How effective is a powered toothbrush as compared to a manual toothbrush? A systematic review and meta-analysis of single brushing exercises

Abstract

Objectives: In adult participants, what is, following a single brushing exercise, the efficacy of a powered toothbrush (PTB) as compared to a manual toothbrush (MTB) on plaque removal?

Methods: MEDLINE-PubMed and Cochrane-CENTRAL were searched from inception to February 2019. The inclusion criteria were (randomized) controlled clinical trials conducted in human subjects ≥18 years of age, in good general health and without periodontitis, orthodontic treatment, implants and/or removable prosthesis. Papers evaluating a PTB compared with a MTB in a single brushing exercise were included. When plaque scores were assessed according to the Quigley-Hein plaque index (Q&HPI) or the Rustogi modified Navy plaque index (RMNPI). From the eligible studies, data were extracted. A meta-analysis and subanalysis for brands and mode of action being oscillating-rotating (OR) and side-to-side (SS) were performed when feasible.

Results: Independent screening of 3450 unique papers resulted in 17 eligible publications presenting 36 comparisons. In total, 28 comparisons assessed toothbrushing efficacy according to the Q&HPI and eight comparisons used the RMNPI. Results showed a significant effect in favour of the PTB. The difference of Means (DiffM) was -0.14 (P < 0.001; 95%CI [-0.19; -0.09]) for the Q&HPI and -0.10 (P < 0.001; 95%CI [-0.14; -0.06]) for the RMNPI, respectively. The subanalysis on the OR mode of action showed a DiffM -0.16 (P < 0.001; 95%CI [-0.22, -0.10]) for the Q&HPI. For the SS mode of action using RMNPI, the DiffM showed -0.10 (P < 0.001; 95%CI [-0.15; -0.05]). The subanalysis for brands showed for the P&G OR PTB using the Q&HPI a DiffM of -0.15 (P < 0.001; 95%CI [-0.22; -0.08]) and the Colgate SS for RMNPI showed a DiffM of -0.15 (P < 0.001; 95%CI [-0.18; -0.12]).

Conclusion: There is moderate certainty that the PTB was more effective than the MTB with respect to plaque removal following a single brushing exercise independent of the plaque index scale that was used.

Keywords: dental plaque; manual toothbrush; powered toothbrush; single brushing exercise; systematic review.