ISSN No: 2582-0559

ABSTRACT

Background of the study:

Controlling plaque accumulation for

prevention of gingivitis, periodontitis and dental caries
effectively is determined by a number of personal and oral
hygiene practice based factors. Tooth brush manufactures have
put forth enormous effort in designing new models to improve
performance characteristics.

Aim and objective:

To evaluate the effectiveness and oral

health status among individuals using modified design special
tooth brush with beat sound developed to assist ideal brushing
technique.

Material and methods:

The present observational study

included 20 study participants of age group between 21 to
45years. All the study participants were educated to use
modified special tooth brush with beat sound regularly for a
period of 21days and their oral hygiene status were evaluated
by using Oral Hygiene Index Simplified (OHI-S) recorded at
regular intervals on 1st, 7th and 21st day.

Results:

It was observed that all the study participants showed

significant difference in the distribution of oral hygiene scores
(P < .05) irrespective of gender and majority having a fair oral
hygiene status with overall mean score of 2.22 ± 0.3259 slightly
higher than previous mean score of 2.77 ± 0.468 (P=.00026)
and initial visit poor oral hygiene status mean score of 3.755 ±
0.4796 (P=.04579).

Conclusion:

Within the limitation of this study, not taking

consideration of confounding factors it can be concluded that
modified special tooth brush with beat sound technique show
significant difference in the Oral Hygiene Index score of an
individual during the observation period thus improving the
overall oral health status.

Keywords:

Calculus index, Manual brushing, Oral Hygiene,

Soft debris, specially designed tooth brush.

EFFECTIVENESS AND ORAL HEALTH STATUS AMONG INDIVIDUALS USING

MODIFIED MANUAL TOOTH BRUSH – AN OBSERVATIONAL STUDY

Dr. Vijay Anand. M, Dr. Keerthi Narayan. V, Beno Gershon, Karthikeyan. K

Department of Prosthodontics and crown & bridge, Thai Moogambigai Dental College and Hospital (Affiliated to Dr. MGR

Educational and Research Institute), Chennai, Tamilnadu, India- 600107.

DOI: 1.37841/jidam_2021_V8_I4_01

Address for Correspondence:

Dr Keerthi Narayan V, MDS,

Senior lecturer,

Department of Oral Pathology and Microbiology,

Thai Moogambigai Dental College and Hospital,

Chennai, Tamilnadu, India- 600107.

Email id:

keerthi.oralpath@drmgrdu.ac.in

Received:

23.11.2021

First Published:

12.12.2021

Accepted:

10.12.2021

Published:

27.12.2021

ORIGINAL ARTICLE

Volume No: 8, Issue No: 4

144

Keerthi et al:

Effectiveness and Oral Health Status among Individuals Using Modified Manual Tooth Brush

Volume No: 8, Issue No: 4

145

ISSN No: 2582-0559

INTRODUCTION

Oral health status is considered as an important diagnostic
element to determine the overall health status that depends
on physiological, biological, environmental, psychological,
and social well-being of an individual

. Oral health is often

compromised due to poor oral hygiene practices, nutritional
and dietary approaches, systemic diseases, hormonal
changes, stress and addictive habits like tobacco, pan
chewing and consumption of alcohol

. It has been well

established that accumulation of debris, dental plaque and
calculus plays a vital role in initiation and development of
dental caries,

gingival and periodontal diseases.

Consequently effective removal of supra-gingival plaque
and calculus by oral hygiene practices such as appropriate
brushing technique, use of adjunctive oral hygiene aids,
mouthwashes, interdental toothbrushes, toothpicks and floss
had shown a profound effect on the gingival and oral
health

Controlling plaque accumulation for prevention of
gingivitis, periodontitis and dental caries effectively is
determined by a number of personal and oral hygiene
practice based factors. Often brushing technique is
recognized as the important aspect along with others like
design of the toothbrush, tooth-brushing frequency and
duration of use

. Inappropriate tooth brushing techniques,

improper use of oral hygiene aids involving excessive
pressure may not efficiently or effectively remove plaque
but also considerably increase gingival recession and loss of
tooth substance by mechanical abrasion

. Recent literature

studies have shown dental professionals perform various
oral health promotion activities both at the individual and
community level to incorporate significant knowledge and
awareness towards importance of oral hygiene practices
among the general population

On the other hand design  or  morphometrics  of the
toothbrush is highly influenced by technological,  physical
and  mechanical properties of the  toothbrush  bristles  and the
shape, size,  arrangement of  the tooth brush head  in  relation
to handle

. Hence, the manufacturers of toothbrushes

currently aim to integrate innovations in the brush head
design that will help to compensate for non-ideal tooth-
brushing technique and related factors

. Thus, the combined

focus on both personal and oral hygiene based factors is
critical to control oral diseases, promotion of oral health
and improve the quality of life. In the present study,
effectiveness of a specially modified manual tooth brush

developed to assist ideal brushing technique in order to
remove plaque and debris to enhance good oral health was
evaluated.

