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NCT Number: NCT07737626

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

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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Key information

Conditions

Dental Plaque Dental Deposits Stomatognathic Diseases Tooth Diseases

Age range

18 year–30 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Lokman Hekim University Faculty of Dentistry

Ankara, Turkey (Türkiye)

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

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.

Primary outcomes

  1. Residual Plaque Index

    Time frame: 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.

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

    Time frame: 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.

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

    Time frame: 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.

Sponsors and collaborators

Lead sponsor

Lokman Hekim University

Other Gov

Registry information

Official study title

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

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Jul 30, 2026
Registry last updated
Jul 30, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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