L. Virginia Powell DMD, GPR
Short-term use of oscillating-rotating powered brushes and manual tooth brushes results in similar recession and gingival abrasion.
The conclusion that oscillating toothbrushes are as safe as manual toothbrushes in terms of recession and gingival abrasion is well supported by the evidence; for hard tissue loss, however, there is only weak support for the hypothesis of no difference.
Based on both in vivo and in vitro studies, is there a difference between oscillating-rotating powered toothbrushes and manual toothbrushes for the safety of oral hard and soft tissues in adults and children?
Following a well-described protocol, two reviewers searched three databases for in vivo clinical trials and in vitro laboratory studies published through May 2010. They conducted hand searches of reference lists and included non-English citations. They excluded studies evaluating the effects of brushing on orthodontic brackets or restorative materials. Two reviewers assessed heterogeneity and risk of bias. A third reviewer resolved discrepancies. They compared most studies descriptively because of the high level of heterogeneity; however, they combined the baseline and trial end data on recession from two clinical trials in a meta-analysis.
Reviewers selected 35 studies and divided them into four groups for analysis: 1) gingival recession; 2) gingival abrasion and brushing force; 3) adverse events; and 4) lab studies of dentin and enamel loss. Two clinical trials involving 263 subjects compared ORPB and MTB in terms of gingival recession at six months, and the observed differences were not statistically significant (weighted mean difference [WMD] baseline 0.04, confidence interval [CI] -0.08, 0.16; WMD trial end 0.03, CI -0.07, 0.13). These studies were homogeneous as determined by chi-square (baseline p=0.21, trial end p=0.46) and I-square (baseline 35.3%, endpoint 0%) tests. Five clinical trials evaluated gingival abrasion and brushing force. Even though post-treatment abrasions increased in number, there was no statistically significant difference between the control and test groups. Toothbrushing force was statistically significantly greater with MTB (p
ORPB and MTB produce similar effects on oral soft tissues in regard to gingival recession and gingival abrasions. Anecdotally few adverse events were reported. Laboratory studies confirm minimal loss of dentin from prepared specimens with both ORPB and MTB and increased brushing force with MTB, although the clinical significance of this finding was not reported.
Source of Funding:
Review was funded in part by Procter & Gamble.
Importance and Context:
Powered toothbrushes are among the most recommended oral devices. A thorough review of the existing literature is essential to confirm the safety of these devices.
Strengths and Weaknesses of the Systematic Review:
Review authors conducted a well-designed and inclusive search, although a non-author employee of Proctor and Gamble assisted in article screening. Authors reported the information in a thorough and organized fashion; tables were complete and figures helpful. They evaluated the quality of the trials and statistically analyzed data where appropriate. While their conclusions in regard to soft tissue safety were supported by the evidence, they may have overreached in concluding that hard tissue safety was definitive.
Strengths and Weaknesses of the Evidence:
Potential variables that could be used to measure the safety of tooth cleaning devices include recession, soft tissue trauma, hard tissue abrasion, sensitivity, and patient-centered concerns such as comfort of use. Of these, the underlying studies investigated only recession and gingival abrasion. In the case of recession, the studies did not compare the change in recession from baseline to trial end. The majority of trials exhibited high heterogeneity and considered safety as a secondary measure. The evidence was usually anecdotal rather than quantitative. Trials were of short duration, often no longer than six months. Hard tissue effects were primarily evaluated by laboratory studies. Nineteen out of 35 studies reported a commercial sponsor.
Implications for Dental Practice:
ORPB when used as directed will produce effects similar to those produced by MTB in regard to recession and gingival abrasion as measured over six months. Anecdotal and laboratory evidence provides weak support for the conclusion that adverse effects are minimal and hard tissue effects are similar and safe.