Intervention Review

Manual versus powered toothbrushing for oral health

  1. Peter Robinson1,*,
  2. Scott A Deacon2,
  3. Chris Deery3,
  4. Mike Heanue4,
  5. A Damien Walmsley5,
  6. Helen V Worthington6,
  7. Anne-Marie Glenny7,
  8. Bill C Shaw6

Editorial Group: Cochrane Oral Health Group

Published Online: 20 APR 2005

Assessed as up-to-date: 16 FEB 2005

DOI: 10.1002/14651858.CD002281.pub2

How to Cite

Robinson P, Deacon SA, Deery C, Heanue M, Walmsley AD, Worthington HV, Glenny AM, Shaw BC. Manual versus powered toothbrushing for oral health. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD002281. DOI: 10.1002/14651858.CD002281.pub2.

Author Information

  1. 1

    School of Clinical Dentistry, Department of Dental Public Health, Sheffield, UK

  2. 2

    Frenchay Hospital, South West Cleft Unit, Bristol, UK

  3. 3

    Edinburgh Dental Institute, Department of Paediatric Dentistry, Edinburgh, Scotland, UK

  4. 4

    Private Dental Practice, Dental Surgery, Sheffield, UK

  5. 5

    School of Dentistry, Department of Prosthetic Dentistry, Birmingham, UK

  6. 6

    School of Dentistry, The University of Manchester, Cochrane Oral Health Group, MANDEC, Manchester, UK

  7. 7

    MANDEC, School of Dentistry, The University of Manchester, Cochrane Oral Health Group, Manchester, UK

*Peter Robinson, Department of Dental Public Health, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA, UK. peter.g.robinson@sheffield.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 APR 2005

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Plain language summary

Background

Removing dental plaque may play a key role maintaining oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this.

Objectives

To compare manual and powered toothbrushes in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost.

Search methods

We searched the Cochrane Oral Health Group Trials Register (to July 2004) and CENTRAL (The Cochrane Library 2004, Issue 2); MEDLINE (January 1966 to week 2 June 2004); EMBASE (January 1980 to week 2 2004) and CINAHL (January 1982 to week 2 June 2004). Manufacturers were contacted for additional data.

Selection criteria

Trials were selected for the following criteria: design-random allocation of participants; participants - general public with uncompromised manual dexterity; intervention - unsupervised manual and powered toothbrushing for at least 4 weeks. Primary outcomes were the change in plaque and gingivitis over that period.

Data collection and analysis

Six authors independently extracted information. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using random-effects models. Potential sources of heterogeneity were examined, along with sensitivity analyses for quality and publication bias. For discussion purposes SMD was translated into percentage change.

Main results

Forty-two trials, involving 3855 participants, provided data.

Brushes with a rotation oscillation action removed plaque and reduced gingivitis more effectively than manual brushes in the short term and reduced gingivitis scores in studies over 3 months. For plaque at 1 to 3 months the SMD was -0.43 (95% CI: -0.72 to -0.14), for gingivitis SMD -0.62 (95% CI: -0.90 to -0.34) representing an 11% difference on the Quigley Hein plaque index and a 6% reduction on the Löe and Silness gingival index. At over 3 months the SMD for plaque was -1.29 (95% CI: -2.67 to 0.08) and for gingivitis was -0.51 (-0.76 to -0.25) representing a 17% reduction on the Ainamo Bay bleeding on probing index. There was heterogeneity between the trials for the short-term follow up. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. There was no evidence of any publication bias.

No other powered designs were as consistently superior to manual toothbrushes.

Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and temporary.

Authors' conclusions

Powered toothbrushes with a rotation oscillation action reduce plaque and gingivitis more than manual toothbrushing.

Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Plain language summary

Manual versus powered toothbrushing for oral health

When compared to manual toothbrushes, powered toothbrushes with a rotation oscillation action provide protection against gum inflammation in the long and short term and better plaque removal in the short term.
Removing dental plaque by toothbrushing helps prevent gum inflammation (gingivitis). Toothbrushing with a fluoride toothpaste prevents tooth decay.
Powered toothbrushes simulate manual toothbrushing in different ways (such as moving side to side or circular motions). The review of trials found that only rotation oscillation (where brush heads rotate in one direction and then the other) is better than manual toothbrushes at removing plaque and reducing gum inflammation, and is no more likely to cause injuries to gums. Long- term benefits of this for dental health are unclear.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Plain language summary

