Efficacy of Chewable Brush Compared to Manual Brush in School Going Children of Age Group 10–12 Years

ABSTRACT

Aim:

Chewable toothbrushes were compared to traditional manual toothbrushes in terms of their ability to remove plaque and their impact on salivary pH in a sample of school-aged children.

Materials and Methods:

The sample size for this research was 200 youngsters aged 10–12. Saliva was collected by spitting into a clean container, and the pH levels were measured using color-coded pH strips to determine where the person was starting from. The plaque score was measured using the OHI-S index after the application of the disclosing agent. The pH and plaque scores were also recalculated after brushing to see how they had changed after surgery.

Results:

Results indicated that both manual and chewable brushes significantly improved post-brushing pH ratings (P = 0.001), and that plaque scores decreased (P = 0.001). When compared to conventional manual toothbrushes, the chewable brush was much more successful in reducing plaque and elevating salivary pH (P = 0.001).

Conclusion:

As a result, parents may offer their kids a chewable toothbrush to help them maintain good oral hygiene after lunch and on lengthy car trips, when they would not have time to wash their teeth properly.

INTRODUCTION

The presence of dental plaque is a possible contributor to both dental caries and gingivitis.[1] Plaque cleaning is an important part of maintaining good oral health and avoiding dental problems. Brushing one’s teeth is both the most common and most successful strategy for removing plaque from one’s teeth. Because of its cheap price, convenience of use, accessible availability, and proven effectiveness in removing plaque, manual teeth brushing continues to be the preference of the majority of the population. Results are comparable to those achieved by using an electric toothbrush.[2]

In 1855, Frederick Wilhelm introduced the world to the powered (electric) toothbrush. People of all ages, including those with limited mobility, will benefit from using this powered toothbrush.[3,4] This brush has the drawback of being cumbersome for youngsters to use because of its weight, expense, and larger size compared to a manual brush. Anticariogenic chemicals such as xylitol, fluoride, or mixtures thereof may be found in commercially marketed chewable toothbrushes.[5] Xylitol’s ability to reduce plaque lactic acid generation heralds a change in dental plaque ecology that is less cariogenic.

Only a little amount of research has been conducted on the effects of xylitol-containing chewing toothbrushes on plaque clearance and salivary pH. In light of this, the purpose of this research was to conduct a systematic review and meta-analysis comparing the effectiveness of a fun toothbrush to that of a conventional toothbrush in terms of plaque removal and the effects on salivary pH in children aged 10–12 years old.

MATERIALS AND METHODS

The present study was carried out to evaluate the effect of chewable brush compared to manual brush on plaque removal and salivary pH in a group of 200 children aged 10–12 years. The instituitional review board (IRB) okayed the trial’s procedures before they began. To get written informed permission from the parents, the lead researcher sent a letter home with their children explaining the study in simple terms.

If both the child and parent are willing to participate and have signed an informed assent form, then any child between the ages of 10 and 12 who is in good general and oral health and who has no history of ongoing hospitalization, chronic illness, or constant prescription is eligible to participate. Children with orthodontic appliances, mental health issues, motor issues, and/or undiagnosed conditions are not eligible for this study.

Information on the children was gathered at the first appointment. Before the start of the trial, participants were asked to go without brushing for 24 hours. Saliva pH was measured after samples were collected. To collect unstimulated saliva, children were instructed to sit up straight and calmly. The pH of the saliva was then determined by utilizing a pH indicator strip. The length of the dipped indicator strip matched three different color-coded charts. After soaking in the saliva sample for 30 seconds, the pH strips were compared to the manufacturer’s color chart to determine the saliva’s pH level. The pH level was determined by observing the indicator paper strip as it changed color. A revealing agent was applied with a microbrush to all tooth surfaces and left undisturbed for 2 minutes to better see the plaque. For the next 30 seconds, patients were instructed to give it a little swirl before spitting it out. The color shifts of the plaques were then tracked. The oral hygiene simplified index (OHI-S) was used to determine plaque index scores, as it has been in previous research.[6]

