Evaluation of a Sonic Toothbrush on the Reduction of Clinical Parameters, Interleukin-1, MMP-8 and Periodontal Pathogens in Incipient to Moderate Periodontitis

Abstract

[한글]

지속적인 칫솔질을 이용한 치태조절은 치주질환의 예방과 치료의 구강위생방법의 중요한 요소이다. 초음파 전동칫솔(Sonicare？ Elite toothbrush)은 초당 520회의 진동을 생성하여, 이 초음파 진동은 치태제거와 더불어 주변 액체에 와류를 형성한다. 이 와류의 역동적인 힘은 칫솔모에서 2-3mm거리의 치아표면까지 치태세균을 탈락시키고 제거하는데 관여하는것으로 보고되고 있다. 이 연구의 목적은 12주간 성인성 치주염 환자에서 초음파 전동칫솔 사용에 따른 임상지수, Interleukin-1, MMP-8, 치주병인균의 감소에 대한 평가를 하고자 함이다.12주간 단일 맹검법으로 시행하였다. 25-55세의 82명이 실험대상자로 선정되었다. 치태지수가 0.5이상, 치은지수가 1.0이상인 성인성 치주염 환자로 한정하였다. 무작위로 초음파 전동칫솔과 일반 칫솔을 제공하고 통법의 칫솔질 교육을 시행하였다. 치태지수, 치은지수, 탐침시 출혈율, 치주낭 깊이, 치주 부착 소실은 0주, 1주, 4주, 12주에 평가하였다. Interleukin-1, MMP-8의 치은열구액 표본 채취와 4종의 치주병인균(Actinomyces viscosus(AV), Porphyromonas gingivalis(PG), Streptococcus sanguis(SS), Tannerela forsythensis(TF))의 16S r DNA 검사를 위한 치은연하치태 채취는 0주, 1주, 12주에 시행되었다.초음파 전동칫솔군과 일반 칫솔군에서 모든 임상지수가 감소되었다. 그러나 치태지수와 치은지수에서 초음파 전동칫솔군이 일반 칫솔군에 비해 유의성있는 감소를 보였다(P<0.001). 탐침시 출혈 감소율은 초음파 전동칫솔군이 76.73%로 일반 칫솔군 44.57%보다 현저히 높았다. 치주낭 깊이는 초음파 전동칫솔군이 18.55%, 일반 칫솔군이 16.94% 감소하였다. 치주 부착소실은 초음파 전동칫솔군이 25.24%, 일반 칫솔군이 16.94%로 감소하였다(p<0.001). Interleukin-1, MMP-8 농도는 두 군 모두에서 감소하였다. 치은연하치태표본의 치주병인균 AV, PG, TF의 유의성 있는 감소는 보이지 않았다. 치주병인균 SS는 초음파 전동칫솔군에서 유의성있는 감소를 보였으나, 일반 칫솔군에서는 유의성이 존재하지 않았다.결론적으로 초음파 전동칫솔이 일반 칫솔보다 치태 제거와 치은 염증 감소에 더욱 효과적이다.

[영문]Daily plaque removal with a toothbrush is an important component of most oral hygiene programs to prevent and treat periodontal diseases. The Sonicare？ toothbrush utilizes solid-state electronics to create sonic-frequency bristle movement with 520 brush strokes per second. This rapid bristle movement, in addition to its scrubbing plaque-removing activity, creates dynamic activities in surrounding fluids. 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. The aim of this study was to evaluate the effectiveness of the sonic toothbrush duration of 12 weeks on the reduction of the clinical parameters, Interleukin-1, MMP-8 quantitatively and Periodontal Pathogens in moderate periodontitisA 12-week, single-blind clinical trial was employed. Eighty two subjects, ages 25-55 years, were selected. Subjects with plaque index (PI) of >0.5, gingival index (GI) of >1.0 were randomly assigned to use either the manual or the Sonicare？ Elite toothbrush, instructed in its use, and asked to brush each morning and evening for 2 minutes. Plaque index, gingival index, percentage of sites which bled on probing, pocket depth, loss of attachment level, Interleukin-1, MMP-8 and four Periodontal Pathogens (Actinomyces viscosus(AV), Porphyromonas gingivalis(PG), Streptococcus sanguis(SS), Tannerela forsythensis(TF)) in a subgingival plaque sample from 16S rRNA test were assessed at baseline and 1, 12 weeks from the selected teeth. Plaque score and gingival inflammatory score (GI) were taken at baseline and 1, 4, 12weeks using Silness & l&ouml;e gingival index, L&ouml;e & Silness plaque index, respectively. Gingival bleeding was assessed by the bleeding tendency score, presence or absence of bleeding on probing (BOP).The results demonstrate that both the Sonicare？ elite brush and manual brush were significantly reduced all of the clinical parameters. However, statistics indicated Sonicare？ was more effective than the manual brush in plaque and gingival Index scores reduction, respectively (p <0.001). Reduction of BOP in the Sonicare？ group (76.73%) was greater than manual group (44.57%). Reduction of Probing pocket depths compared to baseline were reduced in the Sonicare？ group and the manual groups 18.55% and 14.81%, respectively. Clinical attachment level were significantly improved compared to baseline in the Sonicare？ groups (25.24%) and the manual groups (16.94%) (p< 0.001). Concentration of IL-1ss and MMP-8 were decreased compared to baseline in both groups. AV, PG and TF in subgingival plaque samples did not show significantly decreased 12 weeks than the baseline both in sonicare？ and manual groups. SS showed significantly decreased 12 weeks than the baseline in Sonicare？ but were not significantly reduced than baseline in manual group.In conclusion, the tested Sonicare？ toothbrush was more effective than the manual brush in removal plague and reduction of gingival inflammation.