Novel Effects of Traditional Wooden Toothbrush on Bowel Motility Symptoms in Spinal Cord Injury Patients; Findings from a Pilot Quasi-experimental Study

BACKGROUND The aim of this study was to investigate the therapeutic effect of traditional wooden toothbrush usage on most severe constipation, which usually occurs in spinal cord injury (SCI) patients. METHODS In a quasi-experimental study, 61 SCI patients were selected who had injuries in different spinal levels (cervical, thoracic, and lumbar), and severe constipation from one defection in a few days to 3 weeks. They were recommended to use traditional wooden toothbrush for 5 min twice a day, after breakfast and dinner, over a 6 weeks period. Two proper standard scales, called neurogenic bowel dysfunction (NBD), and "Constipation Assessment Scale (CAS)," were used for evaluating the changes in patients' gastrointestinal (GI) habits during the period of using the wooden toothbrush. Through these scales (NBD and CAS), the therapeutic effects of traditional wooden toothbrush usage on the severity of constipation before and after intervention were measured. RESULTS The mean of NBD and CAS scores were reduced significantly, from 8.95 ± 0.78 and 3.34 ± 0.28; respectively, to 3.03 ± 0.57 and 1.74 ± 0.25, after 6 weeks using traditional wooden toothbrush (P < 0.0001). There was a significant difference in terms of NBD scores in patients with different levels of injury (P < 0.01), particularly in patients with thoracic injury, before (10.52 ± 0.88) and after (3.13 ± 0.78) treatment, respectively (P < 0.0001). Eventually, all symptoms of bowel problems improved significantly after the intervention (P < 0.05). CONCLUSIONS The use of traditional wooden toothbrush lead to the improvement of bowel and defecation problems in SCI patients. Yet more studies, particularly randomized control clinical trials are needed to investigate the effect of using wooden toothbrush on other GI reflexes. In addition, if some clinical trials are devised to study the effects of wooden toothbrush on both conscious and unconscious patients in ICU, best results are expected to be found on keeping their mouth and teeth hygiene, as well as, getting rid of their constipations.