Received: 10 February 2022 | Revised: 6 August 2022 | Accepted: 24 October 2022

DOI: 10.1111/idh.12642

ORIGINAL ARTICLE

Oral health status, oral health-­related quality of life and

personality factors among users of three-­sided sonic-­powered
toothbrush versus conventional manual toothbrush

Mahmoud K. AL-­Omiri1,2 | Motasum Abu-­Awwad1 | Mohammad Bustani1 |

Abdulaziz M. Alshahrani3 | Abdullah A. Al Nazeh3 | Lana Alsafadi4 | Farah Majdalawi4 |
Hala M. Allawama4 | Edward Lynch5

1
Department of Prosthodontics, School
of Dentistry, The University of Jordan,
Amman, Jordan
2
Department of Prosthodontics, The City
of London Dental School, London, UK
3
Department of Pediatric Dentistry
and Orthodontics Sciences, College of
Dentistry, King Khalid University, Asir–­
Abha, Saudi Arabia
4
General Dental Practitioner, Private
practice, Amman, Jordan
5
De Montfort University, Leicester, UK
Correspondence
Mahmoud K. AL-­Omiri, School of
Dentistry, University of Jordan, Amman
11942, Jordan.
Email: alomirim@yahoo.co.uk
Funding information
Triple Bristle, Dayton, Tennessee,
USA; University of Jordan; King Khalid
University
Abstract
Objectives: This longitudinal within subject controlled randomized observational in-
vestigation studied the impacts of three-­sided sonic-­powered toothbrush versus con-
ventional manual toothbrush on oral health-­ and oral health-­related quality of life
(OHRQoL) and assessed the relationship between personality factors and OHRQoL.
Methods: A total of 96 participants (48 females and 48 males; mean age = 22.61 years,
SD = 1.21) were recruited into this investigation and were randomly allocated into two
groups. The participants were instructed to control oral hygiene for 1 month using ei-
ther a three-­sided sonic brush (Triple Bristle, Dayton, Tennessee, USA) (sonic group)
or a conventional manual toothbrush (manual group). Dental plaque was assessed via
Turesky-­Modified Quigley–­Hein Plaque Index (TMQHPI). Bleeding on probing (BOP)
was recorded as 1 if present and zero if absent. The NEO Five-­Factor Inventory (NEO-­
FFI) and Oral Health Impact Profile (OHIP-­14) were used to assess personality factors
and OHRQoL, respectively. TMQHPI, BOP and OHIP were assessed at study baseline
and 1 month later.
Results: The TMQHPI, BOP and OHIP-­14 scores were reduced after 1 month in both
groups (p < 0.05), and were more reduced among the three-­sided sonic brush users
(p > 0.05). Higher neuroticism scores were associated with worse OHRQoL (p < 0.05)
in both groups after 1 month.
Conclusions: The three-­sided sonic-­powered toothbrush was associated with supe-
rior oral health and OHRQoL in comparison with the conventional manual toothbrush.
Utilizing three-­sided sonic toothbrush, less plaque deposits and lower neuroticism
scores contributed towards and predicted better OHRQoL after 1 month of oral hy-
giene maintenance.

KEYWORDS
OHIP-­14, oral hygiene, personality, three-­sided, toothbrush NEO-­FFI, toothbrush

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2022 The Authors. International Journal of Dental Hygiene published by John Wiley & Sons Ltd.

