|Year : 2014 | Volume
| Issue : 2 | Page : 45-48
A prospective case-control study to assess and compare the role of disclosing agent in improving the patient compliance in plaque control
Mayuri Bhikaji Nepale, Siddhartha Varma, Girish Suragimath, Keshava Abbayya, Sameer Zope, Vishwajeet Kale
Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Satara, Maharashtra, India
|Date of Web Publication||10-Mar-2015|
Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Satara - 415 110, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Dental caries and periodontal diseases are multifactorial oral health problems that have dental bacterial plaque as their main etiological agent. Dental plaque removal plays an important role in oral health maintenance, which could be achieved by either mechanical or chemical plaque control. Disclosing agents in dentistry are being used to identify bacterial plaque for instruction, evaluation and research purposes. Hence, the current study is aimed at evaluating the effect of at home use of disclosing agent in improving the quality of daily oral hygiene.
Materials and Methods: The present randomized, prospective case-control study was conducted among 100 subjects who were selected from the outpatient department of periodontology and divided into two groups. Group A (n = 50) is the case group who were instructed to use a disclosing agent and Group B (n = 50) is the control group who were not instructed to use a disclosing agent. Plaque status of the subjects was assessed using "Turesky-Gilmore-Glickman Modification of the Quigley Hein Plaque Index" at baseline. Both the groups were trained to perform the similar brushing technique along with same oral hygiene instructions. After 21 days, both groups were recalled, and their plaque status was re-assessed by the same method. The pre and postplaque scores of both the groups were evaluated by unpaired t-test and value of P < 0.05 was considered significant.
Results: Preevaluation plaque score of Group A was 2.02 ± 0.24 and postevaluation score was 1.08 ± 0.26. Similarly in Group B, the preevaluation plaque score was 1.80 ± 0.92 and postevaluation score was 1.62 ± 0.48. The difference in the plaque scores was statistically significant with a P = 0.00001.
Conclusion: The result shows that usage of plaque disclosing agent improves the quality of daily oral hygiene measures performed at home.
Keywords: Dental plaque, oral hygiene, periodontal diseases
|How to cite this article:|
Nepale MB, Varma S, Suragimath G, Abbayya K, Zope S, Kale V. A prospective case-control study to assess and compare the role of disclosing agent in improving the patient compliance in plaque control. J Oral Res Rev 2014;6:45-8
|How to cite this URL:|
Nepale MB, Varma S, Suragimath G, Abbayya K, Zope S, Kale V. A prospective case-control study to assess and compare the role of disclosing agent in improving the patient compliance in plaque control. J Oral Res Rev [serial online] 2014 [cited 2018 Jan 16];6:45-8. Available from: http://www.jorr.org/text.asp?2014/6/2/45/152907
| Introduction|| |
Dental caries and periodontal diseases are multifactorial problems that are primarily caused by dental plaque. Dental plaque is a biofilm that is formed over the teeth and prosthetic appliances placed in the oral cavity. Plaque consists of different proteins derived from the saliva and gingival crevicular fluid, in which a number of microorganisms are embedded to form a highly organized matrix. The plaque is firmly attached to the underlying oral structures not easily detected by the naked eye. Oral hygiene maintenance is an integral part of maintaining an individual's oral health. Plaque control may be achieved by both mechanical and chemical means. Among the former, toothbrush and dental floss play an important role. As dental plaque is not visible to the naked eye, its removal is difficult and complex. In order to neutralize this characteristic and help in oral hygiene, the use of disclosing agents has been recommended since the early twentieth century. [1,2]
Disclosing agents are preparations in liquid, tablet or lozenge, which contain dye or other coloring agents, which is used for the identification of bacterial plaque. Plaque can be distinctly seen providing a valuable visual aid and helps in the maintenance of oral hygiene. Number of chemical substances such as Erythrosine dye, Iodine preparation, Mercurochrome preparation, Bismark brown and two tone solutions etc., have been used as disclosing agents. Some of the utilities of using a disclosing agent are: Helpful in patient instruction and motivation, self-evaluation by the patient, evaluation of the effectiveness of oral hygiene maintenance and preparation of plaque indices. 