After a child’s plaque score was taken, they were sent to a “brushing room” where they brushed their teeth for 2 minutes with either a manual toothbrush or a chewable brush under supervision. The chewable brush handles had 25 cm of floss pre-installed before being given out to pupils. Next, adults gave their kids 2 minutes to clean their teeth with the chewable brush. No dentifrice was utilized with the chewable brush since the dentifrice component is built into the brush, as per the manufacturer’s instructions. Like when chewing gum, they used their tongue to guide the brush about their mouth. Dentifrice was applied to the very end of the bristles in the manual brushing group. A set of instructions for brushing were provided that took into account the intended audience (Modified Bass method). This was done without the use of a mirror so that the participants would not be able to view the plaque that was being revealed. Plaque indices and postoperative salivary pH were obtained after reexamining the children. After participants went without brushing their teeth for 24 hours, the process was repeated with a new set of brushes and a new set of scores. Every test was conducted by a single, impartial analyst who was also required to wear a mask. Statistical Package for the Social Sciences software (Version 19.0, IBM, USA) was used to record and evaluate the data on plaque score and pH changes using the Paired t-test and the unpaired t-test, respectively.

RESULTS

Table 1 indicates that plaque scores are almost predictive of the brush rather than using a conventional toothbrush and toothpaste.

Table 1.

Comparative efficacy of chewable brush vs manual brush on OHI-S

	Pre-brushing OHI-S Mean±Sd	Post-brushing OHI-S Mean±Sd	Mean difference %	P
Chewable brush	1.5022±0.45	0.8050±0.50	50.25	<0.001*
Manual brush	1.4134±0.51	0.7525±0.40	45.70	<0.001*
P	0.54	0.05	0.006

ns=P>0.05, *P≤0.05

Neither the chewable brush nor the manual brush groups had significantly lower preoperative plaque scores than the other (P = 0.54). Chewable toothbrush users had substantially lower postoperative plaque ratings compared to manual brush users (P = 0.05).

Table 2 contrasts the effects of a manual toothbrush and a chewable brush on salivary pH.

Table 2.

Comparative efficacy of chewable brush vs manual brush on salivary pH

	Baseline salivary pH Mean±Sd	Post-brushing salivary pH Mean±Sd	P
Chewable brush	5.225±0.545	10.055±1.450	<0.001*
Manual brush	7.0500±0.40251	8.6500±0.89135	<0.001*
P	0.54	<0.001*

ns=P>0.05, *P≤0.05

After using either the chewable or the manual toothbrush, there was a statistically significant rise in pH levels (P = 0.001).

DISCUSSION

Many factors, including the individual’s brushing habits, the quality and amount of dentifrice used, and the frequency with which teeth are brushed, contribute to the presence of minimum plaque and caries in the mouth.[7,8] These toothbrushes have the extra benefit of containing anticariogenic substances like xylitol, fluoride, or a combination of the two. Studies by Mäkinen et al.[9] show that xylitol is helpful in remineralizing dental enamel because it hastens the neutralization of acid and the absorption of the beneficial calcium phosphate molecule. The levels of S.mutants in both saliva and dental plaque decrease after regular use of xylitol for at least 3 weeks. It has been observed that the rate of caries has been going down for 12–40 months now.[10] A study by Bezgin et al. (2015) found that chewable brushes are just as efficient at eliminating plaque as manual brushes.[11] The xylitol in chewable toothbrushes has made them popular in recent years.

The usefulness of xylitol as an anti-plaque and anti-cariogenic agent has been shown in a number of studies,[12-14] but there is less information on how well it works in chewable toothbrushes.

The oral hygiene simplified index was used to calculate plaque scores in the current investigation due to its simplicity. Since it takes less time to implement, it may benefit more people. Jain et al.[15] state that the OHI-S index gives a more accurate evaluation of plaque reduction scores in large-scale oral health surveys. Using a disclosing agent allows for clearer observation of plaque levels and facilitates subsequent reassessment of plaque scores after treatments. Consistent with the results of Zimmer et al. (1999), who used three different types of brushes (U-shaped head (super brush), manual brush, and swaying brush) to find a significant reduction in post-brushing plaque scores, the current investigation discovered that general plaque scores was essentially reduced with the use of pleasant and manual brushes. with no huge distinction existing between them.

The current study shows that compared to individuals who used manual toothbrushes, those who used chewable toothbrushes had higher salivary pH levels after brushing. Those results ran counter to those observed by Lavanya et al.,[5] who discovered that using the chewable brush caused a decrease in salivary pH.

To evaluate the advantages of chewable brushes in children of varying caries risk levels and children with disabilities, more long-term follow-up studies on young handicapped individuals and older adults are necessary (special needs).

CONCLUSION

With a plaque reduction score of P = 0.008, the chewable brush outperformed the manual brush. In comparison to using a manual brush, the chewable brush was significantly more successful at elevating salivary pH (P = 0.001).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.