Int J Dent Hygiene. 2022;00:1–11.  wileyonlinelibrary.com/journal/idh | 1

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2 AL-­OMIRI et al.
1 | I NTRO D U C TI O N
Proper oral hygiene practice and maintenance impacts the health of
periodontal tissues.1 Application of new technologies such as sonic
vibration, oscillating rotation and three-­sided toothbrush designs
could potentially allow reduction in brushing time, sustain consistent
plaque removal and boost maintenance of oral hygiene. 2–­7
Improved gingival/periodontal health was associated with bet-
ter oral health-­related quality of life.8–­12 However, some researchers
found no association between periodontal disease and oral health-­
related quality of life.13,14 In addition, regular toothbrushing and
maintenance of oral hygiene were associated with better oral health-­
related quality of life.12,15–­17
Furthermore, psychological factors were associated with oral
health-­related quality of life among participants with other dental
conditions and treatments.18–­22 Toothbrushing and oral hygiene
maintenance were associated with self-­coherence, 23 self-­esteem, 24
25,26 27
psychological distress and serious mental illness. In addition,
worse oral health-­related quality of life was associated with lower
sense of coherence, 23 higher depression28 and higher stress.12
Therefore, utilizing new technologies for tooth brushing might
have the potential to improve oral health-­related quality of life
among individuals. However, research is scarce in this regard and
further studies, and comparisons are required on this topic. In ad-
dition, no previous studies investigated the relationships between
oral health-­related quality of life and personality factors among par-
ticipants who utilize three-­sided sonic-­powered toothbrush for oral
hygiene.
The aim of this investigation was to assess impacts of mainte-
nance of oral hygiene using three-­sided sonic-­powered toothbrush
(Triple Bristle, Dayton, Tennessee, USA) versus conventional manual
toothbrush on oral health status and oral health-­related quality of
life. Also, to assess the relationship between personality factors and
oral health-­related quality of life among the study participants.
The null hypothesis was that the maintenance of oral hygiene
using either the three-­sided sonic-­powered toothbrush (Triple bris-
tles brush) or conventional manual toothbrush is not different and
has no impacts on oral health status or oral health-­related quality of
life. In addition, personality factors have no relationships with the
oral health-­related quality of life among participants using either
the three-­sided sonic-­powered toothbrush or conventional manual
toothbrush.
2 | S T U DY P O PU L ATI O N A N D
M E TH O D O LO G Y
2.1 | Study design and population
This longitudinal within subject controlled randomized observa-
tional clinical investigation was conducted following the guide-
lines and standards of Helsinki Declaration (9th version, 2013). The
Institutional Review Board at the University of Jordan has ethically
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approved this investigation (Reference number: 10/2020/18946).
Written informed consent was provided by each participant be-
fore inclusion in this investigation. This investigation was reported
according to the STROBE guidelines and was conducted between
November 2020 and March 2021 in the School of Dentistry at the
University of Jordan.
Ninety-­six participants (48 females and 48 males; mean
age = 22.61 years old, SD = 1.21, SE = 0.123, range = 21–­26, 95%
CI = 22.37–­22.86) were signed up for this investigation. The par-
ticipants were recruited from the school clinic attendants following
simple software randomization using computer produced numbers
and gender stratification.
Participants were eligible for inclusion in this investigation if they
were above 18 years old, medically fit and experience no systemic
disease or condition including cardiovascular disease, diabetes,
gastrointestinal disease, mental disorders, neurological disease, im-
mune disease, renal disease, hepatic disease, endocrine and bleeding
disorders. Also, they should take no regular medications including
antihypertensive drugs, antiepileptic agents, corticosteroids or an-
tibiotics. In addition, they should not be nursing, pregnant, smokers
or have implanted devices including pacemakers. Also, they should
be mentally competent and enjoy proper manual dexterity to use the
tested toothbrush.
Each participant should also have a set of at least 24 intact
natural teeth (excluding the 3rd molars) that have no heavy resto-
rations, marked tooth wear or active periodontal disease or caries.
Furthermore, they should have no fixed and/or removable prosthe-
sis, dental implant treatment, orthodontic appliances or piercings
in oral and/or peri-­oral tissues. They should not have used electric
or sonic-­powered toothbrush before and should not be consuming
medicated toothpastes or mouth washes.
The participants were to be excluded from this investigation if
they were less than 18 years old, smokers, alcoholic, nursing, preg-
nant, utilize any of the above listed medications, or found to suffer
any of the above listed medical issues. Also, they were excluded if
they have less than 24 intact natural dentition or have heavy res-
torations, marked tooth wear, active periodontal disease or caries,
fixed and/or removable prosthesis, dental implant treatment, or-
thodontic appliances, or piercings in oral and/or peri-­oral tissues. In
addition, they were excluded if they previously used electric tooth-
brush or if they utilized other means for oral hygiene including med-
icated toothpastes or mouth washes, interdental brush, miswak or
dental prophylaxis.
None of the participants was lost or excluded from the study
after recruitment (drop out ratio = 0%).
2.2 | Procedures, instruments and experiment
After inclusion and during the first visit (at study baseline), par-
ticipants' personal information (including age, gender, income
and education) as well as medical and dental histories were as-
sessed. Then, the clinical dental examination was carried out using

