title: Mechanical control of biofilm in children with cerebral palsy: a randomized clinical trial.
abstract: BACKGROUND
  Dental biofilm removal is difficult and can be ineffective in individuals with cerebral palsy.
  
  
  OBJECTIVE
  Determine the effectiveness of brushing with an electric toothbrush on and off in comparison with manual brushing for the removal of biofilm in children aged four to 16 years with cerebral palsy.
  
  
  METHODS
  A crossover, randomized, simple-blind, clinical trial was conducted. The examiner was blinded to the brushing method (G1: manual; G2: electric toothbrush on; and G3: electric toothbrush off). The order was determined randomly. The participants (n = 40) were examined before and after brushing performed by caregivers using the Turesky-Quigley-Hein biofilm index. Statistical analysis involved the paired t-test, Wilcoxon, Kruskal-Wallis, and anova tests.
  
  
  RESULTS
  Biofilm was significantly reduced with the three brushing methods (P < 0.001) (mean reductions: 47.6% in G1; 47.4% in G2; 44.5% in G3). Significant differences were found between G1 and G3 (P < 0.001) and between G2 and G3 (P = 0.007). No significant difference was found between G1 and G2 (P = 0.06).
  
  
  CONCLUSIONS
  All methods reduced biofilm. Effectiveness was similar between manual brushing and with the electric toothbrush on, whereas both these methods achieved better results in comparison with the electric toothbrush switched off.
authors.affiliation: School of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), Diamantina, Minas Gerais, Brazil.
authors.forename: Nayara Kelly Lyrio
authors.initials: NK
authors.lastname: Ferraz
authors.forename: Juliana
authors.initials: J
authors.lastname: Tataounoff
authors.forename: Lilian Capanema
authors.initials: LC
authors.lastname: Nogueira
authors.forename: Joana
authors.initials: J
authors.lastname: Ramos-Jorge
authors.forename: Maria Leticia
authors.initials: ML
authors.lastname: Ramos-Jorge
authors.forename: Marcos Luciano Pimenta
authors.initials: ML
authors.lastname: Pinheiro
mesh_terms: D000293:Adolescent; D018441:Biofilms; D002547:Cerebral Palsy; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D003773:Dental Plaque / Q000517:prevention & control*; D003774:Dental Plaque Index; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D016037:Single-Blind Method; D014099:Toothbrushing / Q000295:instrumentation*