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Original Article
The effectiveness of a musical toothbrush for

dental plaque removal: A comparative study
Abstract
Background and Objectives: the purpose of this study
was to clinically evaluate and compare the efficacy of Brush
Buddies musical tooth brush and Colgate Smile tooth brush
in the reduction of established plaque and gingivitis. Materials
and Methods: for this study, 120 healthy kids (73boys
and 47 Girls) were selected. The subjects were randomly
assigned into two groups by a second examiner; one group
used Colgate Smile brush and the other group used Brush
Buddies musical tooth brush. Plaque index (Quigley and
Hein), Modified Gingival Index (Lobene and Associates) and
Gingival Bleeding Index (Ainamo and Bay) were assessed at
baseline, 30th day, 60th day, and 90th day. Results: all the
baseline indices appeared to be well balanced. At the end
of the study, reduction in plaque index, modified gingival
index and gingival bleeding index were statistically highly
significant during each interval for both the toothbrushes.
For Brush Buddies musical tooth brush, the reduction in all
clinical parameters were statistically significant for 30days
and 60 days interval, while nonsignificant at 90 days interval.
Interpretation and Conclusion: both the tooth brushes
used in this study were clinically effective in removing plaque,
improving gingival health. Musical tooth brush is more
effective initially but as the time period increases both tooth
brushes give almost similar results.
Key words
Established plaque, fones technique, gingivitis, musical
tooth brush
Introduction
Prevention has become the corner stone of the modern
dental practice and effective plaque control is the basic
password to the meaningful practice of preventive
dentistry. Intraoral cleaning devices have been a
part of human civilization since long and a strong
correlation exists between the severity of gingivitis and
periodontitis and the accumulation of dental plaque.[1]
Ganesh M, Shah S, Parikh D, Choudhary P,

Bhaskar V
Department of Pedodontics and Preventive Dentistry,
Ahmedabad Dental College and Hospital, Gandhinagar,
Gujarat, India
Correspondence:
Dr. M. Ganesh, Reader, Department of Pedodontics and
Preventive Dentistry, Ahmedabad Dental College and Hospital,
Gandhinagar, Ahmedabad, India.
E-mail: drmganesh@yahoo.com
Access this article online

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DOI:
10.4103/0970-4388.99988
PMID:
***
Dentistry has evolved a lot from the simple tooth pick

to todays state-of-the-art technology. The modern
toothbrush was invented by Chinese during the Tang
Dynasty.[2] Since then the tooth brush has undergone
a lot of change in every aspect except that the purpose
of its action has remained the same to attain a plaque
free tooth surface, thereby preventing the initiation
and progression of gingival and periodontal disease.
Various chemical and other mechanical methods have
been advocated for this purpose, but tooth brushing
has been cited as the most commonly used effective and
safest therapeutic method to remove plaque.[3]
It has been shown that tooth brushing practiced by
the majority of the population is unsatisfactory. De
La Rosa suggested that an average child removes only
about 50% of the plaque present on teeth.[4] Poor oral
hygiene and periodontal disease are still prevalent in
children from rural area (low socioeconomic status). As
a result, dental caries, periodontal disease, and tooth
loss remain an epidemic health problems are common
JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Apr - Jun 2012 | Issue 2 | Vol 30 |
139
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Ganesh, et al.: The effectiveness of a musical toothbrush for dental plaque removal
in children. The normal oral flora (flora associated

with oral health) can be greatly altered as a result of
poor oral hygiene, leading to higher levels and a more
pathogenic type of oral flora. A basic approach to
addressing these problems has been to seek easier and
more effective tooth brushing methods.[5]
Aims and objectives
Bratel and Berggren compared a manual toothbrush

