Manual vs. interactive power toothbrush on plaque removal and salivary Streptococcus mutans and Lactobacillus casei levels : Single-center, examiner-blinded, randomized clinical trial in orthodontic patients.

Introduction: The purpose of this study was to compare efficacy of a manual and an interactive power toothbrush in orthodontic patients by assessing periodontal indexes and bacterial content of saliva samples.

Methods: Forty patients (20 females, 20 males; age range 12-18 years) with fixed orthodontic appliances were included in the study. The patients were randomly divided into two groups in a 1:1 ratio using sealed envelopes: group 1: manual toothbrush (Oral‑B Ortho Brush, Procter&Gamble Company, Dublin, Ireland), group 2: interactive power toothbrush (Oral‑B Genius 8900, Procter&Gamble Company, Marktheidenfeld, Germany). All participants were given the same toothpaste (Colgate Triple Action, Colgate-Palmolive, New York, NY, USA). The brushing procedure for each patient was described in detail, both orally and visually, utilizing a video demonstration. Plaque and bleeding index scores were recorded for both the lower and upper arches at the beginning of the study (T0) and at weeks 6 (T1) and 12 (T2). In addition, the numbers of Streptococcus (S.) mutans, Lactobacillus (L.) casei, and Porphyromonas (P.) gingivalis bacteria were determined using a real-time polymerase chain reaction (PCR) analysis in saliva samples collected at T0, T1, and T2 times. Mann-Whitney U test and Student's t test were used to compare data between the groups, and one-way analysis of variance (ANOVA) and Friedman tests were used to compare data from different time intervals for each group.

Results: Plaque index values were greater in group 1 at T1 and T2, although there was no difference between the groups at T0. The gingival index scores of both groups were similar at T0, T1, and T2. While group 2 had a larger number of salivary S. mutans at T0 and T2, there was no significant difference between the groups at T1. At all three time points, there was no significant difference in salivary L. casei levels between the groups.

Conclusions: Although the interactive power toothbrush was more effective at removing plaque than the manual toothbrush, the results of the gingival index did not reflect the plaque scores. The number of certain salivary bacteria and brush type did not appear to have a clear relationship.