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Background: Powered brushes were first introduced commercially in the 1960s. A recent systematic review suggested the superiority of certain modes of powered over manual toothbrushing for plaque and gingivitis reduction. That review did not allow for direct comparison between different modes of powered toothbrush.
Objectives: To compare different modes of powered toothbrushing against each other for plaque reduction and the health of the gingivae. Other factors to be assessed were calculus and stain removal, cost, dependability and adverse effects.
Search strategy: The following databases were searched: Cochrane Oral Health Group’s Trials Register (to 26 July 2010); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3); MEDLINE via OVID (1950 to 26 July 2010); EMBASE via OVID (1980 to 26 July 2010); CINAHL via EBSCO (1982 to 26 July 2010). There were no language restrictions.
Selection criteria: Trials were considered for inclusion with the following criteria: random allocation of participants; no compromised manual dexterity; unsupervised powered toothbrushing for at least four weeks. The primary outcomes were the plaque and gingivitis scores after powered toothbrush use during trial period.
Data collection and analysis: Data extraction was performed independently and in duplicate. The authors of trials were contacted to provide missing data where possible. The effect measure for each meta-analysis was the standardized mean difference (SMD) with 95% confidence intervals (CI) using the random-effects model. Potential sources of heterogeneity were assessed.
Main results: The review included data from 15 trials with 1015 participants. Due to the dearth of trials assessing the same mode of action, no definitive conclusions can be stated regarding the superiority of one mode of powered toothbrush over any other. Only minor and transient side effects were reported. Cost, dependability were not reported.
Authors’ conclusions: Further trials of good quality are required to establish if any mode of action has superiority over the other modes of action for powered toothbrushes.
PLAIN LANGUAGE SUMMARY
Different types of powered toothbrushes for plaque control and healthy gums
Powered brushes were first introduced commercially in the 1960s. A previously published Cochrane systematic review suggested one type of powered brush was superior to manual toothbrushing for the removal of plaque and reduction of gum inflammation. That review did not allow direct comparison between the different types of powered toothbrushes.
This review included data from 15 trials with 1015 participants. Due to the low numbers of trials using different types of powered brushes, no definitive conclusions can be drawn regarding the superiority of any one type of powered toothbrush over another. Only minor and transient side effects were reported. Cost and reliability of the brushes were not reported in the trials.
Further trials of good quality are required to establish if any type of powered brush has superiority over the other types of action for powered toothbrushes.
The Cochrane Collaboration is an international organization that aims to help people make well-informed decisions about healthcare by preparing, maintaining and promoting the accessibility of systematic reviews on the effects of healthcare interventions. The Cochrane Oral Health Group aims to produce systematic reviews which primarily include all randomized control trials (RCTs) of oral health, including prevention, treatment and rehabilitation of oral, dental and craniofacial diseases and disorders. Full copies of the review papers can be accessed electronically at http://www.cochrane.org/reviews/index.htm, clicking on ‘Login to the Cochrane Library’, followed by clicking on ‘Cochrane Reviews’, and selecting the appropriate review. This is a free service provided by the Australian Government.
The Australian Dental Journal publishes selected abstracts in each issue for our readers’ interest. A detailed description of the activities of the Cochrane Oral Health Group, written by the Review Group Co-ordinator, Dr Emma Tavender, was published in the June 2004 issue of the Journal (Aust Dent J 2004;49:58–59). Also, for explanations of abbreviations and terminology please see Appendix 1 on page 59 of the aforementioned article. EDITOR
Reproduced with permission of SA Deacon, A-M Glenny, C Deery, PG Robinson, M Heanue, AD Walmsley, WC Shaw. Different powered toothbrushes for plaque control and gingival health. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.: CD004971. DOI: 10.1002/14651858.CD004971.pub2. Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Mechanical plaque removal is vital for continued oral health and maintenance of improvements following periodontal therapy. However, the majority of the population don’t brush particularly well or for long enough, leaving a substantial amount of plaque behind.1 The 1998 European Workshop on Mechanical Plaque Control reported that manual OH is dependent on technique with, on average, 60% of plaque left.2 Although Lang et al.3 suggested the optimum frequency of brushing to be once every 48 hours, this was in a population of very dentally aware individuals with high quality brushing. We currently recommend twice daily for our patients due to the amount of plaque left which is partly based on practicality. The frequency aims to overcome the lack of quality. In addition, McCracken et al.4 and van der Weijden et al.5 showed that longer than two minutes is no more effective. Patients on average brush for about 40 seconds, not two minutes.6
The use of an electric toothbrush can improve the efficacy of brushing.7 Deery et al.8 in a systematic review of 29 studies stated that electric toothbrushes removed more plaque and reduced gingivitis more than manual toothbrushing, removed more plaque than manual toothbrushing in the same time and, in the recommended two minutes, roughly 84% of plaque is removed. Therefore, the use of an electric toothbrush is warranted. A number of trials have compared manual toothbrushes to electric, showing superiority of the electric brush,9 but there is a dearth comparing types and makes of electric toothbrushes. There are many types of electric toothbrushes available, ranging from the cheaper battery-operated to the expensive rechargeable. Typical modes of action include vibration, oscillation, rotation, sonic or a combination of these. One would think the more expensive a brush, the better it would be, but the evidence is lacking. In a recent Periodontology 2000 review, Claydon suggested that small round rotating oscillating brush heads were slightly more effective than other brush types.10
The abstract above reports the systematic review comparing the different types of electric toothbrushes. As with many Cochrane reviews, the heterogeneity of the data is such that no firm conclusions can be made, except that further work is needed. The strict inclusion criteria also result in the exclusion of many articles. The authors managed only to include 15 papers with just over 1000 subjects. They were unable to differentiate between cost, model, manufacturer and mode of action. All that can be said is that no matter which electric brush used, it will be better than a manual brush, which has been confirmed in a number of other analyses.
In the management of oral health I think it important that we don’t forget the need of interproximal cleaning. Electric toothbrushes will still not reach interproximally. Sonic brushes are meant to have a radius of effect, whereby the sonic waves disrupt plaque not directly disturbed by the brush head. The limitation is the data used in the review did not allow for comment on this. Therefore, it is clear there is still a need for mechanical interproximal plaque removal by the patient. Interestingly, the selection criteria excluded patients who perhaps have more need of an electric toothbrush, such as those with limited manual dexterity.
In summary, the review shares many of the issues with Cochrane reviews, allowing no firm conclusions to be made on the question of which electric toothbrush is better. The review confirms previous reviews suggesting that an electric brush enables better plaque removal than a manual toothbrush.