AL-­OMIRI et al.
a periodontal probe (anatomical handle single ended, ASA Dental
Co, Italy), a dental mirror (15/16 inch, Hanhnenkratt GMBH,
Germany), and an explorer dental probe (0700–­9 anatomical han-
dle single ended, ASA Dental Co, Italy) on an illuminated dental
unit.
After that, each participant was requested to complete two
questionnaires to assess personality factors and oral health-­related
quality of life. The first questionnaire was the NEO Five-­Factor
Inventory (NEO-­FFI)29 and was used to assess the personality fac-
tors for each participant. The NEO-­FFI appraises the five major per-
sonality factors: neuroticism, extraversion, openness, agreeableness
and conscientiousness. It includes 60 items, and each item is scored
on a 5-­point Likert scale. The NEO-­FFI was utilized in this investiga-
tion as it is easy to score, permits comprehensive appraisal of per-
sonality factors, accurate, valid, reliable and sensitive.18–­22,29,30
The second questionnaire was the Oral Health Impact Profile
(OHIP-­14)31 and was used to assess the oral health-­related impacts
for each participant. The OHIP-­14 appraises the self-­reported oral
health-­related impacts including discomfort, dysfunction and dis-
ability.31 It includes 14 questions, and each question is answered on
a 5-­point Likert scale. The OHIP-­14 was utilized in this investigation
as it is easy to score, short, valid and reliable.31,32
The participants were provided with detailed explanation of the
NEO-­FFI and OHIP-­14 and how to score them before they started
scoring the two questionnaires.
After scoring the questionnaires, the plaque deposits on the
dentition were clinically examined and scored from 0 to 5 using the
Turesky-­Modified Quigley-­Hein Plaque Index (TMQHPI)33,34; 0 = no
plaque, 1 = plaque present as separate flecks at the gingival margin,
2 = plaque present as thin continuous band at the gingival margin,
3 = plaque present as a band wider than 1 mm and covers less than
one-­third of the crown, 4 = plaque covers more than one third but
less than two-­thirds of the crown and 5 = plaque covers more than
two-­thirds of the crown.33,34
Also, the bleeding on probing (BOP) around the dentition was
recorded as 1 if present and zero if absent.35
Then, the participants were randomly allocated into two groups
following a simple software randomization using computer produced
numbers and gender stratification. The participants in Sonic group
(48 participants, 24 females and 24 males; mean age (SD) = 22.38
(1.25) years, SE = 0.180, 95% CI = 22.01–­22.74) were then provided
with a three-­sided sonic brush (Triple Bristle, Dayton, Tennessee,
USA), given supervised oral hygiene training and directed to utilize
the three-­sided sonic-­powered toothbrush for the maintenance
of their oral hygiene according to the manufacturer's instructions.
Meanwhile, the manual group participants (48 participants, 24 males
and 24 females; mean age (SD) = 22.85 (1.13) years, SE = 0.163,
95% CI = 22.53–­23.18) were provided with a conventional manual
brush (soft flat trimmed Oral-­B Indicator 35 manual brush, Procter
& Gamble Co., Cincinnati, OH, United States) for the maintenance
of their oral hygiene and were given supervised oral hygiene train-
ing according to the modified Bass technique following previous
recommendations.7,36
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3
Then, each participant in each group was requested to brush
their teeth using the provided brush 1 minute for each jaw twice
daily for 1 month. They were requested to utilize a plain tooth-
paste (1450 ppm sodium fluoride, Colgate total original toothpaste,
Colgate-­Palmolive Co., USA) and avoid other chemical and mechani-
cal oral hygiene products throughout the study including interdental
brush, miswak and medicated toothpastes and mouth rinses. The
participants were then dismissed and requested to attend for a re-
call visit 1 month later.
One month following the use of the designated brush, the par-
ticipants from both groups were recalled and the TMQHPI, BOP and
OHIP-­14 were assessed for each participant as before.
Figure 1 presents a flow diagram of study participants and meth-
ods throughout the different stages of the study.
None of the participants was affected with any unintended
harms or side effects due to the utilized three-­sided sonic-­powered
toothbrush or any interventions throughout this investigation.
2.3 | The main outcome measures
The main outcome measures for this investigation were the oral
health-­related impacts and the participants' personality factors.
Secondary outcome measures were plaque index and bleeding on
probing scores.
All measures and clinical examinations were conducted by the
same examiners (L.S. and F.M.). Intra-­ and inter-­examiner reliability
was assessed by repeating 10 clinical assessments of plaque scores
(kappa equals 0.94 and 0.90, respectively).
2.4 | Statistical analysis
Data analysis for this investigation was carried out using the SPSS
computer software (IBM SPSS Statistics v19.0; IBM Corp., USA).
Descriptive statistics were conducted for the study variables. The
data distribution was normal and checked using Kolmogorov–­
Smirnov test. Pearson correlation test was utilized to evaluate the
correlations between NEO-­FFI, OHIP-­14, plaque index and bleed-
ing on probing scores within each group. Paired samples t-­test was
utilized to compare OHIP-­14, plaque index and bleeding on prob-
ing scores between study baseline and 1 month after using the
tested toothbrush within each group. Independent t-­test was used
to compare plaque index, bleeding on probing, NEO-­FFI and OHIP-­
14 scores between groups both at study baseline and 1 month after
using the tested toothbrush. Significant statistical results were con-
sidered at 95% confidence intervals and two tailed α of 0.05.
Contribution of personality factors (NEO-­FFI scores) towards
oral health related quality of life (OHIP-­14 scores) was assessed
utilizing the hierarchical regression analysis considering the con-
founding effects of age, gender, income, education, plaque index
scores, bleeding on probing scores and type of brush. Age, gen-
der, income, education, plaque index scores, bleeding on probing
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4 AL-­OMIRI et al.

F I G U R E 1 Participants' and methods flow diagram of the different study stages

scores and type of brush were included in the first block of the G*Power computer software (G*Power, version 3.1.9.7; Heinrich-­
regression model, while the NEO-­FFI scores were included in the Heine University) was used to estimate the required sample size for
second block. this investigation. A priori power analysis based on linear multiple

