Comparative Analysis of Silicone Mouth Swabs with Varying Hardness Levels for Optimal Plaque Removal in Elderly Oral Care

Abstract

Purpose: Silicone mouth swabs have emerged as a promising alternative to gauze, sponge brushes, and soft-bristled toothbrushes, offering a balance between gentle cleaning and effectiveness. The flexibility and softness of silicone make it a suitable material for safely cleaning the sensitive oral tissues of elderly patients. This study aims to determine the optimal hardness level of silicone that maximises cleaning effectiveness while minimising the risk of trauma to oral tissues. Materials and Methods: A pseudo-plaque was created by mixing 6.0 g of Thicken Up Clear food additive with 12.0 ml of water and food colouring, which was then spread onto a NISSIN dentoform silicone rubber sheet (simulated soft tissue) with a thickness of 2.0 mm. Silicone heads with different hardness levels – 20, 30, 40, 50, and 60 Shore A – were attached to a V.P.2000 tooth brushing machine, operating at 75 rounds per minute with a force of 1.96 N. Each swab was used to brush the surface 25 times (n = 16 for each group). Results: A one-way analysis of variance (ANOVA) revealed a statistically significant difference in pseudo-plaque removal among the five hardness levels, with an F-value of 106.161 (degrees of freedom = 4, 75, p < 0.001). The Games-Howell pairwise comparison test showed that all five silicone hardness levels differed significantly from each other in their effectiveness in removing pseudo-plaque (p < 0.05). No visible simulated soft tissue damage was observed before and after brushing, as inspected with a stereomicroscope in all experiments. Conclusion: The silicone oral swab with a hardness level of 60 Shore A was found to maximise pseudo-plaque removal in vitro. This finding is crucial for the development of specialised oral hygiene tools tailored to the needs of the elderly population, thereby enhancing oral health and overall well-being.