METHODOLOGY:

  A total of 20 participants (10 males and 10 females)
age group between 21 to 45years were randomly selected
into this observational study having a cross-sectional
design. All the study participants were given modified tooth
brush (V-Beat TM Manufactured and Marketed by
VISBRODENT Innovations) which is specially designed to
guide proper brushing technique by presence of beads in the
shank portion capable of  producing beat sound  (Fig 1). The
beads are arranged at a regular interval for effective
movement along the direction of vertical and circular
motions with the handle producing noise only at the time of
ideal brushing technique performed. The instructions were
given and study participants were educated to use this
modified special  tooth brush  regularly twice a day for a
period of 21days and not to use any other oral hygiene aids
during the evaluation period.

Fig 1: Photograph showing the modifie d tooth brush with

pre sence of be ads in the shank portion capable of producing

be at sound (V-Beat TM Manufacture d and Marke te d by

VISBRO DEN T INNO VATIO NS)

Oral hygiene status was evaluated by using Oral hygiene
index simplified (OHI-S) index given by John C Greene
and Jack R Vermillion (1964) recorded at the time of initial
visit (pre-assessment) followed by 1st, 7th and 21st day at
regular intervals. Indices scores were calculated based on
the Scoring Criteria. OHI-S has two components namely
Simplified Debris Index (DI-S) and Simplified Calculus
index (CI-S) recorded on six teeth that includes 3
upper/Maxillary tooth- right first molar (16- Buccal), left
first molar (26- Buccal) and Right central incisors (11-
Labial); and 3 lower/Mandibular tooth- left first molar (36-

Keerthi et al:

Effectiveness and Oral Health Status among Individuals Using Modified Manual Tooth Brush

Volume No: 8, Issue No: 4

146

ISSN No: 2582-0559

Lingual), Right first molar (46- Lingual) and left central
incisors (31-Labial).

EXAMINATION AND SCORING:

For Debris Index, the surface area covered by debris is
estimated by  running  the side  of a shepherd’s hook along
the tooth surface being examined. DI-  S-  Scores: 0-  No
debris  or stain present;  1-  soft debris covering not more
than  1/3rd of the tooth surface or presence of extrinsic
stains without other debris; 2-  soft debris covering more
than 1/3rd but not  more than  2/3rd of the exposed  tooth
surface; 3-  soft debris covering  more  than  2/3rd of the
exposed  tooth surface.

For calculus index, supra-gingival calculus usually white to
yellowish brown in color occlusal to the free gingival
margin is examined. CI-S- Scores: 0- No calculus present;
1- Supra-gingival calculus covering not more than 1/3rd of
the exposed tooth surface; 2-  Supra-gingival calculus
covering more than 1/3rd but not more than 2/3rd of the
exposed tooth surface or presence of flecks; 3-  Supra-
gingival calculus covering more than 2/3rd of the exposed
tooth surface or  presence  of heavy calculus band.

CALCULATION AND INTERPRETATION:

For each individual the final OHI-S is calculated by adding
DI-S and CI-S scores based on the number of surfaces
examined. Overall score of 0.0-1.2- Good; 1.3-3.0- Fair; 3.1
to 6.0- Poor was graded. All the data collected was
tabulated. Statistical analysis was performed by using SPSS
software version22.0 (SPSS V22.0 Illinois, Chicago).

RESULTS:

On analysis of the given data the mean age of the study
population was observed to be 38.9 ± 5.8839 years (mean ±
S.D) with 2.753 at 95% confidence level comprising of 10
(50%) male and 10 (50%) female participants. There was a
significant difference in the distribution of oral hygiene
scores (P <  .05)  with  majority of the participants having  a
poor oral hygiene status with mean score of 3.755 ± 0.4796
during pre-assessment before the  initiation  of the study
among which females (3.89) had slightly higher scores than
male group (3.62). No significant gender differences were
observed on the 1st day among female (3.47) and male
(3.29) participants in the OHI-S scores with overall mean
score of 3.38 ± 0.4884 significant at p<.05 (Table 1).

