Muhammad Khalil Khan1 , Abdul Mudassar2 , Abdul Kareem3 , Kamran Masood Mirza4 , Ayyaz Ali Khan5 , Tasleem Hosein6 , Shazia Akbar Ansari7
How to CITE:
KhanMK, MudassarA, KareemA, MirzaKM, KhanAA, HoseinT,Ansari SA. Does the use of toothpowder affect the oral health status of an individual?.J Pak DentAssoc. 2012;21(03):153 – 156
Role of oral hygiene products and devices are very important in our daily life for disease free oral cavity. Many chemotherapeutic dentifrices in the form of powder and pastes are available in the market with the claim of anti-plaque, anti-gingivitis and anti-staining etc. properties. o compare the long-term efficacy of tooth powder with that of the toothpaste.
Total 160 subjects (80 toothpaste users and 80 tooth-powder users) were enrolled in this study and Community Periodontal IndexTreatment Needs (CPITN) was used to access the periodontal health.
In this cross-sectional study there is no significant CPITN score difference among the toothpaste and tooth powder users. Only CPITN score 2 is high in both groups 37.1%in toothpaste users and 38.8%in tooth powder users.
The results of this study support the use of tooth powder for daily maintenance of oral health.
Toothpowder,Toothpaste, Community Periodontal Index (CPITN)
Oral hygiene seeking measures varies across the world owing to socioeconomic, traditional and religious backgrounds. Although the toothpaste tooth brush method is the most popular oral hygiene regime . Other methods such as wooden stick (miswak) and toothpowders are also popular in some parts of the world as a regular daily cleansing agent mainly due to their low cost. Toothpowders are essentially toothpastes without a liquid humectants system . Rare studies have looked into toothpowders . This has resulted in virtually nonavailability of literature on this material. Therefore, it was considered pertinent to explore the efficacy of toothpowders in relation to toothpastes as an oral hygiene regime. For maintaining good oral hygiene and preventing periodontal disease mechanical plaque control play most important role and for that we use dentifrices, toothbrushes dental floss , mouthwashes interdental cleaning tools. In modern societies researchers and manufactures are trying their best to control tooth loss in adults by introducing different types of dentifrices and adjectives. Dental plaque is the most common cause of the tooth loss Selection of dentifrices reduces the plaque score. Hence, consistent own oral hygiene is necessary for good supragingival plaque eradication. The most widespread mechanical means of controlling plaque at home is toothbrushing using dentifrices . In 1965 Loe et al conducted study that established the role of plaque as a causative factor in gingivitis and if gingivitis is not controlled it leads to periodontitis ultimately tooth loss .Areasonable phase to stop the development of this chain would be to inhibit plaque formation or mechanical removal of plaque. Mechanical plaque control by patient care is of supreme, the goal is to generate an encouraging approach by information and motivation to give knowledge about good oral hygiene. The patient should be advised to use appropriate aids and technique. A good dentifrices, soft brush, Interdental tooth brush toothpicks or dental floss has been recommended for maintaining good oral hygiene
This study was a cross-sectional survey on 160 subjects to compare the long-term efficacy of toothpowder with that of the toothpaste. The sample was selected randomly from the study population living in Malir, a low socioeconomic area of Karachi, Pakistan. The study started in April 2010. The ethical committees of Shaikh Zayed Post Graduate Medical Institute, Lahore had approved the protocol.Written informed consent was obtained from the participants for an oral examination. The inclusion criteria in this study were subject’s willingness to participate and life time usage oftoothpowder or toothpaste. Subjects under the age of 18 and over the age of 40 and persons with apparent physical or mental handicap; pan chewers and smokers were excluded from the study.
A total of 80 subjects who were lifetime users of one popular commercially available toothpowder in the market were recruited. These were matched with another 80 subjects who were lifetime users of toothpaste; the matching was done on the basis of socioeconomic status, education, age and gender.
