This study compares the immediate plaque removal efficacy of the natural Miswak versus a traditional manual toothbrush using the Modified Bass technique among orthodontic patients. The main question it aims to answer is: Are there statistically significant differences in the post-brushing plaque index reduction between the dental arch side cleaned with Miswak and the contralateral side cleaned with a manual toothbrush?
Patients aged between 18 and 30 years old.
Presence of fixed orthodontic appliances (brackets and wires) on both upper and lower arches.
Good general systemic health with the absence of any medical conditions that might affect oral health status.
Presence of advanced or aggressive periodontal diseases.
Current smokers.
Use of antimicrobial or antibacterial mouthwashes within 24 hours prior to the study session.
Systemic antibiotic intake within the past 2 weeks preceding the experiment.
Factorial
Natural Miswak (Al-Kureysh, Pakistan)
Device* Preparation: 1-2 cm of outer bark removed, soaked in water for 10-15 mins, and fibers frayed. * Technique: Vertical strokes (gum to tooth), horizontal on occlusal, focusing around brackets. * Duration: 3 to 5 minutes.
Manual Toothbrush (Colgate Zig Zag, China)
Device* Technique: Modified Bass Technique (bristles at 45-degree angle to gingival margin, short vibratory movements) modified to brush above and below orthodontic brackets. * Duration: 3 to 5 minutes.
Modified Quigley-Hein Plaque Index (mQH) Score
Mesial, distal, and mid surfaces of facial and lingual aspects were scored. Scoring was as follows: 0 = no plaque/debris 1. = separate flecks of plaque at the cervical margin of the tooth. 2. = a thin continuous band of plaque (up to 1 mm) at the cervical margin of the tooth. 3. = a band of plaque wider than 1 mm but covering less than one third of the crown of the tooth. 4. = plaque covering at least one third but less than two thirds of the crown of the tooth. 5. = plaque covering two thirds or more of the crown of the tooth. * Scores from all evaluated surfaces are summed together and then divided by the total number of sites evaluated to provide an average score for each mouth side per patient. * Plaque is disclosed using a basic fuchsin solution (VISUPLAC, Maquira, Brazil) applied via micro-applicators.
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