While manual toothbrushes have been the most commonly used mode of oral hygiene since their inception, the need for an even more effective alternative has been recognized for at least two centuries. “Mechanical” toothbrush devices (Figure 2) were patented in the mid-19th century with the goal of addressing the limitations of manual toothbrushes. The power toothbrush as we recognize it today has its roots in prototypes first commercially available in the 1960s. These bulky power brush forerunners - termed ‘electric’ toothbrushes - were initially primarily intended for special populations; e.g. limited dexterity. Their cumbersome size, power source unreliability, and a lack of concurrence regarding effectiveness all likely prevented broad adoption of these early automated offerings.4 Product manufacturing engineers pushed forward with additional development and technological innovation, however, and ever more streamlined, effective, and sophisticated power toothbrush models with diverse designs and modes of action made their way to the marketplace over the next few decades. These second generation power toothbrushes were no longer solely targeted for niche subgroups, as the dental community increasingly came to appreciate the clinically observable benefits of the power toothbrush for all population segments.
Following extensive development, in 1978, Oral-B® (Procter & Gamble Company, Cincinnati, OH, USA) pioneered the first mass-produced power toothbrush intended for general use. The “D-1” (Figure 3a) featured a manual-like brush head and a side-to-side motion.
Over the following decade, electric brushes with modes of action attempting to simulate the rotary, circular-like movements of professional cleaning instruments (e.g., Rotadent® [Zila, Fort Collins, CO, USA]) or utilizing varying brush head tufts rotating in a counter rotational fashion (e.g., Interplak® [Conair, East Winslow, NJ, USA]) were launched, as the popularity of power brushes for general use began to grow.
A major milestone in the development timeline of power toothbrushes occurred in 1991 with the introduction of the Oral-B Plaque Remover ‘D5’ and its novel, prophylaxis-inspired oscillating-rotating mode of action (Figure 3b).5 With a cup-shaped brush head and end-rounded bristles providing robust plaque removal via 5600 oscillations per minute, this was the first power toothbrush technology clinically proven to clean better than a manual toothbrush.6 It also featured new compliance-enhancing features, including a two minute light timer to boost brushing frequency.
A side-to-side motion undergirded by a high frequency (“sonic”) power toothbrush technology was introduced in 1992 (Sonicare® [Philips Oral Healthcare, Snoqualmie, WA, USA]) and later called Advance™. Another significant development in the history of power toothbrushes occurred in 1999, when the first mass-marketed battery-powered toothbrush entered the growing line-up of power toothbrush options.
The next few years brought additional technological advances in oscillating-rotating technology. The Oral-B 3D Plaque Remover (Figure 3c) debuted in 1998, incorporating high frequency pulsating movement to the oscillating-rotating technology for three-dimensional brush head movement, providing enhanced plaque removal and penetration in the approximal regions.7 Later renamed the ‘D15’, this power brush combined 20,000 pulsations with 7600 oscillations per minute.
Adding increased oscillations and pulsating frequencies later culminated in the Oral-B Professional Care Smart Series with SmartGuide™ power toothbrushes. The Oral-B Triumph with Smart Guide (Figure 3d), launched in 2007, was the first power toothbrush with clinically proven combined oscillating/rotating/pulsating technology, together with an innovative new wireless remote display feature (Smart Guide) for continuous visible brushing feedback.8
In 2014, Oral-B introduced The Oral-B PRO 5000 with Bluetooth 4.0 connectivity (Figure 3e), the world’s first Bluetooth connected power toothbrush. The PRO 5000 allows for two-way communication between the brush and the Oral-B app to enable real time feedback, motivation and rewards as well as a smarter, more personalized brushing routine. A key feature of the app is “focused care” which allows for customized brushing directed by a dental professional. This feature allows patients to work hand-in-hand with their dental professional. Dental professionals can program patients’ brushing routines in the app to help improve their brushing behaviors and focus on problem zones within the mouth. This technology gives patients unprecedented control over their oral care, and in turn, the outcome of their dental appointments.
Two years later, Oral-B unveiled its latest innovation that sets a new oral care standard: Oral-B GENIUS (Figure 3f), the first of its kind and Oral-B’s most intelligent brushing system available to-date. The new Oral-B GENIUS features groundbreaking Position Detection Technology that combines cutting-edge motion sensor technology located in the brush, and video recognition using the smartphone’s camera, to track areas being brushed so that no zone is missed. Users receive instant feedback on the brushing of each zone of the mouth via the Oral-B App 4.1, including guidance on pressure applied and brushing duration.
Sonic power toothbrushes have also continued to evolve since their debut in the early 1990s. A second-generation Philips sonic brush - Sonicare Elite™ - was marketed in 2002; it was differentiated from the original sonic brush by a modified bristle trim, slim/angled brush head shaft to target hard-to-reach regions, and modified lighter and smaller brush handle (Figure 4).9 In 2004, Oral-B introduced a new sonic power brush (Sonic Complete™), followed in 2008 by the Pulsonic™, targeting consumers who favored sonic brushes but wanted a quieter, slimmer/lighter option that still provided maximum cleaning performance. Several years ago Phillips introduced DiamondClean™ a redesigned handle and high-density, diamond-shaped bristles that should improve cleaning and whitening (Figure 4). In 2013, Phillips introduced the Soniacre FlexCare Platinum with the InterCare brushhead. The FlexCare Platinum featured 3 modes with 3 levels of intensity offering 9 different brushing experiences. In addition the handle was equipped with a pressure sensor to alert individuals when too much pressure was applied to hard or soft tissue. The FlexCare Platinum also featured an ultraviolet sanitizer to disinfect brush heads after use. In 2016, Phillips introduced the FlexCare Platinum Connected, which incorporated Bluetooth technology into the handle. The FlexCare Platinum Connected features Smart Sensor technology which tracks patients’ brushing in real time and syncs via Bluetooth technology with the free Philips Sonicare app. This feature allows one to create a personalized 3-D Mouth Map, helping users identify missed trouble spots and guiding them to proper brushing technique. The Smart Sensor technology provides feedback to help patients effectively reach more surfaces each time they brush.