Effect of Powered Toothbrushing and Dental Flossing Sequence on Dental Plaque Removal
July 29, 2026 updated by: Sema Merve Altıngöz, Lokman Hekim University
Does the Sequence of Powered Toothbrushing and Dental Flossing Affect Dental Plaque Removal? A Randomized Crossover Clinical Trial
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.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
46
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Ankara, Turkey (Türkiye)
- Lokman Hekim University Faculty of Dentistry
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Yes
Description
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
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Brush-Floss Sequence (Group 1)
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.
|
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.
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.
|
|
Experimental: Floss-Brush Sequence (Group 2)
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.
|
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.
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.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Residual Plaque Index
Time Frame: Immediately after completion of the assigned oral hygiene sequence following 48 hours of plaque accumulation, in each study period.
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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.
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Immediately after completion of the assigned oral hygiene sequence following 48 hours of plaque accumulation, in each study period.
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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.
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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.
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Immediately after completion of the assigned oral hygiene sequence following 48 hours of plaque accumulation, in each study period.
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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.
|
Immediately after completion of the assigned oral hygiene sequence following 48 hours of plaque accumulation, in each study period.
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 2, 2026
Primary Completion (Actual)
July 15, 2026
Study Completion (Actual)
July 15, 2026
Study Registration Dates
First Submitted
July 27, 2026
First Submitted That Met QC Criteria
July 29, 2026
First Posted (Actual)
July 30, 2026
Study Record Updates
Last Update Posted (Actual)
July 30, 2026
Last Update Submitted That Met QC Criteria
July 29, 2026
Last Verified
July 1, 2026
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- LHU-2026-164
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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