title: Evaluation of Orthodontic and Triple-headed Toothbrushes When Used Alone or in Conjunction with Single-tufted Toothbrush in Patients with Fixed Lingual Orthodontic Appliances. A Randomized Clinical Trial.
abstract: Brushing with a single-tufted toothbrush in conjunction with a manual toothbrush has been widely recommended, although its effectiveness has not been proven. This study investigated the effectiveness of orthodontic and triple-headed toothbrushes when used alone or in conjunction with the single-tufted toothbrush in patients with fixed lingual orthodontic appliances.
  
  
  METHODS
  In this randomized, single-blinded, controlled clinical trial, orthodontic patients (N = 26, mean age 27.3 years) with lingual fixed appliances were asked to brush with a triple-headed or an orthodontic toothbrush alone for one month, followed by brushing in conjunction with the single-tufted toothbrush for an additional month. Teeth were professionally cleaned at baseline and one month later. A clinician blinded to group assignments examined the patients and evaluated tooth plaque index, bracket plaque index, modified gingival index and bleeding on probing at baseline at one month and two months.
  
  
  RESULTS
  After one month of brushing with the orthodontic toothbrush, the mean plaque index for tooth and bracket, bleeding index and gingival index were higher by 74.4% (0.68 vs. 0.39, p = 0.026), 54.2% (0.37 vs. 0.24), 15.4% (0.15 vs. 0.13) and 30% (0.26 vs. 0.20), respectively, than after brushing with the triple-headed toothbrush. After combined brushing with the single-tufted toothbrush, no additional statistical differences were found between groups.
  
  
  CONCLUSIONS
  When used alone, the triple-headed toothbrush seems to remove plaque more effectively than the orthodontic toothbrush. The addition of the single-tufted toothbrush eliminates differences between groups.
authors.forename: Malka
authors.initials: M
authors.lastname: Ashkenazi
authors.forename: Nurit Flaisher
authors.initials: NF
authors.lastname: Salem
authors.forename: Silvia
authors.initials: S
authors.lastname: Garon
authors.forename: Liran
authors.initials: L
authors.lastname: Levin
mesh_terms: D000328:Adult; D003773:Dental Plaque / Q000628:therapy; D003774:Dental Plaque Index; D003777:Dental Prophylaxis / Q000379:methods; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016382:Orthodontic Appliance Design; D016910:Orthodontic Brackets; D017060:Patient Satisfaction; D010512:Periodontal Index; D016037:Single-Blind Method; D014099:Toothbrushing / Q000295:instrumentation* / Q000379:methods; D055815:Young Adult