A clinicomicrobiological study to evaluate the efficacy of manual and powered toothbrushes among autistic patients

Evaluation of the effectiveness of novel oral hygiene aids in the prevention of gingival diseases in children and adolescents with special healthcare needs - A systematic review and meta-analysis

Background

Due to a lack of manual dexterity, impaired cognitive and general development, and awareness of caregivers, special children are not able to maintain good oral health. This leads to the development of dental plaque, gingival inflammation, and further periodontal diseases. It is, thus, necessary for dentists and caregivers to understand which of oral hygiene aids can be best suited for a child with special healthcare needs. The aim of this review is to evaluate the most efficacious oral healthcare aids in children and adolescents with special healthcare needs.

Materials and Methods

Systematic search was conducted in databases: PubMed, Cochrane, Google Scholar, Scopus, and ProQuest for studies published from January 1, 2000, till December 31, 2023. Randomized trials conducted among children and adolescents with special healthcare needs below 18 years using oral hygiene aids to reduce plaque were included in this review.

Results

A total of 23 articles satisfying eligibility criteria were included in the systematic review and 11 articles for meta-analysis. Meta-analysis was divided into two parts. Novel toothbrushes were more effective than manual toothbrushes with P = 0.01 (SMD: Standard Mean Difference) 95% confidence interval: -4.23 (-7.62, -0.85), I 2 = 99.63%). In chemical oral hygiene aids, chlorhexidine (CHX) spray at concentration of 0.12% was found to be more effective than placebo to control plaque and was not statistically significant.

Conclusion

Current evidence suggests that novel mechanical oral hygiene aids used with CHX spray as an adjunct can be best suited for children and adolescents with special healthcare needs to control plaque.

Comparison of Oral Hygiene and Gingival Outcomes in Children With Special Care Needs Using Powered or Manual Toothbrushes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

AIM

This systematic review and meta-analysis (SRMA) compares oral hygiene and gingival outcomes in children with special care needs (CSCNs) using powered or manual toothbrushes.

MATERIAL AND METHODS

Two authors searched articles using PubMed and Cochrane library; the search was extended to other databases to include publications until July 2024. RCTs available in English were included. Oral hygiene and gingival outcomes in CSCNs, using powered or manual toothbrushes were: plaque index (PI), Quigley Hein plaque index (QHPI), gingival index (GI), and oral hygiene index simplified (OHI-S). ROB and publication bias was assessed using Cochrane tool and funnel plots, respectively. Meta-analyses were performed using forest plots. GRADE was used for the quality.

RESULTS

Twelve studies were included in SR and 11 studies in MA. In relation to GI and in the subgroup analysis of QHPI, powered toothbrushing was superior to manual toothbrushing with SMD -0.681 [95% CI (-0.911 to -0.451)] and SMD -0.85 [95% CI (-1.166 to -0.53)], respectively using REM. Comparisons with other indices exhibited no significant differences. The ROB and publication bias were moderate, quality of evidence was low to moderate GRADE.

CONCLUSION

Powered toothbrushes had favorable outcomes in a few but not all parameters. The overall quality of evidence is low.

PROSPERO REGISTRATION ID

CRD42024579260.

Comparative Evaluation of Plaque Removal Potential of Manual Electrical and Chewable Toothbrushes in Children: A Clinical Trial

Aim and background

To evaluate and compare the efficiency of a manual, electrical, and chewable toothbrush for plaque removal in children.

Materials and methods

A total of 58 children aged 8-14 years who reported to the Department of Pedodontics. The children and guardians were familiarized with the disclosing agent, manual toothbrush, electrical toothbrush, and chewable toothbrush before the commencement of the study with the help of video and verbal demonstrations. Thirty children who were interested in participating in the study were included.

Results

The study consisted of 30 participants who were divided into three groups of 10 each-group A: manual toothbrush, group B: electrical toothbrush, and group C: chewable toothbrush. A disclosing agent was applied, and Oral Hygiene Index-Simplified (OHI-S) and Toothbrush Quality and Hygiene Index (TQHI) scores were recorded at baseline and after 1 week. The data was tabulated and subjected to statistical analysis. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0. Intragroup comparisons, that is, between baseline and 1 week, were performed using the paired samples t-test. Intergroup comparisons between the three groups were performed using one-way analysis of variance (ANOVA), followed by post hoc Tukey test (pairwise comparisons). A p < 0.05 was considered statistically significant.

