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Cited by 374Oral microbiology and periodontitis researchDental Health and Care UtilizationOral Health Pathology and Treatment

Powered versus manual toothbrushing for oral health

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Yaacob, Munirah, Worthington, Helen V, Deacon, Scott A, Deery, Chris, Walmsley, A Damien, Robinson, Peter G, Glenny, Anne-Marie·2014·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd002281.pub3PMC PMC7133541
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Abstract

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. This is an update of a Cochrane review first published in 2003, and previously updated in 2005. OBJECTIVES: To compare manual and powered toothbrushes in everyday use, by people of any age, 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 following electronic databases: the Cochrane Oral Health Group's Trials Register (to 23 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE via OVID (1946 to 23 January 2014), EMBASE via OVID (1980 to 23 January 2014) and CINAHL via EBSCO (1980 to 23 January 2014). We searched the US National Institutes of Health Trials Register and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised controlled trials of at least four weeks of unsupervised powered toothbrushing versus manual toothbrushing for oral health in children and adults. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration. Random-effects models were used provided there were four or more studies included in the meta-analysis, otherwise fixed-effect models were used. Data were classed as short term (one to three months) and long term (greater than three months). MAIN RESULTS: Fifty-six trials met the inclusion criteria; 51 trials involving 4624 participants provided data for meta-analysis. Five trials were at low risk of bias, five at high and 46 at unclear risk of bias.There is moderate quality evidence that powered toothbrushes provide a statistically significant benefit compared with manual toothbrushes with regard to the reduction of plaque in both the short term (standardised mean difference (SMD) -0.50 (95% confidence interval (CI) -0.70 to -0.31); 40 trials, n = 2871) and long term (SMD -0.47 (95% CI -0.82 to -0.11; 14 trials, n = 978). These results correspond to an 11% reduction in plaque for the Quigley Hein index (Turesky) in the short term and 21% reduction long term. Both meta-analyses showed high levels of heterogeneity (I(2) = 83% and 86% respectively) that was not explained by the different powered toothbrush type subgroups.With regard to gingivitis, there is moderate quality evidence that powered toothbrushes again provide a statistically significant benefit when compared with manual toothbrushes both in the short term (SMD -0.43 (95% CI -0.60 to -0.25); 44 trials, n = 3345) and long term (SMD -0.21 (95% CI -0.31 to -0.12); 16 trials, n = 1645). This corresponds to a 6% and 11% reduction in gingivitis for the Löe and Silness index respectively. Both meta-analyses showed high levels of heterogeneity (I(2) = 82% and 51% respectively) that was not explained by the different powered toothbrush type subgroups.The number of trials for each type of powered toothbrush varied: side to side (10 trials), counter oscillation (five trials), rotation oscillation (27 trials), circular (two trials), ultrasonic (seven trials), ionic (four trials) and unknown (five trials). The greatest body of evidence was for rotation oscillation brushes which demonstrated a statistically significant reduction in plaque and gingivitis at both time points. AUTHORS' CONCLUSIONS: Powered toothbrushes reduce plaque and gingivitis more than manual toothbrushing in the short and long term. The clinical importance of these findings remains unclear. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and only temporary.

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  • Similar results were demonstrated for parameters of gingivitis, which improved by 6% in short-term and by 11% in long-term studies.

    “Similar results were demonstrated for parameters of gingivitis, which improved by 6% in short-term and by 11% in long-term studies.”

    From Contemporary practices for mechanical oral hygiene to prevent periodontal disease. (2020) · cites this paper as [30]

    The Main Results report that powered toothbrushes significantly reduced gingivitis compared with manual toothbrushes in both short- and long-term studies. The passage in our copy cuts off before giving the long-term estimate and does not state the claimed 6% and 11% improvements, so those figures cannot be verified. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • A Cochrane Collaboration meta-analysis demonstrated superior reduction in plaque index score in short-term studies (1-3 months) of 11%, and in long-term studies (>3 months) of 21%, for oscillating-rotating toothbrushes compared with manual toothbrushes.

    “A meta-analysis by the Cochrane Collaboration demonstrated a superior reduction in the plaque index score in short-term studies (1-3 months) of 11%, and in long-term studies (>3 months) of 21%, for oscillating-rotating toothbrushes compared with manual toothbrushes.30”

    From Contemporary practices for mechanical oral hygiene to prevent periodontal disease. (2020) · cites this paper as [30]

    The Main Results report 11% and 21% short- and long-term plaque reductions for powered toothbrushes collectively compared with manual toothbrushes. They also report significant plaque reductions for rotation-oscillation brushes at both time points, but do not assign those percentages specifically to that brush type. No page number is provided in our copy. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • There is a possible risk of bias in the Cochrane meta-analysis.

    “However, the authors point out that there is a possible risk of bias.”

    From Contemporary practices for mechanical oral hygiene to prevent periodontal disease. (2020) · cites this paper as [30]

  • Long-term data on toothbrushing and gingival recession are scarce.

    “Long-term data, however, are scarce.5,30”

    From Contemporary practices for mechanical oral hygiene to prevent periodontal disease. (2020) · cites this paper as [30]

    The available passage (Main Results; page not supplied) defines long-term follow-up and reports long-term plaque results, but says nothing about gingival recession. Searches for recession and long-term adverse effects found no relevant passage; the available text ends mid-sentence, so it cannot establish whether recession data were scarce. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

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Authors
Yaacob, M., Worthington, H. V., Deacon, S. A., Deery, C., Walmsley, A. D., Robinson, P. G., & Glenny, A.-M.
Affiliations
  • International Islamic University Malaysia (MY)
  • University of Manchester (GB)
  • Frenchay Hospital (GB)
  • University of Sheffield (GB)
  • University of Birmingham (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2014-06-17
Volume
2014
Issue
6
Pages
CD002281-CD002281
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd002281.pub3
PMC
PMC7133541
OpenAlex
W1857110780
Cited by
374
References
218
Citations by year
2026: 22 · 2025: 27 · 2024: 37 · 2023: 45 · 2022: 31 · 2021: 49 · 2020: 43 · 2019: 31 · 2018: 29 · 2017: 28 · 2016: 15 · 2015: 13 · 2014: 3
FWCI
3.31
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, other-oa)
  • University of Birmingham Research Portal (University of Birmingham) (publishedVersion)
  • Explore Bristol Research (submittedVersion)
Topics
  • Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
  • Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
  • Health Sciences › Dentistry › Periodontics › Oral Health Pathology and Treatment
Keywords
powered toothbrushes, manual toothbrush, dental plaque removal, gingival health, gingivitis, gingival bleeding, tooth discoloration, dental calculus, oral hygiene, toothbrushing frequency, toothbrushing duration, children, adults, cost-effectiveness, adverse effects, oral health behavior
MeSH terms
Dental Devices, Home Care, Dental Plaque, Gingival Diseases, Gingivitis, Humans, Oral Health, Periodontal Diseases, Toothbrushing, Randomized Controlled Trials as Topic

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