The efficacy of powered toothbrushes: A systematic review and network meta-analysis

Tim M J A Thomassen, Fridus G A Van der Weijden, Dagmar E Slot, Tim M J A Thomassen, Fridus G A Van der Weijden, Dagmar E Slot

Abstract

Aim: This systematic review and network meta-analysis synthesizes the available clinical evidence concerning efficacy with respect to plaque scores following a brushing action with oscillating-rotating (OR) or high-frequency sonic (HFS) powered toothbrushes (PTB) compared with a manual toothbrush (MTB) as control.

Material and methods: Databases were searched up to 1 August 2021, for clinical trials that evaluated the efficacy of a PTB with OR or HFS technology compared with an MTB on plaque removal after a single-brushing action and conducted with healthy adult patients. Meta-analysis (MA) and a network meta-analysis (NMA) were performed.

Results: Twenty-eight eligible publications, including 56 relevant comparisons, were retrieved. The overall NMA results for the mean post-brushing score showed a statistically significant difference for the comparison between an OR PTB and an MTB (SMD = -0.43; 95% CI [-0.696;-0.171]). The change in plaque score data showed a significant effect of a PTB over an MTB and OR over HFS. Based on ranking, the OR PTB was highest, followed by the HFS PTB and the MTB.

Conclusion: Within the limitations of the present study design, based on the outcome following a single-brushing action, it can be concluded that for dental plaque removal, there is a high certainty for a small effect of a PTB over an MTB. This supports the recommendation to use a powered toothbrush for daily plaque removal. There is moderate certainty for a very small benefit for the use of a powered toothbrush with an OR over an HFS mode of action.

Keywords: electric; manual; network meta-analysis; plaque; powered; single brushing; systematic review; toothbrush.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

© 2021 The Authors. International Journal of Dental Hygiene published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Search and selection results
FIGURE 2
FIGURE 2
Confidence in Network Meta‐Analysis (CINeMA). The different nodes represent a device, manual toothbrush (MTB), an oscillating‐rotating power toothbrush (OR) and a high‐frequency sonic power toothbrush (HFS). The colour of the node represents the risk of bias and the size of the node the sample size. The width of the edge shows the number of included studies and the colour the average indirectness. Post‐Brushing. (A) Network meta‐analysis graph irrespective of the plaque indices. (B) Network meta‐analysis graph using only the Q&HPI. (C) Network meta‐analysis graph using only the RMNPI
FIGURE 3
FIGURE 3
Confidence in Network Meta‐Analysis (CINeMA). The different nodes represent a device, manual toothbrush (MTB), an oscillating‐rotating power toothbrush (OR) and a high‐frequency sonic power toothbrush (HFS). The colour of the node represents the risk of bias and the size of the node the sample size. The width of the edge represents the number of included comparisons and the colour the average indirectness. Incremental change between pre‐ and post‐brushing. (A) Network meta‐analysis graph irrespective of the plaque indices. (B) Network meta‐analysis graph using only the Q&HPI. (C) Network meta‐analysis graph using only the RMNPI

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