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 Table of Contents  
Year : 2023  |  Volume : 18  |  Issue : 3  |  Page : 369-371

The effect of toothbrushing duration on plaque removal: A randomized crossover trial

1 Department of Public Health Dentistry, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India
2 Department of Public Health Dentistry, Government Dental College and Hospital, Hyderabad, Telangana, India

Date of Submission16-Jan-2022
Date of Decision25-Sep-2022
Date of Acceptance27-Sep-2022
Date of Web Publication29-Aug-2023

Correspondence Address:
Dr. Bellamkonda Pavani
Department of Public Health Dentistry, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_16_22

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Background: Regular toothbrushing is an important step that removes plaque which is the common risk factor for both periodontitis and dental caries. Commonly prescribed time of brushing by dental professionals is 2 min, despite of which, the average time spent for brushing by the general population is 45 s. Aim: The aim of this study was to determine the relationship between different brushing times from 30 to 180 s, and plaque removal using conventional brushing techniques in the general population. Materials and Methods: Forty participants were included in the study. Study participants brushed for 30, 45, 60, 120, and 180 s randomly. Plaque levels at baseline and after brushing for a specific time period were assessed using the Turesky-modified Quigley–Hein plaque index and a disclosing agent. Results: Plaque removal increased with increased brushing time with maximum removal at 180 s. Conclusions: Dental professionals during health education sessions should highlight the importance of brushing for more than 3 min to achieve maximum plaque removal.

Keywords: Brushing duration, brushing habit, brushing time, plaque, plaque removal

How to cite this article:
Pavani B, Anu V, Cinthiya G S, Deepika V, Ayesha M S, Reddy AA. The effect of toothbrushing duration on plaque removal: A randomized crossover trial. J Datta Meghe Inst Med Sci Univ 2023;18:369-71

How to cite this URL:
Pavani B, Anu V, Cinthiya G S, Deepika V, Ayesha M S, Reddy AA. The effect of toothbrushing duration on plaque removal: A randomized crossover trial. J Datta Meghe Inst Med Sci Univ [serial online] 2023 [cited 2023 Nov 29];18:369-71. Available from: https://journals.lww.com/dmms/pages/default.aspx/text.asp?2023/18/3/369/384724

  Introduction Top

The most critical step in oral hygiene practice to reduce plaque buildup is regular toothbrushing. This, in turn, will reduce the risk of diseases like dental caries and periodontitis for which plaque is the common risk factor.[1],[2],[3] Previous studies that evaluated the association between the duration of brushing and oral hygiene yielded conflicting results. Conversely, when this relation was investigated on a within-subject basis, a considerable effect was witnessed.[4],[5]

More than a few studies investigated the changes in plaque removal with reference to the type of toothbrush, method of brushing, and frequency of toothbrushing.[6] However, studies that evaluated the effect of toothbrushing time on plaque removal in the population who were not trained in brushing techniques are almost none. This is important because, in the procedure of toothbrushing, brushing duration is a such factor, which can be regulated easily.[7]

Dental health professionals commonly recommend a number <2 min as the minimum time a person should spend on toothbrushing, twice a day combined with proper technique. Unfortunately, precise guidelines from dental associations are often missing. Nevertheless, the usual brushing time varies between 30 and 60 s.[8] Since the process of measuring brushing duration has been reported to impact bushing behavior, some discretion should be followed regarding these brushing time estimates.

Recently, Beals et al.[9] conducted a home-utilization study on a sample of 173 adults in the U. S. A. It was concluded that the average brushing time was 46 s, which was obviously shorter than 2 min. Based on this evidence, 45 s could be considered a baseline estimate. Creeth et al.[10] carried out a study to estimate the effect of brushing time on plaque removal in U. S. A. They reported that in the subjects brushing for more than 3 min, plaque removal was removed 55% more compared to brushing for 30 s, whereas 2 min brushing time removed only 26% of plaque.

In India, very few studies investigated the association between toothbrushing time and plaque removal. With this background, the aim of the present study was to verify whether toothbrushing time can determine the amount of plaque removed during routine toothbrushing in a sample of the untrained general population. The definite objective was to compare the brushing duration of 2 min with 45 s.

  Materials and Methods Top

This study is designed as a randomized crossover trial to ensure within-subject comparisons. Ethical clearance was obtained from the institutional review board (123/IRB-IBSEC/SIST: 5/06/2019). Turesky modification of Quigley and Hein plaque index[11] was used in this to estimate the plaque levels. Ethical clearance was obtained from the institutional review board, before starting the study.

The sample size was calculated to ensure a 90% chance of determining the difference in plaque index of 0.16 at the level of significance of 5%. The calculated sample size was 40 participants. This calculation was based on our pilot study which evaluated the amount of plaque removed after brushing for more than 2 min, in which the standard deviation was found to be 0.3. As this study employed a crossover study design and also the time interval between each brushing time was also relatively small; the sample size of 40 was justified. All 40 participants were recruited from the local population. The participants (30 female, 10 male), aged 18–35 years, with a minimum plaque score of 2 estimated using the Turesky Index[11] were included in the study. The study procedure was thoroughly explained and informed consent was obtained from all the study participants before the start of the study.

