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Powered toothbrushes may be more effective at removing plaque in healthy adults than manual toothbrushes

Elkerbout T, Slot D, Rosema NA, et al. How effective is a powered toothbrush as compared to a manual toothbrush? A systematic review and meta-analysis of single brushing exercises Int J Dent Hygiene. 2020; 18:17-26.

Review question

Do powered toothbrushes remove plaque more effectively than manual toothbrushes after one use in healthy adults?

Background

Dental plaque build-up can lead to gingivitis and chronic periodontitis. Oral hygiene habits that help to regularly remove plaque are essential for maintaining good oral health. Past studies have found that powered toothbrushes may be more effective than manual toothbrushes in reducing plaque and gingivitis over periods of 3 months or longer, while noting the need for further research. However, collective evidence directly comparing the effectiveness of plaque removal after a single brushing exercise between powered toothbrushes and manual toothbrushes is needed. Single brushing exercises help to manage other influencing factors, such as frequency of brushing and compliance by study participants. 

How the review was done

This is a systematic review and meta-analysis of 16 randomized controlled trials and 1 controlled clinical trial. The studies were published between 1989 and 2018, and included a total of 1,153 participants. Key features of the studies:

• Participants were adults, aged 18 years old or over, in good general health and with no periodontitis, orthodontic treatment (e.g., treatments fixing the positioning of the teeth), removable prosthesis (e.g., dentures), or dental implants.
• Participants brushed their own teeth with a single-headed manual toothbrush or a single-headed rechargeable powered toothbrush.
• Studies differed in the toothbrush brands used, the mode of action of the powered toothbrushes used (e.g., oscillating‐rotating [head of the brush rotates in one direction and then another], side-to-side [head of the brush moves from side-to-side], circular [head of the brush rotates in one direction], or counter-oscillation [clusters of bristles move in one way and then the other, with clusters always moving in the opposite direction of the clusters next to them]), instruction method (none, written, or visual), brushing duration (between 30 seconds to unrestricted), and how plaque scores were assessed.
• Researchers measured changes in full-mouth plaque scores before and after a single brushing exercise.
• Results were compared between those who used a powered toothbrush and those who used a manual toothbrush.  

What the researchers found

Overall, powered toothbrushes removed more plaque after a single brushing exercise than manual toothbrushes. The difference was small but statistically significant. This effect was seen regardless of the method used to assess the plaque score. All modes of action for powered toothbrushes were included in the overall assessment, however there was only sufficient data to look at oscillating‐rotating and side-to-side modes of action separately. This closer look showed that both oscillating‐rotating and side-to-side powered toothbrushes were more effective than manual toothbrushes at removing plaque.

The findings were based on moderate certainty evidence, meaning that future studies may show different results. The most effective mode of action and brand of toothbrush could not be determined from this review due to a lack of direct comparisons. It should be noted that many of the studies included in the review were industry-financed, so there is a potential for selective reporting of results.

Conclusion

Powered toothbrushes may be more effective at removing plaque than manual toothbrushes in healthy adults after a single brushing exercise.