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From the final review, the Cochrane group determined that
“Power toothbrushes with a rotational oscillation action
provided slightly better plaque removal and may provide
better protection against gum inflammation than manual
toothbrushes.”
5
The researchers discussed the weaknesses of their review
and noted:
5
• “One possible weakness of this review was the grouping
of toothbrushes by their modes of action.”
• “So many factors may influence the effectiveness of
toothbrushes including filament arrangement, orienta-
tion, size, shape and flexibility, brush head size and
shape along with presence or absence and characteristics
of a timer that not all of them could be analyzed.”
• “None of the trials compared durability, reliability, and
cost of using manual versus powered brushes, it is
presently not possible to make a clear recommendation
on toothbrush superiority.”
In summary, the Cochrane review provides important
information on power toothbrushes, but is not without
flaws. Of consideration is that studies on older, obsolete
products with outdated technology were included in the
meta-analysis.
5
Many current power brushes with state-
of-the-art technology have been able to show in well-
designed scientific trials that they are superior to manual
brushes.
1,2,3,4,6,10,11,12
Individual Recommendations
Once clinical efficacy has been established, when recom-
mending a power brush, individual preferences can play a
significant role in product acceptance. In fact, studies have
shown that when individuals play a more assertive role in
healthcare decisions, compliance and satisfaction
increase.
6
Therefore, it is unlikely that all the individuals
in a practice will like or benefit from the same type of
power toothbrush. Importantly, the individual oral health
needs along with personal preferences should influence
the brush recommendation.
1,3,6
There are a large number of power brushes on the market
with a wide array of features, which can influence acceptance
of the product. To help individuals find the product right
for them, there are multiple features to consider.
• Timer: Essential for those who need to extend
brushing time
• Handle size: Should be of adequate size and feel
comfortable
• Brush head motion and configuration: Size is important
as is dexterity
• Lifestyle: Frequent travelers may prefer a battery-
operated unit
• Disposability: This generally means that neither the bat-
tery nor the brush head can be replaced. Products gen-
erally last around 3 months - the same as a manual
toothbrush and often cost the same. May be a good
gateway product
• Affordability: With multiple products in a wide range of
prices, there is a power brush to fit anyone’s budget
Brushing Recommendations
Some individuals may think that once they use a power
brush, they no longer have to make any effort when
brushing. Therefore, it is important to continue empha-
sizing how often and long to brush. Studies have shown
that good biofilm removal takes time, and those who
brush longer tend to remove more biofilm.
8,9
It is important to explain to first time users that power
brushes have a unique or different sound and sensation
than manual brushes. It may take some time to get
adjusted to a new product. Additionally, some products
may enhance the foaming action of the toothpaste and
this may initially be overwhelming. See Figure 1. Advise
individuals not to use an excessive amount of toothpaste
and not to turn the unit on until they have placed the
brush head in their mouth.
3
Figure 1