Basis for Professional Recommendation of Power Toothbrushes

Drugstore shelves are stocked with numerous toothbrush options and regularly see new arrivals. The vast selection and options can prove confusing to patients, who often then look to their dental professional for advice. Should a manual toothbrush or power toothbrush be recommended? There are three key reasons why a power toothbrush is a wise choice.

1. Patient Compliance and Preference

Although the manual toothbrush is still in wide use worldwide, research shows that most patients do not brush or floss thoroughly, may use too much force, and/or brush for an inadequate amount of time.10,16,17 Power toothbrushes can help overcome these barriers to maintaining good oral hygiene via increased self-feedback and ease of use, and have been shown to enhance motivation and compliance.

It is well known that patients underestimate the amount of time they brush. Actual brushing time can be significantly different than estimated brushing time.47 Power toothbrushes with timers enable patients to assess the time spent on brushing. Certain models have timers that signal the patient every 30 seconds, prompting them to switch quadrants. The prompting usually is a few second change in the brushing action. The Oral-B and Sonicare also incorporate this technology into their respective apps to inform patients to switch quadrants. The Oral-B GENIUS model utilizes the camera in the patients smart phone to monitor and inform the patient what region of the mouth they are currently brushing. In a 30-day clinical study, Walters et al. found that subjects were 5.1 times more compliant with twice daily brushing for two minutes when using the wireless remote timer as compared to manual brush users.8 Many models feature multiple speeds and brushing modes to meet the needs of individual patients.

A brushing duration study in preteen and teen youth comparing a sonic power brush (Sonicare Xtreme™) to a manual toothbrush control found that those assigned to the sonic brush for two weeks of home use brushed longer in a final on-site, videotaped session than those who had used the manual toothbrush at home under the same conditions.48

For manual brushing to be efficient and prevent disease, the patient must possess a certain skill level, i.e., they must be able to maneuver the bristles skillfully to thoroughly remove plaque at the critical gingival margin and other hard to clean areas. Power toothbrushes like oscillating-rotating power brushes on the other hand, don’t require a proficient patient technique, as the built-in brushing motion and ability to penetrate approximal regions (in some brushes) are inherent in the brush’s bristle action as patients guide the brush. While this is especially valuable for those with limited dexterity (e.g., children, arthritis patients) all patients are likely to appreciate the fact that they don't need skill to achieve a clean dentition, and find the power brushing experience more enjoyable.

One study examined the compliance level of patients using powered toothbrushes unrelated to any social factors and found that 36 months after the purchase of the powered toothbrush, 62% were still using the brush on a daily basis.49 In a practice study, Warren et al. assessed the effectiveness of an oscillating-rotating electric toothbrush based on the clinical opinion of dental professionals and the patients’ attitudes toward the brush.50 In this study, 90% of the patients exhibited positive results, including reduction in plaque and improved gingival condition. Dental professionals (70%) stated they would be more likely to recommend this power toothbrush to their patients due to the changes evident in their patients’ oral health. Seventy-four percent of the patients perceived their oral health to be better than when they were using a manual toothbrush. The vast majority (94%) of the patients reported that they would continue using the toothbrush after the conclusion of the study.50

2. Clinical Effectiveness

As reviewed previously, many current-generation power toothbrushes have shown convincing evidence of efficacy in reducing plaque, gingivitis, stain and calculus in clinical research of varying study designs, lengths, and patient populations. Notably, a single class of power toothbrushes (oscillating-rotating) have been shown in a large independent systematic review by the Cochrane Collaboration to provide statistically significantly superior short- and long-term plaque and gingivitis control relative to manual toothbrushes.6 Further, the same reviewing organization has concluded in a 2011 report that, “There is some evidence that rotation oscillation brushes reduce plaque and gingivitis reduction more than side to side brushes in the short term.”26

3. Safety

The safety of modern power toothbrushes has been researched extensively and has consistently been shown not to be a concern. Patients and professionals can feel confident that swapping their manual toothbrush for an oscillating-rotating power brush will not result in increased tooth and/or gingival abrasion and gingival recession, as per the results of recent clinical research and a systematic review.

Power toothbrushes with added safety features such as pressure monitors hold an advantage in gentleness over manual brushes, in that they offer the patient feedback to prevent over-aggressive brushing.47