By Sherri M. Lukes, MS, RDH, FAADH
I’ve been in this field long enough to know an innovation when I see it—and I’ve witnessed a huge evolution in toothbrush design over the course of my career. When I was in dental hygiene school, the only brush available was a flat-trim brush, with 3-4 rows across and a straight handle—no curve. Now you can get lost among the choices in the toothbrush aisle.
For years I was never particularly excited about the newest “gizmos” that companies develop to make a sexier brush. As a hygienist I stuck with what I knew—a basic brushhead without all the extra components. When hygiene students asked me what type of brush I recommended, that recommendation didn’t change: a soft-bristle manual brush.
I’ve changed my mind about some things, though, as various power and manual brush designs have been introduced. Toothbrushes on the market today have innovative bristle configurations and brushheads designed to allow for better access and cleaning. Further, these new tools have a high-tech appeal, offering new features to enhance compliance, reduce brushing pressure, and make the overall tooth brushing experience more productive and enjoyable. In a “game-ified” world, this is good news for patients, particularly younger ones.
Perhaps among the most important reasons for my change in perspective was the clinical evidence showing significant oral health benefits for certain toothbrush designs over a standard manual brush. One design that I’ve been particularly impressed with is the oscillating-rotating (O-R) power brush from Oral-B. Most hygienists don’t realize that this brush has been proven safe and effective in numerous studies. In fact, no other power toothbrush has the level of research support that the O-R brush has (Yaacob, 2014; Deacon, 2010).
Data Support Safety and Efficacy of the O-R Power Toothbrush
After O-R power brushes became available and I had gained some experience with them, I realized that the industry just might be on to something. The O-R power brush head can adapt around the teeth better than a manual brush and can remove more plaque. This is especially important for patients with oral health issues, like gingivitis, but in general it’s good for all patients.
As a former educator, data is important to me; I taught my students to look at evidence when they recommended oral care products. Systematic reviews of multiple studies, conducted by the Cochrane Collaboration, have shown that the oscillating-rotating technology is the only type of power brush that consistently reduces plaque and gingivitis more effectively than manual toothbrushes (Yaacob, 2014). These results hold for both short- and long-term study durations. In another Cochrane review comparing power technologies, brushes with an oscillating-rotating action reduced plaque and gingivitis more in the short-term (four to 12 weeks) than brushes with a side-to-side (e.g., sonic) action (Deacon, 2010).
Recently, three long-term safety studies have been published that are particularly notable. If you have concerns about the safety of power brushes, these studies can help provide reassurance.
Impressive results of three-year study—Researchers in Germany recently completed the longest clinical investigation of its kind—a randomized, controlled three-year clinical study comparing the long-term effects of brushing with an O-R power brush versus a manual toothbrush (Dörfer et al., 2016). The study enrolled over 100 patients (55 in the power group and 54 in the manual group) with 2mm or more of pre-existing gingival recession. Patients were required to brush twice daily for two minutes using a standard fluoride toothpaste. They were assessed regularly for clinical attachment loss and probing pocket depths at 6 sites per tooth, and all patients were followed for three years.
At the end of three years, there was no difference between the power and manual groups for sites with initial recession. The study investigators concluded that, when used for daily brushing over three years, neither the power brush nor the manual brush adversely affected pre-existing gingival recession.
Year-long study supports gentleness of a power toothbrush—In another recent long-term study, the effect of using either a power toothbrush with a multidirectional brushhead or a manual brush was evaluated over a 12-month period (Sälzer et al., 2016). This study was conducted in more than 100 patients who had at least two teeth with gingival recession. Patients were randomly assigned to one of the two treatment groups and were examined at baseline, six months, and 12 months by a single, calibrated examiner. The study investigators concluded that, over the 12-month period, neither the power toothbrush nor the manual toothbrush led to an increase in gingival recession with twice daily use.
Six-month trial shows safety and efficacy post-surgery—A six-month randomized clinical trial conducted at the University of Milan, Italy evaluated an oscillating-rotating power toothbrush with a soft, sensitive brushhead versus a soft manual toothbrush among 60 patients who had a surgical root coverage procedure. At the end of the study, the power toothbrush group had significantly better complete root coverage, less bleeding, and reduced plaque relative to the manual toothbrush group. These results attest to the safety and gentleness of the brush and its benefits for oral hygiene among a patient population that is highly sensitive to gingival trauma (Acunzo et al., 2016).
These results provide definitive answers for professionals who wonder whether a power brush might aggravate gingival recession. The data show O-R power technology is gentle enough for ongoing daily use. While your patients might not care about the clinical trials, it’s important for you to know whether or not solid data exists supporting the safety and efficacy of any brush or oral hygiene product you recommend.
