Efficiency of Chewable Toothbrush in Reduction of Dental Plaque in Students

Rasa Mladenovic; Andrijana Cvetkovic; Brankica Martinovic; Kristina Mladenovic; Milan Zivkovic; Zoran Arsic; Sasa Mladenovic; Tanja Zecevic Lukovic; Dragana Dakovic


BMC Oral Health. 2019;19(58) 

In This Article


This prospective study involved 346 students from the University of Pristina, aged between 21 and 24 (average age 23 years). The study was approved by the Ethical Committee and written consents were obtained from all subjects. Clinical examinations were conducted at the University Clinic of Dentistry, Falulty of Medicine, University of Pristina, located in Kosovska Mitrovica. The examinations were conducted during lunch time (12.00–14.00 h). All examinations were performed by a single examiner.


"Oral Health Questionnaire" for students was created as an application for 'smart' phones with Android platform, the developer being the corrensponding author. Students of the University of Pristina were informed that the "Dent.IN TEST" application could be downloaded free of charge from the Google Play Store.

The questionnaire contained information on poor oral hygiene practices, and each question scored one point (Figure 1). The 'Dent.in TEST' application recorded and classified data from all subjects, whereas the students with the score of 0–1 Poor dental care were automatically scheduled for clinical examination using the contact they provided at the end of the questionnaire. Of the 346 students who completed the e-questionnaire, 41 (11.8%) had a score of 0–1 Poor dental care. 6 of these (14.6%) did not report for clinical examination, thus a total of 35 students (85, 4%) were included in further testing (Figure 2 and Table 1).

Figure 1.

Android application questionnaire 'Dent.in TEST' and scoring

Figure 2.

Research protocol

Clinical examination

To identify dental plaque, we used disclosing tablets (TePe® Plaq-Search Disclosing Tablets), and to estimate the plaque accumulation TQHI index (Turesky modification of the Quigley-Hein Index).[11,12] The TQHI index evaluates the plaque revealed on the buccal and lingual non-restored surfaces of the teeth. An index for the entire mouth is determined by dividing the total score by the number of surfaces examined.

Control group - 17 subjects: Control subjects tested the TePe® Select ExtraSoft toothbrushes and toothpaste. Plaque index values were recorded before and after 2-min -brushing in the manner to which they were accustomed. No mirror was available during the brushing procedure.

Test group - 18 subjects: Subjects from the tested group used chewable 'Fuzzy brush' (Fuzzy Brush Ltd., London, UK) approved by the US Food and Drug Administration. It is a unique 'all in one' chewable toothbrush and breath freshener, designed by dentists. No toothpaste or water is required and it contains high concentrations of Xylitol (Figure 3). Students were instructed on how to use the chewable brush for 3 min, in line with manufacturer's recommendations. Plaque index values were recorded before and after tooth brushing.

Figure 3.

"Fuzzy Brush" chewable toothbrush

Statistical Methods

For the analysis of primary data, descriptive statistical methods and methods for testing statistical hypotheses were used. Of the descriptive statistical methods, the measures of central tendency (arithmetic mean), mea surements of variability (standard deviation) and relative numbers (structural indicators) were used. Of the methods for testing statistical hypotheses, the following were used: t-test for two independent samples and the repeated measurements analysis of variance. Statistical hypotheses were tested at the level of statistical significance (alpha level) of 0.05.