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 Table of Contents  
Year : 2021  |  Volume : 13  |  Issue : 4  |  Page : 219-223

Comparative evolution of clinical efficacy of manual tooth brush versus chewable tooth brush a randomized clinical trail

1 Department of Pedodontics and Preventive Dentistry, Mallareddy Dental College for Womens, Hyderabadh, Telangana, India
2 Department of Conservative Dentistry and Endodontics, K.G.F Dental College and Hospital, K.G.F, Hassan, Vidyanagar, Karnataka, India
3 Department of Oralmedicine and Radiology, K.G.F Dental College and Hospital, Hassan, Vidyanagar, Karnataka, India
4 Department of Orthodontics and Dentofacial Orthopedics, Hasanamba Dental College and Hospital, Hassan, Vidyanagar, Karnataka, India
5 Department of Pedodontics and Preventive Dentistry, K.G.F Dental College and Hospital, K.G.F, Hassan, Vidyanagar, Karnataka, India

Date of Submission03-Jul-2020
Date of Decision07-Nov-2020
Date of Acceptance01-Jan-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Kola Srikanth Reddy
Department of Pedodontics and Preventive Dentistry, Malla Dental College for Womens, Hyderabad, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJDS.IJDS_108_20

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Background: Plaque control is the daily removal of dental plaque, oral biofilms, and also prevention of their accumulation on the other parts of the oral cavity. Dental plaque is the major etiology of maximum gingival and periodontal diseases. This study is an effort to find if chewable brushing is better than manual. Objective: The objective was to evaluate and compare the efficacy of manual toothbrush and chewable toothbrush on fifty patients, in the age group of 8–12 years over a period of 28 days. Materials and Methods: This study used a randomized, double-blinding, single-center, two-treatment, parallel group, design subjects with mild to moderate plaque and gingivitis were evaluated for baseline whole mouth gingival margin and approximal plaque. Clinical assessments were performed using the Quigley-Hein Plaque Index (TQHI) and Simplified Oral Hygiene Index. Subjects received either manual or chewable toothbrush. Data were entered on to the Microsoft Excel and statically analyzed using (SPSS version 21.0 IBM, Chicago III, IL, USA). Data were evaluated by t-test with a P < 0.005 considered to be statistically significant. Results: Fifty subjects participated in the study; 25 in the manual toothbrush and 25 in the chewable toothbrush group. Both brushes demonstrated significant reductions in plaque and gingivitis over the 28 days study period (P < 0.001). The chewable toothbrush was significantly more effective than the manual toothbrush. No adverse events were observed with either brush. Conclusion: The plaque and gingivitis reduction for the chewable toothbrush were significantly greater than for the Manual toothbrush.

Keywords: Chewable toothbrush, dental plaque, manual toothbrush

How to cite this article:
Reddy KS, Soubhgya M, Begum N, Vuggirala V, Nallagula K H, Nagakishore. Comparative evolution of clinical efficacy of manual tooth brush versus chewable tooth brush a randomized clinical trail. Indian J Dent Sci 2021;13:219-23

How to cite this URL:
Reddy KS, Soubhgya M, Begum N, Vuggirala V, Nallagula K H, Nagakishore. Comparative evolution of clinical efficacy of manual tooth brush versus chewable tooth brush a randomized clinical trail. Indian J Dent Sci [serial online] 2021 [cited 2022 Jan 21];13:219-23. Available from: http://www.ijds.in/text.asp?2021/13/4/219/327803

  Introduction Top

Dental plaque is one of the etiological factors in the causation of dental caries. Effective removal of plaque can reduce the incidence of caries. Various agents for removing plaque have been introduced, of which, chewable brush is a recent advance. There is limited evidence assessing the effectiveness of using chewable brush in children.[1]

Various chemical and mechanical methods are available commercially for the removal of plaque. Toothbrushing is found to be the most commonly used effective and safest method for plaque removal.[2] Manual toothbrush (MB) (40 regular advantage plus) remains the primary method of maintaining good oral hygiene in majority of the population.[3] The powered toothbrush was introduced in 1960 and 62% of the people are using powered toothbrush on daily basis.[4] Effective toothbrushing requires a certain degree of manual dexterity, which increases only with age.

A recent innovation for plaque removal is the discovery of a chewable toothbrush (CB) (rolly mini toothbrush), comprised of fluoride and xylitol.[5] Fluoride at low concentration is bacteriostatic and at high concentration, it is bactericidal.[6] Xylitol, a nonsugar sweetener used in foods is noncariogenic and has cariostatic effect.