Conclusion

The plaque removal efficiency of electric toothbrushes is the highest, followed by the chewable toothbrush group, while the manual toothbrush group is the least. The chewable toothbrush highly surpasses the manual toothbrush group as it contains xylitol substances, which reduce Mutans Streptococcus in the plaque.

How to cite this article

Mareddy AR, Reddy VN, Done V, et al. Comparative Evaluation of Plaque Removal Potential of Manual Electrical and Chewable Toothbrushes in Children: A Clinical Trial. Int J Clin Pediatr Dent 2024;17(12):1388-1393.

Special aspects of treatment and adaptation of children with autism spectrum disorder at a dental appointment (literature review)

Relevance. Children with autism spectrum disorder (ASD) have poor self-care skills; they depend on sweet food, and their sensory integration is impaired. All of the above leads to poor oral hygiene. High rates of dental disease in these patients require searching for the most effective treatment and prevention methods. Special programs based on clinical manifestations and behaviour modification have been developed for children with ASD to adapt to dental appointments and oral hygiene education. In addition to traditional hygiene education, modern techniques, including electronic devices, are increasingly being introduced. Unfortunately, not all children can get used to dental manipulations, and the dentist has to resort to sedation or general anaesthes ia.Objective. To present up-to-date information about children's adaptation methods to dental appointments, prevention and treatment of oral diseases.Materials and methods. The literature analysis on the topic was the main study method. Publications were searched in the Medline PubMed and E-library databases by the keywords: 'treatment and prevention of diseases', 'children with ASD', 'adaptation' and 'hygiene education', according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.Results. The comprehensive approach to oral-disease treatment in children with ASD under general anaesthesia and sedation enables us to achieve excellent results with optimal comfort for both the patient and the pediatric dentist. The advantage of these methods is that the doctor can perform a larger volume of treatment and preventive measures during one visit.Conclusion. Children with autism need prevention and treatment of dental conditions. Available prevention programs need to be adapted to their disease and personality characteristics, using various methods of hygiene education.

Powered Toothbrushes: An Opportunity for Biofilm and Gingival Inflammation Control

The present review aimed at a broad investigation on the potential of powered as compared to manual toothbrushes in different aspects of clinical dentistry. Studies evaluating plaque and gingival inflammatory parameters were included, as well as those that investigated adverse effects. Emphasis was given separately to adults, youngsters, special-needs patients, and those under fixed orthodontic therapy. In general, comparisons favored powered toothbrushes. In summary, approximately 68% of the included studies, in terms of plaque/gingival inflammation in adults, presented better results for powered toothbrushes. In children and special-needs populations, approximately 40% of the included studies favored powered toothbrushes for plaque/gingival inflammation, and none favored manual ones. In orthodontic individuals, 50% of the studies also demonstrated a better effect of powered toothbrushes on plaque and gingival inflammation. All included studies that assessed adverse events did not demonstrate a difference in these effects when comparing manual vs. powered toothbrushes. It is concluded that the use of powered toothbrushes is an opportunity to enhance patterns of plaque control and associated gingival inflammation.

Manual and Powered Toothbrushing Effectiveness on Autistic Children's Oral Hygiene Status

Background

Autistic children want a lot of help cleaning their teeth and they have a higher risk of periodontal disorder and less caries than the general public. The study's purpose is to see how helpful manual and powered toothbrushing are for autistic kids aged 6-12 years.

Materials and Methods

A total of 40 autistic children aged 6-12 years were chosen at random from Mangalore city schools. The simplified oral hygiene index was used to determine the baseline oral health (OHI-S). Children were split into two classes during an oral review. Children in Group 1 received a manual toothbrush, and those in Group 2 received a powered toothbrush. Many of the children were given Colgate fluoride-free toothpaste. Under the guidance of care professionals, children were taught to brush for 3 min. They were taught to count from 1 to 20 when brushing each buccal and lingual section. The index was rechecked at the conclusion of the 1st month (30th day) and the next month (3rd month) (90th day). On the 60th day, the recently learned techniques were reinforced (end of the 2nd month).

Result

In Group 1, a statistically significant reduction in mean OHI-S scores was observed in baseline versus 30 days and baseline versus 90 days, while in Group 2, a statistically highly significant reduction in baseline versus 30 days, baseline versus 90 days, and 30 days versus 90 days was observed.