AL-­OMIRI et al.
regression fixed model analysis considering significance level (α)
of 0.05, statistic power (1 –­ β) of 0.9, and effect size of 0.21 esti-
mated a minimum sample size of 85 participants for this investiga-
tion. In order to compensate for probable drop out of participants,
104 potential participants were invited to participate in this study.
Four participants declined to participate, and another 4 participants
were excluded because they had orthodontic appliances and fixed
prosthesis. Therefore, 96 participants were recruited into this inves-
tigation (48 females and 48 males) with 11 participants more than
the minimum required sample size, and none was lost during this
investigation (0% drop out ratio).
3 | R E S U LT S
The data from 96 participants (48 females and 48 males; mean
age = 22.61 years old, SD = 1.21, range = 21–­26, 95% CI = 22.37–­
22.86) was collected and analysed during this investigation (0%
drop out ratio). The mean age of the sonic group participants
(48 participants, 24 females and 24 males) was 22.38 years old
(SD = 1.25, range = 21–­26, 95% CI = 22.01–­22.74), and the mean
age of the manual group participants (48 participants, 24 females
and 24 males) was 22.85 years old (SD = 1.13, range = 21–­26, 95%
CI = 22.53–­23.18). The age was not significantly different between
the groups (Independent t-­test: t = −1.97, df = 94, p = 0.052, mean
difference = −0.479, SE = 0.243, 95% CI = −0.092 –­0.003).
Table 1 presents the descriptive statistics for NEO-­FFI, OHIP-­
14, plaque index and bleeding on probing scores at study baseline
and 1 month after using the tooth brush for each group. Significant
differences were found between study baseline and 1-­month OHIP-­
14, plaque index and bleeding on probing scores within each group
(p < 0.01, Table 1). After 1 month, lower plaque index scores, lower
bleeding on probing scores and better oral health-­related quality of
life (i.e. lower OHIP scores) were recorded among the participants
of each group.
At study baseline, the NEO-­FFI, OHIP-­14, plaque index and
bleeding on probing scores were not significantly different between
the two study groups (p > 0.05, Table 2). However, after 1 month,
lower plaque index scores, lower bleeding on probing scores and
lower OHIP scores (i.e. better oral health related quality of life) were
recorded among the three-­sided sonic-­powered toothbrush users
(sonic group) in comparison with the conventional manual tooth-
brush users (manual group) (p < 0.05, Table 2).
Among the sonic group participants, no significant correlations
between OHIP-­14 scores and each of NEO-­FFI, plaque index and
bleeding on probing scores were found; except that higher neurot-
icism scores were associated with higher OHIP-­14 scores at study
baseline as well as after 1 month of using the three-­sided sonic-­
powered brush (p < 0.05, Table 3).
Among the manual group participants, no significant correlations
were found between OHIP-­14 scores and NEO-­FFI scores at study
baseline as well as after 1 month (p > 0.05, Table 3). However, higher
baseline OHIP scores (i.e. worse oral health related quality of life)
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5
were associated with higher baseline plaque index scores and higher
baseline bleeding on probing scores (p < 0.05, Table 3). Also, higher
1 month OHIP scores were associated with higher 1 month bleeding
on probing scores (p < 0.05, Table 3).
Considering the total study sample, the hierarchical regression
analysis showed that the utilized brushing method (p = 0.002), 1-­
month plaque index scores (p = 0.021), and neuroticism scores
(p = 0.005) were able to predict and contributed towards the 1-­
month OHIP scores (Table 4). So, utilizing a three-­sided sonic tooth-
brush for oral health maintenance, having less plaque deposits and
having less neuroticism scores have contributed towards and pre-
dicted better oral health related quality of life after 1 month of oral
hygiene maintenance. On the other hand, only neuroticism scores
(p = 0.002) contributed towards the baseline OHIP scores (Table 4).
When each group was considered separately, the hierarchical
regression analysis for the Sonic group showed that higher neu-
roticism scores contributed towards higher OHIP scores (i.e. worse
oral health related quality of life) at study baseline (R 2 = 0.320,
Beta = 0.431, Unstandardized B = 0.460, t = 2.662, p = 0.012,
95% CI = 0.109–­0.810) as well as after 1 month (R 2 = 0.294,
Beta = 0.372, Unstandardized B = 0.178, t = 2.168, p = 0.037, 95%
CI = 0.011–­0.345).
On the other hand for the manual group, none of the NEO-­FFI
scores was able to predict or contribute towards the baseline OHIP
scores (p > 0.05). Meanwhile, higher neuroticism scores contrib-
uted towards higher 1 month OHIP scores (i.e. worse oral health
related quality of life) within the users of the manual toothbrush
(R 2 = 0.430, Beta = 0.459, Unstandardized B = 0.245, SE = 0.109,
t = 2.242, p = 0.032, 95% CI = 0.022–­0.467).
4 | DISCUSSION
To our knowledge, the current within subject controlled randomized
clinical investigation is the first to compare the oral health-­related
quality of life between three-­sided sonic-­powered toothbrush users
and conventional manual toothbrush users. Also, this investigation
is the first report on the relationship between oral health-­related
quality of life and personality factors among participants who use
three-­sided sonic-­powered toothbrush for oral hygiene mainte-
nance. Besides, it is the first to compare this relationship between
three-­sided sonic-­powered toothbrush users and conventional man-
ual toothbrush users.
The results of this investigation demonstrated that oral hygiene
maintenance and oral health related quality of life were improved after
1 month of using either the three-­sided sonic-­powered toothbrush or
the conventional manual tooth brushing. Also, the three-­sided sonic-­
powered toothbrush was better than the conventional manual tooth-
brush in this regard. In addition, certain personality factors (mainly
neuroticism) had relationships with the oral health impacts among the
study participants. Thus, the null hypothesis was rejected.
The results demonstrated that plaque index and bleeding on
probing scores were more improved following 1 month of using the
 | 6

TA B L E 1 Descriptive statistics for NEO-­FFI, OHIP-­14, plaque index and bleeding on probing scores among the study participants with variable comparisons between study baseline and
1-­month follow-­up within each group (n = 96, 48 for each group)