The CB (Fuzzy brush, Fuzzy Brush Ltd, London, UK) is a recent innovation in oral hygiene. This disposable, all-in-one brush is comprised of Xylitol, flavoring, aqua, and polydextrose. Myoken et al.[7] investigated the effectiveness of the CB in a care-dependent elderly population.

CB is excellent; it cleans upper and lower gums and teeth at the same time. Dr. Chris Steele introduced this award-winning silicone brush. It can be used with or without toothpaste. Unique shape fits little mouths correctly and reaches molar teeth and gums. Suitable from 10 to 36 months, made from the highest grade medical silicone, it is safe for a toddler to chew on.

However, to date, no study has been published on the effectiveness of the CB for plaque removal in children. Therefore, the aim of this study was to compare the effective use of a CB and MB for plaque removal in children.

  Materials and Methods Top

This was a double-blind, parallel, randomized controlled trial conducted in an institution in Khammam city, India. The study was conducted in accordance with the Declaration of Helsinki. Ethical clearance for the study was obtained from Institutional Ethical Committee (MDCR-088179). In this present study including 50 school-going children between the ages of 8 and 12 years, attending the department of Pedodontics and preventive dentistry, before the start of the study, permission from the head of the institution was obtained. The study was conducted over a period of 28 days from December 2016 to January 2017.

Training and calibration

Training and calibration of principal investigator involved in data collection were undertaken at the Department of Pedodontics and Preventive dentistry. Turesky's Modification of Quigley-Hein Plaque Index, Simplified Oral Hygiene Index (OHI-S)[8],[9] was discussed with subject experts to clarify ambiguity related to scoring before the calibration procedure was undertaken. Randomization is done by flipping a coin (heads: started with the manual brush, trails: with chewable toothbrush).

Participants were allotted in a random manner when examination procedures were undertaken. Allotment of participants was done by faculty, and assessment was done in their supervision. Clinical oral examination was done using sterile instruments under adequate illumination. Cronbach's alpha for intraexaminer reliability was 0.79.

Sample size

This study was undertaken on 50 participants with 24 males and 26 females selected from a school. Sample size estimation was done using n Master software for hypothesis testing for two means (equal variances). Assuming a mean difference of 0.3 between the two methods, for an effect size of 1.2 at 5% α error and 80% power, the sample size was computed to be 25 per group.

The total sample size turned out to be 50 in view of parallel design.

Alpha error = 0.7948

Alpha error (%) = 5

Power (%) = 80

Sided = 2

Number needed n = 25 should be taken in each group.

Where, Z1-α =Z value for α level = 1.96.

Z1-β = Z value for β level = 0.842.

Selection of study participants

After obtaining permission from the head of the institute, individuals were screened initially. Children aged 8-12 years with good general and oral health, Children with DMFT score less than 3, Ability to attend the hospital at recalls intervals, Systemically healthy patient with good oral hygiene, Moderate gingivitis (at least 25% of test sites showing bleeding on probing), Children and parents who are willing to participate and signed the informed consent were included in the study.

Children with oral and systemic diseases, three or more carious lesions requiring treatment, children who regularly used antibiotics as well as children with oral soft-tissue lesions, and other severe malocclusion or orthodontic therapy, were excluded in the study.

Study design

Fifty participants were recruited after initial screening. Informed consent was obtained before the start of the study. These fifty participants were allocated into two groups by flipping a coin (head-Manual tooth brush, tails-CB.

Each participant in Group A was given an oral hygiene kit coded I, while participants in Group B were given an oral hygiene kit coded II in Phase I of the study.

Group allocation and distribution of coded oral hygiene kits were done by coordinator who was not involved in data collection. The investigator collecting data on the dental plaque was blinded. Each participant received a coded oral hygiene kit consisting of manual/CB and toothpaste.

Participants who received the manual toothbrushes were instructed to follow their routine practice while those receiving CB followed the manufacturer's instructions. The study schedule was handed out to all concerned caretakers.

Group A

Consisted of 12 males and 13 females, each of them was given a MB and a toothpaste. They were instructed to use the modified Bass method of brushing. The duration of the study was for 28 days.

Group B

Consisted of 12 males and 13 females, each of these subjects was given CB, (rolly toothbrush) tube of toothpaste. They were instructed to use the modified Bass method of brushing. The duration of the study was for 28 days. The subjects were asked to report to the dental office on day 0, 7th, 14th, and 28th day.

