Effectiveness of Tooth Brushing using Modified Manual Tooth Brush and Powered Tooth Brush on Dental Plaque and Gingivitis among Spinal Cord Injury patients

Abstract

BACKGROUND: Spinal Cord Injury (SCI) refers to damage to the spinal cord resulting from trauma (e.g. Road Traffic Accident – (RTA)) or from disease or degeneration .Of the total world population, incidence of Spinal Cord Injuries (SCI) varies from 8.0 to 246.0 cases per million inhabitants per year. SCI patients have poor oral health status and Oral Health Related Quality of Life (OHRQoL) compared to normal individuals. Tooth brushing by manual tooth brush is greatly dependent on the manual dexterity and skill of the users. Patients with spinal injury lack manual dexterity and fine motor skills. In order to perform tooth brushing by themselves with some supportive aids, a pragmatic approach was identified, which included modification of conventional manual toothbrush and powered tooth brush. AIM OF THE STUDY: To compare the effectiveness of tooth brushing using modified manual tooth brush and powered tooth brush on control of dental plaque and gingivitis among spinal cord injury patients. METHODOLOGY: The present cross over clinical trial was conducted among spinal cord injury patients to compare and assess the effectiveness of tooth brushing using modified manual tooth brush and powered tooth brush. The study was conducted in Government Institute for Rehabilitation Medicine, KK nagar, Chennai over a period of 16 weeks. A total of 30 participants, 15 in each group were selected (Group A and Group B). Since it was a cross over design, intervention to the participants were given in two different phases. After the first intervention phase, follow up examinations were carried out among both the groups at the 6 weeks period (Interchanging the intervention arm between Group A and Group B). Washout period of 4 weeks were given between two phases, to nullify the effects from the previous phase of intervention. Following this, the cross over intervention was administered & assessment were conducted at the end of 16th week. The baseline data regarding the oral health knowledge, attitude and practice among the spinal cord injury participants was assessed using the WHO Oral Health Questionnaire for adults (2013). The Oral Health Status of participants in both the groups was assessed using Plaque Index (Silness and Loe 1964) and Gingival Index (Loe and Silness 1963). The data was compiled and analyzed using SPSS software and results were generated. RESULTS: In phase I intervention, at baseline examination, the plaque & gingival score among the Group A and Group B were 1.88 ± 0.32 & 1.79 ± 0.25 and 1.47± 0.28 & 1.46 ± 0.27 respectively. After 6 weeks, the post intervention examination the plaque & Gingival scores were reduced to 1.48 ± 0.19 & 1.53 ± 0.16 and 1.19 ± 0.22 and 1.25 ± 0.17 in both the groups respectively. Later in the phase II intervention after the washout period, baseline the plaque & Gingival score among the Group A and Group B were 1.58 ± 0.20 & 1.63 ± 0.16 and 1.27± 0.20 & 1.33 ± 0.18 respectively. After 6 weeks, the post intervention examination the plaque & Gingival score reduced to 1.42 ± 0.20 & 1.34 ± 0.16 and 1.15 ± 0.19 & 1.12 ± 0.20 in both the groups respectively. There was no statistically significant difference in plaque and gingival scores between the groups (P-0.124, 0.487 respectively). CONCLUSION: Both the modalities can be used as an effective tool for brushing among patients with spinal cord injury to improve their oral hygiene. However, further longitudinal studies could be designed to assess the effectiveness of both the interventions among SCI patients