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

The DOI matches its Crossref record; 205 of the 218 references it cites were found in a registry or an index.

Powered versus manual toothbrushing for oral health

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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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  1. Dentino, 1999, Evaluation of powered vs manual toothbrushing on plaque, calculus and stain, Journal of Dental Research, 78, 413 (Abstract N
  2. Dentino, 1999, Comparison of powered vs manual toothbrushing on gingivitis reduction, Journal of Dental Research, 78, 413 (Abstract N
  3. Hickman, 2002, Powered vs manual tooth brushing in fixed appliance patients: a short term randomized clinical trial, The Angle Orthodontist, 72, 135
  4. Lapiere, 1997, Effectiveness of three toothbrushes for plaque removal in patients with low compliance. (Europerio 2), Journal of Clinical Periodontology, 24, 863
  5. Lazarescu, 2000, Comparative study of an electric and manual toothbrush in patients unfamiliar with electric brushes, Journal of Dental Research, 79, 298 (Abstract N
  6. Singh, 2000, Efficacy of the Butler Pulse (TM) plaque remover in orthodontic patients, Journal of Dental Research, 79, 298 (Abstract N
  7. Ainamo, 1991, Effect of manual versus powered toothbrushes, Journal of Dental Research, 70, 557 (Abstract N
  8. Andreana, 1998, Clinical evaluation of the Ionoral toothbrush, Journal of Dental Research, 77, 211 (Abstract N
  9. Arceneaux, 1996, Efficacy of sonic Vs manual toothbrushes in maintaining oral health, Journal of Dental Research, 75, 86 (Abstract No
  10. Ciancio, 1998, Clinical comparison of the butler G-U-M(r) Pulse(tm) plaque remover to a manual and electric toothbrush, Journal of Dental Research, 77, 211 (Abstract N
  11. Cohen, 1964, Comparative effectiveness of manually and power operated toothbrushing on tooth deposits, Periodontics, 2, 122
  12. Conroy, 1966, Comparison of automatic and hand toothbrushes: cleaning effectiveness for children, ASDC Journal of Dentistry for Children, 33, 219
  13. Cross, 1962, A comparative study of tooth cleansing using conventional and electrically operated toothbrushes, British Dental Journal, 113, 19
  14. Danser, 2000, Efficacy of novel manual toothbrush compared to electric toothbrush, Journal of Dental Research, 79, 298 (Abstract N
  15. de Leeuw J Comparison between hand and electric toothbrushing Journal of Dental Research
  16. Dentino, 1999, Comparative evaluation of the safety of a powered versus a manual toothbrush over one year, Journal of Periodontology, 70, 230
  17. Doherty, 1999, Plaque removal efficacy of a Novel, advanced toothbrush, Journal of Dental Research, 78, 216 (Abstract N
  18. Doll, 1999, The efficiency of different toothbrushes in patients with fixed orthodontic appliances, European Journal of Orthodontics, 21, 581
  19. Galustian, 2002, Plaque removal efficacy of a battery-powered toothbrush versus a manual toothbrush, Journal of Dental Research, 81, A30
  20. Hall, 1971, Comparison of automatic and hand toothbrushes: toothbrushing effectiveness for preschool children, Journal of Dentistry for Children, 38, 309
  21. Heasman, 2001, Testing prototype brush heads for powered toothbrushes - refining the model, Journal of Dental Research, 80, 548 (Abstract N
  22. Hou, 2002, Plaque removal by a battery-powered toothbrush relative to a manual toothbrush, Journal of Dental Research, 81, A
  23. Johnson, 1994, Efficacy and safety of the Sonicare™: a clinical evaluation, Journal of Dental Research, 73, 434 (Abstract N
  24. Killoy, 1988, Comparative plaque removal with power contra-rotary and conventional toothbrushes, Journal of Dental Research, 67, 95
  25. Lange, 1978, [Uber die Plaquereduktion durch multi-Bursten in Verdindung mmit elektrischen Zahnbursten], Deutsche Zahnarztliche Zeitschrift, 33, 84
  26. Lim, 1995, Evaluation of a mechanical toothbrush for oral hygiene, Journal of Dental Research, 74, 589 (Abstract N
  27. Love, 1988, Effectiveness of a rotary action versus a manual toothbrush, Journal of Dental Research, 67, 125
  28. Mayer, 1978, [Rasterelektronenmikroskopische Untersuchungen der Zahnoberflache], Deutsche Zahnarzliche Zeitschrift, 33, 599
  29. McAllan, 1977, Oral hygiene instruction in children using manual and electric toothbrushes. Benefits after six months, Journal of Periodontology, 48, 409
  30. Morris, 1997, DICRG report: Differences in attachment levels; INTERPLAK (r) vs. manual toothbrushes: 24 month comparison, Journal of Dental Research, 76, 204 (Abstract N
  31. Moschen, 1999, Clinical comparative study of one manual and three electric toothbrushes with different mechanical movement patterns, Deutsche Zahnarztliche Zeitschrift, 54, 372
  32. Palmer, 1999, Plaque removal capabilities of one manual and five automated toothbrushes, Journal of Dental Research, 78, 216 (Abstract N
  33. Pelka, 2008, Time-dependent cleaning effectivity of the Sonicare in comparison with the ADA manual tooth brush, Parodontologie, 19, 344
  34. Rashid, 1998, The effect upon plaque and gingivitis of two electrical and one manual toothbrush, Journal Dental Research, 77, 845 (Abstract N
  35. Sato, 1995, Effect of plaque removal by new electric toothbrush, Journal of Dental Research, 74, 575 (Abstract N
  36. Schuler, 1996, Plaque and gingivitis control in children and adults - a comparative study, Journal of Dental Research, 75, 86 (Abstract No
  37. Vervliet, 1989, The effectiveness of a powered toothbrush (interplak) on plaque removal: a pilot study, Journal of Dental Research, 68, 614
  38. Williams, 2003, Plaque removal efficacy of a prototype power toothbrush compared to a positive control manual toothbrush, American Journal of Dentistry, 16, 223
  39. Wilson, 1991, A clinical study to compare the antiplaque and antigingivitis effectiveness of 2 electric toothbrushes and a manual toothbrush after 3 months of normal usage, Journal of Periodontology, 62, 808
  40. Sharma, 2001, Comparative efficacy on supragingival plaque and gingivitis of a manual and battery powered toothbrush (Abstract FDI World Dental Congress), International Dental Journal, 51, 374
  41. British Society of Periodontology, 2012, The Young Practitioners Guide to Periodontology
  42. Chilton, 1962, Comparison of the clinical effectiveness of an electric and a standard toothbrush in normal individuals, Journal of the American Dental Association, 64, 777, 10.14219/jada.archive.1962.0155 · DOI
  43. Cross, 1962, A comparative study of tooth cleansing using conventional and electrically operated toothbrushes, British Dental Journal, 113, 19
  44. Elliot, 1963, A comparison of the effectiveness of a standard and electric toothbrush, Journal of Periodontology, 34, 375, 10.1902/jop.1963.34.4.375 · DOI
  45. Hoover, 1962, Effect of automatic and hand toothbrushing on gingivitis, Journal of the American Dental Association, 65, 361, 10.14219/jada.archive.1962.0262 · DOI
  46. The Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan). Version 5.2 2012
  47. Steele, 2011, 4: Complexity and Maintenance - a Report from the Adult Dental Health Survey 2009
  48. White, 2004, Children’s Dental Health in the UnitedKingdom, 2003

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Metadata

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)
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
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 › General Dentistry › Dental Health and Care Utilization
  • Health Sciences › Dentistry › General Dentistry › 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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