Are Electric Toothbrushes Better?

What’s in a toothbrush?  Early toothbrushes were made using natural bristles from pig skin.  They were irregular, uncomfortable, and frankly, likely not often used by most people.  The invention of nylon in 1935 by DuPont allowed for mass production using softer, more consistent bristles.  Thankfully, toothbrushes have never been better, and with the advent of electric toothbrushes the choices are bewildering.  This article will help address key questions in selecting a toothbrush. 

Why do we need to brush our teeth?  Most of your body’s surfaces shed, including your hair, skin, intestinal lining and nails; but teeth are different… their surface doesn’t shed.  Teeth’s non-living surface is very hard and has little capacity for repair.  Because of this, teeth need daily mechanical cleaning. The oral bacteria that settle on the teeth become much harder to remove after about 24 hours. The colonies of bacteria in our mouths produce acid every time you eat sugar or simple carbohydrates eventually causing cavities. Controlling bacterial colonies on the teeth reduces the acidity in the mouth that causes cavities. Simple. But not easy.

What is available? The choice of toothbrushes at a regular supermarket is bewildering.  The market can be broken up into three general categories: 

1. Manual brushes
2. Electric brushes (disposable battery)
3. Electric brushes (rechargeable battery built in)

Manual toothbrushes are, despite their humble prices and modest technology, quite effective when used with good technique, gently for 2-3 minutes for 2-3 times a day.  

The low power, battery operated electric toothbrushes are popular due to their apparently modern design and low price.  However, they are offer no significant improvement in plaque and tartar/calculus reduction vs. manual toothbrushes.  Their efficacy is limited by their low power and therefore limited rotational speed of the brush head.  

The electric toothbrushes that offer a benefit to consumers in terms of plaque and calculus reduction are divided into the ultrasonic (e.g. Sonicare) type brushes and the high-powered rotating head type brushes (e.g.  Oral-B).  The ultrasonic type brushes vibrate the head up to 31,000 times a minute, literally breaking apart bacterial colonies.  The powerful rotations of an Oral-B physically break off plaque from the tooth, similar to a manual toothbrush, but with greater effectiveness.  This data is supported by a dentist-blinded clinical trial that showed “Oral-B Triumph with its rotation-oscillation action was significantly more effective in single-use plaque removal than Sonicare Elite 7300” [Biesbrock, AR et al.].

In 2003, the prestigious Cochrane reviews critically examined data from 29 well-designed studies looking at toothbrush efficacy.  They concluded that the electric toothbrushes “Consistently provided a statistically significant, although modest, clinical benefit over manual toothbrushes in reducing plaque and gingivitis” [Neiderman et al].  These findings were supported by a 2020 meta-analysis of more recent studies [P.Wang et. al.].

A recent, comprehensive study by Klukowska et al. conclude that after a blinded study of Sonicare and Oral-B’s latest brushes that the Oral-B “Demonstrated statistically significantly greater reductions in whole mouth plaque at Weeks 6 and 12, as well as significantly greater gingivitis reductions over the long-term (12 weeks), compared to the new sonic toothbrush”.

What are my recommendations?  With good technique, soft bristled manual brushes work well.  However, most people don’t brush for 2-3 times a day for 2-3 minutes with ideal technique.  This is why most people would benefit from a more effective brush that helps you to time your brushing too!

Perhaps unsurprisingly, I have a manual brush, a Soniare and an Oral B.  Any of which will work well.  However, after reading enough large, well designed, financial-conflict free studies with similar results, I am confident the Oral-B will provide the best plaque and calculus removal with the Sonicare providing results

Remember, all toothbrushes lose their plaque fighting ability as they age, so be sure to keep a stock of fresh brush heads / brushes at home and replace them every 3-4months or when they frey [ADA] 

If you have any questions, please feel free to email me at Doodes@ParkBlvdDentistry.com.  Who knows, maybe your question will be the subject of another edition!

References:

Biesbrock, AR; Bartizek, RD; Walters, PA; Warren, PR; Cugini, M; Goyal, CR; Qaqish, J (2007). “Clinical evaluations of plaque removal efficacy: an advanced rotating-oscillating power toothbrush versus a sonic toothbrush”. J Clin Dent. 18 (4): 106–11.

P. Wang et. al., Comparison of effictivness of power vs. manual toothbrushes for oral health. A systemic review and meta-analysis. Acta Odontol Scand 2020 May;78(4)

Niederman R, et al.  J Am Dent Assoc. 2003 Sep;134(9):1240-4.  Manual vs powered toothbrushes: the Cochrane review.

Klukowska M, et al., A randomized 12-week clinical comparison of an oscillating-rotating toothbrush to a new sonic brush in the reduction of gingivitis and plaque.  J Clin Dent. 2014;25(2):26-31.

ADA:http://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-toothbrush-care-cleaning-storage-and-

© Paul Doodes DDS PhD.  All rights reserved.