title: Efficacy of ultrasonic, electric and manual toothbrushes in patients with fixed orthodontic appliances.
abstract: OBJECTIVE
  This crossover study compared the efficacy of an ultrasonic toothbrush for the reduction of plaque, gingival inflammation, and levels of Streptococcus mutans, in relation to an electric and a manual toothbrush.
  
  
  METHODS
  Twenty-one patients with orthodontic appliances were divided into three groups. All patients were evaluated by a periodontist and samples of saliva were collected for quantification of S mutans. The patients received their first brushes with appropriate instructions. For each crossover leg, patients used each toothbrush for a period of 30 days. At the end of each washout period, participants received a periodontal evaluation and new samples of saliva were collected. After 15 days of using their own toothbrushes, patients received the next toothbrushes in the experimental sequence.
  
  
  RESULTS
  The ultrasonic brush group presented significant improvement in the reduction of visible plaque on the buccal surfaces (-6.36%, P = .007). The counts of S mutans decreased in the electric (2.04 x 10(5) to 1.36 x 10(5) colony-forming units [CFU]/mL) and ultrasonic (2.98 x 10(5) to 1.84 x 10(5) CFU/mL) groups. There were no statistical differences among the three brushes for the clinical and microbiological parameters evaluated.
  
  
  CONCLUSIONS
  This study did not demonstrate that the ultrasonic toothbrush was better in reducing gingival inflammation in adolescent orthodontic patients, but plaque scores were lowered on buccal surfaces of teeth with orthodontic brackets. In addition, S mutans counts were markedly decreased in the electric and ultrasonic groups, which should be related to a reduced risk of oral disease.
authors.affiliation: São Paulo State University-Araraquara Dental School, Brazil.
authors.forename: Mauricio Ribeiro
authors.initials: MR
authors.lastname: Costa
authors.forename: Vanessa Camila
authors.initials: VC
authors.lastname: Silva
authors.forename: Miriam Nakatani
authors.initials: MN
authors.lastname: Miqui
authors.forename: Tatsuko
authors.initials: T
authors.lastname: Sakima
authors.forename: Denise Madalena Palomari
authors.initials: DM
authors.lastname: Spolidorio
authors.forename: Joni Augusto
authors.initials: JA
authors.lastname: Cirelli
mesh_terms: D000293:Adolescent; D002648:Child; D015169:Colony Count, Microbial; D003773:Dental Plaque / Q000628:therapy*; D004560:Electricity; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D009967:Orthodontic Appliances; D012463:Saliva / Q000382:microbiology*; D013295:Streptococcus mutans; D014099:Toothbrushing / Q000295:instrumentation*; D014464:Ultrasonic Therapy / Q000295:instrumentation