Hence, the current study was aimed at assessing and comparing the efficacy of patient's plaque control with and without the use of a disclosing agent.
| Materials and Methods|| |
The present prospective case - control study was undertaken at the Department of Periodontology School of Dental Sciences, Karad. The study was conducted during the period January to May 2014. A total of 140 subjects in the age group of 18-50 years (30.49 ± 10.27 years) were considered for the study, after obtaining due approval from the Institutional Ethical Committee. 40 subjects who did not meet the selection criteria were excluded from the study. A total of 100 subjects who volunteered were enrolled in the study and were explained about the objective of the study after obtaining an informed consent.
The following are the selection criteria.
- aged between 18 and 50 years.
- Patients are suffering from chronic gingivitis (localized/generalized).
- Patients using manual tooth brush to maintain their oral hygiene.
- Patients who understand and follow the instructions.
The subjects were randomly divided into two groups of 50 patients each by flip of the coin method. The subjects plaque status was assessed by "Turesky-Gilmore-Glickman Modification of the Quigley Hein Plaque Index."  All the subjects underwent complete oral prophylaxis and were educated about oral hygiene maintenance. All the patients were demonstrated and taught modified bass technique along with tongue cleaning for oral hygiene maintenance.
- Patients using antimicrobial mouth wash.
- Patients suffering from periodontitis.
- Patients suffering from any systemic diseases.
- Physically challenged patients with reduced dexterity.
- Patients allergic to any ingredient of disclosing agent.
Subjects enrolled in Group A were instructed to use disclosing agent Plaksee-MD (plaque disclosing tablets by ICPA health products limited) 5 min before brushing the teeth. Patients were advised to chew Plaksee MD multidisclosing tablet, swish it around the mouth to stain the unseen plaque. The patients were asked to brush their teeth and clean all the areas stained by disclosing agent for complete plaque removal.
Patients enrolled in Group B were instructed to follow the advised brushing technique without the application of the disclosing agent.
All the subjects were recalled after 21 days to assess their oral condition and plaque levels using the same "Turesky-Gilmore-Glickman Modification of the Quigley Hein Plaque Index" method.
A single blinded trained and calibrated examiner with confidence interval >95% assessed the plaque status of all the enrolled subjects.
Statistical analysis was carried out using SPSS software version 19 (IBM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp) by unpaired t-test. Significance value was set at *P ≤ 0.05.
| Results|| |
In Group A, there were 25 males and 25 females, in Group B there were 22 males and 28 females with a mean age of 30.49 ± 10.27 [Table 1].
On comparison of pre- and post-evaluation of plaque scores among males in both the groups the difference was statistically significant with P = 0.0236 [Table 2] wherein Group A showed a significant reduction of plaque scores from 2.03 ± 0.19 to 1.02 ± 0.32.
|Table 2: Comparison of Group A and Group B with respect to pre and postevaluation scores of males by unpaired t-test |
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Similarly on comparison of pre and postevaluation of plaque scores among females in both the groups the difference was statistically significant with P = 0.00001 [Table 3] wherein the Group A showed a significant reduction of plaque scores from 2.00 ± 0.29 to 1.14 ± 0.15.
|Table 3: Comparison of Group A and Group B with respect to pre and postevaluation scores of females by unpaired t-test |
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Postevaluation, it was noted that there was significant reduction in plaque scores of both Group A and Group B when compared to baseline. On intergroup comparison, Group A showed significantly lower plaque scores as compared to Group B (*P = 0.0001) [Figure 1].
|Figure 1: Comparison of Group A and Group B with respect to pre and postevaluation scores by unpaired t-test|
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| Discussion|| |
In the present study, patient compliance increased with the help of disclosing agent as evident in significant reduction in postevaluation plaque scores in Group A. Several studies have been done to note the effect of the use of disclosing agents in oral hygiene, whereas only few studies demonstrated a positive influence of disclosing agents on oral hygiene. [4, 5, 6, 7, 8, 9, 10, 11] Hence, use of disclosing agent in home care helps the patient to view their plaque themselves, and remove it by efficient brushing or consult a dentist if they fail to do so.
