초록

Abstract

Daily plaque removal with toothbrush is an important component of oral hygiene program to prevent and treat periodontal diseases.1-4) Although it has been reported that both manual and electric toothbrushes are effective in removing supragingival plaque and reducing clinical signs of gingival inflammation, several recent studies reported that electric toothbrushes show superiority to manual brushes.5-11) The Sonicare® toothbrush utilizes solid-state electronics to create sonic-frequency bristle movement with 520 brush strokes per second. This rapid bristle movement creates dynamic activities in surrounding fluids in addition to its scrubbing plaque-removing activity. It has been suggested that these fluid forces lift and disperse plaque bacteria from tooth surfaces about 2-3 mm beyond the physical reach of the bristles.12-15) Furthermore, in vitro experiments have shown that low-amplitude acoustic energy such as that generated by the Sonicare® brush has structural and metabolic effects on oral bacteria, which may retard their ability to form plaque by disrupting bacterial adherence properties.16) Increased levels of bacterial pathogens common in periodontal pockets are known to be associated with an elevated biochemical inflammatory response that promotes bone resorption. Understanding the process of periodontal pathogenesis in terms of the biochemical pathway prompted by greater than normal levels of bacteria and mitigating the subsequent effects is a primary component of periodontal therapy.17-20) The most potent pro-inflammatory cytokine stimulating bone resorption is interleukin-1 (IL-1).21,22) IL-1 is a pleiotropic cytokine having multiple biological activities including stimulation of osteoclast recruitment and activation. IL-1 also stimulates fibroblast to produce matrix metalloproteinases (MMPs) important for the degradation of non-mineralized extracellular tissue. Several studies have reported increased levels of inflammatory mediators, such as IL-1 and prostaglandin E2 (PGE2), in gingival crevicular fluids (GCFs) from diseased sites exhibiting periodontal bone loss when compared with healthy sites. Furthermore, GCF from diseased sites has been shown to stimulate bone resorption in vitro to a higher degree than GCF from healthy sites. One important factor responsible for this bone resorbing activity seems to be IL-1.21-24) Matrix metalloproteinases (MMPs) are enzymes activated by IL-1 and are involved in tissue destruction and regeneration.15) A complex cascade involving both host and microbial derived proteinases mediates extracellular matrix degradation during periodontal disease. In this regard, the host-derived MMPs are thought to play a key role. Enhanced activity of these enzymes is a consequence of microbial induced inflammation in the periodontal tissues. Polymorphonuclear leukocyte (PMN)-derived MMPs (MMP-8, MMP-9) are the main proteinases related to tissue destruction and remodeling events in periodontal diseases.23) Traditional clinical measurements such as assessments of probing pocket depth, attachment level, gingival inflammation and microbial plaque yield only historic information about periodontal status. By directly analyzing the changes in the levels of MMPs and IL-1 in GCF, we can associate parameters of inflammation with clinical parameters of tissue destruction. Among several methods that have been applied to detect periodontopathogenic microorganisms, nucleic acid-based methods using DNA probes can give insight on changes in bacterial counts in the periodontal pocket.24) Objectives of this study were to assess the effects of the Sonicare® toothbrush on clinical parameters [Probing Pocket Depth (PPD), Plaque index (PI), Gingival index (GI), Bleeding on probing (BOP), Clinical attachment level (CAL)] and to evaluate the changes in MMP-8, IL-1 and the reduction of 4 bacterial species (PG, TF, SS, AV) testing 16S rRNA at 3 sites of selected teeth with moderate chronic periodontitis following 1, 4 and 12 weeks of toothbrush use.