with an electric toothbrush and concluded that the
electric toothbrush was not superior to the manual
brush.[6] Similar findings were made by others when
comparing manual brushes with electric brushes.[7,8]
Studies have also compared foam brushes, Collis-curve
brushes, deep-ground brushes, and double-headed
brushes with standard manual brushes with no or small
site-specific differences in the ability of these devices
to remove plaque mechanically.[9]
Materials and Methods
In the case of children, majority show noncompliance

toward brushing and they try to hide themselves
from daily brushing task because they it considered as
tedious procedure and dislike the brushing. At the same
time parents try to motivate the children for regularly
brushing by using different methods such as contingency
management, gifts, and even pleasing them with bribe at
times. Still most of the parents fail to develop the childs
interest in brushing. It is important to gain childs interest
in brushing by introducing some new devices that child
can enjoy the brushing. Recently musical talking tooth
brush Brush Buddies, which is used widely in USA,
is introduced in Indian market by Ashtel Dental, USA
[Figure 1]. In this brush, music starts while child starts
brushing, it continuous during the brushing and when this
ends child should end the brushing. Till date no reported
studies have been done to compare between musical and
normal tooth brush. Keeping this thing in mind, we have
formulated a study as described in the following.
The present clinical study was undertaken with the

aim to clinically evaluate and compare the efficacy of
musical tooth brush using Fones technique as compared
to normal toothbrush with Fones technique in the
reduction of established plaque, gingivitis.
After obtaining ethical approval from Ethical Committee

of Ahmedabad Dental College a total of 475 kids were
screened from the four different government schools in
Kalol Taluka, Gandhinagar. Out of that 329 kids were
selected who fulfilled the inclusion criteria. Informed
consent forms were given to all the parents/legal
guardian of selected kids. Finally, 120 students legal
guardian (most cases either parents) gave the consent
for participation in the study. The study was conducted
in Department of Pedodontics and Preventive
Dentistry, Ahmedabad Dental College and Hospital,
Gandhinagar. Study includes 120 kids (73 boys and
47girls) with the age group of 3 to 6 years.
Inclusion criteria
Subjects with good general and oral health.
Subjects with moderate gingivitis (according to Loe
and Silness) and fair plaque index.
Ability of the subjects to attend the hospital at recall
intervals.
Subjects with full complement of primary teeth present.
Exclusion criteria
Subjects with poor manual dexterity.
Subjects taking drugs that could affect the state of
the gingival tissues including drugs for convulsion,
immunosuppressant, corticosteroids and nonsteroidal
anti-inflammatory drugs.
Subjects with muco-gingival problems.
Subjects with three or more carious teeth that require
immediate treatment.
Subjects using any other supplemental plaque
control devices such as interdental cleansing aids or
mouthwashes.
Subjects with the habit of chewing tobacco.
Study design
Figure 1: BRUSH BUDDIES musical toothbrush

140
A full mouth, singleblind examiner study was

conducted. The study was carried out for a period of
90 days. All the clinical parameters were recorded at
baseline (0 day), 30th day, 60th day, and 90th day.
Experimental procedure
The selected 120 kids children randomly divided in two
groups. First group will brush with normal tooth brush
[Figures 2 and 3] and second group will brush with
musical tooth brush. [Figure 4] Children were assigned
the toothbrushes by a second examiner. Only the second
examiner knew which child had been given which
brush, and was not involved in the recording of clinical
parameters. And all clinical parameters were recorded
by the first examiner. Instructions and pamphlets
regarding the method of brushing technique, handling
and manipulation of both the brushes (Colgate Smile
and Brush Buddies musical brush) were given with a
commercially available fluoridated dentifrice (Cheerio
gel) for use throughout the study. The children were
asked to refrain from all oral hygiene procedures for 24
h prior to every recall visit.
Clinical parameters recorded