Sonic group Manual group

95% CI 95% CI

Variable Mean (SD) Lower Upper t (df = 47) p Mean (SD) Lower Upper t (df = 47) p

Baseline plaque index 0.8351 (0.4649) 0.7001 0.9701 7.706 <0.0001 0.8103 (0.4477) 0.6803 0.9403 3.982 <0.0001
1 Month plaque index 0.4063 (0.2775) 0.3257 0.4868 0. 5712 (0.3735) 0.4627 . 6796
Baseline BOP frequency 12.35 (7.536) 10.17 14.54 7.413 <0.0001 12.13 (8.162) 9.75 14.50 6.129 <0.0001
1 Month BOP frequency 5.19 (4.841) 3.78 6.59 7.96 (7.93) 5.66 10.26
Baseline BOP percentage 44.12 (26.913) 36.31 51.94 7.413 <0.0001 43.53 (29.36) 35.00 52.05 6.088 <0.0001
1 Month BOP percentage 18.53 (17.288) 13.51 23.55 28.72 (28.76) 20.37 37.07
Baseline OHIP 7.35 (7.918) 5.05 9.65 5.297 <0.0001 7.46 (5.111) 5.97 8.94 3.174 0.003
1 Month OHIP 2.56 (3.554) 1.53 3.59 5.83 (4.023) 4.67 7.00
Baseline Neuroticism 18.29 (7.426) 16.14 20.45 0.496 0.622 20.52 (7.540) 18.33 22.71 1.166 0.249
1 Month Neuroticism 18.17 (6.972) 16.14 20.19 20.15 (7.812) 17.88 22.41
Baseline Extraversion 29.00 (4.510) 27.69 30.31 0.871 0.388 29.46 (3.973) 28.30 30.61 0.238 0.813
1 Month Extraversion 28.67 (5.463) 27.08 30.25 29.38 (4.602) 28.04 30.71
Baseline Openness 25.96 (4.842) 24.55 27.36 1.861 0.069 24.88 (4.144) 23.67 26.08 −0.925 0.360
1 Month Openness 25.38 (5.077) 23.90 26.85 25.10 (4.353) 23.84 26.37
Baseline Agreeableness 25.96 (4.089) 24.77 27.15 −0.436 0.664 27.15 (3.567) 26.11 28.18 0.548 0.586
1 month Agreeableness 26.06 (4.407) 24.78 27.34 27.02 (3.784) 25.92 28.12
Baseline Conscientiousness 31.42 (6.056) 29.66 33.18 −0.687 0.495 33.48 (7.429) 31.32 35.64 −1.396 0.169
1 Month Conscientiousness 31.58 (5.985) 29.85 33.32 33.81 (7.488) 31.64 35.99

Abbreviations: BOP, bleeding on probing; CI, 95% confidence intervals of the mean; df, degree of freedom; manual group, participants utilized conventional manual toothbrush; OHIP, Oral Health Impact
Profile score; p, two-­t ailed probability value using paired samples t-­test; SD, standard deviation; sonic group, participants utilized three-­sided sonic-­powered toothbrush; t, t statistics for paired samples
t-­test.
AL-­OMIRI et al.

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AL-­OMIRI et al. 7

TA B L E 2 Comparison of NEO-­FFI, OHIP, PI and BOP scores between the study groups (n = 96, 48 for each group)

95% CI of the
Difference
Compared parameters between the sonic
group and the manual group t df p Mean Difference SE of Difference Lower Upper

Plaque index at EQ assumed 0.266 94 0.791 0.0248 0.0932 −0.1602 0.2098

study baseline EQ not assumed 0.266 94 0.791 0.0248 0.0932 −0.1602 0.2098
BOP Frequency at EQ assumed 0.143 94 0.887 0.2290 1.6030 −2.9550 3.4130
study baseline EQ not assumed 0.143 93 0.887 0.2290 1.6030 −2.9550 3.4130
BOP Percentage at EQ assumed 0.104 94 0.918 0.0060 0.0575 −0.1082 0.1201
study baseline EQ not assumed 0.104 93 0.918 0.0060 0.0575 −0.1082 0.1201
Plaque index after EQ assumed −2.456 94 0.016 −0.1649 0.0672 −0.2983 −0.0316
1 month EQ not assumed −2.456 87 0.016 −0.1649 0.0672 −0.2984 −0.0314
BOP Frequency EQ assumed −2.066 94 0.042 −2.7710 1.3410 −5.4340 −0.1080
after 1 month EQ not assumed −2.066 78 0.042 −2.7710 1.3410 −5.4410 −0.1010
BOP Percentage EQ assumed −2.105 94 0.038 −0.1019 0.0484 −0.1981 −0.0058
after 1 month EQ not assumed −2.105 77 0.039 −0.1019 0.0484 −0.1984 −0.0055
OHIP at study EQ assumed −0.077 94 0.939 −0.1040 1.3600 −2.8050 2.5970
baseline EQ not assumed −0.077 80 0.939 −0.1040 1.3600 −2.8110 2.6030
OHIP after 1 month EQ assumed −4.221 94 0.000 −3.2710 0.7750 −4.8090 −1.7320
EQ not assumed −4.221 93 0.000 −3.2710 0.7750 −4.8100 −1.7320
Neuroticism EQ assumed −1.459 94 0.148 −2.2290 1.5280 −5.2620 0.8040
EQ not assumed −1.459 94 0.148 −2.2290 1.5280 −5.2620 0.8040
Extraversion EQ assumed −0.528 94 0.599 −0.4580 0.8680 −2.1810 1.2640
EQ not assumed −0.528 93 0.599 −0.4580 0.8680 −2.1810 1.2650
Openness EQ assumed 1.178 94 0.242 1.0830 0.9200 −0.7430 2.9100
EQ not assumed 1.178 92 0.242 1.0830 0.9200 −0.7440 2.9100
Agreeableness EQ assumed −1.516 94 0.133 −1.1880 0.7830 −2.7430 0.3680
EQ not assumed −1.516 92 0.133 −1.1880 0.7830 −2.7430 0.3680
Conscientiousness EQ assumed −1.491 94 0.139 −2.0630 1.3830 −4.8090 0.6840
EQ not assumed −1.491 90 0.139 −2.0630 1.3830 −4.8110 0.6860

