title: Comparative study of 3 types of toothbrushes in patients with fixed orthodontic appliances.
abstract: BACKGROUND
  Plaque and trapped debris that accumulate gingivally to orthodontic wire are difficult to remove. The triple-headed toothbrush (TH-TB) was designed to reach the gingival tooth margin. In this study, we examined its effectiveness in improving the oral health of orthodontic patients as compared with conventional and orthodontic toothbrushes.
  
  
  METHODS
  Orthodontic patients (n = 94; mean age, 15.6 +/- 3.9 years) receiving edgewise treatment in both arches were randomly assigned to 1 of 3 groups (TH-TB, orthodontic toothbrush, and conventional toothbrush). After toothbrushing instruction, each participant received professional tooth cleaning. Tooth plaque index, bracket plaque index, gingival index, and bleeding index were recorded at baseline and after 4 weeks of usage. Satisfaction level was obtained after 4 weeks.
  
  
  RESULTS
  The TH-TB was significantly more effective than conventional and orthodontic toothbrushes in tooth-plaque removal by 2-fold and 1.5-fold, respectively (P < .001); in bracket-plaque removal by 3-fold and 2-fold, respectively (P < .001); and in improving gingival health by 6-fold and 1.5-fold, respectively (P = .011). Patients who used the TH-TB were significantly more satisfied than those who used the other toothbrushes (P < .001).
  
  
  CONCLUSIONS
  The TH-TB is a practical alternative to other manual toothbrushes to improve tooth and gingival health in orthodontic patients wearing fixed appliances.
authors.affiliation: Department of Orthodontics, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Rafe
authors.forename: Alexander
authors.initials: A
authors.lastname: Vardimon
authors.forename: Malka
authors.initials: M
authors.lastname: Ashkenazi
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003742:Dental Devices, Home Care; D003773:Dental Plaque / Q000628:therapy*; D003774:Dental Plaque Index; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D016910:Orthodontic Brackets; D010512:Periodontal Index; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D014099:Toothbrushing / Q000295:instrumentation*; D016896:Treatment Outcome