Table 1: Table Showing the Individual Pre- Assessment and Day 1 Mean OHI-S Score among the study population with One-
Way ANOVA analysis

S NO

Age

(In years)

Gender

Individual

Pre-

Assessment

OHI-S Score

Pre- Assessment

OHI-S Score

(mean ± S.D)

Individual

OHI-S Score

on Day 1

Mean OHI-S

Score on Day 1

(mean ± S.D)

p-value

Male

3.1

3.62 ± 0.4756

2.8

3.29± 0.3843

.32347

Male

3.1

2.9

Male

4.3

3.6

Male

3.5

3.2

Male

4.1

3.9

Male

3.3

3.1

Male

3.5

3.2

Male

4.4

3.9

Male

3.4

3.1

10.

Male

3.5

3.2

11.

Female

3.6

3.89 ± 0.4677

2.7

3.47 ± 0.5813

.17974

12.

Female

3.6

3.4

13.

Female

3.7

2.9

14.

Female

4.8

4.5

15.

Female

3.2

2.8

16.

Female

4.5

4.2

17.

Female

3.8

3.5

18.

Female

4.1

3.7

Keerthi et al:

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19.

Female

3.9

3.6

20.

Female

3.7

3.4

38.9 ± 5.883

(mean ±

S.D)

Overall

3.755 ± 0.4796

Overall

3.38 ± 0.4884

.04579*

*p<.05- Significant

Table 2: Table Showing the Individual Day 7 and Day 21 Mean OHI-S Score among the study population with One-Way
ANOVA analysis

S NO

Age

(In years)

Gender

Individual

OHI-S Score

on Day 7

Mean OHI-S

Score on Day 7

(mean ± S.D)

Individual

OHI-S Score

on Day 21

Mean OHI-S

Score on Day

21 (mean ±

S.D)

p-value

Male

1.6

2.64 ± 0.4671

(p=.0006)*

1.4

2.1 ± 0.3682

(p=.0000)*

.0000*

Male

2.4

2.1

Male

3.4

2.8

Male

2.8

2.1

Male

2.8

2.4

Male

2.5

1.9

Male

2.9

2.1

Male

2.8

2.2

Male

2.4

1.8

10.

Male

2.8

2.2

11.

Female

2.4

2.9 ± 0.4546
(p=.00012)*

2.1

2.35 ± 0.2321

(p=.0000)*

.0000*

12.

Female

2.4

2.3

13.

Female

2.7

2.3

14.

Female

3.6

2.7

15.

Female

2.4

1.9

16.

Female

3.6

2.6

17.

Female

2.8

2.3

18.

Female

3.1

2.4

19.

Female

3.1

2.5

20.

Female

2.9

2.4

38.9 ±

5.883

(mean ±

S.D)

Overall Score

2.77 ± 0.468
(P=.00026)*

Overall score

p value

2.22 ± 0.3259

.0000*

*p<.05- Significant

Table 3: Table showing One-way ANOVA test for independent measures and Post Hoc Tukey HSD test

Pairwise Comparisons

Mean

HSD Difference in

Mean

p value

Post Hoc Tukey HSD (beta)

HSD.05 = 0.3700

HSD.01 = 0.4535

Q.05 = 3.7149 Q.01 = 4.5530

T1:T2

M1 = 3.75

0.38

Q = 3.76 (p = .04579)*

M2 = 3.38

T1:T3

M1 = 3.75

0.98

Q = 9.89 (p = .00000)*

M3 = 2.77

T1:T4

M1 = 3.75

1.53

Q = 15.36 (p = .00000)*

Keerthi et al:

Effectiveness and Oral Health Status among Individuals Using Modified Manual Tooth Brush

Volume No: 8, Issue No: 4

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ISSN No: 2582-0559

M4 = 2.23

T2:T3

M2 = 3.38

0.61

Q = 6.12 (p = .00026)*

M3 = 2.77

T2:T4

M2 = 3.38

1.15

Q = 11.60 (p = .00000)*

M4 = 2.23

T3:T4

M3 = 2.77

0.54

Q = 5.47 (p = .00129)*

M4 = 2.23

*p<.05- Significant T1 –Pre assessment OHI-S score, T2- Day 1 OHI-S Score, T3- Day 7 OHI-S Score, T4- Day21 OHI-S Score

Evaluation of the  OHI-S score on  Day  7 showed significant
difference  in  the distribution of oral hygiene scores  (P <
.05)  majority having a fair oral hygiene status with overall
mean score of 2.77 ± 0.468 among which females (2.9) had
greater scores than male group (2.64) (P < .05) compared to
the previous visit. Final analysis on Day 21 also showed
significant difference in the distribution of oral  hygiene
scores (P < .05) majority having a fair oral hygiene status
with overall mean score of 2.22 ±  0.3259 slightly higher
than previous and initial visits (Table 2). One-way ANOVA
test for independent measures and Post Hoc Tukey  HSD
test  for  pairwise comparison showed  a significant difference
in  the oral  hygiene status of an  individual  during the
observation period (P < .05) (Table 3).

