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Title: Efficiency of cleaning tooth surfaces using manual, oscillating-rotating and sonic toothbrushes


Tooth decay and periodontal diseases including gingivitis and periodontitis are among most common chronic oral cavity conditions worldwide. Therefore, toothbrushing plays a vital part in maintaining daily health of the oral cavity as an effective procedure for maintaining oral hygiene at home. The health of the gums and the amount of plaque are dominant indicators of oral hygiene, however, several studies on cleaning efficiency of different designs of toothbrushes require more thorough systematic reviews and randomised controlled trials (RCTs). A variety of instruments for maintaining oral hygiene are available on the market. Selecting the proper one is a frequent problem faced by patients. A toothbrush not suitable for patient’s needs may lead to improper cleaning of teeth surfaces - the retention of food residue is a substrate for bacteria which consequently leads to the development of caries. Improper oral hygiene contributes to the formation of tartar which is the cause of the development of periodontal diseases. Wrong brushing technique leads to abrasive damage to the tooth surface. Electric and sonic toothbrushes seem to be an effective alternative to manual toothbrushes. Manufacturers of electric and sonic toothbrushes claim that they are more effective in terms of cleaning teeth surfaces and less harmful in case of improper brushing technique. However, t ; here are no good quality clinical studies confirming these reports. Research objectives: 1. To check the hygienic habits of patients based on the questionnaire they filled out 2. To examine which of the tested toothbrushes: manual, oscillating-rotating or sonic is most effective in reducing supragingival biofilm (tested parameter: PI=plaque index) 3. To investigate which of the tested toothbrushes leads to the fastest reduction of supragingival biofilm (PI) 4. To examine which of the tested toothbrushes will most effectively reduce the periodontal tissue inflammation (BOP = Bleeding on probing) 5. To check which of the tested toothbrushes reduces the inflammation of periodontal tissues the fastest (BOP) 6. To examine whether the improvement of the brushing technique and its monitoring lead to better results in terms of improving the tested parameters. Research materials and methods: Patients qualified for the study received a randomly selected instrument for maintaining oral hygiene - a manual, oscillating-rotating or a sonic toothbrush. For the random selection, there were three tickets with the names of the three toothbrushes placed in an envelope. Then, the patient took one ticket with the name of the selected toothbrush out of the envelope. Next, blood pressure was measured, and the patient completed a questionnaire. Afterwards, patients were thoroughly ; trained on the proper technique of cleaning the teeth surface using a formerly selected toothbrush. Next, patients underwent a detailed examination of the oral cavity with the registration of the following indicators: PI - plaque index, BOP - bleeding on probing, PPD - periodontal pocket depth and CAL- clinical attachment loss. The first visit ended with a thorough scaling above and below the gums and polishing the surface of the teeth. Subsequent visits took place 2 and 4 weeks after the first visit, during which blood pressure was measured and the same indices were recorded again: PI - plaque index, BOP - bleeding on probing, PPD - gingival pocket depth and CAL - clinical attachment loss. Results: Out of 120 people who took part in the randomised study, 87 were ultimately qualified for the analysis of the results. 31 people were included in the manual toothbrush group, 25 people were included in the oscillating-rotating toothbrush group, while 31 people were included in the sonic toothbrush group according to the inclusion criteria. The greatest decrease in the bacterial plaque index (PI) value was recorded in sonic toothbrushes, followed by manual ones, while the relatively smallest reduction in the amount of plaque was recorded in oscillating-rotating toothbrushes. The greatest, statistically significant decrease in bleeding on probing, and thus the greates ; t reduction in inflammation within the periodontal tissues, was recorded in manual toothbrushes, followed by sonic toothbrushes, whereas the relatively smallest reduction of inflammation was observed in oscillating-rotating toothbrushes. No statistically significant differences were observed in periodontal pocket depths throughout the study on sonic toothbrushes and oscillating-rotating toothbrushes, while a statistically significant difference appeared with regard to manual toothbrushes. No statistically significant differences in clinical attachment loss were observed throughout the study on oscillating-rotating toothbrushes, while statistically significant changes appear with regard to manual toothbrushes and sonic toothbrushes. Parameters for these toothbrushes are improving. The comparison of the values of parameter changes of measurement 2 in relation to measurement 1, did not show any statistically significant differences. None of the tested toothbrushes performed significantly better than others in improving the values of PI, BOP, CAL, and PPD indices. All indicator values improved in a similar way. Comparing the values of the measurement of parameters 3 and 1 indicates that the manual toothbrush, especially after the demonstration of proper toothbrushing, is a very good tool for improving the condition of periodontal tissues (CAL), reduction of inflamma ; tion (BOP), and reducing the amount of supragingival biofilm (PI). The comparison of parameter changes in measurement 3 versus 2 showed that the greatest improvement in PPD, CAL, PI, BOP parameters took place in the group of patients using manual toothbrushes, less improvement in the group of patients with sonic toothbrushes, whereas the smallest improvement was observed in the group of patients using oscillatingrotating. The comparison of quantitative variables in the three groups was performed using the analysis of variance (ANOVA). The analysis adopted a significance level of 0.05. Thus, all p values below 0.05 were interpreted as significant dependencies. The analysis was carried out in the R programme, version 4.1.3. R Core Team (2022). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/. R Core Team (2023). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/. Conclusion: Considering the individual objectives of the study, the following detailed conclusions were drawn: 1. A manual toothbrush was most often used in patients from the study group in maintaining their oral hygiene. Most of the respondents have never received a professional oral hygiene demonstration provided ; by qualified dental personnel (a dentist or a certified dental hygienist). Most patients brushed their teeth twice a day for the duration of two minutes, had an annual dental check-up and used an interdental aid once a day. The aid was usually chosen intuitively and was not consulted with a dentist 2. The amount of supragingival biofilm was most effectively reduced by the sonic toothbrush, followed by the manual toothbrush, which recorded a statistically significant decrease in the PI plaque index. Any statistically significant improvement regarding the oscillating-rotating toothbrush was not recorded 3. A statistically significant decrease in the amount of supragingival biofilm was recorded during the first measurement after the hygienic treatment, i.e. after two weeks of using the sonic and manual toothbrushes 4. All three types of toothbrushes, manual, oscillating-rotating and sonic, led to a reduction in inflammation with a statistically significant decrease in BOP after just two weeks of brushing with the selected toothbrush 5. A statistically significant reduction in the depth of the gingival sulcus was observed after the first two weeks following the hygienic treatment visit with regard to a manual toothbrush - which may indicate that the improvement of brushing technique plays a vital part regarding the results achieved with this toothbrush. The impr ; ovement of the brushing technique resulting from the professional selection of the technique and the instructions on how to perform it as well as its monitoring and potential corrections every 2 weeks by the dentist, were of key importance in terms of the achieved effects and the improvement of the tested parameters. Oral hygiene demonstration was crucial in improving the parameters studied.

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2 - studia doktoranckie

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Rada Dyscypliny Nauki medyczne


Cześnikiewicz-Guzik, Marta

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Jun 29, 2024

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ZB-140107 Jun 29, 2024


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