Knowledge About Brushing Simulator Among Dentists-A Survey

Arunn Jaikumarr Ram1, Jayalakshmi Somasundaram*2, Balaji Ganesh S2, Anitha Roy3 1Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 77, Tamil Nadu, India 2White LabMaterials Research Centre, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 77, Tamil Nadu, India 3Department of Pharmacology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 77, Tamil Nadu, India


INTRODUCTION
Good oral hygiene is very important to prevent bad odor, improve aesthetics, and also improve oral health (Teja and Ramesh, 2019). But for maintenance, brushing is very important (Ali et al., 2019). Brushing helps to clean the teeth, tongue, gums, and place a major role in maintaining dental hygiene. Chlorhexidine is usually used as a mouthwash to maintain oral health (Noor, 2016;Siddique et al., 2019). Dental plaque is removed by this process. Fluoridated toothpaste must be used for brushing. So regular brushing with a luoridated dentifrice is recommended globally for controlling plaque (Chung et al., 2017). The brushing techniques may vary between individuals. The factors like pressure, speed, timing, the angulation of pressure will vary from person to person. So a brushing simulator was introduced, it is a machine that holds the toothbrush. The number of holders-type available are 4, 8 and 12 (Bizhang et al., 2017). It has many uses like to simulate tooth brushing, to check the effects of brushing on the tooth surface, to check the effects of brushing on the restorative surface, to check abrasion and also used for pre-clinical testingbrushing effectiveness (Ledder et al., 2019). This is a computer program machine where everything is done using the software. The machine produces varied movements like linear, zigzag, and circular. This toothbrushing simulator helps in studying various parameters like the assistance of the substrate to operation (Körner et al., 2020), the abrasiveness of the abrasive, the effects of different kinds of movements, movements of different kinds of the toothbrush. The different pressure and its effects over-brushing can also be studied using this brushing simulator machine (Warren et al., 2002). All the veneer's stability and strength can also be checked with this machine (Ravinthar and Jayalakshmi, 2018) This simulated toothbrush and technique, using a simulator, helps to check the gloss, roughness, and even color change of the tooth due to continuous contact of the bristles with the tooth surface (Lai et al., 2018). In brushing force, a minimum of 3N pressure is required to provide for abrasion (Litonjua et al., 2004). Therefore the purpose of this study is to check the knowledge and awareness of brushing simulators among dentists in Chennai.

MATERIALS AND METHODS
The population considered here are the dentists in Chennai. It is a university setting -where the collection of data is easier and the occupation, i.e., the population taken is the same -dentists. But sometimes the opinion may vary outside the university and also between different universities. The approval was obtained from the institution (SRB). Here the sample size was considered to be 135, with reference to sample size 196 (Ahmad et al., 2017). The sampling method used here is strati ied random. Steps taken to minimize bias is that the survey is digital, so no paper was used in this survey (eco world), a proper questionnaire was created with easily understandable questions.
A questionnaire was prepared with the help of online tools like Google forms and the data was col-lected. Excel sheet was used to transfer the data and tabulate it. A total of 13 questions were created (Lang et al., 2014). Validity checking was done by three internal experts from the institution and three external experts outside the institution. The method of representations here is pie chart. In the statistical test used for descriptive analysis, the statistics software used was SPSS. Chi-square test and pearson correlation analysis were used, with pvalue less than 0.05 to be statistically signi icant.