Abbreviations: 95% CI, 95% confidence intervals; BOP, bleeding on probing; df, degree of freedom; EQ, equality of variance; manual group,
participants utilized conventional manual toothbrush; OHIP, Oral Health Impact Profile scores; p, two-­t ailed probability value using independent
samples t-­test; SE, standard error; Sonic group, participants utilized three-­sided sonic-­powered toothbrush; t, t statistic.

three-­sided sonic-­powered toothbrush in comparison with conven-
tional manual tooth brushing. This is consistent with the findings of
previous reports that tested sonic-­powered and oscillating rotating
2–­7
toothbrushes. This could be accredited to that sonic movement
and three surface cleaning could enhance oral hygiene; and there-
fore, boost plaque removal and decrease bleeding on probing. 2–­7 In
addition, this might be attributed to the enhanced compliance with
oral hygiene due to the simultaneous brushing of all tooth surfaces
2,7
which potentially requires less brushing time.
In addition, the findings of this investigation demonstrated
more improvement in oral health related quality of life following
1-­m onth use of the three-­sided sonic-­p owered toothbrush in com-
parison to conventional tooth brushing. This might be explained
by the reported improvement in oral hygiene as demonstrated by
more reduction in plaque deposits and bleeding on probing fol-
lowing the use of the three-­sided sonic-­p owered toothbrush. This
generally agrees with previous conclusions that an improved gin-
gival/periodontal health was associated with boosted oral health
related quality of life. 8–­12
Previous studies demonstrated that periodontal disease was as-
sociated with worse oral health related quality of life and impacts
in Norway10 and Turkey.8 In addition, generalized chronic and gen-
eralized aggressive periodontitis were associated with worse oral
health-­related quality of life in comparison to gingivitis among a
Turkish population.37 In contrast, some researchers found no rela-
tion between periodontal disease and oral health-­related quality of
life (OHIP-­14 scores) among a population of elderly people in the
UK.14 Also, no association was found between periodontitis and
oral health related quality of life among a population of diabetic
patients.13
Demographic, sampling, psychosocial, racial and cultural factors
could explain the variation from these results. Furthermore, these
 |

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8 AL-­OMIRI et al.

TA B L E 3 Correlations between baseline and 1-­month OHIP scores and NEO-­FFI, plaque index and bleeding on probing scores within
each group (n = 96, 48 test group and 48 controls)

Baseline OHIP 1 month OHIP

Sonic group Manual group Sonic group Manual group

Variables R p R p R p R p

Neuroticism 0.395 0.005 0.120 0.418 0.306 0.035 0.269 0.065

Extraversion −0.009 0.952 −0.052 0.723 0.081 0.584 −0.201 0.170
Openness 0.197 0.179 0.168 0.252 0.057 0.700 0.144 0.328
Agreeableness 0.155 0.293 −0.162 0.270 0.068 0.648 −0.197 0.180
Conscientiousness −0.105 0.479 −0.071 0.629 0.068 0.646 −0.150 0.308
Baseline plaque index 0.218 0.136 0.383 0.007 -­-­ -­-­ -­-­ -­-­
1 Month plaque index -­-­ -­-­ -­-­ -­-­ 0.236 0.106 0.277 0.057
Baseline BOP frequency 0.212 0.148 0.292 0.044 -­-­ -­-­ -­-­ -­-­
1 Month BOP frequency -­-­ -­-­ -­-­ -­-­ −0.209 0.154 0.297 0.041
Baseline BOP percentage 0.212 0.148 0.305 0.035 -­-­ -­-­ -­-­ -­-­
1 Month BOP percentage -­-­ -­-­ -­-­ -­-­ −0.209 0.154 0.299 0.039

Abbreviations: BOP, bleeding on probing; manual group, participants utilized conventional manual toothbrush; OHIP, Oral Health Impact Profile
scores; p, two-­t ailed probability value; R, Pearson's correlation coefficient; sonic group, participants utilized three-­sided sonic-­powered toothbrush.

