ISSN 0970 - 4388

A Comparative Evaluation of an Ultrasonic and a Manual Toothbrush on

the Oral Hygiene Status and Stain Removing Efficacy.
VANDANA K La, PENUMATSA G Sb

ABSTRACT More recently, several sonic and ultrasonic tooth brushes

The efficacy of ultrasonic toothbrush and a manual toothbrush was
compared on the oral hygiene status and on microbial parameters.
26 dental students from the College of Dental Sciences Davangere,
Karnataka, were selected for this single blind study of 4 weeks
duration. The participants were in the age group of 18-25 years. The
brushes were randomly allotted by the co-investigator, who also
supervised the brushing technique throughout the study period.
The subjects were instructed to refrain from brushing their teeth for
12-14 hours prior to each follow up visit. The main investigator
assessed all the clinical parameters at baseline, 14th, 21st and 28th
day. Statistical analysis was carried out by an independent statistician
who remained blind to the test products. Each of the tooth brushes
tested, showed significant reductions in all the clinical parameters
between 0 and 28 th day. The reductions within the groups were
significant although no significant differences between the groups
were found. The reductions in stain index, bleeding index and gingival
index was higher in ultrasonic toothbrush compared to manual
toothbrush. It is concluded that ultrasonic toothbrush is safe and
effective in the removal of plaque, stains, reduction of gingival
inflammation and gingival bleeding.
Key Words : Manual toothbrush, Oral hygiene, Ultrasonic
tooth brush.
INTRODUCTION
Bacterial plaque, the primary etiologic agent in gingivitis and
supragingival plaque formation, appears to be necessary for
the initial colonization of the subgingival environment. Hence
regular removal of dentogingival plaque is crucial for
maintenance of periodontal health. Since the earliest recorded
evidence of the natural toothbrush as a plaque fighter the
evolution of toothbrushes has led to the development of three
distinct technologies, manual, electromechanical and
1 (Modification of Lobene Index, Lobene 1968), Gingival Index
ultrasonic brushes.
Electric/Mechanical tooth brushes offer an alternative to
manual toothbrushes. In addition to the effect of mechanical
brushing, the concept of utilising low frequency acoustic
energy to generate dynamic fluid activity and perhaps a mild
cavitation effect has been developed to provide a beyond the
bristle tip cleaning activity. Acoustic vibrations produced in
vitro have been shown to have significant effects in reducing
2 allotted by the Co-investigator to the subjects, who kept the
the abilities of oral bacteria to adhere to hard surfaces.
a. Professor & Head, b. Postgraduate student, Department of
have been introduced. In an effort to improve the efficiency of
plaque removal, an ultrasonex toothbrush was introduced
which is the new and advanced generation ultrasonex
ultrasonic toothbrush. The ultrasonic toothbrush is a manual
tooth brush with a Piezo-electric ultrasonic emitter embedded
in the brush head. The ultrasonic emitter is driven by a power
supply located in the handle that operates at 1.6 MHz. The
plaque destroying power of ultrasound and the deep gentle
cleansing wave action of sonic vibration penetrate the gum
line to a depth of 5 mm destroying the bacteria, that cause
gingivitis and bleeding gums. The stain removing of ultrasonic
tooth brush has not been frequently dealt with. In the
present clinical study, evaluation of oral hygiene status and
stain removing efficacy of manual and ultrasonic
toothbrush has been compared.
MATERIALS AND METHOD
26 dental students of College of Dental Sciences, Davangere,
who were visiting the out patient Department of Periodontics
were included in the study. All the subjects enrolled for this
single blind study were males in the age range of 18 - 25
years. The subjects were screened and those who met all
the following criteria were selected. The medical and dental
history of the subjects was reviewed and each subject was
examined by the principal Investigator at 0-day (baseline)
th th st th
and at the end of each week i.e.7 , 14 , 21 and 28 day. The
main investigator assessed the clinical parameters, Plaque
3
index (Turesky-Gilmore-Glickman 1970), Lobene Stain Index
4
3
(Lobene Weatherford, Ross 1986) and Bleeding index
3
(Anamio J. Bay I.1975). A professional prophylaxis was not
performed on any of the patients within 1 month of the baseline
measurements or during the course of the study.
The tooth brushes, both manual (Oral - B Laboratories, Div.
of Gillette, Canada, Inc.) and ultrasonic (Sonex International
Corporation, Brewster, Ny 10509 USA.) were randomly
record of the allocated site. The co-investigator also monitored
the brushing using manual tooth brush and the ultrasonic
toothbrush, twice a day throughout the study period. The
 A comparative Evaluation of an Ultrasonic and a Manual Toothbrush
