Manual versus powered toothbrushes for oral health; an update

Background: Plaque removal is a cornerstone in the prevention and treatment of periodontal diseases. Powered toothbrushes have been devised to assist in plaque removal. An earlier Cochrane systematic review found that only powered toothbrushes with a rotation-oscillation action were more effective at removing plaque and reducing gingivitis. That review requires updating to include recent trials. Objective: To compare the effects of manual and powered toothbrushes on plaque removal and gingival health. Method: We searched the Cochrane Oral Health Group Trials Register, CENTRAL; MEDLINE, EMBASE and CINAHL to 9 March 2011. Manufacturers and authors were contacted for additional data. Trials were selected for random allocation of participants to use a manual or powered toothbrush. Participants were members of the public with uncompromised manual dexterity who brushed unsupervised for at least 4 weeks. There was no language restriction. Primary outcomes were plaque and gingivitis scores at the end of the trial. Assessment of methodological quality and data extraction were conducted in duplicate. Potential sources of heterogeneity were examined, along with sensitivity analyses for quality and publication bias. Results: Fifty trials, involving 4326 participants, provided data. Effect sizes, calculated as standardized mean difference (95% confidence intervals) for brushes with a rotation oscillation action were: 1 to 3 months >3 months Plaque -0.53 (-0.74 to -0.31) -0.66 (-1.28 to -0.03) Gingivitis -0.49 (-0.73 to -0.26) -0.34 (-0.56 to -0.11) This represents approximately 27% fewer sites with bleeding on probing in the long term. No other powered designs were consistently superior to manual toothbrushes. There was considerable heterogeneity between trials. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. Conclusion: Rotation-oscillation powered toothbrushes remove plaque and reduce gingivitis more than manual brushes in the short and long term