ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Insufficient Evidence to Support Improved Plaque Index with Powered Toothbrushes in Orthodontic Patients
Clinical Question For patients with multi-bracket orthodontic appliances, is a powered toothbrush more effective in plaque removal compared to a manual toothbrush?
Clinical Bottom Line There is not strong enough evidence at this time to conclude that powered toothbrushes are more effective in plaque removal compared to a manual toothbrush in multi-bracket orthodontic patients.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21250772Silvestrini Biavati/201020 patients with multi-bracket orthodontic appliancesRandomized Controlled Trial
Key resultsBaseline measurements were taken 3 months after orthodontic bracket bonding. Differences in PI between groups using a powered oscillating toothbrush and a manual toothbrush were not significant 4 weeks after T1. However, 8 weeks after bonding, the mean PI of group using the powered toothbrush was significantly lower than that of the group using the manual brush (p-value = 0.010).
#2) 11999936Hickman/200260 patients with upper and lower edgewise fixed appliancesRandomized Controlled Trial
Key resultsAfter 4- and 8-week followups, there was no significant difference in PI for patients who used a powered toothbrush, but patients who use a manual toothbrush did experience a significant reduction in PI. The p-value in this study was <0.001.
Evidence Search (("Toothbrushing"[Mesh]) AND "Dental Plaque Index"[Mesh]) AND "Orthodontic Brackets"[Mesh]
Comments on
The Evidence
Silvestrini Biavati reported an RCT of powered oscillating vs manual tooth brushing during orthodontic treatment, including 20 subjects under the age of 16. With a 100% completion rate, the groups were similar at the start, treated the same, and had adequate followup. Recall bias was unlikely and there were no competing interests. The Hickman article reported an RCT of powered vs manual tooth brushing during orthodontic treatment, including 63 subjects between the ages of 10 and 20. Patients with previous powered toothbrush experience were excluded. There was >80% completion rate, the groups were treated the same, had adequate followup and compliance, and recall bias was unlikely. The authors, however, said there was an increased risk of a Type II error because they assessed only the buccal surfaces of the teeth and not the lingual, which is the area where PI is usually improved in non-orthodontic patients. They also mentioned that the PI for patients using the powered toothbrush may not have improved because the patients had to adapt to a new kind of brushing device and technique. This study was supported by Braun Oral B, Germany.
Applicability The results are applicable to young patients with multi-bracket orthodontic appliances. Patients with orthodontic brackets experience a challenge with plaque accumulation and removal due to obstruction to cleaning. There is insufficient evidence as to whether a powered toothbrush is more effective in plaque removal when compared to a manual toothbrush.
Specialty/Discipline (General Dentistry) (Orthodontics)
Keywords Powered toothbrush, manual toothbrush, orthodontic brackets, plaque index
ID# 2177
Date of submission: 04/04/2012spacer
E-mail jean@livemail.uthscsa.edu
Author Leslie Jean
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Mary Norma Partida, DDS, MPH
Faculty mentor/Co-author e-mail partidam@uthscsa.edu
Basic Science Rationale
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