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Gingival inflammation; oral hygiene practices; powered toothbrush; fluoride toothpaste; antimicrobial mouthwash; flossing; gingival index; plaque index; bleeding on probing; oral health

Introduction

Gingivitis is an inflammatory condition affecting the gingiva, primarily caused by the accumulation of bacterial plaque on the teeth and surrounding tissues. It is one of the most common oral diseases worldwide, affecting individuals of all ages. Gingivitis is characterized by symptoms such as gum redness, swelling, and bleeding, particularly during brushing or flossing. If left untreated, gingivitis can progress to periodontitis, a more severe form of gum disease that can lead to tooth loss [1]. Oral hygiene practices, including brushing, flossing, and the use of mouthwash, are essential for controlling plaque buildup and preventing gingival inflammation. Numerous studies have examined the effectiveness of different oral hygiene products and techniques in reducing plaque and gingival inflammation, but results have been inconsistent. The use of powered toothbrushes, for example, has been suggested to be more effective than manual brushing, while antimicrobial mouthwashes may provide additional benefits in controlling oral bacteria [2].

This study aims to compare the effectiveness of various oral hygiene practices-namely brushing with fluoride toothpaste, using an antimicrobial mouthwash, flossing, and the use of a powered toothbrush-in reducing gingival inflammation. The outcomes measured include the gingival index (GI), plaque index (PI), and bleeding on probing (BOP), all of which are established clinical indicators of oral health [3].

Methods

Study design

This study was a randomized controlled trial conducted over a 6-week period. A total of 120 participants (60 males, 60 females) aged 18 to 45 years, with mild to moderate gingival inflammation, were recruited from a dental clinic. The inclusion criteria required participants to have a baseline gingival index score of at least 1.0 (mild inflammation). Exclusion criteria included individuals with systemic diseases affecting oral health, smokers, pregnant women, and those with allergies to the products being tested [4].

Intervention groups

Participants were randomly assigned to one of the following four intervention groups:

1. Group 1 (manual brushing with fluoride toothpaste): Participants were instructed to brush twice daily using a soft-bristled toothbrush and fluoride toothpaste.
2. Group 2 (powered toothbrush with fluoride toothpaste): Participants used a powered toothbrush with fluoride toothpaste twice daily.
3. Group 3 (flossing and fluoride toothpaste): Participants brushed their teeth with fluoride toothpaste twice daily and used dental floss once daily.
4. Group 4 (antimicrobial mouthwash and fluoride toothpaste): Participants brushed their teeth with fluoride toothpaste twice daily and used an antimicrobial mouthwash (chlorhexidine 0.12%) twice daily.

Outcome measures

The following clinical parameters were measured at baseline and after 6 weeks:

1. Gingival index (GI): This index assesses the severity of gingival inflammation, ranging from 0 (healthy) to 3 (severe inflammation).
2. Plaque index (PI): This measures the amount of dental plaque present on the teeth, with scores ranging from 0 (no plaque) to 3 (abundant plaque).
3. Bleeding on probing (BOP): This evaluates the presence of bleeding after gentle probing of the gingival sulcus, with a positive result indicating gingival inflammation.

Statistical analysis

Data were analyzed using SPSS version 22. Descriptive statistics were used to summarize the baseline characteristics of the participants. Paired t-tests were used to compare the clinical parameters before and after the intervention within each group. One-way ANOVA was employed to compare the effectiveness of the four groups. A p-value of < 0.05 was considered statistically significant [5].

Statistical Findings

• There were significant reductions in GI, PI, and BOP in all groups after 6 weeks (p < 0.05).
• The powered toothbrush group showed the most substantial improvement in GI (1.2 ± 0.3), followed by the antimicrobial mouthwash group (1.3 ± 0.3).
• The manual brushing group showed the least improvement in GI but still had a significant reduction (1.5 ± 0.4).
• The plaque index showed similar trends, with the powered toothbrush group achieving the lowest PI after 6 weeks (1.1 ± 0.4).
• Bleeding on probing was significantly reduced in all groups, with the powered toothbrush group showing the greatest reduction (from 52% to 32%).

Discussion

The present study compared the effectiveness of four commonly used oral hygiene practices in reducing gingival inflammation. The results indicate that all the interventions led to significant improvements in gingival health, but the powered toothbrush with fluoride toothpaste proved to be the most effective [6].

Powered toothbrush: This group demonstrated the greatest reduction in gingival inflammation, plaque accumulation, and bleeding on probing. The powered toothbrush may provide superior plaque removal compared to manual brushing due to its oscillating or rotating motion, which helps in better plaque disruption and cleaning of hard-to-reach areas. The improved performance of powered toothbrushes is consistent with previous studies that have highlighted their superior efficacy in reducing plaque and gingivitis compared to manual toothbrushes.

Flossing and mouthwash: Both flossing and antimicrobial mouthwash use contributed significantly to improvements in gingival health. Flossing, while effective in reducing plaque interdentally, might be less efficient than the powered toothbrush in improving overall gingival health. Antimicrobial mouthwash, especially chlorhexidine, has proven to reduce oral bacteria and plaque, which is likely why the mouthwash group showed marked improvements. However, the mouthwash group did not show as great a reduction in GI and PI as the powered toothbrush group, possibly due to the fact that chlorhexidine, while effective against bacteria, does not mechanically remove plaque [7-9].

Manual brushing with fluoride toothpaste: While less effective than the powered toothbrush, manual brushing with fluoride toothpaste still resulted in significant improvements in gingival inflammation and plaque control. This finding supports the notion that any form of brushing, when done regularly and with fluoride toothpaste, can lead to meaningful reductions in gingival inflammation. However, the mechanical action of brushing is a critical factor, and the enhanced plaque removal seen with powered toothbrushes may account for their greater effectiveness.

Limitations: Although this study provides valuable insights, it is important to note some limitations. First, the sample size, while adequate, could be expanded for more robust conclusions. Second, the study duration was relatively short (6 weeks), and longer-term studies could better assess the sustainability of the effects. Additionally [10].

Conclusion

This study demonstrated that various oral hygiene practices significantly reduce gingival inflammation, plaque accumulation, and bleeding on probing, but the effectiveness varies among the methods tested. The use of a powered toothbrush with fluoride toothpaste was the most effective in reducing gingival inflammation and plaque, followed by antimicrobial mouthwash. While flossing and manual brushing also showed positive outcomes, they were comparatively less effective in achieving significant improvements in gingival health. These findings suggest that incorporating a powered toothbrush into daily oral hygiene routines may offer superior benefits for individuals looking to reduce gingival inflammation and improve overall gum health. Additionally, antimicrobial mouthwash can be a beneficial adjunct to brushing, especially for individuals who may struggle with effective plaque removal. While manual brushing with fluoride toothpaste and flossing remain essential components of good oral hygiene, their combined effectiveness may not be as high as that of powered toothbrushes or antimicrobial mouthwashes in reducing gingival inflammation.

Acknowledgment

None

Conflict of Interest

None 

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