Bringing Study Results Home to Patients
While the results of clinical research can be impressive to us as practitioners, how do we bring those results home to our patients? It starts with understanding why people brush their teeth: to make the mouth feel clean and fresh.
Your patients will tell you that what matters most is what they can feel in their own mouths—and most people can feel the difference between a brush that removes a lot of plaque and one that doesn’t. As always, the user’s technique is very important. Practitioners should always instruct patients (or remind them, if they’re adults) how to properly brush their teeth with any brush—whether they choose a manual or power brush.
Even though a power brush may do the bulk of the work, as with all toothbrushes, user technique remains vitally important to get the maximum benefit. The larger handle of power brushes helps facilitate goodtechnique since patients find it easy to hold; this is especially advantageous for those with compromised grasp, such as older adults and persons with developmental disabilities.
When using oscillating-rotating brushes, patients should not press hard or use a scrubbing motion—they simply need to go tooth-to-tooth and let the brush do its job. The more contemporary O-R brushes have a timer as well as a visual pressure sensor, in addition to an audible sensor, that alert patients if they are brushing too hard. The new long-term studies add further proof that the O-R brush technology is gentle, even for patients with pre-existing recession.
Instruction on home care by the hygienist is one of the most important things she does for her patients. Because individual patient needs vary, customization is a better approach for patient education than a “one size fits all” mentality.
A variety of power brush heads are available to help customize to patient needs. As we seek to individualize patient home care instructions, utilizing innovative brushheads makes a lot of sense for addressing the numerous types of dentitions and restorations our patients present with. This was not possible years ago, when manual brushes were the only option and patients didn’t have the plethora of dental restorations we see now, primarily the various types of dental implants.
The bottom line is that we have to determine what works best for each patient while weighing the evidence available. Some patients like a manual brush better and may do fine with that, but if there are issues with plaque control, they could achieve better results with the small head of a power brush. The O-R power brush can get into interproximal and hard-to-reach areas more effectively than a manual brush.
An advantage of being in a field for a long time is that you can watch trends as they come and go. I’ve certainly seen my share of trends in the toothbrush market. What I care about, though, are results, and I’ve seen that the oscillating-rotating power brush technology has had a very positive effect in treating and preventing plaque-related oral disease in my patients. Studies representing a wealth of data—accumulated over decades—show that this technology is effective for plaque removal.
And there’s more: long-term studies in patients with pre-existing recession have proven that the O-R brush is gentle for regular use. The O-R system has an unmatched level of published scientific evidence, which allows dental professionals to recommend it without reservation to patients for improved efficacy and overall gentleness.
With such a variety of brushes on the market, it can be difficult to identify the best option to meet patients’ personal needs, yet patients look to us for guidance. We can use our experience and patients’ preferences to guide us, but it’s also important to consider effectiveness of plaque removal and gentleness when making brush recommendations.
Regardless of the tool chosen, adequate oral care technique continues to be important to dental outcomes. Hygienists have a front-line role in recommending tools and instructing on techniques that help individuals manage their oral health. Those are trends that are very likely to continue.
References
1. Acunzo R, Limiroli E, et al. (2016) Gingival margin stability after mucogingival plastic surgery. The effect of manual versus powered toothbrushing: A randomized clinical trial. J Periodontol. doi: 10.1902/jop.2016.150528
2. Deacon SA, Glenny AM, et al. (2010) Different powered toothbrushes for plaque control and gingival health. Cochrane Database Syst Rev. Dec 8 (12): CD004971. doi: 10.1002/14651858.CD004971.pub2.
3. Dörfer CE, Staehle HJ, Wolff D. (2016) Three-year randomized study of manual and power toothbrush effects on pre-existing gingival recession. J Clin Periodontol. Jun; 43(6): 512-519.
4. Sälzer S, Graetz C, et al. (2016) Effect of a multi-directional power and a manual toothbrush in subjects susceptible to gingival recession: A 12-month randomized controlled clinical study. J Periodontol 87 (5): 548-556.
5. Yaacob M, Worthington HV, et al. (2014) Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. Jun 17 (6): CD002281. doi: 10.1002/14651858.CD002281.pub3
Sherri M. Lukes, MS, RDH, FAADH, has been a dental hygienist for 35 years. She holds advanced degrees in education. She is associate professor emerita, Southern Illinois University, where she taught oral pathology, public health and multicultural dental hygiene. Research was concentrated in migrant oral health, pathology and public health issues, resulting in multiple peer reviewed publications. She is an approved speaker of and holds a pathology fellowship in the American Academy of Dental Hygiene and is a past president of the Illinois Dental Hygienists’ As sociation. Honors include Community Service, Research, and Teacher of the Year awards while at SIU, IFLOSS Coalition/Illinois Department of Public Health Oral Health Champion Award and the Sunstar/RDH Award of Distinction. Ms. Lukes has done consulting work for Procter & Gamble.
