Evaluation of Orthodontic and Triple-headed Toothbrushes When Used Alone or in Conjunction with Single-tufted Toothbrush in Patients with Fixed Lingual Orthodontic Appliances. A Randomized Clinical Trial

N Y State Dent J. 2015 Apr;81(3):31-7.


Brushing with a single-tufted toothbrush in conjunction with a manual toothbrush has been widely recommended, although its effectiveness has not been proven. This study investigated the effectiveness of orthodontic and triple-headed toothbrushes when used alone or in conjunction with the single-tufted toothbrush in patients with fixed lingual orthodontic appliances.

Methods: In this randomized, single-blinded, controlled clinical trial, orthodontic patients (N = 26, mean age 27.3 years) with lingual fixed appliances were asked to brush with a triple-headed or an orthodontic toothbrush alone for one month, followed by brushing in conjunction with the single-tufted toothbrush for an additional month. Teeth were professionally cleaned at baseline and one month later. A clinician blinded to group assignments examined the patients and evaluated tooth plaque index, bracket plaque index, modified gingival index and bleeding on probing at baseline at one month and two months.

Results: After one month of brushing with the orthodontic toothbrush, the mean plaque index for tooth and bracket, bleeding index and gingival index were higher by 74.4% (0.68 vs. 0.39, p = 0.026), 54.2% (0.37 vs. 0.24), 15.4% (0.15 vs. 0.13) and 30% (0.26 vs. 0.20), respectively, than after brushing with the triple-headed toothbrush. After combined brushing with the single-tufted toothbrush, no additional statistical differences were found between groups.

Conclusion: When used alone, the triple-headed toothbrush seems to remove plaque more effectively than the orthodontic toothbrush. The addition of the single-tufted toothbrush eliminates differences between groups.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Dental Plaque / therapy
  • Dental Plaque Index
  • Dental Prophylaxis / methods
  • Equipment Design
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Orthodontic Appliance Design*
  • Orthodontic Brackets*
  • Patient Satisfaction
  • Periodontal Index
  • Single-Blind Method
  • Toothbrushing / instrumentation*
  • Toothbrushing / methods
  • Young Adult