Partially due to constant developments in the manufacturing of oral hygiene products, toothbrush selection is perceived by many dental patients with gingival disease and plaque as a dilemma. This literature review serves the purpose of summarizing the state of knowledge regarding oscillating-rotating toothbrushes’ effectiveness compared to traditional non-powered toothbrushing to justify the need for further research in this area.
Despite sporadic evidence in favor of powered tools’ more profound effects on gingivitis patients’ overall dental health and plaque scores, manual toothbrushing is still an essential of oral hygiene. Such evidence, however, should be further refined and elaborated to understand oscillating-rotating tools’ individual role in electric toothbrushes’ greater effectiveness. Another problematic aspect that should entail subsequent research is the heterogeneity of conclusions regarding whether oscillating-rotating technology toothbrushes’ advantage over hand-held manual toothbrushes has statistical significance.
- Final Literature Review: Oscillating-Rotating and Manual Toothbrushes;
- The proper and regular use of oral care products is essential to maintaining good dental health and preventing common oral health concerns, such as gingivitis and excessive plaque. Due to an increasing number of toothbrush models in the market, patients with gingivitis may lose their way in the abundance of advertisement information and find toothbrush selection challenging. While some individuals keep track of new offers in the toothbrush market and prefer powered options, such as oscillating-rotating toothbrushes, others might take advertisements with suspicion and continue using manual toothbrushes. To resolve the stated issue and provide a definitive answer regarding the toothbrush type that benefits gingivitis patients most, research and evidence systematization are important. This paper presents the results of a literature review aimed at explaining the selected research question’s importance. As per the review, some evidence in favor of non-manual toothbrushes’ more effective performance in reducing gingival disease and plaque accumulation exists but does not allow for creating definitive and unambiguous toothbrush selection recommendations.
Manual Toothbrushes in Modern Dental Care
As the studies highlight, manual toothbrushes are still regarded as the mainstay of oral hygiene, which might be due to several reasons. The introduction of the first easy-to-use brush with nylon bristles has cemented manual toothbrushes’ role as basic and universally accessible oral hygiene tools (Anas et al., 2018). Firstly, the number of marketed powered toothbrushes with innovative types of bristles, combinations of bristle types, or technical features, such as rechargeability or micro-vibrations, continues to expand on a regular basis (Ccahuana-Vasquez et al., 2019). Under these circumstances, the volume of published research regarding new designs’ effectiveness also increases (Elkerbout et al., 2020).
It might confuse unprofessional consumers even more and make them stick to traditional variants. Secondly, manual tools’ simplicity and no need for any additional accessories contribute to their affordability and ease of maintenance (Elkerbout et al., 2020). These features and advantages could probably make non-powered tools an intuitively attractive choice for an average consumer.
Toothbrush Type as a Factor Influencing Plaque Removal and Gingival Health
In current literature, toothbrush type is considered as an important factor that affects the outcomes of regular toothbrushing in terms of plaque removal. In their comparative study of manual, powered, and ultrasonic tools, Anas et al. (2018) define the regular use of toothbrushes as the fastest and most widespread way to remove dental plaque. However, as their review suggests, the parameters predicting the efficacy of toothbrushing include brushing techniques, the presence of adjuvant methods, for instance, mouth rinse products, timing, and toothbrush type (Anas et al., 2018). Similarly, Ccahuana-Vasquez et al. (2019) list toothbrush type and bristle configurations among the factors that facilitate or hinder access to hard-to-reach areas of the mouth. Thus, in general, the influences of tool type on toothbrushing efficacy are not called into question.
One difficulty that surrounds the provision of an unambiguous answer regarding whether electric oscillating-rotating brushes outperform manual tools in terms of gingivitis reduction is product design diversity in both groups. For instance, as of now, popular manual toothbrush models are far from being homogeneous in terms of bristle configurations, which should be considered in recommendations for gingivitis patients. The currently available manual toothbrushes can be with tapered-end or rounded bristles or use the combination of these bristle types, which has been shown to affect dental health gains from toothbrushing (Ccahuana-Vasquez et al., 2019).
Particularly, as per in vitro studies, the degree of tapering in non-powered toothbrushes is positively related to bristle flexibility (Ccahuana-Vasquez et al., 2019). It results in the greater effectiveness of super-tapered bristles in reaching the subgingival area. Similarly, powered brushes with rotation-oscillation action can have varying characteristics when it comes to toothbrush head diameter and shape, rotation speed, or the type and length of bristles (Elkerbout et al., 2020). Despite this variety, not much research has been done to single out such toothbrushes’ technical features that are the most conducive to optimal dental health.
