A controlled trial to compare the ability of foam swabs and toothbrushes to remove dental plaque

Aims of the study. To measure how effective foam swabs are at removing dental plaque when compared with using a toothbrush and to quantify any difference in ability. Background. Few nursing studies have aimed to determine the effectiveness of different mouth care tools to remove plaque which is associated with the tooth/gingival margin and, therefore, with gingivitis and chronic inflammatory periodontal disease. Findings from a previous case study of two people that compared the ability of foam swabs and toothbrushes to remove plaque at the gum/tooth margin (gingival crevice) and plaque from between teeth (approximal plaque) suggested that the success of a toothbrush is affected by user technique and that foam swabs are not able to remove plaque from some 'sheltered' areas of teeth. Methods. A time-series, cross-over controlled trial with 34 volunteers was used to determine the ability of foam swabs and toothbrushes to remove dental plaque which had been allowed to accumulate overnight. Plaque accumulations were scored at each approximal and crevice site for the buccal surfaces of the eight upper and eight lower teeth after each treatment of either toothbrushing or swabbing. Results. Plaque frequency distributions in the form of boxplots, together with results from summary statistics demonstrate that toothbrushes performed substantially better than foam swabs in the ability to remove plaque from the sites studied in this larger sample of people. Conclusions. The trial verified the findings from the previous study. The conclusions can be generalized to a wider population because of the magnitude and direction of the differences measured. The implications for nurse education and the development of nursing in practice settings include the need to teach effective toothbrushing skills to nurses, and to support clinical staff in developing mouthcare practice, particularly in relation to the use of assessment strategies that include the choice of effective tools.