Dental plaque is defined as soft deposits that form a biofilm adhering to the tooth surface in the oral cavity, including removable and fixed restorations.  Dental plaque has been considered a direct cause of gingival and periodontal diseases. Plaque is also capable of reducing the pH at the surface of enamel to the levels that can cause dissolution of the hydroxyapatite crystals and initiates caries.
Plaque control can be achieved by either mechanical or chemical means. However, mechanical plaque control remains the mainstay for prevention of dental diseases, with chemotherapeutic agents acting as an adjunct to it. The mechanical methods of plaque removal are tooth brushing, flossing, and use of interdental cleansing devices, while the various chemical methods include the use of mouthrinses, dentifrices, enzymes, and antimicrobial mouthwashes.
Various designs of toothbrushes have been recommended to enhance mechanical removal of dental plaque. Two types of brushes are widely used, manual and powered toothbrush.
To determine the efficacy of powered and manual toothbrushes.
To compare the efficacy of manual and powered brushes under supervised and unsupervised conditions.
Two hundred school-going children of age group between 6 and 13 years were selected for the study. They were randomly divided into two groups comprising 100 students each according to the brush used. Each group was further subdivided into two subgroups which comprised 50 students each; one group was supervised for brushing while the other group was left unsupervised.
At 3, 6, 9 and 12 weeks, plaque was recorded according to Turseky-Gilmore-Glickman modification of Quingley Hein index and oral hygiene performance index. Data were statistically analyzed.
The results are shown in [Table 1],[Table 2],[Table 3],[Table 4],[Table 5],[Table 6].
The [Table 1] shows the mean plaque reduction score with Turseky-Gilmore-Glickman modification of Quingley Hein plaque index (S) for powered group to be 1.03 ± 0.1269. Similarly, with Silness and Loe Plaque index (P), it was 0.82 ± 0.1011, and with patient's oral hygiene performance index, it was 1.53 ± 0.2072.
The [Table 2] shows the mean plaque reduction score with Turseky-Gilmore-Glickman modification of Quingley Hein plaque index (S) for manual group to be 0.67 ± 0.0853. Similarly, with Silness and Loe Plaque index, it was 0.54 ± 0.0957, and with patient's oral hygiene performance index, it was 0.99 ± 0.211.
The [Table 3] shows the mean plaque reduction score with Turseky-Gilmore-Glickman modification of Quingley Hein index (S) for powered supervised group to be 1.14 ± 0.0530. With Silness and Loe plaque index (P), it was 0.9 ± 0.0512. Similarly, with patient's oral hygiene performance index (H), it was 1.68 ± 0.0131.
The [Table 4] shows that the mean plaque reduction for powered unsupervised group was 0.920 ± 0.0697 using Turseky-Gilmore-Glickman modification of Quingley Hein index (S). Similarly, the mean plaque score at baseline using Silness and Loe plaque index (P) was 0.73 ± 0.0578, and with patient's oral hygiene performance index, the mean plaque reduction was 1.38 ± 0.1781.
The [Table 5] shows the mean reduction scores with Turseky-Gilmore-Glickman modification of Quingley Hein plaque index (S) for manual supervised group to be 0.73 ± 0.0317. Similarly, with Silness and Loe plaque index (P), it was 0.6 ± 0.0558, and with patient's oral hygiene performance index (H), the mean plaque reduction was 1.12 ± 0.1658.
The [Table 6] shows the mean reduction scores with Turseky-Gilmore-Glickman modification of Quingley Hein plaque index (S) for manual supervised group to be 0.60 ± 0.0677. Similarly, with Silness and Loe plaque index (P), it was 0.47 ± 0.0837, and with patient's oral hygiene performance index (H), the mean plaque reduction was 0.87 ± 0.1741.
Various designs of toothbrushes have now been recommended to enhance the mechanical removal of dental plaque. The high prevalence and severity of dental diseases indicates that tooth brushing, as a basis of prevention, is inadequately performed (Lilenthal, Amerena and Gregory 1965; Alexander 1970).
The types of brushes are manual, powered, ionic and sonic brushes. For hand brushing (manual) to be effective, a certain degree of manual dexterity is required. A number of investigations showed that children are generally not capable of obtaining a sufficient oral hygiene level by manual brushing due to their underdeveloped motor skills, lack of knowledge about oral hygiene and effective brushing, less amount of time spent on brushing than recommended or a combination of these.  Hence ,ionic and powered brushes have been introduced to facilitate tooth cleaning and improve the oral hygiene of the patient.
Hence, the aim of the present study was to compare the efficacy of powered and manual brushing under supervised and unsupervised conditions. Those in the supervised group were given instructions for brushing and those in the unsupervised group were told to brush as before.
The efficacies of the two brushes were compared using Plaque index (modification by Loe 1967), Turseky-Gilmore-Glickman modification of Quingley Hein index and patient's oral hygiene performance index.
Both the brushes significantly reduced the plaque accumulation, though to different degrees. Similar results were obtained from the study conducted by Lazarescu et al.,  Jongenelis,  Martin et al. (1987), Baab and Johnson,  and Preber et al. (1991).
The results of our study differ from those reported by William et al.,  in which they compared the effectiveness of an electric brush and a regular hand brush in preventing or removing dental plaque and concluded that both brushes were equally effective in removing plaque.
In this study, the powered supervised group showed significantly more plaque reduction as compared to the manual group. The result probably can be attributed to a better understanding of hygiene requirement by the children, the use of better brushes than those used previously, and also to Hawthrone effect (because of participation in the study) (Ainamo et al. 1997).
Both brushes significantly reduced the plaque accumulation, though to different degrees. The powered group showed significantly more plaque reduction as compared to the manual group. The supervised group of both manual and powered brushes showed a greater plaque reduction than the unsupervised group. The degree of efficacy of the two brushes in plaque reduction in decreasing order could be summarized as: powered supervised > powered unsupervised > manual supervised > manual unsupervised.
1. Nikiforuk G. Understanding dental caries, prevention basic and clinical aspect, New York, Karger publication; 1985.
2. Lazarescu D, Boccaneala S, Illiescu A, De Boever JA. Efficacy of plaque removal and learning effect of a powered and a manual toothbrush. J Clin Periodontol 2003;30:726-31.
3. Rugg -Gunn AJ, Macgregor ID. A survey of toothbrushing behaviour in children and young adults. J Periodontol Res 1978;13:282-9.
4. Ainamo J, Xie Q, Ainamo A, Kallio P. Assessment of the effect of an oscillating /rotating electric toothbrush on oral health.A 12 month longitudinal study. J Clin Periodontol 1997;24:28-33.
5. Mentes A, Atukeren J. A study of manual toothbrushing skills in children aged 3-11 yrs. J Clin Pediatr Dent 2003;27:91-4.
6. Newman MG, Takei HH, Carranza AF. Clinical Periodontology, 9 th ed. ,Philadelphia, Saunders Company; 2003.
7. Jongenelis AP, Wiedemann W. A comparison of plaque removal effectiveness of an electric versus a manual toothbrush in children. ASDC J Dent Child 1997;64:176-82,165.
8. Baab DA, Johnson RH. The effect of a new electric toothbrush on supragingival plaque and gingivitis. J Periodontol 1989;60:336-41.
9. Williams AS, Ash M. A clinical evaluation of an electric toothbrush. J Periodontol 1964;35:127-36.
Ghassemi, A. and Vorwerk, L. and Hooper, W. and Patel, V. and Sharma, N. and Qaqish, J.