DISCUSSION:

In the early 19th century bristled tooth brushes were
introduced for manual brushing that enhances oral health of
an individual by reducing plaque and calculus deposition,
prevent bad breath, reduce inflammation of gingival and
periodontal tissues, provide sense of freshness and also
psychologically impact the esthetic appearance during smile
or speech

. The bristles were initially made of nylon

supported by plastic handle  to ensure  affordability, and
availability to every individual making brushing a common
practice in day to day life. Since then numerous
modification and inventiveness  in design, shape, size  and
type of  materials  has been applied and  marketed

. However

there is inadequate evidence that one specific toothbrush
design is superior and alternative to other.

Currently tooth brushes are manufactured to remove
accumulation of food debris and plaque in the interproximal
areas apart from routine cleaning surfaces. Vibhute and
Vandana in a meta-analysis observed mechanical plaque
removal with a manual modified or specific toothbrush
remains the principal routine practice of maintaining good

oral hygiene for the majority of the population

. Van der

Weijden GA et al

, Slot DE et al

observed 1-min tooth

brushing exercise in individuals following their customary
method irrespective of tooth brushes used significantly
reduced  the plaque score by  39%  whereas  in the present
study comparison showed a significant difference in the
oral hygiene index score (40% -  50%) of an individual
during the observation period  indicating the  influence  of
effective brushing technique and tooth brush desired.

Slot DE et al

in a systemic review demonstrated an

average variation of 30–53% on the plaque index depending
on bristle  tuft  configuration  and  angulation of the bristle
design.  The  authors concluded that brushing duration,
technique  with appropriate  guidance  contribute to the
efficacy.  Recent studies have shown powered  tooth brushes
represent an effective alternative for Manual tooth brushes
in  removing debris  and plaque however  long term
effectiveness assessment studies have showed limited  role
in slowing  down the  initiation or progression of periodontal
diseases

14,15,16

Taschner et al

, Rosema et al

in their respective studies

evaluated the efficacy  of  manual,  electric tooth brushes and
modified tooth brushes in removal of plaque and debris and
showed manual tooth brushes with modifications
incorporated accompanied by proper brushing technique
improved the effectiveness of oral hygiene practices.
Although statistics from brushing exercise studies can be
viewed under limited information, a toothbrush that
removes more plaque as assessed under controlled
environment condition  following a single-use brushing
might differ in long term different home-based conditions
yet this technique is expected to provide improved plaque
control over time  and, as a result, have long-term benefits
on overall gingival and periodontal health

19,20

Keerthi et al:

Effectiveness and Oral Health Status among Individuals Using Modified Manual Tooth Brush

Volume No: 8, Issue No: 4

149

ISSN No: 2582-0559

Tooth brush manufactures have put forth enormous effort in
designing new models to improve performance
characteristics. Slot DE et al

exhibited that ideal brushing

technique guidance significantly influence multilevel
bristles to reach farther distance between the teeth and
cover large surfaces. In this study we have modified tooth
brush (V-Beat TM Manufactured and Marketed by
VISBRODENT Innovations) which is specially designed to
guide proper brushing technique by presence of beads in the
shank portion capable of producing beat sound. The beads
are arranged at a regular interval for effective movement
along the direction of vertical and circular motions with the
handle producing noise only at the time of ideal brushing
technique performed

. Higgins

specified that performing

multiple studies by different groups in different places with
diverse methods, would be a real estimation of the
particular or specific parameter evaluated. Variations in
several studies reflects the nature of routine oral hygiene
techniques followed along with methodology observed and
parameters taken into consideration.

CONCLUSION:

Within the limitation of this study, not taking
consideration of confounding factors, based on clinical
observations it can be concluded that modified special tooth
brush with beat sound technique show significant difference
in the oral hygiene index score of an individual during the
observation period thus improving the overall oral health
status. Further studies to confirm these findings in different
environment and larger population groups combined with
long term follow up of individuals is needed to demonstrate
the effectiveness of modified special tooth brush method.

FINANCIAL SUPPORT AND SPONSORSHIP

Nil

CONFLICTS OF INTEREST

There are no conflicts of interest.

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