All the subjects who participated in the study underwent oral prophylaxis and teeth polished so that all subjects were similar baseline at the start of the study. Participants were instructed to stop brushing for 48 h before their appointment on day 0.

A total of 50 children were randomly selected and categorized in to group A (MB) and group B (CB). Allocation concealment was done by using sealed envelopes, where in the respective brushes (MB & CB) were randomly allocated by the toss of a coin to 50 children.

Day 0

Each subject was made to sit on the dental chair. The pre brushing plaque score was recorded in the prepared proforma by using the OHI-S, TQHI-S. Following this, each subject was instructed to brush with using toothpaste and the modified Bass technique in which they were instructed for 2 min in the dental clinics, each subject was then reexamined after toothbrushing with disclosing solution and the postbrushing plaque score was recorded using the TQHI-S, OHI-S; the subjects were then asked to rinse the mouth with water.

After having recorded the above parameters, each subject was then instructed to brush twice a day for 2 min at home with the allocated brush and toothpaste using the modified boss technique which they were instructed to follow. Subjects were then given Appointments to return on the 7th, 14th, and 28th day with advice to abstain from brushing for 24 h before each of these appointments. The subjects were then discharged from the dental clinic.

On the 7th, 14th, and 28th day

On the 7th, 14th, and 28th day when the subjects returned to the dental clinic for follow-up appointment, the TQHI-S Index and OHI-S Index were evaluated and recorded as day 0 and average pre- and postbrushing scores were calculated for statistical evaluation.

Data analysis

The recorded data were statistically analyzed using the SPSS 21.IBM, Chicago III, USA, IL) Data were evaluated by t-test. The comparison between Groups A and B was done using an unpaired t-test (t-independent test). P < 0.005 is considered to be statistically significant.

  Results Top

Turkey modification of the Quigley-Hein Index scores

[Table 1] and [Graph 1] show that on day 0 the prebrushing mean Plaque Index score for Group A was 1.56 and 1.77 for Group B, while the postbrushing mean Plaque Index score for Group A was 0.61 and 0.81 for Group B, the prebrushing mean Plaque Index score for Group A was 0.71 and 0.70 for Group B. While the post brushing mean plaque Index score for Group A was 0.19 and 0.13 for Group B. The trend in decline in pre and postbrushing Plaque Index scores for both Group A and Group B was also noticed on the 7th and 14th days.
Table 1: Comparison of pre- and postbrushing mean plaque The Quigley-Hein Plaque Index score for Group A and Group B

Click here to view

In all the occasions, highly significant differences between pre- and postbrushing mean value were seen in both Groups A and Group B (P < 0.001). There was a statistically significant difference between Groups A and Group B subjects.(P = 0.052).

Simplified Oral Hygiene Index scores

[Table 2] and [Graph 2] show that prebrushing and postbrushing mean reduction plaque scores for the chewable brush were 1.0 and manual brush were 1.5, respectively. The OHI-S score differences between the two brushes were statistically significant (P < 0.005).
Table 2: Comparison between chewable toothbrush and manual toothbrush mean oral hygiene index score -index scores

Click here to view

  Discussion Top

The results of this present clinical trial demonstrated the effectiveness of the CB brush and MB in lowering plaque scores. Both clinically and statistically significant improvement in plaque scores were noted for CB.

The duration for this study was for 28 days (4 weeks) and recoding was taken 0 day, 7th, 14th day, and 28th day. This is in accordance with the design by Myoken et al.,[7] and Bezgin et al.,[10]. where the safety and efficacy of the chewable toothbrush with respect to plaque was assessed over a time period of 28 days (28 day).

The mechanical cleaning procedure by tooth brush is efficient, provided the method used is sufficiently through and performed regularly. Failure to comply and lack of technical skill of the patient lessens the effectiveness of conventional toothbrushes. In order to facilitate and improve the quality of tooth cleaning, a number of chewable toothbrushes have been marketed.

One of the primary reasons for the introduction of CB is to enhance the cleaning of teeth, especially for people who are handicapped or who have poor manual dexterity. It is also of great use for those who are unaware of the proper brushing technique.[10]

A chewable toothbrush is a miniature plastic molded toothbrush that can be used when no water is available. They tend to be very small, but should not be swallowed and should be disposed of after use. They are easily available from bathroom vending machines and composed of xylitol, flavoring aqua, and polydextrose. Other types of disposable toothbrushes include those that are a small breakable plastic ball of toothpaste on the bristles which can be used without water and prove to be quite handy to travelers.

