Using an Evidence-based Approach to Making Patient Recommendations for Power Toothbrushes
EBDM Basis for Professional Recommendation of Power Toothbrushes

Course Author(s): Lesley McGovern Kupiec, RDH, MSDH; Jane L. Forrest, EdD, BSDH

EBDM 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 globally, 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.20-22 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.23,24

    It is well known that patients underestimate the amount of time they brush. Actual brushing time can be significantly different than estimated brushing time.55 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 and brush for the recommended 2 minutes. Some companies have created apps that incorporate the timers with more advanced technology to deliver personalized coaching by monitoring user habits and giving real-time brushing guidance (See Table 3).

    The most recent version of the Oral-B power brush (iO) has a “unique intuitive smart interface,” which includes a timer that counts upward to 2 minutes on the actual brush handle. It’s advanced artificial intelligence allows the brush to track the location of brushing without needing to bring your phone in the bathroom and mount, like previous GENIUS versions.9 Earlier research found in a 30-day clinical study, that subjects were 5 times more compliant with twice daily brushing for two minutes when using the wireless remote timer as compared to manual brush users.8 More recent studies have also demonstrated improved brushing times, motivation and compliance with electric toothbrushes.23,24

    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.56

    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 on the other hand, don’t require the same level of proficiency, as the built-in brushing motion and ability to penetrate approximal regions (by 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 as much instruction or skill proficiency to achieve a clean dentition, and find the power brushing experience more enjoyable. Clinical studies have found increased levels of patient compliance and/or nearly all participants intending to continue with usage of electric brushes.8,23,24,57

  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 (O-R) have been shown in several large independent systematic reviews by the Cochrane Collaboration to provide statistically significantly superior short- and long-term plaque and gingivitis control relative to manual toothbrushes.63,13 Further, other SRs have reported “There is some evidence that O-R brushes reduce plaque and gingivitis reduction more than side to side brushes (sonic) in the short term.”28,35 A more recent systematic review and meta-analysis came to the same conclusion looking at the evidence from 2009-2019.38

  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 electric toothbrush will not result in increased tooth and/or gingival abrasion and gingival recession, as per the consistent results of clinical research and systematic reviews.
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