Effect of Powered Toothbrushing and Dental Flossing Sequence on Dental Plaque Removal

NCT07737626 — Not applicable, Completed, 46 participants, Lokman Hekim University

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Does the Sequence of Powered Toothbrushing and Dental Flossing Affect Dental Plaque Removal? A Randomized Crossover Clinical Trial

Registry	NCT07737626
Status	Completed
Phase	Not applicable
Study type	Interventional; randomized, crossover, masking: single, prevention
Enrollment	46 (Actual)
Sponsor	Lokman Hekim University (Other gov)
Conditions	Dental Plaque
Interventions	Powered Toothbrushing, Dental Flossing (Behavioral)
Dates	start 2026-05-02, primary completion 2026-07-15, completion 2026-07-15, first posted 2026-07-30, last updated 2026-07-30
Locations	1 site in Turkey (Türkiye)

-Summary

This randomized crossover clinical trial evaluated whether the sequence of powered toothbrushing and dental flossing affects dental plaque removal. Forty-six systemically and periodontally healthy participants were randomly assigned to one of two oral hygiene sequences. In Group 1, participants performed powered toothbrushing followed by dental flossing during the first period and dental flossing followed by powered toothbrushing during the second period. Group 2 performed the same procedures in the opposite order. The two intervention periods were separated by a 15-day washout period, with professional prophylaxis performed to standardize oral hygiene conditions. Dental plaque was assessed before and after the oral hygiene procedures using the Plaque Index (PI) and the Turesky modification of the Quigley-Hein Plaque Index (TQHPI). The study aimed to determine whether performing powered toothbrushing before or after dental flossing results in greater plaque removal.

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+Arms and interventions

Arm	Type	Interventions	Description
Brush-Floss Sequence (Group 1)	Experimental	Behavioral: Powered Toothbrushing; Behavioral: Dental Flossing	Participants assigned to this sequence will first perform powered toothbrushing followed by dental flossing during the first study period. After the washout period, the order of the oral hygiene procedures will be reversed, with dental flossing performed before powered toothbrushing during the second study period.
Floss-Brush Sequence (Group 2)	Experimental	Behavioral: Powered Toothbrushing; Behavioral: Dental Flossing	Participants assigned to this sequence will first perform dental flossing followed by powered toothbrushing during the first study period. After the washout period, the order of the oral hygiene procedures will be reversed, with powered toothbrushing performed before dental flossing during the second study period.

Powered Toothbrushing (Behavioral): Participants will perform oral hygiene using a powered toothbrush according to the standardized study protocol. The intervention will be applied as part of the assigned brushing-flossing sequence.
Dental Flossing (Behavioral): Participants will perform interdental cleaning using dental floss according to the standardized study protocol. The intervention will be applied as part of the assigned brushing-flossing sequence.

+Outcome measures

Primary outcomes

Residual Plaque Index [Immediately after completion of the assigned oral hygiene sequence following 48 hours of plaque accumulation, in each study period.]: Residual dental plaque was assessed immediately after completion of the assigned oral hygiene sequence using the Plaque Index (PI). Higher scores indicate greater residual plaque accumulation.
Residual Buccal Turesky Modified Quigley-Hein Plaque Index (TQHPI) [Immediately after completion of the assigned oral hygiene sequence following 48 hours of plaque accumulation, in each study period.]: Following plaque disclosure, residual plaque on the buccal tooth surfaces was assessed using the Turesky Modified Quigley-Hein Plaque Index (TQHPI), scored from 0 to 5, with higher scores indicating greater residual plaque accumulation.
Residual Lingual Turesky Modified Quigley-Hein Plaque Index (TQHPI) [Immediately after completion of the assigned oral hygiene sequence following 48 hours of plaque accumulation, in each study period.]: Following plaque disclosure, residual plaque on the lingual tooth surfaces was assessed using the Turesky Modified Quigley-Hein Plaque Index (TQHPI), scored from 0 to 5, with higher scores indicating greater residual plaque accumulation.

+Eligibility

Sex: All, ages: 18 Years to 30 Years, accepts healthy volunteers

Inclusion Criteria:

* Age between 18 and 30 years
* Systemically healthy
* Presence of at least 22 natural teeth
* No signs of active periodontal disease
* Ability to comply with the study procedures and oral hygiene instructions
* Provision of written informed consent

Exclusion Criteria:

* Antibiotic use within the previous 3 months
* Smoking
* Presence of systemic conditions known to affect periodontal health, including diabetes mellitus or immune-mediated disorders
* Ongoing orthodontic treatment
* Presence of fixed prostheses, crowns, or extensive restorations that could interfere with plaque assessment
* Professional periodontal therapy within the previous 3 months
* Pregnancy or lactation
* Severe dental crowding

+Locations (1)

Facility	City	Country	Status
Lokman Hekim University Faculty of Dentistry	Ankara	Turkey (Türkiye)