variations might be due to difference in study designs, investigated
populations and used toothbrushes.
In addition, this finding concurs the findings of previous re-
ports that regular conventional tooth brushing, and maintenance
of oral hygiene was related to better oral health related quality of
life.12,15–­17 Also, professional toothbrushing was associated with
better oral health related quality of life among nursing home resi-
dents.17 Besides, good oral hygiene was associated with less peri-
odontitis and better oral health related quality of life (OHIP-­14
scores).12
The findings of the current investigation demonstrated that
higher neuroticism personality factor could negatively affect the
oral health related quality of life. This might be explained by that
individuals with higher neuroticism might be more self-­conscious
and would be more aware and concerned regarding their den-
tal condition and status; and therefore, would be more ready to
identify negative oral health-­related impacts on their quality of
life and daily living.18–­20 This agrees with the findings of previous
literature among participants with other dental conditions and
treatments.18–­20
This finding is also in line with the findings of previous research
that higher sense of coherence was related to better oral hygiene
maintenance and improved oral health-­related impacts in Norway. 23
Also, higher self-­esteem was found to be associated with higher
frequency of toothbrushing among school children in United Arab
Emirates. 24 In addition, depression and periodontal disease were
found to be associated with inferior oral health-­related quality of life
among the elderly people. 28 Higher levels of stress were also asso-
ciated with worse oral health related quality of life.12 Furthermore,
less frequent and irregular toothbrushing was associated with psy-
chological distress among Indonesian and Finnish adolescents. 25,26
In addition, less frequent toothbrushing was associated with serious
mental illness. 27 However, unlike the current investigation, the pre-
vious investigations did not utilize comprehensive measures for the
big five factors of personality.
For this investigation, reliable, valid and comprehensive tests
were used during the evaluation of oral health-­related quality of
life and personality factors. The maintenance of oral hygiene re-
gardless the applied method was associated with better oral health
and improved oral health-­related quality of life. Furthermore, per-
sonality factors (neuroticism) contributed to the oral health-­related
quality of life among the participants. Thus, evaluation of person-
ality factors would help to understand the impacts of maintaining
oral hygiene on oral health-­related quality of life. This might have
potential association with individual compliance with oral hygiene
maintenance.
Potential influence of cultural, social and racial attributes
on the relationship between personality factors and oral
health-­r elated quality of life was not evaluated in this study.
Nevertheless, other confounding effects of gender, age, income
and level of education were accounted for during data analysis.
Also, the study was conducted among young adults and did not
include children or elderly. This was done to avoid any effects
of age or systemic diseases on oral health as well as to secure
the compliance and ability of participants to strictly follow and
apply the tested brushing protocols and use the three-­sided sonic
toothbrush.
Further research is required to evaluate the potential influence
of cultural, social and racial attributes on the relationship between
personality factors and oral health related quality of life. In addi-
tion, further inquiries are demanded to explore the relationship
between personality factors, oral health related quality of life
 |

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AL-­OMIRI et al. 9

TA B L E 4 Hierarchical regression analysis to predict baseline and 1-­month OHIP scores using NEO-­FFI scores for the total study sample
(n = 96)

Unstand Co Stand Co 95% CI for B

Lower
Dependent variable Predictors* B SE Beta t p Bound Upper Bound

Baseline OHIP (Constant) −22.698 18.809 -­-­-­-­ −1.207 0.231 −60.116 14.719
R2 = 0.253 Group −1.026 1.464 −0.078 −0.701 0.485 −3.939 1.887
Age 0.243 0.864 0.044 0.281 0.779 −1.476 1.962
Gender −0.732 1.415 −0.055 −0.517 0.607 −3.547 2.084
Education −0.528 1.311 −0.063 −0.403 0.688 −3.137 2.080
Income 6.255 E-­5 0.000 0.020 0.199 0.842 −0.001 0.001
Plaque index T1 3.423 1.793 0.235 1.909 0.060 −0.144 6.990
BOP Frequency T1 −3.911 2.151 −4.610 −1.818 0.073 −8.191 0.369
BOP Percentage T1 111.271 59.980 4.702 1.855 0.067 −8.050 230.591
Neuroticism 0.323 0.103 0.367 3.135 0.002 0.118 0.528
Extraversion 0.114 0.174 0.073 0.651 0.517 −0.234 0.461
Openness 0.280 0.146 0.191 1.912 0.059 −0.011 0.571
Agreeableness 0.307 0.191 0.179 1.605 0.112 −0.074 0.687
Conscientiousness −0.015 0.108 −0.015 −0.138 0.891 −0.229 0.199
1 Month OHIP (Constant) −4.067 11.137 -­-­-­-­ −0.365 0.716 −26.233 18.100
R2 = 0.368 Group 2.850 0.888 0.348 3.210 0.002 1.083 4.617
Age −0.214 0.514 −0.063 −0.416 0.679 −1.237 0.810
Gender −1.490 0.844 −0.182 −1.765 0.081 −3.170 0.190
Education 0.658 0.781 0.125 0.843 0.402 −0.896 2.212
Income −1.075 E-­5 0.000 −0.005 −0.059 0.953 0.000 0.000
Plaque index T1 −0.571 1.154 −0.063 −0.495 0.622 −2.867 1.725
Plaque index T2 3.725 1.582 0.305 2.354 0.021 0.576 6.875
BOP Frequency T1 −0.593 1.746 −1.126 −0.340 0.735 −4.070 2.883
BOP Frequency T2 −0.793 1.164 −1.287 −0.682 0.497 −3.110 1.523
BOP Percentage T1 20.326 48.729 1.383 0.417 0.678 −76.666 117.318
BOP Percentage T2 17.467 32.158 1.024 0.543 0.589 −46.542 81.477
Neuroticism 0.176 0.060 0.321 2.916 0.005 0.056 0.295
Extraversion 0.006 0.102 0.006 0.060 0.952 −0.197 0.209
Openness 0.105 0.086 0.115 1.219 0.226 −0.066 0.276
Agreeableness 0.018 0.113 0.017 0.158 0.875 −0.208 0.244
Conscientiousness 0.038 0.063 0.062 0.600 0.550 −0.087 0.162

