The Effectiveness of Manual Versus Powered Toothbrushes. An Update

Objectives: To compare manual and powered toothbrushes in everyday use, principally in relation to plaque removal and gingival health, and secondarily stain and calculus removal, dependability, adverse effects and cost. Method: An update of a Cochrane systematic review was undertaken. Six electronic databases were searched to identify relevant randomised controlled trials (RCTs), irrespective of language of publication. Two reviewers independently reviewed the abstracts identified using defined criteria. Subsequently, data were abstracted independently and in duplicate from all relevant trials. Only RCTs of 28 days duration or longer were eligible for inclusion. Outcomes were analysed as short term (1 to 3 months) or long-term (>three months). Powered brushes were categorised into 7 groups depending on mode of action. Data extracted were checked by a third reviewer for accuracy and entered into RevMan (version 4.2). Results: The original review included 29 trials. The update identified an additional 13 trials; 10 new trials and 3 trials identified in the original search for which information provided by the authors permitted their inclusion. Thirty-four (2,295 participants) reported short-term and 10 trials (705 participants) long-term plaque scores. Thirty-nine trials (2,870 participants) reported short-term and 12 trials (1,372 participants) long-term gingivitis scores. Rotation oscillation powered brushes statistically significantly reduced plaque (11%) and gingivitis (6%) in the short-term and gingivitis (17%) in the long-term. Plaque scores were also significantly reduced by counter oscillation (long-term only) and ionic brushes (long-term only). Gingivitis scores were significantly reduced by ultrasonic (short-term only) and ionic (long-term only) brushes. Regarding the secondary objectives little data were presented on costs or reliability. Conclusion: This update confirms that Rotation oscillation powered brushes significantly reduce gingivitis in the short and long-term and plaque in the short-term. More research is needed of the long-term effects of powered brushes. The clinical significance of these reductions is not known.