RESULTS AND DISCUSSION
A total of 135 responses were received out of which 52% were male and 46% were female. From the results obtained, from that the following conclusions were made and was expressed with the help of pie charts. In the age group, 37% were between the age of 18-20, 35.6% -21 to 25 years, 17.8% were between 26-30 years and 9.6% were above the age of 30. The majority of the people who took up the survey were between 18 to 20 ( Figure 1).49.6% of them who took up the survey were UG students, 23% -PG students, 15.6% -BDS practitioners, 4.4% were MDS practitioners, and 7.4% of the people who were researchers. Here the majority of people who took up the survey were UG students ( Figure 2). 64.4% of the people knew that brushing can be simulated and 35.6% didn't know that it can be simulated ( Figure 3). 17.8% say that it is a robot that helps to brush the teeth, 41.5% responded that it is an electronic toothbrush and 40.7% knew that it is a machine that holds the toothbrush. More than the manual toothbrush and the powered toothbrushing helps in reducing plaque (Yaacob et al., 2014) (Figure 4). 16.4% say that the use of brushing simulator is to simulate tooth brushing, 15.7% says it is to check the effects of brushing onto the surface, 11.2% choose the option, to check the effects of brushing on the restorative surface, 51.5% said all the above, 5.2% went for the options none of above.
Mechanical brushing simulator is used for cleaning the occlusal surfaces with the help of water and dentifrices (Ledder et al., 2019) (Figure 5). Based on the movements provided, 10.4% said linear motion, 14.1% went for a zigzag motion option, 31.1 % opted for circular motion, 5.9% -none of the above, and 38.5% said all the above (Figure 6). Passive brushing, the duration is more with the moment slick circling and horizontal strokes (Ganss et al., 2018). Based on the parameters varied answers were obtained. 9.6% choose the option resistance of the substrate to abrasion, the same percentage 9.6%-abrasiveness of the abrasive. Based on the version of the toothbrush bristle, the abrasion varies.   This is high with a feathered toothbrush which also causes lesions Turssi et al., 2019). 14.8% -effects of different kinds of movements, 11.9% say different kinds of toothbrush, 5.2%-effects of varying pressure, 45.2% say all the above and the remaining 3.7% choose the options none of above (Park et al., 2018). Showed almost similar results with the study (Figure 7). 23.1% say that the tooth surface can be used as a substrate. Whereas 14.2% -restorative material as the substrate, 56.7% -the majority of the people say all the above and 6% choose the options none of the above this is most similar to Weignands research (Wiegand et al., 2013) (Figure 8). 33.3% say that they have used a brushing simulator for a previous study and 66.7% of them have not used it previously (Figure 9). 25.2% have the idea of using it in the future and 43.7% have said no that they will not be using it in the future, 31.1% may have the idea of using it. Brushing force is usually higher for sonic toothbrush and with manual toothbrush dentin face the highest abrasion when compared to the enamel (Wiegand et al., 2013) (Figure 10).
When comparing the awareness of brushing simulator with gender, it was shown that females had a higher level of awareness about the brushing simulator when compared with males (p= 0.029), which was statistically signi icant. (Table 1 and Figure 11).      When comparing the knowledge about the uses of brushing simulator with gender, it was shown that females had a higher level of knowledge about the uses of brushing simulator when compared with males. (p= 0.013), which was statistically signi icant. (Table 2 and Figure 12). When comparing the knowledge about the types of brushing simulator movements with gender, it was shown that females had a higher level of knowledge when com-   pared with males.(p= 0.034), which was statistically signi icant. (Table 3 and Figure 13).
Previously many surveys (Manohar and Sharma, 2018;Jose et al., 2020), reviews (Kumar and Antony, 2018;R and Ms, 2019), in-vitro studies (Ramanathan and Solete, 2015;Rajendran et al., 2019;Janani et al., 2020), molecular and clinical studies (Nasim and Nandakumar, 2018;Ramamoorthi et al., 2015;Ramesh et al., 2018;Teja and Ramesh, 2019) were done by our team to get better knowledge and awareness in dentistry. Based on these, many kinds of research are being conducted and the present study is one of the irst in literature to be done among chennai dentists. Finally, in the present study the people were asked what they wanted to study using a brushing simulator, different responses were received, some of them were like to check the effect of enamel, their assistance, the operation, and also to check the strength of restoration. The limitations of the present study is less sample size. Data presented in the study can be self-reported and also active involvement of participants is required. The scope is that it can be used in research and also in creating knowledge among the people.
In Figure 11, (X-axis represents gender and Y-axis represents no.of respondents; Chi-Square test done. P-value = 0.029, which is statistically signi icant). In Figure 12, (X-axis represents gender with response and the Y-axis represents no.of respondents; Chi-Square test done. P-value = 0.013, which is statistically signi icant). In Figure 13, (X-axis represents gender with response and Y-axis represents no.of respondents; Chi-Square test done. P-value = 0.034, which is statistically signi icant)

CONCLUSIONS
The indings in the study state that the majority of the people are aware of the simulation of brushing but the awareness and knowledge about the brushing simulator machine is quite less and people are mostly not aware of the uses, parameters, the movements, and other purposes of this machine. The people need to be educated about the brushing simulator as it is an important machine that helps in enhancing dentistry.