Cochrane · intervention · CD004971
Different powered toothbrushes for plaque control and gingival health
Deacon, SA, Glenny, A-M, Deery, C, et al. · Cochrane Database of Systematic Reviews · 2010 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
26
current version
GRADE rated
0
No studies
1
Included studies
17
as reported
No studies 1 · 3.8%Ungraded 25 · 96.2%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Individuals of any age with no reported disability that may affect their ability to practise normal self-toothbrushing; individuals wearing orthodontic appliances included | Combined 1369 participants across 17 trials (71 (5%) lost to follow-up). Eleven trials conducted in the USA, two in Belgium, and one each in Canada, Germany, Brazil and the UK |
| Intervention | All forms of powered brush with mechanical movement of the brush head (electric, electronic, sonic, ultrasound) or power delivery to the brush head (ionic), grouped by mode of action: side to side; counter oscillation; rotation oscillation; circular; ultrasonic; ionic; multidimensional; unknown | Side to side (n=10); Counter oscillation (n=3); Rotation oscillation (n=9); Circular (n=2); Ultrasonic (n=1); Multidimensional (n=6); Ionic (n=0) |
| Comparison | Powered toothbrush with a different mode of action | Powered toothbrushes of different modes of action (as above) |
| Outcomes | Primary: quantified levels of plaque (Turesky modification of the Quigley-Hein plaque index) and gingivitis (gingival index of Loe and Silness, or bleeding on probing). Secondary: cost; reliability; calculus; staining; adverse events | Plaque reduction (n=15); Gingivitis reduction (n=16); Calculus (n=1); Staining (n=1); Adverse events (n=4) |
| Study designs | Randomised controlled trials (RCTs) that clearly implied randomisation; cross-over trials eligible; split-mouth trials excluded | RCTs including cross-over trials (n=17) |
| Timing | Trials of 28 days and over eligible; short term 4 weeks to 3 months; long term > 3 months | Plaque at 1-3 months (n=14) and > 3 months (n=1); gingivitis at 1-3 months (n=15) and > 3 months (n=1) |
Search date: 2010-07. Databases: The Cochrane Oral Health Group's Trials Register; The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; CINAHL via EBSCO
Questions and results
Current version onlySide to side action powered toothbrush vs Counter oscillation powered toothbrush
Population: People of any age with no reported disability affecting their ability to practise normal self-toothbrushing; individuals wearing orthodontic appliances included
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | One trial (Khocht 1992) reported 'transient abrasions' in both powered toothbrush groups. | 1 study | Ungraded |
Plaque (level reduction) Short term (1-3 months) | SMD -0.02 [-0.37, 0.32] | 2 studies · 130 participants | Ungraded |
Gingivitis (level reduction) Short term (1-3 months) | SMD -0.02 [-0.37, 0.32] | 2 studies · 130 participants | Ungraded |
Side to side action powered toothbrush vs Rotation oscillation powered toothbrush
Population: People of any age with no reported disability affecting their ability to practise normal self-toothbrushing; individuals wearing orthodontic appliances included
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Calculus Short term (1-3 months) | One trial (Isaacs 1998) reported a significant reduction in lower lingual incisor calculus with rotation oscillation versus side to side in the short term (1-3 months). | 1 study | Ungraded |
Gingivitis (level reduction) Long term (>3 months) | SMD -0.44 [-0.98, 0.11] | 1 study · 54 participants | Ungraded |
Plaque (level reduction) Short term (1-3 months) | SMD 0.24 [0.02, 0.46] | 5 studies | Ungraded |
Adverse events | Grossman 1995 reported some discomfort with use of one mode of action brush; Hefti 2000 reported no difference in dentine hypersensitivity. | 2 studies | Ungraded |
Plaque (level reduction) Long term (>3 months) | Analysis 2.3 Plaque > 3 months (Turesky): 1 trial; totals not selected (no pooled estimate). No differences between the modes for plaque in the long term (> 3 months). | 1 study | Ungraded |
Gingivitis (level reduction) Short term (1-3 months) | SMD 0.35 [-0.04, 0.74] | 6 studies | Ungraded |
Side to side action powered toothbrush vs Circular powered toothbrush
Population: People of any age with no reported disability affecting their ability to practise normal self-toothbrushing; individuals wearing orthodontic appliances included
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Gingivitis (level reduction) Short term (1-3 months) | SMD 0.89 [0.38, 1.41] | 1 study · 64 participants | Ungraded |
Plaque (level reduction) Short term (1-3 months) | Analysis 3.1 Plaque < 3 months (Turesky): 1 trial (Yankell 1997), 64 participants; totals not selected; no significant difference between side to side and circular for plaque in the short term. | 1 study · 64 participants | Ungraded |
Counter oscillation powered toothbrush vs Rotation oscillation powered toothbrush
Population: People of any age with no reported disability affecting their ability to practise normal self-toothbrushing; individuals wearing orthodontic appliances included
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Gingivitis (level reduction) Short term (1-3 months) · Adolescents | Trimpeneers 1997 (36 adolescents); no significant differences between counter oscillation and rotation oscillation for gingival index / bleeding index at 1 and 2 months (P values 0.06 to 0.75); data unsuitable for… | 1 study · 36 participants | Ungraded |
