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

NCT07737626 | Completed

• 1 other identifier: LHU-2026-164
• Study Type: interventional
• Target: 46
• Locations: 1 country
• Sites: 1

Brief 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.

Conditions

Dental Plaque

Outcome Measures

Primary Outcomes (3)

• Residual Plaque Index

  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.

  Immediately after completion of the assigned oral hygiene sequence following 48 hours of plaque accumulation, in each study period.

• Residual Buccal Turesky Modified Quigley-Hein Plaque Index (TQHPI)

  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.

  Immediately after completion of the assigned oral hygiene sequence following 48 hours of plaque accumulation, in each study period.

• Residual Lingual Turesky Modified Quigley-Hein Plaque Index (TQHPI)

  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.

  Immediately after completion of the assigned oral hygiene sequence following 48 hours of plaque accumulation, in each study period.

Study Arms (2)

Brush-Floss Sequence (Group 1)

EXPERIMENTAL

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.

Behavioral: Powered Toothbrushing; Behavioral: Dental Flossing

Floss-Brush Sequence (Group 2)

EXPERIMENTAL

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.

Behavioral: Powered Toothbrushing; Behavioral: Dental Flossing

Interventions

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.

Brush-Floss Sequence (Group 1); Floss-Brush Sequence (Group 2)

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.

Brush-Floss Sequence (Group 1); Floss-Brush Sequence (Group 2)

Eligibility Criteria

• Age: 18 Years - 30 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• 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

You may not qualify if:

• 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

Sponsors & Collaborators

• Lokman Hekim University: lead

Study Sites (1)

Lokman Hekim University Faculty of Dentistry

Ankara, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Dental Plaque

Interventions

Dental Devices, Home Care

Condition Hierarchy (Ancestors)

Dental Deposits; Tooth Diseases; Stomatognathic Diseases

Intervention Hierarchy (Ancestors)

Dental Equipment; Dentistry; Oral Hygiene; Preventive Dentistry; Equipment and Supplies

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: July 27, 2026
• First Posted: July 30, 2026
• Study Start: May 2, 2026
• Primary Completion: July 15, 2026
• Study Completion: July 15, 2026
• Last Updated: July 30, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)