背景

手動刷牙和電動牙刷對口腔健康的影響

去除牙菌斑是保持口腔健康的關鍵。為達到這一目的,使用手動或電動牙刷的相對優點之證據是有矛盾的。

目標

比較手動和電動牙刷,在於去除牙菌斑,對牙齦的健康,染色和牙結石,可靠性,副作用和成本。

搜尋策略

我們檢索了Cochrane Oral Health Group Trials Register資料(至17/06/2004)和Central Register of Controlled Trials(Cochrane圖書第2期,2004年);使用MEDLINE檢索(1966年1月至2004年6月);EMBASE(1980年1月至2004年)和CINAHL(1982年1月至2004年6月)。會和製造商聯繫,以獲得額外數據。

選擇標準

選擇試驗的標準包括以下幾項:設計是隨機分配參與者的;參與者是一般民眾,手的靈巧是沒有問題的;作法無監督情況下,使用手動和電動牙刷至少4週。主要結果是看這一時期,牙菌斑和牙齦炎的變化。

資料收集與分析

6位作者會獨立去取資料。每個metaanalysis的分析,會以standardised mean difference(SMD),95%的信賴區間(CI),使用隨機效應模式來評估。可能潛在的異質性會被研究,以及品質和發表偏差的敏感度分析。為便於討論,SMD被轉換成比例的改變。

主要結論

總共42個試驗,涉及3855位參與者,提供數據。一個旋轉振盪的方式來清除牙菌斑,和減少牙齦炎,在短期內,是比手動更有效地,並且在超過3個月的研究哩,可以減少牙齦炎指數。牙菌斑在1至3個月的SMD為 −0.43(95%信賴區間為: −0.72至 −0.14),對牙齦炎SMD為 −0.62(95%信賴區間為: −0.90至 −0.34),表示Quigley Hein plaque index有11%的差距,而Loe and Silness牙齦指數減少6%。在3個月以上的牙菌斑SMD為 −1.29(95%信賴區間為: −2.67到0.08)和牙齦炎是 −0.51(−0.76至 −0.25),表示Ainamo Bay bleeding on probing index減少17%。 在短期追蹤的試驗中,有些異質性。敏感性分析顯示,當用高標準選擇試驗的時候,這些結果更為顯著。沒有證據顯示任何出版發表的偏差。也沒有其他電動牙刷設計,是一貫從頭至尾優於手動牙刷的。關於成本,可靠性及不良反應的報告是不一致的。任何被報告出的副作用都是局部且暫時的。

作者結論

電動牙刷的旋轉振盪方式,可以比手動刷牙更能減少牙菌斑和牙齦炎。實驗方法指標的觀察和更好的標準化設計,將有利於今後的試驗和metaanalyses。

翻譯人

本摘要由臺灣大學附設醫院蕭琁憶翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

相較於手動牙刷,電動牙刷的旋轉振動方式,提供對抗牙齦炎症的長期和短期保護,以及在短期較好的清除牙菌斑方式。用牙刷移除牙菌斑,有助於防止牙齦發炎(牙齦炎)。用含氟牙膏刷牙可以防止齲齒。 電動牙刷是以不同的方式模擬手動刷牙(如從移動一邊到另一邊或圓形運動)。在回顧一些試驗後發現,只有旋轉振盪的電動牙刷(刷頭旋轉一個方向,然後換另一個方向)在去除牙菌斑和減輕牙齦發炎這項目中,是優於手動牙刷的,但也可能會造成牙齦受傷。但長期來講,對牙齒健康的影響仍是不清楚。

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Plain language summary

Manualne naspram električnih četkica za zube za očuvanje oralnog zdravlja

Manualne naspram električnih četkica za zube za očuvanje oralnog zdravlja

U usporedbi sa manualnim četkicama, električne četkice s rotacijsko-oscilirajućim djelovanjem pružaju zaštitu protiv upale desni nakon dugotrajnog i kratkotrajnog korištenja, a u većoj mjeri smanjenju plak nakon kratkotrajnog korištenja.Uklanjanje zubnog plaka četkanjem pomaže u prevenciji upale desni (gingivitisa). Četkanje uz uporabu zubnih pasti s fluorom sprječava nastanak karijesa.Električne četkice simuliraju manualno četkanje na razne načine (kretanje s jedne strane na drugu kao i kružni pokreti). Sustavni pregled pronašao je da su samo četkice s rotirajućim i oscilacijskim kretnjama ( kod kojih se glava četkice okreće malo u jednom pa malo u drugom smjeru) bolje od manualnih četkica u uklanjanju plaka i smanjenju upale desni, a pritom ne uzrokuju ništa češće ozljede zubnoga mesa. Međutim, dugotrajne koristi električnih četkica na zdravlje zubi nisu istražene..

Translation notes

Translated by: Croatian Branch of the Italian Cochrane Centre