These brushes should be used between the teeth, to swivel from left to right and then, the tongue needs to be used to move the brush around the mouth similar to the way one would use chewing gum.

A chewable toothbrush used in this study contains xylitol. It has been suggested that daily exposures to xylitol may be beneficial to child dental health by reducing caries and assisting remineralization.[11],[12]

The similarities in plaque removal found between the two brushes suggest that the CB may be an appropriate oral hygiene adjunct for school children, including children with disabilities. We need to conduct the study with more number of patients and longer duration.

In order to avoid the risk of swallowing, the manufacturer of the CB does not recommend its use for children under age 6. In addition, as effective handbrushing requires a certain degree of manual dexterity; this study was conducted with a population of healthy children aged 10–11.[13],[14]

The result of this 4-week clinical trial demonstrated the effectiveness of the CB and MB in lowering plaque scores. Clinically and statically significant improvements in plaque scores were noted for the Chewable toothbrushes.

  Conclusion Top

The results of the present study showed that all subjects who participated in the study showed a reduction in plaque index scores, whether they used a CB or manual toothbrush. It is noteworthy, however, that on the 28th day, subjects who used chewable toothbrush showed a better reduction in plaque index.


However, longitudinal studies with a larger sample size are needed to assess the long effectiveness of these brushes on plaque.

Ethical clearance

The Trail protocol was Approved by the Institutional review board. A letter with information regarding the study in an easy to understand language was sent by the principal researcher to the children parents through school authorities to obtain a written informed consent from the parents.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Govindaraju L, Gurunathan D. Effectiveness of chewable tooth brush in children – A Prospective clinical study. J Clin Diagn Res 2017;1:ZC31-2.  Back to cited text no. 1
Deery C, Heanue M, Deacon S, Robinson PG, Walmsley AD, Worthington H, et al. The effectiveness of manual versus powered toothbrushes for dental health: A systematic review. J Dent 2004;32:197-211.  Back to cited text no. 2
Costa CC, Filuo C, et al. Plaque removal by Manual and electrical tooth brushing among children. Psequi Odontol Bras 2001;15:296-301.  Back to cited text no. 3
Stålnacke K, Söderfeldt B, Sjödin B. Compliance in use of electric toothbrushes. Acta Odontol Scand 1995;53:17-9.  Back to cited text no. 4
Rolly Toothbrush on the Go. Available from: http://www.rollybrush.co.uk/. [Last accessed 2016 Nov 04].  Back to cited text no. 5
Ferretti GA, Tanzer JM, Tinanoff N. The effect of fluoride and stannous ions on Streptococcus mutans. Viability, growth, acid, glucan production, and adherence. Caries Res 1982;16:298-307.  Back to cited text no. 6
Myoken Y, Yamane Y, Myoken Y, Nishida T. Plaque removal with an experimental chewable toothbrush and a control manual toothbrush in a care-dependent elderly population: A pilot study. J Clin Dent 2005;16:83-6.  Back to cited text no. 7
Turesky S, Gilmore ND, Glickman I. Reduced plaque formation by the chloromethyl analogue of victamine C. J Periodontol 1970;41:41-3.  Back to cited text no. 8
Bay I, Kardel KM, Skogarrd MR. Quetitative evaluation of plaque removal ability of different types of tooth brushes. J Periodontal 1967;38:526-33.  Back to cited text no. 9
Bezgin T, Dag C, Ozalp N. How effective is a chewable brush in removing plaque in children? A pilot study. J Pediatr Dent 2015;3:41-5.  Back to cited text no. 10
  [Full text]  
Maguire A, Rugg-Gunn AJ. Xlitol and caries prevention – Is it a magic bullet? Br Dent J 2003;194:429-36.  Back to cited text no. 11
American Academy on Pediatric Dentistry Council on Clinical Affairs. Policy on the use of xylitol in caries prevention. Pediatr Dent 2008;30:36-7.  Back to cited text no. 12
Mentes A, Atukeen J. A study of Manual tooth brushing skills in children aged 3-11 years. J Clin Pediatr Dent 2002;27:91-4.  Back to cited text no. 13
Pujar P, Subbareddy VV. Evaluation of the tooth bushing skills in children aged 6-12 years. Eur Arch Pediatr Dent 2013;14:213-9.  Back to cited text no. 14


  [Table 1], [Table 2]


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