Participants underwent an oral and general physical examination to check if at least 20 functional teeth were present, and to rule out any general and oral diseases. All the participants were given the same type of toothbrushes and same toothpaste. The amount of toothpaste used was 1.5 gm. All the participants brushed at the study location and their toothbrushing was supervised and recorded on a total of six occasions.

The brushing times used in this study were 30, 45, 60, 120, and 180 s. Brushing times were allotted randomly for 21 days. Participants were instructed to refrain from toothbrushing for at least 24 h before each investigator visit. The disclosing agent was used to disclose the dental plaque which was then assessed using Turesky Index.[11] In the dentifrice group, 1.5 g of the dentifrice was dispensed by the investigator onto a new toothbrush. Participants were instructed thoroughly before each brushing occasion, on how long they were to brush. Brushing time was equally divided among the four quadrants. Investigator recorded the brushing duration using a countdown timer.

No alterations were made to the subject's technique of brushing. The remaining dental plaque retained on the teeth after brushing was again disclosed using the same disclosing agent used earlier and Turesky index[11] was recorded. The difference in the index scores before and after brushing indicates the amount of plaque removed.

  Results Top

[Table 1] shows the baseline plaque index score and score after brushing for a specific brushing time. The difference between baseline and postbrushing plaque scores was maximum when brushing time was 180 s and minimum for 30 s brushing duration. Despite maximum efficiency compared to other brushing times, 180 s of brushing could not eliminate the plaque completely.
Table 1: Turesky plaque index scores before and after brushing for each brushing time

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[Table 2] data were calculated from Table 1. The column labeled “Difference” indicates the difference in adjusted means. Negative values indicate that the second treatment group was efficient. The maximum difference between the mean plaque scores was seen between the pairs of 30 and 180 s. The least difference was between 120 and 180 s.
Table 2: Pair-wise comparisons between change in plaque level and brushing time between groups

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  Discussion Top

The aim of the present study was to assess the effect of the duration of toothbrushing on the amount of plaque elimination. The objective was to compare the average brushing time of 45 s with the most recommended brushing time of 2 min.

A crossover randomized controlled design was employed, so that within-subject comparisons are possible, and also to minimize the effect of different brushing techniques followed by each study participant.

Hawkins et al.[12] had done a study to assess the duration of toothbrushing that can effectively control the plaque among dental students who were well trained in the Bass technique. This study reported that the duration of brushing had a strong impact on plaque elimination and a linear effect was observed between duration and plaque removal. A similar result was reported by Honkala et al.[13] who conducted a study to investigate the effect of habitual toothbrushing in children and a study by McCracken et al.[14] which was aimed to examine the effect of altering brushing force and brushing duration on the plaque-removing efficiency of a powered toothbrush.

However, Klukowska et al.[15] and Hodges et al.[16] reported that the brushing duration beyond 1 min had not shown any increase in plaque removal. Van der Weijden et al.[17] tested the plaque-removing efficiency of four different toothbrushes and its relation to toothbrushing time. This study showed that the plaque removal of all the tested brushes was greatest after a brushing time of 30 s per quadrant.

The result in the present study shows that even after brushing for 3 min, plaque removal was not complete (before = 2.98 ± 0.47 vs. after = 2.02 ± 0.63) [Table 1]. Our study is in keeping with Creeth et al.[10] and George and John,[18] showed a similar result that brushing for more than 3 min had greater efficacy of plaque removal compared to 45–120 s. Similar studies on plaque removal with manual toothbrushing also reported that plaque removal was incomplete during one session of brushing.[19],[20],[21],[22],[23],[24]

One of the limitations of this study is that exercising the longer brushing time for long time periods was not studied, which would have a greater effect on plaque removal compared to a single session of longer brushing time. Another limitation would be not taking into account the effect of different amounts of dentifrice along with brushing duration.

  Conclusions Top

This study demonstrated a linear effect between brushing duration and plaque removal in untrained participants. There was an increase in the amount of plaque eliminated with increasing time, with 180 s showing maximum plaque removal compared to 30 s, which was the minimum brushing time used in this study. Comparing 45–120 s, 120 s showed 30% plaque removal, whereas 45 s showed 22% plaque removal.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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Honkala E, Nyyssönen V, Knuuttila M, Markkanen H. Effectiveness of children's habitual toothbrushing. J Clin Periodontol 1986;13:81-5.  Back to cited text no. 13
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Paraskevas S, Rosema NAF, Versteeg P, Timmerman MF, Van der Velden U, Van der Weijden GA. The additional effect of a dentifrice on the instant efficacy of tooth-brushing: a crossover study. J Periodontol. 2007;78:1011-6.  Back to cited text no. 21
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  [Table 1], [Table 2]


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