in adults with gingivitis using a manual toothbrush. J Clin Periodontol 2005;32 Suppl 6:214-28.  Back to cited text no. 2
    
3.Versteeg PA, Timmerman MF, Piscaer M, Van der Velden U, Van der Weijden GA. Brushing with and without dentifrice on gingival abrasion. J Clin Periodontol 2005;32:158-62.  Back to cited text no. 3
    
4.Penick C. Power toothbrushes: A critical review. Int J Dent Hyg 2004;2:40-4.  Back to cited text no. 4
[PUBMED]    
5.Parizotto SP, Rodrigues CR, Singer Jda M, Sef HC. Effectiveness of low cost toothbrushes, with or without dentifrice, in the removal of bacterial plaque in deciduous teeth. Pesqui Odontol Bras 2003;17:17-23.  Back to cited text no. 5
    
6.Wikipedia, the free encyclopedia. Search term "Toothpaste". Available from: http://www.en.wikipedia.org/wiki/Toothpaste. [Last accessed on 2010 Feb 15].  Back to cited text no. 6
    
7.John C. Greene, Jack R. Vermillion. The simplified oral hygiene index. J Am Dent Assoc 1964;68:25-31.  Back to cited text no. 7
    
8.Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol 1967;38 Suppl: 610-6.  Back to cited text no. 8
    
9.De la Rosa M, Zacarias Guerra J, Johnston DA, Radike AW. Plaque growth and removal with daily toothbrushing. J Periodontol 1979;50:661-4.  Back to cited text no. 9
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10.Hawkins BF, Kohout FJ, Lainson PA, Heckert A. Duration of toothbrushing for effective plaque control. Quintessence Int 1986;17:361-5.  Back to cited text no. 10
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11.Davis WB. Cleaning and polishing of teeth by brushing. Community Dent Oral Epidemiol 1980;8:237-43.  Back to cited text no. 11
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12.Paraskevas S, Timmerman MF, van der Velden U, van der Weijden GA. Additional effect of dentifrices on the instant efficacy of toothbrushing. J Periodontol 2006;77:1522-7.  Back to cited text no. 12
    
13.Paraskevas S, Rosema NA, Versteeg P, Timmerman MF, van der Velden U, van der Weijden GA. The additional effect of a dentifrice on the instant efficacy of toothbrushing: A crossover study. J Periodontol 2007;78:1011-6.  Back to cited text no. 13
    
14.Creeth JE, Gallagher A, Sowinski J, Bowman J, Barrett K, Lowe S, et al. The effect of brushing time and dentifrice on dental plaque removal in vivo. J Dent Hyg 2009;83:111-6.  Back to cited text no. 14
    
15.Addy M, Moran JM. Evaluation of oral hygiene products: Science is true; don't be misled by the facts. Periodontol 2000 1997;15:40-51.  Back to cited text no. 15
    
16.Herlofson BB, Barkvoll P. Desquamative effect of sodium lauryl sulfate on oral mucosa. A preliminary study. Acta Odontol Scand 1993;51:39-43.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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