Discussion
tooth brush, bleeding, hyperplasia, ’s mouth, gingivitis, caries, tooth brushing, orthodontic
BLEEDING, DEMINERALIZATION, HYPERPLASIA, GINGIVITIS, CARIES, BLIND, COMPLICATIONS
To date, no long-term RCT designed to evaluate the impact of MT versus PT in an orthodontic population has been reported, while more recent studies have once again only reported short-term (<8 weeks) evaluations [A key requirement of any participant undergoing fixed appliance therapy is the need to maintain optimal oral hygiene. Furthermore, the long-term nature of orthodontic treatment increases the likelihood of both hard (enamel demineralization, with white spot lesions or caries) and soft (gingivitis, hyperplasia, and periodontal pocketing/attachment loss) tissue complications, in the absence of this optimal cleaning. Thus regular tooth brushing becomes essential, and with the availability of PT and their inherent appeal, there is a need for robust clinical evidence of their effectiveness over both the short term but perhaps more importantly, the long term [A further strength of the current trial was that following the initial protocol registration with the International Standard Randomised Controlled Trials Centre, no protocol deviations were reported, thus minimizing the risk of bias, through e.g. selective reporting. Furthermore, the trial sample retained its power, with appropriate allowance being made for potential drop-outs, with the observed rate being consistent with previous studies in the same field [The present trial could detect no difference in three primary outcomes (GI, PI, and BoP), at any of the time points from 1 to 12 months, in participants undergoing comprehensive fixed appliance therapy in both arches, in terms of the toothbrush type. These findings do not support the superiority of a specific PT in maintaining optimal health when compared with an MT for those wearing orthodontic appliances. The findings are in contrast with a number of previous studies, which as highlighted above, are at risk of bias, with significant limitations, and perhaps most importantly, fail to take into account the long-term nature of orthodontic treatment. In a recent trial, designed to quantify the duration of tooth brushing, with MT and PT, in children with fixed appliances, no differences were detected in their effectiveness, with a reported brushing time of approximately 3 min [This study did find a significant interaction between the toothbrush type, the follow-up period, and specific tooth in the participant’s mouth. Specifically, an increase was observed in the GI, PI, and BoP at 1 month, which was reduced during the subsequent follow-up periods, with the exception of the lower incisor and posterior molar regions, where the scores remained high. The latter reflects well in terms of the more recently described concept of some bleeding being commensurate with periodontal health [While every effort was made in the design and execution of the current randomized clinical trial to address the many shortcomings in the present literature, nevertheless, there are inherent limitations. The trial was based in a single-hospital setting, and therefore, its findings may not be generalizable. The study was not double-blind, as participants were clearly aware of the choice of tooth brush to be used. However, the operator and outcome assessment, along with the data analysis, were all performed blind.The specific powered toothbrush selected for the present study used a sonic triple clean head, and alternatives are now available, which may be more effective [