Orthodontists' instructions for oral hygiene in patients with removable and fixed orthodontic appliances.

INTRODUCTION: The aim of this questionnaire-based survey was to evaluate information on frequencies, instructions and products relating to oral hygiene (OH) in orthodontic practices. METHODS: Using a computer-generated randomization list, 1000 orthodontists were selected and sent a questionnaire. The size and number of inhabitants of the federal states of Germany were considered. The federal states with the highest return rate (Baden-Wuerttemberg [BW], Bavaria [B], Hesse [H], Lower Saxony [LS], Nordrhein-Westphalia [NRW]) were considered and differences between the 16 federal states were divided into North, South, East and Central Germany. RESULTS: The response rate of the questionnaires was 52.4%. The majority (53.8%) worked in one practice alone. Most (59.1%) have been orthodontists for 5-25 years. For vestibular multibracket appliances (MBA) in BW, B, H and LS over 90% recommended interdental brushes (IDB). In NRW 91.4% recommend fluoride gel. In B and H more than 80% chose electric toothbrush (ETB), in BW, LS and NRW more than 80% manual toothbrush (MTB). For lingual MBA (LMBA) in BW, H, LS and NRW with approximately 50% each fluoride gel, IDB and MTB were chosen. In B fluoride gel, IDB and ETB. For removable apparatus (RA), five federal states recommended MTB (>80%) and ETB (BW, B, H > 80%; NRW > 70%; LS > 60%). CONCLUSION: Electric toothbrushes are recommended for the use with all appliances, only with removable appliances manual toothbrushes are favoured. For vestibular MBA it is strongly advised to use IDB additionally.

Comparison of different plaque indices with regard to sensitivity and specificity for the quantification of plaque during orthodontic therapy.

To compare four plaque indices used in orthodontics. An objective, quantitative plaque index and three subjective conventional plaque indices were analyzed. The study included n = 50 photographs of n = 50 subjects with a multibracket appliance (MB) in the maxilla and mandible. Photographs were taken using Digital Plaque Imaging Analysis (DPIA) and the Percentage Plaque Index (PPI) was calculated. The conventional plaque indices, a modified version of the Turesky-modification of the Quigley & Hein Index (TQH index), Attin index, and modified bonded bracket index (mBB index) were collected from n = 14 evaluators using the DPIA photographs. The evaluators had different levels of orthodontic experience: n = 4 evaluators had little orthodontic experience, n = 5 evaluators had moderate orthodontic experience, and n = 5 evaluators had a lot of orthodontic experience. Plaque accumulation was assessed differently with the plaque indices. Thus, the plaque indices are not interchangeable. We recommend DPIA as an objective, quantitative and sensitive method for plaque determination in scientific studies. The simple statistical evaluation offers a great advantage over conventional plaque indices.

Comparative assessment of plaque removal and motivation between a manual toothbrush and an interactive power toothbrush in adolescents with fixed orthodontic appliances: A single-center, examiner-blind randomized controlled trial.

INTRODUCTION: The objective of this 2-arm parallel trial was to determine the plaque removal efficacy (main outcome) and the motivation assessment (secondary outcome) comparing a manual versus an interactive power toothbrush in orthodontic patients. METHODS: Sixty adolescents with fixed orthodontic appliances in both arches were randomized in a 1:1 ratio in this parallel, randomized, examiner-blind controlled clinical trial. Eligibility criteria included at least 16 natural teeth, 1-6 "focus care areas," plaque score of ≥1.75, no severe caries, gingivitis and periodontitis, no dental prophylaxis, no smoking, no antibiotics, and no chlorhexidine mouth rinse. Subjects were to brush unsupervised with either an interactive power toothbrush (Oral-B Professional Care 6000, D36/EB20) with Bluetooth technology or a regular manual toothbrush (Oral-B Indicator 35 soft). Focus care areas were each brushed for 10 additional seconds. Plaque removal was assessed with the use of the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI) to determine change from baseline at 2 and 6 weeks. Supervised brushing at screening and post-treatment visits recorded actual brushing times. Subject-reported motivational aspects were recorded at screening and week 6. RESULTS: Fifty-nine subjects aged 13-17 years completed the study. The interactive power toothbrush provided significantly (P <0.001) greater plaque reduction versus the manual toothbrush at 2 and 6 weeks according to the whole-mouth TMQHPI. The treatment difference in adjusted mean plaque change from baseline was 0.777 (95% CI 0.614-0.940) at week 2 and 0.834 (0.686-0.981) at week 6. Mean reductions in the number of focus care areas were also significantly greater (P <0.001) in the power brush group at weeks 2 and 6. Brushing times increased significantly at weeks 2 and 6 (P ≤0.013) versus baseline in the interactive power brush group only. Subject-reported motivation was significantly increased in the interactive power brush group at week 6 versus screening (P ≤0.005). CONCLUSIONS: An interactive power toothbrush generated increased brushing times and significantly greater plaque removal versus a manual brush.

A comparative assessment of plaque removal and toothbrushing compliance between a manual and an interactive power toothbrush among adolescents: a single-center, single-blind randomized controlled trial.

BACKGROUND: Many adolescents have poor plaque control and sub-optimal toothbrushing behavior. Therefore, we compared the efficacy of an interactive power toothbrush (IPT) to a manual toothbrush (MT) for reducing dental plaque and improving toothbrushing compliance. METHODS: In this randomized, parallel single-blind clinical study, adolescents brushed twice daily with either a MT (Oral-B® Indicator soft manual toothbrush) or an IPT (Oral-B® ProfessionalCare 6000 with Bluetooth). Subjects brushed for 2 min, plus an additional 10 s for each 'Focus Care Area'. At screening and Week 2, afternoon pre-brushing plaque was assessed via the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI), and supervised brushing duration was measured. RESULTS: Sixty subjects were randomized; 98% completed. At Week 2, the mean reduction in whole mouth plaque relative to baseline was 34% (p < 0.001) for the IPT versus 1.7% (p = 0.231) for the MT. For Focus Care Areas, the IPT yielded a 38.1% mean TMQHPI reduction (p < 0.001) versus 6.2% for the MT (p < 0.001). Mean brushing time versus baseline increased 34 s in the IPT group (p < 0.001) while remaining flat in the MT group (p = 1.0). CONCLUSIONS: Over 2 weeks, adolescents using an IPT experienced superior plaque reduction and increased overall brushing time versus those using a MT. TRIAL REGISTRATION: This trial was retrospectively registered ( ISRCTN10112852 ) on the 18th, June 2018.