Modified gingival index[10]
Scoring criteria
Absence of inflammation.
Mild inflammation: slight change in color, little
change in texture of any portion of the marginal,
or papillary gingival unit.
Mild inflammation: criteria as above but involving
entire marginal or papillary gingival unit.
Moderate inflammation: glazing, redness, edema,
and/or hypertrophy of the marginal or papillary
gingival unit.
Severe inflammation: marked redness, edema
and/or hypertrophy of the marginal or papillary
gingival unit, spontaneous bleeding congestion, or
ulceration.
Totaling around each tooth yields the M.G.I. score for
the area. If the scores around each tooth are totaled and
divided by four, M.G.I. score for the tooth is obtained.
Totaling all the scores per tooth and dividing by the
number of teeth examined provides the M.G.I. score
per person.
Plaque index
[11]
Plaque index: scoring criteria

No plaque.
Separate flecks of plaque at the cervical margin of
the tooth.
A thin, continuous band of plaque (upto 1 mm) at
the cervical margin.
A band of plaque wider than 1 mm but covering less
than one third of the crown.
Plaque covering at least one third but less than two

thirds of the crown.
Plaque covering two thirds or more of the crown.
Plaque was assessed on the facial and lingual surfaces of
all teeth. Totaling all of the plaque scores and dividing
by the number of surfaces examined, gives a plaque
score per person.
Gingival bleeding index[12]

The presence or the absence of the gingival bleeding is
determined by gentle probing of the gingival crevice
with a periodontal probe.
Scoring criteria
Presence of bleeding 10 s after probing.
Absence of bleeding 10 s after probing.
The gingival bleeding index is expressed as the
percentage of all sites examined that bleed on
probing.
Brushing technique
The parents were instructed to observe their child while
he/she is performing brushing.
1. Wet the head of the tooth brush before using.
2. Place the assigned tooth paste on the brush head.
3. The child is asked to stretch his/her arm such that
they are parallel to the floor.
4. Then asked to make big circles using whole arm to
draw circles in the air.
5. The circles are reduced in diameter until very small
circle are make in front of mouth.
6. Now the child is asked to press the brush bristles on
all surfaces of teeth and then make same circles on
teeth.
7. Spend at least 3 min to brush all surfaces of the
teeth.
8. After use, drain off the moisture well and keep the
tooth brush in an airy place.
Instructions
1. Use only the given brushes following the specified
technique.
2. Brush twice daily each time for 3 min with the
assigned dentifrice only.
3. Refrain from brushing 24 h before every recall visit.
4. Return for periodic examination after every 30 days
till the end of the study.
5. Do not use any medication or mouthwash that could
have an inhibitory effect on plaque.
141
Results
The study was conducted in a single blind manner with
the chief investigator being unaware of which subject
was using which toothbrush. There were no dropout cases
and all the subjects maintained their recall appointments.
Paired t test was used to check intra group variables while
unpaired t test was used to check intergroup variables. The
results were interpreted as follows. Colgate smile brush
[Figure 2]. Modified gingival index [Table 1].
60 days (P = 0.04) were statistically significant while

at 90 days (P = 0.17) it was found to be statistically
nonsignificant [Table 4].
The mean Modified Gingival Index (M.G.I) score

at baseline was 1.67 0.23 that was reduced at all
time intervals i.e. at 30, 60, and 90 days, the value of
P < 0.001, this was statistically highly significant.
Plaque index [Table 2].
The mean Plaque index (P.I) score at baseline was 1.70
0.18 which was reduced at all time intervals, that is,
at 30, 60, and 90 days, the value of P < 0.001, this was
statistically highly significant. Gingival bleeding index
(Mean scores in Percentage) [Table 3].
Figure 2: Colgate smiles toothbrush
The mean Gingival Bleeding Index (G.B.I) score at

baseline was 43.0 4.2 that was reduced at all time
intervals, that is, at 30, 60, and 90 days, the value of
Musical brush (Brush Buddies) modified gingival index
[Table 1].
The mean modified gingival index (MGI) score at
baseline was 1.68 0.18, which was reduced at all time
intervals, that is, at 30, 60, and 90 days, the value of P
< 0.001, this was statistically highly significant. Plaque
index [Table 2].
Figure 3: Child brushing with Colgate Smile
The mean plaque index (PI) score at baseline was 1.78