Plaque (level reduction) Short term (1-3 months) · Adolescents | One cross-over trial of 36 adolescents (Trimpeneers 1997); data not presented in a suitable format for meta-analysis; no significant differences between counter oscillation and rotation oscillation for plaque index /… | 1 study · 36 participants | Ungraded |
Counter oscillation powered toothbrush vs Circular powered toothbrush
Population: People of any age with no reported disability affecting their ability to practise normal self-toothbrushing; individuals wearing orthodontic appliances included
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Plaque (level reduction) Short term (1-3 months) · Adolescents | Trimpeneers 1997 reported a significant difference in favour of the counter oscillation brush for plaque index at 2 months over a circular mode of action brush; data were unsuitable for meta-analysis. | 1 study · 36 participants | Ungraded |
Gingivitis (level reduction) Short term (1-3 months) · Adolescents | Trimpeneers 1997 reported a significant difference in favour of the counter oscillation brush for gingival index at 2 months over a circular mode of action brush; data were unsuitable for meta-analysis. | 1 study · 36 participants | Ungraded |
Rotation oscillation powered toothbrush vs Circular powered toothbrush
Population: People of any age with no reported disability affecting their ability to practise normal self-toothbrushing; individuals wearing orthodontic appliances included
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Plaque (level reduction) Short term (1-3 months) | SMD -0.02 [-0.51, 0.47] | 1 study · 64 participants | Ungraded |
Gingivitis (level reduction) Short term (1-3 months) | SMD 0.87 [0.36, 1.39] | 1 study · 64 participants | Ungraded |
Multidimensional powered toothbrush vs Side to side action powered toothbrush
Population: People of any age with no reported disability affecting their ability to practise normal self-toothbrushing; individuals wearing orthodontic appliances included
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Gingivitis (level reduction) Short term (1-3 months) | Analysis 5.2 Gingivitis < 3 months: 2 trials (Patters 2005; Zimmer 2005); considerable heterogeneity, so no statistical pooling was undertaken. | 2 studies | Ungraded |
Plaque (level reduction) Short term (1-3 months) | Analysis 5.1 Plaque < 3 months (Turesky): 3 trials, 236 participants (Goyal 2005; Patters 2005; Zimmer 2005); significant heterogeneity (P < 0.1; I2 = 96%), so no statistical pooling was undertaken. | 3 studies · 236 participants | Ungraded |
Staining Short term (1-3 months) | One trial (Patters 2005) reported reduced staining in the short term (1-3 months) with a multidimensional versus side to side mode of action powered brush. | 1 study | Ungraded |
Multidimensional powered toothbrush vs Rotation oscillation powered toothbrush
Population: People of any age with no reported disability affecting their ability to practise normal self-toothbrushing; individuals wearing orthodontic appliances included
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Plaque (level reduction) Short term (1-3 months) | Analysis 6.1 Plaque < 3 months: 1 trial; totals not selected. The two trials making this comparison (Heasman 1999; Williams 2002) show no significant difference for plaque in the short term (1-3 months). | 1 study | Ungraded |
Gingivitis (level reduction) Short term (1-3 months) | SMD 0.24 [-0.10, 0.58] | 2 studies · 137 participants | Ungraded |
Ultrasonic powered toothbrush vs Multidimensional powered toothbrush
Population: People of any age with no reported disability affecting their ability to practise normal self-toothbrushing; individuals wearing orthodontic appliances included
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Plaque (level reduction) Short term (1-3 months) | One cross-over trial (Costa 2007) made this comparison; data were not available in a useable form. | 1 study | Ungraded |
Gingivitis (level reduction) Short term (1-3 months) | One cross-over trial (Costa 2007) made this comparison; data were not available in a useable form. | 1 study | Ungraded |
Adverse events | Costa 2007 reported no adverse events identified by either participants or examiner. | 1 study | Ungraded |
Ionic powered toothbrush vs Powered toothbrush with a different mode of action
Population: People of any age with no reported disability affecting their ability to practise normal self-toothbrushing; individuals wearing orthodontic appliances included
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Ionic: no included trials investigated this brush type (Table 3, 'Interventions used in included trials'). | NR | No studies |
Powered toothbrush (one mode of action: side to side, counter oscillation, rotation oscillation, circular, ultrasonic, ionic, or unknown) vs Powered toothbrush with a different mode of action
Population: People of any age with no reported disability affecting their ability to practise normal self-toothbrushing; individuals wearing orthodontic appliances included
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects | Protocol planned outcome: adverse effects such as hard or soft tissue injury and damage to orthodontic appliances and prostheses. No studies (protocol). | NR | No studies |
Gingivitis (level reduction) | Protocol planned outcome: quantified levels of gingival inflammation (gingival index of Loe and Silness, or bleeding on probing). No studies (protocol). | NR | No studies |
Plaque (level reduction) | Protocol planned outcome: quantified levels of plaque (Turesky modification of the Quigley-Hein plaque index). No studies (protocol). | NR | No studies |