Electric Toothbrushes and Gingivitis Home Care
Electric toothbrushes are regarded as an important development in dental care. The first nylon-bristled toothbrush with a plastic handle appeared in the U.S. dental equipment market in the 1930s and became a critical technological advance of the time (Anas et al., 2018). However, the subsequent miniaturization of electric tools advanced the creation of the first electric toothbrush of the rotating systems family in the 1950s (Anas et al., 2018; Elkerbout et al., 2020).
With the lapse of time and by trial and error, it became possible to present an electric brush model that would achieve the necessary frequency of oscillations. Modern powered or electric toothbrushes are subdivided into two large groups, including the rotating systems family (oscillo-rotary, oscillo-rotary with pulsation, and rotary brushing) and sonic technology (Anas et al., 2018). Finally, apart from being a promising decision for plaque removal, non-manual brushes can potentially improve dental care routine in individuals with arm mobility issues.
In the context of gingivitis, plaque removal capacity presents the most critical technical characteristic of dental hygiene tools, but electric toothbrushes’ manufacturers promise both good action and comfort. Oscillating-rotating toothbrushes currently available in the market are often claimed to be designed to take this effectiveness to the next level while offering incredible consumer experiences. Particularly, Oral-B’s novel iO toothbrushes represent the new generation of tools that use oscillation-rotation action and are positioned as an easy-to-use product that maximizes plaque removal by using magnetic drive principles (Grender et al., 2020).
This toothbrush type makes use of micro-vibrations to ensure the optimal distribution of energy and directs more energy to the bristles to increase the tool’s plaque removal effectiveness (Grender et al., 2020). The product’s said advantages are not limited to dental plaque reduction. Particularly, the iO series toothbrushes are also advertised with special attention to their relative quietness (Elkerbout et al., 2020; Grender et al., 2020). Considering this, novel toothbrushes of the oscillating-rotating family are associated with rather attractive advertising slogans.
Aside from bristle/head configurations, electric toothbrushes are advertised to gingivitis patients with attention to other features, including interactive displays and rechargeable batteries. The effects of interactive features have not been fully explored yet. However, toothbrushes with displays or indicators can be positioned as a viable supplemental device to support the development of proper dental hygiene habits and techniques in particular populations (Elkerbout et al., 2020). As an example, the effects of interactive powered toothbrushes on adolescent dental patients’ toothbrushing practices and motivation are of special interest to subject matter experts (Elkerbout et al., 2020).
Speaking about rechargeability, this technical characteristic is also framed as a factor that might add to user experiences and effectiveness in plaque reduction. On the one hand, rechargeable batteries eliminate the need for purchasing replacement batteries, which is convenient for many users. On the other hand, toothbrushes that can be recharged have been shown to outperform models with replaceable batteries in terms of effects on plaque accumulation (Elkerbout et al., 2020). Taking this into account, dental patients and the general population encounter multiple facts that point to powered toothbrushes’ role as an optimal consumer choice.
Gingivitis care requires regular plaque removal, but whether or not electric oscillating-rotating brushes are always better is not perfectly clear. As the first stage of periodontal disease, the condition in question is extremely common. As per the boldest estimates, gingivitis can be found in up to 90% of adult dental clients in the U.S., whereas around 50% of them develop periodontitis (Grender et al., 2020).
Being caused by adverse reactions to bacteria in plaque, periodontal disease and gingivitis cases should involve strict adherence to everyday plaque control measures, such as toothbrushing (Grender et al., 2020). However, general recommendations for gum disease prevention are more centered on the regularity of toothbrushing instead of recommending one toothbrush type as the best option (Grender et al., 2020). Due to product diversity in the market, gingivitis patients are welcome to choose between powered and manual tools.
In general, the regular use of electric toothbrushes in home-based dental care procedures seems to be a high-potential tooth loss prevention intervention for those with early signs of periodontal disease. Particularly, powered toothbrushes can have a positive influence on tooth retention in the long term. For example, in an eleven-year cohort study by Pitchika et al. published in 2019, electric toothbrushes have been shown to decrease tooth loss by 20% (Grender et al., 2020).
The mentioned findings do not refer only to those with gingivitis since it is not the only widespread dental health concern. However, considering that tooth decay and the subsequent loss of teeth are typical for untreated gingivitis advancing to moderate and late-stage periodontitis, this evidence possesses unique importance for this patient demographic (Grender et al., 2020). Despite these encouraging conclusions, data from longitudinal dental health research remain relatively scarce, which can be due to the high speed of new developments in power toothbrushing technologies.
Finally, the superiority of oscillating-rotating toothbrushes over manual toothbrushing for gingivitis management could be regarded as a controversial question. As per the Cochrane Collaboration, powered brushing is better at promoting gingival status improvement compared to manual tools (Elkerbout et al., 2020).