0.21, which was reduced at all time intervals that is at
30, 60, and 90 days, the value of P < 0.001, this was
statistically highly significant. Gingival bleeding index
(mean scores in percentage) [Table 3].
The mean gingival bleeding index (GBI) score at
baseline was 41.9 7.0, which was reduced at all time
intervals, that is, at 30, 60, and 90 days, the value of
Comparison of reduction in modified Gingival

Index between musical tooth brush and
Colgate smile brush
The mean reduction in the MGI score on intergroup
comparison, the difference at 30 days (P = 0.04), at
142
Figure 4: Child brushing with Brush Buddies
Table 1: Reduction in modified gingival index from baseline

Time of
assessment
(days)
Mean SD
0 (Baseline)
30
60
90
1.67 0.23
1.40 0.08
1.23 0.07
1.17 0.06
Colgate smile
Reduction from Reduction %
baseline
0.27 0.20
0.44 0.21
0.50 0.20
16.2
26.3
29.9
t*
Mean SD
6.19
9.59
11.26
<0.001
<0.001
<0.001
1.68 0.18
1.26 0.08
1.10 0.04
1.16 0.05
Brush Buddies musical toothbrush

Reduction from Reduction
t*
baseline
%
0.42 0.18
0.58 0.17
0.51 0.19
26.0
29.6
30.4
8.12
12.53
12.12
<0.001
<0.001
<0.001
Table 2: Reduction in the plaque index from baseline

Time of
assessment
(days)
Mean SD
0 (Baseline)
30
60
90
1.70 0.18
1.41 0.09
1.31 0.17
1.20 0.05
Colgate smile
Reduction
Reduction
from baseline
%
0.29 0.17
0.39 0.28
0.50 0.19
17.1
22.9
29.4
t*
Mean SD
7.52
6.25
12.06
<0.001
<0.001
<0.001
1.78 0.21
1.29 0.09
1.17 0.08
1.19 0.04

Reduction
Reduction
t*
from baseline
%
0.49 0.19
0.61 0.19
0.61 0.21
25.9
31.2
34.3
8.88
11.90
13.02
<0.001
<0.001
<0.001
Table 3: Reduction in the gingival bleeding index from baseline

Time of
assessment
(days)
0 (Baseline)
30
60
90
Colgate Smile
Brush Buddies Musical toothbrush
Mean SD
Reduction
from
baseline
Reduction
%
t*
Mean SD
Reduction
from baseline
Reduction
%
t*
43.0 4.2
34.1 6.3
30.6 3.7
27.6 3.6
8.9 3.7
12.4 2.5
15.4 2.7
20.7
28.8
35.8
10.80
22.21
25.82
<0.001
<0.001
<0.001
41.9 7.0
33.4 4.2
32.9 3.8
26.4 3.5
12.5 4.0
15.0 4.6
15.5 4.6
27.1
33.0
37.0
11.9
12.70
15.1
<0.001
<0.001
<0.001
Comparison of reduction in Plaque Index

between musical tooth brush and Colgate
smile brush
The mean reduction in the PI score on inter-group
60 days (P = 0.042) were statistically significant and
Comparison of reduction in Gingival Bleeding

Index between musical tooth brush and
Colgate smile brush
The mean reduction in the GBI score on intergroup
60 days (P = 0.042) were statistically significant and
Discussion
As periodontal investigation began to discover
the aetiological effect of dental plaque and the
therapeutic role of oral hygiene became clear,[1,13,14]
various mechanical devices and chemical agents were

