International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 15 , ISSUE 4 ( July-August, 2022 ) > List of Articles


A Randomized Controlled Trial for Evaluation of the Effectiveness of Oral Irrigator and Interdental Floss for Plaque Control in Children with Visual Impairment

Vajrala Deepika, A Ratnaditya

Keywords : Interdental floss, Oral hygiene, Oral irrigator, Randomized controlled trial, Visual impairment

Citation Information : Deepika V, Ratnaditya A. A Randomized Controlled Trial for Evaluation of the Effectiveness of Oral Irrigator and Interdental Floss for Plaque Control in Children with Visual Impairment. Int J Clin Pediatr Dent 2022; 15 (4):389-393.

DOI: 10.5005/jp-journals-10005-2404

License: CC BY-NC 4.0

Published Online: 17-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: To evaluate the effectiveness of oral irrigator and interdental floss as adjuncts to manual tooth brushing in 8–16 years old children with visual impairment. Materials and methods: A three-arm, parallel-group randomized controlled trial with blinded outcome assessment was carried out with the inclusion of 90 institutionalized children with visual impairment of age 8–16 years. They were equally allocated to three groups: group I: tooth brushing along with interdental flossing, group II: brushing along with a powered oral irrigator, and group III: brushing alone (control). Baseline oral hygiene index-simplified (OHI-S), gingival index (GI), and plaque index (PI) scores were recorded for all the samples and compared with post-intervention scores at 14 and 28 days intervals. Repeated measures of analysis of variance (ANOVA), one-way ANOVA, and post hoc Tukey tests were used for statistical analysis. Results: At 28 days interval, children in group II showed a highly statistically significant reduction in OHI-S (0.46; p = 0.0001), PI (0.16; p = 0.0001), and GI (0.24; p = 0.0001) scores compared to control group. They also showed a significant reduction in OHI-S (0.25; p = 0.018), PI (0.15; p = 0.011), and GI (0.15; p = 0.0001) scores compared to group I. There is no significant reduction in the scores of children of group I compared to control group except for the GI score (0.08; p = 0.02). Conclusion: Oral hygiene maintenance using oral irrigator along with brushing was found to be more effective in visually challenged children. Interdental flossing, along with brushing and brushing alone was found to be less effective. Clinical significance: This study underlines the fact that comprehensive oral hygiene care should include interdental cleaning aids for effective plaque control to prevent dental diseases in children with visual impairment. Since these children have less manual dexterity to perform good oral hygiene practices, electrically driven interdental cleaning aids like oral irrigator may help them to overcome the problem.

  1. Lewis C, Robertson AS, Phelps S. Unmet dental care needs among children with special health care needs: implications for the medical home. Pediatrics 2005;116(3):e426–e431. DOI: 10.1542/peds.2005-0390
  2. Bhor K, Shetty V, Garcha V, et al. Effect of oral health education in the form of Braille and oral health talk on oral hygiene knowledge, practices, and status of 12–17 years old visually impaired school girls in Pune city: a comparative study. J Int Soc Prev Community Dent 2016;6(5):459–464. DOI: 10.4103/2231-0762.192938
  3. Joybell C, Krishnan R, V SK. Comparison of two brushing methods—Fone's vs modified bass method in visually impaired children using the audio tactile performance (ATP) technique. J Clin Diagn Res 2015;9(3):ZC19–ZC22. DOI: 10.7860/JCDR/2015/11307.5651
  4. Reddy K, Sharma A. Prevalence of oral health status in visually impaired children. J Indian Soc Pedod Prev Dent 2011;29(1):25–27. DOI: 10.4103/0970-4388.79922
  5. Shahabudin S, Hashim H, Omar M. The effectiveness of dental health education tools for visually impaired students in Bukit Mertajam. AIP Conf Proc 2016;1791(1):020011. DOI: 10.1063/1.4968866
  6. Houwen S, Visscher C, Lemmink KAPM, et al. Motor skill performance of school-age children with visual impairments. Dev Med Child Neurol 2008;50(2):139–145. DOI: 10.1111/j.1469-8749.2007.02016.x
  7. Sharma A, Arora R, Kenchappa M, et al. Clinical evaluation of the plaque-removing ability of four different toothbrushes in visually impaired children. Oral Health Prev Dent 2012;10(3):219–224.
  8. Baruah K, Thumpala VK, Khetani P, et al. A review on toothbrushes and tooth brushing methods. Int J Pharm Sci Invent 2017;6(5): 29–38.
  9. Khatri M, Malik AS, Bansal M, et al. Effect of supragingival oral irrigation as an adjunct to toothbrushing on plaque accumulation in chronic generalized gingivitis patients. J Indian Soc Periodontol 2017;21(4):296–302. DOI: 10.4103/jisp.jisp_393_15
  10. Reddy VK, Chaurasia K, Bhambal A, et al. A comparison of oral hygiene status and dental caries experience among institutionalized visually impaired and hearing impaired children of age between 7 and 17 years in central India. J Indian Soc Pedod Prev Dent 2013;31(3):141–155. DOI: 10.4103/0970-4388.117963
  11. Barnes CM, Russell CM, Reinhardt RA, et al. Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque. J Clin Dent 2005;16(3):71–77.
  12. Murthy PS, Shaik N, Deshmukh S, et al. Effectiveness of plaque control with novel pediatric oral hygiene need station (modified oral irrigation device) as compared with manual brushing and flossing: randomized controlled pilot trial. Contemp Clin Dent 2018;9(2): 170–173. DOI: 10.4103/ccd.ccd_749_17
  13. Rosema NAM, Hennequin-Hoenderdos NL, Berchier CE, et al. The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol 2011;13(1):2–10.
  14. Patel D, Mehta F, Trivedi I, et al. Study of the effects of oral irrigation and automatic tooth brush use in orthodontic patients with fixed appliances. J Orthod Res 2015;3(1):4–10. DOI: 10.4103/2321-3825.147973
  15. Bhaskar BV, Janakiram C, Joseph J. Access to dental care among differently-abled children in Kochi. J Indian Assoc Public Health Dent 2016;14(1):29–34. DOI: 10.4103/2319-5932.178723
  16. Shetty V, Hegde AM, Varghese E, et al. A novel music based tooth brushing system for blind children. J Clin Pediatr Dent 2013;37(3): 251–255. DOI: 10.17796/jcpd.37.3.28v62k5114659g62
  17. Ng E, Lim LP. An overview of different interdental cleaning aids and their effectiveness. Dent J (Basel) 2019;7(2):56. DOI: 10.3390/dj7020056
  18. Sharma NC, Lyle DM, Qaqish JG, et al. Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop 2008;133(4):565–571. DOI: 10.1016/j.ajodo.2007.12.008
  19. Husseini A, Slot DE, Weijden GAVD. The efficacy of oral irrigation in addition to a toothbrush on plaque and the clinical parameters of periodontal inflammation: a systematic review. Int J Dent Hyg 2008;6(4):304–314. DOI: 10.1111/j.1601-5037.2008.00343.x
  20. Graves RC, Disney JA, Stamm JW. Comparative effectiveness of flossing and brushing in reducing interproximal bleeding. J Periodontol 1989;60(5):243–247. DOI: 10.1902/jop.1989.60.5.243
  21. Bellamy P, Barlow A, Puri G, et al. A new in vivo interdental sampling method comparing a daily flossing regime versus a manual brush control. J Clin Dent 2004;15(3):59–65.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.