However, these results do not distinguish between powered toothbrush types, such as sonic and oscillating-rotating devices, thus making it unclear which type contributed to that advantage most of all. Some previous studies conducted between 2009 and 2015 suggest that toothbrushes using oscillating-rotating technology outperform sonic models in promoting gingival health, which implies their great advantage over manual tools (Grender et al., 2020). Other authors report ultrasonic tools’ advantage over oscillating-rotating brushes and the latter’s statistically irrelevant advantage over traditional manual tools (Anas et al., 2018). Thus, the existence of conflicting findings may hinder the provision of patient education.
Gaps in the Literature and the Significance of the Proposed Research
In summary, based on the selected literature, multiple knowledge gaps surround the chosen research topic. The first gap that is worth discussing refers to the need for further studies that would consider manual and electric brushes’ long-term effects on gingivitis patients with reference to individual factors. To start with, to establish better control over subjects’ toothbrush use, the majority of topic-specific studies measure the outcomes of single-brushing exercises (Anas et al., 2018; Elkerbout et al., 2020). It leaves the question of whether electric toothbrushes’ advantage for gingivitis patients exists only in the short term open to discussion.
It would be logical for single toothbrushing activities to possess at least some predictive power with regard to the longer-term use of the same products, but conducting additional longitudinal research is still a critical opportunity. Another gap, such as the inability to consider an average patient’s imperfect adherence, practices, and difficulties, follows from this preference over non-longitudinal studies. Particularly, even if oscillating-rotating toothbrushes are proven to be the most effective in studies where subjects’ dental routine is supervised, it does not guarantee the absence of real-life mistakes that would ruin its effectiveness.
The second gap, the limited generalizability of findings from modern literature, supports the significance of the proposed quantitative systematic review. Firstly, as the preliminary review indicates, there is an increasing diversity of product designs in both manual and oscillating-rotating tools (Ccahuana-Vasquez et al., 2019). Considering this, single RCTs that draw comparisons between very specific toothbrush models from these two groups do not necessarily shed light on general tendencies, which limits individual studies’ contributions to answering the stated research question. In itself, another single experimental study would also be ineffective in formulating toothbrush selection recommendations for gingivitis patients.
In contrast, a systematic review of evidence from single studies, including those conducted within the last five years, would support such endeavors by allowing to consider toothbrush model in such recommendations. Additionally, single studies focusing on those with gingivitis vary in terms of patient characteristics, which makes their results of unknown significance for those with dental implants or other subgroups (Grender et al., 2020). By considering multiple studies with diverse patient profiles, the systematic review would support the development of more accurate recommendations, including contraindications.
Finally, modern literature suggests that manual toothbrushes remain the mainstay of dental care despite evidence in favor of oscillating-rotating brushes’ advantages for individuals with gingivitis. It goes without saying that brushing one’s teeth regularly and removing dental plaque present the key home-based interventions for the prevention of early-stage gingival disease’s progression to the irreversible stages of periodontal disease. However, the presence of conflicting findings regarding such toothbrushes’ superiority over manual tools makes the selected question open to further exploration. Additionally, despite single studies’ important contributions to the progression of dental hygiene knowledge, there are concerns and gaps in research that point to the need for subsequent large-scale studies and systematic reviews.
Among them are a number of extraneous factors that might be poorly addressed, including adherence and individual-level mistakes in the implementation of toothbrushing techniques. More than that, the emergence of new electric toothbrush models and the heterogeneity of design solutions implemented in both powered and non-powered tools add to the importance of future studies. With that in mind, the proposed study will review all relevant research systematically to improve patient education regarding home-based toothbrushing interventions in gingivitis.
Anas, B., Merlem, E. M., Abdelhadi, M., Zahra, L. F., & Hamza, M. (2018). A single-brushing study to compare plaque removal efficacy of a manual toothbrush, an electric toothbrush and an ultrasonic toothbrush. Journal of Oral Hygiene and Health, 6(3), 1-7. Web.
Ccahuana-Vasquez, R. A., Adam, R., Conde, E., Grender, J. M., Cunningham, P., Goyal, C. R., & Qaqish, J. (2019). A 5-week randomized clinical evaluation of a novel electric toothbrush head with regular and tapered bristles versus a manual toothbrush for reduction of gingivitis and plaque. International Journal of Dental Hygiene, 17(2), 153-160. Web.
Elkerbout, T. A., Slot, D. E., Rosema, N. M., & Van der Weijden, G. A. (2020). How effective is a powered toothbrush as compared to a manual toothbrush? A systematic review and meta-analysis of single brushing exercises. International Journal of Dental Hygiene, 18(1), 17-26. Web.
Grender, J. M., Ram Goyal, C., Qaqish, J., & Adam, R. (2020). An 8-week randomized controlled trial comparing the effect of a novel oscillating-rotating toothbrush versus a manual toothbrush on plaque and gingivitis. International Dental Journal, 70, S7-S15. Web.