introduced for plaque control. Although these have been
proved to be effective to some extent, but mechanical
plaque removal using tooth brush still remains the most
popular and effective method.
In the case of children, the major problem is to have
their compliance in brushing the teeth twice a day.
Mostly children use to refrain from brushing because
they consider as a tedious procedure. At 35 years of
age most of child cannot understand the importance
of brushing. So the brushing should be introduced in
such a way that child can enjoy it rather than to ran
away from it. As an effective option the musical tooth
brush can solve this problem. This tooth brush consists
of the handle that is available in different animal shape
and also when we press the button the music will
play for 3 min. When music starts, the child will start
the brushing when the music stop the child will stop
the brushing. Thus, child will enjoy and brush teeth
regularly for 3 min twice a day. The basic aim of this
study is to check compliance from the child while using
this type of brush.
143
Table 4: Comparison of reduction (changes) in modified gingival index between the two brushes
Time interval (days)
0-30
0-60
0-90
Colgate smile
Mean reduction SD
Reduction %
0.27 0.20
0.44 0.21
0.50 0.20

Mean reduction SD
Reduction %
16.2
26.3
29.9
0.42 0.18
0.58 0.17
0.51 0.19
26.0
29.6
30.4
Significance of difference
Mean difference
t*
P
0.8
0.7
0.1
0.74
0.54
0.16
0.046
0.049
0.17
Table 5: Comparison of reduction (changes) in plaque index between the two brushes
Time interval (days)
0-30
0-60
0-90
Colgate smile

Mean reduction SD
Reduction %
Mean reduction SD
Reduction %
0.29 0.17
0.39 0.28
0.50 0.19
17.1
22.9
29.4
0.49 0.19
0.61 0.19
0.61 0.21
25.9
31.2
34.3
Mean difference
t*
P
2.0
2.1
1.1
1.61
1.60
1.68
0.032
0.042
0.10
Table 6: Comparison of reduction (changes) in gingival bleeding index between the two brushes
Time interval (Days)
0-30
0-60
0-90
Colgate smile
Mean reduction SD
Reduction %
8.9 3.7
12.4 2.5
15.4 2.7

Mean reduction SD
Reduction %
20.7
28.8
35.8
12.5 4.0
15.0 4.6
15.5 4.6
27.1
33.0
37.0
Mean difference
t*
P
3.6
2.6
0.1
1.35
0.51
0.09
0.039
0.042
0.93
To reduce the examiner bias, the study was designed as

a single blind. The examiner who scored the indices was
unaware of which student was using which particular
brush. The second examiner, who had selected the
children according to inclusion/exclusion criteria, was
only knowing which tooth brush had been allotted to
which particular child. The second examiner was not
involved in the recording of clinical parameters at any
of the recall visits.
by the sound while brushing the teeth. The fact that music
makes the child motivated to brush his/her teeth and
better participation in the brushing. The child feels like
playing with a toy while brushing the teeth. This allows
the child to brush more regularly and properly. But later
on as the time progresses the child become habitual with
brushing and regardless of the type of tooth brush he/she
will continue to brush regularly. So at the end of 90 day
we found no significant difference in oral hygiene index.
This study design was in accordance with the ADA

guidelines[15] for the clinical tooth brush trials, that for
each product 120 subjects were enrolled in the study.
In the present study, subjects were asked to refrain
from oral hygiene measures for 24 h before each recall
visits which is in accordance with Van der Weijden
et al.[16] The overnight plaque test model is highly
reproducible[17] and allows a reasonable result in a
short period of time and also using a lower prebrushing
plaque score can affect the final outcome of the study.
This also reduced the Hawthorne effect.[18]
Designing a short-term clinical study to test the

efficacy of plaque removal is not an easy task. Many
different factors such as frequency, duration, technique,
thoroughness of tooth brushing, manual dexterity,
motivation, individual pathogenicity of plaque formation,
type of dentifrice used, regularity of subjects, and
novelty effect may interfere with results.[2,19] This study
design was developed in order to minimize the effects of
these variables as much as possible.
From this study, it is evident that regardless the type

