ISSN : 0376-4672
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.
1. Löe H, Theilade E, Jensen JB. Experimental gingivitis in man, J Periodontol 1965;36:177-187
2. Theilade E. Dental plaque & dental calculus, In Lindhe J, Textbook of Periodontology 1983, Copenhagen, Munksgaard
3. Theilade E, Wright WH, Jensen JB. Experimental gingivitis in man. II. A longitudinal clinical and bacteriological investigation, J Periodont Res 1966;1:1-13
4. JY Hong, SN Kim, CK Kim, et al. Suppressive effect of Curcuma xanthorrhiza oil on plaque and gingivitis, J Korean Acad Periodontol 53;4:1053-71
5. Barnes CM, Weatherford TW, Menaker L. A Comparison of the Braun Oral-B Plaque Remover(D5) and a manual toothbrush in affecting gingivitis, J Clin Dent 1993;4:48-51
6. Chilton NW, DiDio A, Rothner JT. Comparison of the effectiveness of an electric toothbrush and a standard toothbrush in normal individuals, J Am Dent Assoc 1962;64:777-782
7. Forgas-Brockmann LB, Carter-Hanson C, Killoy WJ. The effects of an ultrasonic toothbrush on plaque accumulation and gingival inflammation, J Clin Periodontol 1998;25:375-379
8. McKendrick AJW, Barbenel LMH, McHugh WD. A two-year comparison of hand and electric toothbrushes, J Periodon Res 1968;3:224-231
9. Versteeg PA, Timmerman MF, Rosema NAM, et al. Sonic-powered toothbrushes and reversal of experimental gingivitis, J Clin Periodontol 2005;32:1236-1241
10. Quirynen M, Vervliet E, Teerlinck J, Darius P, Van Steenberghe D. Medium- and long-term effectiveness of a counterrotational electric toothbrush on plaque removal, gingival bleeding, and probing pocket depth, Int J Periodont & Rest Dent 1994;14:364-377
11. Tritten CB, Armitage GC. Comparison of a sonic and manual toothbrush for efficacy in supragingival plaque removal and reduction of gingivitis, J Clin Periodontol 1996;23:641-648
12. Hope CK, Wilson M. Effects of dynamic fluid activity from an electric toothbrush on in vitro biofilms, J Clin Periodontol 2003;30:624-629
13. Hope CK, Petrie A, Wilson M. In vitro assessment of the plaque-removing ability of hydrodynamic shear forces produced beyond the bristles by 2 electric toothbrushes, J Periodontol 2003;74:1017-1022
14. Stanford CM, Srikantha R, Wu CD. Efficacy of the Sonicare toothbrush fluid dynamic action on removal of human supragingival plaque, J Clin Dent 1997; 8:10-14
15. Engel D, Nessly M, Morton T, Martin R. Safety testing of a new electronic toothbrush, J Periodontol 1993;64:941-946
16. Wu-Yuan CD, Anderson RD, McInnes C. Ability of the SonicareⓇ electronic toothbrush to generate dynamic fluid activity that removes bacteria, J Clin Dent 1994; 5(3):89-93
17. Beirne GO, Johnson RH, Persson GR, Spektor MD. Efficacy of a sonic toothbrush on nflammation and probing depth in adult periodontitis, J Periodontol 1996;67:900-908
18. Bruun C, Ekstrand KR, Andreasen KB. A new in vitro method for testing the interproximal cleaning potential of toothbrushing, J Clin Dent 1998;9:11-15
19. Lobene RR. Evaluation of altered gingival health from permissive powered toothbrushing, J Am Dent Assoc 1964;69:585-588
20. Stoltze K, Bay L. Comparison of a manual and a new electric toothbrush for controlling plaque and gingivitis, J Clin Periodontol 1994;21:86-90
21. Page RC, Schroeder HE. Pathogenesis of inflammatory periodontal disease. A summary of current work, Lab Invest 1976;33:235-249
22. Tonetti MS, Imboden MA, Gerber L, et al. Molecular factors associated with compartmentalization of gingival immune responses and transepithelial neutrophil migration, J Periodontal Res 1997; 32: 104-109
23. Page RC, Kornman KS. The pathogenesis of human periodontitis: an introduction, Periodontol 2000 1997;14:9-11
24. Haffajee AD, Smith C. Efficacy of manual and powered toothbrush(II). Effect on microbiological parameters, J Clin Periodontol 2001;28: 947-954
25. Löe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity, Act Odont Scand 1963;21:533-551
26. Hong JY, Jung SW, Kim CK, et al. Efficacy of the Sonicare Elite in plaque removal and reduction of gingival inflammation from hard-to-reach sites of the moderate periodontitis, J Korean Acad Periodontol 2006;36:693-703
27. Baab DA, Johnson RH. The effect of a new electric toothbrush on supragingival plaque and gingivitis, J Periodontol 1989;60:336-341
28. Killoy WJ, Love JW, Love J, et al. The effectiveness of a counter-rotary action powered toothbrush and conventional toothbrush on plaque removal and gingival bleeding. A shortterm study, J Periodontol 1989;60:473-477
29. Khocht A, Spindell L, Person P. A comparative clinical study of the safety and efficacy of three toothbrushes, J Periodontol 1992;63:603-610
30. 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
31. Van der Weijden GA, Timmerman MF, Nijboer A, Lie MA, Van der Velden U. A Comparative study of electric toothbrushes for the effectiveness of plaque removal in relation to toothbrushing duration, J Clin Periodontol 1993;20:476-481
32. van der Weijden GA, Timmerman MF, Reijerse E, et al. The long-term effect of an oscillating/ rotating electric toothbrush on gingivitis. An 8- month clinical study, J Clin Periodontol 1994;21:139-145
33. Elliott JR. A comparison of the effectiveness of a standard and an electric toothbrush, J Periodont 1963;34:375-379
34. Glass RL. A clinical study of hand and electric toothbrushing, J Periodontol 1965;36:322-327
35. Rainey BL, Ash MM. A clinical study of short stroke reciprocating action electric toothbrush, J Periodontol 1964;35:455-462
36. Smith WA, Ash MM. A clinical evaluation of an electric toothbrush, J Periodontol 1964;35:127- 136
37. Boyd RL, Murrsy P, Robertson PB. Effect of rotary electric toothbrush versus manual toothbrush on periodontal status during orthodontic treatment, American J Orthodontics & Dentofacial Orthopedics 1989;96:342-347
