Clinical and Microbiological Evaluation of Manual Toothbrush, Electric Toothbrush and Nano-b Toothbrush on Plaque Removing Efficacy among Visually Impaired Children: A Randomised Clinical Trial

Introduction: Oral hygiene can be maintained by mechanical and chemical methods. Maintenance of oral hygiene is challenging in visually impaired children due to physical limitations. Aim: To compare plaque removal efficacy using different toothbrushes among visually impaired children. Materials and Methods: This randomised clinical trial conducted on 45 visually impaired children aged between 7-12 years from a blind school in Bengaluru, Karnataka, India, after obtaining informed consent. Study was conducted in the month of September 2020 and October 2020 for a period of two months. All potential participants were randomly divided into three groups depending on the type of toothbrush used. A plaque disclosing agent (Alpha Plac) was applied and Turesky Modified Quigley Hein Plaque Index (TQHPI) was recorded for all subjects on 15th, 30th, 45th and 60th day from the baseline. Plaque samples were collected from all the subjects and microbial assessment was done for detection of Colony Forming Units (CFUs), on 30th and 60th day from the baseline. Data was analysed using One-way Analysis of Variance (ANOVA) test followed by Tukey's posthoc analysis at baseline and post interventional time periods. Friedman's test followed by Wilcoxon's Signed Rank post-hoc analysis was used to compare mean CFUs between different time intervals, in each study group. Results: At baseline, no statistically significant difference was noted between the three groups with respect to TQHPI and CFUs. At two months follow- up, nano-b toothbrush group showed significant decrease in mean Plaque Index (PI) score compared to electric toothbrush group (p-value=0.01) and manual toothbrush group (p- value <0.001). Similarly, at two months, mean reduction in CFUs was greater in nano-b toothbrush group followed by electric toothbrush group and manual toothbrush group which was statistically significant (p-value=0.003). Conclusion: Plaque removal efficacy in visually impaired children was superior in nano-b toothbrush group, followed by electric toothbrush group and manual toothbrush group in succession, respectively.