Rose, JenniferGhoneima, AhmedLippert, FrankMaxwell, LisaEckert, GeorgeStewart, Kelton T.2022-08-172022-08-172020-11-01Rose J, Ghoneima A, Lippert F, Maxwell L, Eckert G, Stewart KT. A visual evaluation of oral plaque removal utilizing an adjunct enzyme pre-rinse in orthodontic subjects. Angle Orthod. 2020;90(6):844-850. doi:10.2319/120819-776.1https://hdl.handle.net/1805/29804Objective: To determine if an adjunct proteolytic pre-rinse along with contemporary methods of dental cleaning may more effectively remove visual plaque in subjects with fixed orthodontic appliances. Materials and methods: Forty-three orthodontic subjects, ages 10 to 25, completed this single site, double-blind, crossover clinical trial. Subjects randomly received bromelain enzyme or a powdered-sugar placebo pre-rinse, followed by manual tooth brushing and use of a Waterpik. Subjects received the alternate pre-rinse during the subsequent visit. Baseline and residual plaque accumulation were recorded via disclosing tablet and digital photography. A single, blinded examiner scored visual plaque scores from randomized photographs. Treatment effects on composite plaque score were evaluated using repeated-measures analysis of variance. A 5% significance level was used for all tests. Results: No significant differences in plaque scores were noted at baseline or post-rinse between the enzyme and placebo. The changes from baseline to post-rinse (P = .190), post-brushing (P = .764), and post-Waterpik (P = .882) were not significantly different between interventions. Significant reduction in plaque scores were observed in both arms of the study after brushing (P < .01) and waterjet use (P < .01). Neither age (P = .220) nor gender (P = .449) impacted plaque scores. Conclusions: Use of a bromelain enzyme pre-rinse alone did not significantly enhance plaque removal. A significant reduction in retained plaque was observed with the application of brushing and or Waterpik.en-USPublisher PolicyBromelainFixed orthodontic treatmentOral hygieneOral plaque removalProteolytic enzymeArticle