of brush, regular oral hygiene maintenance can reduce
the plaque deposition and improve the gingival health.
But the comparison between two groups does not show
statistically significant difference between them. So both
toothbrushes can be effective if they are used at regular
basis with proper technique.
The better results were shown by the musical tooth brush
group during 30 and 60 days follow up. It can be explained
144
Based on the present data, the musical tooth brush may

be assigned as the better tooth brush as compared to the
Colgate smile tooth brush, but the difference between
the two is statistically insignificant. Thus, the results of
this study demonstrate that both the toothbrushes have
a great potential to remove plaque, improve gingival
health and reduce halitosis effectively.
Conclusion
Following conclusions can be drawn from the study
The reduction in Plaque Index, Modified Gingival

Index and Gingival Bleeding Index was highly
significant during each interval, for both the tooth
brushes.
The differences in the reduction of clinical parameters
between the two brushes were statistically significant
during the 30 days and 60 days follow up while non
significant at 90 days follow up.
Overall, Musical tooth brush was shown to be more
effective than the Colgate Smile toothbrush on the
percentage basis.
Both the brushes are safe and effective for children
when used supervised on regular basis for the
removal of human dental plaque.
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relates to plaque development and gingival health. J Periodontol
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15. Council on Scientific Affairs of ADA. American Dental
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2009. Available from: http://www.ada.org/sections/science and
research/pdfs/guide_toothbrushes.pdf. [Last accessed on 2012
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16. Van der Weijden GA, Timmerman MF, Reijerse E, Mantel MS,
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How to cite this article: Ganesh M, Shah S, Parikh D, Choudhary

P, Bhaskar V. The effectiveness of a musical toothbrush for dental
plaque removal: A comparative study. J Indian Soc Pedod Prev
Dent 2012;30:139-45.
Source of Support: Nil, Conflict of Interest: None declared.
145

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[Downloadedfreefromhttp://www.jisppd.comonWednesday,October17,2012,IP:114.79.18.

The effectiveness of a musical toothbrush for

Ganesh M, Shah S, Parikh D, Choudhary P,

Access this article online

Dentistry has evolved a lot from the simple tooth pick

in children. The normal oral flora (flora associated

Aims and objectives

Bratel and Berggren compared a manual toothbrush

Materials and Methods

In the case of children, majority show noncompliance

The present clinical study was undertaken with the

After obtaining ethical approval from Ethical Committee

Figure 1: BRUSH BUDDIES musical toothbrush

A full mouth, singleblind examiner study was

Clinical parameters recorded

Plaque index: scoring criteria

Plaque covering at least one third but less than two

Gingival bleeding index[12]

60 days (P = 0.04) were statistically significant while

The mean Modified Gingival Index (M.G.I) score

Figure 2: Colgate smiles toothbrush

The mean Gingival Bleeding Index (G.B.I) score at

Figure 3: Child brushing with Colgate Smile

The mean plaque index (PI) score at baseline was 1.78

Comparison of reduction in modified Gingival

Figure 4: Child brushing with Brush Buddies

Table 1: Reduction in modified gingival index from baseline

Brush Buddies musical toothbrush

Table 2: Reduction in the plaque index from baseline

Brush Buddies musical toothbrush

Table 3: Reduction in the gingival bleeding index from baseline

Brush Buddies Musical toothbrush

Comparison of reduction in Plaque Index

Comparison of reduction in Gingival Bleeding

various mechanical devices and chemical agents were

Brush Buddies musical toothbrush

Brush Buddies musical toothbrush

Brush Buddies musical toothbrush

To reduce the examiner bias, the study was designed as

This study design was in accordance with the ADA

Designing a short-term clinical study to test the

From this study, it is evident that regardless the type

Based on the present data, the musical tooth brush may

The reduction in Plaque Index, Modified Gingival

Loe H, Theilade E, Jensen SB. Experimental gingivitis in man.

How to cite this article: Ganesh M, Shah S, Parikh D, Choudhary

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