Abbreviations: B, beta statistics; BOP, bleeding on probing; CI, confidence intervals; Group, sonic and manual groups; OHIP, Oral Health Impact
Profile scores; p, two-­t ailed probability value; R 2, coefficient of determination; SE, standard error; Stand Co, standardized coefficient; t, t statistics;
T1, at study baseline; T2, after 1 month; Unstand Co, unstandardized coefficient.
*Group, age, gender, income, education, plaque index scores and bleeding on probing scores were included in the first block of the regression model,
while the NEO-­FFI scores were included in the second block.

and compliance with oral hygiene maintenance among partici- 5 | CO N C LU S I O N S

pants using different oral hygiene practices, using different tooth-
brushes that utilize different technologies and designs, or having
different dental treatments and oral conditions. Also, longer term
research is required on participants from different age groups and
participants with different medical conditions that could poten-
tially affect the oral health.
Within the limitations of this investigation, the maintenance of
oral hygiene for 1 month was associated with improved oral health
status and improved oral health related quality of life, with the
three-­sided sonic-­p owered toothbrush was superior to the con-
ventional manual toothbrush in this regard. In addition, higher
 |
10
neuroticism levels were associated with worse impacts on oral
health-­related quality of life.
6 | C LI N I C A L R E LE VA N C E
6.1 | Scientific rationale for study
This investigation studied the impacts of three-­sided sonic-­powered
toothbrush versus conventional manual brushing on oral health and
oral health-­related quality of life (OHRQoL) and assessed the rela-
tionship between personality factors and OHRQoL.
6.2 | Principal findings
The three-­sided sonic toothbrush was associated with bet-
ter oral hygiene and better OHRQoL. Using a three-­sided sonic
toothbrush for oral health maintenance, presence of less plaque
deposits and scoring lower on neuroticism predicted and contrib-
uted towards better OHRQoL following 1 month of oral hygiene
maintenance.
6.3 | Practical implications
This might have potential impacts on individual oral health, OHRQoL
and compliance with oral hygiene maintenance.
AU T H O R C O N T R I B U T I O N S
M.K.AL-­O. and E.L. conceived the study. M.K.AL-­O. designed
the study. M.K.AL-­O., F.M., L.A., and H.M.A. collected the data.
M.K.AL-­O., M.A.A., M.B., A.M.A., A.A.AL., F.M., L.S. and H.M.A.
interpreted the data, conceived the results, drafted sections of the
manuscript, and revised the manuscript. M.K.AL-­O. carried out the
data analysis. All authors critically revised the manuscript. All authors
read and approved the submitted final version of the manuscript.
AC K N OW L E D G E M E N T S
The authors thank Mrs AbdelAziz M. for her help during the prepara-
tion of this manuscript. Thanks also to the University of Jordan, King
Khalid University and De Montford University for making this study
possible. The authors thank the Triple Bristles Company (Triple
Bristle, Dayton, Tennessee, USA) for providing the three-­sided
sonic-­powered toothbrushes.
F U N D I N G I N FO R M AT I O N
This research received funding by the Triple Bristles Company (Triple
Bristle, Dayton, Tennessee, USA) who supplied the three-­sided
sonic-­powered toothbrushes. This research did not receive any
other specific grant from funding agencies in the public, commercial
or not-­for-­profit sectors.
16015037, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/idh.12642 by Cochrane Kuwait, Wiley Online Library on [26/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
AL-­OMIRI et al.
C O N FL I C T S O F I N T E R E S T
This study was funded by the Triple Bristles Company (Triple Bristle,
Dayton, Tennessee, USA). The funding company provided the used
three-­sided sonic-­powered toothbrushes. The funding company has
no role in any part of the study and has no input into conceptualiza-
tion, design, data collection, analysis, decision to publish or prep-
aration of the manuscript. The authors declare no other potential
conflict of interest.
DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from
the corresponding author upon reasonable request.
ORCID
Mahmoud K. AL-­Omiri https://orcid.org/0000-0002-9226-3697
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How to cite this article: AL-­Omiri MK, Abu-­Awwad M,
Bustani M, et al. Oral health status, oral health-­related
quality of life and personality factors among users of
three-­sided sonic-­powered toothbrush versus conventional
manual toothbrush. Int J Dent Hygiene. 2022;00:1-11.
doi: 10.1111/idh.12642