The results obtained in the present study show that the plaque scores of both groups fell in a similar range irrespective of the gender of the patients. The present study resulted in effectively reducing plaque scores in subjects who were advised to use disclosing agent before brushing contrary to the results of similar studies done by Tan and Wade and Paulo et al. [12,13] The discrepancies could be the result of certain confounding factors like dexterity in performing oral hygiene procedures. Thorough and repeated oral hygiene education seems to be the most important feature in patient motivation. 
The current study showed that disclosing agents helps patients to visualize the plaque by themselves so they could remove it effectively. Montevecchi et al., studied the use of disclosing agent during resective periodontal surgery for improved removal of biofilm. They concluded that the total removal of root deposits during osseous resective surgery is never obtained by conventional instrumentation. Use of disclosing agent during periodontal resective surgery seems to be effective in improving the scaling and root planning results. 
The characteristics of the present study allow us to assume that potentially confusing factors been controlled. However, we cannot completely discard the possibility of interventions by certain variables connected to the phenomenon.
Some studies have indicated that other factors may play a role in the relationship between disclosing agents and plaque removal, including aspects that can be found among the subjects of the present study. Plaque score improvement for all subjects regardless of the use of disclosing agent may be attributed to greater motivation for the achievement of efficient cleansing, since subjects knew ahead of time that their teeth would be re-examined.  Motivation generated by the quality of both, relationship and professional supervision of oral hygiene also may play a relevant role in the efficacy of dental plaque removal along with the use of a disclosing factor.
| Conclusion|| |
Plaque accumulation is the first step towards initiation of periodontal problems. Disclosing agent guides the patient in revealing the presence of plaque thereby eventually increasing the individual's compliance in removal of plaque. On the patient's end, it is imperative to remove plaque in timely manner in order to limit the progression of periodontal disease process and further calculus formation.
| References|| |
Skinner FH. The prevention of pyorrhea and dental caries by oral prophylaxis. Dent Cosm 1914;56:299-309.
Hartzell TB. Clinical experiments on the efficiency of ultraviolet light in the treatment of dental disease. J Am Dent Assoc 1930;17:138-41.
Sharma S. Plaque disclosing agent. A review. J Adv Dent Res 2010;1(1). Available from: http://www.ispcd.org/~cmsdev/userfi les/ rishabh/plaque%20fi nal%20new.pdf. [Last accessed on 2015 Feb 16].
Quigley GA, Hein JW. Comparative cleansing efficiency of manual and power brushing. J Am Dent Assoc 1962;65:26-9.
Iannarone F, Larghi L. Considerations on the use of agents detecting dental plaque as a measure of controlling oral hygiene. Rass Int Stomatol Prat 1965;16:545-8.
Bennett CG. Disclosing solutions for periodontics. J Dent Child 1964;31:131-4.
Fodor JT, Ziegler JE. A motivational study in dental health education. J South Calif Dent Assoc 1966;34:203-16.
Cohen DW, Stoller NH, Chace R Jr, Laster L. A comparison of bacterial plaque disclosants in periodontal disease. J Periodontol 1972;43:333-8.
Gillings BR. Recent developments in dental plaque disclosants. Aust Dent J 1977;22:260-6.
Barrickman RW, Penhall OJ. Graphing indexes reduces plaque. J Am Dent Assoc 1973;87:1404-8.
Katz S, McDonald JL, Stookey GK. Preventive Dentistry in Action. New York: DCP Publishing; 1982. p. 340.
Tan AE, Wade AB. The role of visual feedback by a disclosing agent in plaque control. J Clin Periodontol 1980;7:140-8.
Paulo F, Mirella S, Silvia HV. Effect of disclosing agents in oral hygiene. Cien Odontol 2004;1:52-9.
Montevecchi M, Checchi V, Gatto MR, Klein S, Checchi L. The use of a disclosing agent during resective periodontal surgery for improved removal of biofilm. Open Dent J 2012;6:46-50.
Daly CG, Chapple CC, Cameron AC. Effect of toothbrush wear on plaque control. J Clin Periodontol 1996;23:45-9.
[Table 1], [Table 2], [Table 3]