What do systematic reviews say?

Powered toothbrush, ultrasonic action vs Manual toothbrush

Powered toothbrush, ultrasonic action led to lower gingivitis score (1 to 3 months) compared with manual toothbrush; GRADE not reported.

• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Short term (1 to 3 months)
  SMD -0.99 [-1.21, -0.76]
  5 studies · 354 participants
  GRADE not reported
• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Long term (>3 months)
  Ultrasonic vs manual, gingivitis at >3 months: one trial (Terezhalmy 1995a); no statistically significant difference; totals not selected (no pooled estimate presented in this version).
  1 study · 46 participants
  GRADE not reported

Powered toothbrush, unknown/other action vs Manual toothbrush

• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Long term (>3 months)
  Unknown/other action vs manual, gingivitis at >3 months: 1 trial; totals not selected.
  1 study
  GRADE not reported
• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Short term (1 to 3 months)
  Unknown/other action vs manual, gingivitis at 1 to 3 months: 3 trials; totals not selected (data presented in forest plots but not pooled).
  3 studies
  GRADE not reported

Powered toothbrush, counter oscillation action vs Manual toothbrush

Powered toothbrush, counter oscillation action showed no clear difference in gingivitis score (1 to 3 months) compared with manual toothbrush; GRADE not reported.

• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Short term (1 to 3 months)
  SMD 0.01 [-0.30, 0.31]
  4 studies · 172 participants
  GRADE not reported
• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Long term (>3 months)
  SMD -0.19 [-0.66, 0.29]
  2 studies · 69 participants
  GRADE not reported

Powered toothbrush (any mode of action) vs Manual toothbrush

Powered toothbrush (any mode of action) probably leads to lower gingivitis score (1 to 3 months) compared with manual toothbrush (moderate certainty).

• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Short term (1 to 3 months)
  SMD -0.43 [-0.60, -0.25]
  44 studies · 3345 participants
  Moderate
• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Long term (>3 months)
  SMD -0.21 [-0.31, -0.12]
  16 studies · 1645 participants
  Moderate

Powered toothbrush (any mode of action) vs Manual toothbrush

• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes
  SoF 'Adverse events' row (narrative): There was no apparent relationship between the use of powered toothbrushes and soft tissue trauma. In part this finding was due to the very small number of adverse events reported…
  40 studies
  GRADE not reported

Powered toothbrush, unknown/other action vs Manual toothbrush

• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Short term (1 to 3 months)
  Unknown/other action vs manual, plaque at 1 to 3 months: 2 trials; totals not selected (data presented in forest plots but not pooled owing to lack of clarity about the toothbrushes).
  2 studies
  GRADE not reported

Powered toothbrush, rotation oscillation action vs Manual toothbrush

Powered toothbrush, rotation oscillation action led to lower gingivitis score (1 to 3 months) compared with manual toothbrush; GRADE not reported.

• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Short term (1 to 3 months)
  SMD -0.49 [-0.73, -0.26]
  21 studies · 1479 participants
  GRADE not reported
• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Long term (>3 months)
  SMD -0.35 [-0.50, -0.20]
  8 studies · 684 participants
  GRADE not reported

Powered toothbrush (any mode of action) vs Manual toothbrush

Powered toothbrush (any mode of action) probably leads to lower plaque score (1 to 3 months) compared with manual toothbrush (moderate certainty).

• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Short term (1 to 3 months)
  SMD -0.50 [-0.70, -0.31]
  40 studies · 2871 participants
  Moderate
• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Long term (>3 months)
  SMD -0.47 [-0.82, -0.11]
  14 studies · 978 participants
  Moderate

Powered toothbrush, ultrasonic action vs Manual toothbrush

• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Long term (>3 months)
  Ultrasonic vs manual, plaque at >3 months: one trial (Terezhalmy 1995a); no statistically significant difference; totals not selected (no pooled estimate presented in this version).
  1 study · 46 participants
  GRADE not reported
• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Short term (1 to 3 months)
  SMD -1.33 [-1.59, -1.07]
  4 studies · 301 participants
  GRADE not reported

Powered toothbrush, circular action vs Manual toothbrush

Powered toothbrush, circular action showed no clear difference in gingivitis score (1 to 3 months) compared with manual toothbrush; GRADE not reported.

• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes

  Short term (1 to 3 months)
  SMD -0.18 [-0.53, 0.17]
  2 studies · 128 participants
  GRADE not reported

Powered toothbrush (any mode of action) vs Manual toothbrush

The review found no eligible studies for this question.

• Powered versus manual toothbrushing for oral health 2014 · Cochrane All outcomes
  None of the included trials reported on the relative costs of manual compared with powered toothbrushes.
  0 studies
  No studies found

Interdental brushing plus toothbrushing vs Toothbrushing alone

The review found no eligible studies for this question.

• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes
  Not estimable. No included study assessed bad breath as an outcome. (See comment)
  0 studies
  No studies found

Interdental brushing plus toothbrushing vs Flossing plus toothbrushing

The review found no eligible studies for this question.

• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes
  Not estimable. No included study assessed bad breath as an outcome. (See comment)
  0 studies
  No studies found

Interdental brushing plus toothbrushing vs Toothbrushing alone

The review found no eligible studies for this question.

• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes
  Not estimable. No included study assessed quality of life as an outcome. (See comment)
  0 studies
  No studies found

Interdental brushing plus toothbrushing vs Flossing plus toothbrushing

The review found no eligible studies for this question.

• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes
  Not estimable. No included study assessed quality of life as an outcome. (See comment)
  0 studies
  No studies found

Interdental brushing plus toothbrushing vs Toothbrushing alone

The review found no eligible studies for this question.

• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes
  Not estimable. No included study assessed periodontitis as an outcome. (See comment)
  0 studies
  No studies found

Interdental brushing plus toothbrushing vs Flossing plus toothbrushing

The review found no eligible studies for this question.

• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes
  Not estimable. No included study assessed clinical attachment loss, a measure of progression of periodontitis. (See comment)
  0 studies
  No studies found

Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone

It is very uncertain whether flossing plus toothbrushing (self-performed; manual or automated… changes plaque (Turesky-modified Quigley-Hein/other plaque indices; SMD) compared with toothbrushing alone (with or without a negative-control/placebo rinse) (very low certainty).

• Flossing for the management of periodontal diseases and dental caries in adults 2011 · Cochrane All outcomes

  1 month (mean 29 days)
  SMD -0.23 [-0.52, 0.06]
  5 studies · 416 participants
  Very low
• Flossing for the management of periodontal diseases and dental caries in adults 2011 · Cochrane All outcomes

  6 months
  SMD -0.06 [-0.23, 0.12]
  3 studies · 487 participants
  GRADE not reported
• Flossing for the management of periodontal diseases and dental caries in adults 2011 · Cochrane All outcomes

  3 months
  SMD -0.20 [-0.36, -0.04]
  5 studies · 594 participants
  GRADE not reported

Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone

• Flossing for the management of periodontal diseases and dental caries in adults 2011 · Cochrane All outcomes
  Not estimable (5 studies). Adverse effects were assessed in five studies, but they used different outcome measures, so meta-analysis was not appropriate. The main harm identified was soft-tissue trauma to the gingival…
  5 studies
  GRADE not reported

Flossing plus toothbrushing (self-performed; manual or automated floss) vs Toothbrushing alone

Flossing plus toothbrushing (self-performed; manual or automated… led to lower gingivitis (Gingival Index, 0-3 scale; SMD) compared with toothbrushing alone (with or without a negative-control/placebo rinse); GRADE not reported.

• Flossing for the management of periodontal diseases and dental caries in adults 2011 · Cochrane All outcomes

  3 months
  SMD -0.41 [-0.68, -0.14]
  6 studies · 656 participants
  GRADE not reported
• Flossing for the management of periodontal diseases and dental caries in adults 2011 · Cochrane All outcomes

  1 month
  SMD -0.36 [-0.66, -0.05]
  7 studies · 489 participants
  Very low
• Flossing for the management of periodontal diseases and dental caries in adults 2011 · Cochrane All outcomes

  6 months
  SMD -0.72 [-1.09, -0.35]
  4 studies · 564 participants
  GRADE not reported