Efficacy of Sonic-Powered and Manual Toothbrushes on Plaque-Induced Gingivitis in Pregnant Women: A Randomized Controlled Trial

Abstract

Hormonal changes and physiological alterations in pregnancy increase the susceptibility of the woman to oral diseases such as plaque-induced gingivitis. In individual oral prophylaxis, effective tooth brushing can reduce gingival inflammation. Therefore, it is necessary to update the scientific evidence to identify which type of toothbrush, manual or sonic-powered, is most effective in reducing the incidence of gingivitis in pregnant women. The aim of this clinical trial is to compare the biofilm control effectiveness of two manual and two sonic toothbrushes in pregnant women. This study is designed as a four-arm, parallel, randomized controlled trial with an allocation ratio of 1:1:1:1. The pregnant woman will be included at 15–18 weeks of amenorrhea and followed for 3 months. The primary outcome will be the change in the incidence of gingival bleeding from a baseline and various follow-up periods of the study. Secondary outcomes measures will be to compare clinical effects of the toothbrushes tested on (i) gingival inflammation, (ii) dental plaque, (iii) gingival attachment and (iv) periodontal pocket; and to assess toothbrush acceptability. Thus, identifying the best device for effective tooth brushing in pregnancy could be helpful in reducing and improving the incidence of gingival inflammation.

The Impact of Periodontal Disease on Preterm Birth and Preeclampsia

“…Today, it is recognized that a substantial proportion of premature and low birth weight (PLBW) cases, ranging from 30% to 50%, can be attributed to infections, with periodontitis and periodontal diseases representing genuine oral infections. Infection has emerged as a primary contributor to low birth weight and preterm births [60]. The oral cavity serves as a continual source of infectious agents, and alterations in its health often indicate underlying diseases.…”

“…Proinflammatory mediators can breach the placental barrier, inducing fetotoxicity, resulting in preterm delivery and low birth-weight neonates. These endotoxins also stimulate the release of cytokines and prostaglandins (IL-1, IL-6, and TNF-), which, in appropriate concentrations, trigger labor [60,61].…”

“…The release of periodontal-secreted cytokines into the plasma due to inflammation can lead to premature birth or low birth weight. During pregnancy, the levels of inflammatory cytokines such as IL-1β, TNF-α, and PGE2 in amniotic fluid increase to critical levels, precipitating amniotic sac membrane rupture, uterine contraction, cervical dilation, and ultimately the onset of labor [60]. Elevated amniotic fluid levels of IL-1β, IL-6, TNF-α, PGE2, fibronectin, and α-fetoprotein have been associated with preterm birth [64][65][66][67].…”