Comparison of different toothbrushing protocols in poor-toothbrushing orthodontic patients

The aim of this study was to determine, using a computerized image analysing system, whether the use of a curved-bristle toothbrush (CBT) alone is more effective than two other toothbrushing protocols on dental plaque elimination in poor-toothbrushing orthodontic patients. The labial surfaces of the maxillary canine-to-canine anterior teeth of 30 patients (12 males and 18 females) were individually photographed following dental plaque staining before and 4 weeks after each toothbrushing protocol, with a 1-month washout interval. The toothbrushes used were (1) a CBT, (2) an orthodontic toothbrush (OT), and (3) an OT in combination with interproximal toothbrush (IT) (OT + IT). Total labial surfaces of the anterior teeth and stained plaque areas were measured and gingival indices (GIs) were also recorded. Repeated measures analysis of variance and Tukey's Honestly Significant Difference multiple range tests showed that the OT + IT produced a statistically significant decrease in the mean plaque percentage both for the total labial (7.2%) and interproximal (17.7%) tooth surfaces, when compared with the other toothbrushing protocols (P < 0.05). No statistically significant differences were found between the CBT and OT for the amount of bacterial plaque and GI scores (P > 0.05). Neither the CBT nor the OT alone was able to remove plaque under the archwires in poor-toothbrushing patients. Therefore, the use of ITs should be mandatory for effective plaque removal in these patients.