Conclusion

Furthermore, in autism children, powered teeth brushing shows potential. Long-term follow-up and greater sample size are, however, needed.

Associations of oral hygiene with incident hypertension and type 2 diabetes mellitus: A population based cohort study in Southwest China

Oral health has been previously reported to be related with cardiovascular diseases (CVD). This study aimed to evaluate whether oral hygiene could reduce the risk of incident hypertension and type 2 diabetes mellitus (T2DM) in a population-based cohort. A total of 9280 people aged 18 years or above in Guizhou province were recruited from November 20th, 2010 to December 19th, 2012. Sociodemographic characteristics, lifestyles, anthropometric measurements, oral health status and care were collected by trained interviewers. The occurrences of hypertension and T2DM were ascertained until 2020. Cox proportional hazard models were used to evaluate the associations between oral hygiene and the occurrence of hypertension and T2DM, respectively. Compared with almost no tooth brushing, tooth brushing at least twice a day was associated with a 45% reduction (HR: .55; 95% CI: .42-.73) in hypertension events and reduced diabetes risk by 35% (HR: .65; 95% CI: .45-.94). For hypertension, those associations tended to be more pronounced in participants with Han ethic, or living in urban area, while those aged less than 60 or without baseline hypertension were more likely to have T2DM when they brush teeth less than twice a day. Frequent tooth brushing was associated with reduced risks of incident hypertension and T2DM. Tooth brushing at least twice a day may prevent future hypertension and T2DM events.

Electric toothbrush for biofilm control in individuals with Down syndrome: a crossover randomized clinical trial

Poor oral hygiene seems to be the norm in children and teenagers with Down Syndrome (DS). Advances in design and types of toothbrushes may improve biofilm control. This randomized, single-blind, crossover clinical trial evaluated the effectiveness of electric toothbrushes regarding mechanical control of biofilm in children and teenagers with DS and their cooperation. Twenty-nine participants with DS, aged 6 to 14 years, used both types of toothbrushes: electric (ET) and manual (MT). The order of use of the different types of toothbrushes was randomly defined, including a 7-day period with each type with 7-day washout period in between. The Turesky-Quigley-Hein biofilm index was used before and after brushing to assess the effectiveness of the technique. Frankl's behavioral scale was used during toothbrushing to assess the participants' cooperation. Paired T-test, Mann Whitney, Chi-square, and Fisher's Exact tests were applied, with a significance level of 5%. The quantity of dental biofilm was significantly reduced after both brushing techniques (p < 0.001). However, no significant difference was found in total biofilm (ET: 0.73 ± 0.36; MT: 0.73 ± 0.34; p = 0.985) or % biofilm reduction (ET: 72.22%; MT: 70.96%; p = 0.762) after brushing between techniques or in % biofilm reduction between toothbrushes of age groups (6 -9 years, p = 0.919; 10-14 years, p = 0.671). Participants showed similar cooperation level with the two types of toothbrush (p = 1.000). The use of electric or manual toothbrush had no effect on the quantity of dental biofilm removed in children and teenagers with DS, nor did it influence their cooperation during the procedure.

Yoga therapy as an adjunct to traditional tooth brushing training methods in children with autism spectrum disorder

AIM

To evaluate if yoga could be an adjunct to regular training methods in training brushing skill to children with autism spectrum disorder (ASD).

METHODS

Seventy-two children with ASD aged 7-15 years were selected and divided into two groups (N = 36). Children in Group I received visual pedagogy and video modeling and children in Group II received visual pedagogy and video modeling with yoga. Plaque and gingival indices (PI and GI) were recorded at baseline and at the end of first, second, third, and sixth month. The scores were summarized as mean and standard deviation and inter-group comparison was done using independent t-test.

RESULTS

Inter-group comparison of mean plaque and gingival indices scores were statistically significant at second month (P = .039 for PI and P = .009 for GI). The scores were statistically significant even at third month (P = .001 for PI and P = .002 for GI) and sixth month (P = .001 PI and GI), with children in Group II demonstrating better oral hygiene.

CONCLUSION

Yoga training can be used as an adjunct to enhance tooth brushing learning capabilities of children with ASD in addition to visual modeling and pedagogy.