A Comparison of Pre- and Postbreakfast Tooth Brushing in Caries Prevention through the Estimation of Streptococcus mutans Counts: A Prospective Clinical and Microbiological Study

OBJECTIVES: The purpose of this study was to compare the efficacy of prebreakfast tooth brushing (PrBTB) and postbreakfast tooth brushing (PoBTB) with or without a prebrushing rinse in caries prevention through the estimation of Streptococcus mutans count. MATERIALS AND METHODS: Sixty consenting dental students were divided into three age-matched groups of 20 each and instructed to follow prebreakfast, postbreakfast tooth brushing, and prebreakfast rinsing plus PoBTB using the Bass technique. Plaque samples were collected at the start and at the end of every quarter for a total of 6 quarters (18 months) for the evaluation of S. mutans colony-forming unit (CFU) counts. The decayed missing filled surface (DMFS) index of participants was also recorded and compared at the beginning and end of the study period. RESULTS: The post-breakfast tooth brushing group with pre-breakfast rinse (RPoBTB) and without pre-breakfast rinse (PoBTB) showed a highly significant reduction in total S. mutans CFU counts per ml (38% and 29% respectively) at the end of the study. The changes in DMFS value were not significant and did not show any correlation with the S. mutans counts. CONCLUSION: Our study revealed that PoBTB with or without a prebreakfast rinse reduces the total counts of the cariogenic bacteria S. mutans more efficiently than PrBTB. Although further proof in the form of clinical trials is essential, this study provides the proof of concept for a minor change in the tooth brushing habit, which can significantly enhance caries prevention.