The examination of clinical parameters was carried out according to the CPITN and using a special WHO periodontal probe. . This special probe has a ball point of 0.5 mm diameter and color coding extending from 3.5 to 5.5 mm for the easy reading of pocket depths. According to the CPITN, the dentition is divided into six sextants. Only one recording is given to each sextant as follows:
Score 0: no signs of gingival disease; Score 1 : bleeding after probing with gentle force of 20 to 25 gm; Score 2: presence of calculus or over-hangs of fillings; Score 3: presence of one or more pathological, 4 to 5-mm deep pockets; Score 4: presence of one or more pathological pocket >6 mm . All subjects were examined under sunlight using size 4 plane mirrors and CPITN probe. CPITN was used to record all periodontal parameters included in this study. Three examiners in this study were blind and were calibrated earlier with each other and the kappa score for inter examiner and intra examiner reliability was 0.86 and 0.9 respectively. Calibration was done on 10 subjects.
Pockets deeper than 6 mm (score = 4) in this study were found to be very low, 2.7% and 1.9% toothpaste users and toothpowder users respectively (Table 1).This study shows that3.7% and 4.3% of adults had a CPITN score 3 (pockets 45 mm) in toothpaste users and toothpowder users, respectively (Table 1). Score 2, calculus was recorded 21.3% in toothpaste users and 18.1% in toothpowder users (Table 1). Score 1, regarding gingival bleeding, was very high; 37.1% in paste users and 38.8% in toothpowder users respectively (Table 1). However, 35.2% toothpaste users and 36.9% toothpowder users of the sextants were periodontally healthy with a CPITN Score 0 (TableNo1).
The production of multi care toothpastes for daily use has made product endorsements easier for oral health professionals looking for all their patients’ requirements and needs for maintaining good oral health and sound psychological health . People in different areas of the world have different oral hygiene seeking behaviors . These behaviors had roots lying as back as 1.8 million years ago and may be regarded as one of the oldest human customs; according to a paleontologist report. Some ancient human teeth discovered, have grooves made by grass; when used as floss or a toothpick .Avarious kind of simple products and devices were used since before recorded history, like chewing sticks; tree twigs; bird feathers; animal bones; tooth powder and home-made mouth rinses . The recipe of a toothpowder has been discovered, which Roman patricians used before our time. It was made up of rose petals, nuts and myrrh and the base of the powder was from eggshell or ground bones mixed with honey . Often, sodium carbonate was added, so obviously the Romans knew of its ability to restore whiteness to the teeth. Having cleaned the teeth with such powder, the mouth was rinsed with a grape wine. These habits revolutionized to the modern day usage of toothpastes, toothbrushes and dental flosses . Populations of the modern and developed countries mainly use toothpastes and toothbrushes, while people living in the developing countries also use a number of other things like toothpowders, wooden sticks, tree barks, charcoal powder, homemade materials . Mostly these agents are applied using a finger or sometimes a toothbrush. In South Asia, toothpowders are used on a very large scale . Recent evidence suggests that an optimal level of supra-gingival plaque control can have profound effects on the subgingival micro flora. Toothpowder has been found an equally effective supra-gingival plaque-removing tool in this study. These results also match the results of a study conducted in Peshawar (Pakistan), where it was found that those girls who used toothpaste / toothpowder with toothbrush have less gingival bleeding as compared to those who used finger instead of toothbrush to apply toothpaste / toothpowder to the teeth, the difference being statistically insignificant . It has also been found out that toothbrush with any cleaning material whether toothpaste or tooth powder, is an effective medium for the removal of plaque Generally it is thought that the tooth powders are more abrasive than toothpastes and are more likely to cause tooth wear, our findings are in contrast because the relative dental abrasivity (RDA) of toothpowder used by all study subjects was 153, which is in the normal range (below 250 is recommended by ADA). In this study long time users of powder did not reported of abrasivity and were found with a good clinical picture of oral cavity. Its main ingredients are calcium carbonate, essential oils and sodium saccharin. All of these constituents have proven benefits. Essential oils’ efficacy is surmounting in the dental literature. Essential oils are volatile aromatic oils that are synthetic or are derived from plants by distillation, expression or extraction. It has been found that dentifrices formulated with fixed combination of essential oils possess anti-plaque and anti-gingivitis properties
At the end of this study we formulated a hypothesis that both dentifrices have same effects. For testing this hypothesis need to design the analytical type of study. The results of long time users of toothpowder in this study are comparable with toothpaste users and there is no such difference between the dentifrices. This study tested the efficacy of only one popular commercially available powder in the market. It is recommended that subsequent studies should encompass the testing of a wider spectrum of toothpowder brands and formulations with other commercially available dentifrices.
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