The Effectiveness of Power Versus Manual Toothbrushes on Plaque Removal and Gingival Health in Children-A Systematic Review and Meta-Analysis

Abstract

Objective: The objective of this systematic review was to assess the efficacy of self-brushing using a single-head power toothbrush(PTB) in comparison to a single-head manual toothbrush(MTB) in terms of plaque removal and reduction of gingivitis in children.

Materials and methods: MEDLINE-PubMed and Cochrane CENTRAL were searched up to November 2023. The inclusion criteria comprised randomised clinical trials involving healthy children up to the age of 18 years who did not have fixed orthodontic appliances. Included papers assessed the impact of self-administered toothbrushing using a rechargeable PTB compared to an MTB on plaque removal and gingivitis. Data extraction was conducted, and the risk of bias was evaluated. A descriptive analysis, a meta-analysis, and subgroup analysis, when feasible, were carried out.

Results: The search yielded 12 eligible publications, encompassing 30 relevant comparisons. Results showed a significant difference of means (DiffM) on plaque scores in favour of the PTB. Both the end and incremental difference scores indicated a significant difference in effect in favour of the PTB for single-use brushing (DiffM-end = -0.26 (95% CI [-0.31; -0.21]; p < 0.00001)|DiffM-difference = -0.26 (95% CI [-0.31; -0.21]; p < 0.00001)) and also for follow-up studies (DiffM-end = -0.22 (95% CI [-0.36; -0.07]; p = 0.004)|DiffM-difference = -0.34 (95% CI [-0.45; -0.23]; p < 0.00001)). The meta-analysis on gingival index scores showed no significant difference. Subgroup analysis was only possible for the follow-up studies. For the OR mode of action, a significant difference of means for plaque scores was found (DiffM-end = -0.19 (95% CI [-0.37; -0.01]; p = 0.04)|DiffM-difference = -0.22 (95% CI [-0.43; -0.01]; p = 0.04)). The subgroup analysis contained only studies with a low risk of bias.

Conclusions: There is moderate evidence that in children a PTB offers a small advantage in plaque removal over an MTB. This evidence primarily pertains to PTBs with an OR mode of action.

Registration: PROSPERO: #CRD42023144871; ACTA: #2023-75707.

Keywords: children; electric; gingivitis; manual; plaque; power; toothbrush.