title: Six-month comparison of powered versus manual toothbrushing for safety and efficacy in the absence of professional instruction in mechanical plaque control.
abstract: BACKGROUND
  Reports suggest powered toothbrushing may provide some clinical benefit over manual tooth-brushing, but most studies have been of short duration with subjects trained in toothbrush use. The aim was to determine if the oscillating-rotating powered brush (PB) could safely provide clinical benefits over and above a manual brush (M) in subjects with no formal instruction or experience in powered brush use.
  
  
  METHODS
  This 6-month, single-masked, parallel design, randomized clinical trial compared the PB with an American Dental Association (ADA)-accepted soft-bristle manual brush in a non-flossing gingivitis population (n = 157). Subjects were given written instructions but no demonstration on toothbrush use at baseline. Efficacy was assessed by changes in gingival inflammation, plaque, calculus, and stain, while changes in clinical attachment levels and recession measurements provided safety data. A prophylaxis was provided after baseline assessment. The 6-month plaque index (PI) was recorded immediately post-brushing after covert timing of the subjects, and correlation analyses were run to assess the relationship of brushing time to PI. Paired t tests, analysis of variance (ANOVA), and analysis of covariance (ANCOVA) were used to assess within and between treatment group differences for PB (n = 76) versus M groups (n = 81).
  
  
  RESULTS
  Measures of inflammation showed a statistically significant drop for both brushes at 3 and 6 months. Mean overnight full-mouth PI scores were significantly lower at 3 months for the PB (1.57) compared to the M group (1.80), P = 0.0013. Immediate post-brushing PI at 6 months was also significantly lower for the PB (1.10) versus M (1.39) (P= 0.0025). There was an overall negative correlation for PI and brushing time (r = -0.377, P= 0.0001). Mean calculus index (CI) scores were lower for the PB at 3 (P= 0.0304) and 6 months (P = 0.0078), while no significant differences in stain were observable. Clinical attachment level and recession measurements showed no significant between-group changes from baseline for either brush on canine teeth or on teeth with recession at baseline.
  
  
  CONCLUSIONS
  The oscillating-rotating toothbrush safely provides clinical benefits in plaque and calculus reduction over a manual brush even in subjects with no formal oral hygiene instruction.
authors.affiliation: Marquette School of Dentistry, Milwaukee, WI 53201-1881, USA. andrew.dentino@marquette.edu
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Dentino
authors.forename: Gay
authors.initials: G
authors.lastname: Derderian
authors.forename: MaryAnn
authors.initials: M
authors.lastname: Wolf
authors.forename: MaryAnn
authors.initials: M
authors.lastname: Cugini
authors.forename: Randy
authors.initials: R
authors.lastname: Johnson
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Van Swol
authors.forename: Dennis
authors.initials: D
authors.lastname: King
authors.forename: Pam
authors.initials: P
authors.lastname: Marks
authors.forename: Paul
authors.initials: P
authors.lastname: Warren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003728:Dental Calculus / Q000517:prevention & control; D003773:Dental Plaque / Q000517:prevention & control*; D003774:Dental Plaque Index; D004560:Electricity; D004869:Equipment Safety; D005260:Female; D005891:Gingivitis / Q000628:therapy; D006267:Health Education, Dental; D006801:Humans; D008297:Male; D008875:Middle Aged; D009911:Oral Hygiene Index; D010512:Periodontal Index; D016037:Single-Blind Method; D014075:Tooth Discoloration / Q000628:therapy; D014099:Toothbrushing / Q000295:instrumentation*