formation was allowed and assessment of plaque scores was
made before and after using the brushes.
A safety assessment of the tooth brushes was made at each
visit for any soft tissue changes. The subjects had a plaque
score ranging from 2-3 according to Turesky modification of
Quigley Hein Plaque Index (1970) and had healthy gingiva/
mild gingival inflammation score ranging between 2-3
according to Modified Gingival Index (1986) and fulfilling the
score of 1-2 for (area stained) and light to heavy stains
(severity) on teeth surface according to Lobene stain index
(Modification of the Lobene Index, Loben 1968). After the
28th day clinical examination, all subjects completed a
questionnaire to assess their preferences for the two types
of brushes.
RESULTS
A breach of compliance with the study protocol was reported
by 2 subjects and these subjects were excluded from the
analysis. One subject was excluded because of the necessity
Fig. 1 : "O" Day : Upper Quadrant.
of taking antibiotics and the other subject did not report for
the intervals during the course of the study. The safety
assessments revealed no adverse effects during the entire
duration of the study period. It was a single blind split mouth
study design wherein the principal investigator was blind with
respect to the quadrant in which the two brushes were used.
Descriptive statistics for the clinical measurements for both
th
manual and ultrasonic toothbrushes on 0-day and 28 day
respectively are summarized in Table 1.
Analysis of Questionnaire: On an analysis of questionnaire
it was found that on the basis of comfort and overall preference
80% subjects found ultrasonic toothbrush more comfortable,
while only 20% found manual brush more comfortable.
DISCUSSION
With the recent introduction of this device in 1994; there is a
need to investigate the efficacy of the ultrasonic toothbrush.
Hence, this present clinical study has been undertaken to
compare manual toothbrush with the ultrasonic toothbrush
Fig. 2 : "28th day" Stain Removing efficacy of manual
(Right side) and ultrasonic toothbrush (Left side).
 A comparative Evaluation of an Ultrasonic and a Manual Toothbrush
on the clinical parameters of oral hygiene status such as
plaque index and bleeding index. Additionally, stain index
has also been evaluated in this present study. The stain
removing effect of the brushes was evaluated on extrinsic
brown stains due to coffee, tea, tobacco (CTT) which were
noninduced unlike in most of the studies in the literature
demonstrated stain removal efficacy of the brushes on induced
stains by chlorhexidine. The extrinsic stain, brown stains
due to coffee, tea and tobacco was scored on a minimum of
8-12 anterior teeth either labially and/or lingually fulfilling the
scores.
There were no significant difference between treatment groups
with respect to the 0-day mean scores for plaque, gingival
and bleeding index. These findings are similar to the findings
5 th
of Fogas Brockmann et al . From 0-28 day there was no
significant differfence between plaque, gingival and bleeding
indices between the treatment groups. These findings are
5
similar to the findings of Forgan Brockmann and contrast to
6,7
the findings of Terezhalmy .
Although all the clinical parameters were assessed on each
visit of the subject, the comparison of clinical parameters
th
between 0-28 day showed significant decrease in
plaque, stain, gingival and bleeding indices within the
treatment groups but the difference in reduction of plaque
index, stain index, gingival index and bleeding index
between treatment groups was not statistically significant
from baseline to any given interval. However, the numerical
value of reductions in stain index, bleeding index and
gingival index was higher in ultrasonic toothbrush
compared to manual toothbrush. The advantage of
ultrasonic brush can be putforth as cleaning of the teeth 5
mm beneath the gum line, and it is theorized that the
ultrasonic waves remove adhered bacteria and may induce cell
surface alterations that are necessary for plaque
attachment, thereby influencing plaque formation.
As evident from the present study, it can be concluded that
ultrasonic toothbrush is safe and effective in the removal of
plaque, in reduction of gingival inflammation and the gingival
bleeding, and it is as effective as conventional manual tooth
brush in the reduction of above clinical parameters. The stain
removing efficacy of ultrasonic brush was better appreciable.
Further long term clinial and microbiological studies are
recommended to evaluate the efficacy of the ultrasonic
toothbursh.
ACKNOWLEDGEMENT
We truly acknowledge Mr. Robert Bock, of Sonex International Corporation,
Brewster, N. Y, providing the ULTIMA™ toothbrush samples and for their
valuable support.
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Reprint requests to:
Dr. Vandana K. L.
Prof, and Head
Department of Periodontics
College of Dental Sciences,
Davangere - 577 004,
Kamataka, India.