Manual versus powered toothbrushes: The Cochrane review

Background. In a report released in January 2003, The Cochrane Collaboration Oral Health Group provided a systematic review of the effectiveness of powered versus manual toothbrushes, which generated much interest in the popular press. Methods. The Cochrane researches developed and implemented search strategies for the Cochrane Oral Health Group's Trial Register, the Cochrane Central Register of Controlled Trials, MEDLINE and the Cumulative Index to Nursing and Allied Health Literature. They contacted manufactures for additional information. Trials were selected if they met the following criteria: compared power versus manual toothbrushes, had a randomized design, drew participants from a general population without disabilities provided data regarding plaque and gingivitis, and were at least 28 days in length. Reviewers evaluated only studies published in 2001 or earlier. Six reviewers from the Cochrane study independently extracted information in duplicate. Indexes for plaque and gingivitis were expressed as standardized values for data distillation. Data distillation was accomplished using a meta-analysis, with a mean difference between powered and manual toothbrushes serving as the measure of effectiveness. Results. The searches identified 354 trials, only 29 of which met the inclusion criteria. These trials involved about 2,500 subjects and provided data for meta-analysis. The results indicated that only the rotating oscillating toothbrush consistently provided a statistically significant, although modest, clinical benefit over manual toothbrushes in reducing plaque and gingivitis. Conclusions and Clinical Implications. Some powered toothbrushes with a rotation-oscillation action achieve a significant, but modest, reduction in plaque and gingivitis compared with manual toothbrushes.